Suchergebnisse

The goal of every health care institution (HCI) is to provide safe and highquality services to patients, but sometimes the provision of health care (HC) services result in unavoidable adverse events (AE). AE can harm and cause irreversible health problems to the patient, so patient safety and AE remain a global concern worldwide. Recently there has been a growing number of researches both locally and worldwide on how to ensure patient safety (PS), how to deliver quality services in HC sector, and how to reduce the number of AE. Council of Europe has issued recommendations on how to improve HC services, but according to the results of the survey conducted in 2014, AE remain a big problem in EU countries. Later in 2017, it has been noted that the recommendations were insufficiently implemented at a national level. The European Commission has pointed out some shortcomings: lack of cooperation between EU countries, deficiencies in safety culture implementation, lack of knowledge and skills in analyzing AE. This article analyzes the success of AE policy implementation in Lithuania, why Lithuania and the EU countries have created a mandatory AE register, but the registration of these events is slow, most of them are still unreported, their real number and frequency are still hidden, and their causes are not analyzed. Based on a case study and qualitative study in one large hospital, attempts are made to identify the factors of AE management that constitute a barrier to effective AE management policy in healthcare institutions. Prerequisites for successful AE management consist of electronisation of AE reporting system, development and control of quality standards, strategic, continuous and ongoing leadership of HC administration and staff involvement and their motivation, also adjusted training, creating organizational culture of confidentiality and learning from mistakes. Some shortcomings were also noted: lack of knowledge and skills, overcoming fears of being punished and humiliated, lack of feedback, lack of national AE IT system. This limits the efficiency of the AE management process both nationally and locally. Successful choice of AE management model directly depends on the internal policies, operations, and leadership of HC institution. Well-planned, organized and controlled measures, based on European recommendations, help to achieve the objectives by monitoring and evaluating their results in a consistent and long-term manner. It is confirmed, that AE registration and continuous analysis is key to prevent future AE. Therefore, the basis of EU countries' AE management policy is choosing the right AE management model according to the maturity of the system, which includes the implementation of the reporting system in HC institutions and, most importantly, the analysis and development of prevention actions. This helps to share experience, constantly analyze, learn from mistakes, and shape a new approach and PS culture.

The goal of every health care institution (HCI) is to provide safe and highquality services to patients, but sometimes the provision of health care (HC) services result in unavoidable adverse events (AE). AE can harm and cause irreversible health problems to the patient, so patient safety and AE remain a global concern worldwide. Recently there has been a growing number of researches both locally and worldwide on how to ensure patient safety (PS), how to deliver quality services in HC sector, and how to reduce the number of AE. Council of Europe has issued recommendations on how to improve HC services, but according to the results of the survey conducted in 2014, AE remain a big problem in EU countries. Later in 2017, it has been noted that the recommendations were insufficiently implemented at a national level. The European Commission has pointed out some shortcomings: lack of cooperation between EU countries, deficiencies in safety culture implementation, lack of knowledge and skills in analyzing AE. This article analyzes the success of AE policy implementation in Lithuania, why Lithuania and the EU countries have created a mandatory AE register, but the registration of these events is slow, most of them are still unreported, their real number and frequency are still hidden, and their causes are not analyzed. Based on a case study and qualitative study in one large hospital, attempts are made to identify the factors of AE management that constitute a barrier to effective AE management policy in healthcare institutions. Prerequisites for successful AE management consist of electronisation of AE reporting system, development and control of quality standards, strategic, continuous and ongoing leadership of HC administration and staff involvement and their motivation, also adjusted training, creating organizational culture of confidentiality and learning from mistakes. Some shortcomings were also noted: lack of knowledge and skills, overcoming fears of being punished and humiliated, lack of feedback, lack of national AE IT system. This limits the efficiency of the AE management process both nationally and locally. Successful choice of AE management model directly depends on the internal policies, operations, and leadership of HC institution. Well-planned, organized and controlled measures, based on European recommendations, help to achieve the objectives by monitoring and evaluating their results in a consistent and long-term manner. It is confirmed, that AE registration and continuous analysis is key to prevent future AE. Therefore, the basis of EU countries' AE management policy is choosing the right AE management model according to the maturity of the system, which includes the implementation of the reporting system in HC institutions and, most importantly, the analysis and development of prevention actions. This helps to share experience, constantly analyze, learn from mistakes, and shape a new approach and PS culture.

The goal of every health care institution (HCI) is to provide safe and highquality services to patients, but sometimes the provision of health care (HC) services result in unavoidable adverse events (AE). AE can harm and cause irreversible health problems to the patient, so patient safety and AE remain a global concern worldwide. Recently there has been a growing number of researches both locally and worldwide on how to ensure patient safety (PS), how to deliver quality services in HC sector, and how to reduce the number of AE. Council of Europe has issued recommendations on how to improve HC services, but according to the results of the survey conducted in 2014, AE remain a big problem in EU countries. Later in 2017, it has been noted that the recommendations were insufficiently implemented at a national level. The European Commission has pointed out some shortcomings: lack of cooperation between EU countries, deficiencies in safety culture implementation, lack of knowledge and skills in analyzing AE. This article analyzes the success of AE policy implementation in Lithuania, why Lithuania and the EU countries have created a mandatory AE register, but the registration of these events is slow, most of them are still unreported, their real number and frequency are still hidden, and their causes are not analyzed. Based on a case study and qualitative study in one large hospital, attempts are made to identify the factors of AE management that constitute a barrier to effective AE management policy in healthcare institutions. Prerequisites for successful AE management consist of electronisation of AE reporting system, development and control of quality standards, strategic, continuous and ongoing leadership of HC administration and staff involvement and their motivation, also adjusted training, creating organizational culture of confidentiality and learning from mistakes. Some shortcomings were also noted: lack of knowledge and skills, overcoming fears of being punished and humiliated, lack of feedback, lack of national AE IT system. This limits the efficiency of the AE management process both nationally and locally. Successful choice of AE management model directly depends on the internal policies, operations, and leadership of HC institution. Well-planned, organized and controlled measures, based on European recommendations, help to achieve the objectives by monitoring and evaluating their results in a consistent and long-term manner. It is confirmed, that AE registration and continuous analysis is key to prevent future AE. Therefore, the basis of EU countries' AE management policy is choosing the right AE management model according to the maturity of the system, which includes the implementation of the reporting system in HC institutions and, most importantly, the analysis and development of prevention actions. This helps to share experience, constantly analyze, learn from mistakes, and shape a new approach and PS culture. ; Kiekvienos asmens sveikatos priežiūros įstaigos (toliau – ASPĮ) tikslas suteikti saugias ir kokybiškas paslaugas pacientams, tačiau kartais teikiant sveikatos priežiūros (toliau – SP) paslaugas susiduriama su nepageidaujamais įvykiais (toliau – NĮ), kurių nepavyksta išvengti. NĮ gali pakenkti pacientui ir sukelti negrįžtamas sveikatos problemas, todėl pacientų sauga ir NĮ medicinoje išlieka globalinė problema visame pasaulyje. Pastaruoju metu mūsų šalyje ir pasaulyje gausėja tyrimų, įrodančių, kaip užtikrinti pacientų saugą (toliau – PS), kaip teikti kokybiškas paslaugas SP sektoriuje ir sumažinti NĮ skaičių. Europos Taryba 2009 m. pateikė rekomendacijas, kaip tobulinti PS, tačiau 2014 m. atlikto tyrimo rezultatai rodo, kad NĮ išlieka ASPĮ problema Europos Sąjungos (toliau – ES) šalyse.1 Kiek vėliau, 2017 m., nuspręsta, kad pateiktos rekomendacijos nacionaliniu lygiu nepakankamai įgyvendintos. Europos Komisija įvertino, kad vis dar yra trūkumų: bendradarbiavimo stoka tarp ES šalių, saugos kultūros įgyvendinimo, žinių ir įgūdžių analizuojant NĮ trūkumai. Straipsnyje analizuojama, kaip sekasi Lietuvoje įgyvendinti NĮ politiką, kodėl Lietuvoje ir ES šalyse patvirtintas privalomų registruoti nepageidaujamų įvykių sąrašas, tačiau šių įvykių registravimas vyksta vangiai, apie daugumą jų nepranešama, slepiamas jų realus skaičius ir dažnis, neanalizuojamos priežastys. Per praktinį didelės ligoninės pavyzdį atliekant atvejo studiją ir kokybinį tyrimą bandoma identifikuoti NĮ valdymo veiksnius, kurie yra barjeras veiksmingai vykdyti NĮ valdymo politiką SP įstaigose. Įžvelgiamos prielaidos sėkmingam NĮ valdymui: NĮ pranešimų sistemos elektronizavimas, kokybės standartų sukūrimas ir jų kontrolė, strateginė, tęstinė ir nuolatinė SP įstaigos administracijos lyderystė bei viso personalo įtraukimas jį motyvuojant, pritaikyti padalinio reikmėms mokymai, organizacinės kultūros laikantis konfidencialumo ir mokymosi iš klaidų palaikymas. Taip pat pastebėti ir trūkumai: žinių ir įgūdžių stoka, baimės būti nubaustam ir pažemintam įveikimas, grįžtamojo ryšio trūkumas, nacionalinės NĮ IT sistemos nebuvimas. Tai riboja NĮ valdymo proceso efektyvumą ir nacionaliniu, ir įstaigos mastu. Sėkmingas NĮ valdymo pasirinkimas tiesiogiai priklauso ir nuo vidinės tinkamos ASPĮ politikos, veiklos ir lyderystės. Nuosekliai ir ilgalaikėje perspektyvoje remiantis europinėmis rekomendacijomis planuojamos, organizuojamos ir kontroliuojamos priemonės stebint ir vertinant jų rezultatus padeda pasiekti tikslus. Dar kartą patvirtinta, kad, norint išvengti NĮ ateityje, būtina juos registruoti ir nuolat analizuoti. Todėl ES šalių NĮ valdymo politikos pamatas – tinkamo NĮ valdymo modelio, priklausomai nuo sistemos brandos, pasirinkimas; valdymo modelis apima pranešimų sistemos diegimą ASPĮ, jų analizavimą ir prevencijos veiksmų sudarymą bei įgyvendinimą. Tai padeda dalytis patirtimi, nuolat analizuoti, mokytis iš klaidų ir formuoti naują požiūrį ir PS kultūrą.

Nursing policy and its implementation in the hospital was analyzed in Master's thesis. Scientific literature, international and national nursing policies governing documents were analysed; nursing definitions and functions for tasks of nursing policies were presented. The analysis of statistical data reveals Lithuania nursing situation and identify the main nursing policy problems. Qualitative semi-structured interviews study justifying in theoretical part described care policy issues were carried out. Study reveals the main interferences for purposeful nursing policy-making and implementation.

Nursing policy and its implementation in the hospital was analyzed in Master's thesis. Scientific literature, international and national nursing policies governing documents were analysed; nursing definitions and functions for tasks of nursing policies were presented. The analysis of statistical data reveals Lithuania nursing situation and identify the main nursing policy problems. Qualitative semi-structured interviews study justifying in theoretical part described care policy issues were carried out. Study reveals the main interferences for purposeful nursing policy-making and implementation.

Object.To investigate the flow of patients and nurses' workload ratio emergency section. Tasks. 1. Analise patient flow patterns change day period LSMU KK emergency departament. 2. Identify patient flow patterns change weekly.3. Compare flow changes in patients with nurses working hours per day during the period. Research methods. A retrospective analysis of patients flow was made analysis LSMU KK emergency section 01.01.2016 - 01.01.2017 calendar year. Also nurses work schedules are analysed in the same period. The obtained data were processed using SPSS 20.0 software package for Microsoft Office Excel 2010 program. The comparative analysis of the literature data, luginantto same type of work in the emergency department of the European Union. Results. The minimum number of patients served per day by the hour set from 4:00 to 7:00. - an average of 2 patients per hour., The highest from 12:00 to 12:59 hours. - an average of 12 patients per hour. The analysis of patient flows within a week minimum set of patients served Wednesdays - an average of 157 patients, the largest lead times - an average of 182 patients. Patient flow-month periods are different.The minimum number of patients served per day is in January - an average of 155 patients, the highest in July and August - an average of 181 patients. A comparison of patient-nurses ratio found that from 2 to 4 times there were more nurses than the patients from 0:00 to 8:59 min. From 22:00 to 12:00 min. and from 10:00 to 21:59 there was 1.2 more patients than nurses. Conclusions. 1.LSMU KK ED serves the average of 170 patients per day. Individual daily hours of patient flow changes. Minimum average quantity of patients are served from 0:00 to 7:00., The maximum average day flow of patients is from 10:00 to 20:00.2. Separately weekdays patient flow is different. Minimum patient flow points on Wednesday - average of 157 patients, the highest is on Monday - 181 patients. 3. Nurse - patient relationship (work intensity) significant changes in all analyzed in daily hours. From 0:00 to 8:59 min. nurses - patient ratio is 2-4: 1, from 22:00 to 0:00 min. 1.2: 1.All the other hours the ratio is 1: 1.2-1.5. The results show that nurses who work from 9:00 to 21:59 have significantly higher workload (1.2 - by 1.5 times) compared to nurses working from 22:00 to 8:59. Recommendations. In assessing the uneven distribution between patients and nurses during the day can be changed by adjusting the distribution of nurses' schedules. From 0:00 to 7:00 there should be smaller amount of nurses than it is at the moment, but it is recommended to increase the amount of nurses from 10:00 to 22:00.

Object.To investigate the flow of patients and nurses' workload ratio emergency section. Tasks. 1. Analise patient flow patterns change day period LSMU KK emergency departament. 2. Identify patient flow patterns change weekly.3. Compare flow changes in patients with nurses working hours per day during the period. Research methods. A retrospective analysis of patients flow was made analysis LSMU KK emergency section 01.01.2016 - 01.01.2017 calendar year. Also nurses work schedules are analysed in the same period. The obtained data were processed using SPSS 20.0 software package for Microsoft Office Excel 2010 program. The comparative analysis of the literature data, luginantto same type of work in the emergency department of the European Union. Results. The minimum number of patients served per day by the hour set from 4:00 to 7:00. - an average of 2 patients per hour., The highest from 12:00 to 12:59 hours. - an average of 12 patients per hour. The analysis of patient flows within a week minimum set of patients served Wednesdays - an average of 157 patients, the largest lead times - an average of 182 patients. Patient flow-month periods are different.The minimum number of patients served per day is in January - an average of 155 patients, the highest in July and August - an average of 181 patients. A comparison of patient-nurses ratio found that from 2 to 4 times there were more nurses than the patients from 0:00 to 8:59 min. From 22:00 to 12:00 min. and from 10:00 to 21:59 there was 1.2 more patients than nurses. Conclusions. 1.LSMU KK ED serves the average of 170 patients per day. Individual daily hours of patient flow changes. Minimum average quantity of patients are served from 0:00 to 7:00., The maximum average day flow of patients is from 10:00 to 20:00.2. Separately weekdays patient flow is different. Minimum patient flow points on Wednesday - average of 157 patients, the highest is on Monday - 181 patients. 3. Nurse - patient relationship (work intensity) significant changes in all analyzed in daily hours. From 0:00 to 8:59 min. nurses - patient ratio is 2-4: 1, from 22:00 to 0:00 min. 1.2: 1.All the other hours the ratio is 1: 1.2-1.5. The results show that nurses who work from 9:00 to 21:59 have significantly higher workload (1.2 - by 1.5 times) compared to nurses working from 22:00 to 8:59. Recommendations. In assessing the uneven distribution between patients and nurses during the day can be changed by adjusting the distribution of nurses' schedules. From 0:00 to 7:00 there should be smaller amount of nurses than it is at the moment, but it is recommended to increase the amount of nurses from 10:00 to 22:00.

This paper analyzes the scientific discourse of governance and university governance within the framework of the existing concepts, it also deals with alternation of university governance in the context of European higher education regulations and directives, presents analysis of the traditional and entrepreneurial university governance models of the content aspect. It also presents the results of "International Comparative Research on University Governance Models" carried out by the paper authors emphasizing the context of Finland's higher education and university governance and the case of Lapland University. Although traditional higher education values dominate in many missions and visions of Finnish universities, internal institutional governance of the University of Lapland has recently become entrepreneurial. Good governance of the university is associated not only with distinction of administrative and academic functions, reduction of bureaucratic processes, but also with the openness of the university, good communication and understanding of the academic culture.

Foreign body and food bolius impaction in the upper gastrointestinal tract is a common clinical situation in emergency departments throughout the world. The majority of foreign bodies will pass through the gastrointestinal tract and naturally go out with the stool, but in about 1/5 of cases the foreign bodies must be removed. The impaction of a foreign body in the upper gastrointestinal tract is the second leading cause of urgent endoscopy after bleeding. The aim of this retrospective descriptive study is to review a quarter-century (25 years) experience of removal foreign bodies from the upper gastrointestinal tract by flexible endoscopic approach in Republican Vilnius University Hospital (RVUL). We conclude that the endoscopic removal of foreign bodies by a qualified specialist is an effective and safe method with a great success rate of the procedure using an endoscope with accessories: loop, basket and forceps, which significantly reduces the length of hospitalization and requirement of surgery.

Foreign body and food bolius impaction in the upper gastrointestinal tract is a common clinical situation in emergency departments throughout the world. The majority of foreign bodies will pass through the gastrointestinal tract and naturally go out with the stool, but in about 1/5 of cases the foreign bodies must be removed. The impaction of a foreign body in the upper gastrointestinal tract is the second leading cause of urgent endoscopy after bleeding. The aim of this retrospective descriptive study is to review a quarter-century (25 years) experience of removal foreign bodies from the upper gastrointestinal tract by flexible endoscopic approach in Republican Vilnius University Hospital (RVUL). We conclude that the endoscopic removal of foreign bodies by a qualified specialist is an effective and safe method with a great success rate of the procedure using an endoscope with accessories: loop, basket and forceps, which significantly reduces the length of hospitalization and requirement of surgery.

Foreign body and food bolius impaction in the upper gastrointestinal tract is a common clinical situation in emergency departments throughout the world. The majority of foreign bodies will pass through the gastrointestinal tract and naturally go out with the stool, but in about 1/5 of cases the foreign bodies must be removed. The impaction of a foreign body in the upper gastrointestinal tract is the second leading cause of urgent endoscopy after bleeding. The aim of this retrospective descriptive study is to review a quarter-century (25 years) experience of removal foreign bodies from the upper gastrointestinal tract by flexible endoscopic approach in Republican Vilnius University Hospital (RVUL). We conclude that the endoscopic removal of foreign bodies by a qualified specialist is an effective and safe method with a great success rate of the procedure using an endoscope with accessories: loop, basket and forceps, which significantly reduces the length of hospitalization and requirement of surgery.

Public healthcare institutions face a variety of tasks to provide the public with high quality services. Those serving a prison sentence are not an exception. These individuals are a part of our society; they are only temporarily isolated, but eventually return to it. Imprisoned, they carry the same health problems that exist outside. Incarcerated individuals tend to show standards of behavior that had already formed before prison and which can predispose the fast spread of infection in a closed group. The health care questions of these individuals are a component of public healthcare and it is integral to ensure that healthcare is as available to the public as possible. The provision of public services has a deep tradition: general consensus is that, due to differences in public administration, forming equal for every country, unchangeable mechanisms of providing healthcare services is impossible. Therefore, having evaluated the quality of healthcare services of the Lithuanian Healthcare System and the Central Prison Hospital, it is appropriate to search for innovative solutions that are based not only on the experience of advanced foreign countries, but on the economy, the socio-cultural environment and politics of our country.