Patient Safety: Improving Medication Reconciliation Accuracy for Long-Term Care Residents by Annisa L. Stover MSN, Southern University, 2008 BSN, Our Lady of the Lake College, 2005 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 During transition of care, inaccurate medication reconciliation is associated with increased risk of adverse events for patients. Older adults are the population most often affected by medication errors, and long-term care facilities struggle to accurately document medication reconciliation. Errors are more common at hospital discharge, but the critical moment for detecting and resolving them is during hospital or long-term care admission. Guided by Rosswurm and Larrabee's model for change, Rogers' diffusion of innovation, and the Multi-Center Medication Reconciliation Quality Improvement toolkit, a 6-member interdisciplinary team composed of nurses, pharmacists, and institutional stakeholders was mobilized to develop policy and practice guidelines as well as secondary documentation necessary to implement and evaluate a quality improvement initiative to address medication reconciliation. Current evidence was explored and used to develop policy and practice guidelines for medication reconciliation, then submitted to 4 scholars, including 2 practice experts, a nurse administrator, and a specialist in pharmacy, to validate content. Scholarly validation supported the premise that the developed products would be beneficial in the accurate documentation of medication reconciliation. Scholarly feedback was evaluated by comparing to current best practices for medication reconciliation. Implementation, education, and evaluation plans were developed to guide operationalization of policy and practice guidelines. This project may positively affect social change by fostering a new practice policy, practice guidelines, and supporting documents to manage medication reconciliation of long-term care residents transitioning to acute care settings, thereby improving medication safety at transitions of care for vulnerable populations.

The most important factor in increasing the competitiveness of enterprises is to improve the quality of management, including through the use of information systems used on the basis of improving the assessment of the effectiveness of information systems in the gas industry. Such systems are the software implementation of modern management standards, which are understood as a standard for the functional consideration of processes (production, logistics, Finance, marketing, Economics) and their results in relation to each other. These standards make it possible to organize and synchronize business processes in real time. The purpose of the master's thesis is to Improve the assessment of the effectiveness of information systems in the gas industry. Educational and research literature, results of empirical research, and corporate statistics were used as sources. The master's thesis developed an algorithm for preliminary evaluation of the effectiveness of information systems in the gas industry, which allows to conduct a comprehensive assessment of the effectiveness of the use of IP through the decomposition of business processes with the calculation of forecast and cost indicators of each business operation, which allows you to choose the IP with the best efficiency. / Важнейшим фактором повышения конкурентоспособности предприятий является улучшение качества управления, в том числе за счет применения информационных систем, используемых на основе совершенствования ..оценки эффективности использования информационных систем на предприятиях газовой промышленности. Подобные системы являются программной реализацией современных стандартов управления, под которыми понимается стандарт функционального рассмотрения процессов (производства, логистики, финансов, маркетинга, экономики) и их результатов во взаимосвязи. Эти стандарты дают возможность упорядочить и синхронизировать бизнес-процессы в реальном времени. Целью магистерской диссертации является Совершенствование оценки эффективности использования информационных систем на предприятиях газовой промышленности. В качестве источников использовалась учебно-методическая и научно-исследовательская литература, результаты эмпирических исследований и данные корпоративной статистики. В магистерской диссертации был разработан алгоритм предварительной оценки эффективности использования информационных систем на предприятиях газовой промышленности, позволяющий провести комплексную оценку эффективности использования ИС через декомпозицию бизнес-процессов с расчетом прогнозных и стоимостных показателей каждой бизнес операции, что позволяет выбрать ИС с наилучшей эффективность.

This study examines the historical evolution and legislative valuation of the National Teacher Certification Incentive Reward Program and Fund in the Commonwealth of Virginia. This fund offers stipends to teachers who earn National Board Certification from the National Board of Professional Teaching Standards. This research project included three steps of data collection. First, the legislative history of Virginia's National Teacher Certification Incentive Reward Program and Fund, which covered the General Assembly Session in 1999, was reviewed. The second step was open-ended interviews with legislators and a representative from the Virginia Education Association who participated in the creation of the "Fund." The third step was to collect and report the incentives that are offered by the local education agencies for teachers who earn National Board Certification. The study reported that the initial plan devised by the Carnegie Forum on Education and the Economy in the report, A Nation Prepared (1986) that National Board Certification was not implemented with fidelity in the Commonwealth of Virginia, according to the intended design when it pertained to both how to strategically use the skills of NBCTs and how to ensure NBCTs are working with the students most in need of help. As supported by the interview data, the study shows those interviewed value great teachers and are willing to support them with financial incentives. / Ed. D.

Web page loading time is one of the critical challenges on the Internet. This topic attracts more researchers as it largely reflects the user satisfaction. A web page resources typically consists of Hyper Text Markup Language (HTML), Cascading Style-Sheet (CSS), JavaScript (JS), media files, etc. As the complexity of the web page increases, the size of files fetched from server also increases which causes delay in transmitting, loading, parsing and rendering the web page. The web page is not rendered until HTML, CSS and JS files are loaded and parsed. Not all such files are needed to be rendered for the first page. Optimizing and loading only critical les required for the first page, can considerably reduce time taken to load the web page. After the first page is rendered, the rest of the files can be loaded and executed. In this thesis, we focus on improving the time taken for First Meaningful Paint(FMP) of website by loading the critical files initially. We used Design Science Research( DSR) methodology and created a PhantomJS application, to identify and segregate used and unused CSS for the first meaningful paint of the web page. We also analyzed script files to load only critical files required for FMP and the rest later. We evaluated our experiment by studying a case on Axis Communications AB and measured its website's performance to find if our experiment reduced FMP time. It showed improvement in time taken for FMP from 1284ms to 372.6ms. Based on the results, we suggest to web developers to separate and load the files required for FMP and load the rest of the files needed for the website later, so that the first page is rendered quickly.

Text in Afrikaans, abstract in Afrikaans and English / Die nie-nakoming van onderhoudsbevele is 'n universele problem. Wereldwyd word daar gedurig pogings aangewend om by wyse van wetgewing effektiewer afdwinging van onderhoudsbevele te bewerkstellig. Op 1 Maart 1992 het die wetgewer hier te lande 'n aantal nuwe maatreels vir hierdie doel beliggaam in die Wysigingswet op Onderhoud, 2 van 1991, wat op genoemde datum in werking getree het. 'n Ondersoek is gedoen by die Johannesburgse Landdroshof waar 'n studie gemaak is van 2,248 afgehandelde sake en strek oor die periode 1Maart 1992 tot 31Augustus1995. Die ondersoek bring aan die lig dat die bepalings van genoemde Wysigingswet op Onderhoud, wat gerig is op effektiewer afdwinging van onderhoudsbevele, nie 'n noemenswaardige verbetering in effektiewer afdwinging van hierdie bevele in die praktyk tot gevolg gehad het nie. Dit blyk dat die meeste howe geneig is om belangrike afdwingingsmeganismes soos besoldigingsbeslag bevele en lasbriewe vir eksekusie oor die hoof sien. Kritiek word uitgespreek op sommige van hierdie bepalings en voorstelle word gemaak hoe relatiewe geringe wysigings daaraan effektiewer afdwinging van onderhoudsbevele kan bewerkstellig. Daar word kortliks verwys na die afdwinging van onderhoudsbevele in antler regstelsels en hoe hulle poog om effektiewer afdwinging van onderhoudsbevele te bewerkstellig. / The ineffective enforcement of maintenance orders appears to be a world wide phenomenon. Legislators here and aboard are always attempting to improve the effectiveness of maintenance collection and enforcement methods. Research done at the Johannesburg Magistrate's Court involving 2,248 cases covering the period 1 March 1992 to 31 August 1995 reveals that the Maintenance Amendment Act, 2 of 1991, which is aimed at improving the enforcement of maintenance orders had a negligible effect on enforcement mechanisms used by the courts. It appears that most courts are inclined to overlook important collection methods such as garnishee and attachment orders. Criticism is levelled at certain provisions contained in the Maintenance Act, 23 of 1963, as amended. Suggestions are made how relatively simple amendments would contribute to more effective enforcement of maintenance orders. A brief survey is made of attempts by some Western countries to improve the manner of maintenance collection. / Private Law / LL. M. (Law)

This thesis critically examines a national programme in mental health which has been driven by the implementation of National Institute of Health and Clinical Excellence (NICE) guidance. Assumptions which underpin research method, drawn from the natural sciences, are critiqued in terms of their adequacy in accounting for human relating and expert therapeutic practice. The work of Dreyfus and Dreyfus (1986) is problematized in how they account for proficiency and expertise as intuition and the leap that they make from calculative to deliberative rationality. An alternative source of understanding, based on non-linear causality and complex responsive processes, is developed, building on the work of Stacey (2001, 2005, 2007). The ineffability of expert practice (or clinical judgement) is contrasted with competence based, rule governed practice, which necessarily underpins the early stages of learning. It is argued that because research practices undertaken in randomised controlled trials (RCTs) must be describable, measurable and focussed on predictable outcomes, then these cannot account for expert practice, therefore the assertion that the Improving Access to Psychological Therapies programme (IAPT) is wholly based on research based, evidence based therapies, cannot be substantiated. The work explores professionalism and specifically considers the role of psychiatrists, psychologists and psychological therapists in mental health and in increasing access to psychological therapies. The role of managers and managerialism are explored, specifically how the NHS has sought to manage 3 professional staff and multi-disciplinary teams in adopting corporate and new ways of working (NWW). This includes the importance of and difficulty in countering professional identity using competence based approaches. The performance management processes in the NHS are recognised as an equally relevant source of evidence (to that of NICE), despite there being a poor (traditional) evidence base for it (Stacey, 2010; Seddon, 2008). Power relating in human relationships is identified as immanent, using the context of a management group, and it is argued that Foucault’s concept of disciplinary power (1994) can account for what is considered to be knowledge and truth, drawing on specialist expertise based on science and research, with a forceful potential for rendering others silent as well as pervasively self-silencing, in processes of inclusion and exclusion (Elias, 1978). It is argued that these on-going processes of relating influence policy decisions at national and local levels and how these policies are implemented in practice. The inevitability of unpredictable outcomes is highlighted, despite strong centralised programme management along with the provision of an explicit blueprint for implementation.

Thesis (MBA (Business Management))--University of Stellenbosch, 2007. / ENGLISH ABSTRACT: Globalisation has changed markets significantly. In order to maintain and improve competitiveness it is generally agreed among executives that the quality of products and services is essential (Omachonu & Ross, 1994: iii). In order to strive for higher quality, organisations have chosen different paths to achieve this goal. Several years ago one of the most discussed topics was the DIN EN 9001 certification. Thousands of organisations have taken this step towards quality management and are certified today. The DIN EN 9001 became the global standard, and there are markets where companies are not able to operate without this certification anymore. Some companies have profited greatly from the introduction of ISO 9000, because for the first time a quality management system (QMS) was introduced. It initiated significant restructuring programs. Consequently, processes were streamlined and organisations became more transparent. But many companies still do not “live” the concept, but instead and only show relevant paperwork to the external certification body in order to obtain the certificate. Even more particularly companies, which live the QMS face the question of which concepts are suitable to not only further improve quality and productivity but also to generate long-term sustainable business success. For these companies Total Quality Management (TQM) can be a very promising concept. Although the concept of TQM already dates back several decades it became very popular recently. TQM is a concept that puts quality in the centre of all aspects. Its principles encompass the involvement of all employees, and it strives for long-term customer satisfaction. TQM is based on continuous improvement and focuses on sustainable achievements. The objectives of this approach are not only long-term business success but also benefits for the individual employees and the society. Therefore TQM can be considered as one of the most far-reaching quality concepts existing today. The Fliess Company is a medium sized production company for welding wires. In 2001 Fliess introduced the IS0 9001: 2000. It has taken the company several years to fully live the QMS, after it mainly introduced it only to satisfy customers’ requirements of the certification. Today the processes are aligned in accordance with ISO 9001: 2000 and the company lives the QMS. But as a producer of very specialised premium products, management realised that it needed continuing on in order to maintain the competitive advantage. Therefore Fliess is busy at present implementing TQM. There are various areas of applying TQM at Fliess. The main focus lies on further improving customer satisfaction through continuous improvement and special attention is paid to the involvement of the individual employee. But TQM needs to be implemented in a very careful way to prevent a failure. Organisational changes must be supervised closely by top management. If top management is not fully committed and does not fully support the implementation in both the short and long term it can be very frustrating for the employees, and the implementation will not only fail but might even have negative effects, too. / AFRIKAANSE OPSOMMING: Globalisasie het markte geweldig verander. Ten einde kompeterendheid te behou en te bevorder is bestuurders dit eens dat hoë kwaliteit van produkte en dienste noodsaaklik is (Omachonu & Ross, 1994: iii). Maatskappye volg verskillende roetes in die strewe na hoë kwaliteit, en hierdie ondersoek fokus op hoofkonsepte rakende kwaliteit en kwaliteitsbestuur. ’n Tydjie terug was die bespreking van “sertifisering” hoog op die agenda van enige kwaliteitsforum. Maatskappye het groot baat gevind met die bekendstelling van ISO 9000, waar daar vir die eerste keer ’n kwaliteitsbestuur program ingestel is. Dit het tot grootskaalse maatskappy verandering en proses herstrukturering gelei, en maatskappye in geheel het meer deursigtig geword. Duisende maatskappye het die stap geneem en is vandag gesertifiseer. Die DIN EN ISO 9000 het die globale standaard geword, en daar is markte waar maatskappye sonder diè sertifisering nie langer besigheid kan beoefen nie. Daar is egter steeds maatskappye wat nie regtig die stelsel “uitleef” nie, maar bloot sertifisering soek omdat kliënte dit vereis – nie omdat hulle self dit wil toepas nie. Selfs maatskappye wat die stelsels ten volle inkorporeer het staan egter voor die uitdaging van hoe hulle kwaliteit verder kan verbeter en op langtermyn ’n suksesvolle onderneming kan verseker. Vir baie van die maatskappye is Totale Kwaliteitbestuur (Total Quality Management - TQM) ’n belowende konsep. Alhoewel TQM konsepte reeds ’n hele aantal jare terug ontwikkel is, geniet dit huidiglik ’n nuwe oplewing. TQM plaas kwaliteit in die middelpunt van aktiwiteite, insluitende die volledige betrekking van werknemers en langtermyn kliënte tevredenheid. TQM is gebaseer op kontinue verbetering en fokus op volhoubaarheid. Die doelwitte sluit nie net langtermyn besigheidsukses in nie, maar ook voordele vir individuele werknemers en die samelewing in geheel. Dus kan TQM gesien word as een van die mees omvattende kwaliteitskonsepte wat huidiglik bestaan. Die ontwikkeling en toepassing van die konsepte soos bo beskryf word in hierdie verslag voorgestel en uitgelig aan die hand van die Fliess Maatskappy, ’n medium grootte vervaardigingsmaatskappy van sweisdrade. In 2001 het Fliess die ISO 9001:2000 standaard begin implementeer. Dit het ’n hele aantal jare geneem voordat die stelsel volledig benut is, nadat dit aanvanklik bloot op grond van kliëntevereistes ingestel is. Vandag kan daar met trots gesê word dat alle prosesse in lyn is met die sertifiseringsvereistes, en die maatskappy “lewe” die ISO 9001:2000 standaard. Bestuur besef egter die noodsaaklikheid om verder te ontwikkel en aan te pas in die hoogs kompeterende omgewing ten einde hulle kompeterende voordeel nie net te behou nie maar uit te bou. Daarom is Fliess besig om TQM beginsels verder uit te brei en in verskillende areas te implementeer om sodoende kliënte tevredenheid te verhoog – dit word gedoen deur veral deurlopende verbetering en die betrokkenheid van elke individuele werknemer.

O objetivo deste estudo foi analisar as repercussões da avaliação PMAQ-AB no processo de trabalho das equipes de saúde da família avaliadas. Para abordar esse objeto, utilizou-se como referencial teórico o processo de trabalho em saúde e a avaliação dos serviços de saúde no contexto da Atenção Primária à Saúde (APS), situando o Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). Trata-se de pesquisa qualitativa, na forma de estudo de caso, realizado no Departamento Regional de Saúde V - Barretos (DRS-V), cuja amostra foi constituída por dez profissionais. As entrevistas foram semiestruturadas e realizadas no local de trabalho. A análise das entrevistas seguiu a análise de conteúdo temática de Bardin. Tomou-se como referência o trabalho e o processo de trabalho, segundo Marx e Gonçalves, e os três elementos que o compõe: objeto, meio e finalidade. O PMAQ-AB apresentou-se como um instrumento capaz de induzir modificações, principalmente, relacionadas ao meio e às tecnologias duras e leve duras como: melhorias na infraestrutura, ampliação da oferta e redistribuição de área. Identificou-se o fortalecimento do trabalho vivo e das tecnologias leves no trabalho da equipe. Os resultados permitiram concluir que ele foi considerado em sua maioria; como uma ferramenta essencial para identificar lacunas no processo de trabalho, induzir reflexões críticas a partir da realidade vivenciada pelas equipes, e contribuiu para melhor organização do processo de trabalho. Os desafios encontrados pelas equipes foram a dificuldade de implantação das Práticas Integrativas e Complementares (PICs), a rotatividade dos profissionais, a falta de apoio institucional, a falta de apoio dos gestores e a carência em ações de educação permanente. Comprova-se neste estudo, algumas fragilidades do PMAQ-AB, como a forte relação entre o instrumento e o repasse de recursos financeiros, a falta de espaços para devolutiva dos dados, e a possibilidade de mascaramento das ações nas equipes. Considera-se que este estudo, pode contribuir para um novo olhar e para o desenvolvimento de novos trabalhos a partir da institucionalização da avaliação nos serviços de saúde, na visão dos avaliados que compõem este processo, e também para validar o instrumento de avaliação PMAQ-AB / The objective of this study was to analyze the repercussions of the PMAQ-AB evaluation in the work process of the family health teams evaluated. In order to approach this object, we use as theoretical reference, the work process in health and the evaluation of health services in the context of Primary Health Care (PHC), placing the Program of Improvement of Access and Quality of Primary Care (PMAQ-AB ). It is a qualitative research, in the form of a case study, carried out in the Regional Health Department V-Barretos (DRS-V), whose sample was constituted by ten professionals, the interviews were semi-structured and performed in the workplace. The analysis of the interviews followed the analysis of the thematic content of Bardin. According to Marx and Gonçalves, and the three elements that compose it: object, means and purpose, PMAQ-AB presented itself as an instrument capable of inducing changes mainly related to the environment and the hard and light technologies such as: infrastructure improvements, supply expansion and area redistribution. We identified the strengthening of living labor and light technologies in the work of the team. The results allowed us to conclude that it was considered mostly as an essential tool to identify gaps in the work process, to induce critical reflections based on the reality experienced by the teams, and to contribute to a better organization of the work process. The challenges encountered by the teams were the difficulty of implementing the Integrative and Complementary Practices (ICPs), the turnover of professionals, lack of institutional support, lack of support from managers and the lack of permanent education actions. In this study, we verified some weaknesses of PMAQ-AB, such as the strong relationship between the instrument and the transfer of financial resources, the lack of spaces for data retrieval, and the possibility of masking the actions in the teams. We believe that this study may contribute to a new look and to the development of new work from the institutionalization of evaluation in the health services, from the view of the evaluators that compose this process and also to validate the PMAQ-AB evaluation instrument

Uma das preocupações fundamentais desta pesquisa foi acompanhar e entender o processo decisório em torno das políticas econômicas que, ao contrário do que muitas vezes se alegou, demonstrou ter uma importância central no Estado brasileiro, em meados do século XIX. A análise dos discursos políticos sobre a moeda e o sistema bancário foi utilizada como ferramentas que ajudassem a entender melhor os consensos temporários sobre as questões econômicas e as posições políticas da elite política imperial. O estudo revelou que as inversões de rumo adotadas pelos parlamentares brasileiros não estavam relacionadas apenas com transformações estruturais centradas nos partidos políticos, o que revelou um quadro mais complexo e dinâmico tanto no campo político, quanto no econômico, do que se costuma supor. Pelo acompanhamento dos debates depreende-se que os projetos saneadores da moeda adotados pela elite política foram sinceros, o que significa dizer que ao enfrentar os problemas econômicos os representantes da nação utilizaram seus conhecimentos para encontrar soluções viáveis aos obstáculos que se apresentavam, nem sempre sendo bem-sucedidos nos resultados obtidos. Portanto, ressaltei que se tratava também de uma história de anseios e frustrações, readequações e sucessos, mas, acima de tudo, das transformações de conceitos econômicos que foram refinados, de posições políticas alternadas e de projetos paulatinamente adaptados. / One of the main concerns of this research was to follow and understand the decision-making process surrounding the economic policies that, contrary to what is often claimed, demonstrated a central role in the Brazilian State in the mid-nineteenth century. The analysis of political speeches on the currency and the banking system has been used as tools to help better understand the temporary consensus on economic issues and the political elite of imperial policy. The study revealed that the reversals of direction taken by Brazilian legislators were not only related to structural transformations centered on political parties, which revealed a more complex and dynamic both in the political field and on the economic, than is commonly supposed. By tracking the discussions it appears that projects correctives currency adopted by the political elite were sincere, which means that the economic problems facing the nation\'s representatives used their expertise to find viable solutions to the obstacles that presented themselves, not always being successful the results. So I pointed out that it was also a story of longing and frustrations, and successes, adjustments, but, above all, the transformations of economic concepts that have been refined, political positions and alternate projects gradually adapted.

Research suggests that Black women living in the United States are not engaging in sufficient physical activity, which is a major factor negatively impacting their health outcomes. Black Girls Run (BGR) is a targeted national health movement using the capacity of social networking technology as a tool to interact with and inspire Black women to live healthy through running. Literature lacked the voice and perspective of Black women who were embracing the innovation of technology to positively improve their health behaviors. The purpose of this qualitative phenomenological study was to gain a better understanding of the composite experiences of women in BGR and how they utilize social networking technology to improve their physical activity. Social cognitive theory provided the theoretical framework. Semistructured interviews were conducted with 13 women participants of BGR, who were selected using purposive sampling technique. Data were transcribed, organized, analyzed, and coded into common themes with the support of Nvivo 11 software. The findings revealed that social networking served as a tool that the women in BGR used to connect, encourage, and motivate physical activity, and it thereby helped to support their social and physical well-being. Study findings may contribute to positive social change by increasing knowledge and awareness of how technology can be used to promote healthy behaviors among Black women. This study may also provide useful information to stakeholders interested in health promotion strategies and programs to reduce the health disparity gap for Black women in the United States.