Isolation of those ill with contagious disease has been a fundamental infection control concept for hundreds of years. However, recent studies suggest that fewer than 50% of health—care workers comply with their hospitals' isolation precaution policies and that efficacy of some of those policies is questionable. In response, two new systems, based upon fundamentally different goals, were promoted. The Centers for Disease Control, prompted by health—care worker& concerns about occupational risk of human immunodeficiency virus (HIV) from a growing number of patients with acquired immunodeficiency disease syndrome (AIDS), issued formal guidelines in 1987. This formed the basis for Universal Precautions (UP), a unifying strategy for precautions with all patients regardless of diagnosis intended to reduce risk to hospital staff members. Also in 1987, one hospital issued guidelines for Body Substance Isolation (BSI), hygienic precautions to be used with all patients based on recognition that colonized body substances are important reservoirs for cross—infection to both patients and staff members. These new strategies have been promoted widely, but there have been no formal assessments to reconcile controversies they raised nor to confirm their effectiveness. Further, necessary assessment tools have not been validated. This thesis provides new tools and new information to address three vital questions: Have hospitals adopted Universal Precautions or Body Substance Isolation? Do their staff members use the new system of precautions in daily practice? Has reliable use of a new system led to decreased risk of infection? A confidential mailed survey of all acute—care Canadian hospitals was conducted to measure rates of guideline receipt and adoption. It also obtained information on motivations for and perceived effectiveness of strategies adopted. A self—selected group of responding hospitals subsequently participated in standardized covert observation of their nurses infection control practices, then had the observed nurses complete a test examining their knowledge and beliefs. Employee health records were also examined to determine whether needlestick injury rates had changed since adoption of a new infection control strategy. Most Canadian hospitals adopted and modified new strategies based upon reasonable but unproven extensions of logic to protect health—care workers from HIV. 74% claimed UP (65%) or BSI (9%) but only 5% of 359 claiming UP and 0 of 50 claiming BSI adopted all policies expected. Many hospitals had not received key guideline publications. Guideline source, hospital size, and other variables were significantly associated with receipt. Nurses in 35 hospitals were observed to wear gloves during only z60% of procedures in which gloving was expected; rates varied widely among hospitals. Direct examination of sharps disposal containers confirmed compliance with a policy to not recap used needles (taken as recapping rate of 25%) in only 47% of 32 hospitals. Paired analysis of needlestick injury rates in 11 hospitals during comparable 90—day periods before versus after implementing UP/BSI showed no significant difference. 489 nurses completing a written test achieved their highest scores and least discordance among questions regarding procedural issues established long before UP/BSI, and lower scores or greater discordance on UP/BSJ concepts of philosophy, risk recognition and newer procedures. Positive correlation between knowledge and practice was not evident. UP and BSI now mean different things in different hospitals and have not been effective in harmonizing health—care workers’ infection control practices. Carefully standardized assessment methods are needed to guide their evolution to cost—effectiveness. / Graduate and Postdoctoral Studies / Graduate

There are many examples in the literature of conventional or traditional drug distribution systems in hospitals which possess many shortcomings with reference to medication errors, the amount of time spent by nursing personnel in medication-related duties, inventory losses, the preparation of intravenous admixtures, and the lack of adequate drug usage records. These deficiencies primarily are due to the pharmacist's minimal influence over the control of the traditional drug distribution systems. An analysis and evaluation of the present pharmacy services at St. Paul's Hospital, Vancouver, B.C., similarly identified a traditional distribution system subject to many of the aforementioned potential problems. Using information based on existing unit dose systems as reviewed in the literature and data collected from a general questionnaire, new pharmacy services based on unit dose drug distribution are projected for St. Paul's Hospital. The required facilities and personnel for a progressive unit dose drug distribution system, an intravenous (I.V.) admixture preparation service and a drug surveillance program are projected accordingly. It would appear that a "centralized" approach to implementing unit dose distribution is most appropriate for St. Paul's Hospital's present requirements. This would involve the preparation and distribution of all drugs to nursing units in single dose packages from a central pharmacy area. A similarly centralized intravenous admixture service and a decentralized drug surveillance program also are described. These services commonly feature a greater responsibility being placed with the pharmacy department for preventing therapy problems such as admixture incompatibilities, drug interactions, adverse drug reactions and inappropriate drug selection. The effect of the above services on the responsibilities and number of pharmacy and nursing personnel is estimated based on results in similar programs. These changes also reflect extended hours of coverage in each area. Finally, a potential phasing plan and time schedule for the implementation of the proposed unit dose drug distribution system, I.V. admixture preparation service and drug surveillance program at St. Paul's Hospital is suggested. / Pharmaceutical Sciences, Faculty of / Graduate

The objective of this research is to develop a simulation model as an aid in planning hospital operations. The hospital pharmacy is selected as an appropriate area for study. An extensive systems analysis of pharmacy functions is undertaken. A simulation model of the inpatient dispensary operations is developed using the IBM General Purpose Simulation System. This model allows experimentation with dispensary work-load, operations, and manpower schedule. Statistics are provided on service to the patient, work-load distribution, and manpower utilization. Variation in pharmacist availability and type of prescription entering the dispensary allows optimization of operations. Several experiments are conducted to illustrate the model concept and experiment possibilities. It is concluded that the model is a valuable planning tool for the hospital pharmacy administrator and can be extended to simulate operations in other areas of the pharmacy. / Business, Sauder School of / Graduate

The purpose of the present study was to examine some of the relationships between the level of performance and job satisfaction, goal perceptions, and value of rewards. The subjects for the study were the department managers and nursing supervisors of a small general hospital. Performance criteria for the subjects were obtained by convergent and discriminant analysis of superiors' ratings on a number of traits. The data obtained, indicated that the two groups of subjects, although working in the same organization, had quite dissimilar attitudes and perceptions. The findings were interpreted as manifestations of the different organizational micro-climates in which the two groups operated. / Business, Sauder School of / Graduate

The impact of the introduction of hospital medical day care programs on inpatient use was studied, to see if there was a reduction in average lengths of stay, cases or patient days, for those diagnostic categories in the programs. The provincial government funded these programs to create an alternative to hospitalization. Studies on the issue of whether or not day care is an alternative or substitutes for inpatient use were examined. Interest in ambulatory care is growing because of the increasing age of the population, increasing duration of chronic illness and increasing costs of hospital services. Three programs at Lions Gate Hospital in North Vancouver, B.C. were chosen: Chronic Obstructive Lung Disease (CO.L.D.) program, Diabetic Day Care,and the Neuro (Neurology) program. The population for study were divided into four groups: those from North and West Vancouver who used Lions Gate Hospital, patients from the rest of the Greater Vancouver Regional District (G.V.R.D.) who used other G.V.R.D. hospitals, arid to allow for 'spill-out' cases, those from North and West Vancouver who used other hospitals in the province and those from the rest of the G.V.R.D. who used Lions Gate Hospital. The methodology involved the use of a multiple time series design which would allow some comparison before and after the introduction of the CO.L.D. program, as well as comparison between the North Shore and the rest of the G.V.R.D. A regression analysis, using a dummy variable for the CO.L.D. program, on average length, of stay, cases and patient days showed no statistically significant results. The data collection period, 1970 to 1979/80, does not provide conclusive answers for Diabetic Day Care, introduced at Lions Gate Hospital in 1966 and in some of the hospitals of the rest of the G.V.R.D. in 1972, or for the Neuro program, introduced at Lions Gate Hospital in 1979. However, population and age adjusted cases and patient days for all three programs are consistently higher in the rest of the G.V.R.D. when compared with North and West Vancouver and deserve further investigation. The implications from this study, that there is no impact from medical day care, programs on rates of inpatient use, is consistent with similar studies on Diabetic Day Care and Day Care Surgery. The health care system does not seem to be able to respond to innovations of this type and they are additions to existing services. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Unidad de práctica para optar al título de Químico Farmacéutico / No autorizada por el autor para ser publicada a texto completo en el Portal de Tesis Electrónicas / Objetivo: Este trabajo se realizó con el objetivo de lograr la implementación de un sistema automatizado de almacenamiento y dispensación de medicamentos en la Farmacia Central del Hospital Padre Hurtado. El sistema permitiría optimizar los recursos y el proceso de dispensación de medicamentos. Metodología: El estudio realizado en este proyecto fue del tipo retrospectivo en un comienzo, ya que el sistema automatizado estaba instalado en la farmacia y existía un estudio de logística para aquello. Posteriormente, el diseño del estudio realizado fue del tipo observacional con intervención del autor para lograr los objetivos propuestos. El método utilizado para la recolección de datos consistió en uno empírico, primero se realizó un diagnóstico de la situación en farmacia, luego se siguió con la implementación y finalmente, con una evaluación, considerando en esta etapa la comparación del sistema automatizado con el sistema manual de dispensación de medicamentos, midiendo el tiempo empleado en retirar medicamentos (procedimiento de dispensación), los costos asociados al uso del sistema automatizado y los errores cometidos en su funcionamiento. Resultados: La comparación de ambos sistemas con respecto al tiempo empleado en retirar medicamentos, indicó que con el sistema automatizado se logran retirar dos prescripciones por minuto y en el sistema manual solo una prescripción por minuto. El costo promedio mensual asociado al total de comprimidos y cápsulas dispensadas en farmacia con el sistema automatizado disminuyó $259.600 en comparación con el sistema manual de dispensación. Los errores más comunes en el manejo del sistema automatizado se produjeron en el proceso de inventario (37,7%) y a su vez en el digitado de recetas (28,8%). Conclusión: En el Hospital Padre Hurtado se logró la implementación del 50% del total de las camas, lo que irá en aumento a mediano plazo. El sistema automatizado logró disminuir el tiempo del proceso de dispensación de medicamentos en el hospital, en comparación al sistema manual que antes se usaba en farmacia. Además, se concluye que existe una disminución de costos con el sistema automatizado, a pesar que el reenvasado en dosis unitaria bajo este sistema posee un costo más elevado. Con respecto a los errores cometidos al utilizar el sistema automatizado, estos disminuyen con el pasar del tiempo y además, existe menor variabilidad entre un usuario y otro, en comparación con el sistema manual de dispensación

Unidad de práctica prolongada para optar al título de Químico Farmacéutico / Desarrollo de propuesta de mejora en seguridad y trazabilidad de medicamentos en Hospital Peñaflor desde Unidad de Bodega de Farmacia hasta la dispensación al paciente Se realizó una unidad de práctica prolongada de seis meses en Servicio de Farmacia de Hospital Peñaflor. El objetivo de esta práctica prolongada fue desarrollar propuestas de mejora en el proceso de flujo de medicamentos tanto informático como físico desde su llegada a Hospital Peñaflor hasta la dispensación a los pacientes. Estas mejoras se enfocan en otorgar más seguridad a los pacientes y en lograr trazabilidad completa de los medicamentos para obtener los beneficios que otorga esta serie de procedimientos. Para lograr identificar las barreras que impiden tener procesos trazables y seguros en Hospital Peñaflor, se desarrollaron flujogramas del movimiento de los medicamentos al interior del hospital, además se resolvió realizar un estudio de tiempos de espera y una encuesta de satisfacción usuaria para evaluar cuál era el panorama actual del Servicio de Farmacia y así encontrar la mejor forma de realizar mejoras sin interferir en el actual servicio otorgado. También se evaluó la factibilidad del programa informático que utiliza Hospital Peñaflor para trazar medicamentos y cuáles son las herramientas que se podrían aprovechar de él para obtener procesos más seguros. Una vez que fueron identificados los nodos críticos de seguridad y trazabilidad se realizó una reunión con personal del Servicio de Salud Metropolitano Occidente (SSMOCC) y con personal de Hospital Peñaflor, determinando de manera definitiva cuáles eran las propuestas factibles de implementar. Así, estas fueron desarrolladas en una etapa de marcha blanca de veinte días en donde se establecieron indicadores de evaluación. Se concluyó que los procedimientos involucrados en el flujo de medicamentos deben tener la máxima seguridad posible, y por ello debieron modificarse algunos de estos para garantizarla sin interferir en la calidad del servicio actual. Existen diversas formas de llevar a cabo la trazabilidad, para el caso de Hospital Peñaflor la manera más factible es realizando el etiquetado de los medicamentos con códigos de barra bidimensionales Data Matrix ya que se adecúa a las necesidades de etiquetado que se presentan en Servicio de Farmacia; además disminuiría los tiempos de espera de los pacientes y la carga de trabajo de los técnicos en farmacia al hacer el procedimiento más ágil. X Las medidas implementadas tuvieron aceptación tanto por parte de los pacientes como de los técnicos en farmacia. Esto se reflejó en la “encuesta de percepción de la nueva forma de dispensación” realizada a los usuarios de farmacia, donde se obtuvieron comentarios positivos. Se reforzó en Hospital Peñaflor la importancia de tener procedimientos seguros y con registros fidedignos. / Development of proposal for improvement in safety and traceability of medicines in Peñaflor Hospital from pharmacy warehouse unit to patient dispensation Prolonged practice unit with duration of six-month was performed in the Peñaflor Hospital Pharmacy Service. The objective of this prolonged practice was to develop proposals for improvement in the process of flow of medication both physical and information systems, from their arrival at Peñaflor Hospital to the dispensation to patients. These improvements focus on providing more safety to patients and achieving full traceability of medications to obtain the benefits granted by this series of procedures. In order to identify the barriers that prevent having traceable and safe processes in Hospital Peñaflor, flow charts of the movement of drugs were developed inside the hospital, and a study of waiting times and a user satisfaction survey was determined to evaluate which was the current panorama of the Pharmacy Service and thus find the best way to make improvements without interfering in the current service granted. The feasibility of the information system used by Hospital Peñaflor to plot medications and which tools could be used to obtain safer processes was also evaluated. Once the critical security and traceability nodes were identified, a meeting was held with staff of the Metropolitan Health Service West (SSMOCC) and with personnel from Hospital Peñaflor, determining definitively which were the feasible proposals to implement. Thus, these were developed in a stage of white march of twenty days where indicators of evaluation were established. It was concluded that the procedures involved in the flow of medications should have the maximum possible safety, and therefore some of these had to be modified to guarantee it without interfering in the quality of the current service. There are several ways to carry out traceability, for the case of Peñaflor Hospital the most feasible way is to make the labeling of drugs with two-dimensional bar codes Data Matrix as it meets the labeling needs that are presented in Pharmacy Service. In addition, it would reduce waiting times for patients and the workload of pharmacy technicians by making the procedure more agile. The measures implemented had acceptance by both patients and pharmacy technicians. This was reflected in the "new form of dispensation perception survey" made to pharmacy users, where positive comments were obtained. The importance of having safe procedures and with reliable records in Hospital Peñaflor was reinforced.

Los hospitales actualmente según la OMS están destinados a ser lugares de sanación tanto en el aspecto físico como emocional de los pacientes, pero en el Perú la inversión en salud pública se encuentra muy por debajo de la recomendada y la preocupación por mejorar estos espacios para los pacientes con cáncer es nula, sobre todo cuando se habla de niños el tema es aún más delicado. Por lo tanto, este proyecto aborda la importancia de que los niños tengan acceso a establecimientos de salud que cuenten con espacios eficientes que logren producir efectos positivos sobre el estado de ánimo, cambiando la percepción del espacio de los niños; con el fin de crear un espacio amigable y cálido, el cual les de confort y seguridad. Se propone utilizar la hipótesis del diseño basado en la evidencia como marco para el diseño, que aportan los beneficios de: iluminación y ventilación natural, presencia de áreas verdes, ambientes para la integración y el encuentro entre los pacientes infantiles y familiares. No obstante, sin perder la correcta y eficaz funcionalidad de un hospital debido a su alto nivel de complejidad. / The hospitals currently according to the OMS are destined to be places of healing both in the physical and emotional aspect of the patients, but in Peru the investment in public health is well below the recommended and the concern to improve these spaces for patients Cancer patients are null, especially when talking about children the subject is even more sensitive. Therefore, this project addresses the importance of children having access to health facilities that have efficient spaces that achieve positive effects on mood, changing the perception of children's space; in order to create a friendly and warm space, which gives them comfort and safety. It is proposed to use the evidence-based design hypothesis as a framework for design, which provide the benefits of: natural lighting and ventilation, presence of green areas, environments for integration and the encounter between children and family patients. However, without losing the correct and effective functionality of a hospital due to its high level of complexity. / Trabajo de Suficiencia Profesional

Among 10,384 rural Colorado female patients who received MDC 14 (obstetric services) from 2000 to 2003, 6,615 (63.7%) were admitted to their local rural hospitals; 1,654 (15.9%) were admitted to other rural hospitals; and 2,115 (20.4%) traveled to urban hospitals for inpatient services. This study is to examine how network participation, service scopes, and market competition influences rural women's choice of hospital for their obstetric care. A conditional logistic regression analysis was used. The network participation (p < 0.01), the number of services offered (p < 0.05), and the hospital market competition had a positive and significant relationship with patients' choice to receive obstetric care. That is, rural patients prefer to receive care from a hospital that participates in a network, that provides more number of services, and that has a greater market share (i.e., a lower level of market competition) in their locality. Rural hospitals could actively increase their competitiveness and market share by increasing the number of health care services provided and seeking to network with other hospitals.

Symptom control may become challenging for terminally ill patients as they near the end of life. Patients often seek hospital admission to address symptoms, such as pain, nausea, vomiting, and restlessness. Alternatively, palliative medicine focuses on the control and mitigation of symptoms, while allowing patients to maintain their quality of life, whether in an outpatient or inpatient setting. Hospice care provides, in addition to inpatient care at a hospice facility or in a hospital, the option for patients to receive symptom management at home. This option for symptom control in the outpatient setting is essential to preventing repeated and expensive hospital readmissions. This article discusses the impact of hospice care on hospital readmission rates.