Journal of

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Background: Reporting of  medication errors  leads to saving Patients &apossafety and also is counted as a valuable information source for further prevention of mistake in future.  The aim of this study was to determine the reasons for refusing to report medication errors from the viewpoints of nurses.

Material and Methods:In this descriptive study, 140 of 200 nurses who were employees of Baharlo hospital of Tehran participated in the study (response rate = 70%). Data were collected through a questionnaire. Test- retest analysis conducted for measuring reliability of the questionnaire and content and face validity of the instrument confirmed by key statisticians and methodologists. . SPSS software and descriptive statistics were used for analyzing the collected data. 

Results:Our findings indicate that the reasons of not reporting medication errors were Management factors (3.68 ± 1.12), Fear of reporting outcomes (3.09 ± 1.68) and Process related to reporting (2.73± 1.26). Management factors domain was the major cause of refuse of reporting medication errors. 

Conclusion:Since medication errors seem to be unavoidable, suppression, decreasing medication error depends on using a systematic approach with emphasis on management and nursing care. 

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Background: Patients' safety is a critical component of health care quality. As health care organizations continually strive to improve, there is important growing recognize of establishing a culture of patients' safety. To establish a safety culture in a healthcare organization, the first step is measuring the current culture. The aim of the study was to measure physicians, nurses and Para clinical personnel perceptions in patient safety culture in Tehran's selected hospitals, and to compare findings with U.S. hospitals.
Materials & Methods: Physicians, nurses, and Para clinical personnel who worked in training hospitals affiliated with Tehran university of medical sciences were asked to complete a self-administrated patients' safety culture survey (n = 145). Data collection was carried by using the Persian version of HSOPS, developed by Agency for Healthcare Research and Quality (AHRQ). Cronbach's alpha and chi-square tests were employed in statistical analyses.
Results: Among the dimensions of patients' safety culture with the highest percentage of positive responses the teamwork within units (67%) was higher, whereas that with the lowest percentage of positive responses was non-punitive response to error (51%). Except to Handoffs and transitions dimension the entire dimension scores were lower than the benchmark scores. The study revealed that more than half of the participants were not reported the errors.
Conclusion: Improving patients' safety culture should be a priority among hospital administrators. Meanwhile, Healthcare staff should be encouraged to report errors without fear of punishment action.

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Background: Patient safety is one of the most important components of health care quality. Given that assessing the current culture of patient safety is the first step in improving patient safety, we decided to translate and validate one of the most used patient safety culture assessment tool (HSOPS questionnaire) for the first time in Iran, and in this way take a step toward improving patient safety in our hospitals.
Materials & Methods: This cross sectional study was done among four general hospitals of Tehran University of Medical Sciences (TUMS), which were selected purposefully. Questionnaires randomly distributed among 420 members of the study population, and were collected after completion. Results were analyzed using Confirmatory Factor Analysis (CFA), internal Consistency and correlation.
Results: The value of Fitness function (FF) was 14.25 and according to that, the value of Goodness of Fit Index (GFI) was 0.96. Almost in all of the dimensions, the internal consistency of items in the translated Persian questionnaire was lower than the original one and ranged between 0.57 to 0.8.
Conclusion: Regarding to the findings of this study the Persian translation of the HSOPS questionnaire is a valid tool for the assessment of patient safety culture in Iran's hospitals.

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Background: Today using contrast media in order to diagnose different tissues in radiology section has found a vast range of applications. Thus application of safe procedures and protocols in usage of contrast media to prevent dangerous reactions seems to be of great necessity. That is why in this study we aimed to evaluate the safety of intravenous administration of contrast media in the radiology sections of medical-educational Centers of Urmia. Materials & Methods: This is a descriptive and cross sectional study. Data were gathered using questionnaires derived from articles and international standard guidelines such as (ESURE, RCR) in three areas including: drugs, protocols and facilities. Results: Results indicated that the level of compliance with safety protocols, facilities and drugs were 91.3% and 69.4% and 100% respectively. The average safety observance was 80.9% totally. The results showed that there were some deficiencies in some equipment such as pulse Oximeter and ECG. Moreover, it was found that a unique protocol is not used in all surveyed sections. Conclusion: Regarding the importance of this issue it is necessary to publish and implement a unique protocol for contrast media administrating and to provide all required equipment for improving patient safety process. Meanwhile a wide supervision should have been done by related authorities in or out of the organization.

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Abstract Background: Accreditation is a program that is designed for evaluation of health care organizations and measured processes and structures according to predetermined standards. The purpose of this study is to survey the safety situation and quality of care in selected hospitals of Tehran University of medical sciences based on the Joint Commission International (JCI) standards and determination of their strengths and weaknesses. Materials and Method: This descriptive, analytical and cross-sectional study was carried out in 5 hospitals. Translated Joint Commission International (JCI) questionnaire checklist with 14 standards was used as the study tool. Data entry and statistical analysis were performed using the SPSS.13 and K Independent Samples tests were used to compare hospitals. Results: Highest quality and safety of care score belonged to the hospital B (84%) and then to hospitals C (83%), A (72.75%), E (72%) and D (70.5%). Central indices like patient and family rights, quality improvement and patient safety, infection prevention and control standards in the studied hospitals are completely different according to the statistical results. Conclusion: Study results show that the status of hospitals in terms of safety and quality of care are almost appropriate but in some cases there is a large distance between JCI standards and their current status and the studied hospitals have to make appropriate and related policies in order to plan and implement proper programs to improve their situation in quality and safety of care.

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Background: There is now a global concern about significant numbers of patients who are harmed or faced financial problems.Therefor, interving in organized approach to provide safe services seems necessary. This study is aimed to assess the basic indicators of patient safety in hospitals affiliated with Tehran University of Medical Science. Materials and Methods: This descriptive–analytical study was conducted in the 5 selected hospitals affiliated with Tehran University of Medical Sciences. The data were collected using patient safety assessment protocol published by WHO(WORLD HEALTH ORGNAZIATION) tool.The questionnaires were filled using variety of different ways such as : interview, observation and documents investigation. The data were analyzed using SPSS software and also with descriptive and analytical tests. Results: The results showed total average of maintaining the standards was 51.1% which categorized as weak level based on the protocol . The highest and lowest rates of the domains studied were safe environment (68.8%) and continuing education (24.8%) respectively. Farabi and Rasul Akram hospitals had the best and the worst levels of maintaining indicators of patient safety standards .It is worth mentioning that the status of all the hospitals was in the same level. Statistical tests indicate that maintaining the standards does not differ significantly between participating hospitals. Conclusion: All participating hospitals has a poor performance through developing basic patient safety indicators .Managers` support and staff participation can be helpful to solve the mentioned issues. Paying attention to patient safety in managerial plans and putting equal value to various aspects of patient safety are pivotal

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Background: Injuries related to failures and errors due to clinical interventions in patient hospitalization period in hospital are the main reasons of mortality and mortality in worldwide. This study tries to identify and description ICU care failures and assessing the causes of risks, Severity, Occurrence and identifying risk probability ratio and risk prioritizing using FMEA method.

Materials and Methods: This study was carried out in order to evaluating existing situation using Failure Mode and Effect Analysis and utilizes volere logic to plan the patient safety management system. This study performed in the intensive care unit of Loghman Hakim hospital in Iran.

Results: Study finding revealed sixteen routine failures and its priorities which the five main issues were documented as error in decision phase for patients admission or in-admission (PRN 1000), error in discharge time of patient from ICU (PRN 1000), insufficient infection control (PRN 1000) and error in clinical ordering and prescriptions (PRN 800).

Conclusion: The main requirements of the patient safety management identified as planning standards and clinical guidelines, developing evidence based admission and non admission indicators, enacting infection control rules and education of anticipating standards places, hand washing and disinfecting instrument and equipments.

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Background: One of the main components of the quality of health services is patient safety. This study aimed to determine safety culture status of psychiatric patients from the viewpoint of the medical staff of Ibn Sina and Hafez hospitals in Shiraz.
 
Materials and Methods: This descriptive-analytic study performed as a cross-sectional one in 2017. The study population included 165 health care personnel of the hospitals which were selected by census sampling. The study tool was a standard questionnaire for the hospital's safety culture. Data were analyzed using descriptive statistics and independent t-test, ANOVA, Pearson correlation coefficient and multivariate linear regression using SPSS version 23 software at a significant level of α = 5%.
 
Results: The average of safety status of the patients calculated 154.62 ± 19.74. The patient safety culture was estimated at an acceptable level (64.1%). The dimensions of personnel affairs (36%) and non-punitive responses to errors (34.7%) were in an unfavorable situation. There was a significant association between the employment status of personnel and patient safety (P<0.05).
 
Conclusion: Despite the acceptable condition of the patient's safety culture, however, the dimensions of the non-responsive response to the mistakes and issues related to the personnel were in an unfavorable situation and require prompt and appropriate actions. It is suggested that hospital authorities to provide the necessary interventions including cultures for reporting of errors, organizing comprehensive training programs, and continuously improving the clinical governance system.
 

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Background: Nosocomial Infections (Nis) Are Regarded As The Most Common Complications Of Health Cares. These Infections Affect Patient’s Safety in Developing and Developed Countries. The Aim Of This Study Was To Epidemiology and Determine the Causes of Nosocomial Infectioin Teaching Hospital of Tehran In A Teaching Hospital In Tehran.
Materials and Methods: This Cross-Sectional, Descriptive And Analytical Study Was Designed In 2019 At A Teaching Hospital Affiliated With Iran University Of Medical Sciences. The Nosocomial Infection Registry Data between 2017 and 2018 Was Used. The SPSS24.0 Software Package Was Used To Analyze Data Into Descriptive (Frequency, Percentage, Mean and Standard Deviation( And Analytical) ANOVA) Statistics.
Result: The Most Frequent Type of Infections Were Urinary Tract (39.76%), Ventilator Associated Events (20.92%), Bloodstream (20.71%), Respectively. Skin and Soft Tissue Infections (0.7%) Had The Lowest Prevalence. The Highest Incidence Of Nosocomial Infection Was In The ICU With 200 Patients And The Lowest Incidence Was In The ENT With 23.1 Patients And The Overall Incidence Of Nosocomial Infections Was 84.9 Patients Per 10,000 Patient-Days.

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Background and purpose: Electrocautery is a very important tool in surgery. Electrocautery burn is a common side effect of operation surgeries. Quality management is a useful strategy for improving the quality and safety of hospital services. The objective of this study was to examine the impact of quality management on reducing electrocautery burns.
 
Materials and methods: A participatory action research was conducted in the operating theatre of a hospital in Tehran, Iran, in 2013 and 2014. A quality improvement team was established in the hospital operating theatre. The quality improvement team using an 8-step quality management model, standardized working processes, identified quality goals for the processes and improved them until achieved the quality goals. Data on electrocautery burns was collected before and after the intervention and compared.
 
Results: Electrocautery burn rate was 0.40% in 2012. A wet patient due to sweating or washing during the surgery, in-appropriate patient position, faulty earth well, faulty anti-static mattress and long usage of electrocautery devices were the main reasons of electrocautery burn injuries. Accordingly an action plan was developed and implemented for preventing and reducing electrocautery burns. Consequently, electrocautery burn rate was reduced to 0.21% and 0.02% in 2013 and 2014. Electrocautery burn was significantly reduced by 95% in two years.
 
Conclusion: Electrocautery burns can be easily prevented using the quality management strategy. Implementing an appropriate quality management model appropriately in a supportive environment enhances the safety of hospital services.