A continuous quality improvement project to reduce medication error in the emergency department

BACKGROUND:Medication errors are a common source of adverse healthcare incidents particularly in the emergency department(ED) that has a number of factors that make it prone to medication errors.This project aims to reduce medication errors and improve the health and economic outcomes of clinical care in Hong Kong ED.METHODS:In 2009,a task group was formed to identify problems that potentially endanger medication safety and developed strategies to eliminate these problems.RESULTS:Responsible officers were assigned to look after seven error-prone areas.Strategies were proposed,discussed,endorsed and promulgated to eliminate the problems identified.A reduction of medication incidents(Ml) from 16 to 6 was achieved before and after the improvement work.CONCLUSION:This project successfully established a concrete organizational structure to safeguard error-prone areas of medication safety in a sustainable manner.

Improving immunization capacity in Ethiopia through continuous quality improvement interventions:a prospective quasi-experimental study

Background:Strong scientific evidence is needed to support low-income countries in building effective and sustainable immunization programs and proactively engaging in global vaccine development and implementation initiatives.This study aimed to implement and evaluate the effectiveness of system-wide continuous quality improvement(CQI)interventions to improve national immunization programme performance in Ethiopia.Methods:The study used a prospective,quasi-experimental design with an interrupted time-series analysis to collect data from 781 government health sectors(556 healthcare facilities,196 district health offices,and 29 zonal health departments)selected from developing and emerging regions in Ethiopia.Procedures included baseline quality assessment of immunization programme and services using structured checklists;immunization systems strengthening using onsite technical support,training,and supportive supervision interventions in a Plan-Do-Check-Act cycle over 12 months;and collection and analysis of data at baseline and at the 6th and 12th month of interventions using statistical process control and the t-test.Outcome measures were the coverage of the vaccines pentavalent 3,measles,Bacillus Calmette-Guérin vaccine(BCG),Pneumococcal Conjugate Vaccine(PCV),as well as full vaccination status;while process measures were changes in human resources,planning,service delivery,logistics and supply,documentation,coordination and collaboration,and monitoring and evaluation.Analysis and interpretation of data adhered to SQUIRE 2.0 guidelines.Results:Prior to the interventions,vaccination coverage was low and all seven process indicators had an aggregate score of below 50%,with significant differences in performance at healthcare facility level between developing and emerging regions(P=0.0001).Following the interventions,vaccination coverage improved significantly from 63.6%at baseline to 79.3%for pentavalent(P=0.0001),62.5 to 72.8%for measles(P=0.009),62.4 to 73.5%for BCG(P=0.0001),65.3 to 81.0%for PCV(P=0.02),and insignificantly from 56.2 to 74.2%for full vaccination.All seven process indicators scored above 75%in all regions,with no significant differences found in performance between developing and emerging regions.Conclusions:The CQI interventions improved immunization capacity and vaccination coverage in Ethiopia,where the unstable transmission patterns and intensity of infectious diseases necessitate for a state of readiness of the health system at all times.The approach was found to empower zone,district,and facility-level health sectors to exercise accountability and share ownership of immunization outcomes.While universal approaches can improve routine immunization,local innovative interventions that target local problems and dynamics are also necessary to achieve optimal coverage.

CONTINUOUS IMPROVEMENT THROUGH INTEGRATION OF QUALITY TOOLS

The relationship between major quality tools such as quality function development （QFD）, failure mode and effects analysis （FMEA）, design of experiments （DOE） and statistical process control （SPC） is analyzed through an extensive review of the literature and the concurrent quality engineering philosophy, and a basic structure for the integration of quality tools is presented. An integrated quality management system （IQMS） is developed using C＋＋ Builder, running in the Windows 2000 Server environment with the basic internet connections, and SQL Server 2000 as the platform for developing the database, An illustrative example applying IQMS to the continuous quality improvement for a crane equipment manufacturing is reported. The result shows that the application of IQMS can optimize the process of design and manufacturing, shorten the cycle time of product, reduce the cost, and realize quality improvement continuously, The proposed integrated framework with IOMS is believed to be applicable to continuous quality improvement in many manufacturing companies.

Successfully managing a rapidly growing peritoneal dialysis program in Southern China

Background The maximal use of the limited resource to improve peritoneal dialysis （PD） penetration and clinical outcomes is a challenge for all PD centers. In this study, we reported the experience and outcomes in successfully managing a rapidly growing PD center in Southern China. Methods A standard PD program with a team consisted of 6 nephrologists （3 doctors were in charge of catheter insertion and in-patients care, the other 3 doctors focused on PD patients＇ follow-up and education） and 11 nurses in a PD center at Sun Yat-sen University was established for PD patients follow-up in 2005. A prospective and observational study was conducted in all patients undergoing continuous ambulatory PD （CAPD） at our center from January 1,2006 to December 31,2009. Results The yearly number of prevalent CAPD patients was 297, 409, 547 and 695 in 2006, 2007, 2008 and 2009, respectively. The PD catheter insertion was performed by the nephrologists with open surgical procedure and 94% of catheters were patent at one year. In 841 incident CAPD patients, the survival rates at the end of 1,2, 3 and 4 years were 94%, 87%, 83% and 76%, respectively, while cumulative technique survival rates （death-censored） were 98%, 95%, 91% and 90%, respectively. Peritonitis rate was 1/68.5 patient months. Conclusions Better patient and technical survival rates as well as lower peritonitis episode have been achieved in our rapidly growing PD center. A standardized PD program, well-trained team members of PD doctors and nurses, and continuous quality improvement of PD are important elements in managing a successful PD program.