Suchergebnisse

Objective: To identify the types and extent of workaround strategies with the use of Bar Code Medication Administration (BCMA) in acute care and long-term care settings. Background: Medication errors are the most commonly documented cause of adverse events in hospital settings. Scanning of bar codes to verify patient and medication information may reduce medication errors. Method: A prospective ethnographic study was conducted using targeted observation. Fifteen acute care and 13 long-term care nurses were directly observed during medication administration at small, medium, and large Veterans Administration hospitals to detect workaround strategies. Results: Noncompliance with recommended practices was observed in all settings and facilities. A larger proportion of acute care nurses than long-term care nurses scanned bar-coded wristbands to identify patients (53% vs. 8%, p = .016). A larger proportion of acute care nurses than long-term care nurses administered barcoded medications immediately after scanning (93% vs. 23%, p < .001). Conclusion: Workaround strategies were employed with BCMA that increased efficiency but created new potential paths to adverse events. There was a significant difference in the rate of use of workaround strategies between acute and long-term care. Application: The extent of workaround strategies varied by care setting and facility. BCMA should be tailored to the long-term care setting, including increasing the efficiency of use. Hospitals implementing bar coding should facilitate the intended use through equipment procurement, implementation, and quality improvement strategies.

The world is becoming increasingly urbanised, impacting human interactions with natural environments (NEs). NEs take a number of forms, ranging from pristine, modified, to built NEs, which are common in many urban areas. NEs may include nature-based solutions, such as introducing nature elements and biological processes into cities that are used to solve problems created by urbanisation. Whilst urbanisation has negative impacts on human health, impacting mental and physical wellbeing through a number of mechanisms, exposure to NEs may improve human health and wellbeing. Here, we review the mechanisms by which health can be improved by exposure to NEs, as explained by Stress Reduction Theory, Attention Restoration Theory, and the 'Old Friends'/biodiversity hypothesis. Such exposures may have physiological and immunological benefits, mediated through endocrine pathways and altered microbiota. Citizen Science, which often causes exposure to NEs and social activity, is being increasingly used to not only collect scientific data but also to engage individuals and communities. Despite being a named component of scientific and environmental strategies of governments, to our knowledge, the intrinsic health benefits of Citizen Science in NEs do not form part of public health policy. We contend that Citizen Science programs that facilitate exposure to NEs in urban areas may represent an important public health policy advance.