Nursing Administration globally faces the impact of high attrition of experienced nurses. The challenge of ensuring patient safety and maintaining optimum standards can be taken care of by implementing the preceptorship model and competency based skill development for new nurses easing their transition from novice to competent nurses.

There is an increasing focus on having quality systems in place during the planning stages of clinical trials. Such systems require the development and implementation of standards for each step. Although this is not imposing something totally new on clinical research, a systematic approach will produce a more reliable and useful end product-high-quality data obtained without compromising the protection of human subjects' rights and welfare. A suggested quality system with standards for each step is addressed in this article. The organization measures and improves when necessary, compliance with organizational policies, procedures, and applicable laws; regulations, codes, and guidance. The organization also measures and improves when necessary, the quality, effectiveness, and efficiency of the clinical trial process to protect the research participant.

Background and Context: Lean Six Sigma (LSS) in healthcare was conceived as a national demonstration project by Quality Council of India to launch and manage their continuous quality improvement programs. Aims and Objectives: To explore the potential benefits of applying LSS principles in the clinical domain to enhance patient satisfaction and as a clinical performance indicator. Materials and Methods: Through the supplier, inputs, process, outputs and customers (SIPOC) were identified. On the supplier side there were surgical coordinators, surgeon, optometrists and medical store. Input and process are important in that patient selects lens based on an estimate, intra ocular lens and refraction as analyzed by an optometrist. The define, measure, analyze, improve and control (DMAIC) cycle was used in taking the project further. Results: The residual refractive error was reduced from 0.35D to 0.33D and eventually to 0.25D (3 sigma). Project helped the hospital in terms of tangible and intangible benefits. Number of cataract surgeries surged by 17.75%, giving rise to an increase in financial accrual from rupees 11.5 Cr to 13.5 Cr. Conclusion: A control plan was deployed through visual display of the process flow in out-patient department and monthly review of visual outcomes during clinical audit using average, standard deviation and sigma presented as key performance indicators, to ensure no drift in performance post the closure of the project.

Introduction: Proactive prevention of medical errors is critical in medical practice. Root causes analysis is a conventional method used to deal with errors that result in an adverse event. Aim: The aim of this paper was the application of the failure mode and effects analysis (FMEA) tool used to evaluate the risks to prevent the infections and adverse treatment effect in dialysis for patients and it leads to improving the quality of care provided by Healthcare Organizations and to assure patients' safety. Materials and Methods: FMEA to hemodialysis unit and sequential steps in the FMEA process are explained. Assigned severity, occurrence, and detection scores for each failure mode and calculated the Risk Priority Numbers (RPNs). The RPN was calculated as the product of the three attributes: RPN = occurrence rating × severity rating × detectability rating. Statistical Analysis: Statistical evaluation of plan results was performed with a two-tailed Chi-square test. Results were considered statistically significant at P < 0.05. Results: The Technical Expert Panel analyzed failure modes causes, made recommendations and planned new control measures. After failure mode elimination or reduction, we find out the association of resulting RPN with severity scores, occurrence scores, and detection scores. Conclusions: FMEA has helped in the prospective evaluation of dialysis processes, determination of risks associated with dialysis care and development of solutions and preventive actions. Thus reduce the risk and improving the patient safety of the Dialysis Department.

Aim: The present cross-sectional questionnaire survey was conducted with an aim of assessing the knowledge, attitude, and practice (KAP) related to pharmacovigilance among the health-care professionals in a teaching hospital located in Central India region. Materials and Methods: To assess the demographic details of the health-care professionals, their KAPs toward pharmacovigilance and adverse drug reaction (ADR) reporting; a predesigned, structured, close-ended 18 item questionnaire was used. Results: A total of 392 questionnaires were distributed among the health-care professionals. It was found that only 38.01% health-care professionals comprising 54.43% medical, 38.01% nursing and 19.01% dental professionals were aware regarding the existence of pharmacovigilance program of India. While, only 40.56% health-care professionals felt that ADR monitoring center should be established in every hospital. Similarly, very few health-care professionals, that is, 6.12% have ever reported ADR to pharmacovigilance center. Conclusion: The results of our study indicate that the majority of the health-care professionals had a poor knowledge and attitude about pharmacovigilance. There was a huge gap between the ADR experienced, and ADR reported by the health-care professionals especially among dentist and nursing staff. It has been advised that the health-care professionals; especially dental and nursing, should be trained properly on ADR reporting to improve the current scenario in the pharmacovigilance program of the country.

Background: The present study aimed at assessing the sample rejection rate during the 1 ^st year of implementation of the quality management system in the laboratory of a tertiary care medical center in the developing world. Materials and Methods: Retrospective analysis of data relating to rejections of the request forms and samples sent for hematological and biochemistry investigations from inpatients departments after 1-year of implementation of laboratory management system (ISO 15189; 2007) was done. The mean rejection rate was calculated. It was compared with rejection rates reported by various laboratories. The criteria followed for rejection in our laboratory were compared with those laid down by laboratories in previous studies. Descriptive statistics was used in the study. Results: Of the 54,603 request forms and samples received during the study period, 3936 (7.2%) were rejected. Issues related to request forms and issues related to the sample, each accounted for nearly 50% rejections. Among the issues related to request from, the most common reason was "incomplete form" leading to 50% rejection. The most common reason for rejection of the sample was "clotted sample" (27.1%). When rejection rates as well as criteria followed by our laboratory were compared with other laboratories, it was found that 32 different criteria for rejections were followed across various laboratories. However, only one criterion (inadequate volume) was followed by all except one study (90%), suggesting a lack of uniformity over rejection criteria across studies. Conclusions: We found that the rejection rates among various laboratories in developing and developed countries differ. Moreover, the rates differ among various laboratories in developing countries. And the criteria that were followed for rejection differed across studies.