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Investigating the Incidence of Instruments Fall During Surgery in Alzahra Medical Educational Center of Isfahan in 2017
Abstract
Falling of instruments is seen as a major problem and defect in the most surgical procedures that leads to an increase in operating time, surgical flow disruptions, more cost and possible damage to surgical instruments. The aim of this study was to analyze and compare statistically the incidence of accidental fall of instruments during neurosurgical, general, gynecological, orthopedic and urological operations. In this cross-sectional study, the prevalence of steel surgical instruments downfall during 100 open surgical operations was recorded. The data were recorded by intra operative observation using a self administered checklist which were confirmed. Data were then analyzed by SPSS software version 18 and descriptive tests. A total of 55 instruments falling were recorded. The results of this study showed that the most frequent number of instruments falls was in supine position and abdominal region. The causes of instruments' fall in control (49.1%) was related most commonly to time that the tools were left on the side of the patient body at a reachable region and ignoring instruments dropped on the floor (80%) was the most common condition after falling surgical instruments in both groups. Documentation of intra operative falling of instruments provides a basis for the development of solutions for improving operating room efficiency.
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Background and research: Leadership styles are categorized in different ways, and time management as one of the determinants of leadership success is of great importance. This study aimed to investigate the relationship between the dominant leadership style of nursing managers and their use of time management skills. Materials and Methods: This was a descriptive study. The population of the study consisted of 485 senior and middle managers of Shiraz University of Medical Sciences, among which 182 were selected by simple random sampling method. In this research, three separate questioner consist of demographic information questionnaires, the leadership style of Bass and Avolio managers and the time management of Nazem questionnaire were used. Findings: Most of the research units leadership style consist of task oriented, then humanistic and then non-inter-ventional. The task-oriented leadership style at the significance level of 0.05 has the strongest correlation with time management, but the non-intervention leadership style is not correlated with time management. Conclusion: Managers need to pay more attention to time management because their ability to gain individual skills in managing time has a positive effect on organizational skills and as a result of increasing organizational productivity. © 2019 Revista Latinoamericana de Hipertension. All rights reserved.
Background: Recently, there has been an increase in life expectancy due to improvements in nutrition, health, and sanitation. The aim of this study was to evaluate the geriatric curriculum in the field of general medicine at Shiraz University of Medical Sciences (SUMS), Iran to improve the quality of services provided to this population in the community.
Methods: This was a qualitative study. Six educational hospitals and ambulatory centers of Shiraz University of Medical Sciences participated in this study. Within these centers, 15 medical education faculty members and educational experts, 6 medical students, 6 elderly patients and 6 nurses working in the university related to the geriatric field were selected using purposive sampling. Data were gathered through semi-structured interviews, focus group discussion and field observations in the teaching hospital and ambulatory setting of SUMS from June 2017 to May 2018. Based on the qualitative research, the data underwent conventional content analysis and the main themes were developed from this.
Results: Three main themes were extracted from the data: effective clinical education, geriatrics curriculum challenges and promotion strategies for geriatric medicine. Subcategories that emerged were a competent curriculum teacher, a challenging program, management of resources, promotion of the program, and the revision required in the curriculum, which were related to other concepts and described in the real-world situation of the geriatric curriculum in the university, as observed in field observations.
Conclusions: This study identified three concepts as main themes that can be used to explain how to implement a geriatric curriculum in a medical university. The main contributing factor to different views of the participants was identified as the revision required to the curriculum for integrative care in a geriatric patient. This should be taken into consideration while planning any programs and decisions aimed at education of medical students on this topic.
Objective
To comprehend the experiences of nursing students in clinical education.
Methods
A qualitative study using conventional content analysis was conducted. Data were collected using focus group interview with 16 nursing students from two public nursing schools of Shiraz and Fasa, Iran. The participants were selected by purposeful sampling. Data analysis accomplished according to conventional content analysis.
Results
From this study five categories were emerged: Theory and practice disruption (The inability to use the lessons learned in practice, Routine-oriented work, The difference between theoretical knowledge and clinical training), Shaky communications (Inappropriate behavior, Inadequate support of nurses, instructors and other caregivers), Inadequate planning (Wasting time for students in clinical training, Inadequate preparation of instructors and students), Perceived tension (Stress, Anxiety and Fear), Personal and professional development (Learning more steadily, Paying attention to the spiritual dimension of care, Increasing interest in the profession, More knowledge, greater Self Confidence). Conclusion. The results of this study showed that nursing students have desirable and undesirable experiences in clinical education in the process of training, which must be addressed with proper planning for reduce the students' problems in the clinical education of future nurses.
The aim of the study was to analyse and compare statistically the incidence of accidental fall of instruments during elective and emergency caesarean section. Material and Methods: A prospective study was carried out at (V. C. S. G. G. Medical Sciences and Research Institute) Srinagar, Pauri Garhwal, India over a period of 24 months. The instrument fall during elective and emergency caesarean sections was observed. The observer counted the number of times an instrument fell during surgery. The personnel responsible were identified. A note of the nature of instrument falling was made. Results: We observed 362 surgeries which included 242 emergency caesarean sections and 120 elective caesarean sections. There were a total of 159 falls. Falls were classified as major and minor. There were 22 falls (18.33%) during elective caesarean sections and 137 falls (56.61%) during emergency caesarean sections. There were 53 major and 106 minor falls. Two or more falls were noted in 31 surgeries. In 96 instances (60.37%) the operating surgeon was responsible for the fall. In 37 cases (23.27%) assisting surgeon and in 17 cases (10.69%) the scrub nurse was responsible for the fall of the instruments. Nine falls (5.66%) were unaccountable. Most falls in elective caesarean section were in later half of the surgery while in emergency caesarean section, they were before and during the extraction of the baby. The surgeries were delayed, on an average by 5.7 minutes after a major fall of an instrument. Conclusions: Falling of instruments in the theatre is a common problem all over the world. This leads to increase in operating time, more resources and quality compromise. The operating surgeon was mainly responsible for the fall. Ashort training programme in instrument handling should be conducted for operating surgeons which may be helpful in preventing such avoidable falls.
Introduction: Child’s surgery makes parents’ anxiety and concern. Therefore, the present study was conducted to evaluate anxiety and self-efficacy of the mothers of the children undergoing cochlear implant surgery.
Methods: This randomized trial was performed on 70 mothers of children who had undergone cochlear implant surgery in Khalili Hospital in Shiraz from December 2017 to March 2018. The samples were randomly assigned to intervention (35) and control (35) groups. Four training sessions were held for the intervention group. The data were gathered by Spielberger and Sherer’s questionnaires and analyzed through SPSS version 21, using Chi-square test, Fisher’s exact, Independent t- test and repeated measurements (p <0.05).
Results: Before the intervention, the mean score of hidden and apparent anxiety and self-efficacy in the intervention group were 46.48±7.93, 47.40±8.73 and 61.40±9.86.In the control group, it was 46.25±8.89, 46.77±9.63 and 59.42±10.42 and no differences were seen between two groups variables (p <0.05). Immediately after the intervention the results showed a significant decrease in variables (P <0.001). Two months later variables in the intervention group were 25.42±3.22, 26.80±3.70 and 82.14±2.41 (P <0.001). In the control group, they were 46.60±8.79, 47.25±9.87 and 58.68±9.95 (P<0.001). Moreover, a significant difference was shown between the two groups in the mean of apparent (F=277.40, P <0.001) and hidden anxiety (F=285.96, P <0.001) and also in the mean of self-efficacy of the mothers (F=170.17, P <0.001) during the three study periods.
Conclusion: Educational interventions in the mothers of the children undergoing cochlear implant surgery were effective in reducing the amount of anxiety and increasing their self-efficacy.
Trial Registration Number: IRCT201708072432N5.
Keywords: Education, Cochlear implantation, Anxiety,
Self-efficacy
Background and Aim: One of the important priorities of the World Health Organization is training of mothers about care during pregnancy and preparation training for natural delivery. Effective education could increase the awareness and attitude of mothers during pregnancy and subsequently promote self-confidence and preparedness of pregnant mothers to accept safe natural delivery without intervention. This study aimed to evaluate the effect of preparation classes on the awareness and attitude of pregnant mothers toward the type of delivery in Razi Hospital of Saravan. Materials and Methods: An interventional study was designed with the sample size of 50 volunteer mothers participated in the preparation classes for delivery in 5 groups of 10 people. The classes were conducted for 2 weeks in Razi Hospital in Saravan. In these classes, the knowledge and skills needed for mothers about pregnancy and its care, special exercises during pregnancy, the effect of exercise and other methods on reducing delivery pain, planning for choosing the type of delivery and other related subjects were taught. Teaching methods were included pamphlets, films and lectures. The collected data were analyzed by Chi-square test and Tukey’s post hoc test using SPSS version 18. Results: The results of the study showed that there was a significant difference between before and after the intervention (P <0.0001). The minimum score obtained for the awareness among mothers was 0 and the maximum was 20. For the attitude, the minimum and maximum scores were 0 and 80, respectively. Positive attitude score was increased from 46.40 before the training to 55.17 after the training. The mean awareness score of mothers before the training was 7.33 which reached to 18.50 after the training, which showed a significant difference and it was confirmed that the provided training had a positive effect on the awareness and attitude of mothers participating in the course. Conclusion: Delivery preparation classes for delivery could be effective in increasing the awareness and attitude of mothers toward the correct choice of delivery for active participation in safe and non-interventional delivery and consequently reduce maternal and neonatal mortality. © 2018 Revista Latinoamericana de Hipertension. All Rights Reserved.
This paper proposes a fair and balanced risk and value-added distribution as a novel approach for collaborative supply chain. The objective of this article is to analyze the existing methods and approaches for risk management, value-adding, risk and revenue sharing to develop a new framework for balancing risk and value-adding in collaborative supply chains. The authors reviewed and synthesized 165 scientific articles which were published between 2001 and 2017. The reviewed articles were categorized into supply chain management and performance, risk management, value-added, fair risk and value-added distribution and supply chain negotiation. The potentials identified for future research were the importance of decision-making and sustainability for effectiveness of supply chain risk management. Most previous authors have applied an approach of revenue and risk sharing with both decentralized and centralized supply chains to achieve the fair risk and value-added distribution. The dominant methods we found in literature were game theory and complex mathematical formulation. Most literature focused on operation research techniques and there was a lack of discussion of the intelligent system approach. The contribution of this paper was mapping the method and approach in risk management, value added analysis and develop new framework. This paper developed and suggested a new framework for a fair and balanced risk and value-added distribution model. For a future agenda, we point towards the development of a systematic intelligent system applying soft-computing techniques and knowledge transfer for maintaining sustainable supply chains.
According to this systematic review of epidemiological studies, fibroid prevalence varied widely, with no consistent association across studies between observed estimates and country, methodology, and population. Fibroid incidence was higher in black than in white women independently of other risk factors, suggesting a racial predisposition. A genetic influence was confirmed also by the association with a positive family history. The association with age and menopausal status maybe interpreted in terms of varying degrees of oestrogen exposure, which could explain also the association with food additives and soybean consumption. Along this line, the "anti-oestrogenic" effect of smoking was observed only in women with low BMI. Association were observed also with reproductive factors (parity and time since last birth) and oral/injectable contraceptives. This article is protected by copyright. All rights reserved.
Cleaning, decontaminating, and handling instructions for instruments vary widely based on the type of instrument and the manufacturer. Processing instruments in accordance with the manufacturer's instructions can help prevent damage and keep devices in good working order. Most importantly, proper cleaning and disinfection may prevent transmission of pathogenic organisms from a contaminated device to a patient or health care worker. The updated AORN "Guideline for cleaning and care of surgical instruments" provides guidance on cleaning, decontaminating, transporting, inspecting, and storing instruments. This article focuses on key points of the guideline to help perioperative personnel implement appropriate instrument care protocols in their practice settings. The key points address timely cleaning and decontamination of instruments after use; appropriate heating, ventilation, and air conditioning parameters for the decontamination area; processing of ophthalmic instruments and laryngoscopes; and precautions to take with instruments used in cases of suspected prion disease. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.
Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.
Communication errors contribute to the occurrence of adverse events in various domains of health care. Recent studies surveying perceptions of communication in the operating room have found disparities in the perceived quality of communication among members of the operating room team. Our aim was to characterize the nature of communication failures observed in the operating room and to assess whether a Team Training curriculum had any impact on observed communication errors.
Intraoperative observation was performed and communication errors were identified according to predetermined criteria. Observed errors were classified according to the type of error, subject matter, and observed effect.
Seventy-six communication failures were observed over 150 hours of observation. Overall, communication errors relating to equipment and keeping team members informed of the progress of an operation comprised 36% and 24% of all observed communication errors, respectively. Prior to the introduction of a Team Training curriculum, 56 errors were observed over 76 hours (rate,737 errors per hour; standard error, 0.098). After Team Training, 20 errors over 74 hours were observed (rate .270 errors per hour; standard error, 0.060; P < .001).
Communication failures related most frequently to equipment and keeping team members updated as to the progress of an operation. These failures can lead to procedural delay and inefficiencies. A program that teaches teamwork and communication skills is one strategy that may improve communication among members of the operating room team.
The aim of the study was to evaluate statistically the occurrence and causes of accidental fall of instruments and implants during orthopaedic procedures.
A prospective study was carried out over a period of 18 months. Total of 120 randomly chosen major orthopaedic surgeries were observed. The observer counted the number of times an instrument fell during surgery. The offending operating room personnel were identified. A note of the nature of instrument falling was made.
A total of 120 surgeries were observed. There were 15 falls (38.5%) during elective surgeries and 24 (61.5%) during emergency (trauma) surgeries. Falls were classified as major and minor. There were a total of 39 falls with 11 major and 28 minor falls. Seven surgeries had two or more falls. In 26 instances (66.7%) the operating surgeon was responsible for the fall. In seven (17.9%) assisting surgeon and in three (7.7%) of the instances the scrub nurse was responsible for the fall of the instruments. Three falls (7.7%) were unaccountable. An average delay of 7.6 min was noted after the fall of the instrument or implant.
Fall of instruments in the theatre is a common problem all over the world. It leads to increased operating time and extra resources and can hamper the end result of surgery. Our study is the first of its kind to evaluate the problem. Most falls occurred because of the operating surgeon. A course in instrument handling similar to one conducted by the theatre nurses may be helpful in preventing such falls.
To capture communication patterns in operating room (OR) management to characterize the information needs of OR coordination.
Technological applications can be used to change system processes to improve communication and information access, thereby decreasing errors and adverse events. The successful design of such applications relies on an understanding of communication patterns among healthcare professionals.
Charge nurse communication was observed and documented at four OR suites at three tertiary hospitals. The data collection tool allowed rapid coding of communication patterns in terms of duration, mode, target person, and the purpose of each communication episode.
Most (69.24%) of the 2074 communication episodes observed occurred face to face. Coordinating equipment was the most frequently occurring purpose of communication (38.7%) in all suites. The frequency of other purposes in decreasing order were coordinating patient preparedness (25.7%), staffing (18.8%), room assignment (10.7%), and scheduling and rescheduling surgery (6.2%).
The results of this study suggest that automating aspects of preparing patients for surgery and surgical equipment management has the potential to reduce information exchange, decreasing interruptions to clinicians and diminishing the possibility of adverse events in the clinical setting.
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