ABSTRACT
BACKGROUND: Experts call for stronger safety cultures and transparent reporting practices to increase medication safety in today's strained healthcare environments. The field of ecological restoration is concerned with the effective, efficient, and sustainable repair and recovery of ecosystems that have been degraded, damaged, or destroyed. A study was undertaken to determine whether the lessons of restoration science can be adapted to the study of medication safety issues. METHODS: Working with 26 practitioners, the principles of good restoration were used to design and pilot an innovative multifaceted medication safety intervention. The intervention included focus groups with practitioners, the construction and administration of a research based medication safety inventory, repeat digital photography of environmental safety issues, and targeted environmental modifications. RESULTS: Participants were most concerned about staff education and the physical environment for medication administration. Ward staff used the research to build a healthy reporting culture, introduce regular discussions of near misses, develop education strategies, redesign delivery and storage processes, and renovate the environment. CONCLUSIONS: Members of a busy hospital ward successfully adapted methods of restoration science to study, redesign, and strengthen medication safety practices and ward safety culture within existing resources. Further research will be conducted to test the merits of restoration science for health care.
Subject(s)
Ecosystem , Hospital Units/organization & administration , Medication Errors/prevention & control , Medication Systems, Hospital/organization & administration , Nursing Staff, Hospital/education , Organizational Culture , Safety Management/organization & administration , Alberta , Health Facility Environment , Health Services Research/methods , Hospital Units/standards , Hospitals, Teaching/organization & administration , Humans , Inservice Training , Medication Systems, Hospital/standards , Organizational Innovation , Systems AnalysisSubject(s)
Fatty Acid Synthases/metabolism , Fatty Acids/biosynthesis , Liver/enzymology , Mammary Glands, Animal/enzymology , Palmitoyl-CoA Hydrolase/metabolism , Thiolester Hydrolases/metabolism , Animals , Cytosol/enzymology , Female , Immunoassay , Lactation , Molecular Weight , Palmitoyl-CoA Hydrolase/isolation & purification , Pregnancy , Rabbits , Substrate SpecificitySubject(s)
Bradykinin/pharmacology , Uterine Contraction/drug effects , Animals , Female , In Vitro Techniques , RatsABSTRACT
The cytosol from lactating-rabbit mammary gland contains a medium-chain acyl-thioester hydrolase. This hydrolase terminates chain lengthening of the fatty acids synthesised by fatty acid synthetase so as to release C8:0 and C10:0 fatty acids which are characteristic of rabbit milk. The medium-chain hydrolase and the fatty acid synthetase present in this cytosol have been shown to be immunologically distinct. When fatty acid synthetase was purified from this cytosol it showed unexpected immunological reactivity towards antiserum raised to the medium-chain hydrolase. The precipitate formed was not due to fatty acid synthetase, but to medium-chain hydrolase contaminating the synthetase. However, the proportion of this medium-chain hydrolase which was recovered with the purified synthetase was too small to be detected by sodium dodecyl sulphate-polyacrylamide gel electrophoresis, and was too small to elicit an antibody response in sheep. Immunological techniques have shown that the medium-chain hydrolase appears in rabbit mammary gland between days 17 and 22 of pregnancy. This coincides with the onset of milk-fat synthesis. The medium-chain hydrolase could not be detected in the cytosol from lactating-rabbit liver.
