Hospital management support

Notes Safety Culture Dimension 1 Hospital management support for patient safety 2 Supervisor/manager expectations/actions 3 Teamwork across hospital units 4 Teamwork within units 5 Communication openness 6 Hospital handoffs and transitions 7 Nonpunitive response to error 8 Feedback and communication about error 9 Staffing 10 Organizational learning Outcome dimensions 11 Overall perceptions of safety 12 Frequency of event reporting. 

Factors critical to success include clear objectives a firm mandate support by the senior hospital management transparency wide representation technical competence a multi-disciplinary approach and sufficient resources to implement the DTC s decisions. 

Another example noted in some PGDs is that working practices may not be in line with Summary of Product Characteristics for that medicinal product (www.medicines.org.uk/). For example some PGDs have indicated that the amount of Omnipaque (an X-ray contrast agent) to be administered can exceed that outlined on the product information sheet. The only evidence used to support this is that some peers do this in other Trusts. Not only does this practice fall short of minimizing risk but it might also fail one component of the Bolam test (Bolam v Friern Hospital Management Committee, 1957 and Bolitho v City and Hackney Health Authority, 1997). 

A sample of 475 staff from 10 hospitals in Costa Rica, Gimeno et al. (2005) found that safety culture was related to self-reported work-related injuries. Another study of 789 hospital-based healthcare workers in the USA, found that experienced blood and body fluid exposure incidents for workers were lower when senior management support, safety feedback and training were perceived favourably (Gershon et al. 2000). In Japan, reduced needle-stick and sharp injuries to hospital workers were associated with safety culture factors, such as being involved in health and safety matters (Smith et al. 2010). In our Scottish hospital sample, we collected information on self-reports of worker injuries, as well as observed errors affecting patients. 

Turunen, H., Partanen, P, Mantynen, R., Kvist, T., Miettinen, M. and Vehvilainen-Julkunen, K. 2011. Management Support for Patient Safety A Three Year Follow Up Study for Hospital Staff in Four Finnish Acute Care Hospitals. 10th ENDA Congress, 5-8 October 2011, Rome. 

Based on the literature review, key dimensions of hospital patient safety culture were identified and items drafted to measure those dimensions. Items were written to obtain a staff-level perspeetive of the extent to which a hospital organisation s culture supports patient safety and event reporting. In addition, most of the items were foeused on the respondent s own work area or unit beeause unit-level eulture is more salient and relevant and has the most immediate influenee on staff attitudes and behaviors. Sinee eulture varies aeross units, it was important to foeus respondents on their own unit s eulture by asking them to identify and seleet their unit first and then answer the questions in the survey about that unit. However, some patient safety eulture issues cut across units, so the last part of the survey foeused specifically on hospital-wide patient safety eulture, ineluding handoffs and transitions, pereeptions of management support and teamwork aeross units. 

Management support for patient safety Hospital management provides a work climate that promotes patient safety and shows that patient safety is a top priority... 

Jeremy, 66, has an autistic spectrum disorder (ASD), mild LD, and depression historically he s tied clothing around his neck as nooses, when distressed. He was discharged from hospital to supported accommodation several months ago. The care home manager has requested you review Jeremy s recent tearfulness. On arrival, you notice bruises on Jeremy s neck and wrists. 

Managing viral hepatitis involves both prevention and treatment. Prevention of hepatitis A and B (and indirectly for hepatitis D) can be achieved with immune globulin or vaccines. There is no specific pharmacologic treatment for acute viral hepatitis A, B, C, D, or E only supportive care is available. Individuals with mild to moderate symptoms rarely require hospitalization. Occasionally, hospitalization is required in individuals experiencing significant nausea, vomiting, diarrhea, and encephalopathy. Liver transplantation may be required in rare instances if fulminant hepatitis develops. 

Medical Management Immediate decontamination after exposure is the only way to prevent damage to victims, followed by symptomatic management of lesions. Hospital care tends to be supportive. It should be repeated that liquid arsenical vesicants produce more serious lesions on dermal surfaces than do liquid mustard. In toxic victims, liberal fluids by mouth or intravenous, and high-vitamin, high-protein, high-carbohydrate diets could be indicated. For those victims where shock is in evidence, provide the usual supportive measures such as intravenous administration, blood transfusions, or other vascular volume expanders should be indicated. 

Decontamination immediately after exposure is the only way to present damage, with symptomatic management of lesion/blisters thereafter. All victims and first responders shall be decontaminated when leaving the Hot Zone. Clothes should be removed if at all possible, and no one should be transported to a hospital until he of she has been thoroughly decontaminated. Care in a hospital is strictly supportive. First responders have to ensure that every one contaminated goes through an efficient decontamination procedure. 

During the initial evaluation, providing for the safety of the patient is of paramount importance. The severity of intoxication and potential for withdrawal must be quickly and accurately determined. Extreme alcohol intoxication can be fatal either by the production of cardiac arrhythmias, aspiration (the inhalation of stomach contents that are vomited), or other causes. We have all seen reports of college students dying from alcohol poisoning. Likewise, up to 10% of patients in severe alcohol withdrawal can die without treatment. Fortunately, most patients do not experience the most severe forms of alcohol withdrawal such as the DTs. Mild withdrawal can be managed in the outpatient setting with appropriate support and patient adherence, but severe withdrawal requires an inpatient hospitalization. See Section 6.5 for further discussion of the initial evaluation. 

Lactic acidosis is a medical emergency that must be treated in a hospital setting. In a patient with lactic acidosis who is taking metformin, immediately discontinue the drug and promptly institute general supportive measures. Because metformin is dialyzable (with a clearance of up to 170 mL/min under good hemodynamic conditions), prompt hemodialysis is recommended to correct the acidosis and remove the accumulated metformin. Such management often results in prompt reversal of symptoms and recovery. 

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