Open Access Minireview Article

Lean Six Sigma, Root Cause Analysis to Enhance Patient Safety in Healthcare Organizations: A Narrative Review, 2000-2016

Sara O. Salem, Dalal S. Al-Dossari, Ibrahim A. Al-Zaagi, Naseem Akhtar Qureshi

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-26
DOI: 10.9734/JAMPS/2017/31541

Background: Lean Six Sigma [LSS] and Root Cause Analysis [RCA] are powerful quality business tools that cost-effectively improve efficiency and effectiveness of and client satisfaction in healthcare, academia and other industries. RCA, an iterative process helps in the identification of the root cause of an adverse medical incident and injuries and consequently prevents its recurrence provided RCA recommendations are properly implemented in the healthcare industry.

Objective: This narrative review aims to describe the principles and objectives of LSS and RCA tools with a special focus on their diverse roles in healthcare organizations.

Methods: A computer searches of PubMed, OvidSP, and Google Scholar (2000-2016) were made using keywords such as Lean, or Six Sigma or lean six sigma or medication errors (MEs) or adverse drug events or RCA which retrieved thousands of references but only 110 articles were included in this paper.

Results: Lean, Six Sigma, LSS, and RCA are powerful quality improvement tools that prevent adverse events, produce better quality services and result in enhancing patient satisfaction and safety. These quality tools also decrease costs, work performance variance, waste and increase customer satisfaction and the work performance of healthcare professionals.

Conclusion: The use of the quality improvement tools produce better quality healthcare services with greater efficiency, and good outcome and also prevents adverse drug events linked with significant morbidity, mortality and financial burden on the public health around the world.

Open Access Original Research Article

Drug Use in the National Health Insurance Scheme at a Tertiary Hospital in the South East Nigeria

Roland Nnaemeka Okoro, Chijioke Nmeka, Patrick O. Erah

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-10
DOI: 10.9734/JAMPS/2017/30593

Background: Due to increased out-of-pocket spending on health care by Nigerians, National Health Insurance Scheme (NHIS) was created to protect families from the financial hardship of huge health care bills among other objectives.

Aim: The objectives of the study were to investigate the drug use practices and overall prescribing pattern in the NHIS at a Tertiary Hospital in Nigeria.

Methods: Retrospectively, randomly sampled 1200 out-patient’s NHIS prescriptions were evaluated using WHO core drug use indicators. Prospectively, a conveniently sampled 120 patients each at General Out-Patient Department (GOPD) clinic, NHIS, and GOPD dispensing pharmacy outlets were observed during consultations and interviewed before leaving pharmacy to assess the patient care indicators. Data were analyzed using descriptive statistics and independent samples t-test.

Results: The average number of drugs per prescription, encounters with an antibiotic, and drug prescribed by generic name and from NHIS essential drug list were 4.2±1.8, 31.6%, 52.8% and 66.1% respectively. In NHIS and GOPD dispensing pharmacy outlets, the pharmacists’ average prescriptions assessment time were 9.24 seconds and 64.03 seconds with significant difference (P < 0.05), whereas the average medication counselling time were 15.6 seconds and 34.7 seconds respectively with significant difference also (P < 0.05). Dispensed drugs that were properly labelled were higher in NHIS than in GOPD (62.0% vs 20.4%). Patients’ correct drug dosage knowledge was also higher in NHIS than in GOPD (37.5% vs 23.3%).

Conclusion: Poor drug use practices including poly-pharmacy, overuse of antibiotics, lack of adherence to generic prescribing, poor conformity to NHIS essential drug policy, inadequate prescription assessment, inadequate patients’ medication counselling, incomplete labelling of drugs, and inadequate patients’ knowledge of correct drug dosage were apparent. Antihypertensive drug class was the most prescribed drug class.

The findings of this study have provided first time evidence of irrational drug use in NHIS in the South East Nigeria. Therefore, we recommend training and re-training of healthcare providers in the health insurance scheme on rational drug prescribing and dispensing.

Open Access Original Research Article

The Effectiveness of Reality Therapy Concepts on Self-esteem of the Elderly in the Center of Aramesh in Parsabad

Seyyed Jalal Younesi, Kazem Khazan, Setareh Jani, Zahra Mahdizadeh

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-8
DOI: 10.9734/JAMPS/2017/28297

Aim: This research was conducted to study the effectiveness of reality therapy concepts on self-esteem of the elderly.

Materials and Methods: The present study was semi-experimental and its design was pretest-posttest with a control group. The statistical population consisted of elderly men at the Center of Aramesh in Parsabad. Using the inclusion and exclusion criteria, 50 elderly men were evaluated, and among them 30 persons were identified to enter this study, and they were randomly assigned into two groups: Experimental and control group. Self-esteem scale was performed to both experimental and control groups. To collect data, Rosenberg self-esteem questionnaire was used. Reality therapy training sessions for two intervention groups were held twice a week during eight sessions, and there was follow- up for a month. Data were analyzed using variance analysis with repeated measures.

Findings: The results showed that the difference between self-esteem mean scores of two groups is significant, and reality therapy was to increase self-esteem of the elderly significantly (p<5 %). Also, comparison between mean scores of pretest and posttest in both groups showed increasing self-esteem scores in posttest period was a significant difference.

Conclusion: The results of this research revealed that reality therapy is useful in increasing self-esteem among the elderly. The implementation of such group sessions are recommended in the residences and retirement centers of the elderly.

Open Access Original Research Article

Prevalence and Pattern of the Nutritional Status of Adolescents Attending Public Secondary Schools in Gokana, A Rural Community in Rivers State, Nigeria

R. U. Oluoha, E. O. Asuquo, M. M. Mezie-Okoye

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-9
DOI: 10.9734/JAMPS/2017/31805

Aims: To evaluate the prevalence and pattern of malnutrition among adolescents in public secondary schools in a rural community.

Study Design: A school based cross-sectional descriptive study.

Place and Duration of Study: Public secondary schools in Gokana Local Government Area, Rivers State, Nigeria between August and October, 2016.

Methodology: A total of 300 adolescents between 10 and 18 years were recruited from students attending public secondary schools in Gokana Local Government Area of Rivers State using a two staged simple random sampling technique. Information from respondents was obtained using a pretested semi-structured interviewer administered questionnaire. The respondents’ weights and heights were measured and used to calculate their body mass index (BMI). BMI was used to classify them into stunted, underweight, normal and overweight/obese adolescents using the 2007 World Health Organisation’s reference population. Data analysis was done using the Statistical Package for Social Sciences (SPSS) version 20.

Results: The prevalence of stunting, underweight and overweight/obesity in this study were 14.3%, 15.6% and 0.0% respectively. Male and older adolescents were more likely to be underweight and stunted compared to female and younger adolescents.

Conclusion: Acute and chronic under-nutrition is still a major problem among adolescents in rural communities in Rivers State unlike overweight / obesity. Our findings have implications for intensified nutrition programmes generally and specifically for adolescents at all levels of government.

Open Access Original Research Article

Effects of Aqueous Leaf Extract of Annona muricata on Pregnancy and Pregnancy Outcome

Enyi Obianuju, Okorie Pamela, Iyare Eghosa, Ugwu Princewill, Anyaehie Ugochukwu Bond

Journal of Advances in Medical and Pharmaceutical Sciences, Page 1-6
DOI: 10.9734/JAMPS/2017/31444

Background: Indiscriminate and increasing consumption of herbal medicinal products by pregnant women presents major concern due to paucity information on safety. Annona muricata also known as soursop is commonly consumed in Nigeria including by pregnant women, but information remains poor on effects on pregnancy outcomes.

Aims and Objectives: This study was carried out to determine the effect of the aqueous extract of Annona muricata leaves on maternal weight gain during pregnancy, placental weight, litter size, body weight at birth and placental/body weight ratio in female Wistar rats.

Materials and Methods: Twenty-four (24) female Wistar rats were used for this study. On confirmation of pregnancy by presence of spermatozoa in vaginal smears and  vaginal plugs in cages, the rats were then divided into four groups of six rats each receiving different concentration of the extract as follows; 15 mg, 30 mg, and 45 mg/kg of body weight. The extract was administered orally and daily throughout the gestational period of the Wistar rats. The maternal body weights were measured daily; before extract administration, during extract administration and prior to sacrifice.  On day 18 of pregnancy, 4 rats from each group were sacrificed; placentae harvested and weighed using analytical weighing balance. The foetal number in utero were also determined and recorded. On the day of delivery for the remaining 2 rats, the gestational length, litter size and birth weight were recorded and litter length measured to the nearest (cm) using a measuring tape. Morphological appearance of the offspring was also assessed.

Statistics: Data obtained as mean ± standard deviation were analysed using one way analysis of variance (ANOVA) followed by a post hoc student’s Neuman-Keul’s test. Level of significance between groups was taken as p<0.05.

Results:  There was a significant reduction in maternal weight during pregnancy, litter birth weight, litter length, placental weight and placental/birth weight ratio of the extract-treated pregnant group (p<0.05) compared to control group.

Conclusion: Consumption of Annona muricata by pregnant women can significantly reduce the utero-placental transfer of nutrients and as a consequence impair fetal growth.