BACKGROUND AND OBJECTIVE

Proper documentation of patient safety events is important to be able to provide changes that can prevent events from occurring again. The Philippine General Hospital launched an online platform for reporting patient safety events in 2017. This paper aimed to describe the patient safety events, initial response to the event, and preventive actions done in the institution.

This is a retrospective descriptive study of patient safety event records from August 2017 to April 2022. General data of the patients, details surrounding the events, response to the event, and preventive measures done after the event were documented. Descriptive analysis was performed.

There was a total of 625 events reported with 525 total unique reports. There was an increased rate of patient safety event reports from 2021 to 2022. The average rate was 23.8 and 25.7 reports per month, respectively. Most reports were for in-patient cases and were type 3 preventable adverse events. The general initial response of healthcare personnel to the adverse events is to provide the appropriate clinical care. Preventive measures include re-orientation and event specific actions.

Documentation is crucial for patient safety events to provide solutions and prevent reoccurrence of these events that can cause harm to patients.

BACKGROUND AND OBJECTIVE

Medication errors pose substantial risks in hospitals, particularly concerning patient safety. These errors, occurring throughout the medication use process, are one of the most common causes of morbidity and mortality in clinical practice. In the Philippines, there is a lack of evidence on the prevalence and effects of medication errors, emphasizing the need for further investigation. This study evaluated the prescribing, transcribing, and monitoring errors among inpatients under the Pulmonary Medicine Service of the Department of Medicine in the Philippine General Hospital.

This cross-sectional retrospective records review used the total population purposive sampling technique to examine eligible charts of inpatients with asthma and/or COPD from August 1 to December 31, 2022. The frequency, type, and severity of medication errors were determined. Linear regression and Cox proportional hazards models were used to examine the relationship between patient-related factors and medication errors, and length of hospital stay and mortality.

Fifty (50) out of 226 medical records were processed and analyzed. Included patients were predominantly older male adults. More than two-thirds of the patients were diagnosed with COPD while approximately one-fourth suffered from asthma. All patients were practicing polypharmacy and the vast majority presented with comorbidities. A total of 6,517 medication errors, predominantly prescribing errors (99.1%), were identified. Despite the high prevalence of medication errors, the majority were classified as “error, no harm” (98.8%), while only 1.17% were deemed as “error, harm.” As the frequency of prescribing errors increases in the power of three (rough approximation of e), from 1 to 3 to 9 to 27, etc., the expected hospital stay increases by 2.078 days (pCONCLUSION

All eligible patient charts had at least one medication error, with the majority being prescribing errors. Among the variables, prescribing errors significantly affected the length of stay, while severity of transcribing errors had a marginally significant effect. It is essential to develop comprehensive education and training initiatives and adopt a systematic approach to mitigate medication errors and promote patient safety.

INTRODUCTION: Medical errors commonly occur in medical imaging departments. These errors are frequently influenced by patient safety culture. This study aimed to develop a suitable patient safety culture assessment tool for medical imaging departments. METHODS: Staff members of a teaching hospital medical imaging department were invited to complete the generic short version of the Safety Attitude Questionnaire (SAQ). Internal consistency and reliability were evaluated using Cronbach's α. Confirmatory factor analysis (CFA) was conducted to examine model fit. A cut-off of 60% was used to define the percentage positive responses (PPR). PPR values were compared between occupational groups. RESULTS: A total of 300 complete responses were received and the response rate was 75.4%. In reliability analysis, the Cronbach's α for the original 32-item SAQ was 0.941. Six subscales did not demonstrate good fit with CFA. A modified five-subscale, 22-item model (SAQ-MI) showed better fit (goodness-to-fit index ≥0.9, comparative fit index ≥ 0.9, Tucker-Lewis index ≥0.9 and root mean square error of approximation ≤0.08). The Cronbach's α for the 22 items was 0.921. The final five subscales were safety and teamwork climate, job satisfaction, stress recognition, perception of management and working condition, with PPR of 62%, 68%, 57%, 61% and 60%, respectively. Statistically significant differences in PPR were observed between radiographers, doctors and others occupational groups. CONCLUSION The modified five-factor, 22-item SAQ-MI is a suitable tool for the evaluation of patient safety culture in a medical imaging department. Differences in patient safety culture exist between occupation groups, which will inform future intervention studies.
Humans ; Surveys and Questionnaires ; Patient Safety ; Attitude of Health Personnel ; Diagnostic Imaging ; Reproducibility of Results ; Male ; Female ; Adult ; Job Satisfaction ; Factor Analysis, Statistical ; Middle Aged ; Hospitals, Teaching ; Safety Management ; Organizational Culture ; Medical Errors/prevention & control*

BACKGROUND: The use of potentially inappropriate medications (PIMs) is a major concern for medication safety as it may entail more harm than potential benefits for older adults. This study aimed to explore the prescribing rate, healthcare utilization, and expenditure of older adults using PIMs in China. METHODS: A cross-sectional analysis was conducted using a national representative database of all medical insurance beneficiaries across China, extracting ambulatory visit records of adults aged 65 years and above between 2015 and 2017. Descriptive analysis was conducted to measure the rate of patients exposed to PIM, prescribing rate of each PIM, average annual outpatient visits per patient, average total medication costs for each visit, average annual cost of PIMs for each patient, and average annual medication costs for each patient. Generalized linear model with logit link function and binomial distribution was used to examine the adjusted associations between PIMs and independent variables. RESULTS: In total, 845,278 (33.2%) participants were identified to be exposed to at least one PIM. Patients aged 75-84 years (38.1%, 969,809/2,545,430) and ≥85 years (37.9%, 964,718/2,545,430) were more likely to be prescribed with PIMs. Beneficiaries of the Urban Employee Basic Medical Insurance (UEBMI) and living in eastern and southern regions were more frequently prescribed with PIMs. Compared with patients without PIM exposure (7.5 visits, drug cost of RMB 1545.0 Yuan), patients with PIM exposure showed higher adjusted average annual number of outpatient visits (10.7 visits, β = 3.228, 95% confidence interval [CI] = 3.196-3.261) and higher annual drug costs (RMB 2461.8 Yuan, Coef. = 916.864, 95% CI = RMB 906.292-927.436 Yuan). CONCLUSIONS The results showed that the use of PIM among older adults was common in China. This study suggests that the use of PIM could be considered as a clear target, pending multidimensional efforts, to promote rational prescribing for older adults.
Humans ; Aged ; Cross-Sectional Studies ; Aged, 80 and over ; Male ; Female ; China ; Inappropriate Prescribing/economics* ; Patient Acceptance of Health Care/statistics & numerical data* ; Potentially Inappropriate Medication List/statistics & numerical data* ; Health Expenditures/statistics & numerical data*

Recurrent syncopal episodes associated with head and neck lymphoma are rarely reported. Through a typical case study, this article analyzes the clinical features of patients with neck lymphoma presenting with syncope as the initial symptom, aiming to improve understanding of this type of disease. By reviewing the clinical data of this patient with neck masses admitted for recurrent syncope in June 2023 and integrating findings with relevant literature, the clinical characteristics of this patient population is presented. The first symptoms of lymphoma presenting as syncope are relatively rare and often lead to misdiagnosis. Diagnosis is mainly based on pathological and immunohistochemical analysis.
Humans ; Head and Neck Neoplasms/diagnosis* ; Lymphoma/diagnosis* ; Recurrence ; Syncope/etiology* ; Young Adult ; Diagnostic Errors

Listeria brainstem encephalitis with myelitis is extremely rare in clinical practice.Since the clinical manifestations are non-specific,MRI is helpful for diagnosis.Positive cerebrospinal fluid culture is considered the gold standard for diagnosis.This article reports a case of an immunocompetent individual with listeria brainstem encephalitis with myelitis,aiming to enhance the awareness of this condition.
Humans ; Brain Stem/pathology* ; Diagnostic Errors ; Encephalitis/complications* ; Encephalomyelitis, Acute Disseminated/diagnosis* ; Listeriosis/complications* ; Myelitis/complications*

BACKGROUND AND OBJECTIVE

Proper documentation of patient safety events is important to be able to provide changes that can prevent events from occurring again. The Philippine General Hospital launched an online platform for reporting patient safety events in 2017. This paper aimed to describe the patient safety events, initial response to the event, and preventive actions done in the institution.

This is a retrospective descriptive study of patient safety event records from August 2017 to April 2022. General data of the patients, details surrounding the events, response to the event, and preventive measures done after the event were documented. Descriptive analysis was performed.

There was a total of 625 events reported with 525 total unique reports. There was an increased rate of patient safety event reports from 2021 to 2022. The average rate was 23.8 and 25.7 reports per month, respectively. Most reports were for in-patient cases and were type 3 preventable adverse events. The general initial response of healthcare personnel to the adverse events is to provide the appropriate clinical care. Preventive measures include re-orientation and event specific actions.

Documentation is crucial for patient safety events to provide solutions and prevent reoccurrence of these events that can cause harm to patients.

Background and Objective: Medication errors pose substantial risks in hospitals, particularly concerning patient safety. These errors, occurring throughout the medication use process, are one of the most common causes of morbidity and mortality in clinical practice. In the Philippines, there is a lack of evidence on the prevalence and effects of medication errors, emphasizing the need for further investigation. This study evaluated the prescribing, transcribing, and monitoring errors among inpatients under the Pulmonary Medicine Service of the Department of Medicine in the Philippine General Hospital. Methods: This cross-sectional retrospective records review used the total population purposive sampling technique to examine eligible charts of inpatients with asthma and/or COPD from August 1 to December 31, 2022. The frequency, type, and severity of medication errors were determined. Linear regression and Cox proportional hazards models were used to examine the relationship between patient-related factors and medication errors, and length of hospital stay and mortality. Results: Fifty (50) out of 226 medical records were processed and analyzed. Included patients were predominantly older male adults. More than two-thirds of the patients were diagnosed with COPD while approximately one-fourth suffered from asthma. All patients were practicing polypharmacy and the vast majority presented with comorbidities. A total of 6,517 medication errors, predominantly prescribing errors (99.1%), were identified. Despite the high prevalence of medication errors, the majority were classified as “error, no harm” (98.8%), while only 1.17% were deemed as “error, harm.” As the frequency of prescribing errors increases in the power of three (rough approximation of e), from 1 to 3 to 9 to 27, etc., the expected hospital stay increases by 2.078 days (p <0.001) (e.g., 32 = 9 errors with LOS of around 4 days); meanwhile, more severe transcribing errors increase the length of stay by 4.609 days (p = 0.034) All independent variables were noted to have a lack of significance and thus no meaningful patterns in the data related to patient mortality were identified, primarily due to the insufficient amount of observed mortality in the included sample. Conclusion All eligible patient charts had at least one medication error, with the majority being prescribing errors. Among the variables, prescribing errors significantly affected the length of stay, while severity of transcribing errors had a marginally significant effect. It is essential to develop comprehensive education and training initiatives and adopt a systematic approach to mitigate medication errors and promote patient safety.
medication errors ; patient safety ; pulmonary medicine

A crucial aspect of prostate cancer grading, especially in low- and intermediate-risk cancer, is the accurate identification of Gleason pattern 4 glands, which includes ill-formed or fused glands. However, there is notable inconsistency among pathologists in recognizing these glands, especially when mixed with pattern 3 glands. This inconsistency has significant implications for patient management and treatment decisions. Conversely, the recognition of glomeruloid and cribriform architecture has shown higher reproducibility. Cribriform architecture, in particular, has been linked to the worst prognosis among pattern 4 subtypes. Intraductal carcinoma of the prostate (IDC-P) is also associated with high-grade cancer and poor prognosis. Accurate identification, classification, and tumor size evaluation by pathologists are vital for determining patient treatment. This review emphasizes the importance of prostate cancer grading, highlighting challenges like distinguishing between pattern 3 and pattern 4 and the prognostic implications of cribriform architecture and intraductal proliferations. It also addresses the inherent grading limitations due to interobserver variability and explores the potential of computational pathology to enhance pathologist accuracy and consistency.
Humans ; Prostatic Neoplasms/pathology* ; Male ; Neoplasm Grading ; Prognosis ; Observer Variation ; Prostate/pathology* ; Reproducibility of Results

OBJECTIVE: To evaluate the intra-fraction and inter-fraction positional deviations in head and neck tumor patients undergoing intensity-modulated radiation therapy (IMRT) guided by cone-beam CT (CBCT), as well as the correction capability and stability of the HexaPOD evo RT 6D couch in addressing these deviations. METHODS: From May 2019 to April 2022, 59 consecutive patients with head and neck tumors were enrolled at the Department of Radiation Oncology, Peking University Third Hospital.Using the Elekta AXESSE image-guided stereotactic treatment system, a pre-treatment CBCT scan was performed, followed by bone window mode registration with the planning reference images.Deviations were corrected automatically or manually on the 6D couch, followed by a second CBCT scan for confirmation of the deviation correction.Positional errors in translation (X, Y, Z directions) and rotation (Rx, Ry, Rz directions) were recorded before and after correction, and intra-fraction and inter-fraction positional errors were analyzed. RESULTS: Positional error data before and after correction of the 6D couch were successfully obtained and corrected online in 506 CBCT scans.The maximum positional errors before and after correction were 0.90 cm to 0.04 cm (X direction), 1.74 cm to 0.09 cm (Y direction), 1.80 cm to 0.09 cm (Z direction), and 2.90° to 0.14°(Rx direction), 3.00° to 0.15°(Ry direction), 3.00° to 0.15°(Rz direction), respectively.The mean absolute values of translational (X, Y, Z directions) and rotational (Rx, Ry, Rz directions) errors significantly decreased after online correction, from 0.18 cm, 0.22 cm, 0.25 cm, and 0.82°, 1.11°, 0.73° to 0.01 cm, 0.01 cm, 0.01 cm, and 0.04°, 0.06°, 0.04°(all P values < 0.001).After correction, the frequencies of translational errors less than 0.10 cm in the X, Y, Z directions were 99.60%, 98.62%, and 95.45%, respectively, and the frequencies of rotational errors less than 0.2° were all above 99.80%. CONCLUSION Online correction combined with CBCT and the 6D couch significantly reduces both translational and rotational positional errors in patients undergoing head and neck radiation therapy, greatly enhancing the precision of treatment.
Humans ; Cone-Beam Computed Tomography ; Head and Neck Neoplasms/diagnostic imaging* ; Radiotherapy, Image-Guided/methods* ; Radiotherapy, Intensity-Modulated/methods* ; Patient Positioning/methods* ; Radiotherapy Planning, Computer-Assisted/methods* ; Male ; Radiotherapy Setup Errors/prevention & control* ; Female