Abstract: To define the incidence of adverse events and their preventability in a representative sample of patients in five acute hospitals located in the North, the Centre and the South of Italy. Other objectives include the evaluation of the consequences of adverse events and their distribution according to specialties.
Abstract: Cross-unit handovers transfer responsibility for the patient among healthcare teams in different clinical units, with missed information, potentially placing patients at risk for adverse events.
Abstract: In February 2007, three organs from an human immunodeficiency virus (HIV)-positive donor were transplanted at two hospitals in the Tuscany Regional Health Care Service, owing to a chain of errors during the donation process. The heart-beating donor was a 41-year-old woman who died as a result of head trauma. The patient's history did not highlight any risky behavior. The available data on previous hospital admissions reported a negative result on HIV testing. During the donation process, the result of the lab test performed for evaluation of organ suitability was mistakenly transcribed from positive to negative. This wrong negative result was then included in the donation record without any cross-check. Therefore, the Regional Transplant Center allocated the liver and both kidneys. The patient also donated tissues, and a second laboratory conducted an evaluation of suitability for the tissue banks. During this process, only 5 days after the successful transplantation procedures, the positive HIV result was fed back to the Regional Transplant Center and the previous error discovered. Transplanted patients were immediately assessed and then treated with antiretroviral medications. A national commission soon performed a systems analysis of the adverse event. Besides the active error committed during the manual transcription for the HIV lab test result, the commission also identified technological factors, such as the lack of integration between the lab machine, the laboratory information system (LIS), and the donor record, as well as organizational factors, such as the distribution to two different labs of the suitability evaluation for organs and tissues. Recommendations included: automatic transmission of lab test results from the lab machine to the LIS and to the donor record, centralization of lab tests for suitability evaluation of organs and tissues, a training program to develop a proactive quality and safety culture in the regional network of donation and transplantations.
Abstract: High Reliability Organizations (HROs) are complex systems in which many accidents and adverse events that could occur within those systems or at the interfaces with other systems are actually avoided or prevented. Many organizations in high-risk industries have successfully implemented HRO approaches. In recent years, initiatives have been undertaken aimed at transforming hospitals into HROs. Actually, despite some improvements, these initiatives have not shown the expected results. In this paper, we discuss the possible reasons for such outcomes. We will show that, when compared with traditional HROs, hospitals are undoubtedly high-risk organizations, but have specificities and experience systemic socio-organizational barriers that make them difficult to transform into HROs.
Abstract: ABSTRACT
Background Incident-reporting systems (IRS) are tools
that allow front-line healthcare workers to voluntary
report adverse events and near misses. The WHO has
released guidelines that outline the basic principles on
how to design and implement successful IRS in
healthcare organisations.
Methods A written survey was administered with an
assisted self-assessment technique to a representative
sample of healthcare workers in Italian hospitals with
and without IRS. Data were collected using two different
16-item questionnaires. The questionnaires targeted two
issues: (1) workers’ experience of patient safety
incidents and (2) their expectations on incident reporting.
Results 70% of respondents confirmed involvement in
a patient safety incident, but only 40% utilised an IRS to
formally report the event. The data indicate that
information regarding patient safety incidents is not
communicated throughout the entire organisation.
Conclusions Research findings are consistent with the
available evidence on healthcare workers’ experience of
patient safety incidents.
Abstract: The efficacy of adjusted-dose oral anticoagulant therapy (OAT) in the prevention of thrombotic complications in various clinical conditions is well documented. Management of OAT requires a trained physician, an organized system of follow-up, reliable international normalized ratio monitoring, and good patient communication and education. Drug interactions with coumarins are a major cause of excessive anticoagulation and hence could be an important determinant of bleeding in patients on OAT. An analysis conducted in Toscana in 2005 found 31,221 patients persistently on OAT. During the same period, potential drug-drug interactions were detected in 11,778 of these patients (37.7%). Thus, the regional government enacted a specific law for the organization of OAT management to give all patients a minimal standard of quality of OAT. A specific educational campaign was promoted with the slogan "Written is better." Three possible models to follow individual patients were identified in relation to available resources and geographic characteristics of the living area: Anticoagulation Clinic (AC), General Practitioner (GP), or combined AC and GP management. This experience, although obtained in a limited geographic area, could help improve the efficacy and safety of OAT management.
Abstract: Preliminary data of a follow-up study on effectiveness of mechanical devices for patients handling are shown. Main study results highlight a statistical significant decrease for subjective referred episodes of acute low back pain during the previous 12 months, a decrease in perceived effort and Borg scale score in the subgroup who received any sort of mechanical devices. However no difference was found regarding to proportion of subjects positive at symptom questionnaire for low back pain and mean length of absenteeism for disease was similar even after the introduction of mechanical devices.
Abstract: In industrialised countries, carpal tunnel syndrome (CTS) is considered an epidemic work-related disease. We have set up the MODS (Malattie Occupazionali Da Sovraccarico biomeccanico, biomechanical overload-related occupational diseases) collaborative group, formed by epidemiologists, ergonomists and occupational physicians to investigate CTS in Italy, applying the methods that epidemiologists commonly use to understand epidemics. Several studies are already ongoing. Two different descriptive studies based on current hospitalisation data are in the reporting phase. A pilot case-control multicentre study (260 cases and 520 controls in 13 centres) is in the final phase of data collection. A longitudinal study on a cohort of 3000 subjects exposed to different risk factors has reached the third year of follow-up. Moreover, a surveillance system has been set up to cover selected districts of the Emilia Romagna region. These studies will generate new information about the prevalence and incidence of CTS in Italy, along with identification of regional, high-risk job titles and work sectors, and the relative influence of non-occupational factors.
Abstract: The aim of this research is the application of the Method of Organizational Congruencies before and after the substitution of organic solvents with vegetable agents for the cleaning of an offset printing machine in order to assess the organizational changes. A solvent-free process is the goal of the Subsprint Project (Technology Transfer Program of the European Community). This study shows how human and environmental health is improved by using vegetable agents, though this change may lead to some other organizational constraints such as an increase of the time needed, monotony, and repetitiveness of the technical actions involved. The authors underline that the knowledge of the impact of the new technology on health helps a better understanding of the resistance to the change and its further amelioration.
Abstract: The etiology and frequency of low back pain among health care personnel have been widely studied by means of cross sectional studies. The aim of our study was to calculate low back pain incidence in a prospective cohort of nursing students. A population of 344 subjects (72 males and 272 females) was involved in this investigation. Every student was submitted to a clinical and functional examination of the spine before beginning training and was checked in two following steps by a specific questionnaire for epidemiological studies of spinal disorders in working communities. 197 subjects (57.3%)(41 males and 156 females) completed follow-up. The low back pain incidence was similar at the end of two exposure periods (12.1% and 13.1%). The cumulative incidence was 22.5% throughout the study period. The longitudinal study allowed good control of selection bias and confounding factors; more over it showed that compared to other measurements of occurrence the cumulative incidence was between other occurrence measures, more informative, in our case, than prevalence and incidence rates. A cumulative incidence of low back pain over 20% after only two years of exposure in a young and healthy population of nursing students, requires implementation of ergonomic measures for patient handling tasks.
Abstract: We analyzed the occupational health activities of physicians in a public occupational health service using the Method of Organizational Congruences (MOC). Occupational health activities are changing in Italy with the application of the European Community Directives (Decreto Legislativo 626/94). We identified four major organizational constraints: a lack and difficult in interdisciplinary work, absence of worker control on the activities, limitations in planning specific industrial area studies, increased conflict between prevention and control activities. We predict for the future an increase of these constraints with a reduction in the professional level of the physicians employed in the state system of local occupational health units.
Abstract: An evaluation was made of the degree of exposure to risk and the frequency of disorders attributable to biomechanical overload of the upper limb in workers employed on packaging in an ice cream factory. The risks were first evaluated against a checklist, then subsequently an assessment was made of the tasks found to feature the highest risks, using an ergonomic analysis method. The method identified several jobs, such as placing ice cream coupes and such like in boxes, as requiring a large number of actions per minute (> 30) and considerable muscular strength. The 59 female workers performing the packaging operations were given a risk-targeted physical examination. The clinical test detected an extremely high frequency of carpal tunnel syndrome, (7.1%) epicondylitis (5.2%) and scapulo-humeral periarthritis (3.5%) in the over 35 years age group, with respect to a control population not exposed to risk. The authors conclude that the repetitiveness of the actions, the use of gloves due to prolonged contact with frozen products and the effects of the low temperatures themselves, may have favoured the spread of the disorders that appeared in this population of workers. These findings must be further supported by more in-depth epidemiological studies.
Abstract: An evaluation was made of the degree of exposure to risk and the frequency of disorders attributable to biomechanical overload of the upper limb in workers performing finishing operation on ceramic vases and cups in a ceramics factory. The risks were first evaluated against a checklist, then subsequently an assessment was made of the tasks found to feature the highest risks, using an ergonomic analysis method, which identified activities associated with a large number of actions per minute (> 50). The 22 female workers performing the tasks in question underwent a risk-targeted physical examination which included an electroneurographic test using surface electrodes. The clinical test detected an extremely high frequency of carpal tunnel syndrome cases, in addition to other upper limb disorders. In particular, nine female workers (41%) were found to be suffering from carpal tunnel syndrome, and five (22%) from other pathologies of the upper limbs (4 scapulo-humeral periarthritis, 1 epicondylitis). As a result of the findings arising out of this study, immediate preventive measures were adopted; moreover, it has become evident that further epidemiological studies on larger sample populations are needed.
Abstract: The aim of the study was to generate hypotheses on what could be the ISTAT (National Institute of Statistics) job classes with a major risk of carpal tunnel syndrome in order to plan more specific analytic epidemiology studies and apply more correct ergonomic solutions. A case-control cross-sectional survey without matching was carried out. The source of data were the computerized medical records of a large regional hospital: 833 carpal tunnel syndrome cases (mean age 48, SD 9.33) and 3222 controls (mean age 43.5, SD 13.22) hospitalized for other diseases, were selected. The odds ratio (OR) and 95% confidence limits, controlled for age and gender by a logistic linear regression model, were calculated as measures of association for the comparison between non-exposed managerial/administrative staff and industrial workers. The analysis showed a statistically significant risk for some ISTAT job classes, in particular class 53 (spinners, weavers, dyers and similar jobs) (OR = 2.65; C.L. 1.52-4.62) class 54 (knitters, tailors, hatmakers, upholsterers and similar jobs) (OR = 1.69; C.L. 1.06-2.71), 55 (tanners, shoemakers, leather manufacture workers and similar jobs) (OR = 2.74; C.L. 1.66-4.53) and group 742 (Hotel and restaurant cooks) (OR = 2.99; C.L. 1.45-6.13). Job classes 45 (carpenters, welders and similar jobs). 62 (electricians, electrotechnicians, radio engineers and similar jobs), 63 (gasfitters, plumbers, heating engineers and similar jobs) and 85 (porters and other jobs involving manual handling of loads) showed ORs higher than 2 but without statistical significance. The results are valid for planning further studies, especially in the textile and shoe and leather manufacturing sectors.
Abstract: The wide-spread use of video display units in many work places has led to an increase in ophthalmologic examinations of the operators. For this reason, instruments for visual test screening (for example Visotest) have become widely used. Nevertheless, the literature does not seem to offer any clarification about the utility of these instruments as epidemiological tools. The costs and benefits of visual screening programmes were estimated in relation to specific visual deficit prevalence in a differently age-structured population. Via epidemiological calculation, it was demonstrated that positive and negative predictive values, which are directly related to deficit prevalence, are more important than sensitivity and specificity calculations. In view of the disorders screened, a visual test with a low positive predictive value is more expensive than one with a low negative predictive value. A visual test for visual deficits screening does not appear to be advisable in young populations, where the true positives/false positives ratio is 1:4, whereas in older populations the ratio is 2:1.
Abstract: Interest in occupational mental illness has increased as a result also of the technological changes at the workplace. A total of 22 epidemiological studies on this topic were reviewed on the following basis: subject of the study, epidemiological design, type of psychometric scale, results. The authors discuss the methods and constraints of these studies, especially the lack of knowledge on occupational exposure and its relationship to mental health. The need for further studies in order to improve prevention of mental illness at the workplace is stressed.
Abstract: Back pain is a major health and economic problem for preventive medicine. It has been found to be significantly associated with nursing. The present paper reviews a number of epidemiological studies on back pain in nurses and examines the main confounding factors. The different approaches to back pain prevention are briefly discussed.
Abstract: Data concerning all accidents with absence from work exceeding three days were analysed in a cohort of 5000 workers (all employees of a Local Health Unit). A total of 1062 accidents were recorded in the file from 1987 to 1989, 118 coded as "low-back injury". A case-control study design was used to detect the main causes of these accidents, using accidents coded as other than low-back injury as controls. The odds ratios and related confidence limits were calculated in order to assess the degree of association, taking account of potentially confounding factors. A significant relationship was observed between hospital wards and other health service departments rated as "high exposure" and low-back injury (OR high exposure versus low exposure = 2.13; 95% C.L. 1.06-4.29). Selection bias and its influence on the results is also discussed.
Abstract: An evaluation was made of the posture risk and occurrence of alterations of the spine in a sample of female sewing machine operators in the clothing industry. The results revealed a greater risk for sewing operators of contracting spinal disorders compared with a control population matched for sex and age. The cause of these disorders appears to be due to the fact that the work station cannot be adjusted to the anthropometric requirements of the individual subject, and also because the seated position is maintained for long periods.
