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The nursing schedule generation is an important activity that takes a considerable amount of time for managers to prepare and amend. It involves the optimal allocation of nurses to shifts, factoring various constraints like shift timings, holidays, leaves, and emergencies. This paper provides the design and development details for an automated nurse scheduling system called "ROTA," implemented for a 2032 bed multi-specialty tertiary teaching hospital, having 1800 staff nurses and 98 wards. The system generates daily, weekly, monthly schedules, nurse face sheets, duty allocation charts, swapping schedules, and training details for nurses. The system improved managerial control and saved a considerable amount of time for nurses to prepare the schedule. A survey conducted to gauge the system's satisfaction level showed that 91% of nurses were satisfied with ROTA. Overall, the system saved 78% of nurse scheduling time, resulting in a 3% cost reduction for the hospital. [ABSTRACT FROM AUTHOR]

Introduction: Obstructed labor is one of the most common preventable causes of maternal morbidity and mortality. In Ethiopia, 36% of maternal mortality was due to obstructed labor with uterine rupture. Thus, this study proposed to measure predictors of maternal mortality among women with obstructed labor in a tertiary academic medical center in Southern Ethiopia. Methods: An institution-based retrospective cohort study was conducted at Hawassa University Specialized Hospital from July 25 to September 30, 2018. Women who had obstructed labor from 2015 to 2017 were recruited. A pretested checklist was used to retrieve data from the woman's chart. A multivariable logistic regression model was employed to identify variables associated with maternal mortality, and variables with a p -value <.05 were considered significant at 95% CI. Results: With a response rate of 96.3%, 156 moms who experienced labor obstruction were included in the study. Obstructed labor caused the deaths of 14 women, resulting in a maternal mortality rate of 8.9% (95% CI: 7.15, 16.4). Maternal mortality from obstructed labor was reduced in women who received antenatal care visits (AOR = 0.25, 95% CI: 0.13, 0.76) and blood transfusions (AOR = 0.49, 95% CI: 0.03, 0.89). Women who experienced uterine rupture (AOR = 6.25, 95% CI: 5.3, 15.6) and antepartum hemorrhage (AOR = 14, 95% CI: 2.45, 70.5) had a greater risk of maternal mortality than women who did not have the corresponding morbidity. Conclusions: The center had a higher rate of maternal mortality due to obstructed labor. Early screening and improving the care for women at greatest risk of antenatal and postnatal co-morbidities like uterine rupture and shock were the major priorities and fundamental strategies to decreasing maternal mortality. It also showed that antenatal care visits, early referral, and blood transfusion for women with obstructed labor should be amended in order to lower maternal mortality. [ABSTRACT FROM AUTHOR]

Background: Executive Quality and Safety WalkRounds (EWRs) is a tool that engages department leadership in discussion with the front-line employees to solicit feedback to improve quality and safety. The purpose of this study was to evaluate the impact of the implementation of pharmacy department specific EWRs on quality and safety at a tertiary academic medical center. Method: This was a single-center, retrospective analysis conducted at Brigham and Women's Hospital between November 2016 and November 2019. This study aimed to analyze the implementation of EWRs conducted every other month throughout various service areas and satellites of the pharmacy department. Data evaluated included the number of EWRs conducted, the specific areas visited, the total number of action items recommended by the staff, along with the total number of action items that were completed or remained in process. Results: During the study period, 17 visits were completed in 12 different BWH pharmacy sub-departments. A total of 98 operational, technological, and environmental action items were recommended by staff to improve quality and safety. Of the 98 action items documented, 95 (96.9%) were completed by time of our analysis. Conclusion: Pharmacy department EWRs are an important and systematic process of communication between the pharmacy leadership and frontline staff. Pharmacy department EWRs have resulted in safety and quality improvements at different levels in the pharmacy department. The EWRs program at the pharmacy department was effective in identifying and completing safety initiatives to improve the safety culture of the department. [ABSTRACT FROM AUTHOR]

Catheter-related (CR) thrombosis is a significant complication of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Limited existing data for MCs suggest a favorable complication profile for MCs. To compare incidence of CR thrombosis between MCs and PICCs and to evaluate the impact of quantity of lumens and catheter diameter on CR thrombosis. This was a retrospective comparison spanning 13 months of MCs and PICCs for symptomatic CR thrombosis at an 1100 bed tertiary care academic medical center. Adult patients who had an MC or a PICC placed by the were included. Data were collected using the electronic medical record. Statistical analysis was performed using SAS software. A total of 2577 catheters were included in the analysis with 1094 MCs and 1483 PICCs. One hundred thirty (11.88%) MCs developed CR thrombosis (deep vein thrombosis [DVT] or superficial venous thrombophlebitis [SVT]) as compared to 112 (6.88%) PICCs (odds ratio [OR]: 1.82; P < .0001). Midline catheters had a 53% greater odds of developing CR DVT than PICCs (7.04% MCs and 4.72% PICCs; OR: 1.53; P ¼ .0126). For CR SVT, MCs have a 2.29-fold greater odds of developing CR SVT than PICCs (4.84% MCs and 2.16% PICCs; OR: 2.29; P ¼ .0002). For MCs and PICCs, the incidence of CR thrombosis was 13.50% for double lumen/5F lines and was 6.92% for single lumen/4F lines (OR: 2.10; P ¼ <.0001). Symptomatic CR thrombosis is a serious, life-threatening complication that occurs more frequently in MCs compared to PICCs. Inserters should consider placement of single lumen catheters with the smallest diameter to reduce this risk when a midline is used. [ABSTRACT FROM AUTHOR]