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Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Thesis (M.S.)--Boston University

No description available.

The prevalence of medication errors in a major teaching hospital was investigated using several methodologies. The existing ward stock drug distribution system was assessed and a new system designed based on a novel use of failure mode and effects analysis. The existing system was compared to the new unit supply individual patient dispensing system on two wards in terms of medication errors, nursing time, pharmacy time, drug costs, drug security and nurses' opinion. A review of a one year sample of reports submitted under the existing incident reporting scheme was also undertaken. Errors were categorised according to drug group, error type, reason cited for the error, and probability ranking (probability of occurrence, detection and harm). In addition, a "no-blame" medication error reporting scheme was implemented and assessed.Results of the study showed that in the newly designed individual patient dispensing system there was a reduction in nursing time associated with medication activities of approximately 29%, an increase in pharmacy staff time of 64%, a reduction in drug costs and an increase in drug security. Using the disguised observer methodology a reduction in medication errors by 23.5% (including timing errors) and 7.3% (excluding timing errors) was seen on Ward A. Similarly a reduction of 21.1% (including timing errors) and 9.8% (excluding timing errors) was observed on Ward B. Significant support for the individual patient dispensing system was given by nursing staff. Of the errors self-reported under the existing incident/accident reporting scheme the most common type of error was omissions (32.2%), the most common drug group was cardiovascular drugs (19.8%), and the most common cause of the error cited was a faulty check (42.3%). The probability ranking showed that 75% of errors reported scored between 12 and 17 points (from a possible 30 points). In ++ / the no-blame error reporting system, an error rate of 2.1% was detected in the existing system and 1.7% in the failure mode analysis designed phase.

It has consistently been documented in many countries and sectors that there are difficulties in implementing public policy effectively. A priori, the Australian health care system is no exception to this general proposition. While governments issue directives with particular goals in mind these goals are not always met, because of the modifications, interpretations or lack of uptake by targeted populations. However it is not clear the extent to which these difficulties occur in the public hospital sector, and we lack clear empirical data on this phenomenon. This thesis investigates the effects of a state government directive on the development and implementation of elective admission policies in New South Wales public hospitals. It did this by three separate but related studies that examined the impact of the directive at the hospitals??? management and staff levels. The first two studies were quantitative and qualitative surveys of hospital managers and admission staff. The management survey aimed to ascertain the extent to which managers responded to the directive in terms of developing and implementing hospital policies. The staff survey sought to investigate staff awareness and knowledge of the developed policies. The third study was a qualitative analysis of the policy contents to determine the extent to which they reflected the aims and objectives of the government directive guidelines. All three studies found a general lack of relevance and applicability of the government directive and its guidelines to individual hospital organisations. The manager survey showed a disconnection between the central government office responsible for implementing the directive and hospital managers??? perspectives. This was apparent by the lack of response to the directive by many hospitals and the fact that managers often passed on the task of implementing the directive and its guidelines to other hospital staff. The findings of the qualitative analysis of policies showed evidence of hospital strategies to manage pressures created by the directive. These difficulties were corroborated by the surveyed staff that reported difficulties in translating the directive???s requirements (as reflected by the hospital policy), into the reality of their daily work; a lack of organisational commitment to policy enforcement; and a suspicion regarding the directive???s political motives. The findings of this thesis show that, as with other public service sectors effective policy implementation in the public hospital arena is problematic, with government agendas frequently not aligned with the requirements of stakeholders, and inadequate understanding of implementation barriers. Recommendations are made regarding methods to improve the synchronicity of political directives with organisational realties in the public hospital sector.

Thesis (B.Sc)--University of Hong Kong, 2006. / Includes bibliographical references (p. 94-102)