Therapeutische Umschau. Revue thérapeutique
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Knowledge of the most frequent and relevant safety problems is necessary in order to identify areas of risk in patient safety and to specify need for action. For Switzerland, there was no data available that systematically describes the type and frequency of critical incidents in outpatient care. Due to differences in primary care systems world wide, the transfer of international data to the Swiss context is of limited validity. ⋯ In addition, errors in tests and therapeutic interventions should be prioritized for future action. Several differences between professional groups could be identified regarding the perception and estimation of critical incidents as with respect to the safety climate. In conclusion, physicians and nurses should be involved when analysing risks and developing measures in order to insure high quality standards in patient care.
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Medication errors are responsible for up to 50% of errors in healthcare. Therefore, they are an important target for the improvement of patient safety. The application of evidence-based methods for the analysis of institution-specific medication safety hotspots is crucial. ⋯ Evidence-based data for improvement methods is limited. However, the implementation of clinical pharmacy services, IT tools (electronic prescribing, barcoding) and standardized double-check showed a significant impact on error reduction. In addition, the support of institutional leadership is an important prerequisite.
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Multiple studies in the last years on patient safety brought this issue into focus for healthcare workers, but also politics and public. It is evident, that patient safety in health care is not longer a "nice to have", but an absolutely "must", analog others high risk industries. This article presents the most important basis principles of patient safety. ⋯ The terms adverse event, error and incident are defined as well other important terms and possible human pitfalls. At the end epidemiology correlations are presented, to underline the importance of patient safety in medicine. This article should help to understand the terminology of patient safety, to be able to understand the real important ideas and context of patient safety.
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The various types of glomerulonephritis, including many forms of vasculitis, are responsible for about 15% of cases of end-stage renal disease (ESRD). Arterial hypertension represents a frequent finding in patients suffering from glomerulonephritis or vasculitis and hypertension also serves as an indicator for these severe types of diseases. In addition, there are symptoms and signs like hematuria, proteinuria and renal failure. ⋯ Respective immunosuppressive drug regimens contain traditionally medications, such as glucocorticoids (e. g. prednisone), cyclosporine A, mycophenolate mofetil, cyclophosphamide, and azathioprine. With respect to more severe forms of glomerulonephritis and vasculitis, the antibody rituximab represents a new and less toxic alternative to cyclophosphamide. Finally, in certain special cases, like Goodpasture's syndrome or severe ANCA-positive vasculitis, a plasma exchange will be useful and even required.
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Many patients with advanced diseases complain about refractory breathlessness when breathlessness is present although the underlying disease is optimal treated. After exclusion of potential curable causes of breathlessness, management of refractory breathlessness includes general approaches, pharmacological (opioids) and non-pharmacological (e.g. handheld fan, rollator) interventions. Oxygen should be used far less than used in clinical practice at the moment and needs critical appraisal of effectiveness.