The aim of this thesis is to examine the contributory factors in drug errors and their reporting so as to design an enhanced reporting scheme to improve the quality of reporting in an acute hospital trust. The related research questions are: 1. What are the contributory factors in drug errors? 2. How effective is the reporting of drug errors? 3. Can an enhanced reporting scheme, predicated on the analysis of local documentary and interview data, identify the contributory factors in drug errors and improve the quality of their reporting in an acute hospital trust? The study aim and research questions reflect a growing consensus, articulated by Boaden and Walshe (2006), that patient safety research should focus on understanding the causes of adverse events and developing interventions to improve safety. Although there are concerns about the value of incident reporting (Wald & Shojania 2003, Armitage & Chapman 2007), it would appear that error reporting systems remain a high priority in advancing patient safety (Kohn et al 2000, Department of Health 2000a, National Patient Safety Agency 2004, WHO & World Alliance for Patient Safety 2004), and consequently it is the area chosen for intervention in this study. Enhancement of the existing scheme is based on a greater understanding of drug errors, their causation, and their reporting.

The aim of this thesis is to examine the contributory factors in drug errors and their reporting so as to design an enhanced reporting scheme to improve the quality of reporting in an acute hospital trust. The related research questions are: 1. What are the contributory factors in drug errors? 2. How effective is the reporting of drug errors? 3. Can an enhanced reporting scheme, predicated on the analysis of local documentary and interview data, identify the contributory factors in drug errors and improve the quality of their reporting in an acute hospital trust? The study aim and research questions reflect a growing consensus, articulated by Boaden and Walshe (2006), that patient safety research should focus on understanding the causes of adverse events and developing interventions to improve safety. Although there are concerns about the value of incident reporting (Wald & Shojania 2003, Armitage & Chapman 2007), it would appear that error reporting systems remain a high priority in advancing patient safety (Kohn et al 2000, Department of Health 2000a, National Patient Safety Agency 2004, WHO & World Alliance for Patient Safety 2004), and consequently it is the area chosen for intervention in this study. Enhancement of the existing scheme is based on a greater understanding of drug errors, their causation, and their reporting.

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Made available in DSpace on 2014-07-29T15:18:18Z (GMT). No. of bitstreams: 1 dis pedro r r adriano geotec - pre text.pdf: 293347 bytes, checksum: 0d38b1697ea8493167fcf7f1b15fd61a (MD5) Previous issue date: 2009-09-29 / The main objective of this research is to investigate a three-dimensional (3D) slope stability analysis technique using the enhanced limit equilibrium method. The other objectives are to evaluate the practical applicability of the 3D analysis method, to interpret the physical significance of 3D stress states to the stability of a slope, and to determine the relationship between two-dimensional and three-dimensional factors of safety. For that, a computer program called SAFE3D was developed. The computer program is used to calculate the three-dimensional factor of safety (FS3D) for pre-established slip surfaces with spherical or ellipsoidal shape. The computer program is based on the two-dimensional analysis method proposed by Kulhawy, combined with an extension of this theory to 3D conditions that is proposed herein. The method developed consists in determining the in-situ stress fields by means of an elastic 3D stress-strain analysis using the finite element method. The 3D stress fields are then used to calculate the normal and shear stresses along any pre-determined slip surface and to determine the value of FS3D. Two slope stability problems widely studied by other researchers were analyzed in order to validate the program SAFE3D. The first problem corresponds to a symmetric cohesive slope and the second problem corresponds to a non-symmetric slope with cohesion and friction. Excellent results were obtained, suggesting that the program SAFE3D is efficient, stable, and robust for the problems studied. The values of FS3D obtained herein are similar to the values presented by other authors using distinct methods of analysis. A parametric study was carried out considering the shape of the slip surface and the shape of the face of the slope, including concave and convex slopes. The results indicate that the values of FS3D are always higher than the two-dimensional factor of safety (FS2D) of the intermediate surface. The value of FS3D decreased for slip surfaces extended across the sliding direction and approached the value of FS2D. It was determined that the Poisson's ratio has an important influence on the FS3D. The value of FS3D increases with the increase of Poisson's ratio. This influence varies with the geometry of the problem and the treatment given to the cinematically inadmissible shear stresses. Finally, a 3D analysis of the historic case of Lodalen is presented. The results indicate that the FS3D at the time of the slide is slightly higher and approaches 1 if the less favorable shear strength parameters determined by previous studies are used. In this case, the values obtained for FS2D are considerably smaller than 1, thereby indicating the potential superiority of the 3D approach. / Esta dissertação tem por objetivo principal investigar uma técnica de análise tridimensional (3D) de estabilidade de taludes pelo método do equilíbrio limite aperfeiçoado. É também objetivo deste trabalho avaliar a aplicabilidade prática do método de análise 3D, interpretar a significância física do estado de tensões 3D na estabilidade de taludes e determinar a relação entre os fatores de segurança bidimensional e tridimensional. Para tal, foi desenvolvido um programa computacional denominado SAFE3D. O programa permite o cálculo do fator de segurança tridimensional (FS3D), considerando superfícies de ruptura pré-estabelecidas, com formato esférico ou elipsoidal. O programa é baseado no método de análise bidimensional proposto por Kulhawy, sendo proposta aqui uma extensão deste método para condições 3D. O método desenvolvido consiste na determinação dos campos de tensões in-situ por meio de análises tensão-deformação 3D elásticas pelo método dos elementos finitos. Os campos de tensões 3D assim determinados são utilizados para o cálculo das tensões normais e cisalhantes ao longo de uma superfície de ruptura qualquer, pré-determinada, e para a determinação do FS3D. Para validar o programa SAFE3D foram feitas análises de dois problemas amplamente estudados por outros pesquisadores, o primeiro correspondendo a um talude simétrico coesivo e o segundo a um talude não-simétrico com coesão e atrito. Foram obtidos excelentes resultados, que sugerem que o programa SAFE3D é eficiente, estável e robusto para os problemas estudados. Os valores de FS3D obtidos são semelhantes àqueles obtidos por outros autores, utilizando métodos distintos. Foram realizadas também baterias de análises paramétricas, considerando o formato da superfície de ruptura e o formato da face do talude, incluindo taludes côncavos e convexos. Os resultados indicam que o FS3D é sempre superior ao fator de segurança bidimensional (FS2D) da superfície intermediária. O valor de FS3D diminuiu para superfícies de ruptura alongadas transversalmente à direção de ruptura, tendendo ao valor de FS2D. Foi determinado que o coeficiente de Poisson possui importante influência no FS3D, sendo que o FS3D cresce com o aumento do coeficiente de Poisson. Tal influência varia de acordo com a geometria do problema e com o tratamento dado às tensões cisalhantes cinematicamente inadmissíveis. Finalmente, é apresentada uma análise 3D do caso histórico de Lodalen. Os resultados obtidos indicam que o FS3D no momento da ruptura é ligeiramente superior e se aproxima de 1, caso sejam utilizados os parâmetros de resistência menos favoráveis, determinados pelos estudos originais. Neste caso, os valores de FS2D são consideravelmente inferiores a 1, indicando a potencial superioridade da abordagem 3D.

Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture.

The diploma thesis deals with an application of partial reliability coefficients of reliability in assessing the safety of water works. The reliability factors are the quantitative condition of the marginal equilibrium. A more detailed study of the methods of the marginal equilibrium method led to an assessment of the overall and local stability of the Vranov Dam. The baseline for the evaluation were the data provided by the Technical Surveillance (TBD) and available literature. The GeoStudio 2018 was used to calculate the loads on the Vranov waterworks. The model of the groundwater flow in the subsoil was calculated by the Seep/W module and the Sigma/W module was used to determine the local stresses. Subsequently, the selection of partial reliability coefficients and theirs subsequent application to the limit equilibrium conditions were performed. Stability assessments were complemented by calculations of safety factors. The results were compared with each other.

Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture.

Traffic safety has been considered one of the most important issues in the transportation field. Crashes have caused extensive human and economic losses. With the objective of reducing crash occurrence and alleviating crash injury severity, major efforts have been dedicated to reveal the hazardous factors that affect crash occurrence. With these consistent efforts, both fatalities and fatality rates from road traffic crashes in many countries have been steadily declining over the last ten years. Nevertheless, according to the World Health Organization, the world still lost 1.24 million lives from road traffic crashes in the year of 2013. And without action, traffic crashes on the roads network are predicted to result in deaths of around 1.9 million people, and up to 50 million more people suffer non-fatal injuries annually, with many incurring a disability as a result of their injury by the year 2020. To meet the transportation needs, the use of expressways (toll roads) has risen dramatically in many countries in the past decade. In fact, freeways and expressways are considered an important part of any successful transportation system. These facilities carry the majority of daily trips on the transportation network. Although expressways offer high level of service, and are considered the safest among other types of roads, traditional toll collection systems may have both safety and operational challenges. The traditional toll plazas still experience many crashes, many of which are severe. Therefore, it becomes more important to evaluate the traffic safety impacts of using different tolling systems. The main focus of the research in this dissertation is to provide an up-to-date safety impact of using different toll collection systems, as well as providing safety guidelines for these facilities to promote safety and enhance mobility on expressways. In this study, an extensive data collection was conducted that included one hundred mainline toll plazas located on approximately 750 miles of expressways in Florida. Multiple sources of data available online maintained by Florida Department of Transportation were utilized to identify traffic, geometric and geographic characteristics of the locations as well as investigating and determination of the most complete and accurate data. Different methods of observational before-after and Cross-Sectional techniques were used to evaluate the safety effectiveness of applying different treatments on expressways. The Before-After method includes Naive Before-After, Before-After with Comparison Group, and Before-After with Empirical Bayesian. A set of Safety Performance Functions (SPFs) which predict crash frequency as a function of explanatory variables were developed at the aggregate level using crash data and the corresponding exposure and risk factors. Results of the aggregate traffic safety analysis can be used to identify the hazardous locations (hot spots) such as traditional toll plazas, and also to predict crash frequency for untreated sites in the after period in the Before-After with EB method or derive Crash Modification Factors (CMF) for the treatment using the Cross-Sectional method. This type of analysis is usually used to improve geometric characteristics and mainly focus on discovering the risk factors that are related to the total crash frequency, specific crash type, and/or different crash severity levels. Both simple SPFs (with traffic volume only as an explanatory variable) and full SPFs (with traffic volume and additional explanatory variable(s)) were used to estimate the CMFs and only CMFs with lower standard error were recommended. The results of this study proved that safety effectiveness was significantly improved across all locations that were upgraded from Traditional Mainline Toll Plazas (TMTP) to the Hybrid Mainline Toll Plazas (HMTP) system. This treatment significantly reduced total, Fatal-and-Injury (F+I), and Rear-End crashes by 47, 46 and 65 percent, respectively. Moreover, this study examined the traffic safety impact of using different designs, and diverge-and-merge areas of the HMTP. This design combines either express Open Road Tolling (ORT) lanes on the mainline and separate traditional toll collection to the side (design-1), or traditional toll collection on the mainline and separate ORT lanes to the side (design-2). It was also proven that there is a significant difference between these designs, and there is an indication that design-1 is safer and the majority of crashes occurred at diverge-and-merge areas before and after these facilities. However, design-2 could be a good temporary design at locations that have low prepaid transponder (Electronic Toll Collection (ETC)) users. In other words, it is dependent upon the percentage of the ETC users. As this percentage increases, more traffic will need to diverge and merge; thus, this design becomes riskier. In addition, the results indicated significant relationships between the crash frequency and toll plaza types, annual average daily traffic, and drivers* age. The analysis showed that the conversion from TMTP to the All-Electronic Toll Collection (AETC) system resulted in an average reduction of 77, 76, and 67 percent for total, F+I, and Property Damage Only (PDO) crashes, respectively; for rear end and Lane Change Related (LCR) crashes the average reductions were 81 and 75 percent, respectively. The conversion from HMTP to AETC system enhanced traffic safety by reducing crashes by an average of 23, 29 and 19 percent for total, F+I, and PDO crashes; also, for rear end and LCR crashes, the average reductions were 15 and 21 percent, respectively. Based on these results, the use of AETC system changed toll plazas from the highest risk sections on Expressways to be similar to regular segments. Therefore, it can be concluded that the use of AETC system was proven to be an excellent solution to several traffic operations as well as environmental and economic problems. For those agencies that cannot adopt the HMTP and the AETC systems, improving traffic safety at traditional toll plazas should take a priority. This study also evaluates the safety effectiveness of the implementation of High-Occupancy Toll lanes (HOT Lanes) as well as adding roadway lighting to expressways. The results showed that there were no significant impact of the implementation of HOT lanes on the roadway segment as a whole (HOT and Regular Lanes combined). But there was a significant difference between the regular lanes and the HOT lanes at the same roadway segment; the crash count increased at the regular lanes and decreased at the HOT lanes. It was found that the total and F+I crashes were reduced at the HOT lanes by an average of 25 and 45 percent, respectively. This may be attributable to the fact that the HOT lanes became a highway within a highway. Moreover adding roadway lighting has significantly improved traffic safety on the expressways by reducing the night crashes by approximately 35 percent. Overall, the proposed analyses of the safety effectiveness of using different toll collection systems are useful in providing expressway authorities with detailed information on where countermeasures must be implemented. This study provided for the first time an up-to-date safety impact of using different toll collection systems, also developed safety guidelines for these systems which would be useful for practitioners and roadway users.