Issues Evident in VLAD Graphs

A family member had been complaining about the medical errors towards her father at the health facility. The errors are human and committed by both the nurses and the doctors. The new CEO of the hospital carried out an investigation and came up with the following justifications. The senior managers had delegated follow-ups into the wards and departments. The hospital was understaffed and had many patients. The wards do not know about the complaints by the family since the wife is always by the side of the patient. The nurses admitted that the regular changing of medication might be the cause of the problems. The family members have high expectations about the health facility. This essay will look at the methods of resolving the issues that the family is facing.

The family complains of the medical errors that the doctors and the nurses cause. Moreover, the family members claim that the mistakes are human. Therefore, the nurses and other health practitioners are negligent in their line of duty. The father of the family suffers from numerous ailments hence a medical error can be life-threatening. The nurses stuff-up the medication for the ailing father. Due to his multiple diseases, the medication tablets are also a lot. The nurses should separate the medicines for easy admission and error-free intake by the patient. However, the nurses put the medication together hence leading to a mix-up.

The Doctors in the emergency wing where the father is admitted fail to write the medication correctly. Failure to label the medication complicates the administration of such medication to the patient. To make matters worse, other doctors don’t write medication at all. The clinical negligence of failing to write medication leads to errors in treatment. The nurses and the wife of the patient cannot give the right medication without a proper write-up. Therefore, the human error occurs since the doctor makes it difficult for the nurse to administer care to the patient.

The Doctors unclearly write the medication before passing the write-up to the nurse. Therefore, the nurses fail to read the medication since they cannot see the handwriting of the doctor. The failure to understand the medication leads to treatment errors. Moreover, the cause of the error is the doctor who has written unclear documentation. Other nurses also read the medication information in a wrong format. Improper interpretation of medication leads to incorrect treatment. The situation goes against the standards of practice of the Registered Nurses of Australia. Moreover, the wrong medical attention is against the Code of Ethics for the health practitioners.

Monitoring Stroke Management Strategies within the Hospital

Some nurses cannot read the chart that contains the information about all the ailments of the patient. Medical charts have details of the specific diseases and the appropriate remedies for those ailments. If the nurses cannot read the charts, then they cannot know the conditions affecting the client. Moreover, they cannot do the medications to administer to the patient. Therefore, the patient receives poor treatment that jeopardizes his life. Other nurses look at the charts on a halfway basis. They look at the first page and stop there. The first page contains few of the ailments. The other disease conditions exist in the preceding pages.

There is also a poor handover of treatment from one nurse to the other. The scenario results in the misplacement of medical documents. Moreover, some drugs go missing due to the negligence by the nurses. In other extreme cases, the nurses cannot appropriately read the drug containers. The daughter and the wife of the patient have reported the complaints to the hospital authorities. However, the heads of departments have promised to act on the claims but failed to respond on their promises.

The first cause is inadequate empathy when the nurses are handling the patients (Hayes, Jackson, Davidson, & Power, 2015). Moreover, the doctors and the nurses lack compassion when discharging their duties. A health practitioner who is compassionate and full of empathy should ensure that they don’t stuff up medication for the patient. Due to the lack of the two moral qualities, doctors fail to write medicines for the patients appropriately. The manufacturers of drugs use complex terminologies on the bottles containing the pills. Therefore, the nurses face difficulties in reading and interpreting the bottles. The nurses do not consult the doctor or other nurses when they cannot understand the medication. The other cause of the errors is poor handover between the nurses (Reader, Gillespie, & Roberts, 2014). The health professionals fail to communicate adequately hence complicating the handover process. Moreover, the nurses fail to give adequate information about the steps they have made in the treatment.

The nurses also do not explain the nature of the complication to the doctors at the appropriate time (Gallagher, & Mazor, 2015). Moreover, the family members do not tell the practitioners about the extent of the complications that are affecting the patient. The hospital Authorities do not give timely responses to the request of meetings by the relatives of the patient. Additionally, the hospital staff does not take the patient’s complaints seriously. Moreover, the hospital authorities are slow in action towards the allegations of the clients.

Actions to Investigate Clinical Errors in Stroke Management

The negligence by the nurse and the doctor leads to the clinical errors (Clark, Collier, & Currow, 2015). The errors occur more often due to the numerous patients that visit the health facilities. Moreover, the hospital faces understaffing problems. The nurses change medication without informing the wife of the patient about the changes. Furthermore, the nurses fail to explain the reasons for the alteration in the type of medical attention.  There is lack of training for the nurses (Young, Menon, Street, Al-Hertani, & Stafinski, 2017).

The members of staff should be trained to avoid the errors. The training of nurses should emphasize the need to properly hand over the treatment files after the completion of their respective shifts (Brown, Edwards, Seaton, & Buckley, 2017). The doctors need the training to enable them to improve on their handwriting when writing medication. The training should be in line with the standards of practice, and the codes of ethics of the Australian Registered Nurses (Admi, & Eilon-Moshe, 2016). All stakeholders should hold discussions to look at the complaints made by the patients. Moreover, each stakeholder should give their contributions on the best ways to eliminate clinical errors. The doctors should share the guidelines on best practice procedures with the nurses. The methods enable the nurses to minimize errors during the administration of treatment.

The training should emphasize on the need of proper channels of communication between the caregivers and the family members of the patient. Nurses should also observe the standards of practice and ethics when interacting with the relatives of the patient (Scanlon, Cashin, Bryce, Kelly, & Buckely, 2016).  The nurses should improve their handover techniques to prevent the human errors during treatment. Moreover, the health facility should educate the nurses on the considerations during the treatment process. The health practitioners should forward the patient’s complaints to the doctors and eventually to the hospital authorities. The new members of staff require an adequate sensitization on the procedures of the health facility. They should know when to summon a senior doctor during treatment. Moreover, the doctors should control the expectations of the patients and the relatives. Expectation management requires proper communication channels at the onset of treatment.

The first step in quality assurance according to MPSF is the commitment of the resources towards quality healthcare (Harvey, & Kitson, 2015). The hospital fails to avail the resources needed to ensure world-class treatment. Furthermore, the health facility has given minimal priority to the provision of quality care. Clinical error prevention techniques are present within the health facility (Harvey, & Kitson, 2015). Furthermore, there are committees and strategies to deal with the medical errors. However, the nurses, doctors, and the hospital authorities failed to use the available systems to eliminate clinical mistakes (Harvey, & Kitson, 2015). The nurses are unaware of the clinical errors that they are committing on a regular basis. Moreover, they don’t know about the ways of minimizing those errors.

Patient Experience Feedback and its Role in Clinical Error Investigations

The second safety culture is the creation of records and evaluation of patient’s complaints (Marshall et al., 2017). Moreover, nurses should learn and reflect on the past mistakes and endeavor to avoid them in the future. The health facility has appropriate mechanisms that the nurses can use to record the errors that the relatives of the patients report. However, the nurses are ignorant and only record incidences that they deem to be deadly. In other cases, the authorities record the complaints but fail to take action towards them. The nurses at the emergency ward do not understand the essence of safe practice in the provision of healthcare. The health specialists do not attempt to recognize the previous mistakes and avoid them in the future.

The third safety culture involves proper communication regarding the issues of patient’s safety (Parker, Wensing, Esmail, & Valderas, 2015). There is poor communication between the doctors and the nurses. The specialists do not consult each other in case of difficulties in healthcare delivery. The nurses have problems in reading the medical instructions from the doctors but do not inform the physicians. Moreover, the nurses do not seek for clarifications on complex medical terminologies on the drug containers. The authorities received the complaints from the family members but did not discuss the concerns with the nurses and the doctors.  They kept the charges to themselves and promised to address them. However, they made little efforts in addressing the clinical errors that the family members brought to their attention.

The fourth desirable culture is teamwork among the health stakeholders (Sari, 2017). In the health facility, the specialists are working in isolation. The nurses cannot read the drug containers but cannot seek help from their colleagues. Moreover, the nurses are aware of the incomplete medical report by the doctors but do not inform the doctor about the errors. In case of the existence of health teams, then they are not functioning. The nurses themselves are not in a group since there are problems of treatment handover between the shifts of duty. The hierarchy is rigid as it cannot confront the doctors and the nurses about the complaints that the family members report. Furthermore, the staff members do not share essential patient information among themselves. In case they were holding meetings to discuss issues affecting the patients, they would have to avoid the recurrent clinical errors.

The Manchester framework suggests that a health facility should commit adequate resources to eliminate clinical errors (Sari, 2017). Furthermore, the hospital authorities should ensure proper communication channels of reporting patient complaints. Moreover, the stakeholders should act on the patient’s concerns promptly. The nurses and the doctors should form working teams to ensure quality medical attention (Thomas, Ashcroft, Parker, & Phipps, 2015). Finally, the hospital should prioritize the issuance of quality care.

The CEO should improve the quality and safety of the healthcare services. Proper healthcare helps to restore confidence and trust of the patients and their relatives on the healthcare system. Moreover, the CEO should propose efficient resolutions to encounter the recurrent clinical errors at the health facility. Efficient problem-solving strategies safes the time required to offer excellent treatment (Sahay, Hutchinson, & East, 2015). The head of the department should encourage the patients and the family members to report clinical errors. Furthermore, the hospital leader should hold any nurse who commits a clinical mistake accountable for the mistakes.

The manager should create a favorable environment for the nurses and doctors. The Chief Executive should encourage teamwork amongst the health specialists. Furthermore, the administrator should urge the patients to offer their take on the quality of care. In case the feedback is positive, the administrator should encourage the staff to keep up with the satisfactory service delivery. However, negative feedback should attract stakeholder engagements to rectify the mistakes. The administrator should manage the expectations of the patients and their family members (Sahay, Hutchinson, & East, 2015). The hospital leader should explain the procedures of treatment at the health facility.

The administrator should form a viable framework for dealing with patient complaints. Furthermore, the administrator should offer necessary mechanisms to enable the patients to report their concerns. The administrator should then assess the nature of the claim and the sources of the errors. Moreover, the Chief Executive should come up with ways of eliminating clinical errors. The manager should learn from the clinical errors and endeavor to avoid the recurrence of the mistakes (Sahay, Hutchinson, & East, 2015). The CEO should foster working teamwork between the nurses and the doctors. The technique assists in minimizing the number of errors that patients report on a regular basis.

The CEO should organize for regular training of the health specialists. The training should emphasize the importance of teamwork in healthcare. Moreover, the hospital administration should focus on the development of professionalism among the staff members. Professionalism ensures that the doctor writes complete medical reports (Sahay, Hutchinson, & East, 2015). Furthermore, a professional nurse consults the colleagues on points of uncertainty in their line of duty. The CEO should hold a joint meeting with both the nurses and the doctors to discuss the complaints of the patients. Moreover, the session should discuss strategies for avoiding future clinical errors.

The CEO should expose the staff members on the standards of best practice and the codes of conduct. Moreover, the nurses should learn about the legal and ethical issues in treatment. The four pillars of practice require nurses to desist from making clinical errors. The CEO should encourage the nurses to learn from their mistakes and strategize to eliminate the clinical errors. The CEO should tell the nurses about the consequences of the clinical errors on the health of the clients. The manager should create viable communication channels between the patients and the health specialists (Sahay, Hutchinson, & East, 2015). An additional channel is necessary between the medical staff.

The CEO should create mechanisms to boost the handover process between nurses. Furthermore, the CEO should alert the nurses about the considerations in the provision of healthcare. Moreover, the manager should encourage the nurses to consult their colleagues on contradicting issues (Hewitt, Tower, & Latimer, 2015). The CEO should also manage the elevated expectations of the patients about the healthcare system. The management of expectations is through the improvement of communication between the stakeholders.

Medication management refers to a Person-Centered Care that prioritizes safety, effectiveness, and efficient drug administration. To ensure proper treatment which is error-free, the CEO of the hospital should employ PDAC to boost the quality of care.

Planning (Plan)

The current rates of clinical errors are numerous and recur in the health facility. The hospital administration should organize for workshops to train the health specialists on how to avoid clinical mistakes. The health facility should endeavor to expose the nurses on the codes of ethics and the professional codes of conduct (McLean, Coleman, Hasan, Williams, & Lee, 2015). Moreover, the hospital administrator should carry out specialized training on the consequences of medical errors. The plans by the hospital to eliminate the errors should be progressive to ease the monitoring of the progress.

Doing (Do)

 At this level, the training begins on the methods of avoiding medication errors. The administration urges the doctor’s to write clear medical reports that the nurses can read and implement. The CEO calls the nurses to work as a team in a bid to eliminate clinical errors. Moreover, the administrator encourages the nurses to consult with their colleagues in case a treatment plan is not clear to them. Furthermore, the manager urges the nurses to communicate effectively during the handover of the treatment. Moreover, the nurses expose themselves to the techniques of avoiding stuffing up of drugs (Venugopal, Kasubhai, & Paruchuri, 2017). The doctors encourage the nurses to go through the medication chart before commencing treatment entirely. The health facility helps doctors to write all the diseases that a patient is suffering from on the chart.

Checking (Checking)

  At this point, the hospital looks at the outcome of the actions that they had put in place. The administration checks to ascertain whether the training has minimized the number of medication errors. The health facility then compares the numbers of clinical mistakes prior and after the training exercise. The hospital checks to ascertain any differences or similarities in the set of data collected. The hospital administration also evaluates the efficacy of the training process. A desirable result shows that the training was appropriate while a lousy result shows poor coaching by the tutors (Van Der Vleuten, Schuwirth, Driessen, Govaerts, & Heineman, 2015). The process of checking enables the health specialists to know the loopholes of the training exercise. They can also point at the success of the practice. Afterward, the health facility improves on the areas of weakness. Moreover, they implement the points of success.

Act (Action)

  This is the implementation stage. The stage of checking the process should show whether the planning was efficient or otherwise. Moreover, the phase of monitoring the progress should indicate whether the doing stage was a success or a failure (Hu, 2017). In case the whole process of training reduces the number of medication error, then the hospital implements the stage. Therefore, regular exercise becomes part of the medical providers in the hospital (Puccetti, 2015). If the training did not reduce the number of clinical mistakes, then the hospital returns to the planning process. The cycle continues until the facility eliminates medication errors.

1. How are VLAD graphs interpreted? Explain the important features/aspects of a VLAD graph? As an example what does the red line, blue line, black line indicate, what are the numbers, what does the y axis indicate, what are the level 1 to 3 limits for (Note:this is not an exhaustive list. There may be other features that you should explain-what they are and what is their purpose)?

VLAD graph stands for Variable Life Adjustment Displays (Gan, Tang, Zhu, & Lim, 2017). VLAD is a nursing tool that helps health specialists to identify the complications that mostly affects the most significant number of individuals.  VLAD graphs also act as a guideline for the improvement of healthcare provision (Wittenberg, Gan, & Knoth, 2018). Additionally, caregivers use the figure to enhance the safety of the clients during medical attention.  The chart also assists care providers to identify the causation of various complications and decide on the useful corrective measure. Moreover, the chart determines whether the corrective action is essential or otherwise. If necessary, the health association adopts it, if not, they reject the measure.

  VLAD is all about flagging when the caregivers attain a particular outcome (Wittenberg, Gan, & Knoth, 2018). When the caregivers reach a certain variation level, they flag out and construct the graph. The levels of flagging are three in total. The flagging areas indicate that an abnormality in the number of patients suffering from a given disease. The number can either be higher or lower than the expected outcome. The graph serves as a starting point for future interpretation of a specific illness (Wittenberg, Gan, & Knoth, 2018). The caregivers should not hurry in interpreting the curve as desirable or worst disease condition. At specific instances, flagging occurs but does not necessarily call for an alarm or a precautionary measure.

  The clinicians should adopt a pyramid structure to assist in the interpretation of the VLAD graph. From the pyramid, the clinicians can gauge the order of emergencies of given ailments. The chart plots the expected outcome and the observed values against the time. The graph given has red, black and blue lines (Czarnecki et al., 2015). The red line represents the lower quartile; that is the lowest number of mortality rates expected at the time (Yue, Lai, Liu, & Lai, 2017). The blue line denotes the upper limit; that is, the highest number of mortality rates expected at a given point in time (Woodall, & Steiner, 2016). The black line is the VLAD line. The black line indicates the rates of deaths as a result of stroke (Carolino, Ramos, Viegas, & Viegas, 2016). The front shows the observed rates of deaths with time.

In open view, the black line indicates the VLAD in a theoretical perspective. The black line is correct in case of 10% mortality rate of the baseline (Carolino et al., 2016). The observed mean death rates should also near the 10% mark. The blue line indicates the appearance of the VLAD graph if there is a loss in the follow-up process (Woodall, & Steiner, 2016). The respective deficit should not exceed 10%. The red line indicates what the graph would look like if the numbers that disappeared during the process of follow-up double the death rates (Yue et al., 2017). The VLAD procedure applies majorly in the monitoring of the death rates due to given complications. The chart indicates the minimum and maximum expectations and also the observed values in real time.

The graph shows the mortality rates due to stroke in the various health facilities. The research spans for three years that is from 2011 to 2014. The lowest mortality rates were in 2011 and 2014. The graph shows the technique that detects mortality at an earlier stage. The chart shows a display of cumulative against time (Czarnecki et al., 2015). The values on the negative sides of the Y-axis indicate the death rates as a result of stroke (Czarnecki et al., 2015). On the other hand, the positive values indicate the number of people who survived from stroke from 2011 up to 2014.

The negative figures indicate the chances of the stroke patients of survival (Patella et al., 2015). On the hand, the positive value indicates the possibilities of chances of death due to the stroke complications. A significant section of the graph is on the positive side meaning high chances of fatalities as a result of the stroke. Therefore, the chart indicates that the admitted patients have high possibilities of dying than surviving when they are suffering from the stroke. The depression of the map towards the downside suggests a decline in the quality of care towards stroke patients. Therefore, from 2014, the responsibility towards stroke patients has been declining sharply leading to more deaths.

The first two years indicate an upwards trend in the management of stroke. The pattern shows that the quality of treatment between the years was higher than that of the subsequent periods. From 2013, the slope of the graph declines showing laxity in the provision of healthcare. The health practitioners should not critically look at the first two years due to the proper stroke management during that period. However, an immediate review is necessary between 2013 and 2014 due to the decline in the slope. The stakeholders must come up with measures to improve the quality of care in the management of stroke.

Apart from the points of depression and depreciation from the graph, caregivers should also evaluate the three levels of the chart (Farenden, Gamble, & Welch, 2017). The first level does not require a review due to the ideal conditions. During the first level, the slope is appreciating, thus indicating quality healthcare in the management of stroke. Furthermore, a significant number of values exist in the negative sides. The negative values indicate high chances of survival from a stroke. The lower levels of two and three require an urgent investigation. The review is due to the high death rates and low quality of care during that period.

The review in the last two levels is necessary to determine the causes of the high mortality rates. Additionally, the caregivers should find out about the origins of low levels of care for the stroke patients. Finally, the review should provide suggestions for improving the quality of medical attention (Farenden, Gamble, & Welch, 2017). Moreover, the study should offer tips on reducing the death rates and improving the standards of survival.

1. You are the Director of the Acute Stroke Unit of a large hospital.  Your CEO has passed the above VLAD chart on to you.  The CEO has asked to you investigate the issues identified from the chart and to prepare a report to advise her on the following:
2. The underlying issues –what could be the causes of the problems evident in this chart?Note: As you do not have access to the patient records you will need to use the pyramid of investigation categories and describe potential causes for each category.

The primary causes of high mortality rates are the factors at the bottom of the model. The determinants at the apex have a little effect on the high standards of deaths (Coulson, Mullany, Reid, Bailey, & Pilcher, 2016). Therefore, numerous factors emanate from the health facilities. The rates can be due to faulty machinery or the unfavorable working conditions in the management of stroke.  The mix up in the treatment order of the patients also leads to the elevated rates of mortality (Petrelli, Pau, Plebani, & Di Stefano, 2015). The information from the patients also helps in determining the causes of the heightened death rates. In real cases, the faultiness in the provision of healthcare results into mortalities (Mitra, 2016). The least cause of deaths is the lack of professionalism from the practitioners.

The Data from the VLAD graph indicates increased death rates between 2013 and 2014. The data also indicate minimal deaths reported in the first two years. A proper interpretation of the data suggests that patients were more responsive to treatment in the first two years (Coulson et al., 2016). However, the response to medical attention has declined sharply since that time. Moreover, the number of stroke patients was minimal therefore matching the management resources in various health facilities.

The Care Mix is the other cause of mortality rate. An active regiment to care for the victims lowers the mortality rates (Jensen, Brown, Pagel, Barron, & Franklin, 2014). However, limited medication increases the chances of occurrence of deaths due to the disease. Therefore, the proper mix of care existed in the first two years of the investigations. However, in the remaining period, there was either not care blend or poor response from the patients. Another reason may be the refusal of the patients to receive the combined treatment regiments. There are treatment plans that contradict the cultural beliefs of the patients.

There are hospitals which lack the necessary resources to attend to patients. The appropriate equipment should measure the extent of the brain hemorrhage. Moreover, the machines should determine a potential blockage of brain blood vessels. Possible rectification measures are also essential. 

The Stakeholders should collect data on stroke from the health facilities. They should look for the number of patients that report annually due to the disease (Yasipourtehrani, Strezov, Bliznyukov, & Evans, 2017). Moreover, data on the number of survivors and the casualties are also necessary. The health specialists should investigate to find out the mix of care that patients receive in response to stroke (Duta, Nguyen, Aizawa, Ionescu, & Sebe, 2016). Additionally, the clinicians should investigate the reactions of the patients to the care mixes (Lipnitskaya et al., 2014). The government should avail the necessary resources to aid in the treatment of stroke. The stakeholders should ensure that the process of health care is appropriate for stroke management (Walecki, Rudovic, Pavlovic, & Pantic, 2015). Moreover, the Australian Executive should train specialized professionals to attend to stroke patients.

The stakeholders should ensure that they assign the management duties to the relevant professionals. The professionals should review and produce a VLAD that is relevant to the status of stroke in Australia (Sposato et al., 2015). The health specialists should also document the responses of stroke patients in a timely fashion. The answers enable the government to identify the weaknesses in the management of stroke. Furthermore, the stakeholders recognize the treatment plans that the patients prefer from the feedback of the patients. The health specialists should conduct a regular review of the three flagged stroke indicators. The stakeholders should keenly evaluate the parameters in the pyramid of Investigation.

The stakeholders should formulate a viable action plan to respond to the claims of the model. Apart from the pyramid, the stakeholders should also consider the feedback from the indicators. Afterward, an adjustment is necessary for the management plan. The appropriate plan should ensure progress in finding the solutions to the mortality rates (Guekht, Skoog, Edmundson, Zakharov, & Korczyn, 2017). Before the submission of the stroke mortality report, the stakeholders should investigate the relevance of the response by the patients. The story should be a proof of an adequate examination of the causes of the high levels of mortality rates.

The submitted report should suggest an appropriate plan of action to minimize the death rates due to stroke. Moreover, the call to action should have a remedy to every cause of death as a result of the stroke. The plan of action should be implemented to reduce the mortality rates. Moreover, the stakeholders should evaluate the proposed modes of operations. Unrealistic points should give room for new practical ideas (Collet et al., 2018). A proper implementation leads to the addressing of all concerns on stroke management. Every member of staff should actively participate in the review process. The stakeholders should carry out an awareness campaign to educate people on the treatment plans for stroke.

The specialists should honor all the principles when managing the death rates that stroke causes. The code of ethics is essential to the dignity of the patients is necessary before treatment. Moreover, the implementation team should observe the professional codes of conduct during the action procedure (Koronowski et al., 2015). They should ensure partiality in the treatment process and provide quality care to eliminate the deaths.

The patient gives various feedbacks concerning the treatment options. There are those who oppose specific treatment plans that contradict their cultural beliefs. The treatment methods should match the preference of the patient (Koronowski et al., 2015). Moreover, the practitioners should create multi options to suit the needs of every patient. The stakeholders should take the responses of the patients into consideration before an action plan.

References

Admi, H., & Eilon-Moshe, Y. (2016). Do hospital shift charge nurses from different cultures experience similar stress? An international cross-sectional study. International journal of nursing studies, 63, 48-57.

Brown, D., Edwards, Management., Seaton, L., & Buckley, T. (2017). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Elsevier Health Sciences.

Carolino, E., Ramos, R., Viegas, C., & Viegas, S. (2016, May). Joint Control Charts applied to monitor the concentration of particles with health effects in the professional environment. In BOOK OF ABSTRACTS (p. 101).

Clark, K., Collier, A., & Currow, D. C. (2015). Dying in Australian hospitals: will a separate national clinical standard improve the delivery of quality care?. Australian Health Review, 39(2), 202-204.

Collet, J. P., Cayla, G., Ennezat, P. V., Leclercq, F., Cuisset, T., Elhadad, S., … & Barthelemy, O. (2018). Systematic detection of polyvascular disease combined with aggressive secondary prevention in patients presenting with severe coronary artery disease: the randomized AMERICA Study. International journal of cardiology, 254, 36-42.

Coulson, T. G., Mullany, D. V., Reid, C. M., Bailey, M., & Pilcher, D. (2016). Measuring the quality of perioperative care in cardiac surgery. European Heart Journal–Quality of Care and Clinical Outcomes, 3(1), 11-19.

Czarnecki, A., Prasad, T. J., Wang, J., Wijeysundera, H. C., Cheema, A. N., Dzavík, V., … & Tu, J. V. (2015). Adherence to the process of care quality indicators after percutaneous coronary intervention in Ontario, Canada: a retrospective observational cohort study. Open heart, 2(1), e000200.

Duta, I. C., Nguyen, T. A., Aizawa, K., Ionescu, B., & Sebe, N. (2016, December). Boosting VLAD with the second assignment using in-depth features for action recognition in videos. In Pattern Recognition (ICPR), 2016 23rd International Conference on (pp. 2210-2215). IEEE.

Farenden, S., Gamble, D., & Welch, J. (2017). Impact of implementation of the National Early Warning Score on patients and staff. British Journal of Hospital Medicine, 78(3), 132-136.

Gallagher, T. H., & Mazor, K. M. (2015). Taking complaints seriously: using the patient safety lens.

Gan, F. F., Tang, X., Zhu, Y., & Lim, P. W. (2017). Monitoring the quality of cardiac surgery based on three or more surgical outcomes using a new variable life-adjusted display. International Journal for Quality in Health Care, 29(3), 427-432.

Guekht, A., Skoog, I., Edmundson, S., Zakharov, V., & Korczyn, A. D. (2017). ARTEMIDA trial (A randomized trial of efficacy, 12 months international, double-blind actovegin): a randomized controlled trial to assess the effectiveness of actovegin in poststroke cognitive impairment. Stroke, 48(5), 1262-1270.

Harvey, G., & Kitson, A. (2015). Implementing evidence-based practice in healthcare: a facilitation guide. Routledge.

Hayes, C., Jackson, D., Davidson, P. M., & Power, T. (2015). Medication errors in hospitals: a literature review of disruptions to nursing practice during medication administration. Journal of clinical nursing, 24(21-22), 3063-3076.

Hewitt, J., Tower, M., & Latimer, S. (2015). An education intervention to improve nursing students’ understanding of medication safety. Nurse education in practice, 15(1), 17-21.

Hu, Y. (2017). A quantitative approach to patient risk assessment and safety optimization in intensive care units (Doctoral dissertation, Massachusetts Institute of Technology).

Jensen, H. A., Brown, K. L., Pagel, C., Barron, D. J., & Franklin, R. C. (2014). Mortality as a measure of the quality of care in infants with congenital cardiovascular malformations following surgery. British medical bulletin, 111(1).

Koronowski, K. B., Dave, K. R., Saul, I., Camarena, V., Thompson, J. W., Neumann, J. T., … & Perez-Pinzon, M. A. (2015). Resveratrol preconditioning induces a novel extended window of ischemic tolerance in the mouse brain. Stroke, 46(8), 2293-2298.

Lipnitskaya, S., Mynbaev, K., Nikulina, L., Kramnik, V., Bougrov, V., Kovsh, A., … & Romanov, A. (2014). Investigation of light extraction from light emitting module chip-on-board. Optical Review, 21(5), 655-658.

Marshall, M., Cruickshank, L., Shand, J., Perry, S., Anderson, J., Wei, L., … & de Silva, D. (2017). Assessing the safety culture of care homes: a multimethod evaluation of the adaptation, face validity and feasibility of the Manchester Patient Safety Framework. BMJ Qual Saf, BMJ’s-2016.

McLean, A., Coleman, M. T., Hasan, K., Williams, L., & Lee, E. (2015). Quality Improvement in Healthcare Literacy for an Interprofessional Team of Learners. Journal of Interprofessional Education & Practice, 1(2), 63.

Mitra, A. (2016). Fundamentals of quality control and improvement. John Wiley & Sons.

Parker, D., Wensing, M., Esmail, A., & Valderas, J. M. (2015). Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care. European Journal of General Practice, 21(sup1), 26-30.

Patella, M., Sandri, A., Pompili, C., Papagiannopoulos, K., Milton, R., Chaudhuri, N., … & Brunelli, A. (2015). Real-time monitoring of a video-assisted thoracoscopic surgery lobectomy programme using a specific cardiopulmonary complications risk-adjusted control chart. European Journal of Cardio-Thoracic Surgery, 49(4), 1070-1074.

Petrelli, A., Pau, D., Plebani, E., & Di Stefano, L. (2015, October). RGB-D visual search with compact binary codes. In 3D Vision (3DV), 2015 International Conference on (pp. 82-90). IEEE.

Puccetti, D. D. (2015). Does ethical climate predict wisconsin nurses’ reporting of medication errors? (Doctoral dissertation, Capella University).

Reader, T. W., Gillespie, A., & Roberts, J. (2014). Patient complaints in healthcare systems: a systematic review and coding taxonomy. BMJ Qual Saf, 23(8), 678-689.

Sahay, A., Hutchinson, M., & East, L. (2015). Exploring the influence of workplace supports and relationships on safe medication practice: A pilot study of Australian graduate nurses. Nurse education today, 35(5), e21-e26.

Sari, A. A. (2017). Assessing Patient Safety Culture in the Hospital: A Pilot Study using a Modified Manchester Patient Safety Framework (MaPSaF). JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit), 6(3), 187-200.

Scanlon, A., Cashin, A., Bryce, J., Kelly, J. G., & Buckely, T. (2016). The complexities of defining nurse practitioner scope of practice in the Australian context. Collegian, 23(1), 129-142.

Sposato, L. A., Cipriano, L. E., Saposnik, G., Vargas, E. R., Riccio, P. M., & Hachinski, V. (2015). Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. The Lancet Neurology, 14(4), 377-387.

Thomas, C., Ashcroft, D. M., Parker, D., & Phipps, D. L. (2015). Identifying the challenges of maintaining a good safety culture in community pharmacy using the Manchester Patient Safety Assessment Framework. International Journal of Pharmacy Practice, 23, 2-3.

Van Der Vleuten, C. P., Schuwirth, L. W. T., Driessen, E. W., Govaerts, M. J. B., & Heeneman, S. (2015). Twelve tips for programmatic assessment. Medical Teacher, 37(7), 641-646.

Venugopal, U., Kasubhai, M., & Paruchuri, V. (2017). Introduction of a quality improvement curriculum in the Department of Internal Medicine, Lincoln Medical Center.

Walecki, R., Rudovic, O., Pavlovic, V., & Pantic, M. (2015, May). Variable-state hidden conditional random fields for facial expression recognition and action unit detection. In Automatic Face and Gesture Recognition (FG), 2015 11th IEEE International Conference and Workshops on (Vol. 1, pp. 1-8). IEEE.

Wittenberg, P., Gan, F. F., & Knoth, S. (2018). A simple signaling rule for variable life?adjusted display derived from an equivalent risk?adjusted CUSUM chart. Statistics in medicine.

Woodall, W., & Steiner, S. H. (2016). Debate: what is the best method to monitor operational performance?.

Yasipourtehrani, S., Strezov, V., Bliznyukov, S., & Evans, T. (2017). Investigation of thermal properties of blast furnace slag to improve process energy efficiency. Journal of Cleaner Production, 149, 137-145.

Young, A., Menon, D., Street, J., Al-Hertani, W., & Stafinski, T. (2017). Exploring patient and family involvement in the lifecycle of an orphan drug: a scoping review. Orphanet journal of rare diseases, 12(1), 188.

Yue, J., Lai, X., Liu, L., & Lai, P. (2017). A new VLAD?based control chart for detecting surgical outcomes. Statistics in medicine, 36(28), 4540-4547.