Risk mitigation and the legal and ethical considerations for COVID-19 in a psychiatric inpatient setting

2020 ◽  
Vol 16 (2) ◽  
pp. 101-110
Author(s):  
Lucy Blake ◽  
Ria Pugh ◽  
Luke Skelton ◽  
Eric Baskind ◽  
Bethan Harries ◽  
...  
Keyword(s):  
Intensive Care ◽  
Risk Mitigation ◽  
Psychiatric Inpatient ◽  
Mitigation Strategies ◽  
Risk Prevention ◽  
Inpatient Setting ◽  
Ethical Challenges ◽  
Care Services ◽  
Restrictive Practice ◽  
Related Risk

This series of brief reports highlights the experience of a London psychiatric intensive care unit (PICU) that cared for patients with COVID-19 relatively early in the pandemic. The objective is to contribute to learning and consider the challenges for psychiatric intensive care services. This article will discuss COVID-19-related risk prevention and mitigation strategies in a psychiatric inpatient setting, followed by an overview of the legal and ethical challenges, relating to risk prevention, mitigation and restrictive practice, in psychiatric inpatient care during the time of the pandemic.

scholarly journals Patient-Stated Preferences Regarding Volume-Related Risk Mitigation Strategies for Hemodialysis

2014 ◽  
Vol 9 (8) ◽  
pp. 1418-1425 ◽  
Author(s):  
Jennifer E. Flythe ◽  
Thomas W. Mangione ◽  
Steven M. Brunelli ◽  
Gary C. Curhan
Keyword(s):  
Risk Mitigation ◽  
Stated Preferences ◽  
Mitigation Strategies ◽  
Related Risk ◽  
Risk Mitigation Strategies

scholarly journals Evaluation of the Patients’ Satisfaction with Psychiatric Health Care Services with an Adapted PIPEQ-OS Tool

2019 ◽  
Vol 73 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Natālija Bērziņa-Novikova ◽  
Māris Taube
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Average Length ◽  
Demographic Data ◽  
Psychiatric Inpatient ◽  
Psychiatric Ward ◽  
Inpatient Setting ◽  
Cognitive Interviews ◽  
Patients Satisfaction ◽  
Care Services

Abstract Until now, the assessment of health care services provided by psychiatric institutions in Latvia has not been carried out and questionnaires to provide assessment from the patient’s perspective have not been adapted. For this study, a questionnaire that has been validated and successfully employed for several years in Norway was chosen to assess patients’ experience and in a psychiatric inpatient setting. The aim of the study was to determine patients’ satisfaction with the quality of mental health care services in Latvia in the subacute inpatient psychiatric ward in Rīga, adapting during this process the PIPEQ-OS (Psychiatric Inpatient Patient Experience Questionnaire) tool in Latvia. The pilot quantitative study was conducted from June 2016 till February 2017. In the study, an anonymous patient self-assessment questionnaire PIPEQ-OS containing 21 questions was used. During the adaptation process, the questionnaire was translated from English into Latvian and Russian and backwards. The quality and compliance of the translation was subsequently tested in cognitive interviews. During the study, 297 patients were discharged from the unit, and 231 of them completed the questionnaire. 12% of the completed questionnaires were not included in data processing due to being incorrectly filled in. Cognitive interviews with 20 patients were carried out; the average length of an interview was 15 minutes. Overall, the translation of the questionnaire proved to be relevant to the research theme. The subsequent factor analysis revealed three significant factors that reached the Cronbach’s alpha index of 0.7. Further studies using socio-demographic data and based on various inpatient units as well as the comparison of satisfaction indicators across different diagnostic groups are needed.

Social media use in the legal profession

2018 ◽  
Vol 43 (2) ◽  
pp. 120-125
Author(s):  
Alyce Zawacki
Keyword(s):  
Social Media ◽  
Media Use ◽  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Ethical Challenges ◽  
Social Media Use ◽  
Legal Professionals ◽  
The Public ◽  
Risk Mitigation Strategies ◽  
Important Evidence

There has been a large uptake of social media use by legal professionals over recent years, but with the embrace of the 21st-century lawyer comes an obligation to not only use social media but to do so ethically. Undoubtedly, social media presents a number of ethical challenges for the profession. However, with risk mitigation strategies, Web 2.0 can be used to gain clients through advertising, gather important evidence, serve court documents, network with others in the field and, most importantly, educate the public.

Proactive Actions Based on a Resilient Approach to Urban Seismic Risk Mitigation

2020 ◽  
Vol 14 (1) ◽  
pp. 321-335
Author(s):  
Marco Vona
Keyword(s):  
Urban Planning ◽  
Emergency Management ◽  
Seismic Risk ◽  
Risk Mitigation ◽  
Housing Stock ◽  
Mitigation Strategies ◽  
Housing System ◽  
Management Tools ◽  
Natural Risk ◽  
Seismic Risk Mitigation

Background: Seismic risk mitigation is an important issue in earthquake-prone countries, and needs to be solved in those complex communities governed by complex processes, where urban planning, socioeconomic dynamics, and, often, the need to preserve cultural assets are present simultaneously. In recent years, due to limited financial resources, mitigation activities have often been limited to post-earthquake events, and only a few in periods of inactivity, particularly in urban planning. At this point, a significant change in point of view is necessary. Methods: The seismic risk mitigation (and more generally, natural risk mitigation) must be considered as the main topic in urban planning and in the governance of communities. In fact, in several recent earthquakes, significant socioeconomic losses have been caused by the low or lack of resilience of the communities. This is mainly due to the high vulnerability of private buildings, in particular, housing units. Results: Therefore, in recent years, several studies have been conducted on the seismic resilience of communities. However, significant improvements are still needed for the resilience assessment of the housing stock, both qualitatively and quantitatively. In this study, which is applied to the housing system, a proposal regarding a change in urban planning and emergency management tools based on the concept of resilience is reported. As a first application, a case study in Italy is considered. Conclusion: The proposal is focused on defining and quantifying the improvement of the resilience of the communities and this must be obtained by modifying the current Civil Protection plan. New tools are based on a new resilience community plan by encompassing urban planning tools, resilient mitigation strategies, and consequently, emergency management planning.

scholarly journals 307 A systems approach to understanding biosecurity decision-making

2020 ◽  
Vol 98 (Supplement_4) ◽  
pp. 43-43
Author(s):  
Scott C Merrill ◽  
Christopher Koliba ◽  
Gabriela Bucini ◽  
Eric Clark ◽  
Luke Trinity ◽  
...  
Keyword(s):  
Decision Making ◽  
Negative Impact ◽  
Risk Mitigation ◽  
African Swine Fever Virus ◽  
The United States ◽  
Mitigation Strategies ◽  
Communication Strategy ◽  
Livestock Industry ◽  
Diarrhea Virus ◽  
Operational Level

Abstract Disease and its consequences result in social and economic impacts to the US animal livestock industry, ranging from losses in human capital to economic costs in excess of a billion dollars annually. Impacts would dramatically escalate if a devastating disease like Foot and Mouth Disease or African Swine Fever virus were to emerge in the United States. Investing in preventative biosecurity can reduce the likelihood of disease incursions and their negative impact on our livestock industry, yet uncertainty persists with regards to developing an effective biosecurity structure and culture. Here we show the implications of human behavior and decision making for biosecurity effectiveness, from the operational level to the owner/managerial level and finally to the systems level. For example, adjustments to risk messaging strategies could double worker compliance with biosecurity practices at the operational level. The improvement of our risk communication strategy may increase willingness to invest in biosecurity. Furthermore, the adaptation of policies could nudge behavior so that we observe a short disease outbreak followed by a quick eradication instead of a pandemic. Our research shows how the emergence of now-endemic diseases, such as Porcine Epidemic Diarrhea virus, cannot be adequately modeled without the use of a human behavioral component. Focusing solely on any one sector or level of the livestock system is not sufficient to predict emergent disease patterns and their social and economic impact on livestock industries. These results provide insight toward developing more effective risk mitigation strategies and ways to nudge behavior toward more disease resilient systems.

scholarly journals Harnessing New and Existing Virtual Platforms to Meet the Demand for Increased Inpatient Palliative Care Services During the COVID-19 Pandemic: A 5 Key Themes Literature Review of the Characteristics and Barriers of These Evolving Technologies

2021 ◽  
pp. 104990912110366
Author(s):  
Holly R. Cherniwchan
Keyword(s):  
Palliative Care ◽  
Control Measures ◽  
Inpatient Setting ◽  
Overall Acceptability ◽  
Care Services ◽  
Infection Control Measures ◽  
Home Based ◽  
Palliative Care Services ◽  
Virtual Services ◽  
Case Basis

The COVID-19 pandemic has increased the demand for end-of-life services and bereavement support, and in many areas of the world, in-person palliative care is struggling to meet these needs. Local infection control measures result in limited visitation rights in hospital and patients are often dying alone. For many years, virtual platforms have been used as a validated alternative to in-person consults for outpatient and home-based palliative care; however, the feasibility and acceptability of a virtual inpatient equivalent is less studied. Virtual inpatient palliative care may offer a unique opportunity for patients to have meaningful interactions with their care team and family while isolated in hospital or in hospice. This narrative review examines strategies employed during the COVID-19 pandemic to implement virtual palliative care services in the inpatient setting. Five key themes were identified in the literature between January 2020-March 2021 in the LitCovid NCBI database: 1) overall acceptability of virtual inpatient palliative care during the pandemic, 2) important logistical considerations when developing a virtual inpatient palliative care platform, 3) commonly used technologies for delivering virtual services, 4) strategies for harnessing human resources to meet increased patient volume, and 5) challenges of virtual inpatient palliative care implementation. Upon review, telepalliative care can meet the increased demand for safe and accessible inpatient palliative care during a pandemic; however, in some circumstances in-person services should still be considered. The decision for which patients receive what format of care—in-person or virtual—should be decided on a case-by-case basis.

‘Who Ya Gonna Call …?’ Ethical and legal dilemmas in specialist children centres and district general hospitals

2021 ◽  
pp. 147775092110366
Author(s):  
Harika Avula ◽  
Mariana Dittborn ◽  
Joe Brierley
Keyword(s):  
Intensive Care ◽  
Clinical Ethics ◽  
Ethical Issues ◽  
General Setting ◽  
Daily Practice ◽  
Paediatric Intensive Care ◽  
Ethical Challenges ◽  
Legal Cases ◽  
Ethics Support ◽  
The Uk

The field of Paediatric Bioethics, or ethical issues applied to children's healthcare, is relatively new but has recently gained an increased professional and public profile. Clinical ethics support to health professionals and patients who face ethical challenges in clinical practice varies between and within institutions. Literature regarding services available to paediatricians is sparse in specialist tertiary centres and almost absent in general paediatrics. We performed a mixed-methods study using online surveys and focus groups to explore the experiences of ethical and legal dilemmas and the support structures available to (i) paediatric intensive care teams as a proxy for specialist children's centres and (ii) paediatricians working in the general setting in the UK. Our main findings illustrate the broad range of ethical and legal challenges experienced by both groups in daily practice. Ethics training and the availability of ethics support were variable in structure, processes, funding and availability, e.g., 70% of paediatric intensive care consultants reported access to formal ethics advice versus 20% general paediatricians. Overall, our findings suggest a need for ethics support and training in both settings. The broad experience reported of ethics support, where it existed, was good – though improvements were suggested. Many clinicians were concerned about their relationship with children and families experiencing a challenging ethical situation, partly as a result of high-profile recent legal cases in the media. Further research in this area would help collect a broader range of views to inform clinical ethics support's development to better support paediatric teams, children and their families.

scholarly journals Use of failure modes and effects analysis to mitigate potential risks prior to implementation of an intravenous compounding technology

2021 ◽  
Author(s):  
Agnes Ann Feemster ◽  
Melissa Augustino ◽  
Rosemary Duncan ◽  
Anand Khandoobhai ◽  
Meghan Rowcliffe
Keyword(s):  
Medication Safety ◽  
Failure Modes ◽  
Risk Mitigation ◽  
New Technology ◽  
Hazard Index ◽  
Mitigation Strategies ◽  
Investigational Drug ◽  
Workflow Optimization ◽  
Proactive Approach ◽  
Risk Mitigation Strategies

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The purpose of this study was to identify potential failure points in a new chemotherapy preparation technology and to implement changes that prevent or minimize the consequences of those failures before they occur using the failure modes and effects analysis (FMEA) approach. Methods An FMEA was conducted by a team of medication safety pharmacists, oncology pharmacists and technicians, leadership from informatics, investigational drug, and medication safety services, and representatives from the technology vendor. Failure modes were scored using both Risk Priority Number (RPN) and Risk Hazard Index (RHI) scores. Results The chemotherapy preparation workflow was defined in a 41-step process with 16 failure modes. The RPN and RHI scores were identical for each failure mode because all failure modes were considered detectable. Five failure modes, all attributable to user error, were deemed to pose the highest risk. Mitigation strategies and system changes were identified for 2 failure modes, with subsequent system modifications resulting in reduced risk. Conclusion The FMEA was a useful tool for risk mitigation and workflow optimization prior to implementation of an intravenous compounding technology. The process of conducting this study served as a collaborative and proactive approach to reducing the potential for medication errors upon adoption of new technology into the chemotherapy preparation process.

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