Facilitated self-reported anaesthetic medication errors before and after implementation of a safety bundle and barcode-based safety system.

BACKGROUND: Anaesthetic medication administration errors are a significant threat to patient safety. In 2002, we began collecting data about the rate and nature of anaesthetic medication errors and implemented a variety of measures to reduce errors. METHODS: Facilitated self-reporting of errors was carried out in 2002-2003. Subsequently, a medication safety bundle including 'smart' infusion pumps were implemented. During 2014 facilitated self-reporting commenced again. A barcode-based medication safety system was then implemented and the facilitated self-reporting was continued through 2015. RESULTS: During 2002-2003, a total of 11 709 paper forms were returned. There were 73 reports of errors (0.62% of anaesthetics) and 27 reports of intercepted errors (0.23%). During 2014, 14 572 computerised forms were completed. There were 57 reports of errors (0.39%) and 11 reports of intercepted errors (0.075%). Errors associated with medication infusions were reduced in comparison with those recorded in 2002-2003 (P<0.001). The rate of syringe swap error was also reduced (P=0.001). The reduction in error rate between 2002-2003 and 2014 was statistically significant (P=0.0076 and P=0.001 for errors and intercepted errors, respectively). From December 2014 through December 2015, 24 264 computerised forms were completed after implementation of a barcode-based medication safety system. There were 56 reports of errors (0.23%) and six reports of intercepted errors (0.025%). Vial swap errors in 2014-2015 were significantly reduced compared with those in 2014 (P=0.004). The reduction in error rate after implementation of the barcode-based medication safety system was statistically significant (P=0.0045 and P=0.021 for errors and intercepted errors, respectively). CONCLUSIONS: Reforms intended to reduce medication errors were associated with substantial improvement.

Visuospatial learning in elementary school children with and without a family history of alcoholism.

Chronic alcohol abuse has been consistently associated with cognitive deficits in right-hemisphere-mediated visuospatial operations. Recent evidence indicates that visuospatial deficits may be present in alcoholics prior to the onset of chronic heavy drinking, but it remains unclear whether such deficits are present prior to any alcohol exposure in persons at risk of developing alcoholism. The purpose of this study was to investigate visuospatial information processing in young children with and without a family history of alcoholism. Male and female elementary school children (N = 36), ranging in age from 6 to 11 years, served as participants. Of these children, 18 were from families in which one or both biologic parents had a history of alcoholism. The remaining 18 children had no family history of alcoholism or alcohol-related problems. During a single experimental session, each child received a visuospatial paired-associate learning task, requiring the learning of the spatial positions of five low semantic content "nonsense shapes." The learning performance of the children with a family history of alcoholism was significantly poorer than the performance displayed by the children with no family history of alcoholism. The family history positive children required significantly more trials to learning criterion, gave fewer correct responses and committed more errors. Further, an analysis of response-type frequency relative to the learning trials and analysis of response intercorrelations indicated that the pattern of learning displayed by the children with a family history of alcoholism was similar to that displayed by detoxified alcoholics during a similar learning task.

Rehabilitation of unilateral below-elbow amputees with myoelectric prostheses.

A rehabilitation program is described for unilateral below-elbow amputees resulting in prosthesis acceptance in 9 out of 16 patients 1-4 years after application. The features of the program were information and early training of stump muscles after amputation, application of prosthesis as early as possible, and extensive information and follow-up at regular intervals for about one year. Technical service was given special attention and each patient had access to a spare prosthesis. At a follow-up examination the results of two functional performance tests were compared with a subjective clinical rating and with a rating of acceptance. The functional tests yielded equally much information about function as the conventional clinical ratings. Technical skill in controlling the prosthesis was found not to be related to acceptance.

Clinical application study of multifunctional prosthetic hands.

A control system for a multifunctional hand prosthesis, which requires a minimum of training for the amputee, has been developed. The great advantage of the pattern recognition technique in making it possible to control as many as six prosthetic movements has prompted this study. The development of a complete miniaturised system has allowed a clinical trial on four patients. Two different tests have been employed to evaluate this system: an objective computer test and a test representing activities of daily living (ADL test). The computer test shows that a high rate of correct recognition is obtained immediately after the prosthesis is applied to the amputee. The ADL test shows that forearm rotation, and flexion and extension of the wrist are used in most activities, indicating that few compensatory movements are performed. It is suggested that this control system is feasible and that long periods of training are unnecessary.