Inledning Intrahospitala transporter av intensivvårdpatient är ett ansvarsfullt arbetsmoment och en stor del av intensivvårdssjuksköterskans och undersköterskans arbete. Det är riskfyllt eftersom tillbud med patient och utrustning kan ske. Syfte: Syftet var att beskriva förekomsten av tillbud och typ av tillbud under intrahospitala transporter av intensivvårdspatienter, samt jämföra om det finns skillnader i förekomst av antalet tillbud under olika tidpunkter på dygnet och skillnad mellan akut respektive planerad transport. Syftet var också att undersöka sjuksköterskors och undersköterskors upplevda grad av stress och trötthet under transporten samt om det finns skillnad i förekomst av trötthet och/eller stress vid transporter där det sker tillbud respektive inte sker tillbud. Metod: Studien är kvantitativ, deskriptiv och jämförande. Förekomst av tillbud samt upplevelse av stress/trötthet besvarades på ett svarsformulär av sjuksköterska och undersköterska under eller direkt efter intrahospital transport. Totalt ingår 42 transporter. Resultat: Tillbud förekom vid 19 transporter. Inga skillnader i förekomst av tillbud mellan dagtransporter och nattransporter eller mellan akuta och planerade transporter kunde ses. Sjuksköterskor och undersköterskor rapporterade mer stress vid de transporter där det förekommit tillbud än vid de där tillbud inte förekommit. Slutsats: Tillbud förekommer i knappt hälften av intrahospitala transporter och sjuksköterskor och undersköterskor rapporterar mer stress i samband med transporter med tillbud än transporter utan tillbud. / Introduction: Intrahospital transport of critical care patient is a responsible working operation and much of the critical care nurse and the assistant nurses´ work. It is risky, because incidents of patient and equipment can happen. Purpose: The objective was to describe the occurrence of incidents and types of incidents during intrahospital transport of ICU patients, and compare if there are differences in the occurrence of incidents during different times of day and the difference between emergency and planed transportation. The aim was to investigate nurses and assistans nurses´ perceived level of stress and fatigue during transport and if there are differences in the incidence of fatigue and/or stress during transport where  incidents occurs or not occurs. Method: The study is quantitative, descriptive and comparative. The presence of the incident and the experience of stress/fatigue were answered on a response form of nurses and assistant nurse during or immediately after intrahospital transport. A total of 42 transports are included. Results: Adverse events occurred at 19 transports. No differences in the occurrence of incidents between day transports and night transport or between acute and planned transports could be seen. Nurses and assistant nurses reported more stress during the transports, where there have been adverse events than in those were adverse events had not occurred. Conclusion: Adverse events occurs in almost half of intrahospital transport and nurses and assistant nurses reported more stress associated with transports with adverse events other than the transports without adverse events.

För att säkra patientsäkerheten krävs att kommunikationen mellan vårdpersonal främjas, de har visat sig att kommunikationen har ett samband med de misstag som sker i patientvården. Ett speciellt behov av vidare forskning på kommunikationen mellan sjuksköterska och läkare finns, detta för att professionernas kommunikation sinsemellan är en stor del av patientens vård och säkerhet. Syftet med denna litteraturstudie var att belysa faktorer som påverkar kommunikation mellan läkare och sjuksköterska relaterat till patientsäkerheten. Studien utfördes som en litteraturstudie. Resultatet visade att C-HIP och SBAR ansågs vara användbara för att främja en god kommunikation mellan professionerna och för att främja patientsäkerheten. För att främja kommunikationen professionerna emellan krävs god kvalitet av information och att informationen är relevant. Humor, empati, förståelse och öppenhet är faktorer i beteendet som främjar en god kommunikation. Hierarkin som fortfarande råder i sjukvården påverkar kommunikationen mellan sjuksköterskan och läkaren negativt. Att höja rösten, nedvärdera varandra och att uppvisa ett respektlöst beteende är också faktorer som hindrar kommunikationen. Fler kurser behöver införas i sjuksköterskan och läkarens utbildning för att främja kommunikationen dem emellan. Ett förslag kan vara att införa en gemensam kurs där professionerna kan öva och även få en inblick i varandras arbetsuppgifter. / It requires better communication between medical staff to ensure patient safety. It’s proved that communication is linked to the mistakes that occur in patient care. A special need for further research on communication between nurses and doctors are needed, this for the communication between them is a big part of patient care and safety. The purpose of this study was to illuminate factors that affect communication between doctors and nurses related to patient safety. The study was conducted as a literaturestudy. The results showed that C-HIP and SBAR were useful methods for promoting good communication between the professions and to promote patient safety. It requires good quality of the information and relevant information to foster good communication. Humor, empathy, understanding and openness are factors in behavior that promotes good communication. The hierarchy that still exists is affecting communication between the nurse and doctor negative. Raising his voice, depreciate each other and show a disrespectful behavior are barriers that effects the communication. More courses need to be introduced in the nurse and physician education to promote communication. One suggestion might be to introduce a common course in which professions can practice and also get an insight into each other's work.

Fallolyckor är en vanlig orsak till skador hos äldre vilket leder till stort lidande för den enskilde. Dessutom medför fallolyckor hos äldre stora kostnader för samhället. När antalet äldre ökar så kommer också lidandet och kostnaderna orsakade av fallolyckor att öka. Sjuksköterskor har ett ansvar i sitt omvårdnadsarbete att förebygga fallolyckor. Vårt syfte med denna studie var att beskriva sjuksköterskors erfarenhet av fallpreventivt arbete hos äldre på särskilt boende. Metoden som användes i denna studie var kvalitativ metod genom intervjuer med sjuksköterskor. Data analyserades med kvalitativ innehållsanalys. Två teman framkom, att man gemensamt ser individen och miljön är inte alltid tillräckliga åtgärder samt hinder finns för att arbeta fallförebyggande Dessa teman kunde sedan beskrivas genom sex olika kategorier som benämndes mångfasetterad fysisk miljö, åtgärder kan vara otillräckliga, individuell bedömning, samarbete behövs, behov av ökade kunskaper, samt tidsbrist. Resultatet av vår studie visade att sjuksköterskor upplevde kommunens ekonomi som ett hinder då de på grund av detta inte fick utbildning och tillgång till ny kunskap samt hjälpmedel att använda i sitt fallförebyggande arbete. Sjuksköterskorna beskrev också att de hade tidsbrist vilket resulterade i att de individuella bedömningar och uppföljningar av fallrisk inom särskilda boenden inte hanns med i den utsträckning de önskade. / Falling accidents are a common reason for injuries among elderly people which leads to great suffering for the individual. Falling accidents among elderly also causes high costs for the society. As the number of elderly people increases the suffering and the cost due to falling accidents will also increase. Nurses have a responsibility in their work to prevent falling accidents. Our intention with this study was to describe nurse´s experience preventing falling accidents among elderly in nursing homes. The method used in this study was a qualitative method by interviews with nurses. Data was analyzed with qualitative content analysis. Two themes emerged, that you jointly look at the individual and the environment are not always sufficient actions and there are obstacles in the work of preventing falling accidents. These themes could then be described by six different categories: diverse natural environment, actions may be insufficient, individual estimation, need for cooperation, need for increased knowledge and lack of time. The result of our study showed that nurses experienced the economy of the municipality as an obstacle when they due to this did not get education and access to new knowledge and technical aids to use in the work of preventing falling accidents. The nurses also described that they did not have the time they wished, for the individual estimation for following up the risk of falling in the nursing homes.

¡eAbstract¡f The difference of medical diagnosis and its related effect is important to medical quality consistency and medical care cost-effectiveness. At present, the specialists including radiologists, chest medicine doctors & family medicine doctors able to perform X-ray diagnosis of foreigners¡¦ physical examination would cause the difference of flow fluency & consistency of medical quality in foreigners¡¦ physical examination. Due to the shortage of studies in discussing the difference among doctors¡¦ diagnosis in our country, the study is an experimental cross-section design that focuses on the diagnosis difference of 3595 foreigners¡¦ chest X-ray among 3 different specialists. The result of research may be useful for making policy of public health and be referent to the quality control and management in the hospital. According to the result, the X-ray diagnosis of lung TB showed no difference between specialists & hospital levels in Chi-square analysis, but the diagnosis consistency of kappa between every 2 doctors was so fluctuant among 10 doctors, the kappa value ranged from ¡V0.005 to 1.0. Besides, the consistency of kappa among either 10 doctors, 4 chest medicine doctors, 3 radiologists or 3 family medicine doctors were poor, and the kappa value ranged from 0.035 to 0.2. The highest kappa was 0.18629 among 3 family medicine doctors, while the lowest kappa was 0.038197 among 4 chest medicine doctors. The other studying result also showed low consistency of kappa among 10 doctors in X-ray diagnosis of lung abnormality, the kappa value ranged from ¡V0.009 to 0.375. Besides, the low consistency of ICC was also noted among 10 doctors in X-ray diagnosis scores of lung abnormality. ICC value ranged from ¡V0.0159 to 0.5540. The exploration of doctors¡¦ difference in X-ray diagnosis of lung was under no interference of medical payment system. If the X-ray diagnosis followed the standard of CDC, only requiring the abnormal TB, 3 specialists would show no difference in X-ray TB diagnosis. Therefore, the first line family medicine doctors who see the foreigners directly would also fit to make the diagnosis of X-ray lung TB. Moreover, due to the family medicine doctors understand the foreigners¡¦ history than other specialists, if the family medicine doctors make the diagnosis of X-ray lung TB, the overall examination procedure would be fast and better. From the article review, the consistency was low among doctors in many medical diagnoses, such as chest X-ray, cytology, CT scan, breast sono, emergent chest X-ray, KUB and skeletal X-ray. Due to the low consistency, there were researchers making effort and doing study to suggest that the doctors could elevate the consistency and reliability by continual discussion and learning. However, our country is short of study in discussing the difference among doctors. From the study result, the variation of consistency is huge. Whether it would affect the medical behavior of doctors, such as overusing the related tests or medicine having influence on patients¡¦ health and safety, further studies will be needed.

The aim of the present research was to investigate the relationships between patient safety culture within hospitals and individual factors on medical practice among physicians. A total of 240 physicians from ten different hospitals completed the Medical Practice Questionnaire, Hospital Survey on Patient Safety Culture, Maslach Burnout Inventory and Eysenck Personality Questionnaire Revised- Abbreviated Form. In order to assess frequency and types of medical errors, Medical Practice Questionnaire was developed by the author. Factor analysis of this Questionnaire demonstrated the existence of four subscales named as Patient Management/Information Delivery Errors, Execution Errors, Procedure Related errors and One Source Errors. ANOVA results revealed that males conduct more Procedure Related Errors than females. In support of the hypothesis, a number of differences observed on patient safety culture between types of institutions that public hospitals received lower scores on most of the safety dimensions. Regression analysis results revealed that personality dimensions and burnout levels were significantly related to types and frequency of errors. Considering significant predictors, while the extravert participants were found to report more Patient Management/Information Delivery, Execution and Procedure Related errors, Neurotics were found to report lower levels of errors on these three dimensions. Regression analysis of burnout levels showed that depersonalization were also associated with these three error dimensions.The level of depersonalization were found to increase the frequency of Patient Management/Information Delivery, Execution and Procedure Related Errors. The research findings however, did not support the assertion in a manner that safety culture dimensions were not found to have main effects on types of errors. The limitations of the current research and implications for further research were discussed.

<p>Fallolyckor är en vanlig orsak till skador hos äldre vilket leder till stort lidande för den enskilde. Dessutom medför fallolyckor hos äldre stora kostnader för samhället. När antalet äldre ökar så kommer också lidandet och kostnaderna orsakade av fallolyckor att öka. Sjuksköterskor har ett ansvar i sitt omvårdnadsarbete att förebygga fallolyckor. Vårt syfte med denna studie var att beskriva sjuksköterskors erfarenhet av fallpreventivt arbete hos äldre på särskilt boende. Metoden som användes i denna studie var kvalitativ metod genom intervjuer med sjuksköterskor. Data analyserades med kvalitativ innehållsanalys. Två teman framkom, att man gemensamt ser individen och miljön är inte alltid tillräckliga åtgärder samt hinder finns för att arbeta fallförebyggande Dessa teman kunde sedan beskrivas genom sex olika kategorier som benämndes mångfasetterad fysisk miljö, åtgärder kan vara otillräckliga, individuell bedömning, samarbete behövs, behov av ökade kunskaper, samt tidsbrist. Resultatet av vår studie visade att sjuksköterskor upplevde kommunens ekonomi som ett hinder då de på grund av detta inte fick utbildning och tillgång till ny kunskap samt hjälpmedel att använda i sitt fallförebyggande arbete. Sjuksköterskorna beskrev också att de hade tidsbrist vilket resulterade i att de individuella bedömningar och uppföljningar av fallrisk inom särskilda boenden inte hanns med i den utsträckning de önskade.</p> / <p>Falling accidents are a common reason for injuries among elderly people which leads to great suffering for the individual. Falling accidents among elderly also causes high costs for the society. As the number of elderly people increases the suffering and the cost due to falling accidents will also increase. Nurses have a responsibility in their work to prevent falling accidents. Our intention with this study was to describe nurse´s experience preventing falling accidents among elderly in nursing homes. The method used in this study was a qualitative method by interviews with nurses. Data was analyzed with qualitative content analysis. Two themes emerged, that you jointly look at the individual and the environment are not always sufficient actions and there are obstacles in the work of preventing falling accidents. These themes could then be described by six different categories: diverse natural environment, actions may be insufficient, individual estimation, need for cooperation, need for increased knowledge and lack of time. The result of our study showed that nurses experienced the economy of the municipality as an obstacle when they due to this did not get education and access to new knowledge and technical aids to use in the work of preventing falling accidents. The nurses also described that they did not have the time they wished, for the individual estimation for following up the risk of falling in the nursing homes.</p>

Applying information technology (IT) to support or magnify a competitive business strategy has been recognized which IT had adopted by enterprises. Many examples of various enterprises illustrate applying IT to create and sustain competitive advantage. Applying information strategy is becoming a trend for success and also for coping with dramatic environmental changing.The Institute of Medicine (IOM) brought patient safety issue into the public attention in its 1999 report “To Err is Human”. It is estimated those medical errors responsible for 44,000 and 98,000 deaths in the United States per year. Medical errors are causing patient’s death, permanent loss of health functions, etc.. Facing on these errors, main strategy for preventing errors is applying IT strategy. Many studies and surveys show that information technology can effectively reduce the rate of medical care errors and adverse events, up to 50%.Thus, information technology plays the role as a gatekeeper for promoting and protecting patient safety in various fields of medical care. The object of this thesis is from historical review to explore various IT strategies adopted by hospitals to improve patient safety and to explore of Taiwan hospitals applying patient safety information technologies to pursue patient safety and its contribution. We are designing this research by three phases. Phase I study, various of SCI literature review from 1990 to 2005 and in-depth interview with physicians, administrators from hospital was used to collect the data. Phase II study; from previous literature reviewed, the model and comments will gather from Phase I interviews to develop a structured questionnaire. Phase III study, In order to reduce the probability of misinterpretation, a Delphi approach was used to further revise and validate the extended framework, which has been synthesized from Phase I and Phase II study. Patient safety has become an important trend and international health facilities operation guidelines. Therefore, hospitals need a well-developed plan to implement in the near future by steps to achieve risk free hospital for patient treatment. We are happy to share our findings to hospitals and learn more on what we can do to make the hospital a safer place for all type of errors.Hospitals not only pursuing a patient safety goal by innovative information technologies but also diffusing, assiminating as a trend of enhance patient safety era. Key Words: Patient Safety, Medical Error, RFID, Electronic Medical Record.

Bakgrund: Vårdplatserna på svenska sjukhus har minskat drastiskt det senaste decenniet.  Detta har inneburit en högre beläggning på de kvarvarande och medfört längre väntetid på landets akutmottagningar. Platsbristen skapar, ibland dagliga, överbeläggningar och utlokaliseringar av patienter. Syfte: Att undersöka hur sjuksköterskor och läkare upplever att vårdplatssituationen påverkar deras arbete och vad detta får för konsekvenser för patienterna. Metod: Kvalitativ design med semistrukturerade intervjuer med tre läkare och nio sjuksköterskor från akutvårdsavdelning med inriktning infektion, mottagning med akutintag och akutmottagning. Analysarbetet genomfördes med Malteruds (2009) innehållsanalys. Resultat: Vårdplatssituationen kommer sig av en brist på vårdplatser inom främst medicindivisionen, samt en oförmåga att hålla de platser som finns öppna på grund av sjuksköterskebrist. Bristen på vårdplatser har inneburit en oförmåga för läkare och sjuksköterskor att utföra sitt arbete i enlighet med sin kompetens och beprövad erfarenhet. Slutsats: Svårigheterna med att finna platser till patienterna på deras hemavdelningar samt de ständiga omflyttningarna av patienter medför svårigheter för vårdpersonalen att ge god medicinsk vård och omvårdnad vilket medför stora risker för patientsäkerheten. / Background: Under the last decade hospital beds in Swedish hospitals have been reduced dramatically which have increased the bed – occupancy rates as well as the waiting hours at the emergency departments.  As a consequence to this the medical wards become overcrowded and patients are been located in other wards then the ward with the right expertise.   Purpose: To examine how registered nurses and physicians are affected by the lack of patient beds in an emergency hospital and how they think the situation affect patient safety. Method: Qualitative study consisting of semi –structured interviews with nine registered nurses and three physicians, all working in an emergency department, an surgery with acute intake and a department for acute infectious diseases. Content analysis (Malterud, 2009) was used to analyse the material. Vårdplatssituationen kommer sig av en brist på vårdplatser inom främst medicindivisionen, samt en oförmåga att hålla de platser som finns öppna på grund av sjuksköterskebrist. Bristen på vårdplatser har inneburit en oförmåga för läkare och sjuksköterskor att utföra sitt arbete i enlighet med sin kompetens och beprövad erfarenhet.   Results: The problem to find adequate in-hospital beds for the patients are caused by the lack of physical beds in especially the medicine division and the inability to keep existing beds open as a result of the lack of registered nurses. The lack of hospital beds have made it difficult for the physicians and the registered nurses to give safe and adequate care to their patients. Conclusion: The shortage of hospital beds, and the constant relocation of patients, is making it difficult for nurses and physicians to give patients the medical care they need which have a great effect on patients safety.

Background: Surgical complications has been the main cause of medical injuries and deaths worldwide. In 2008 WHO developed the checklist for safe surgery to reduce the number of surgical complications. The objective of the checklist is to strengthen already established safety routines and contribute to better cooperation and communication. Research shows that compliance to the checklist is deficient, which can affect patient safety. Aim: The aim was to study the extent to which theatre nurses participate in the use of the checklist. Method: Observational study was conducted with a descriptive design and quantitative approach. 24 observations were carried out with aid of an observation protocol of two surgical units at a hospital in central Sweden. Result: The results showed that Timeout initiated widely but compliance to all items was considerably lower. Team member introductions, patient ID, planned surgery and antibiotic prophylaxis had highest compliance. Theatre nurse responsibilities in Timeout, particularly sterility and positioning of the patient had low compliance. During Sign In the majority of theatre nurses greeted the patient in the operating room and everyone performed skin control. One theatre nurse asked the patient about allergies/intolerance. The theatre nurses participated rarely in Sign Out. Conclusions: The study showed that there are large differences in compliance between items of the checklist. Theatre nurses can increase their participation by being more involved in the surgical team communication and thus clearly demonstrate her responsibilities in the perioperative nursing. Revisited routines and continuous monitoring may be needed for increased checklist compliance

Pressure ulcers and related skin integrity threats are a significant problem in current transfer/transport systems used for spinal cord injury patients. To understand this problem twenty-three different slings with varying type, material, and features were analyzed in hopes to identify at-risk areas for skin integrity threats such as pressure ulcers. Population samples included non-disabled (otherwise referred to as "healthy") volunteers as well as SCI patients from the James A. Haley Veterans Hospital. High resolution pressure interface mapping was utilized to directly measure the interface pressures between the patient and sling interface. Overall results provide relevant feedback on the systems used and to suggest a particular type of sling that might reduce and possibly minimize skin integrity threats as well as extend safe patient handling guidelines with sling use. It was found that the highest interface pressures convened along the seams of the sling, regardless of manufacturer or type.