PubMed Health⌕ Search

Biomedical subjects

D S Wakefield

Publications and source records attributed to D S Wakefield.

48 records · Page 3Linked to original sources
PubMedDate not supplied

The clinical microbiology laboratory as an aid in infection control. The application of molecular techniques in epidemiologic studies of methicillin-resistant Staphylococcus aureus.

A microbiologic surveillance study was performed in order to estimate the point prevalence, source, and nosocomial acquisition of methicillin-resistant Staphylococcus aureus (MRSA) within the Iowa City Veterans Affairs Medical Center (IC VAMC). Immediately following the microbiologic surveillance study, a cluster of nosocomial MRSA infections was detected by routine infection control surveillance. An epidemiologic investigation was conducted and all isolates of MRSA detected during the microbiologic surveillance study and the subsequent cluster of nosocomial infections were characterized by restriction endonuclease analysis of plasmid DNA (REAP). REAP subtyping defined a total of ten distinct subtypes from 24 patients infected or colonized with MRSA. The documentation of a single subtype of MRSA (subtype A2) in nine patients from the surgical service, eight of which were hospitalized in the surgical intensive care unit, provided convincing evidence of a breakdown of infection control practices in that unit. REAP subtyping was a highly discriminating means of identifying different subtypes among the various isolates of MRSA and was useful in directing infection control efforts to specific problem areas within the hospital. Molecular typing methods, such as REAP, when used appropriately in conjunction with careful epidemiologic investigation provide an effective approach to the investigation and control of the spread of MRSA within the hospital.

Clindamycin↗
PubMedDate not supplied

The peer review process: the art of judgment.

Peer review is an essential mechanism for evaluating the judgment and performance of clinical providers. Reasons for conducting physician peer review range from identified quality-of-care concerns to general education. There are a variety of challenges to conducting an effective peer review, including the personal concerns of the peers conducting the reviews. This article reviews the potential uses of physician peer review, its basic methodologies, and challenges to and suggestions for obtaining effective peer review.

Accreditation↗
PubMedDate not supplied

Comparing providers' performance: problems in making the "report card" analogy fit.

This article examines the applicability of a "report card" strategy as a means of differentiating among providers on the basis of performance. The specific focus is on the potential effect of differences in data collection processes on the meaningfulness of subsequent comparisons among similar types of providers. Variations in reported nosocomial infection rates are analyzed in light of differences in reported surveillance practices; data for similar nursing units are analyzed as well. Thirty-one rural, rural referral, and urban acute care hospitals in the midwest participated in the study. The reported nosocomial infection rates for different types of nursing units and different hospital groups varied substantially. Likewise, there were marked variations in the nosocomial infection surveillance practices at the hospitals, which were found to explain some of the variation in the reported nosocomial infection rates for specific types of nursing units and nosocomial infections. The study conclude that differences in data collection processes may result in incorrect conclusions about differences in the quality of care provided by various providers.

Cross Infection↗
PubMedDate not supplied

Organizational culture, continuous quality improvement, and medication administration error reporting.

This study explores the relationships among measures of nurses' perceptions of organizational culture, continuous quality improvement (CQI) implementation, and medication administration error (MAE) reporting. Hospital-based nurses were surveyed using measures of organizational culture and CQI implementation. These data were combined with previously collected data on perceptions of MAE reporting. A group-oriented culture had a significant positive correlation with CQI implementation, whereas hierarchical and rational culture types were negatively correlated with CQI implementation. Higher barriers to reporting MAE were associated with lower perceived reporting rates. A group-oriented culture and a greater extent of CQI implementation were positively (but not significantly) associated with the estimated overall percentage of MAEs reported. We conclude that health care organizations have implemented CQI programs, yet barriers remain relative to MAE reporting. There is a need to assess the reliability, validity, and completeness of key quality assessment and risk management data.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Understanding and comparing differences in reported medication administration error rates.

The prevention of medication administration errors (MAEs) represents a central focus of hospitals' quality improvement and risk management initiatives. Because the identification and reporting of MAEs is a nonautomated and voluntary process, it is essential to understand the extent to which errors may not be reported. This study reports the results of 2 multihospital surveys in which over 1300 staff nurses in each survey estimated the extent to which various types of nonintravenous (non-i.v.) and intravenous (i.v.)-related MAEs are actually being reported on their nursing units. Overall, respondents estimated that about 60% of MAEs are actually being reported. Considerable differences in estimated rates of MAE reporting were found between staff and supervisors working on the same patient care units. A simulation based on actual and perceived rates of MAE reporting is presented to estimate the range of errors not being reported. Implications regarding the reliability, validity, and completeness of MAEs actually being reported are discussed.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Understanding why medication administration errors may not be reported.

Because the identification and reporting of medication administration errors (MAE) is a nonautomated and voluntary process, it is important to understand potential barriers to MAE reporting. This paper describes and analyzes a survey instrument designed to assist in evaluating the relative importance of 15 different potential MAE-reporting barriers. Based on the responses of over 1300 nurses and a confirmatory LISREL analysis, the 15 potential barriers are combined into 4 subscales: Disagreement Over Error, Reporting Effort, Fear, and Administrative Response. The psychometric properties of this instrument and descriptive profiles are presented. Specific suggestions for enhancing MAE reporting are discussed.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

Methods of determining the prevalence of changes in vital signs among internal medicine inpatients.

OBJECTIVE: To investigate the prevalence of changes in vital signs and methods of summarizing these changes. DESIGN: A survey of vital sign values for all eligible inpatients over a three-day period. PATIENTS: All 91 patients who remained for an entire three-day period in January 1991 on 1 of 11 nonintensive care internal medicine units in the medical center. RESULTS: Prevalence of changing vital signs varied by type of vital sign, inpatient unit, and method of computation. A method of computation that relies on daily extreme vital sign values. Pulse rates and blood pressure were more variable than respiratory rates. CONCLUSIONS: Mean daily pulse rates and blood pressure may be useful for quality assessment purposes, whereas individual readings may be more appropriate for respiratory rates. Computation of expected rates of changing vital signs should be tailored to inpatient unit type.

Academic Medical Centers↗
PubMedDate not supplied

Perceived barriers in reporting medication administration errors.

BACKGROUND: Assuring that medication administration error (MAE) reports are reliable and valid is of great significance for the patient, the hospital, and the nurse. In most hospitals, MAE reporting relies on the nurse who discovers an error to initiate an error report, whether the error was committed by that nurse or someone else. Because of the potential for negative consequences, there may be significant disincentives for the nurse to report the error. This, the first of two articles, describes the results of a large-scale survey designed to assess nurses' perceptions of the reasons why MAE may not be reported. The companion article compares nurses' estimates of the extent to which MAEs are reported with the actual reported medication error rates. METHODS: Nurses in 24 acute-care hospitals were surveyed to determine perceptions of reasons why medication errors may not be reported. RESULTS: The factor analysis reveals four factors explaining why staff nurses may not report medication errors: fear, disagreement over whether an error occurred, administrative responses to medication errors, and effort required to report MAEs. CONCLUSIONS: There are potential changes in both systems and management responses to MAEs that could improve current practice. These changes need to take into account the influences of organizational, professional, and work group culture.

Adverse Drug Reaction Reporting Systems↗