Journal of School of Public Health and

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Background and Aim: Pressure ulcer is a common problem and a large drain on hospital resources, especially in wards such as ICU where patients stay for a long time. The aim of this study was to explore the likely factors contributing to pressure ulcers in the ICU units of Tehran University of Medical Sciences teaching hospitals, Tehran, Iran.

Materials and Methods: This project was conducted in all the seven ICUs of four teaching hospitals affiliated to Tehran University of Medical Sciences. In the first phase the researcher performed a direct observation of all the 90 patients who were admitted to the ICU units to check the presence of any pressure ulcer. In the second phase, 310 patients discharged from the same ICU units between March 2007 and February 2008 was randomly selected and their medical records reviewed. A structured questionnaire was used to collect the data.

Results: Pressure ulcer occurred more frequently in the elderly women patients who were less active and had less mobility, hospitalized for a long time, or those with fever, diabetes, high blood pressure, paralysis, or respiratory diseases. In addition, pressure ulcer was seen more frequently in the patients hospitalized in the general ICUs, as well as in those with infections and different types of tumors.

Conclusion: Using a standard risk assessment tool and paying attention to the main risk factors of pressure ulcer can be a useful method for identifying the high-risk patients before admission in order to prevent them from developing such ulcers.

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Background and Aim: Medication is a very important part of care and therapeutic services in health service delivery units. Therefore, medication errors in hospitals may cause serious problems in patient care and, even, death. This study aimed to determine the relationship between the type of medication errors reported and patient safety standards in a public hospital in Tehran, Iran.
Materials and Methods: In this study, the establishment of safety standards in 30 departments of Rajaee Hospital in Tehran, Iran and its relation to quality reporting medication errors by the hospital medical staff during the period 1391-1395 were investigated. Data were collected using two separate checklists, namely, "The establishment of medication safety” using the model 6R" and "The quality of reporting medication errors" and analyzed using the SPSS software, the statistical tests being inferential statistical tests including chi-square, phi coefficient and Cramer’s V.                                                                                        
Results: The data showed that the drug safety standards were established as regards five of the six components in this hospital (the sixth was safe patient positioning). The patient safety establishment was statistically significantly associated with the type of medication errors reported in the hospitals.
Conclusion: Since the process of drug therapy is a common practice in nursing services in the cardiac intensive care units, increased knowledge of nurses about the causes of medication errors, in order to prevent and reduce the occurrence of these errors, is considered quite necessary. Recommendations were made to reduce medication errors in hospitals.

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Background and Aim: Quality management, as an organizational strategy, helps enhance hospital effectiveness and efficiency. This study aimed to examine the effect of a quality management model on the efficiency of the respiratory intensive care unit in Labafijejad Hospital, Tehran in 2013-14.
Materials and Methods: This was a participatory action research conducted  in  the respiratory intensive care unit in Labafijejad Hospital, Tehran in 2013-14. A quality improvement team was formed to implement the quality management system and promote working processes.  The team identified and standardized working processes, determined the quality goals for the processes, and improved the processes based on the 10-stage Mosaddeghirad Quality Management model. Performance indicators of the unit  (bed occupancy, bed turnover, and bed interval rates;  patient average length of stay in the ward) were calculated and compared before and after the intervention.
Results: Implementing quality management brought about an increase of 2.8% and 19.2% in bed occupancy rate and bed turnover rate, respectively, as well as a decrease of 14.1% in patient average length of stay and a decrease of 35.6% in bed interval rate in the respiratory intensive care unit of the hospital.
Conclusion: Implementing quality management can increase the efficiency of the respiratory intensive care unit of a hospital. A suitable quality management system and the commitment of the hospital manager and staff can result in enhancement of efficenicy in a hospital.