Andreeva Bay in northwest Russia hosts one of the former coastal technical bases of the Northern Fleet. Currently, this base is designated as the Andreeva Bay branch of Northwest Center for Radioactive Waste Management (SevRAO) and is a site of temporary storage (STS) for spent nuclear fuel (SNF) and other radiological waste generated during the operation and decommissioning of nuclear submarines and ships. According to an integrated expert evaluation, this site is the most dangerous nuclear facility in northwest Russia. Environmental rehabilitation of the site is currently in progress and is supported by strong international collaboration. This paper describes how the optimization principle (ALARA) has been adopted during the planning of remediation work at the Andreeva Bay STS and how Russian-Norwegian collaboration greatly contributed to ensuring the development and maintenance of a high level safety culture during this process. More specifically, this paper describes how integration of a system, specifically designed for improving the radiological safety of workers during the remediation work at Andreeva Bay, was developed in Russia. It also outlines the 3D radiological simulation and virtual reality based systems developed in Norway that have greatly facilitated effective implementation of the ALARA principle, through supporting radiological characterisation, work planning and optimization, decision making, communication between teams and with the authorities and training of field operators.
To examine the psychometric and unit of analysis/strength of culture issues in patient safety culture (PSC) measurement.
Two cross-sectional surveys of health care staff in 10 Canadian health care organizations totaling 11,586 respondents.
A cross-validation study of a measure of PSC using survey data gathered using the Modified Stanford PSC survey (MSI-2005 and MSI-2006); a within-group agreement analysis of MSI-2006 data. Extraction Methods. Exploratory factor analyses (EFA) of the MSI-05 survey data and confirmatory factor analysis (CFA) of the MSI-06 survey data; Rwg coefficients of homogeneity were calculated for 37 units and six organizations in the MSI-06 data set to examine within-group agreement.
The CFA did not yield acceptable levels of fit. EFA and reliability analysis of MSI-06 data suggest two reliable dimensions of PSC: Organization leadership for safety (alpha=0.88) and Unit leadership for safety (alpha=0.81). Within-group agreement analysis shows stronger within-unit agreement than within-organization agreement on assessed PSC dimensions.
The field of PSC measurement has not been able to meet strict requirements for sound measurement using conventional approaches of CFA. Additional work is needed to identify and soundly measure key dimensions of PSC. The field would also benefit from further attention to strength of culture/unit of analysis issues.
A culture of safety in healthcare will not be achieved until the fragmentation that currently characterizes the delivery system is replaced by an alignment of the many component parts, including providers, patients and their families and front-line workers on the "sharp end'--physicians, nurses and pharmacists. A systemic approach should be introduced that would recognize the interacting nature of the delivery system's component parts, and that a change in one component of the system will provoke a change in another part. Consumers and their families can be empowered through programs that raise awareness, prevent error and mitigate its effect when error does happen. Within the system, the "safety sciences' can provide guides to effective work processes. Finally, it is critical to capture knowledge of what type of error occurs in what place and to elucidate strategies to prevent the error.
To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture.
Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control).
A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop.
Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture.
A statistically significant improvement in one of three safety culture measures was shown for the study group (p
Cites: Qual Saf Health Care. 2002 Mar;11(1):40-412078368
Cites: Health Aff (Millwood). 2002 May-Jun;21(3):80-9012026006
Falls are a common problem among institutionalized adults, often resulting in serious negative consequences (Tideiksaar 2002). Fortunately, many of these falls are preventable (Tideiksaar 2002). However, there has been a recent shift from a fall "prevention" approach to one of fall "management," which aims at preventing injuries rather than falls. Falling is regarded as indicative of activity, which strengthens muscles, improves balance, and ultimately reduces the risk of falling (North Eastman Health Association Inc. 2005). For this research, the effectiveness of a fall "management" program that has been implemented in five provincial personal care homes "PCHs" in a Manitoba rural regional health authority will be evaluated. Fall-related administrative data will be analyzed to determine if there are differences (i) within the study sites over time (from pre- to post-intervention) and (ii) between the study and comparison sites. Qualitative information from staff interviews and chart audits will supplement the quantitative information.
A qualitative and quantitative assessment was conducted regarding falls sustained by in-patients receiving rehabilitation therapy following major lower limb amputation at the Glenrose Rehabilitation Hospital. During the nine-month assessment period, 18 of 58 patients in the amputee unit experienced a fall, of which 17% resulted in a moderate injury. The majority of falls occurred during patients' use of a wheelchair (14 of 18) and involved poor balance (nine of 14). Patient wheelchair self-transfers accounted for 71% (10 of 14) of the falls, while sitting in the wheelchair and reaching represented 29/ (four of 14). The hospital's rehabilitation program teaches patient safety including using assistive devices such as wheelchairs but did not include a comprehensive graded learning path to monitor patients' ongoing risk for falls. Based upon the data collected, an intervention program was initiated to improve patient safety and reduce the number of falls. The multidisciplinary program encompassed aspects ranging from an environmental assessment of the patients' room to medication management, continuous patient wheelchair skills training and alteration of the care plan. The effectiveness of the intervention program was assessed through a series of interviews and questionnaires administered to medical personnel. This article presents the preliminary data collected during the first three months of the six-month study. Overall, satisfaction has significantly improved as a direct result of the intervention program. The article provides evidence-based interventions that improve safety for a subset of in-patients known to be susceptible to falls when using wheelchairs. Other in-patient groups will also benefit from these findings as many are universally applicable.