The recent increased focus on patient safety in hospitals has yielded a flood of new technologies and tools seeking to improve the quality of patient care at the point of care. Hospitals are complex institutions by nature, and are constantly challenged to improve the quality of healthcare delivered to patients while trying to reduce the rate of medical errors and improve patient safety. Here a simple mistake such as patient misidentification, specimen misidentification, wrong medication, or wrong blood transfusion can cause the loss of a patient’s life. Misidentification of patients is a common problem that many hospitals face on the daily basis. Patient misidentification is one of the leading causes of medical errors and medical malpractice in hospitals and it has been recognised as a serious risk to patient safety. Recent studies have shown that an increasing number of medical errors are primarily caused by adverse drug events which are caused directly or indirectly by incorrect patient identification. In recognition of the increasing threat to patient safety, it is important for hospitals to prevent these medical errors from happening by adopting a suitable patient identification system that can improve upon current safety procedures. The focus of this master’s thesis is the design, implementation, and evaluation of a handheld-based patient identification system that uses radio frequency identification (RFID) and IEEE 802.11b wireless local area networks to identify patients. In this solution, each patient is given a RFID wristband which contains demographic information (patient ID number, ward number, hospital code, etc.) of the patient. A handheld device equipped with IEEE 802.11b wireless local area network connectivity and a RFID reader is then used by the medical staff to read the patient’s wristband, identify the patient, and access the relevant records of this patient. This work was carried out at the Department of Medical Physics and Bioengineering at the University College Hospital Galway (UCHG), Ireland and the National University of Ireland, Galway. / Ökande de nya fokuserar på patientsäkerhet i sjukhus har givit en översvämning av nya teknologier och bearbetar sökande att förbättra det kvalitets av patient omsorg på peka av omsorg. Sjukhus är komplexa institutions vid naturen och utmanas ständig för att förbättra det kvalitets av sjukvården som levereras till prövas patient för att förminska klassa av medicinska fel och för att förbättra patient säkerhet. Här kan ett enkelt fel liksom patient misidentification, specimenmisidentification, fel läkarbehandling eller fel blodtransfusion orsaka förlusten av ett liv för patient. Misidentification av patient är ett allmänningproblem som många sjukhus vänder mot daglig. Patient misidentification är en av leda orsakar av medicinska fel, och den medicinska malpracticen i sjukhus och den har känts igen som ett allvarligt riskerar till patient säkerhet. Nya studies har visat att ett ökande numrerar av medicinska fel orsakas i första hand av motsatt droghändelser vilka orsakas direkt eller indirekt av oriktigt patient ID. I recognition av den ökande hot till patientsäkerhet är det viktigt att sjukhus förhindrar dessa medicinska fel från att hända, genom att adoptera ett passande patient ID system som kan förbttra på säkerhetsrutin. Fokusera av denna avhandling är designen, genomförande, och utvärderingen av ett patient IDsystem, som använder radiofrekvensidentifiering (RFID) och radion 802.11b, knyter kontakt för att identifiera patient. I denna lösning ges varje patient ett RFID-armband som innehåller demografikinformation (den patient personnumer, avdelning kod, sjukhuset kod, osv.) av patient. En handdator, som utrustas med trådlös IEEE 802.11b och en RFIDs ändare/mottagare, används därefter av den medicinska personal för att läsa armbandet för patient och för att identifiera patient. Detta arbete bars ut på avdelningen av medicinskfysik och bioteknik på Universitetssjukhuset Galway (UCHG), Irland och den Nationella Universitet av Irland, Galway.

Neonatal Intensive Care Unit (NICU) patients present unique patient identification challenges. Prospective hazard analysis (PHA) assesses safety by identifying hazards before an adverse event occurs. This project analyzes a barcoded feeding process in one NICU, and conducts a preliminary evaluation of PHA methods. Observations were conducted to quantify patient identification methods used in one NICU; the unit’s barcoded feeding process was examined for potential failures. The process underwent PHA with two methods, Global Hazard Ratings (GHR), a simplified method developed for this project, and Failure Modes and Effects Analysis (FMEA). FMEA showed greater interrater reliability; there was poor agreement between methods. A list of 21 hazards was developed for the clinical team from the FMEA results. Recommendations are for the unit to formulate and implement mitigation strategies for the identified hazards. Future work involves a more in depth look at FMEA interrater reliability and reliability comparison with other PHA methods.

Neonatal Intensive Care Unit (NICU) patients present unique patient identification challenges. Prospective hazard analysis (PHA) assesses safety by identifying hazards before an adverse event occurs. This project analyzes a barcoded feeding process in one NICU, and conducts a preliminary evaluation of PHA methods. Observations were conducted to quantify patient identification methods used in one NICU; the unit’s barcoded feeding process was examined for potential failures. The process underwent PHA with two methods, Global Hazard Ratings (GHR), a simplified method developed for this project, and Failure Modes and Effects Analysis (FMEA). FMEA showed greater interrater reliability; there was poor agreement between methods. A list of 21 hazards was developed for the clinical team from the FMEA results. Recommendations are for the unit to formulate and implement mitigation strategies for the identified hazards. Future work involves a more in depth look at FMEA interrater reliability and reliability comparison with other PHA methods.

With a strong and continuous development in medical technology products, the need to connect the right data to the right person is increasing, a form of patient identification. When the identification is not working it could lead to catastrophic accidents like the wrong person being operated. The problem could be solved with a mobile application. After desktop research and interview a prototype was made that would work as a patient identifier. The prototype is made as a mobile application that uses the NFC technique to transfer data. After, among other things, interviews with staff from health care the conclusion was that only bigger errors within patient identification were documented. It was hard to know how many errors were made in total. Therefore, the solution to the problem could be a mobile application that reads ID bands. This could be one step in the patient identification chain to reduce even small errors. / Med en stark och kontinuerlig utveckling av medicintekniska produkter ökar behovet att koppla rätt data till rätt person, en form av patientidentifiering. När det inte blir rätt kan det leda till katastrofala olyckor som exempelvis att fel patient opereras. Detta skulle då kunna lösas med hjälp av en mobilapplikation. Efter skrivbordsundersökning och intervju framställdes en prototyp som ska fungera som patientidentifiering. Prototypen är gjord som en mobilapplikation som använder NFC-teknik för att överföra data. Efter bland annat intervjuer med anställda inom vården har slutsatsen dragits att enbart större felhandlingar kring felidentifiering har dokumenterats och att det har varit svårt att veta hur många felidentifieringar som totalt uppstår i vården. Därför skulle en lösning kunna vara en mobilapplikation som avläser ID-band vara ett steg i identifieringskedjan för att även minska små fel inom patientidentifiering.

Specimen collection and identification errors are a significant problem in healthcare, contributing to incorrect diagnoses, delayed care, lack of essential treatments, patient injury or death, increased length of stay and increased healthcare costs, and decreased patient satisfaction. The purpose of the project was to evaluate the implementation of specimen collection technology with barcode scanning and bedside label printing in the maternal child health division of a community teaching hospital. The project was driven from Donabedian's quality framework for healthcare implementations, indicating that evaluating the quality of health care can be drawn from the categories of structure, process, and outcomes. The project featured a quantitative analysis with a pretest-posttest design. Mislabeled specimen rates and collection turnaround times were generated from laboratory quality data and measured before, during, and after implementation of specimen collection technology. Data analysis using an independent samples t test in SPSS 17.0 compared the changes in the mean scores of specimen collection turnaround times and mislabeled specimen rates. Mislabeled specimen percentages in all areas decreased from 0.0250% preimplementation to 0.0023% postimplementation with a p value less than 0.001. Collection turnaround times greater than 60 minutes decreased following implementation of specimen collection technology by 22% with a p value less than 0.001. The implementation of specimen collection technology has positive implications for social change, including the expectation that as technology is proven to significantly improve the safety and quality of laboratory collections, there will be a mandate for implementation of safer collection processes in healthcare.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-22T14:20:42Z No. of bitstreams: 2 Dissertacao_SimoneFranciscattoPanno.pdf: 24728642 bytes, checksum: 70b8361698b1e4342af3bd188424423e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-08-22T14:20:42Z (GMT). No. of bitstreams: 2 Dissertacao_SimoneFranciscattoPanno.pdf: 24728642 bytes, checksum: 70b8361698b1e4342af3bd188424423e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-11-30 / The correct identification of the patient is fundamental in the provision of safe care, being the first international safety goal of the World Health Organization. Protocols for patient identification in health services standardize actions and reduce the occurrence of errors. The general objective of this study was to evaluate the adherence of the professionals to the institutional protocol of identification of the patient, in the pediatric units of a teaching hospital. As specific objectives were considered: verify if the health care professionals identify the patients with bracelets; identification of the patient prior to care / procedures / transfers / discharge and educating / advising patients / caregivers on the correct identification, according to the protocol; verify the presence and general compliance of identification wristbands; and, produce a video emphasizing the importance of identification actions. A cross-sectional study was carried out, with a descriptive design and a quantitative approach. The population was composed by the health / support professionals, who worked in the care of patients of the Pediatric Emergency Room, the Pediatric Intensive Care Unit and the Pediatric Clinical and Surgical Unit of a teaching hospital in Rio Grande do Sul. The sample consisted of 385 opportunities of actions. At each opportunity, we sought: to verify if the patients were identified with bracelets - action 1; to observe if the professionals confer the identification of the patients - action 2; and, if the patients / companions were educated about the correct identification - action 3. Also, in the opportunities in which the bracelet was present, the conformity of the bracelet with the protocol was verified. Data collection took place from April to June 2017, through the completion of a research instrument. Data was entered into Excel 2007 spreadsheets and analyzed by descriptive statistics. The adhesion of professionals to action 1 was 74.28%, action 2 had no adhesion, and action 3 had adhesion of 2.08%. The bracelet was present at 82.85% of the opportunities and overall compliance was 12.22%. Regarding the location / fixation of the bracelet, compliance was 89.56%; in the presence of the three correct identifiers, 25.07% and, in the specifications, 69.29%. The findings contributed to establish the situational diagnosis of the professionals' adherence to the institutional protocol. In addition, it will enable the implementation of measures for compliance with the proposed actions and strengthening of the safety culture. The resulting product was a video aimed at informing and sensitizing health professionals / support, patients and caregivers as to the importance of the first goal. / A identificação correta do paciente é fundamental na prestação do cuidado seguro, sendo a primeira meta internacional de segurança da Organização Mundial da Saúde. Os protocolos para identificação do paciente nos serviços de saúde padronizam as ações e reduzem a ocorrência de erros. O objetivo geral deste estudo foi avaliar a adesão dos profissionais ao protocolo institucional de identificação do paciente, nas unidades pediátricas de um hospital de ensino. Como objetivos específicos foram considerados: verificar se os profissionais de saúde/apoio identificam os pacientes com pulseiras; se conferem a identificação do mesmo antes dos cuidados/procedimentos/transferências/alta e se educam/orientam os pacientes/ acompanhantes sobre a correta identificação, conforme o protocolo; verificar a presença e a conformidade geral das pulseiras de identificação; e, produzir um vídeo enfatizando a importância das ações de identificação. Realizou-se um estudo transversal, com delineamento descritivo e abordagem quantitativa. A população foi composta pelos profissionais de saúde/apoio, atuantes na assistência aos pacientes do Pronto Socorro Pediátrico, Unidade de Tratamento Intensivo Pediátrico e Unidade Pediátrica Clínica e Cirúrgica de um hospital de ensino do Rio Grande do Sul. A amostra foi constituída por 385 oportunidades de observação das ações. Em cada oportunidade buscou-se: verificar se os pacientes estavam identificados com pulseiras – ação 1; observar se os profissionais conferiam a identificação dos pacientes – ação 2; e, se realizavam a educação dos pacientes/acompanhantes sobre a identificação correta – ação 3. Também, nas oportunidades em que a pulseira estava presente foi verificada a conformidade da mesma com o protocolo. A coleta dos dados ocorreu de abril a junho de 2017, mediante o preenchimento de um instrumento de pesquisa. Os dados foram digitados em planilhas do Excel 2007 e analisados por estatística descritiva. A adesão dos profissionais à ação 1 foi de 74,28%, a ação 2 não teve adesão, já a ação 3 teve adesão de 2,08%. A pulseira estava presente em 82,85% das oportunidades e a conformidade geral foi de 12,22%. Em relação à localização/fixação da pulseira, a conformidade foi de 89,56%; na presença dos três identificadores corretos, 25,07% e, nas especificações, 69,29%. Os achados contribuíram para estabelecer o diagnóstico situacional da adesão dos profissionais ao protocolo institucional. Além disso, possibilitará a implementação de medidas em prol do cumprimento das ações propostas e fortalecimento da cultura de segurança. O produto resultante foi um vídeo com a finalidade de informar e sensibilizar os profissionais de saúde/apoio, paciente e acompanhantes, quanto à importância da primeira meta.

La problématique du transport de la donnée médicale, de surcroît nominative, comporte de nombreuses contraintes, qu’elles soient d’ordre technique, légale ou encore relationnelle. Les nouvelles technologies, issues particulièrement des grilles informatiques, permettent d’offrir une nouvelle approche au partage de l’information. En effet, le développement des intergiciels de grilles, notamment ceux issus du projet européen EGEE, ont permis d’ouvrir de nouvelles perspectives pour l’accès distribué aux données. Les principales contraintes d’un système de partage de données médicales, outre les besoins en termes de sécurité, proviennent de la façon de recueillir et d’accéder à l’information. En effet, la collecte, le déplacement, la concentration et la gestion de la donnée, se fait habituellement sur le modèle client-serveur traditionnel et se heurte à de nombreuses problématiques de propriété, de contrôle, de mise à jour, de disponibilité ou encore de dimensionnement des systèmes. La méthodologie proposée dans cette thèse utilise une autre philosophie dans la façon d’accéder à l’information. En utilisant toute la couche de contrôle d’accès et de sécurité des grilles informatiques, couplée aux méthodes d’authentification robuste des utilisateurs, un accès décentralisé aux données médicales est proposé. Ainsi, le principal avantage est de permettre aux fournisseurs de données de garder le contrôle sur leurs informations et ainsi de s’affranchir de la gestion des données médicales, le système étant capable d’aller directement chercher la donnée à la source.L’utilisation de cette approche n’est cependant pas complètement transparente et tous les mécanismes d’identification des patients et de rapprochement d’identités (data linkage) doivent être complètement repensés et réécris afin d’être compatibles avec un système distribué de gestion de bases de données. Le projet RSCA (Réseau Sentinelle Cancer Auvergne – www.e-sentinelle.org) constitue le cadre d’application de ce travail. Il a pour objectif de mutualiser les sources de données auvergnates sur le dépistage organisé des cancers du sein et du côlon. Les objectifs sont multiples : permettre, tout en respectant les lois en vigueur, d’échanger des données cancer entre acteurs médicaux et, dans un second temps, offrir un support à l’analyse statistique et épidémiologique. / Nominative medical data exchange is a growing challenge containing numerous technical, legislative or relationship barriers. New advanced technologies, in the particular field of grid computing, offer a new approach to handle medical data exchange. The development of the gLite grid middleware within the EGEE project opened new perspectives in distributed data access and database federation. The main requirements of a medical data exchange system, except the high level of security, come from the way to collect and provide data. The original client-server model of computing has many drawbacks regarding data ownership, updates, control, availability and scalability. The method described in this dissertation uses another philosophy in accessing medical data. Using the grid security layer and a robust user access authentication and control system, we build up a dedicated grid network able to federate distributed medical databases. In this way, data owners keep control over the data they produce.This approach is therefore not totally straightforward, especially for patient identification and medical data linkage which is an open problem even in centralized medical systems. A new method is then proposed to handle these specific issues in a highly distributed environment. The Sentinelle project (RSCA) constitutes the applicative framework of this project in the field of cancer screening in French Auvergne region. The first objective is to allow anatomic pathology reports exchange between laboratories and screening structures compliant with pathologists’ requirements and legal issues. Then, the second goal is to provide a framework for epidemiologists to access high quality medical data for statistical studies and global epidemiology.

Introdução: A identificação inequívoca do paciente é um componente essencial na atenção à saúde e determinante para garantir uma assistência segura e de qualidade. Objetivo geral: Avaliar o protocolo de identificação por meio das pulseiras das mulheres admitidas na Clínica Obstétrica e dos neonatos no Centro Obstétrico em um hospital universitário do Município de São Paulo. Método: Estudo quantitativo, exploratório, descritivo e prospectivo, realizado na Clínica Obstétrica e no Centro Obstétrico, em um hospital universitário de atenção terciária. A casuística correspondeu a 800 oportunidades de observação, selecionadas por amostragem probabilística aleatória simples. A coleta de dados ocorreu entre setembro de 2013 e março de 2014, conforme um formulário, contendo os itens das três etapas do protocolo de identificação: presença e quantitativo de pulseiras, componentes de identificação e condições da pulseira. A análise foi baseada na estatística descritiva e inferencial, com significância de 5%. Resultados: A conformidade geral do protocolo na Clínica Obstétrica correspondeu a 58,5% e no Centro Obstétrico a 22,3%. Quanto às três etapas, na Clínica Obstétrica, a maior conformidade foi nos componentes de identificação (93,4%) e a menor, condições da pulseira (70%). No Centro Obstétrico, a maior conformidade também foi nos componentes de identificação (69%), e a menor, condições da pulseira (44,5%), com diferença estatística significante p<0,001. Quanto aos itens avaliados na Clínica Obstétrica, nas três etapas, os melhores foram: a presença do registro hospitalar (99,5%) e o número sequencial do parto (98,3%); no Centro Obstétrico, a presença das pulseiras plásticas, do código de barras (100%) e do nome e sobrenome maternos (99%). Os piores índices de conformidade na Clínica Obstétrica corresponderam à legibilidade (76,1%) e às condições de uso da pulseira (80,3%); no Centro Obstétrico, foram as condições de uso (46,3%) e pulseiras no membro preconizado (55,2%). Na comparação entre as duas unidades, quanto à conformidade geral, houve diferença estatisticamente significante, p<0,001. Conclusão: Os achados possibilitaram retratar que há necessidade de elevar os índices de conformidade na Clínica Obstétrica na primeira e terceira etapas e nas três etapas do Centro Obstétrico. Outrossim, ratificam a relevância do monitoramento sistemático dos protocolos institucionais, possibilitando a implementação de medidas corretivas e preventivas no processo de identificação, visando a estabelecer metas assistenciais e gerenciais para a melhoria contínua da qualidade e segurança do binômio mãe-filho, dos profissionais de saúde e da instituição / Introduction: The unequivocal identification of the patient is an essential component in health care and crucial to ensure safe and quality care. General Objective: To assess the identification protocol by means of bracelets for women admitted to the Obstetric Clinic and for newborns at the obstetric center in a university hospital in the city of São Paulo. Methodology: Study quantitative, exploratory-descriptive and prospective study conducted in the Obstetric Clinic and Obstetric Center, in a university hospital of tertiary care. The sample corresponded to 800 opportunities of observation, selected by simpler random probability sampling. Data collection occurred between September 2013 and March 2014, according to a form containing the items of the three stages of the identification protocol: presence and quantity of bracelets, identification components and bracelet conditions. The analysis was based on descriptive and inferential statistics, with 5% significance. Results: The overall compliance to the protocol was as follows: Obstetric Clinic accounted for 58.5% and 22.3% for Obstetric Center. Regarding the three stages, in Obstetric Clinic, the major compliance was assigned to the identification components (93.4%) and the minor to bracelet conditions (70.0%). In Obstetric Center, the main conformity was related to identification components (69.0%) and the minor regarding to bracelet conditions (44.5%), showing a statistically significant difference p<0.001. Regarding the items in the three stages of the Obstetric Clinic, the best was the presence of hospital records (99.5%) and the sequential number regarding child birth (98.3%); in the Obstetric Center, the presence of plastic bracelets, bar code (100.0%), maternal name and surname (99.0%). The worst compliance rates in Obstetric Clinic corresponded to legibility (76.1%) and the bracelet conditions of use (80.3%) and in the Obstetric Center, conditions of use (46.3%) and bracelets in the recommended member (55.2%). Comparing the two units, on the topic of the overall compliance, a statistically significant difference, p <0.001 was observed. Conclusion: The findings allowed verifying the need to improve compliance rates in Obstetric Clinic in the first and third stages and in the three steps of the Obstetric Center. Also, showed the relevance of systematic monitoring of institutional protocols, enabling the implementation of corrective and preventive measures in the identification process aiming to establish care and management goals for the continuous improvement of quality and safety of mother and child, health professionals and the institution

Introdução: A identificação inequívoca do paciente é um componente essencial na atenção à saúde e determinante para garantir uma assistência segura e de qualidade. Objetivo geral: Avaliar o protocolo de identificação por meio das pulseiras das mulheres admitidas na Clínica Obstétrica e dos neonatos no Centro Obstétrico em um hospital universitário do Município de São Paulo. Método: Estudo quantitativo, exploratório, descritivo e prospectivo, realizado na Clínica Obstétrica e no Centro Obstétrico, em um hospital universitário de atenção terciária. A casuística correspondeu a 800 oportunidades de observação, selecionadas por amostragem probabilística aleatória simples. A coleta de dados ocorreu entre setembro de 2013 e março de 2014, conforme um formulário, contendo os itens das três etapas do protocolo de identificação: presença e quantitativo de pulseiras, componentes de identificação e condições da pulseira. A análise foi baseada na estatística descritiva e inferencial, com significância de 5%. Resultados: A conformidade geral do protocolo na Clínica Obstétrica correspondeu a 58,5% e no Centro Obstétrico a 22,3%. Quanto às três etapas, na Clínica Obstétrica, a maior conformidade foi nos componentes de identificação (93,4%) e a menor, condições da pulseira (70%). No Centro Obstétrico, a maior conformidade também foi nos componentes de identificação (69%), e a menor, condições da pulseira (44,5%), com diferença estatística significante p<0,001. Quanto aos itens avaliados na Clínica Obstétrica, nas três etapas, os melhores foram: a presença do registro hospitalar (99,5%) e o número sequencial do parto (98,3%); no Centro Obstétrico, a presença das pulseiras plásticas, do código de barras (100%) e do nome e sobrenome maternos (99%). Os piores índices de conformidade na Clínica Obstétrica corresponderam à legibilidade (76,1%) e às condições de uso da pulseira (80,3%); no Centro Obstétrico, foram as condições de uso (46,3%) e pulseiras no membro preconizado (55,2%). Na comparação entre as duas unidades, quanto à conformidade geral, houve diferença estatisticamente significante, p<0,001. Conclusão: Os achados possibilitaram retratar que há necessidade de elevar os índices de conformidade na Clínica Obstétrica na primeira e terceira etapas e nas três etapas do Centro Obstétrico. Outrossim, ratificam a relevância do monitoramento sistemático dos protocolos institucionais, possibilitando a implementação de medidas corretivas e preventivas no processo de identificação, visando a estabelecer metas assistenciais e gerenciais para a melhoria contínua da qualidade e segurança do binômio mãe-filho, dos profissionais de saúde e da instituição / Introduction: The unequivocal identification of the patient is an essential component in health care and crucial to ensure safe and quality care. General Objective: To assess the identification protocol by means of bracelets for women admitted to the Obstetric Clinic and for newborns at the obstetric center in a university hospital in the city of São Paulo. Methodology: Study quantitative, exploratory-descriptive and prospective study conducted in the Obstetric Clinic and Obstetric Center, in a university hospital of tertiary care. The sample corresponded to 800 opportunities of observation, selected by simpler random probability sampling. Data collection occurred between September 2013 and March 2014, according to a form containing the items of the three stages of the identification protocol: presence and quantity of bracelets, identification components and bracelet conditions. The analysis was based on descriptive and inferential statistics, with 5% significance. Results: The overall compliance to the protocol was as follows: Obstetric Clinic accounted for 58.5% and 22.3% for Obstetric Center. Regarding the three stages, in Obstetric Clinic, the major compliance was assigned to the identification components (93.4%) and the minor to bracelet conditions (70.0%). In Obstetric Center, the main conformity was related to identification components (69.0%) and the minor regarding to bracelet conditions (44.5%), showing a statistically significant difference p<0.001. Regarding the items in the three stages of the Obstetric Clinic, the best was the presence of hospital records (99.5%) and the sequential number regarding child birth (98.3%); in the Obstetric Center, the presence of plastic bracelets, bar code (100.0%), maternal name and surname (99.0%). The worst compliance rates in Obstetric Clinic corresponded to legibility (76.1%) and the bracelet conditions of use (80.3%) and in the Obstetric Center, conditions of use (46.3%) and bracelets in the recommended member (55.2%). Comparing the two units, on the topic of the overall compliance, a statistically significant difference, p <0.001 was observed. Conclusion: The findings allowed verifying the need to improve compliance rates in Obstetric Clinic in the first and third stages and in the three steps of the Obstetric Center. Also, showed the relevance of systematic monitoring of institutional protocols, enabling the implementation of corrective and preventive measures in the identification process aiming to establish care and management goals for the continuous improvement of quality and safety of mother and child, health professionals and the institution

yes / In the health care systems, a high security level is required to protect extremely sensitive patient records. The goal is to provide a secure access to the right records at the right time with high patient privacy. As the most accurate biometric system, the iris recognition can play a significant role in healthcare applications for accurate patient identification. In this paper, the corner stone towards building a fast and robust iris recognition system for healthcare applications is addressed, which is known as iris localization. Iris localization is an essential step for efficient iris recognition systems. The presence of extraneous features such as eyelashes, eyelids, pupil and reflection spots make the correct iris localization challenging. In this paper, an efficient and automatic method is presented for the inner and outer iris boundary localization. The inner pupil boundary is detected after eliminating specular reflections using a combination of thresholding and morphological operations. Then, the outer iris boundary is detected using the modified Circular Hough transform. An efficient preprocessing procedure is proposed to enhance the iris boundary by applying 2D Gaussian filter and Histogram equalization processes. In addition, the pupil’s parameters (e.g. radius and center coordinates) are employed to reduce the search time of the Hough transform by discarding the unnecessary edge points within the iris region. Finally, a robust and fast eyelids detection algorithm is developed which employs an anisotropic diffusion filter with Radon transform to fit the upper and lower eyelids boundaries. The performance of the proposed method is tested on two databases: CASIA Version 1.0 and SDUMLA-HMT iris database. The Experimental results demonstrate the efficiency of the proposed method. Moreover, a comparative study with other established methods is also carried out.