Effect of six sigma program on the number of surgeries cancellation.

BACKGROUND: Today, the rate of surgeries is increasing, but surgeries are canceled due to various reasons. Unexpected cancellation of surgeries not only results in disorder in the operating room schedule, but also causes stress for patients and their family and increases costs. We determined the number and causes of surgery cancellations and areas for improvement. MATERIALS AND METHODS: This outcome evaluation of Six Sigma program was conducted on 850 cases after the implementation of the program and compared to that of 850 cases which received routine care before the program. Cases were selected through easy sampling during the study. Before the implementation, the number of cancellations was recorded daily and their reasons were investigated. Then, Six Sigma program was implemented in accordance with the reasons for each category and necessary steps were taken to prevent the cancellation of surgeries. Data were collected for 3 months using a three-section data collection form. For data analysis, distribution and relative frequency and chi-square test were used. RESULTS: The three categories of patient, physician, and hospital system were identified as the main causes. The highest rate of cancellation was related to ENT surgeries (74.19%). No cancellations were made in orology surgeries. The implementation of the Six Sigma program caused a significant difference in surgery cancellation (P = 0.003); 31 (3.6%) cases of cancellation were reduced to 12 (1.4%) cases. CONCLUSIONS: The results showed that Six Sigma program is a pre-surgery care quality improvement program. Patient education and the implementation of the 6 sigma program can be effective in reducing the rate of cancellation of operations.

Effect of watching a movie on family members' anxiety level during their relatives' surgery.

BACKGROUND: Surgery is a stressful condition for both patient and family members. This anxiety may interfere with the adequate family functioning and in providing positive support for the patient. Thus, specialized assessment and interventions to reduce anxiety level of family members are essential. The aim of this study was to assess the effect of watching movie on anxiety level of family members during their relatives' surgery. MATERIALS AND METHODS: This was a before-after trial study conducted in Alzahra Medical Center, Isfahan, Iran. Between February 2010 and November 2010, 164 eligible family members in the surgical waiting room who met the inclusion criteria entered in the study. Before and after watching movie, the anxiety level was evaluated using the State-Trait Anxiety Inventory (STAI). Chi-squares, ANOVA and paired-t test were used for analysis using the Statistical Package for Social Sciences (SPSS, Version 14) for Microsoft Windows. RESULTS: The study population were 164 people, of whom 87 (53%) were female and 77 (47%) were male. The mean age of participants was 36.6 (SD: 8.4) years ranging from 18 to 67 years. After watching movie, the mean STAI score reached from 46.06 (SD: 9.26) to 39.15 (SD: 11.81) and this difference was statistically significant (p = 0.003). CONCLUSIONS: The results of this study indicated that watching movie could reduce family members' anxiety during surgery. The findings suggested that movie might be a simple and cost-effective tool to help family members to manage anxiety during surgery of their relatives.

The effect of fish oil on improvement of first stage bed sore.

BACKGROUND: Bed sore is one of the main problems for people confined to bed for long time and cannot move. According to the fact that prevention is easier and cheaper than therapy, in this study the effect of fish oil ointment on the improvement of first stage bed sore was assessed. MATERIALS AND METHODS: This study was carried out on two groups with 30 patients that had bed sore on shoulders, sacrum or heel. In the intervention group patients' position was changed every 2-3 hours and the bed sore was washed with water and cotton-wool and fish oil with thickness of 2-3 mm was applied on the place of sore. This method was used for seven days. If they improved, the method was stopped in the first days of procedure. At the end of seven days, again the first day checklist was completed, and it was compared to the questionnaire of the two groups, and analyzed separately according to the daily changes of intervention and control group. FINDINGS: There was statistically significant difference between the average of changes in the size of sore of the study group and control group (p < 0.002). The time average of improvement in the intervention group was less than control group. CONCLUSIONS: Local use of fish oil could increase the improvement of first stage bed sore and increase in vessels, blood and oxygen supply of the place of sore.

Designing the Vocal Alarm and improving medical ventilator.

BACKGROUND: Today, as many as 1.5 million Americans use ventilators once in a year. Response to mechanical ventilation alarms remains to be one of the most challenging tasks facing physicians, nurses or other medical personnel in the ICU. In the present study we aimed to compare the response times to "vocal alarms" and "visual or audible ones". METHODS: In the present study we developed a system to evaluate the "Vocal Alarm" and improve the medical ventilator "Benet 7200 Alarms" with it. Ventilator generates the alarms when patient has any problem. The time of Activation & Deactivation is recorded. The survey was done in central ICU for six days, 3 days with vocal alarm, and 3days with "Beep" alarms and detected Alarm events then recorded seventy-two hours of data for each type of alarms. All of events information saved in the memory and SPSS was used to determine difference between two types of alarms. RESULTS: On the average, the duration of the ventilator alarms activation were 33 ± 21 seconds for vocal alarms and 60 ± 46 for audible "Beep" alarms. The response times for vocal alarms were significantly lower (P = 0.001). CONCLUSIONS: The response times for normal "Beep" alarms were longer than vocal alarms.

Effect of black tea on enteral feeding tolerance in ICU patients.

BACKGROUND: Tea consumption has been known mostly as a well-drink after water in the world. Tea drink can affect balance of fluids and renal function. In addition, it can cause loss of many viruses in the stomach and can increase or decrease gastrointestinal movements. This research was done to determine the effect of tea on increasing enteral feeding tolerance in ICU patients in Alzahra Hospital. METHODS: In this clinical trial study, 45 patients were enrolled in two groups, tea consumption group and the standard method of nutrition as control group. Tea gavage was performed two times in the morning; 100 cc tea used for the study group and the same volume of water was used for the control group. Residual volume was measured before gavage. Data collected for one week. Information sheet had two pages; the first page described how to complete the form and the method of tea gavage and the second page was for data collection. Data were analyzed by t-student test, chi-square, and analysis of variance. RESULTS: In two groups, 92% of patients tolerated liquid gavage. Their difference by chi-square test was not significant. Average urine volume after black tea gavage was 783.3 L in the study group and 802.2 L in the control group. ANOVA test showed no significant difference. CONCLUSIONS: Although the difference was not statistically significant between the two groups, but in study group consumption of tea was acceptable by patients.

Assessing the nursing error rate and related factors from the view of nursing staff.

BACKGROUND: Error is an inevitable aspect of all the professions particularly health and treatment-related jobs and it should be acknowledged that committing it cannot absolutely be preventable. Among the causes that necessitate the evaluation of nursing errors, it should be noted that errors not only lead to damage and mortality for the patients, but also they are one of the obvious and costly problems in the hospitals. It is believed that nurses have the focal role in committing nursing errors.The main objective of this study was to identify nursing errors and the related factors. METHODS: This was a descriptive-correlative study which was conducted in 2010. 239 nurses and head nurses who were working in the selected hospitals in Isfahan were selected randomly and participated in this research. In order to collect the data, two questionnaires were used, each one consisting of three sections of the demographic data, questions about the type of error and the effective factors for making the errors. RESULTS: The highest rate of error was reported about the lack of compiling and reviewing the medical history of the patient (31.75%) and also disregarding the appropriate time for prescription of the medicine (31.75%). Besides, the nurses and head nurses believed in more than one factor for committing the errors and mentioned the managerial factors (84.2%) and patient-related factors (50.5%) as the most important and the least important causes for the commitment of errors respectively. Moreover, there was a direct relationship between gender, ward, and having an extra job with the score of the nursing errors. CONCLUSIONS: Attempts for reducing and controlling the nursing errors can rely on the usage of systemic approaches for assessing the effective factors, removing these factors as much as possible, and designing a system for increasing the level of reporting these errors for identifying the weak points and jeopardizing factors.