Policies & Health Management السياسات والإدارة الصحية

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Assessing the Supply and Demand for Dentists in Jenin District
(AL-Quds University, 2011-06-26) محمود ناجي محمود الحمدان; Mahmoud Naji Mahmoud Alhamdan; معتصم حمدان; محمد شاهين; Ahmad Rahal
Assessment of Nurses Perception towards Medication Errors in Palestinian Hospitals
(AL-Quds University, 2015-07-04) رضا رضوان صبري سلمي; Reda Radwan Sabri Silmi; معتصم حمدان; Hussein Hallaq; Hussein Jabareen
Background: Medication errors are one of the most common causes of accidental errors affecting patients’ safety and can cause serious consequences for patients. Medication errors are underreported worldwide, particularly in developing countries. Which lead to the lack of information regarding the problems of medication errors. Aim: To assess the input from nurses’ regarding several issues in medication error, exploring their perception towards medication error causes, types, rate, and reporting. which might help in pinpointing some areas in medication safety issues where there is potential for making improvement to be reflected in the nurses practices regarding medication managements at hospitals. Methods: A cross-sectional design was used. Data was collected using a self-administered questionnaire. The study was conducted in three hospitals; public, private, and NGO. A total of 267 nurses participated in the study Findings: The overall response rate was (57.17%). Female were 59.8%, and males 40.2%. The most perceived causes of MEs were lack of pharmacological knowledge and skills (82%), and heavy workload and shortage of staff (77.7%). As for the most common types of MEs, wrong medication dose (57.5%) and wrong time (53.2%) were the most prevalent. The mean number ofcommitted MEs in the past 12 months was 1.94, and the mean number of reporting medication errors in the past 12 months was 1.6. With regard to the most common type of medications involved in MEs, antibiotics was given the highest frequency in MEs. Regarding the level of harm resulted from medication error that occurs in the past 12 months, the higher frequency was for MEs causing temporary harm to patients (28.2%). Moreover, participants from the NGO and public hospitals scored higher than private hospital participants inregard to shortage of nursing staff and heavy work overload cause (P<0.001). Also 57.9% of participants with bachelor’s degree indicated the effect of lacking pharmacological knowledge and skills more than diploma and graduate studies participants (P<0.001). Finally a statistically significant relationship was found in the frequency of committing MEs (P=0.001) and frequency of reporting MEs (P<0.001) in relation to the hospital ownership. Conclusions: the results of the study indicate that there are areas of potential improvements in Palestinian hospitals. Medication safety interventions should be formulated to address strategies to reduce and eliminate medication errors.
Assessment of Quality Standards and Nursing Performance of Perioperative Nursing Care in Operating Rooms at Governmental Hospitals in the West Bank
(AL-Quds University, 2014-05-13) أسماء محمد أحمد عبد الحق; asma mohammad ahmad abdelhaq; اسمى الإمام; معتصم حمدان; د. شاهيناز نجار
Background: Improving the quality of health care becomes the primary concern of all health care institutions. Operating Room (OR) nurses are part of the healthcare providers and they should be knowledgeable about the quality of health services in order to perform their roles in improving patient‘s safety. Aim: The purpose of this study was to assess the application of quality care and nurses performance standards in operating rooms in the Palestinian governmental hospitals in the West Bank. Method: A quantitative cross sectional descriptive design was used. The population of the study consisted of all operating room nurses working at 10 Governmental Hospitals in the West Bank/Palestine. A self-administered questionnaire was distributed to 129 nurses, out of which (77.5%) responded, Data was analyzed by using the statistical package of social science (SPSS) version 17. Findings: The results of this study showed that the overall level of quality care standards application was moderate in the following standards; nursing assessment (63.2%), cleaning and sterilizing surgical instruments (81.3%), positioning patients according to the type of surgery (75.45%), using of homeostasis devices (71.25%), wound management(82.8%)andinfecationcontrol(77.78%). And it was high in the following standards; counts in surgery and sample preparation (91.5%), and preparation for surgery (89.36%). On the other hand low in reporting errors (58.68%). OR nurses, who were older, applied the quality care standards of cleaning and sterilizing surgical instruments more than younger (P< 0.035). Female nurses applied preparation for surgery standards more than male nurses (P<0.028). On the other hand there was no significant difference in the application of quality care standards in the operating rooms this is due to the academic level, training period, training site, years of experience. Also, results showed that OR nurses who worked in hospitals that have less numbers of operating rooms, applied quality standards (cleaning and sterilizing surgical instruments (P<0.008%)preparation for surgery P<0.017, positioning patients according to the type of surgery (P<0.001), wound management (P<0.014%), reporting errors (P<0.002) more than those who work in hospitals that have more numbers of operating rooms. OR nurses who work in hospitals that have low numbers of nurses applied quality standards of Using homeostasis devices (P<0.002) and Infection control (P< 0.011) more than those work in hospitals that have more numbers of nurses in OR wards. The overall application of performing standards was moderate in standard of Ethics (71.8%)، but it was low in the following standards; resources utilization (58.25%), professional practice evaluation 58.95%,leadership 57.1%, education 44.58%, quality of practice 44.3% and collaboration 28.08%). Nurses who had less experience years, applied performance standard of Education more than more experienced (P< 0.019). On the other hand there was no significant difference for academic level, training periods، scientific qualification, training site, age, gender, and standards of performance application. Also results showed that OR nurses who work in hospitals which have high numbers of OR nurses ( more than 13) applied the following performance standards: ethics (P< 0.017), collaboration (P<0.003), resources utilization (P<0.028), leadership (P<0.001) more than who work in hospitals that have low numbers of OR nurses. And OR nurses who work in hospitals which have less numbers of operating rooms (1-3) applied the following performance standards: professional practice evaluation (P<0.001), resources utilization (P<0.000), quality practice (P<0.009), Education (P<0.009), Ethics (P<0.020), more than those work in hospitals that have more numbers of operating rooms.Conclusions and recommendations: The study employed an assessment of the quality standards and nursing performance of perioperative nursing care in operating rooms at Governmental Hospitals in the West Bank. The compliance of OR nurses with quality standards was moderate whereas the compliance with performance standards was low which was reflected on nurses's performance and patient safety. So, there is a need for improving quality culture in Governmental Hospitals by introducing a policy and strategies for applying quality standards and performance appraisal of OR nurses. Additional studies needed to clarify the causes that prevent the application of quality and performance standards.
attitudes of the employees in the health sector towards the draft national health insurance
(AL-Quds University, 2011-01-08) وردة محمد ابراهيم المشاعلة; Warda Mohammad Ibrahim Mashaala; محمد شاهين; منى حميد; اسعد الرملاوي
Burnout and the Intention to Leave among Oncology Hematology Nurses in Palestinian Hospitals
(AL-Quds University, 2016-05-14) بلال عبد الرحمن نمر الجوابرة; Belal A N Al Jawabreh; سلام الخطيب; معتصم حمدان; حسين جبارين
Introduction: Nursing is inevitably a demanding and stressful job. Extra stressors like burnout have a severe impact on nurses’ wellbeing, patient safety, and the health organization as a whole. Oncology nursing has been described as one of the most stressful specialty areas (Lederberg, 1989). The oncology field is a complex environment in which to work because it requires nurses who are educated, skilled, and clinically competent to care for patients with cancer. Therefore oncology nurses are valuable resources in the healthcare system. Aim: The aim of the study is to assess burnout level and reasons behind leaving the work at oncology /hematology departments; and to identify their predictors. Methodology: The study population is 230 Palestinian oncology /hematology nurses, the response rate were above 93% .The researcher used a descriptive analytic cross sectional design. The MBI-HSS was used to assess burnout in the study participants. The AWS was used in conjunction with the MBI-HSS to assess the six areas of the work environment that influence burnout Result: The study observed that almost (57.2%) of Oncology/Hematology nurses in Palestinian hospitals had an average level of burnout. Lack of positive reinforcement represented the main source of burnout of the participants (M 3.38 SD 0.90), while the power of labor is the less source (M 2.42 SD 0.72) . Additionally, almost 53% of the participants indicated their intention to leave the department (to another ward) (M 2.65 SD1.43) The findings revealed that place of residency, income and educational level do not,indicate any significant difference, However, it was found that gender, marital status, working system, hospital name and job title are significant variables. Besides, a statistical significant positive correlation was found between the burnout level sub-scales(emotional exhaustion, depersonalization, and personal accomplishment scores and the intention to leave the department (to another ward) among Oncology/Hematology nurses in Palestinian hospitals, Moreover, the findings revealed that the demographic variables do not indicate any significant difference in the intention to leave the department (to another ward) among Oncology/Hematology nurses in Palestinian hospitals. Conclusion: Burnout among oncology /hematology nurses is a serious issue. Results from this study indicate that burnout is a manageable condition which can also beprevented. Good management and leadership, development of nurse practice environment, stress reduction interventions, good lifestyle choices, emotional intelligence, emotion and problem focused coping strategies are linked to high job satisfaction, less stress and therefore reduce the likelihood of burnout among oncology /hematology nurses and this will achieve the optimal level of retention rates. Keywords: Burnout, MBI-HSS, Intention to Leave, Hematology-Oncology nurse
Comparison of Palestinian Immunization Adherence Rates for Refugee and Non-Refugee 2-Years Old Children
(AL-Quds University, 2006-06-28) سليمان عطا توفيق غوشة; Suliman Atta Tawfiq Ghosheh; زياد عابدين; Mohamad Shaheen; Ted Tulchinsky
Compliance to iron supplementation among pregnant women receiving antenatal care at UNRWA clinics - West Bank
(AL-Quds University, 2012-05-05) نادرة يوسف عبودة سمحة; NADERA YUSUF ABBOUDAH SAMHA; نهى الشريف; معتصم حمدان; امية خماش
Determinants and Motivational Factors of Healthcare Staff: A Comparison between Governmental and Non-Governmental Hospitals in the South of West Bank / Palestine
(AL-Quds University, 2016-12-18) تامر شوقي فرح عوض; Tamer S F Awad; شهناز النجار; Dr. Asma Imam; Dr. Mutaz Dredi
Background: Palestine is a low-income country with very limited resources. Human resources are the most valuable resource for the country. Human resource management determines how to use other resources in order to achieve organizational goals. Aim: To identify and compare the motivational factors of healthcare workers and its determinants in the Palestinian hospitals in the South of West Bank. Methods: A quantitative cross sectional study design was used. Data collection was through self-administered questionnaire. A total of 297 healthcare workers participated in this crosssectional survey from four major hospitals in Bethlehem and Hebron. The study was conducted between June and October, 2015. Data collection tool included 18 motivational factors that were found in the literature. Other demographic characteristics were also collected. Descriptive and inferential statistics were used for data analysis by using SPSS version 16. Findings: Working according to ethics, helping people, recognition, reward and appreciation, ensuring job security, continuous education and opportunities for growth were major motivational factors for choosing work place (P<0.01). On the other hand, ensuring jobsecurity, full/part-time positions, sharing creativity and leadership, continuous education, working and living conditions and opportunities for advancement were major motivational factors to do work properly (P<0.01). Regarding place of work, healthcare workers in nongovernmental hospitals have experienced significantly higher motivational factors for choosing work place than those in governmental hospitals (P<0.05). Moreover, duration of work was an important motivational factor for choosing work place (P<0.05). Conclusion: Improving healthcare workers’ motivation is a vital process towards having better quality of health services. It requires support from managers and enhancing good management practices. The findings of this study suggests that further efforts should be extended in some aspects such as job security, continuous education, recognition, reward and appreciation, working and living conditions and opportunities for growth. Keywords: Motivational factors, healthcare workers, Palestine.
factors affecting compliance to anti-hypertensive drug treatment and lifestyle modification among patients attending primary health care clinics in Bethlehem
(AL-Quds University, 2014-05-18) امل محمود يونس العزه; AMAL MAHMOUD YOUNIS ALAZZEH; محمد شاهين; د. معتصم حمدان; د. أميه خماس
Antihypertensive treatment is an important challenge and public health issue, compliance to treatment of hypertension is one of the important factors that affect blood pressure control, no enough studies had been done about this issue in Palestine. In this study compliance to drug and lifestyle modification treatment were investigated. The aim of this study was to assess the factors affecting compliance to antihypertensive drug treatment and recommended lifestyle modifications among hypertensive Palestinian patients attending primary health care clinics in Bethlehem district. A descriptive cross sectional design was applied on systematic random sampling, sample of 300 hypertension participant at UNRWA, Government, and Non-Governmental clinic, using an interviewer administrated close ended questionnaire which depended on Health Belief Model. The questionnaires were filled face to face, the response rate was 100% in all clinics, Data analysis was done using (SPSS) version 19 to measure compliance on a 4- point Likert scale. The most important findings were (65.6%) of the participants were female, and (34.3%) were male, participants had a range age of (28-80). Among the total respondents (32.6%) didn’t had any complications, (67.1%) had one problems or more related to hypertension,the majority of the respondents took one to three medication (96%), ( 0.7%) didn't had any medications. (99.1%) took one to three doses of medication per day, (69.3%) of the total respondents didn't skip any dose and (30.7%) skipped one or more dose. And there was a strong significant association between doses skipped per day (p-value = 0.000) perception of severity (p-value = 0.003), perception of barriers (p-value = 0.000 and internal factors (p-value = 0.001) of total respondents and treatment compliance. ForUNRWA respondents there was significant relationship between gender (p-value =0.035), doses skipped in the last three days (p-value =0.035), perception of barriers (p-value =0.001), internal factors (p-value = 0.011) and treatment compliance. For the government respondents there was significant association between doses skipped in the last three days (p-value = 0.000) and body mass index (p-value = 0.013), perception of severity (p-value = 0.039), perception of barriers (p-value = 0.008), cues to action (p-value = 0.019) and treatment compliance. For the NGO there was association between educational status(pvalue = 0.037)and occupational status (p-value = 0.03), perception of barriers (p-value =0.024), internal factors(p-value = 0.008) and treatment compliance. The best predictor variables for treatment compliance were perception of barriers, perception of internal factors and perception of severity of total respondents. For UNRWA respondents the best predictor variables were perception of barriers and perception of internal factors. For Government respondents the best predictive variables were perception of barriers and cues to action. For NGOs the best predictive variables were internal factors and perception of barriers. This study concluded that the most important factors affected treatment compliance of therespondents were doses skipped, gender, body mass index, educational status, occupational status, perception of severity, perception of barriers, cues to action and internal factors. This study concluded that the total respondents were compliance to their drug treatment and lifestyle modification, NGOs respondent were more compliant than UNRWA and Government respondents in drug treatment while Government and UNRWA were more compliant than NGOs in lifestyle modification Key words: Compliance; hypertension; lifestyle modification; drug treatment.
Free medical samples effect on the behavior of doctors in the southern West Bank
(AL-Quds University, 2013-07-13) بسام محمد يونس ابو جحيشه; Bassam Mohammed Younes Abu Jheishah; أسمى الإمام; د. حسين الحلاق; د. سعيد السراحنة
Background: Pharmaceutical companies introduced the idea of free samples with a view to promotion and marketing of their products. The promotion is an effective tool which is used for introducing products to the clients. The drug companies are spending huge amounts of money on promotion. Promotion strategy has effects directly on the consumers despite the fact that in pharmaceutical advertising the efforts are directed toward the service providers and not to the medicine consumers. Therefore this research looked at the effect of free samples on the behavior of doctors in dispensing of medicines. Methodology: This study aimed to identify the effect of free medical samples on the behavior of physicians in the southern West Bank, according to the following variables: gender, age, years of experience, the country where he studied, specialty, level of education, and the workplace. The study sample consisted of 269 randomly selected physicians from all doctors practicing medicine in Hebron and Bethlehem. The response rate was 81.8%. A descriptive analytical design was used to achieve the goal of the study. A questionnaire based on the literature review was developed and tested for validity by panel of experts and internal consistency by calculating Cronbach alpha which was 0.74 Results: The study findings that the respondents have average estimated degrees (69.75%) about the activities undertaken by pharmaceutical companies for introducing its brands. And the overall score for physicians’ behaviors regarding drug prescriptions was average (64.25%). And, there were seven statements with high percentages, eight items average and one paragraph low. And the overall score for the free medical samples effect on thebehavior of doctors was average (65%). And it ranged between 29.25%-72.50%. And findings that there were no statistically significant differences at α≤0.05 in the effect of free samples on the doctors behavior in the South of West-Bank related to the following variables: sex, age, years of experience, qualifications, country of study, specialization,work place, the number of monthly visits by Representatives, and the amount of promotion activities practiced by pharmaceutical companies. And there were significant differences at α ≤0.05 in the impact of free samples on doctors behaviors related to type of company that provides pharmaceutical propaganda, and to type of promotion activities. Recommendations: The study recommends that must educate physicians to the importance of adherence to biomedical ethics. And the physicians should participate in medical conferences (update) information in the pharmaceutical industry to enable them to apply it in the treatment of patients Also recommends to create mechanisms that shall enable and motivate physicians to follow-up their patients, especially those receiving new medications. And to motivate physicians to access and review research studies on pharmaceutical products and their effectiveness. And to create and adopt policies to regulate the relationship between doctors and pharmaceutical companies by the Ministry of Health.
Improve and assailment of Palestinian food import
(AL-Quds University, 2015-09-19) معن خليل صالح السروجي; MAAN KHALIL SALEH ALSROUJI; ابراهيم عفانة; صالح صوالحة; محمد السيد
This study has aimed at studying the Palestinians system for importing stuffs and identifying all parties related to this system whether they are governmental or non-governmental and also recognizing the stages that the trader pass through from the beginning of importing until the goods reach the stores of the trader before displaying them in the market. It has also aimed at assessing and developing this system through answering the following questions: What are the governmental institution that are related to importing food.1 in Palestine? What are the non-governmental and local institutions that are relevant.2 to importing stuffs in Palestine? ؟ What are the crossing points among these governmental institutions.3 ؟ What is the effectiveness of the governmental institutions in controlling.4 food importing stuffs which aren’t complied the imported Palestinian system? Is it possible to build a system for importing food stuffs in Palestine.5 through a unified outlet? For answering these questions, the researcher has used a studying tool, that iscomparing the Jordanian importing food system and the Israeli importing food system with Palestinian one, then using the Jordanian system as a reference for this comparison.This study has farmed a challenge for the researcher as it unique and this thing has made it. More difficult task as there isn’t any possibility for making use of other previous studies that are related to this subject, so he depended a Jordanian and Israeli system as previous studies and as a tool for comparing and deducing recommendations for developing the Palestinian system for import food stuffs. This study has been conducted on the ministries and the private sector institutions in the west bank that are related to system and they are: . The Ministry of National Commerce.1 . The Institution of Measurement and.2 . The Ministry of Health.3 . The Ministry of Agriculture.4 . Palestinian Shipping Council.5 In addition to visited the Hashemite Kingdom of Jordan and also visiting: . Food and Drug Association.1 . The Ministry of Agriculture.2 . The Ministry of Industry and Trade. 3
“Knowledge, Attitudes and Practices towards Antimicrobial Stewardship among Healthcare Providers at Beit Jala Hospital”
(AL-Quds University, 2018-05-06) خليل ابراهيم خليل ابو سبيتان; Khalil Ibrahim Khalil Abu Sbitan; ماهر الخضور; Hussein Hallak; Hatem Hejaz
Background Several studies had been conducted about Antimicrobial Resistance (AMR) as a serious threat in both patient safety and public health which needs urgent interventions. An appropriate and judicious use of antibiotic is one of the important factors to curb this problem. Antimicrobial Stewardship Program (ASP) is an effective way of changing prescribing patterns and reducing inappropriate use in hospitals. The study revealed that Healthcare Providers (HCPs) are aware of the importance of AMR, and believe that an appropriate use of these agents will reduce this problem. They also agree that the implementation of ASP is necessary. Despite this concept, some HCPs lack consistency in practice and attitude towards antimicrobial use. Objective The aim of this study is to assess the level of Knowledge, Attitudes, and Practices (KAP) towards ASP among HCPs at Beit- Jala Hospital. Method A descriptive cross sectional study was conducted through an anonymous self-administered questionnaire given to HCPs at Beit- Jala Hospital in Bethlehem, Palestine from February 15 to May 15, 2018. The questionnaire was designed based on earlier studies to meet the study objectives and conceptual framework. In addition, some modifications were done to the questionnaire. The validity of the questionnaire was tested and the total instrument reliability test(Cronbach’s Alpha) gave a score of 0.877. Stratified sampling with proportional allocation was applied for sampling. The inclusion criteria in this study included all healthcare providers Physicians, Pharmacists, Nurses and Lab technicians, who are willing to participate in the study, and the exclusion criteria included radiologists. The data were analyzed by using the Statistical Package for the Social Sciences Software (SPSS) version 20 using descriptive statistics, means and standard deviation and Chi-square test. Results and Discussion One hundred and eighty eight 188 out of 214 distributed questionnaire were returned successfully. Over half 116 (62%) of them were males. Ninety two percent (92%) of the participants had good knowledge, (44%) had positive attitude towards ASP and (70%) of HCPs had good practices related to ASP. The demographic character was not a significant predictor of HCPs knowledge, attitude and practices towards ASP. However, there was a significant predictor between practice, degree and certificate (p=0.028). There were a positive relationship at the level of significance 𝛼 ≤0.05 between knowledge and attitude, knowledge and practices, and attitude and practice. Our results support the implementation of ASP by healthcare institutions to reduce inappropriate antimicrobial use, reduce adverse consequences of antimicrobial use, improve patient’s outcome and safety, reduce costs and length of stay, and capture all AMs usage and containments of antimicrobial agent and decrease resistance. Conclusions Despite the fact that the ASP is not implemented in our hospitals, the majority of HCPs had good knowledge, and practices. However, most of them showed negative attitude towards it. The Ministry of Health should develop guidelines and policies to implement and monitor ASP in all governmental and private Palestinian hospitals.
Magnitude and Consequences of Violence against Physicians and Nurses working at Governmental Hospital in north of West Bank.
(AL-Quds University, 2012-02-23) محمد تميم يوسف كتانه; Mohammad Tameem Yousef Ketaneh; معتصم حمدان; اسمى الامام; توفيق ناصر
“Married Female Satisfaction with Reproductive Health Services in Ramallah District at the West Bank of Palestine”
(AL-Quds University, 2011-01-15) أيمن حسن عبد ابومحسن; Ayman Hasan Abed Abu Muhsen; محمد شاهين; Dr. Murshid Farhat; Dr. Najjah Khateeb
Reproductive health (RH) in a community compromise the main aspect of overall community health where patient satisfaction with this aspect contributes to increase the quality of the service provided and patient participation at his/her treatment. The main aim of this study was to assess married female level of satisfaction with reproductive health care services provided at Ramallah district- Palestine. The population of the study consists of all married females who seek reproductive health service from a reproductive health centers in Ramallah district. A total of 300 married females were targeted for the study and interviewed while existing from the centers, 30 of them were piloted and excluded from the study, a total of 248 female were responded from the rest 270 yielding to respond rate of 91.8%. A pre tested Likert five scale questionnaire were used, six domains of satisfaction were studied for satisfaction (quality of service, informativeness, accessibility to the centers, waiting time, gender sensitivity and privacy). The results revealed a relatively high satisfaction (64.2% satisfied and 29% were strongly satisfied) with reproductive health service provided at Ramallah from different providers; Governmental, United Nations Relief and Work Agency, and Non Governmental Organizations. Despite this evidence of satisfaction, the study results show that there are some leading factors of dissatisfaction attributed to a range of factors as; long waiting time to enter the examination room, gender of the service provider and privacy tools as; shutters, and screens, some of them are harder to control thanother. In relation to the type of provider, it was found that governmental organizations had the highest level of participant’s satisfaction, followed by the NGOs which was ranked secondly, while the UNRWA had the lowest level of satisfaction. In addition, results revealed that centers located in villages and nearby the participants resident area had higher level of participant’s satisfaction from the centers located in cities. This relatively high satisfaction finding could be justified to the enhancements done on reproductive health services by different providers in the past few years while taking into consideration the sensitive needs of this type of services, and due to the competition andgeneral development all aspects especially in terms of coverage, fund raising, well trained human resources and quality dimensions. From the results of this research, it is highly recommend to raise the community awareness regarding the importance of their reproductive health and to incease the number of resources and logestics to ease the access to reproductive health centers,. In addition, other recommendation should take place onsite as: reducing the waiting time before interring the exam room; the heath practitioner to be from the same gender while delivering a reproductive health service, it was emphasized that all health staff have to introduce themselves before starting the reproductive health examination. Staff caring and cooperation, the availability of privacy in addition to the service quality and specialized female staff are all considered to be very important factors in directing participants to the type of provider of a reproductive health service point to get the service from..
Medication Reconciliation at Admission to Surgical Departments: A Study at Jericho Hospital
(AL-Quds University, 2018-03-18) محمد ابراهيم 'محمد رشيد' عتيلي; Mohammed Ibrahim 'Moh. Rasheed' Attili; معتصم حمدان; Asma Emam; Hatem Hejaz
Background: Adverse Drug Events (ADEs) at care transition expose patients to susceptible harm. Lack of medication reconciliation is a major factor leading to ADEs. It is highly important to apply medication reconciliation at care transitions to minimize medication discrepancies and reduce medication errors. Some patients are at higher risk due to medication errors: those with chronic diseases and poly-pharmacy, elder patients, those with other co-morbid factors and patients who are admitted to certain surgical procedure. Aim:The study aims to assess prevalence and factors associated with medication discrepancies at admission to surgical operation in hospitals using the Electronic Medical Record (EMR) system and to analyze the factors associated with medication discrepancies. Method: A prospective cross-sectional observational design was employed. The study was done in Jericho Governmental Hospital. The inclusion criteria was all patients who were aged ≥18 years old, who were admitted for any surgical operation in the hospital at least for 24 hours and underwent major surgery. Data were collected in the period between the middle of July to the end of September, 2016, over a period of 75 days. All patients who were admitted to surgical operation and met the criteria were included. Findings: A total of 145 patients who satisfy the criteria were included, 19.3% of them hadat least one medication discrepancy, 93% of these discrepancies were unintentional. Moreover, 93% of the discrepancies were omission of certain medication at time of admission, 20.7% of discrepancies occurred in patients taking 1-2 medications prior to admission and 7.6% in patients taking 3 or more medications. Logistic regression showed significant association between medication discrepancy and having a chronic disease(Exp(B) = 12.910, P <0.001), and with the number of medication consumed prior to admission (Exp (B) = 23.953, P <0.001). Conclusion: The risk of medication discrepancy was higher in patients with chronic disease and polypharmacy. The most frequent medication discrepancy was omission of certain medication consumed prior to admission. Therefore, medication reconciliation should be carried out for susceptible patients who have chronic diseases or consuming medication regularly at time of admission. Moreover, medication discrepancies may occur at any care transition other than admission, so it is highly important to perform medication reconciliation at any care transition.
Nurses Perceptions towards the Impact of JCI Accreditation on Quality of Care and Patients’ Safety at Augusta Victoria Hospital
(AL-Quds University, 2015-12-30) جهاد خليل الياس خير; Jehad Khalil Elias Khair; أسمى الإمام; معتصم حمدان; Musa Hindiyeh, PHD
This study was held at Augusta Victoria Hospital (AVH) between July and August 2015. AVH is a specialized cancer and dialysis care center in East Jerusalem. It is considered the only radiotherapy center and pediatric dialysis center present in Palestine. In May, 2013, AVH became the first Palestinian institution with multiple specialties to hold the accreditation from the Joint Commission. The Joint Commission International (JCI) accreditation is an international evaluation process used to assess and to improve the quality, the efficiency and the effectiveness of health care organizations and guarantees efficient and effective quality of patient care and patient safety. The complexity of the nursing practice has increased at AVH and the nursing roles have expanded in order to respond to the new strategic, highly specialized services at the hospital and to maintain the high quality of care based on the JCI standards and evidence based practices. On the other hands, the perception of nurses towards the JCI accreditation process and its impact on the patients' safety and the quality of care are still unclear and not studied. The aims of this study are: 1) to assess the nurses’ perceptions towards the impact of JCI accreditation on the quality of care and patients' safety at AVH. 2) to assess the relationship between the nurses’ perceptions towards the impact of accreditation on the patients’ safety and quality of care and selected demographic and organizationalfactors. A quantitative descriptive cross-sectional design was used. The researcher adopted a validated self-administered questionnaire from previous studies, and the questionnaire distributed to the total of 125 nurses working at the inpatient and outpatient departments in AVH. The nurses were asked to put the filled questionnaires in sealed envelope in a special box labeled research questionnaires at the reception area in AVH without putting their names or the department they work in. Descriptive and inferential statistics were applied using SPSS 18.The response rate of participants in this study was 72.8%. The majority of participants were males (60.4%), young below 40 years of age and has Bachelor’s degrees in nursing. The majority of nurses (86.6%) were trained in quality and mainly about policies and procedures within the JCI standards. The overall percentage mean scores (PMS) for the nurses’ perceptions towards the accreditation impact on quality of care was (71%) and on patients' safety was (77.5%), reflecting the fact that they have positive perception to accreditation impact and that the accreditation benefits the patient, the staff and the hospital with a percentage of (74.25%). There was a significant positive relationship among the nurses' perceptions on the bases of the organizational factors (α ≤ 0.05) which include leadership commitment and support, strategic quality planning, human resources utilization, quality management, use of data and staff involvement, with the highest correlation in leadership, commitment and support (r = 0.583 , α = 0.001) and the lowest correlation in human resources utilizations (r = 0.227 , α = 0.009). JCI accreditation is a good tool for improving quality of care and patients' safety. Health care organizations need strategies to reinforce the quality improvement planning,human resources utilizations, quality management, use of data and staff involvement in order to improve the quality of health care. However, there is a need to ensure effective quality and safety improvements based on measuring other patient outcome indicators. activities including leadership commitment and support, strategic quality
Nutritional Factors and the Risk of Non-Hodgkin Lymphoma among Palestinians
(AL-Quds University, 2015-09-12) مرام محمد شاكر دحدول; maram mohammed shaker dahdol; رانيا أبو سير; حازم آغا; صبري الصغيّر
Background: The incidence of Non-Hodgkin Lymphoma (NHL) increased worldwide during the second half of the last century and then stabilized during the nineties but subsequently increased. Environmental factors and dietary habits have been reported to play an important role in the etiology of NHL by influencing the immune system. However, no such data are available from Palestine. Objectives: To participate in establishing a platform to study B-NHL in Palestine and further to examine the association between dietary factors and the risk of B-NHL among Palestinian B-NHL patients versus controls. Design: Case-control study. Methods: A case-control study was conducted between 2009-2013 including 306- histological confirmed B-NHL cases and 392 cancer-free controls among adult Palestinians recruited from three major Palestinian hospitals in the West Bank and Jerusalem which have an oncology department in addition to Hadassah Hospital in West Jerusalem. In the primary study analysis, an imbalance was encountered in the regional distribution of cases and controls in the central area. In order to correct for this imbalance, I recruited 71 controls from the primary health care centers in Jericho, Ramallah and Al-Azaria on the basis of frequency matched case-control study in terms of age and gender and region. The study participants were administered a questionnaire which is based on the international Epi-Lymph questionnaire, which focuses on demographic characteristics, types of environmental exposure and on diet and nutritional intake, specifically meat, milk, dairy,vegetables and fruits. Blood samples were also collected from participants for the purpose of DNA purification and viral serology testing. The overall data-base was used to study the association between nutritional factors and the risk of NHL. The data was analyzed by Statistical Package for the SocialSciences(SPSS)and associations were examined by multivariate logistic regression. For food intake analysis, the median value for each food group was calculated from overall distribution of the study population in order to use the value below the median as a reference value to detect associations by logistic regression. Results: High consumption of meat (OR=1.8; 95% CI: 0.8-4.3) and milk (OR=1.3; 95% CI: 0.7-2.6) was found to be positively associated with the risk of B-NHL. Vegetable intake was also positively associated with the risk of B-NHL (OR=1.3; 95% CI: 0.4-4). Similarly, dairy products were significantly associated with an increased risk of B-NHL (OR=2.3; 95% CI: 1.2-4.4). In contrast, a significantly inverse association was encountered between fish consumption and B-NHL risk (OR=0.4; 95% CI: 0.2-0.8), and an inverse association was found between the consumption of fruits and B-NHL risk (OR=0.7; 95% CI: 0.2-2.1). Conclusion:The results of this study showed that dietary intake may affect the risk of NHL as positive associations were found with meat, milk, dairy products and vegetables consumption, while an inverse association with fish and fruits consumption was encountered. Keywords: dietary factors, non-Hodgkin lymphoma, case–control study, Palestine.
The Organizational Barriers, Facilitators and Strategies related to the implementation of the Baby Friendly Hospital Initiative (BFHI): A study in selected Palestinian hospitals.
(AL-Quds University, 2016-12-20) اية مرتجى حسني الفار; AYAH MURTAJA HUSNI ALFAR; معتصم حمدان; د. حازم الأغا; Dr. Weam Hammoudeh
Background: The Baby-Friendly Hospital Initiative (BFHI) aims to promote and support breastfeeding. Globally, around 20,000 facilities have been designated BabyFriendly. In Palestine, only 6 hospitals have the ‘Baby Friendly’ designation since 2010. Despite the increasing evidence for the positive impact of BFHI on breastfeeding and health outcomes, few studies have explored the barriers and facilitating factors influencing to the implementation of Baby-Friendly practices that can be used to enhance the implementation of this initiative in different healthcare settings. Study aim and objectives: The aim of this study is to investigate the organizational factors that hindered or facilitated the implementation of the Baby-Friendly Hospital Initiative (BFHI) in two selected Palestinian governmental and private hospitals, to determine the strategies implemented by the participating hospitals to overcome these barriers and to identify points of convergence and divergence between the explored governmental and private hospitals. Methods: Using an interpretive qualitative approach, A purposive sampling technique was used to conduct in-depth, semi-structured interviews with 15 clinical and nonclinical staff members from different professional groups and managerial positions. Data were analyzed using content comparative analysis method. Results: One of the main organizational facilitators found in this study was the endorsement of a well-coordinated implementation strategy characterized by autocratic BFHI adoption and enforcement, strong administrative support, the presence of BFHIor quality coordinator as well as the financial and technical support by external partners. The designing of mandatory breastfeeding education for all levels of relevant professional groups was found to be also necessary to improve breastfeeding knowledge, attitudes, and practices among staff responsible for the implementation of BFHI tasks. The most frequently reported organizational barriers to implementing the initiative were inadequate staffing especially in the governmental hospital limiting the staff ability to implement BFHI related tasks and provide breastfeeding support. Another commonly reported challenge was hospital structures or routines that interfere with maternal-infant attachment and breastfeeding practices and lack of comprehensive auditing and monitoring tools in both hospitals. Conclusion: findings have indicated that the success of BFHI is achieved by addressing the integrated sociopolitical, organizational and individual factors. The organizational barriers and facilitating factors determined by this study provides a comprehensive model tailored to the Palestinian context which can be adopted to utilize the most effective strategies for a sustainable implementation of the BFHI in different health facilities and consequently the attainment of ‘Baby Friendly’ designation.
Patient Experiences of Undesirable Safety Events during Hospital Care: A Study in the Palestinian Medical Complex, Ramallah
(AL-Quds University, 2015-07-04) مي طارق محمود بشر; May Tareq Mahmoud Bisher; معتصم حمدان; أسمى الإمام; Musa Hindiyeh
Background: Some patients are subjected to undesirable safety events during hospitalization and their health may be negatively affected by the health care received. The consequences can be permanent injury, an increased length of stay (LOS) in hospital, and in some cases even death. As health systems become more complex and interrelated, the focus on patient safety has intensified. Wide-ranging efforts have been devoted to evaluating the harm incurred by patients and to learning from errors, but data about health care problems reported solely from the perspective of professionals engaged in this field is insufficient. Therefore, this study addresses patient-centered data that take into account the patient’s experience of undesirable safety events within three main categories: medical complications, health care process problems and communication problems. Aim: To investigate patient experience of undesirable safety events and to evaluate the extent and nature of harm occurring during hospitalization. Methods: The survey design was a quantitative, descriptive cross-sectional survey. Existing updates to the Picker survey tool were reviewed, translated and adapted to the Palestinian context, and validated by an expert committee in the area of patient safety. Chronbach’s alpha test was conducted to test the reliability of the survey categories and items and showed an overall acceptable internal consistency (0.778). The study was carried out in the Palestinian MedicalComplex in Ramallah. The study sample consisted of adult medical and surgical patients who had already spent at least four days in hospital. Findings: The survey was conducted on a total of 98 patients, of whom fifty percent were females and fifty percent were males, with a mean age of 57 years. Of those surveyed, 46.9%were over 60 years of age; 58.2% were medical patients; and 41.8% were surgical patients. The mean length of stay was seven days. Patients reported a total of 851 undesirable events (an average of 8.68 events per person). Patients reported 168 medical complications (20%), 187 health care process problems (22%), and 496 communication problems (the highest event rate with 58%). About 43% of the patients rated the undesirable safety events they had faced as high risk, and 20.4% of patients indicated that they had had serious concerns about experiencing a medical error in their care prior to being admitted to hospital. The results showed that patients with poor and very poor health were more exposed to experience undesirable safety events (P =0.015). Also, surgical patients reported more problems in the care process than medical patients (P=0.047). Participants who had experienced health care process problems rated their experience of undesirable events as posing a high degree of risk (P<0.001). Finally, communication problems between patients and health professionals have a very detrimental effect on patient health (P<0.001).
Patient Safety during Pre- and Post-analytical phases of clinical testing in Beit Jala hospital؟
(AL-Quds University, 2014-10-01) ميشيل وليم ابراهيم لاما; Michael William ibrahim Lama; اسمى الامام; motasem hamdan; basma al- damiri

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