patientsafetyforum - BMJ · Tarek Aldabbagh, Zeyad Yousef, Mohamed Harbi, Ali Zahrani, Abdulaleem Alatassi, Nabeeha Tashkandi, Brintha Naidu, Hasan Al-Dorzi, Yaseen Arabi ... The

2016 Patient Safety Forum 1

Conference ProceedingsKingdom of Saudi ArabiaMinistry of National Guard Health AffairsKing Saud Bin Abdulaziz University for Health Sciences

patientsafetyforum.org

2016 Patient Safety Forum 19 - 21 April


Introduction

We are sixteen years away from the publication of the Institute of Medicine’s Seminal report To Erris Human: Building a Safer Health System. Following the report our awareness of the patient safetyissues and harm was heightened and massive efforts were exerted. We have made significant butslow progress in patient safety, too slow for the magnitude of the problem. We are humbled. Thetask proved to be far more difficult and more complex than we originally appreciated. Changing the healthcare system, as recommended in the report, required a monumental unrelenting effort that continues to be challenging. The blue print for the improvement was missing. We now appreciate that in addition to the technical issues and simple rules for system redesign, culture change is far more important. The pursuit of patient safety requires the human elements of transparency, patient engagement, team work and trust.

The Scientific Committee determined that in addition to the global concepts and experience anemphasis on local improvement work should be actively supported, encouraged and included. The abstracts appearing in the following pages are samples of the ongoing activities to address the challenges of delivering safe care in complex academic medical centers in Saudi Arabia. They cover the full spectrum of patient safety strategies of optimizing care such as delivering best practices, improving process and systems in addition to risk control and monitoring, adapting and responding to safety problems.

James Reason wrote that: ‘Safety is a continually emerging property of a complex system’. Complex adaptive systems are in a state of continuous change. The abstracts presented exemplify the ever changing nature of our complex healthcare system and attempts to adapt and respond to these changes.

Dr Saadi Taher Chairman, Scientific Commitee, Patient Saftey Forum 2016 Executive Director of the Saudi Arabian National Guard Health Affairs

4 2016 Patient Safety Forum

Abstract review selection committee

Chairman:Dr. Abdulrahman JaziehChairman, Department of OncologyKing Abdulaziz Medical City, Ministry of National Guard Health Affairs

Members:Dr. Ashley McKimmEditor-in-Chief, BMJ Quality Improvement Reports Journal

Dr. Abdulrhman Al FayezDean, Postgraduate EducationKing Saud bin Abdulaziz University for Health Sciences

Dr. Reem Al SudairyChairman, Department of Pediatric Hematology/OncologyKing Abdullah Specialized Children’s Hospital, Ministry of National Guard Health Affairs

Dr. Hasan M Al DorziSection Head, Adult Intensive Care Unit ConsultantIntensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs

Dr. Eman MiligiAssistant Professor, Nursing DepartmentCollege of Nursing-Riyadh, King Saud bin Abdulaziz University for Health Sciences

Dr. Khaled Al SurimiAssistant Professor of Health Systems and Quality ManagementChairperson, Quality Assurance and Academic Accreditation UnitCollege of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health SciencesHonorary Senior Research Fellow, Department of Primary Care & Public Health School of Public Health, Faculty of Medicine, Imperial College London, UK



Improving postoperative handover process in a tertiary-care hospital in Saudi Arabia: a quality improvement projectTarek Aldabbagh, Zeyad Yousef, Mohamed Harbi, Ali Zahrani, Abdulaleem Alatassi, Nabeeha Tashkandi, Brintha Naidu, Hasan Al-Dorzi, Yaseen Arabi

King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

BackgroundIneffective communication among healthcare providers in the postoperative period is common and may jeopardize patient safety and adversely affect patient outcomes. In this project, we aimed to achieve effective postoperative handover at a tertiary-care hospital.

Methods A quality improvement project was conducted at the surgical intensive care unit (ICU) of King Abdulaziz Medical City-Riyadh to improve the postoperative handover process. The project stakeholders were physicians (surgeons, anesthesiologists, and intensivists), nurses (operating room [OR], ICU), and the hospital administration. The project had multiple phases. In the pre-implementation period, an assessment tool was generated to measure the elements of the handover process. For purposes of measurement, a postoperative handover bundle was created, which consisted of the presence of physicians from the three disciplines at the bedside on arrival to the ICU. In the preparation phase, a multidisciplinary team generated a postoperative handover checklist that included several elements filled by the three disciplines involved in the care: anesthesia, surgery, and ICU. In the implementation phase, all involved disciplines focused on the new handover process. The compliance with the process was measured and feedback was provided to the involved departments.

ResultsIn the pre-implementation period, compliance with the postoperative handover bundle was 0%. In the six months post implementation, there were 180 postoperative handovers and compliance with the bundle increased to 92.2%. On the postoperative handover forms, documentation by surgeons of anticipated surgical problems in the first 24 postoperative hours was specified in 88.4%, feeding plan in 89.5%, DVT prophylaxis in 87.3%, and family update in 82.8%. Documentation by anesthesiologists of difficult airways was 96.7%. Predefined outcome measures were documented for 83 patients: intubation within 6 hours of ICU admission in 1.2%, fluid resuscitation or adding vasopressors within 1 hour of ICU admission in 13%, unplanned return to OR in 1.2%, and cardiac arrest in 1.2%.

ConclusionThe risk adjusted mortality rate (RAMR) for coronary artery bypass grafting was obtained for each surgeon from publically reported databases for each state.


A systematic approach using the Lean Six Sigma methodology to improve an electronic modified early warning system (e-MEWS) at King Abdulaziz Medical City-Jeddah (KAMC-JD)Jane Thomson, Shaymaa Malibari, Abdulaziz AlJahdali, Maryam Khalil, Bonnie Scudder, Goitsemang Haman, Abeer Hawsawi, Milagros Biaco, Jafar Othman, Eman Matar, Arlene Rashwan, Pedro Ison, Abdullah Binhamdan, Essam Zimaiti, Yasir Tashkandi

King Abdulaziz Medical City, Ministry of National Guard – Health Affairs, Jeddah, Saudi Arabia

BackgroundIn our institution, cardiac arrest (Code Blue) alerts have shown that some patients have deteriorated without detection. The MEWS is an evidence-based tool used to flag changes in vital signs at an early stage. Building on our previous work, we now aim to: (1) culturally transform and improve the process for detecting deteriorating patients using Lean Six Sigma; and (2) assess compliance to e-MEWS through timely nursing assessment and

clinician intervention.

Methods This study was conducted in the medical-surgical wards of KAMC-JD, from October 2015 to the present. The intervention began in January 2016. We used the Lean Six Sigma framework, DMAIC (Define, Measure, Analyze, Improve, and Control), to assess the current system and redesign the e-MEWS process. Data collected retrospectively included: (1) Code Blue statistics; (2) an observational survey; (3) staff satisfaction survey; and (4) value stream mapping and failure modes and effects analysis. A cause and effect analysis was also done.

ResultsA total of 29 CCRT alerts occurred pre-intervention, and 11 post-intervention. For Code Blue, four occurred pre-intervention, with only one case being detected by e-MEWS, while four occurred post-intervention, with all four cases being detected and acted upon. In the pre-intervention phase, a total of 390 vital sign entries were audited, system reliability was 6% (23 of 390), escalation to primary nurses was 36% (140 of 390), and physician notification was 0% (i.e., not recorded). In the post-intervention phase, a total of 366 vital sign entries were audited, system reliability increased to 100% (366 of 366), escalation to primary nurses increased to 91% (221 of 244), and physician notification increased to 78% (172 of 221).

ConclusionWe have improved the process for detecting deteriorating patients through Lean Six Sigma by identifying the gaps, streamlining the process, and redesigning the e-MEWS system. Reliability of the system was fully achieved, and compliance to e-MEWS increased for nursing staff. Further evaluation of clinical interventions is required to achieve optimum patient rescue.


Improving quality of care for advanced chronic kidney disease patients by a multidisciplinary approachDr Wasim Ahmed, Dr Elbadri Abdelgader, Nihar Palahuddin, Dr Khamees Obeid Khamees, Ramy Abulikailik, Mohammad Ellouly, Ibrahim Al Dossary, Zahra Basri, Khadija Al Baqshi, Michelle Condenimi, Nuha Beneid, Saba Shuwish

King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia

BackgroundPatients with estimated glomerular filtration rate (eGFR) <20 mL/min (advanced chronic kidney disease [CKD]) have complex needs. Standard outpatient care is fragmented among nephrologists, nurses, education teams, dieticians, and social workers, resulting in suboptimum care. Multidisciplinary team (MDT) care can overcome these issues and improve outcomes. Our aims of this project are to provide CKD education to patients and

families, and prepare patients in a coordinated manner for renal replacement therapy (RRT).

Methods The project was designed on the Institute for Healthcare Improvement’s (IHI) Model for Improvement. An MDT was formed. Meetings were conducted from June to August 2015 to agree on aims, delivery of education, and quality indicators. Process and MDT roles were defined. A video, education, and medication/vaccination booklets were made in Arabic. A pilot PDCA (plan-do-check-act) was done and modifications made in the process. The program started in November 2015. MDT care is provided to all patients referred from outpatient care and also to those who are admitted to hospital for emergency dialysis.

Results44 patients received MDT care until March 2016. 13 patients started RRT. Eight of 13 were seen after starting dialysis as emergency. Four of 13 were from outpatient care and in the program for at least 3 months. One patient received pre-emptive transplantation, which had never happened in our unit, and was attributed to MDT care. Mean age was 47.5 years. 57% were male. 50% of outpatients who started hemodialysis had an arteriovenous fistula (AVF; 5% 1 year prior). Mean hemoglobin was better, at 9.85 g/dL in MDT care (8.81 g/dL 1 year prior). 100% of these patients received full hepatitis B vaccination before RRT (40% 1 year prior). Additional data will be presented at the forum.

ConclusionIn a short period, our MDT care program has begun to show improvement in care of patients with advanced CKD and this care will continue to improve. This project is the first of its kind in MNGHA Hospitals, Saudi Arabia.


Reducing central venous catheter usage in donor’s peripheral stem cell collectionSamer Ghazi, Dr Ayman Hejazi, Dr Mohsen Al Zahrani, Mona Shami, Salman AlShammary, Dr Abdulrahman Jazieh

King Abdulaziz Medical City, Ministry Of National Guard Health Affairs, Riyadh, Saudi Arabia

BackgroundPeripheral blood stem cell (PBSC) collection from donors by apheresis has become the main source of stem cells. This procedure requires a high blood flow venous access. Peripheral venous catheter (PVC) is considered a safer venous access compared with central venous catheter (CVC). In our institution, the use of CVC was considerably high (72%).

Methods The multidisciplinary team conducted a situational analysis and evaluated the current process of donor PBSC collection aimed to reduce CVC use to less than 20%. A quality improvement methodology through rapid cycles of improvement method plan-do-study-act (PDSA) was used to test a set of initiatives. Three PDSA cycles were used to achieve the goal in reducing utilization of CVC. The IV team was appointed to assess donor venous access and insert appropriate PVCs if eligible.

ResultsThe project ran over 16 months during which 42 adult donors underwent a PBSC collection. During the first PDSA cycle, one CVC was inserted for a total of four donors (25%). An additional CVC was also inserted during the second cycle out of eight apheresis donations (12.5%). Finally, no CVC was used during the last PDSA cycle among 30 donors (0%). All donors achieved targeted CD34 dose in one apheresis session and no patient originally assigned for PVC required subsequent CVC insertion. Thus, we observed a significant reduction in CVC use from our historical cohort rate of 72% to 0%.

ConclusionWe demonstrated that successful apheresis procedures can be easily and safely achieved in the majority of PBSC donors through reducing CVC use, thus minimizing the potential adverse events associated with CVC-related complications. Interdisciplinary collaboration between the IV team, apheresis team, and clinical hematology team was paramount to optimize donor selection. This project highlights the value of internal quality improvement to constantly improve delivery of safe care.


Comprehensive unit-based safety program for mechanically ventilated patients: compliance with the measurement of daily process care in the ICUs of King Abdulaziz Medical, RiyadhHanan Aqeel, Bibin George, Maha Aljaeed, Raymond Khan, Asad Latif, Bickey Chang, Sean M. Berenholtz, Mohammed M. Aboudeif, Sultan Tayar, Rajeh Shehab, Khalid Maghrabi, Hassan Hawa, Yasser Mandourah, Khaled Imran, Ismaael Qushmaq, Yosef Ameen, Khloud Al-Harbi, Yaseen Arabi

Ministry of National Guard Health Affairs, Saudi Arabia

BackgroundPatients on mechanical ventilation are vulnerable to many complications, such as ventilator-associated pneumonia, acute respiratory distress syndrome, pulmonary embolism, and pulmonary edema in the short term, whereas physical disabilities, cognitive dysfunction, and psychiatric issues can be long-term consequences. The Comprehensive Unit Based Safety Program for Mechanically Ventilated Patients and Ventilator Associated Pneumonia (CUSP 4 MVP-VAP) project was initiated in collaboration with the Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital, USA, aiming to reduce short- and long-term harms that could happen with patients on mechanical ventilation. A total of 16 intensive care units (ICUs) from eight hospitals in Saudi Arabia are participating in this project. In this abstract, we report the compliance with daily care process measures for

mechanically ventilated patients in the ICUs of King Abdulaziz Medical City, Riyadh.

Methods A data collection tool was used to measure the compliance with daily care process measures, which included presence of endotracheal tubes with subglottic suctioning (ET-SGS), elevation of head of bed ≥30° (HOB ≥30°), spontaneous awakening trials, and spontaneous breathing trials. Data were collected on all mechanically ventilated patients daily for 3 months then twice weekly for 3 months, from October 2015 to March 2016. The program’s robust web-based data platform could generate real-time data reports so participating ICUs could track their progress over time and benchmark their performance with others.

ResultsAbout 1600 patients were screened. Episodes of mechanical ventilation were 98% in the first quarter vs 83% in the second. The average duration of mechanical ventilation was 6.85 days and 7.69 days, respectively. Compliance with the daily process care measures in the first 3 months compared with the last 3 months were as follows: ET-SGC 88.9% vs 73.6%; HOB ≥30° 99.4% vs 99.4%, SAT 53.0% vs 81.9%; and SBT 87.3% vs 87.6%.

ConclusionImplementing the CUSP 4 MVP-VAP program can produce improvement in compliance with quality measurements in ICU daily care processes, which may contribute to decreasing patient harms and enhancing safety.


Variations in outcome by the time of diagnosis and disease expression among cases of Middle-East respiratory syndrome (MERS) during the time of hospital outbreakAiman El-Saed, Hanan H. Balkhy, Thamer H. Alenazi, Majid M. Al shamrani, Henry Baffoe-Bonnie, Yaseen Arabi, Sameera Al Johani, Ra’ed Hijazi, Adel Alothman, Abdulhakeem Althaqafi, Maha Muneef

King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia

BackgroundInternational recommendations have emphasized early recognition of new Middle-East respiratory syndrome coronavirus (MERS-CoV) cases to limit disease spread. However, the impact of this on the outcome of MERS-CoV cases has never been fully examined. The objective of the current study was to examine the association of

outcome with the time of disease suspicion or expression.

Methods We conducted an epidemiologic investigation of the recent MERS-CoV outbreak in King Abdulaziz Medical City (Riyadh) between June and September 2015. Disease suspicion was defined as the date of isolation or the date of first swab or sample, whichever came first. The incubation period was calculated only in cases with documentedexposure history that was pinpointed to 1-3 days.

ResultsOf 130 MERS-CoV cases, 96 (73.8%) were hospitalized, 63 (48.5%) were admitted to the ICU, 60 (46.2%) required ventilation, and 51 (39.2%) died. Approximately 34.6% of cases were suspected before or on the same day of onset of symptoms, 45.4% within a week of onset, and 20.0% after a week of onset. Compared with other groups, those who were suspected before or on the same day of onset had markedly lower rate of hospitalization (40.0% vs 91.8%, p<0.001), ICU admission (17.8% vs 64.7%, p<0.001), ventilation (17.8% vs 61.2%, p<0.001), and mortality (24.4% vs 47.1, p<0.001). The incubation period was calculated only for 34 cases with an average of 7.1±0.5 days. Those who had shorter incubation period (less than a week) were less likely to be hospitalized (55.6% vs 87.5%, p=0.063), admitted to ICU (38.9% vs 68.8%, p=0.082), or ventilated (38.9% vs 75.0%, p=0.034), but there was little difference in mortality (44.4% vs 56.3%, p=0.492).

ConclusionMERS-CoV cases who were suspected and to a lesser extent expressed early in the course of the disease had much better outcome. The findings further emphasize the importance of early recognition and active surveillance during the time of outbreak.


Conducting process surveillance at a hemodialysis unit: road map to sustain reduction in dialysis events (DE)Ahmed Ibrahim, Dr Fayez Hejaili, Dr Abdullah Sayyari, Dr Henry Baffoe-Bonnie, Dr Aiman El-Saed Ramadan, Siti Rohani Kasirie, Bernie Reyes, Ananda Collemallay, Bella Mae Versoza, Khawla Salman, Noelle Francesca Bambilla, Maribel Fontanilla Tabar, Francinah Madikoane, Maria Theresa Tejada, Cielito Alvarez, Remedios Almazan, Jennifer Flores, Honelyn Sabando, Kristine Joy Valdez, Karen Angelie Panique, Silvia Cimene, Nimfa Dagunton, Dr Hanan Balkhy


BackgroundPatients with end-stage renal disease (ESRD) are at high risk for bacteremia because the process of hemodialysis

requires frequent use of catheters and needles to access the bloodstream.

Methods Following the methodology set by the National Healthcare Safety Network (NHSN), dialysis event (DE) surveillance was conducted for seven quarters (from 2012 to 2015) at an outpatient hemodialysis unit at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia. Patients were monitored for the following events: in-unit IV antimicrobial start, positive blood culture, and local access infection. Interventions were continuously implemented throughout the study period, which included but were not limited to training staff on access care, aseptic technique, catheter hub scrubbing, appropriate use of skin antiseptics, and disinfection of equipment. A process surveillance using the CDC audit tools focusing on catheter connection and disconnection practices was done in the second quarters of 2014 and 2015 to measure compliance of staff to recommended guidelines on access care.

ResultsThe rate of DE per 100 patient-months showed a minimal reduction for two quarters in 2014 (quarter 1 and 3) and the second quarter of 2015. Consequently, a review of the results of the process surveillance done in 2014 and 2015 (Graph I) showed a significant rise in compliance to the scrub the hub technique before connection of a catheter from 53% in 2014 to 93% in 2015. Compliance of allowing antiseptic to dry before connection increased from 20% to 93%. Similarly, compliance of hand hygiene after glove removal increased from 78% to 91%.

ConclusionAlthough there was a minimal reduction in the DE per 100 patient-months for the last two quarters (2014 and 2015) in parallel with the implementation of the process surveillance, more surveillance studies need to be done to see if sustainability in reduction in DE can be achieved in the long term.

Graph I: Catheter connection auditing compliance


Oncology department plan to overcome the impact of a MERS-CoV outbreak on patient careAbdul-Rahman Jazieh, Abdul-Rahman Hadab, Mohsen Al Zahrani, Ashwaq Olayan, Ayman Hejazi, Faisal Safi, Abdullah Qarni, Faisal Farouqi

Oncology Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia

BackgroundThe Department of Oncology was affected by an outbreak of Middle-East respiratory syndrome coronavirus (MERS-CoV) that resulted in closure of the Ministry of National Guard Health Affairs (MNGHA) hospital and other hospitals in the city. We developed a plan to overcome the challenges of patient care during the crisis.

Methods

The department leadership responded to the outbreak by formulating a crisis leadership and communication plan, proper patient and staff management, infection control processes, and by developing a recovery plan. The leadership committee included different disciplines from medicine, nursing, quality improvement, and operation administration. The group met at least twice a week to take the required actions in a timely fashion. Patients and visitors were screened before entering the clinic and the wards and anyone with suspected infection was referred to a triage area. Routine follow-up appointments were rescheduled as far as safe for the them. Suspicious cases were isolated in one ward. All patients who required inpatient care other than chemotherapy or stem cell transplantation were sent to another hospital based on a formal agreement and our medical staff provided coverage there. Staff underwent nasopharyngeal swab and were screened before entering the ward, fitting test for N95 mask to clinical staff, training and educating staff about personal protective equipment (PPE), and minimize contact between clinical and non-clinical staff. The recovery plan was implemented in three strategic phases: urgent, intermediate, and long-term.

ResultsThe above interventions and plans were implemented and resulted in zero transmission of infection after September 2015 and reopening all oncology services in the new building with no documented MERS-CoV infection among oncology patients and staff since then.

ConclusionLessons learned from this crisis will certainly help our department handle any future outbreaks more efficiently.


The relationship between hospital safety culture and staff outcomes: a hospital-based cross-sectional surveyKhaled Al-Surimi, Nawwaf Alhmaidan

Prince Mohammed bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, Saudi Arabia

BackgroundThis research aims primarily to assess the level of hospital safety culture and its potential impact on staff outcome

items of job satisfaction and intention to leave at a tertiary hospital in Riyadh, Saudi Arabia.

Methods This is a cross-sectional electronic-based survey, targeting all hospital staff working at Prince Mohammed bin Abdulaziz Hospital (PMAH), Riyadh, during the study period.

ResultsOverall, 800 respondents participated with a response rate of 53% of 1500 staff working at PMAH. Overall, only half (53.3%) of the hospital staff had a positive perception of patient safety, 69% had a positive perception of job satisfaction, but at the same time 64.2% had an intention to leave. The correlation and multiregression analysis revealed a significant relationship between safety culture and job satisfaction. The main significant factors were “hospital handoffs and transitions” (-0.275), “supervisor/manager expectations and actions promoting safety” (0.337), “teamwork within hospital unit” (0.554), “feedback and communication about error” (0.393), and “hospital management support for patient safety” (0.408), with overall R²=0.438 (p<0.001). Likewise, there was a significant association between safety culture domains and intention to leave; staff intention to leave the hospital was nearly two times due to their perception of the current teamwork in hospital units and perception of the hospital handoffs and transition (OR 1.72, p=0.053; OR 1.60, p=0.011, respectively), while the positive perception of job satisfaction and staffing were highly significant as protective measures for minimizing staff intention to leave (OR 0.11, p=0.00; OR 0.684, p=0.055, respectively).

ConclusionThe overall positive perception of safety culture is low among hospital staff. Notably, prompting patient safety culture could play a major role in developing strategies and actions in relation to job satisfaction and staff intention to leave.


Moving on after a catastrophe: the 2015 MERS-CoV outbreak in a large tertiary hospital in Saudi ArabiaNimfa Dagunton, Dr Abdulhakeem Al Thaqafi, Dr Maha Al Muneef, Dr Henry Baffoe-Bonnie, Dr Abdulrahman Fayez, Dr Mustafa Bodrick, Dr Aiman El-Saed Ramadan, Joseph Tannous, Bassem Abukhzam, Bassem Al Shadfan, Dr Hanan Balkhy


BackgroundIn July 2015, an outbreak of the novel virus Middle-East respiratory syndrome coronavirus (MERS-CoV) was declared at King Abdulaziz Medical City (KAMC), a tertiary hospital in Saudi Arabia, which led to the closure of our emergency department. One of the major gaps identified was a breach in infection control practices that led to

further transmission of the disease.

Methods To implement effective interventions, a competency-based hospital-wide training was mandated by the hospital administration. In collaboration with international experts, the Infection Prevention & Control department developed a curriculum that was launched from September 28 to December 17, 2015. It was conducted three times a day for 12 weeks in collaboration with the nursing department. The teaching format was lecture-based along with a competency-based module on the proper donning and doffing of personal protective equipment and N95 fit testing. To measure the effectiveness of the workshop, a pre-test and post-test were done.

ResultsAmong the 9973 total trained healthcare workers (HCWs), the majority (65% [6379]) were non-Saudis. As depicted in Graph I, a large proportion of the participants (46% [4615]), were nurses, 32% (3167) were from other professional categories, 13% (1318) were physicians, and a small number 9% (873) were students. Out of the total, 81% (7700) of those tested showed improvement, while 12% (1112) showed no improvement and 7% (727) did worse on the post test.

ConclusionAs part of the overall disaster management training to deal with MERS-CoV outbreaks, a competency-based module is crucial. This training process has been shown to be effective in improving the knowledge and skills of our staff. To sustain the competency of our HCWs, annual training with testing is probably required and educational materials must be available online and on hand for distribution when needed.

Graph I: Job category of participants of the Right Care, Right Now Infection Prevention Training Program


Intentional care rounds in PMBAH-Madinah, Saudi Arabia: a pilot project in transforming quality and safety of patient carePerjit Kaur, Charanjit Singh

Prince Mohammad Bin Abdulaziz, Ministry of National Guard Health Affairs, Madinah, Saudi Arabia

BackgroundIntentional care rounds address nurses’ complaints about too many call bells and distribution of small tasks (e.g.,

curtains and screens not being closed properly, rooms being too cold, requests for television remote controls,

etc). Additionally, patients were not very satisfied because, for example, call bells were not answered soon enough

and patients were being interrupted during meals and having to leave their food unfinished. Nurses were equally

interrupted during breaks. Patients called when pain was too severe and complained that analgesia was delayed,

and patients might fall when trying to go to the bathroom alone. Reduction in pressure ulcers was also a concern.

Methods An intentional care round was done by nurses in alternation with patient care technicians every hour. These rounds intended to address eight key behaviors such as opening keywords, performing scheduled tasks, addressing pain, personal needs, and position or comfort needs, safety environment assessment, closing keywords, explaining the next hour visit and documentation. A survey was done by phone calls and data analyzed. This study was an observational prospective quantitative and qualitative study. The result was shown in simple percentages.

ResultsAs anticipated, we reached a 35% reduction in call lights, a 12-point mean increase in patient satisfaction, a 47% reduction in patient fall rates, and a 12% reduction in pressure ulcers.

ConclusionConcerns about essential nursing care have refocused attention on the need to ensure fundamental aspects of care are delivered reliably. Intentional care rounds involve health professionals carrying out regular checks with individual patients at set intervals. The approach helps nurses to focus on clear, measurable aims and expected outcomes. It also helps frontline teams to organize their workload, providing more systematic and consistent care.


Screening of exposed healthcare workers during an outbreak of MERS in Saudi ArabiaHanan Balkhy, Fatimah Al Abdulkarim, Rasha Awad Al Ahmari, Maha Muneef, Waseem Khan, Mohammad AlQahtani, Aiman El-Saed, Henry Baffoe-Bonnie, Thamer H. Alenazi, Azzam Mohammed, Nimfa Dagunton, Sameera Al Johani, Yaseen Arabi, Adel F. Alothman

King Abdulaziz Medical City, Ministry of National Guard Affairs, Riyadh, Saudi Arabia

BackgroundHealthcare workers (HCWs) represent approximately 15% to 40% of cases detected during hospital outbreaks

of Middle-East respiratory syndrome coronavirus (MERS-CoV) described before in Saudi Arabia and South Korea.

The objective of the current study was to describe the process and outcome of HCW screening during a large

MERS-CoV hospital outbreak in Saudi Arabia.

Methods The screening of HCWs was a part of an epidemiologic investigation done in response to the 2015 MERS-CoV

outbreak at King Abdulaziz Medical City, Riyadh. Two clinics were designated for screening: one for symptomatic

and the other for asymptomatic HCWs. Nasopharyngeal swabs were tested using RT-PCR test for MERS-CoV.

Screened HCWs were given sick leave until cleared either by turning negative or becoming asymptomatic.

ResultsOf 3901 identified exposed HCWs, 3105 (79.6%) were screened at the symptomatic (1654 [53.3%]) and asymptomatic (1451 [46.7%]) clinics. The source of exposure was identified as patients (86.0%) and other HCWs (14.0%). The screened HCWs were mainly nurses (52.5%), followed by support staff (17.5%), technicians (12.6%), physicians (8.7%), and other HCWs (8.6%). They were working in wards (20.0%), outpatient clinics (14.7%), emergency department (11.4%), intensive care units (10.3%), laboratory/medical imaging (7.9%), respiratory services (2.8%), and other hospital locations (32.9%). Of 2992 successfully processed swabs, 10 (0.3%) had positive RT-PCR test results. A total of 1280 (41.2%) HCWs were rescreened because of persistence of symptoms with negative results, intermediate test results, multiple exposures, or to allow HCWs to resume work. Rescreening identified an additional 27 positive results. HCWs identified during screening or rescreening represented 86% of HCW cases identified during the outbreak (n=43).

ConclusionA screening program is an efficient way for detecting early MERS-CoV disease among HCWs and to limit spread of infection during an outbreak setting. More efforts needs to be done to reach all exposed HCWs.


Timing of the first antibiotic dose in patients with sepsis: a quality improvement project in the ICUHasan M Al-Dorzi, John Alchin, Amal A Matroud, Ruby Corales, Haifa Alhumedi, Eman Rayi, Lucie Pelunkova, Fawaz Rabeeah, Raymond Khan, Shmylan, Yaseen M Arabi


BackgroundThe timely administration of appropriate antibiotics is associated with improved outcomes in sepsis. We assessed

timing of the first antibiotic dose in a tertiary-care intensive care unit (ICU).

Methods This quality improvement project aimed at administering the first antibiotic dose within 60 minutes of electronic ordering. In September to December 2014 (phase I), we audited the time of ordering and administering first intravenous antibiotic doses in three adult ICUs of King Abdulaziz Medical City-Riyadh. The results were discussed with ICU staff; nurses were encouraged to treat every new antibiotic order as STAT and physicians were asked to use critical care timing in “Quadramed”. The audit was repeated in March, 2015 (phase II) and February to March 2016 (phase III) after the hospital information system changed to “BestCare” (22/01/2016).

ResultsWe evaluated 255 doses in the three phases. The mean time between electronic ordering and antibiotic administration was 123±113 minutes (range: 1-662 minutes; 36% administered within 60 minutes, 27% within 61-120 minutes, and 37% after 120 minutes). It was 110±116 minutes in ICU2, 126±88 minutes in Trauma-ICU, and 159±119 minutes in Neuro-ICU (p=0.03). The mean time was 100±90 minutes in phase I (118 doses), 52±38 minutes in phase II (16 doses), and 155±130 minutes in phase III (121 doses; p<0.01; p<0.01 between phase I and III). It was similar in the AM versus PM shifts (p=0.73). The mean time was 146±150 minutes for meropenem, 127±108 minutes for piperacillin/tazobactam, 80±69 minutes for vancomycin, and 69±40 minutes for caspofungin (phases I-III difference was only significant for piperacillin/tazobactam; p=0.02).

ConclusionFirst antibiotic dose administration was frequently more than 60 minutes after ordering in our ICUs. A quality improvement project resulted in a transient improvement. Changing from “Quadramed” to “BestCare” was associated with an increase in the time between ordering and administering. We need to redesign antibiotic ordering and administering processes and enhance “BestCare”.


Effectiveness of safety event management through Safety HuddleDr Arwa Al Yamani, Azif Zahirin Amin, Jessica Wong, Ahmed Asmadi, Osama Younis, Elizabeth Moodi, Danielle Mareun, Selina Gcilishe, Shahnaaz Mahboeb, Dr Nabil Moulammy, Faiz Bahadi, Dr Queen Ibekweh, Dr Mansoor Khan, Saleh Kharmani, Omar Abuskout, Dr Ahmed Saeed, Dr Ahmed Shehri, Sara Ozbak, Dr Wasil Jastaniah

Oncology QPS, King Abdulaziz Medical City, Ministry of National Guard Affairs, Jeddah, Saudi Arabia

BackgroundCommunication and team collaboration play a vital part in improving patient safety. Few studies have prospectively recommended Safety Huddle as a tool towards high reliability organization. This project targeted

improving effectiveness of safety event management through improving safety reporting.

Methods This was a prospective study in which 24 hours look back and look ahead safety issues were addressed in a 15-minute daily meeting by the multidisciplinary frontline members. Issues that potentially pose significant harm to patients and/or staff were escalated for an action plan after the meeting. Responsibility to follow up and provide feedback immediately was assigned through team consensus. Data were collected during the meeting and through the safety reporting system (SRS). The data collected included event date, event type, factual description, person affected outcome, consequence rating, likelihood rating, level of risk, and outcome notes. Analysis of pre- and post-Safety Huddle was conducted.

ResultsA total of 227 SRSs were reported in the 60 days pre-Safety Huddle compared with 407 SRSs following initiation of Safety Huddle. This represented a 79% increase in safety reporting. Despite increased reporting, approximately 97% of reviewed SRS reports were reviewed in the pre- and post-Safety Huddle. However, SRS events were shared with the multidisciplinary team involved in real-time Safety Huddle discussion compared with electronic forwarding the SRS to the Reporting or Specific Occurrence Location Manager in the pre-Safety Huddle.


Suspected cancer program to improve the process of initial work-up of patients with suspected malignancyDr Ashwaq Al Olayan, Dr Fahad Azzumea, Dr Sultan Al Khatib, Ms Wafa AlHeres, Ms Yosra Ali, Dr Abulrahman Jazieh


BackgroundThe suspected cancer program (SCP) was established in early 2014 to facilitate the early diagnosis of patients with suspected malignancies and to avoid loss to follow-up or delay in diagnosis that carries risk for the patient’s life. Our aim was to shorten the time between the date of suspecting a cancer diagnosis and the date of confirmation of the

diagnosis to less than one month.

Methods Data were obtained for the following time intervals: from time of identifying the suspected finding of cancer to the time of diagnosis, to see the oncology specialist, and to the time of receiving cancer-specific treatment. Patients with the suspected findings by imaging, or laboratory or physical exam were referred to the program and then assigned to proper service for evaluation and follow-up.

ResultsThe number of patients referred was 107 and 237 in 2014 and 2015, respectively. The number of days from SCP contact to diagnosis was 33 days in 2014 and 31 days in 2015. Time to be seen by a diagnostic specialist was 19 days in 2014 and 30 days in 2015 (delay may be due to the MERS-CoV outbreak). Time to be seen by the oncologist from diagnosis was 41 days in 2014 and 21 days in 2015. Time to receive the first cancer-specific treatment was 39 days in 2014 and 25 days in 2015. Renal cell cancer average interval diagnosis was 151 days in 2013, 37 days in 2014, and 17 days in 2015.

ConclusionImplementation of the suspected cancer program helped to reduce the time from identifying suspicious findings to diagnosis and treatment. Further plans to improve these measures are underway.


Total house surveillance of CLABSI in a large tertiary-care hospital in Saudi ArabiaJoseph Tannous, Aiman El-Saed Ramadan, Henry Baffoe Bonnie, Bassem Abukhzam, Nimfa L Dagunton, Bassema Shadfan, Kassem Zehri, Marissa Alarcon, Khawla Salman, Ahmad Ibrahim, Tamer Abu Areshih, Ohaila Slim, Hisham Eid, Azzam Mohammed, Tereza Portuga, Dr Hanan Balkhy


BackgroundCentral-line-associated bloodstream infection (CLABSI) is one of the deadly healthcare-associated infections that can be prevented through proper insertion techniques and management of the central line. The objective of this study was to examine at the same time the burden of CLABSI in three settings: intensive care units (ICUs), oncology wards, and non-oncology wards at King Abdulaziz Medical City (KAMC) in Riyadh during December

2014.

Methods Infection control practitioners (ICPs) conducted an active, patient-based, pan-hospital prospective surveillance in 44 locations using the CDC’s National Healthcare Safety Network (NHSN) definitions and methodology. Central-line bundles were implemented based on the practice recommendations of the Institute for Healthcare Improvement (IHI) since 2007, while maintenance components were added in 2012. Compliance with the practices was monitored by reviewing the central-line bundle components assessed by the physicians, the nurses, and the ICP upon insertion and on a daily basis.

ResultsDuring the surveillance period, nine cases of CLABSI were identified among 26,881 patient-days and 4741 central-line days (CLDs) at a rate of 1.9 per 1000 CLDs. The rate of CLABSI per 1000 CLDs was 0.9 in ICUs (two events), 2.9 in non-oncology wards (five events), and 2.3 in oncology wards (two events). All these cases occurred ≥5 days after the central-line insertion date. Compared with NHSN, the KAMC rates were generally similar to respective rates in ICU and oncology wards but higher in non-oncology wards. Low compliance rates with the central-line bundle elements was identified mainly in the non-oncology wards.

ConclusionThe current findings indicate the need for more preventive efforts including widespread implementation of maintenance bundles outside the ICU. Follow-up surveillance is required to evaluate the outcome of such implementation.


Analysis of incident reports of vascular access mechanical complications in critically ill patientsAhmad Deeb, Saeed Obbed, Khalid Al Attas, Basit Baig, Souzan M Al Owais, Khalid Al-Zahrani, Ahmed Al Amry, Yaseen Arabi

King Abdullah International Medical Research Center, Ministry of National Guard Affairs, Riyadh, Saudi Arabia

BackgroundVascular catheterizations are common in critically ill patients. However, these interventions are often associated with mechanical complications during placement, maintenance, and removal. The objective of this study was to describe vascular access (VA) mechanical complications, possible risk factors, and associated harm based on

voluntary incident reports.

Methods A retrospective observational study was conducted at the intensive care department of all voluntarily reported mechanical complications of VA for the period from March 2010 to September 2012. A team from the intensive care and quality management departments developed and validated a tool to assess the potential contributing factors of mechanical complications of VA. The level of harm was determined by using National Coordinating Council for Medication Error Reporting and Prevention Index for Categorizing Errors.

ResultsThere were 60 voluntary incident reports related to mechanical complications of VA. Of these, 13 (21.6%) were related to placement, 44 (73.3%) to maintenance, and three (5%) to removal. The commonest complications of placement were pneumothorax (23.1%) and bleeding (15.4%); and the commonest complications of maintenance were dislodgment (47.7%) and accidental migration (40.9%). Bleeding was the only reported complication of removal. The level of harm ranged from grade C - error that reached patient with no harm (21.7%), D - error that reached patient and required monitoring to confirm no harm (33.3%), E - temporary harm to patient and required intervention (40%), F - temporary harm to patient and required initial or prolonged hospitalization (1.7%), and H - required sustaining life intervention (1.7%). Sepsis and dehydration were common in patients who had complications related to placement (30.8% and 23.1%, respectively) and maintenance (40.9% and 18.2%, respectively). The commonest site related to placement complications was femoral (53.8%), while subclavian and internal jugular (34.1%) were the commonest sites related to maintenance complications.

ConclusionThe VA mechanical complications are not uncommon in critically ill patients. The incidence and harm of such complications are probably underestimated. These complications should be the target for quality improvement projects.


Improving case presentation in tumor boardsMr Tabrez Pasha, Dr Abdulrahman Jazieh


BackgroundA tumor board is a multidisciplinary meeting that provides enhanced care to patients with cancer. All cancers have been categorized under ten tumor boards. Baseline review on 2012 data revealed that 50% of tumor boards had a presentation rate of less than 50% of new cases. Our project aimed at improving the presentation rate to more than 50% of new cases in all tumor boards.

Methods On a quarterly and annual basis, diagnosed cancer cases in the hospital cancer registry from 2013 to 2014 were reviewed and compared with the cases presented in tumor boards to ensure the number of cases presented were above the targeted proportion of 50%. These analyzed results were shared with all the tumor board facilitators to have a motivational approach to increase the percentage of cases presented, for the tumor boards who achieved the 50% target and also for those who did not. This quarterly approach was effective in most of the tumor boards, resulting in a radical increase in the percentage of cases presented in tumor boards and this eventually increased the multidisciplinary approach in patient care management.

ResultsComparative analysis for 2015 data revealed a presentation rate ranging from 3% to 94% with seven (70%) of ten tumor boards showing an increase in case presentation. Eight of ten tumor boards have a presentation rate above 50% and three of ten tumor boards have a rate above 75%. The case presentation rate for individual tumor board has increased by up to 200%.

ConclusionThe intervention has significantly improved the proportion of cancer cases presented in the tumor boards. From the obtained results, it is evident that the tumor board meetings have a positive trend by showing an increase in the proportion of cases presented in the tumor boards.


A cohort study of the relationship between adverse drug reactions and potentially inappropriate medications among hospitalized geriatric patientsMuath Fahmi Najjar, Syed Azhar Syed Sulaiman, Hadeer Abdul AlRazzaq, Majed Al Jeraisy, Hashim Balubaid

King Abdullah International Medical Research Center (KAIMRC) Ministry of National Guard Health Affairs, Riyadh Saudi Arabia, University Sains Malaysia (USM)

BackgroundCases of adverse drug reactions (ADRs) and potentially inappropriate medications (PIMs) are growing continuously among geriatric patients. The objective of this study was to identify the relationship between ADRs and PIMs

among geriatric patients admitted to the King Abdulaziz Medical City (KAMC) in Riyadh.

Methods A prospective cohort design was carried out for 200 geriatric inpatients at internal medicine wards of KAMC, Riyadh, from 2014 to 2015. PIMs in this study were assessed based on Beers’ criteria and screening tool of older persons’ prescriptions (STOPP) criteria.

ResultsThe mean age for geriatric inpatients was 76.5±8.4 years old. Male patients (56.5%) and patients of Saudi nationality (93.5%) were more frequent in our sample in this study. The incidence of PIMs and ADRs were 61% and 27%, respectively. The main significant predictors of ADRs were PIMs, ICU admission, CACI, body-mass index, and history of recurrent ADRs.

ConclusionThis study showed a significant relationship between PIMs use and ADRs among geriatric inpatients.


Checklist for early recognition and treatment of acute illnessShihab Mundekkadan, Jawad Subhani, Sadaf Sardar, Ahmed Hassanien, Mohamed Saied Mohamed, Amira Ahmed, Rahul Kashyap, Yue Dong, Marija Vukoja, Ognjen Gajic, Yaseen Arabi

King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

BackgroundCritical care delivery is complex and associated with high cost and complications. Optimal delivery of best practices is vital in improving patient outcomes. The objective of this study was to determine the impact of the implementation of the Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) tool on patient care processes and outcomes. In this abstract we describe the progress, obstacles, and facilitators for

implementation of this project.

Methods This study is being conducted in a 21-bed intensive care unit (ICU) at King Abdulaziz Medical City, Riyadh, as part of the international multicenter study done across 35 ICUs in 21 countries led by the CERTAIN team at Mayo Clinic. The study consists of three phases: pre-implementation (phase 1), training and implementation (phase 2), and post-implementation (phase 3). The main intervention is the application of the CERTAIN tool, which is an electronic checklist for ICU admission and for daily rounding. In phase 1 data on demographics, daily processes of care, organ function and support, length of ICU and hospital stay, and 28-day mortality were collected prospectively on 50 consecutive eligible patients. In phase 2, training of clinicians was done using an online curriculum and four local champions were identified. Baseline simulation assessment and clinician survey on the use of CERTAIN was performed. Rounding and admission checklist use were simulated remotely and knowledge assessment was performed via scored testing. Local champions trained other staff. Phase 3 includes data collection on 100 patients similar to phase 1.

ResultsA total of 15 (65%) ICU staff physicians were trained as local champions in 9 months and 80% compliance with use of the CERTAIN tool for four consecutive weeks was achieved. The main facilitators were the research culture in the ICU and the already existing daily care bundle (FAST-HUGS-BID) and other checklists. The main difficulties were related to the large number of staff, the occasional interruption of internet access, the occasional inability to access external links, engaging some of the staff, and the manpower needed for data collection.

ConclusionThe implementation of CERTAIN is feasible. The impact of implementing CERTAIN on processes of care and outcomes will be studied on completion of the project in all other participating ICUs.


Implementation of home intravenous antibiotic programDr Majid Al-Shamrani, Dr Amany Fodaily, Dr Sahal Khoshhal, Ms Karen Ting Hie Hee, Mr Ayad Mohammad, Asmaa Taha Battah, Mr Yousef Younis, Ms Sawsan Mady, Ms Rizza Ramos

King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia

BackgroundConcerns regarding the soaring costs of hospitalization and shortage of hospital beds have inspired King Abdulaziz Medical City-Jeddah to provide alternatives when patients with infections no longer need other treatment apart from IV antibiotic(s). The Home Intravenous Antibiotic Program (HIVAP) has proven to be safe, practical, and cost-effective for a range of infections. The aim of this project was to study our new HIVAP for bone and joint infections in terms of

safety, cost, and patient satisfaction.

Methods This study examined the impact of HIVAP on incidence of intravenous access-related adverse events, readmission due to complications, timeliness of antibiotic administration, patient satisfaction, savings in hospital-bed days, and return on investment. New processes on referral of patients to the Home Health Care (HHC) Department, and ordering and delivery of antibiotics were piloted to facilitate the HIVAP. Training was provided to HHC nursing staff on safe handling of central venous lines and administration of IV therapy in the community.

ResultsFrom March 2014 to December 2015, 20 patients were treated for 3 to 195 days (mean 41.6 days) at home with HIVAP. Three patients developed an intravenous access-related event; of these, two patients were readmitted and one patient required insertion of peripheral access for continuation of antibiotic. 102 (9%) of the antibiotic doses were delayed. Uncontrolled factors such as traffic and patient’s clinic appointment have affected the timeliness of antibiotic administration. 832 hospital-bed days were saved. 100% of the surveyed patients (n=7) are very satisfied with the HIVAP. The return on investment for HIVAP has been recorded at 2.8, equivalent to a saving of SAR 241124.

Conclusion

The HIVAP is cost-effective. However, more data are required to demonstrate any major clinical outcomes compared with hospital therapy and patient satisfaction with HIVAP.


Parental knowledge of potential cancer risk post exposure to ionized radiation (skull x-ray and brain computed tomography) in King Abdulaziz Medical City, RiyadhWijdan Al Johi, Arwa Badakhan, Somaya Aljedeba, Milfi AlOnazi, Nesrin Alharthy

King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

BackgroundOn the basis of the best current estimate for lifelong cancer risk post exposure to skull x-ray and brain CT, one child in every 500,000 to 1 million children who have an x-ray, and one child in every 10,000 children who have CT may develop cancer. Parental knowledge about the risk of cancer post exposure to ionizing radiation varied across international studies. In Saudi Arabia, there is a paucity of published reports that assess parents’ knowledge of cancer risks post exposure to ionizing radiation.

Methods A cross-sectional survey was done in 208 parents whose children presented to KASCH-Riyadh emergency department and outpatient clinic with various medical complaints. A validated survey tool was used and adopted from “parental perceptions of the potential risk of ionizing radiation from diagnostic imaging in children with head injuries, emergency department, Hospital for Sick Children”.

Results208 parents successfully enrolled in the questionnaire survey, 56% participated from the pediatrics emergency department and 44% from the outpatient clinic. The majority were female (66%) and had Saudi nationality (95%). Parents’ knowledge about potential risks post-radiation exposure indicated that 33% of parents had previous knowledge. Parents’ knowledge was statistically associated with parent age more than 30 years (p=0.0183). There were no significant associations between parent’s knowledge and any other demographic character, such as gender, nationality, and level of education. The major sources of information among parents who had previous knowledge about cancer risk of radiation were from the internet and television. Physician disclosure to parents of children who underwent radiologic investigation about cancer risk post-radiation exposure was 10% across the survey.

ConclusionBecause the vast majority of parents indicate their preference to be informed about the risks of malignancy before exposure to ionizing radiation, we strongly recommend a formal method for the physician to disclose the risk and discuss the benefits based on clinical need.


Assessment of the knowledge of patient families/visitors about the patient disease and isolation statusDr Nabeela Al Abdullah, Elaf Altwairqi, Wajd Alotaibi, Bashayr Alamri, Hadeel Khoj, Raneen Abousaadah, Abeer Daghistani, Rehab Alshmarani, Nedaa Alyami, Hawazin Fallatah, Ebtisam Alhawsawi, Amal Zahrani, Marwah Hakami, Elaf Alrehaily, Abaad Almutairi, Ghadi Mashat

King Abdulaziz University, Jeddah, Saudi Arabia

BackgroundA successful infection control program requires a multidisciplinary team, which includes patients, visitors, and healthcare workers to prevent transmission of infectious diseases and microorganisms. Engaging and educating patients, their families, and visitors about isolation precautions and proper use of personal protective equipment (PPE) will help control the transmission of infectious diseases. The aim of this study was to assess the knowledge of

patients’ families/visitors about the patient’s disease and isolation status.

Methods The research project was done in November 2015, based on a cross-sectional study. The sample of this study is a random sample chosen between 1 and 5 November from different units in King Abdulaziz University Hospital. The units involved were isolation, medical, surgical, and pediatrics, both male and female. After validity confirmation, data collection took place.

ResultsThere were 52 responses. A total of 54% of visitors did not know that his or her patient was isolated. The majority of the respondents who did not know about isolation were not from the isolation unit. Only 30% of visitors from units other than the isolation unit knew about the isolation precaution, whereas all isolation unit visitors knew about the isolation precaution. Only 30% reported that someone had told them about isolation, either a doctor or a nurse. Furthermore, only 15% understood the meaning of the isolation signs. 23% knew the reason for isolation. 98% spoke Arabic.

Conclusion

This study focused on the importance of communication with patients’ visitors. We found that the majority of visitors and companions did not know about the patient’s isolation and the reason for it. One of the causes was that the isolation cards are written in English language only. The isolation unit visitors were more educated about isolation and its precautions while non-isolation unit visitors were less educated.


Transforming bedside care by reducing falls: a new strategy in PMBAHAbdullah Ali Almomani

Prince Mohammed Bin Abdulaziz Hospital, Ministry of National Guard Health Affairs, Madinah, Saudi Arabia

BackgroundFalls are a common and often devastating problem among older people, causing a tremendous amount of morbidity, mortality, and use of healthcare services including premature nursing home admissions. Most of these falls are associated with one or more identifiable risk factors (e.g., weakness, unsteady gait, confusion, and certain

medications), and research has shown that attention to these risk factors can significantly reduce rates of falling.

Methods A new strategy was developed in our institute Prince Mohammed Bin Abdulaziz Hospital (PMBAH), Madinah, to reduce fall rates. A simple pamphlet written in Arabic with pictures was produced. Upon admission, Arabic-speaking personnel were assigned to explain the content to the patient, sitter, and family, and simple questions were asked to check for understanding. The nurse documented compliance of call bell use, availability of non-skid footwear by the bedside, and fall risk assessment. A high risk for fall sign was placed on the wall to alert staff. An audit for fall incident and documentation of fall education was collected and analyzed in percentages.

ResultsWe found a 14% reduction in falls after implementing the strategy and methods above.

ConclusionConsiderable evidence now documents that the most effective (and cost-effective) fall reduction programs have involved systematic fall risk assessment and targeted interventions, exercise programs, and environmental-inspection and hazard-reduction programs. These findings have been substantiated by careful meta-analysis of large numbers of controlled clinical trials and by consensus panels of experts who have developed evidence-based practice guidelines for fall prevention and management. Medical assessment of fall risks and provision of appropriate interventions are challenging because of the complex nature of falls. Optimal approaches involve interdisciplinary collaboration in assessment and interventions, particularly exercise, attention to co-existing medical conditions, and environmental inspection and hazard abatement.


Total house study evaluating the effectiveness of cleanliness performance using ATP in a large tertiary-care hospital in Saudi ArabiaJoseph Tannous, Elias Tannous, Bassem Abukhzam, Nimfa L Dagunton, Bassema Shadfan, Kassem Zehri, Marissa Alarcon, Khawla Salman, Ahmad Ibrahim, Tamer Abu Areshih, Ohaila Slim, Hisham Eid, Azzam Mohammed, Tereza Portugal, Dr Hanan Balkhy


BackgroundMonitoring cleanliness performance in healthcare settings is essential to ensure consistent and effective cleaning and disinfection of surfaces. Because germs are invisible, direct observation of cleanliness is unreliable since it cannot assess the microbial load in the environment. Thus, the use of technology was incorporated in the

assessment of the appropriateness and effectiveness of cleanliness at King Abdulaziz Medical City, Riyadh.

Methods Trained infection control practitioners used the 3M “Clean Trace” hygiene management system, which measures the levels of ATP (adenosine triphosphate) present on a surface after terminal cleaning, between July and December 2014. The benchmark values were adopted based on a review of current published literature as well as 3M’s clinical experience to decide whether an item was clean using RLU (relative light unit). Below 500 RLU indicates that the item swabbed is considered clean and therefore safe. Above 1000 RLU indicates that the swabbed item is considered dirty and unsafe. Between 501 and 999 RLU is a caution result that can be used to improve cleaning practices.

Results649 samples were collected from 25 highly touched items in 31 clinical areas. 451 samples had RLU values below 500 at a cleanliness rate of 69%. Laptops, monitors, curtains, and tray tables were the dirtiest items with an RLU above 1000.

Conclusion

The results of this study demonstrate that the ATP system can be useful in determining quantitatively the effectiveness of cleaning and can be used as a quality control to drive continuous improvement and development of best cleaning practices for the hospital’s environmental services.


An outbreak of Pseudomonas aeruginosa from tracheal aspirates in the NICU of a tertiary hospitalNimfa L. Dagunton, Dr Saif Al Saif, Noura Shami, Marissa Alarcon, Joseph Tannous, Yvonne Makins, Sheandy Go, Rashed Ghonaim, Dawn Winger, Dr Henry Bonnie-Baffoe, Dr Hanan Balkhy


BackgroundIn July 2015, we observed an increase in the incidence of carbapenem-resistant Pseudomonas aeruginosa in tracheal aspirates of neonates in a neonatal intensive care unit (NICU) at King Abdulaziz Medical City of the

Ministry of National Guard, Riyadh, Saudi Arabia.

Methods To identify the factors that led to the outbreak, a team was formed that included staff from infection control, nursing administration, NICU consultants, respiratory therapy, and the central sterilization department. Control measures were promptly implemented that included strict monitoring of practices, assessing the methodology of cleaning and disinfection of equipment focusing on ventilator machines, evaluating the disinfection process, storage and handling of ventilator flow sensors, conducting a weekly point prevalence surveillance (PPS) screening for Pseudomonas aeruginosa from the tracheal aspirates of all ventilated neonates for 3 weeks to identify any additional cases, and environmental swabbing of equipment.

ResultsAfter our thorough review, the following findings were revealed: breaks in aseptic technique, poor compliance to cleaning of ventilator machines with no cleaning documentation found among the 18 files reviewed, ineffective ways of handling, disinfecting, and storage of ventilator flow sensors as shown by the results of cultures taken from one of the three flow sensors which grew Pseudomonas aeruginosa, and outcome of the PPS cultures taken from the 18 neonates for 3 weeks resulted in a negative result.

ConclusionOur investigation revealed multiple factors that possibly led to the spread of this multidrug-resistant organism. The main reason, however, was the breakdown of sound infection control practices. To prevent any such future outbreaks, healthcare workers need to be educated on the importance of strict adherence to infection control practices, including but not limited to proper cleaning and disinfection of equipment.


The impact of medication reconciliation by pharmacist during transition of care from adult intensive care unit (ICU) to regular hospital wardsNuha Fairaq, Mohammed Aseeri, Umair Ansari, Navid Amlani, Sherine Ismail

King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia

BackgroundTransitions of care may expose patients to serious preventable errors. Patient discharge from ICU to hospital ward is one of the high-risk transitions. Many previous studies have confirmed the benefit of pharmacist medication reconciliation (MedRec) at different transition points (e.g., emergency department admission, long-term facilities), but few have evaluated MedRec during ICU-to-ward transitions. We aimed to assess the impact of pharmacist MedRec during transition from adult ICU to regular ward in our hospital.

Methods This quasi-experimental study included patients aged ≥14 years who were discharged from the adult ICU to surgical or medical wards. In the pre-phase (phase I), a pharmacy resident performed MedRec and reported discrepancies within 72 hours from transition. This phase was followed by an interventional post-phase (phase II) where it is done upon transition. The primary outcome is the proportion of medication discrepancies corrected within 72 hours of ICU discharge before and after implementing pharmacist MedRec. Secondary outcomes are type and potential harm of medication discrepancies. A sample of 298 patients in both phases is estimated to detect a 16% difference in the proportion of discrepancies corrected by the pharmacist with a power of 80% and alpha of 0.05.

ResultsIn phase I, 149 patients showed a 49.6% medication discrepancy within 72 hours of ICU discharge. 29.7% of errors were caused by duplication, 18.9% were inappropriate dose, and 14.8% were use without indication. Interestingly, 66.2% of errors detected were classified to cause harm: 6.12%, 61.2%, and 32.6% for class I, II, and III, respectively. The most common medication classes involved were antibiotics (13.8%) and anticoagulation (8.3%).

Conclusion

Phase I results have shown a medication discrepancy of 48.3% detected by pharmacy resident during ICU-to-ward transitions. Phase II study results will ascertain the impact of pharmacist MedRec upon transition of care from ICU to wards.


Can an awareness campaign teach people the basics of dealing with common emergencies?Wed Rasheed Albardi, Dr Mawya Abdulkarim Khafaji, Sundus Aziz Ansari, Orjuwan Abdulbari Mazi, Dana Ayed AlRahmani

College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

BackgroundSince there is a strong emphasis on public awareness and education to lower the risk of common emergencies, the education of non-healthcare personnel should be addressed. The increase in the number of accidents and emergent cases encouraged us to share knowledge that can help in identifying and dealing with risks. The goal of our research was intended to identify whether our campaign can teach and increase awareness about the importance of first aid and its basic principles.

Methods A sample was obtained from among the students of random girls’ schools around Jeddah. Participants were aged 14 years and older. A questionnaire was developed to assess the accuracy of prior knowledge of first aid principles as well as where that knowledge was obtained (e.g., casual reading, television shows, etc). A teaching workshop was held, demonstrating common first aid principles. Subsequently, a second questionnaire was completed to evaluate knowledge of first aid after the workshop. Data collected were analyzed to assess knowledge of first aid among high school students in Jeddah and to evaluate the benefit of regular first aid workshops at schools in Jeddah.

Results

ConclusionThe study’s results show that most students in the sample have benefited from the lecture and workshop. Therefore, increasing the spread of these campaign goals and other similar educational projects should be addressed. Use of workshops and simulation systems is recommended.


Factors related to unplanned readmission among cardiac patients in King Abdulaziz University HospitalDr Kamal Waheeb AlGhalayini, Eman Kamal Kamal, Heba Jamalaluddin Mominkhan, Afraa Arif Shaikh, Rana Salem Bajahmoom

Department Of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

BackgroundHeart failure imposes an extensive burden of disease globally, affecting 26 million adults worldwide. The American Heart Association reported that 4.7 million Americans, and 400,000 new cases are diagnosed each year. Heart failure accounted for about 25% of cases related to unplanned readmission in less than 30 days in the USA. Readmission affects patients’ health and hospital costs. In this study, we aimed to determine the most common

factors related to unplanned readmission among patients with heart failure in order to decrease its rate.

Methods This was a retrospective study of patients who were admitted to King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from January 2015 to December 2015. Admission books were reviewed. Unplanned readmission criteria were used to determine the rate, and the most common diagnosis. Heart failure was found to be the most common cause related to unplanned readmission. We reviewed all files of patients with heart failure who had unplanned readmission. Clinical, radiographic, and laboratory data were collected. Data analysis was done using descriptive statistics.

ResultsA total of 1531 patients were admitted to King Abdulaziz University Hospital, with a total of 1983 admissions during the study period. Mean age was 52.4 years (n=856) and readmission within 30 days was found in 88 (5.8%) patients. Cardiac diseases were the most common diagnoses associated with unplanned readmission (19 [21.6%]). 26% of cases were male. Mortality within 30 days was 16%. Hypertension was the most common factor related to unplanned readmission followed by anemia, diabetes mellitus, follow-up, and chronic kidney disease.

Conclusion

According to the study results, cardiac diseases are the most common conditions related to unplanned readmission. We recommend more focused and effective programs to increase the level of awareness among cardiac patients and to emphasize the importance of a multidisciplinary approach that takes all risk factors into consideration.


Assessment of the knowledge of physicians towards inappropriate medications in geriatric inpatients: a pilot studyMuath Fahmi Najjar, Syed Azhar Syed Sulaiman, Hadeer Abdul AlRazzaq, Majed Al Jeraisy, Hashim Balubaid


BackgroundPrescribing appropriate medications for geriatric patients is still a challenge for healthcare professionals. STOPP and Beers’ criteria for potentially inappropriate medication (PIM) use in older adults have been designed for assessing the appropriateness of prescribing medications among geriatric patients. There is overuse of PIMs in geriatric patients in Saudi Arabia because of a lack of knowledge among physicians. The purpose of this research was to assess the knowledge of internal medicine physicians towards PIMs use among geriatric inpatients based

on STOPP and Beers’ criteria.

Methods This research was done as a cross-sectional survey in March 2014 among internal medicine physicians of the King Abdulaziz Medical City (KAMC) in Riyadh. A questionnaire was distributed to 40 physicians. Participants were also briefed about the study objectives and the expected outcomes of this research; an informed consent form was signed voluntarily before filling out the questionnaire.

Results40 respondents participated voluntarily in the study. 80% were male. Most doctors (59.5%) were aged from 36 to 45 years old, half the physicians had Saudi nationality, 50% were consultants or associate consultants, 15% were staff physicians, and 35% were residents. Median length of physician experience was 9 years. Overall knowledge about PIMs was 48%. Unfortunately, 41% of physicians gave wrong answers and 11% had no knowledge. In terms of knowledge domains about PIMs, the proportions of respondents who gave correct answers for general information, PIMs regardless of diagnosis, drug-disease interaction, and PIMs to be used in caution were 17%,

12%, 8%, and 11%, respectively.

ConclusionThe results of this study showed that physicians had low overall knowledge of PIMs. About half the physicians had inadequate knowledge of PIMs.


Assessment of safety culture in emergency departments at National Guard Health Affairs: a multicenter studyDr Nesreen Al Wallan, Dr Khalid Al Surimi, Dr Ahmed Al Amry, Dr Ashraf El Metwally

King Abdullah Specialized Children Hospital, Ministry of National Guard Health Affairs, Saudi Arabia

BackgroundA positive workplace culture has an impact on the safety of patient care. The primary purpose of this study was to assess the patient safety culture among emergency staff working at four National Guard Health Affairs (NGHA)

hospitals in different regions: central, western, and eastern.

Methods This cross-sectional survey used a well validated Safety Culture Questionnaire (SAQ) to assess the safety culture among health professionals working in the emergency departments of four NGHA hospitals. Data were collected through an online survey sent to all emergency staff. SPSS version 22 was used to analyze the results with appropriate descriptive and inferential statistics.

ResultsWe received 681 completed surveys from staff working in the emergency departments at the four hospitals. 479 (70.3%) were female and 202 (29.7%) were male. Most participants (418 [61.4%]) were nurses. There was wide variation in safety culture scores across the four hospitals. The overall positive perception of safety culture scores showed that there is an urgent need for safety culture improvement. Positive perception of teamwork climate, job satisfaction, and perception of local/unit management differed significantly between male and female respondents (p=0.05, p=0.04, and p=0.05, respectively). Likewise, there were significant differences in safety culture scores for teamwork climate, safety climate, job satisfaction, work condition, and perception of senior and local management support between those working at in adult emergency room (ER) compared with the pediatric ER and those working at both adult and pediatric ERs (p=0.02 and p=0.001, respectively). Mean safety culture scores for job satisfaction and perception of management support differed between those working day shifts and those working evening and night shifts (p=0.007 and p=0.001, respectively). The period of work experience had a role in the positive perception of safety culture for job satisfaction among those who had experience of more than 5 years, among physicians compared with nurses, administration staff, and technicians (p=0.001 and p=0.001, respectively).

Conclusion

The overall positive safety culture among the four hospitals’ emergency departments was found to be low and needs improvement. Different explanatory factors could have a role in understanding the safety culture in emergency departments, including working shifts, work experience, work settings (adults vs pediatric), among others. The findings of this study could provide local evidence for introducing quality improvement projects at the ER to promote positive safety culture and improve patient care outcomes.


Assessment of mothers’ knowledge about oral health in National Guard primary schools, Riyadh, Saudi ArabiaAbdullah Altammami, Dr Nasser Al Shrim, Mohammed Nasser Aldosari, Ibrahim Aljabali, Abdulrahman Obaid, Emad Alshehri

College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

BackgroundThe leading cause of dental caries and other serious oral problems in children is not because of the children themselves but because of their mothers’ lack of knowledge about good oral health. Children obtain living skills and knowledge from their mothers and up to a specific age they rely on their mothers in forming habits. Since mothers have a critical role in preventing dental problems in children, it is important to educate mothers about the prevention and treatment of oral health. The objective of this study was to evaluate mothers’ knowledge

about oral health in primary schools of the National Guard, Riyadh, Saudi Arabia.

Methods A cross-sectional study was carried out in primary schools of King Abdulaziz Iskan City. 400 questionnaires were given to students of selected schools to give to their mothers. The questionnaire started with demographic questions, the mother's knowledge of oral health-related questions, and socioeconomic status of the family. Mother age, education level, and family income were considered as factors that might influence the mother's knowledge of oral health.

ResultsWe received 257 completed questionnaires with a response rate of 64.25%. Results showed that there was a lack of knowledge and awareness about the importance of fluoride (62%), regular dental visits (59%), and plaque (24%). By contrast, there was good knowledge about brushing and the relation between oral health and general health (95%). Mothers with a high level of education had better knowledge than mothers with a low level of education. In addition, families with higher income had more knowledge, especially regarding fluoride (p=0.034)

and dental visits (p=0.022).

ConclusionMothers’ knowledge about the importance of oral health needs to be improved. Coordinated efforts by dentists and other health professionals are required to impart education about oral health among parents.


Most common diseases related to unplanned readmission among patients at King Abdulaziz University HospitalDr Kamal Waheeb Alghalayini, Eman Kamal Kamal, Rana Khalid Alrasheed, Heba Jamalaluddin Mominkhan


BackgroundUnplanned hospital readmission is defined as unexpected readmission associated with complications within 30 days of last admission. It is a major event that affects patients’ health and hospital resources. In this study we aimed to determine the rate of unplanned readmission, and to find the most common related conditions, in King Abdulaziz University Hospital.

Methods This was a retrospective study of all patients who were admitted to King Abdulaziz University Hospital in Jeddah, Saudi Arabia, from January 2015 to December 2015. All admissions records were collected from the admissions book. Records with fulfilled criteria of unplanned readmission were sorted to determine the rate, and diagnoses for most readmitted patients. Data analysis was done using descriptive statistics.

ResultsA total of 1531 patients were admitted to King Abdulaziz University Hospital, with a total of 1983 admissions during the study period. Mean age was 52.4 years, mortality was 18.4% (n=282), 856 patients (56.6%) were female, and readmission within 30 days was found in 88 (5.8%) patients. Cardiac diseases were the most common diagnoses associated with unplanned readmission (19 [21.6%]), chronic kidney diseases were the second most common (18 [20.2%]), and respiratory diseases were the third most common (10 [11.2%]). Other causes were gastroenterologic, neurologic, hematologic, infectious, endocrine, and rheumatologic diseases. Diseases with higher unplanned readmission rates were chronic kidney diseases, hematologic diseases, and cardiac diseases in male patients, and cardiac diseases, chronic kidney diseases, and gastroenterologic diseases in female patients.

Conclusion

According to our findings, the rate of unplanned readmission varies between different conditions. We recommend further investigations to determine factors associated with higher readmission rate in these diseases, regular assessments of unplanned readmission rate, and the investment of findings in developing programs to reduce the rate of unplanned readmission.


Satisfaction survey of Safety Huddle as a measure to improve safety reportingDr Arwa Al Yamani, Azif Zahirin Amin, Jessica Wong, Dr Wasil Jastaniah


BackgroundSafety Huddle improves safety reporting through effective safety event management. The goal of this study was to assess frontline staff satisfaction as a measure of improving safety culture.

Methods This was a cross-sectional anonymous questionnaire that was randomly distributed to all staff involved in the care of oncology patients, including physicians, nurses, allied health personnel, and administrative staff. The questionnaire targeted the following areas: profession, years of service, and awareness, participation, and challenges in safety and quality reporting and culture of safety.

ResultsEighty concurrent survey questionnaires were distributed and 80 (100%) staff responded (nurses 48.8%; physicians 28.7%; other allied health personnel 22.5%). Responses were recorded as follows: 30% had heard about Safety Huddle, 60% had raised QPS concern to their direct supervisor, 55% had filed an SRS, 87.5% had no difficulties in reporting the SRS, 82.5% feel safe when they report the SRS. In addition, 70% wanted to have a daily discussion about safety and quality during their unit handover.

ConclusionIncreased staff consciousness about safety as everyone's responsibility and openness to discuss error will foster a culture of safety.


Most common diseases related to unplanned readmission among patients at King Abdulaziz University HospitalDr Kamal Waheeb Alghalayini, Eman Kamal Kamal, Rana Khalid Alrasheed, Heba Jamalaluddin Mominkhan


BackgroundUnplanned hospital readmission is defined as unexpected readmission associated with complications within 30 days of last admission. It is a major event that affects patients’ health and hospital resources. In this study we aimed to determine the rate of unplanned readmission, and to find the most common related conditions, in King

Abdulaziz University Hospital.

Methods This was a retrospective study of all patients who were admitted to King Abdulaziz University Hospital in Jeddah, Saudi Arabia, from January 2015 to December 2015. All admissions records were collected from the admissions book. Records with fulfilled criteria of unplanned readmission were sorted to determine the rate, and diagnoses for most readmitted patients. Data analysis was done using descriptive statistics.

ResultsA total of 1531 patients were admitted to King Abdulaziz University Hospital, with a total of 1983 admissions during the study period. Mean age was 52.4 years, mortality was 18.4% (n=282), 856 patients (56.6%) were female, and readmission within 30 days was found in 88 (5.8%) patients. Cardiac diseases were the most common diagnoses associated with unplanned readmission (19 [21.6%]), chronic kidney diseases were the second most common (18 [20.2%]), and respiratory diseases were the third most common (10 [11.2%]). Other causes were gastroenterologic, neurologic, hematologic, infectious, endocrine, and rheumatologic diseases. Diseases with higher unplanned readmission rates were chronic kidney diseases, hematologic diseases, and cardiac diseases in male patients, and cardiac diseases, chronic kidney diseases, and gastroenterologic diseases in female patients.

Conclusion

According to our findings, the rate of unplanned readmission varies between different conditions. We recommend further investigations to determine factors associated with higher readmission rate in these diseases, regular assessments of unplanned readmission rate, and the investment of findings in developing programs to reduce the rate of unplanned readmission.


Satisfaction survey of Safety Huddle as a measure to improve safety reportingDr Arwa Al Yamani, Azif Zahirin Amin, Jessica Wong, Dr Wasil Jastaniah


BackgroundSafety Huddle improves safety reporting through effective safety event management. The goal of this study was

to assess frontline staff satisfaction as a measure of improving safety culture.

Methods This was a cross-sectional anonymous questionnaire that was randomly distributed to all staff involved in the care of oncology patients, including physicians, nurses, allied health personnel, and administrative staff. The questionnaire targeted the following areas: profession, years of service, and awareness, participation, and challenges in safety and quality reporting and culture of safety.

ResultsEighty concurrent survey questionnaires were distributed and 80 (100%) staff responded (nurses 48.8%; physicians 28.7%; other allied health personnel 22.5%). Responses were recorded as follows: 30% had heard about Safety Huddle, 60% had raised QPS concern to their direct supervisor, 55% had filed an SRS, 87.5% had no difficulties in reporting the SRS, 82.5% feel safe when they report the SRS. In addition, 70% wanted to have a daily

discussion about safety and quality during their unit handover.

ConclusionIncreased staff consciousness about safety as everyone's responsibility and openness to discuss error will foster a culture of safety.


The application of the Glasgow Coma Scale (GCS) in clinical practice: are nurses doing it right? Clinical patient safety issueElmer Catangui


BackgroundDeterioration is common during the acute phase of stroke. Early identification and detection of evolving stroke is an important monitoring role of a nurse. The Glasgow Coma Scale (GCS) has been predominantly used by healthcare professionals to assess any changes in the patient’s level of consciousness. The aim of this study was to assess nurses’ understanding and application of the GCS in a clinical setting and to identify the safety implications

to stroke patients.

Methods The GCS competencies comprising theoretical and practical components have been developed and piloted among ten clinical resource nurses (CRNs) from the emergency room, and acute medical and stroke units. A validated pre- and post-GCS knowledge test was given to participating nurses to gauge their understanding of the GCS. The nurse specialist in stroke assessed the nurses’ application of the GCS in stroke patients using competency checklists. Inaccurate execution of critical points were documented and discussed with nurses. A focus group was carried out to evaluate the pilot study of the GCS in practice.

ResultsThe pre-post GCS knowledge audit shows that nurses need clarity on the following key points: difference between localizing and withdrawal to pain, decerebrate and decorticate, and the GCS result range. In the GCS competency check, some nurses had confusion in applying peripheral and central pain, asking questions to determine a verbal response, differentiating confusion and inappropriate words, and checking pupil size and reaction. In the focus group using a thematic analysis, nurses felt that patient safety is at risk because the GCS is not done correctly and having GCS competencies ensures consistency and improves patient safety.

Conclusion

Although the pilot sample size is small, the findings suggest the need to roll out a GCS skill validation among nurses within the organization. Education and developing competencies are central themes in this study. All nurses caring for stroke patients should therefore be adequately armed with specialized knowledge and skills on the use of the GCS in practice.


Assessment of the attitude of physicians towards potentially inappropriate medication use among geriatric inpatients: a pilot studyMuath Fahmi Najjar, Syed Azhar Syed Sulaiman, Hadeer Abdul AlRazzaq, Majed Al Jeraisy, Hashim Balubaid


BackgroundSTOPP and Beers’ criteria are guidelines and tools for physicians to assess prescribing patterns for geriatric patients. Improvement in the attitude of physicians towards potentially inappropriate medications (PIMs) is essential to achieve appropriate prescribing patterns among geriatric inpatients and hence prevent the adverse outcomes of PIMs. The purpose of this research was to assess the attitude of internal medicine physicians

towards PIMs use among geriatric inpatients.

Methods This cross-sectional study was done in March 2014 among internal medicine physicians at King Abdulaziz Medical City, Riyadh. A questionnaire designed to determine physicians’ attitudes was distributed to 40 consultants, associate consultants, staff physicians, and residents. All items on the questionnaire were scored on a 5-point Likert scale. Physicians in the weekly grand round were briefed on geriatric pharmacotherapy. An informed consent form was voluntarily signed before filling out the questionnaire.

ResultsOnly 25% of physicians in the internal medicine wards indicated that they were aware and familiar with Beers’ criteria, and the majority (36 [90%]) of respondents were unaware of the STOPP criteria. This pilot study recorded a mean attitude score of 60.4±9.3 out of a maximum of 80, which implied that physicians agreed to the need for an educational and training program. 80% agreed that STOPP and Beers’ criteria are useful and effective tools for prescribing among geriatric patients. About 82% of participants agreed that there is a need for STOPP and Beers’

criteria as guidelines to improve prescribing among geriatric inpatients.

ConclusionInternal medicine physicians have relatively adequate attitudes towards PIMs. Consultants and associate consultants have higher attitude scores towards the practicality of STOPP and Beers’ criteria than staff physicians, and residents showed the lowest attitude score among physician groups.


The impact of an improvement project on return medication from one unit to pharmacy in KAMC, 2014Saleh Ayed Al Anazi, Dr Saleh Al Dekhail, Mr Thamer K Alotaibi, Ms Amerah N Alsaleh, Mr Hamza F Alsamannoudi


BackgroundThe Ministry of National Guard Health Affairs in Saudi Arabia is committed to being a high reliability organization (HRO) and pharmaceutical care service, and is working to achieve a zero harm practice. Since December 2014, it had been noted that a huge quantity of medications were being returned to the pharmacy from one of the surgical units. Therefore, we checked all the returned medications from that period on a daily basis. We are aiming to eliminate this kind of instance since it will reduce work load and increase staff satisfaction, and thus improve workflow and affect patient care.

Methods We started our improvement project in order to solve this problem by applying the Lean Six Sigma method (DMIAC), in which all data were collected for one week and analyzed.

ResultsWe found that the proportion of ongoing returned medications was 29%, discharge medications was 13%, and discontinued medications was 13%. Hence, the identified causes of this matter were that patch medications were sent early once per 24 hours and the main returned medications were from patch medications; and there was duplication of orders for missing doses that were in fact not missing.

Conclusion

The following procedures have been done in order to improve the rate of returned medications. For the patch medications, we have divided the dispense of patch medication to three times as a pilot, which has resulted in an improvement of 28%. For duplication of orders, we are looking forward to having an automated dispense cabinet in 2016.


Nurses’ perception of just culture in Saudi ArabiaRasheed Kurawley, Sam Haidar

King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia

BackgroundThe increased reporting of patient safety issues to facilitate error reduction and promote learning from errors is widely espoused in the literature. Yet the promotion of a just culture in Saudi Arabia to encourage increased reporting may not be clearly understood, nor fully valued. This pilot qualitative study elicits the perceptions of nurses on just culture and acts as a precursor to determine if conducting a wider study is necessary at the King Abdulaziz Hospital.

Methods A general inductive approach was employed. Data obtained from a structured questionnaire given to 40 nurses from two clinical areas were content and thematically analyzed. Initial analysis focused on understanding the transcribed data. Following a first round coding, several themes such as a trusting and equitable environment, fears and anxieties, victimization, blaming and shaming, and increased communication and collaboration were identified. A second round coding by a second researcher identified several more themes from the data.

ResultsFour broad categories such as a trusting environment, the elimination of blame and shame, communication and collaboration, and organizational culture – changing the mindset were then created, which captured the meaning of the data. These categories were then discussed in light of current literature to conceptualize the feelings of this sample of nurses on just culture.

ConclusionThe results demonstrated the qualms inherent among nurses and the possible reasons for the under-reporting of patient safety issues. The findings have prompted the need to conduct a more widespread quantitative and qualitative study, where the combined synthesis of data may enable one to fully elucidate the mindset of the healthcare population, ahead of initiating strategies to implement a just culture more effectively. This would facilitate the increased reporting of patient safety issues in a workplace that is valued by its workforce.


Impact of healthcare workers’ incivility while combating the MERS-CoV outbreakAzurahazri Abd Rahim


BackgroundIncivility in healthcare settings and/or workplaces has become a very common scenario. There are many different reasons for the causes of incivility, some of which were experienced during the outbreak of Middle-East respiratory syndrome coronavirus (MERS-CoV) at Prince Mohammed bin Abdulaziz Hospital. Hence, this study was designed to investigate the impact of incivility on healthcare workers during the MERS-CoV outbreak and also to look at the possible effects on patient outcomes.

Methods The study was a qualitative content analysis pilot study. An 18-item anonymous survey was used to identify the frequency, type, perpetrators, and personal and professional consequences of bullying experienced by staff nurses. Departments were selected and an 18-item and 6-item survey was designed in order to obtain subjective and detailed answers from each department.

ResultsWorkplace bullying during the MERS-CoV outbreak had a huge impact on the physical and psychological health of staff. These staff also expressed that their performance at work had been affected, which had a further consequence on the quality of patient care that had been provided. Workplace bullying can have effects on the healthcare worker and further on the organization through decreased productivity in general; diminished staff and patient satisfaction; reduced morale; an increase in sick time and patient complaints; and an increased risk of incident and accident.

Conclusion

Incivility among healthcare workers is an unforeseeable matter that can occur at any time. A noticeable change was seen by the adverse impact it had on staff performance and also on the quality of patient care delivered. This study shows that evaluations need to be done by the organization in order to develop and implement strategies to educate and create awareness about incivility and further support the control of incivility and prevent any form of bullying.


Nurses eat their young: prevalence of lateral violence at PMBAH-Madinah and its effect on work performance and productivity in nursing practiceHawazen Albalawi


BackgroundLateral violence (LV) is a common concerning and harmful behavior defined as aggressive behavior by employees towards their colleagues in the workplace as a result of dissatisfaction or work-related stress. LV is very common in the nursing profession and is believed to have devastating effects on nurses’ performance and productivity, and may worsen patient care as a result. This pilot study aims to identify the prevalence of LV among nursing staff in Prince Mohammed Bin Abdulaziz Hospital (PMBAH), Madinah, Saudi Arabia, and to examine the

impact of LV on nursing staff performance and productivity in the workplace.

Methods A cross-sectional, descriptive design was used to conduct this pilot study. The chosen nurses from PMBAH in Madinah were selected from different departments including medical-surgical, outpatient department, pediatrics, intensive care unit, and emergency room. A self-administered electronic questionnaire was used to collect the relevant data.

ResultsBased on the literature review and the initial findings of this project, I anticipate that the prevalence of LV is high and continues to escalate in the healthcare organization by causing psychosomatic symptoms to the victims, such as nervous tension headaches, eating disorders, sleep disturbances, and onset of chronic illness. The consequences of LV would be extended to patient care by increasing work dissatisfaction rate, absences from work, and lost productivity. On the other hand, LV interferes with effective healthcare communication and

impacts patient safety by causing serious medical errors.

ConclusionKnowledge of LV in nursing appeared to allow healthcare leaders to develop educational programs on appropriate professional behaviors to eliminate the damaging effects of LV on the whole healthcare organization.


I color I learn Project and its impact on childrenSarah Maatouk Shaikhoon, Hanin Mohammed Barhameen, Shahad Hamdan Alorabi, Lubna Muqnee Zahrani, Khuld Adel Saeedi, Bayan Abdulrhman Aldeibani, Bodour Saleh Alsalmi, Amani Faleh Alhakami, Mada Ali Sultan, Duaa Fareed Jastaniyyah, Eman Hamad Albldy, Nada Hamed Alsafari, Rana Saad Alkhaibari, Arej Abdulshakor Fadel, Layan Khalid Arafah, Haifa Mohammed Alshaikh, Prof Abdulmoein Al Agah

King Abdulaziz University, Saudi Arabia

BackgroundHealthy habits are important in all age groups because they limit disease spread. They also improve quality of life in the long term, and as a healthcare provider, implanting these habits in children is very important. Our aim was to educate children about healthy habits in an enjoyable way, spread awareness between mothers, involve them to encourage their children, and monitor their habits and progression.

Methods 128 children aged 4 to 12 years were randomly selected from King Abdulaziz University Hospital (KAUH). A coloring booklet was distributed containing drawing pages of two characters, demonstrating different habits, and a board of achievement was given to mothers to demonstrate their child’s adherence over a week with a questionnaire that measured mothers’ knowledge about self-hygiene, sleep habits, and diet. Healthy habits were taught to children in an entertaining way and brochures about child health were distributed to mothers. After a week, mothers were contacted to collect the data.

ResultsRegarding mothers’ knowledge, 96.9% of mothers agreed on the importance of body hygiene, and 98.4% agreed on nail care and its role in infection control. Mothers were asked about the importance of a healthy diet: 95.3% agreed, and 96.1% agreed on the positive impact of early sleeping on growth. Adherence of children to certain health habits were measured and the results showed that self-hygiene was improved in 93.7%, nail trimming was adopted by 79.5%, and handwashing was adopted by 81.1%. Additionally, 78.1% adopted a healthy diet and 63.3% adopted early sleeping habits. 86.7% of mothers were satisfied with the improvements in their child’s behavior.

Conclusion

Health education is important for parents and children to ensure better quality of life. It is also important to explain these healthy habits to children in an engaging way, to teach them the importance of a healthy lifestyle, which they can apply throughout their lives.


Auditing adherence to acute myeloid leukemia guidelines in a tertiary centerKhadega A Abuelgasim, Ashwaq Al Olayan, Abdul Rahman Jazieh

Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia

BackgroundManagement of patients with acute myeloid leukemia (AML) requires timely and coordinated care. Many newly diagnosed adults are considered candidates for upfront allogeneic stem-cell transplantation. Baseline cytogenetics, FISH, and molecular tests are important not only for risk stratification and response assessment, but also to evaluate disease relapse. HLA typing should be done at diagnosis because receipt of blood products may affect the results. A pregnancy test should be done in females of childbearing age before commencing chemotherapy. Our AML management guidelines were developed based on National Comprehensive Cancer Network guidelines and were approved in early 2013. We evaluated adherence to these guidelines to ensure quality patient care.

Methods We reviewed the electronic/paper records of all newly diagnosed AML cases from 2013 to 2015. We used an internally developed auditing tool designed to capture essential elements of diagnosis, prognosis, and therapy based on our guidelines. We used the plan-do-study-act (PDSA) approach and completed three yearly cycles. We came up with strategies based on our findings, including updating admission order set, procedure note template, and frequent communications with all disciplines involved in care of patients with AML, including hematologists and hematopathologists.

ResultsA total of 27 patients were diagnosed with AML. In cycle 1, two patients did not have baseline cytogenetics or FISH testing. One premenopausal female was not checked for pregnancy. In cycle 2, one of ten cases was not

discussed in the leukemia board. At the end of cycle 3, the AML subtype was not identified in one of seven cases.

ConclusionDepartmental guidelines are essential to ensure quality patient care. It is vital that these guidelines are followed by all involved healthcare providers. Frequent communication between the department staff as well as with staff from ancillary departments is essential to improve and maintain quality care for such patients.



Documents

patientsafetyforum - BMJ · Tarek Aldabbagh, Zeyad Yousef, Mohamed Harbi, Ali Zahrani, Abdulaleem Alatassi, Nabeeha Tashkandi, Brintha Naidu, Hasan Al-Dorzi, Yaseen Arabi ... The