Presentation Dka free essay sample

Diabetes mellitus, often simply referred to as  diabetes, is a group of metabolic diseases in which a person has high  blood sugar, either because the body does not produce enough  insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of  polyuria  (frequent urination),  polydipsia  (increased thirst) and  polyphagia  (increased hunger). There are three main types of diabetes: * Type  1 diabetes: results from the bodys failure to produce insulin, and presently requires the person to inject insulin. Also referred to as insulin-dependent  diabetes mellitus,  IDDM  for short, and  juvenile  diabetes. ) * Type  2 diabetes: results from  insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as  non-insulin-dependent  diabetes mellitus,  NIDDM  for short, and  adult-onset  diabetes. ) * Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. We will write a custom essay sample on Presentation Dka or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page It may precede development of type  2 DM. (1) In the Philippines, according to the Department of Health (DOH), an estimated four million Filipinos suffer from  diabetes. It appears that most Filipinos suffer from Type 2 Diabetes Mellitus. Early signs are lethargy, extreme thirst, and frequent urination. Other symptoms may include sudden weight loss, slow  wound healing, urinary tract infections, gum disease, or blurred vision. It is not unusual for  Type II diabetes  to be detected while a patient is seeing a doctor about another health concern that is actually being caused by the yet undiagnosed diabetes. Diabetic ketoacidosis  (DKA) is a potentially life-threatening complication in patients with  diabetes mellitus. It happens predominantly in those with  type 1 diabetes, but it can occur in those with  type 2 diabetes  under certain circumstances. DKA results from a shortage of insulin; in response the body switches to burning  fatty acids  and producing acidic  ketone bodies  that cause most of the symptoms and complications. (2) DKA may be the first symptom of previously undiagnosed diabetes, but it may also occur in known diabetics due to a variety of causes, such as intercurrent illness or poor compliance with  insulin therapy. Vomiting,  dehydration,  deep gasping breathing,  confusion  and occasionally coma  are typical symptoms. DKA is diagnosed with  blood  and  urine tests; it is distinguished from other, rarer forms of  ketoacidosis  by the presence of high  blood sugar  levels. Treatment involves  intravenous fluids  to correct dehydration, insulin to suppress the production of ketone bodies, treatment for any underlying causes such as infections, and close observation to prevent and identify complications. (2) DKA is a  medical emergency, and without treatment it can lead to death.

Free Essays on Comparing Prisons And Universities

Comparing Prison and University For my paper I have chose to write about the institutions of the prison and the university. I will be defining these terms as an institution and also be comparing and contrasting both. These two institutions both serve a very specific purpose to what try to accomplish and as well have many similarities and differences. I will first define and write about prison. As defined in the Webster’s Collegiate Dictionary, prison is defined as an institution (as one under state jurisdiction) for confinement of persons convicted of serious crimes. As it may not seem to us today, the use of institutions for the extended confinement of offenders, as the method of punishment, is a relatively recent idea. Not until the later years of the nineteenth century, the usual method of dealing with convicted offenders as to â€Å"impose fines or to mete out to them some more of less brutal form of corporal punishment, such as execution, flogging, mutilation, branding, and public humiliation in the stocks, pillory, and ducking-stool†(Prison History). The only time someone was confined is a public institution for any considerable length of time were mainly those imprisoned for debt or accused persons awaiting trial. Now I will write about the university as an institution. As defined by Webster’s Collegiate Dictionary, the university is an institution of higher learning providing facilities for teaching and research and authorized to grant academic degrees. The university is a place for one to go if they desire to gain knowledge in an array of subjects or a specific area of study. One has to complete a certain curriculum on a subject while also holding a good standing with the university in order to earn the degree of choice. The institutions of the prison and the university have several differences and similarities. First I will point out the various differences they have. The main difference that comes to mind when I c... Free Essays on Comparing Prisons And Universities Free Essays on Comparing Prisons And Universities Comparing Prison and University For my paper I have chose to write about the institutions of the prison and the university. I will be defining these terms as an institution and also be comparing and contrasting both. These two institutions both serve a very specific purpose to what try to accomplish and as well have many similarities and differences. I will first define and write about prison. As defined in the Webster’s Collegiate Dictionary, prison is defined as an institution (as one under state jurisdiction) for confinement of persons convicted of serious crimes. As it may not seem to us today, the use of institutions for the extended confinement of offenders, as the method of punishment, is a relatively recent idea. Not until the later years of the nineteenth century, the usual method of dealing with convicted offenders as to â€Å"impose fines or to mete out to them some more of less brutal form of corporal punishment, such as execution, flogging, mutilation, branding, and public humiliation in the stocks, pillory, and ducking-stool†(Prison History). The only time someone was confined is a public institution for any considerable length of time were mainly those imprisoned for debt or accused persons awaiting trial. Now I will write about the university as an institution. As defined by Webster’s Collegiate Dictionary, the university is an institution of higher learning providing facilities for teaching and research and authorized to grant academic degrees. The university is a place for one to go if they desire to gain knowledge in an array of subjects or a specific area of study. One has to complete a certain curriculum on a subject while also holding a good standing with the university in order to earn the degree of choice. The institutions of the prison and the university have several differences and similarities. First I will point out the various differences they have. The main difference that comes to mind when I c...

Change plan Assignment Example | Topics and Well Written Essays - 1000 words

Change plan - Assignment Example However, the facilitys corporate structure has come with various strategies to deal with highlighted challenges affecting the facility. As a result, the merged has emerged as one of the most prominent old care agency in Miami. Employee culture has been supportive of the development of the facility, which has contributed to the achievement of the most vital goals and objectives. The county and Federal governments have also been supportive through economic, social, and cultural contributions to the agency. Additionally, charity organizations have also played a major role in the financial maintenance of the facility. Consequently, the facility has been capable of holding more than a thousand old individuals in the society. Moreover, the community nursing has also been emphasized in the region whereby nurses can directly attend to the old in various communities. The organizational change is based on the Theory of change that is based on the achievements of the long-term goals of the facility (Cunliffe, 2008). The theory operates on the principles that a non-profit organization has an obligation to achieve the goals and objectives of an organization in both the short and long-term periods (Cunliffe, 2008). As a result, the long-term goals have been a motivational factor for a better future of the organization and society. Importantly, the society has been a major beneficiary of the facilitys organizational change. The county government has come up with a financing strategy that has helped reduce the cost of facilitys operational activities. Importantly, the facility has also been involved in assisting the non-well up towns in the society. As a result, the changes have been noted and publicized by international welfare organizational facilities that deal with taking care of the old. The changes that have occurred in the society have made a major improvement in the society. The facility has gathered information based on experiences of other old caring

Historical and political perspectives Essay Example | Topics and Well Written Essays - 1000 words

Historical and political perspectives - Essay Example , and it became clear that further action was necessary to ensure that the mandate to protect the rights and autonomy of disabled children was not impeding the realistic delivery of a personal understanding of their unique needs and potential. The CAF was one of several initiatives taken in response to widespread doubt regarding the efficacy of the Acts and provided a nationwide model of expectation and practice (Pithouse, 2006). Together, these two changes in national policy have turned the tide for the education of children with special educational needs. The SEN Code of Practice 2001 recommended a graduated distribution of nationwide change in the areas of assessment and inclusion in the mainstream schools. Thereafter, with the emphasis on building bridges between schools, a firm foundation was laid for the CAF 2005. Specifically, the CAF 2005 established a database of information for ascertaining with the special needs of children and standardized related expectations and recommended practices (â€Å"Behaviour and Individual Differences†, 2010). The function of CAF 2005 in addressing the shortcomings of the SEN 2001 Act was never explicitly acknowledged, but was rather a generalized reinforcement of a number of educational reforms. The official purposes focused upon children with an impaired â€Å"opportunity of achieving or maintaining a reasonable standard of health or development† (Pithouse, 2006, 201). Thus, by combining methodological recommendations for focus and economy, the CAF proposes educational change in a multi-faceted and complex manner (Pithouse, 2006). From the above discussion, it is evident that the CAF 2005 was an incremental approach over the objectives established under the 2001 SEN act. While the SEN 2001 act provides legal rights to disabled students, the CAF 2005 focuses more on an integrated approach towards assessing the needs of children and young people. Thus, the latter facilitates a wholesome strategy towards reaching a wider

Philosophy Essay Example | Topics and Well Written Essays - 750 words - 16

Philosophy - Essay Example Adopting the average worshipper’s premise, this paper assumes the supposition that this Higher or Perfect Being is clothed with the qualities of omnipotence, omniscience and omnipresence and is the creator of everything and that the goal of praying is to affect in some manner the object of the prayer, whether to express gratitude, ask forgiveness or solicit a favorable response to a request. Various methods and manner of praying exist, each claimed to be the correct method by their users. The orthodox method of praying follow the tradition prescribed by established doctrines of respective churches and faiths. This may consist of rote and memorized prayers, chants and hymns. A gregarious and an expressive way of praying is through dancing and singing of catchy tunes. Another modern way is to compose one’s prayer spontaneously and share it out loud with the rest. Then there are the worshippers whose prayers are solely kept to themselves, their praying manifested only by the solemnity of their countenance. of endless praising and extolling of virtues, if scrutinized closely, can be said to be useless and even denigrating to the object of worship. Seen from the same perspective, formulaic and memorized prayers will seem to suffer the same fate. Taking into consideration the infinite qualities of the worshipped object - it is almost certain that He knows exactly who He is and to tell Him who He is and what wonderful things He has done over and over is useless and accomplishes nothing. Not only is it futile but also insulting. On the contrary, those who engage in this kind of praying could have their motives cast with aspersion. It could be one of two things, none of which are noble: first; endless praises and flatteries may be used to advance a position through ingratiation, and; second, constantly reminding another of his good deeds may

Clinical Risk Management Health And Social Care Essay

Clinical Risk Management Health And Social Care Essay The aim of this essay to provide the reader with insight to the term clinical risk management and how this is implemented within NHS trusts focusing particularly on the role of Pharmacists in doing this. Objectives: Defining clinical risk management and discussing its importance Discussing ways in which trusts implement clinical risk management Defining what is a medication error and identifying the role of the pharmacist to reduce these Discussing systems or processes in place in my base hospital to reduce medication errors 1.0 Importance of clinical risk management Clinical governance was first mentioned in British Health policy in 1997 as a term used to describe the accountability processes for clinical quality of care. It evolved as a system to address and respond to a series of high profile media cases highlighting poor quality patient care as revealed in the Nottingham IT vincristine disaster, Bristol Heart surgery, Shimpan and Alder Hey organ retention. During I997 in England, the Department of Health published the white paper the New NHS; modern, dependable which introduced Clinical governance as a method of accounting for clinical quality in health care but really came to prominence in 1998 when Scally and Donaldson appraised Clinical governance and the drive for quality improvement in the NHS   in the British Medical Journal. The paper highlighted four components of quality as initially identified by the World Health Organisation: Professional performance (technical quality) Resource use (efficiency) Risk management (risk of injury or illness associated with the service provided) Patient satisfaction with the service provided. Majority of NHS care is of a very high standard and in comparison to the high volume of care provided on a daily basis in hospital and community, incidence of serious failures are uncommon.1 However when they do occur, they have devastating consequences for individual patients and families.1 Greater patient expectations, knowledge and media exposure of high profile cases have resulted in the NHS being scrutinized focusing on its policies of operation, facilities and operating culture. It is estimated that an average of 850,000 adverse events may occur in the NHS hospital sector each year resulting in a  £2billion direct cost in additional hospital days alone.1 Poor clinical performance results in patient harm and loss of patients confidence in the NHS services as well as an increase in litigation costs.4 In 2009/10, 6,652 claims of clinical negligence and 4,074 claims of non-clinical negligence against NHS bodies were received by the NHS Litigation Authority, up from 6,088 claims of clinical negligence and 3,743 claims of non-clinical negligence in 2008/09.4  £787 million was paid in connection with clinical negligence claims during 2009/10, up from  £769 million in 2008/09.4 Errors are discussed as either human or systematic in the Department of Health document An organisation with a memory. As an NHS organisation the focus is systematic, a more holistic approach when dealing with errors. This approach recognises the importance of resilience within organisations and that errors result as a number of interacting factors and failures within the system.1 NHS Quality Improvement Scotland (NHS QIS) clinical governance and risk management standards define risk management as the: Systematic identification and treatment of risk Continuous process of reducing risk to organisations and individuals alike Culture, processes and structures that are directed towards realising potential opportunities whilst managing adverse events In the past, clinical risk management was poorly managed in the NHS. There were no individuals designated to manage risk management, incident reporting in primary care was largely ignored, there was no standard approach to incident investigation, and existing systems did not facilitate learning across the NHS.1 In the 1990s there was a concerted drive to develop risk management and risk management within NHS organisations.1 Following on from this there has been an increased awareness of the cause of medication errors in NHS trusts and how these can be prevented.1 In 2000, the government made a commitment to reduce the rate of serious errors by 40%. The advances in technology and knowledge in recent decades has resulted in a more complex healthcare system.2 This complexity carries risks and evidence indicates that things do and will go wrong in the NHS sometimes resulting in patient harm.2 The NHS quality improvement strategy1 encompasses; Clear national quality standards; NICE, NSF Dependable local delivery; systems of clinical governance in NHS organisations Strong monitoring mechanisms; a new statutory commission for health improvement, an NHS performance assessment framework, and a national survey of NHS patient and user experience. It is hoped adaptation of these approaches in individual NHS organisations should have a positive impact on the development to detect, prevent and learn from system failures at a local level.1 The introduction of clinical governance provides NHS organisations with a powerful imperative to focus on tackling adverse health care events1. The time is right for a fundamental re-thinking of the way that the NHS approaches the challenges of learning from an adverse health care event.1 2.0 Implementing Risk Management within NHS trusts The Department of Health publication An organisation with a memory facilitated the patient safety movement in the NHS.2 It proposed solutions to risk management incidences through a culture of openness, reporting and safety consciousness within NHS organisations.2 Four Key areas highlighted from this report were:2 Unified mechanisms for reporting and analysis when things go wrong; A more open culture in which incidents or service failures can be reported and discussed; Systems and monitoring processes to ensure that where lessons are identified the necessary changes are put into practice; A much wider appreciation of the value of the systems approach in preventing, analyzing and learning from patient safety incidents. In response to an organisation with a memory, the Government report Building a safer NHS for patients focuses on how to implement these recommendations2. It outlined a blueprint for a national Incident reporting system and discussed the role of the National Patient Safety Agency (NPSA).2 The NPSA was set up by the Department of Health in 2001 with the aim of preventing harm from high risk medicines. The NPSA produced the National Incident reporting and Learning system (NRLS) to set priorities, develop and disseminate actionable learning following reports of patient safety incidents. Following this guidance all NHS trusts should have a risk management strategy in place. This includes systems for the identification of all risks which may compromise delivery of patient care. To aid with this trusts are obliged to deliver patient services in compliance with statutory regulations according to national and local requirements highlighting the level and quality of services required. The implementation of risk management policies within NHS trusts will be overseen by Clinical Governance managers and Risk managers4. Trust Risk management strategies will need to be regularly reviewed and audited; individual trusts will have Risk Managers within each department to oversee this4. The Trust Board will ensure that risk management, quality and safety receive priority and the necessary resources within budgets. Pharmacy departments will have a medicines management team comprising of a risk management pharmacist to implement risk management at a local level. The Risk management pharmacist will ensure staff are aware of risk management issues both locally and nationally and will update staff on actions to be taken to minimise risk thereby promoting compliance with external risk management standards. The risk management pharmacist will also need to ensure local risk management policies are kept up to date. In order to deliver the risk management agenda, individual trusts must meet the requirements of the NHS Litigation Authority Risk Management standards and the Care Quality Commission standards (CQC) from the Health and Social Act 2008. From April 2010, NHS providers will need to register with the CQC and provide proof of adherence to standards set by the CQC5. 2.1 National Patient safety agency and National Reporting Learning System In 2001, following the publication of the Department of Health document and Organisation with a Memory1 the National Patient safety agency (NPSA) was set up. The introduction of the NPSA has for the first time provided a systematic focus on medication safety6. The aim of the NPSA is to lead and contribute to improved, safe patient care by informing, supporting and influencing organisations and people working in the health sector with one core purpose to improve patient safety by reducing the risk of harm through error7. The NPSAs initiative was to identify patterns and trends in avoidable adverse events so that the NHS could implement changes to prevent these incidents from reoccurring. The NPSA will 2, 8: Collect and analyze information an adverse events in the NHS Assimilate other safety-related information from a variety of existing reporting systems Learn lessons and ensure that they are fed back into practice Where risks are identified, produce solutions to prevent harm, specify national goal and establish mechanisms to track progress The NPSA then went onto produce the National Incident Reporting and Learning system (NRLS) which aims to identify and reduce the risks to patients receiving NHS care and leads on national initiatives to improve patient safety. There are NHSLA risk management standards for each type of NHS health care organisation. The standards will address clinical and non-clinical health and safety risks.4 Individual trusts will be examined regularly and measured against standards to ensure a risk management strategy has been devised, it is in place throughout the trust, it is workable.4 This will minimise litigation costs resulting in more funds available to trusts to improve patient care; providing an incentive for better clinical and non-clinical risk management. The NRLS collects confidential data on medication errors from all NHS trusts in England and Wales and improves patient safety by enabling the NHS to learn from patient safety incidents8. This builds on incident reporting systems that were previously used on an adhoc basis in individual trusts. The NRLS reporting system has been designed to be compatible with local risk management systems that are used in majority of NHS organisations.2 NRLS reports are analyzed by clinicians and safety experts8 and key themes and trends contributing to patient safety incidents are identified.2 Steps are then taken to minimize these risks through the development and prioritisation of national solutions. Trusts reporting incidents regularly suggest a stronger organisational culture of safety.8 Encouraging staff to report clinical incidents affecting patient safety can help implement risk management strategies within NHS trusts. The more incident reports submitted the more data available to rapidly identify and act upon patient safety incidents. The NRLS suggests trusts should be submitting incident reports monthly.8 In pharmacy these will mostly involve incidents relating to medication errors. The development and promotion of the NHS fair blame culture encouraged error reporting reassuring staff the root causes of errors will be looked into. However, lack of awareness and fear of disciplinary action remain as some of the main barriers to incident reporting.8 To overcome this staff need to be adequately trained on when and how to report clinical incidents. At my base hospital, incident-reporting training is included in the trust induction and at a local pharmacy level as an in-house induction. Each trust incident is graded in accordance to standardised NPSA scoring systems; 1 being minor with no harm to patient ranging to catastrophic level 5 i.e. patient death. Following the completion of an online incident form, the risk lead for that particular area will receive a copy of the report. These reports will be analysed and appropriately graded and any serious incidents will then be reported to the Trust Board via the risk management committee. A report by the NPSA stated the most commonly reported medicine related incidents to be:8 Wrong dose, strength and frequency of medicines Wrong medicine Delayed and omitted doses Medicine related incidents will be reported to the Risk Management pharmacist who will provide feedback to the pharmacy team. All category 4 and 5 incidents have a full root-cause analysis performed and are submitted to the NRLS. These reports are then analysed by the NPSA, and if necessary rapid response alerts are produced.1, 8 Rapid response alerts act as a crucial means to focus the efforts of trust clinical risk managers into proven high risk areas.8 Delayed and omitted doses of medication led to the production of a recent rapid response alert. This alert was delivered to trusts by the NPSA via the NHSs Central Alerting system.8 On receipt of this alert, trusts were expected to respond and act upon requests contained within it within the specified deadline provided. Each alert contains instructions for regular audits in order to review the action taken. 3.0 Medication Errors Most medication are not without adverse effects and most side effects and adverse events are predictable, thus exposure to these adverse events can be minimised or avoided through careful prescribing and usage. Nevertheless some adverse effects are unpredictable and therefore unavoidable.6 However medication errors occurring as a result of mistakes or lapses when medications are prescribed dispensed or used are avoidable. These can be related to practice, procedures, products or systems. 6 Medication errors as defined by the NPSA are any preventable event(s) that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient or consumer. Such events may be related to professional practice, health care products, procedures and systems, including prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use. 10 Numerous studies have been conducted to investigate the incidence and outcomes of medication-related harm. A 2008 study conducted in an emergency department in Scotland found 2.7% of admissions were related to adverse drug reactions. 11 In 56.7% of cases the adverse drug reaction was the documented reason for admission but only 13.3% were considered to be unavoidable.11 Another study carried out by Charles Vincent reviewed more than 1000 records and found that 10.8% of patients experienced an adverse event and that half of these were preventable.12 It was found that a third of these adverse events led to either serious consequences or death.12 Medication errors also occur in other health care systems, and is estimated harmful errors occur in 1.8% of hospital admissions in the United States, leading to about 7,000 deaths each year.6 Similarly, an Australian study showed that 0.8% of inpatients suffered a harmful medication error.6 3.1 Why do medication errors occur? To be able to reduce the risk of medication errors, the cause of medication errors need to be understood.6 Previously medication errors were thought to be the sole responsibility of the individuals considered to be the cause of the error. However, now a more holistic approach is taken and it is acknowledged errors occur when both human and system factors interact in a chain of events often complex- resulting in an undesirable outcome.6 Not only the individual at fault but latent conditions within an organisation and triggering factors in clinical practice should also be considered as important causes of error as well.6 As Lucian Leape, the Physician and Professor at Harvan school of Public Health said: Human beings make mistakes because the systems, tasks and processes they work in are poorly designed. 6 Human factors result from the individual and may occur due to lack of training and education and lapses in concentration. System errors result from the running of the organisation and the lack of policies and procedures in place to reduce clinical risk. Recent experience shows in certain situations those safeguards have not been adequate and have failed to prevent serious error and harm to the patient.6 Active failures and latent conditions cause holes in the defence system to open up.6 The active failures occur as a result of unsafe practices of the people working with a system, examples include the prescriber failing to double check a prescription, or the pharmacist failing to identify an incorrect dose on a prescription.6 Latent conditions occur due to the structure of the organisation and its resources, management and processes in place.6 These either alone or in combination with an active failure, can lead to error. Examples include the lack of a computerised prescribing system with inbuilt systems to highlight an erroneous prescription or the lack of an effective communication system between primary and secondary care.6 3.2 The role of the pharmacist in managing medication errors Pharmacists as experts in medicines have an invaluable role in reducing medication errors. As a profession and specialists in the careful use of medicines we are best placed to minimise the risks associated with medication usage.12 The government safety of doses report recommended seven action points to improve medication safety. These are:13 Increase reporting and learning from medication incident. Implementation and audit of NPSA medication alerts guidance. Improve staff training and competence. Minimising dose errors. Ensure medicines not omitted. Ensure correct medicine correctly labeled gets to the patient. Document patient allergy status. The three areas of focus in medication error reduction for Pharmacists to detect and prevent are:12 Risk in the medicine itself. Risk in the manufacture, storage, and distribution of medicines. Risk in use of medicines. Pharmacy departments as a whole are similar to high quality manufacturing units and test each stage in the production, storage and distribution of medicines.12 Pharmacists are involved in almost all stages of the medication cycle from clinically checking of the prescription to the accuracy checking and final release of the medication dispensed. Within the pharmacy culture there is the expectation for errors to occur and consequently systems have been developed and put in place to minimise these.12 Examples of pharmacy services to reduce medication related errors in hospitals are:12 Checking of prescriptions and supplying of drugs. Ward drug charts. Use of our knowledge and pharmacokinetics to assess toxic and sub-therapeutic doses. Quality control and assurance measures. 3.2.1 Ward based Pharmacy services Pharmacy services at ward level were first proposed as a health policy in 1970 and have proven to detect and prevent prescribing errors.12 The role of the pharmacist is ever evolving and pharmacists are becoming recognised as an integral part of the multi-disciplinary team. The pharmacists role has moved on from the traditional supply role to a more clinical role allowing pharmacists to use their specialist knowledge surrounding medication use to reduce medication errors at ward level. Pharmacists are a lot more active at ward level and as such are now the first port of call for advice on medication by patients and other health care professionals. The pharmacists role also extends to medicines management and formulary development, medicines information and involvement in various dispensing stages. Throughout these different roles the pharmacists remain active in promoting safer practice and reduction of medication errors. 3.2.2 Medicines Reconciliation Medicines reconciliation is a process designed to ensure that all medication a patient is currently taking is correctly documented on admission and at each transfer of care. It encompasses: Collection Checking Communicating The National Institute for Health and Clinical Excellence (NICE) in collaboration with the NPSA issued guidance to ensure appropriate processes are in place to assure any medication patients are taking prior to admission is properly documented on admission to hospital.8 The NPSA reported the number of incidents of medication errors involving admission and discharge as 7070 with 2 fatalities and 30 that caused severe harm (figures from November 2003 and March 2007).8 An accurate medication history is necessary to aid safe prescribing. To improve medicines reconciliation at hospital admission NICE/NPSA has recommended that:8 pharmacists are involved in medicines reconciliation as soon as possible after admission the responsibilities of pharmacists and other staff in the medicines reconciliation process are clearly defined; these responsibilities may differ between clinical areas strategies are incorporated to obtain information about medications for people with communication difficulties. At my base hospital, medicines reconciliation involves doctors, nurses, pharmacists and pharmacy technicians. Systems and policies are in place to deliver medicines reconciliation in different areas of care and to ensure all staff involved in the medicines reconciliation process are accredited and adequately trained. 3.2.3 Education and Training At my base hospital information regarding clinical risk management is widely accessible to all staff through a variety of sources; alongside co-operate clinical mandatory training sessions and in-house local training sessions, a wide variety of information is available on the local trust intranet. These include a governance newsletter entitled Lessons Learned detailing adverse events which have occurred and steps taken to prevent reoccurrence of such events, risk management manuals available on-line and the NPSA patient safety literature. At a local pharmacy level, the monthly medicines management bulletin includes medication safety updates and is distributed to all pharmacy staff. As well as these measures education and training to other health care professionals and patients on medication is paramount. Pharmacists are the professionals best placed to do this. The Central Manchester Foundation Trust took part in a prescribing error audit known as the EQUIP study. This showed pharmacists as experts in medicines held invaluable knowledge and through organised education programmes can help reduce medication errors.14 The main cause of prescribing errors amongst newly qualified medical staff was simply due to lack of knowledge regarding medicines.14 Results demonstrated the need for pharmacists at ward based level and the prevention of potentially serious medication errors through their presence on the ward.14 Pharmacists on wards gave medical staff immediate access to advice regarding dosing, interactions and therapeutic monitoring of drugs.14 Pharmacists are also more likely to complete incident reports involving medicines and should encourage other staff to do the same. Ensuring staff are aware the only way to improve the systems in place is to learn what we are doing wrong. Pharmacists are also involved in developing and delivering teaching sessions for various groups of staff. Examples included at my base hospital are VTE prophylaxis, IV drug calculations and monitoring for unfractionated heparin. All Pharmacists are encouraged to deliver and attend teaching sessions early on in their career. As well as educating medical staff, pharmacists counselling of patients in outpatients and at discharge will also aid reduction in medication errors. As well as delivering information and teaching packages, pharmacists need to ensure information provided is sufficient, easily accessible and up to date. Medicine information pharmacists will review how best to provide information for safe prescribing and drug administration.6 The formulation and dissemination of medicine policies and clinical guidelines by pharmacists contributes to risk management. Pharmacists also advice clinicians on risk issues arising from quality assurance reports e.g. NPSA, national and local clinical audit.4 3.3 Reduction in medication errors Medication errors occur due to a number of failures. Pharmacists clinically reviewing a prescription can detect and prevent prescribing errors, but prescribing is only one aspect of the medication cycle.7 Failures in the processes of reviewing, dispensing, administering and monitoring of medicines also occur.7 To overcome these adequate systems and checks to prevent medication errors need to be in place. Examples of such systems include:13 Effective communication Education of all health care professionals Integrated electronic care records Systems and policies in place for ordering, dispensing, administering and transporting in medicines Providing 24 hours medicines information services and support to medical staff Increase specialists staff, more training for junior staff from an undergraduate level and improved discharge procedures Development of information technology services and standardised electronic incident reporting systems 3.3.1 Information Technology The developments of technological systems have helped in the running of medicine based services and include automated dispensing systems and electronic prescribing. Similar packagings of medications by the same manufacture lead to frequent dispensing errors. The implementation of an automated dispensing robot in my trust has significantly reduced error rates through the incorrect selection of medication. It also minimises administration errors through the production of standard warning labels such as Methotrexate weekly dosing warnings, and reminders to attach penicillin containing stickers to relevant antibiotics. However, the system is not fool proof and as such errors still occur mainly due to over reliance causing staff to become deskilled. Near miss audits to identify potential errors are conducted regularly within my trust to highlight areas of concern and systems put in place to prevent these errors reoccurring. Implementation of electronic prescribing systems (medisec) for discharge and electronic dose calculator on our neonatal unit has also proven to reduce medication errors. Medication errors due to illegible handwriting no longer occur minimising risk of dispensing errors. The availability of drug name, dose, formulation and dosing schedule have also reduced the risk of medication errors.7 3.3.2 Medication safety at discharge Poor communication between different health care professionals can lead to medication errors at discharge. Medicines reconciliation on admission has proven to be useful in linking patients care at primary care and secondary care. However, more focus needs to be placed on ensuring community pharmacists and GPs are aware of changes to medication at the point of discharge. Improved communication will prevent GPs from prescribing drugs that are no longer indicated, contra-indicated or even duplicate drugs.7 The implementation of the electronic discharge system medisec and the automated electronic copy of the discharge summary detailing information regarding medication changes has proven to be a useful tool in improving communication to GPs, and maintaining the link between primary care and secondary care. In addition to this, patients receiving a copy of their discharge summary and being counseled on their medication at the point of discharge will contribute to reducing medication errors . 4.0 Conclusion The need to manage risks is particularly important in the NHS because of: Finite resource the NHS has a limited amount of money and staff to provide a service Complexity the service we provide is extremely complex because of both the size and nature of the task Expectation we strive to meet the expectations of an increasingly aware public Clinical Risk Management is an integral part of clinical governance and thus everyones business. Managers in all areas are responsible for ensuring that risks in the area are identified, monitored and controlled in line with the Trusts Risk Management Strategy. This will contribute to improved delivery of services by providing a structured approach to decision-making. . All staff working in the NHS have a responsibility to be aware of and implement risk management within their individual job roles. The development of technology, systems and processes and education of all staff will be the key to implement clinical risk management at local and national levels in individual trusts. Word count: 4,338

Psychiatry as a Career Essay -- Psychiatrist Psychology

The study of the mind, psychiatry, has in the last few years struck an interest within me. I wonder why we react differently when we face the same obstacles. For example, families with several children, raised by the same parents and in the same environment, yet turn out to be completely different individuals, sometimes very disturbed. The how, why and where of it all interests me. My immediate goal is to get my diploma and find out who I really am and what my soul desire truly is. I realize I have a deep desire to be of service to others. This is not a skill however, it's just me. I do feel one of my strongest skills is my artistic ability. I have a taste for and enjoy a diverse selection of movies, music, and reading material. I enjoy studying photography, biology, along with human behavior. Psychiatrists treat patients who have mental illnesses and help diagnose them. They strive to find solutions for their patient's mental disorders. It can and usually does, involve counseling for the patient and sometimes their family as well. Medication can be prescribed to help with chemical imbalances, some of these are caused by their emotional problems. Sometimes even shock therapy is given. It can be a take home job much of the time. Psychiatrists do a lot of side work and research to expand their knowledge. Most keep updated on the latest data and new medications available. Sometimes psychiatrists deal with life or death situations and they need to know exactly how to react. This occupation requires an extensive amount of thinking and the ability to figure out problems. It is important to be able to focus, listen and process information. They have to be able to give positive feedback and come to a decision on how to treat each patien... ...metimes even death. The world today is sue happy, so if something goes wrong they are usually blamed. This career involves many years of education, which could be very costly. I am very interested in mental health and the care and well being of .individuals that need this assistance. I see a great need for those who are capable of helping troubled souls... Many of our disturbed youth are especially in need of some sort of mental assistance. I believe this field is wide open with possibilities. I know there is a growing need to have more compassionate, skilled, well trained, highly educated, individuals, in this field However, I now realize also, after my research, which becoming a psychiatrist is a very difficult career choice. Although, I still wish to have some sort of career in the mental health field, it may be this career choice is a bit much for me, I wonder?

Associate Level Material Essay

Directions: Choose one of the Facts for Consideration sections from Ch. 3 of the text and list the page number for the section you chose. Then, complete the following table. List five threats appropriate to the environment from the section you chose. Rate the risk for each threat from 0 (low) to 10 (high). Then, list five appropriate countermeasures. Once you complete the table, write a brief explanation of the countermeasures for the two threats with the highest risk total, stating how the countermeasure reduces the risk associated with that threat. The inmate escape is very important. If there are extra guards then it will be easy to prevent this from happening, especially since some trips can take up to 48 hours to complete. With all the stopping (two to eight stops on any given trip) and going it would be great to have the countermeasure. When it  comes to inmates taking over the van, I feel as though that is something that can happen even if there are two officers on the van. Inmates are strong and they always have something up their sleeves. So if we were to take the countermeasure and actually have them checked before they get on the van and then handcuffed it makes the ride safer and less threatening.

PietyEast Asia Tradition and the Practice of Filial Piety essays

PietyEast Asia Tradition and the Practice of Filial Piety essays East Asia Tradition and the Practice of Filial Piety According to Confucius, In serving his parents, a filial son reveres them in daily life; he makes them happy while he nourishes them; he takes anxious care of them in sickness; he shows great sorrow over their death; and he sacrifices to them with solemnity. The practice of filial piety has and has had direct consequences for a persons psychological, social, and economic well being in East Asia. According to Chinese tradition, the practice of filial piety was the primary duty of all-Chinese. Being a filial son or daughter came with a lot of family rules and traditions. Complete obedience to their parents during their lifetime and as they grow older, taking the best possible care of them. The practice of filial piety could bring honor and prestige to a community, an unfilial act could bring dishonor and shared punishment. Failure to live up to local standards of filial piety can result in damage to ones own self-image, loss of reputation in the community, and loss of ones inher itance. Refusal to fulfill obligations of filial piety made one suspect in the eyes of other Chinese. Filial piety is a social value, which has greatly influenced the parent care and parent-child relationship of East Asian peoples. Among the paths to filial piety in everyday life is maintaining a multi-generational large household, and one of the most important. Living with your family after marriage was big in East Asia. To break up ones family would be unfilial and social disapproval. When you got married the women would move in with their husbands families. Men practiced filial piety by maintaining the unity of the parental household, while women practiced it by helping their husbands fulfill their filial duties and as their everyday duties as daughters-in-law. Daily household chores in complex households were tedious and never-ending work, requiring ar...

Aliasing a Method in Ruby Takes Simple Programming

Aliasing a Method in Ruby Takes Simple Programming To alias a method or variable name in Ruby is to create a second name for the method or variable. Aliasing can be used either to provide more expressive options to the programmer using the class or to help override methods and change the behavior of the class or object. Ruby provides this functionality with the alias and alias_method keywords. Create a Second Name The alias keyword takes two arguments: the old method name and the new method name. The method names should be passed as labels, as opposed to strings. Labels are used to refer to methods and variables without directly referencing them. If youre a new Ruby programmer, the concept of labels may seem odd, but whenever you see a label like :methodname, just read it as the thing called methodname. The following example declares a new class and creates an alias for the on method called start. #!/usr/bin/env rubyclass Microwavedef onputs The microwave is onendalias :start :onendm Microwave.newm.start # same as m.on Change the Behavior of a Class There may be times when you want to change the behavior of a class after its been declared. You can alias and add new methods to an existing class by creating second class declaration that has the same name as the existing class declaration. You can also add aliases and methods to individual objects using a syntax similar to the inherited class syntax. The behavior of any class can be changed by creating an alias for any method and then creating a new method (with the original method name) that calls the method with the alias. In the following example, a microwave class is declared and an instance is created. The second class declaration uses the alias method to change the behavior of the on method in order to add a warning message. The third class declaration is used to change the behavior of the specific microwave instance to add an even more stern warning. When aliasing a method multiple times, be sure to use different method names to store the old method. #!/usr/bin/env rubyclass Microwavedef on  Ã‚  Ã‚  Ã‚  puts Microwave is on  Ã‚  end endm Microwave.newm.onclass Microwave  Ã‚  alias :old_on1 :ondef on  Ã‚  Ã‚  Ã‚  puts Warning: Do not insert metal objects!  Ã‚  Ã‚  Ã‚  old_on1  Ã‚  end endm.on# Message for this specific microwaveclass   Ã‚  def onputs This microwave is weak, add extra timeold_on2endendm.on # Displays extra messagem2 Microwave.newm2.on # Does not display extra message

Program Development Essay Example | Topics and Well Written Essays - 2000 words

Program Development - Essay Example Working people have workload pressure and due to workload sometimes, they face frustration, mood swings and lose their mental calm leading to a state known as depression. Moreover, it is vital to state that people with depression do not even realize their illness and avoid consulting doctors. This is also regarded as a serious illness, which might lead to suicide attempt. From a medical perspective, it is situation where the mood and behaviour of people changes and affects their decision taking capability. Therefore, a program should be developed in the society for the people who face depression problem to increase awareness related to its impacts and symptoms. The purpose of the program is to improve the quality of life of people by increasing awareness and providing them better opportunities to live the life effectively (Cook, Burke & Petersen, 2004).This paper also deals with the recreational experiences along with the activities, which are involved in the program. This paper intends to provide a better insight to what the program will deal with and the time it will devote towards the welfare of people. The educational program can be most appropriate program to create awareness among people who face depression problem along with people who are not facing the depression problem. Through educational programs, people will be able to increase their knowledge about how they can reduce their depression or mental problem and secure their health for a better life and mental problem (CDC, 2012). Educational program will be effective to identify the reason for such problem and analyse the same based on symptoms. Through the educational program, people of society can obtain information about the basic signs along with symptoms of depression (Hutchinson, 2011). The major aim of the educational program is to create awareness among people and enhance their knowledge

Process Paragraph Essay Example | Topics and Well Written Essays - 500 words - 1

Process Paragraph - Essay Example This could be highly unsettling and make it difficult for people to adjust in the new place. The culture shock therefore becomes a key issues for migrating population which must be addressed to make their transition from one culture to another easier and friendly. Different language, laws and regulations, dress code, food etc. become crucial factors that inculcate a sense of homesickness, depression, isolation etc. amongst the immigrant population and travelers. Therefore, it becomes very important to have prior knowledge about the new country and its culture so that one is prepared for changes. All the people who travel to new country, especially those with different culture experience varying level of culture shock. When they are prepared for new experience, the culture shock is not so severe. But, nonetheless, it is a temporary phase but serious issue if not tackled early. Language and laws are major elements of discomfort. The diverse society with people having varying socio-cultural values highlights the contemporary dynamics of changing societal pattern across the globe. Overcoming culture shock by making adjustments within the evolving society therefore becomes hugely pertinent issue for peaceful co-existence. It necessitates understanding of cross cultural values and willingness to adapt oneself into new environment through different mechanisms of adjustment. Culture shock for people from Asian region and other developing economies, when they come to the West is considerably more than their European counterparts. The language, gender outlook, dress code etc. become critical aspects of cultural paradigms that evoke differing response. Language barrier is one of the most defining issues that plays critical role in overcoming culture shock. Thus, learning the language of the mainstream society of host nation becomes impartment part