Introduction:Pediatric emergency has been considered as a high risk area, and blood transfusion is known as a unique clinical measure, therefore this study was conducted with the purpose of assessing the proactive risk assessment of blood transfusion process in Pediatric Emergency of Qaem education- treatment center in Mashhad, by the Healthcare Failure Mode and Effects Analysis (HFMEA) methodology.Methodology:This cross-sectional study analyzed the failure mode and effects of blood transfusion process by a mixture of quantitative-qualitative method. The proactive HFMEA was used to identify and analyze the potential failures of the process. The information of the items in HFMEA forms was collected after obtaining a consensus of experts’ panel views via the interview and focus group discussion sessions.Results:The Number of 77 failure modes were identified for 24 sub-processes enlisted in 8 processes of blood transfusion. Totally 13 failure modes were identified as non-acceptable risk (a hazard score above 8) in the blood transfusion process and were transferred to the decision tree. Root causes of high risk modes were discussed in cause-effect meetings and were classified based on the UK national health system (NHS) approved classifications model. Action types were classified in the form of acceptance (11.6%), control (74.2%) and elimination (14.2%). Recommendations were placed in 7 categories using TRIZ (“Theory of Inventive Problem Solving.”)Conclusion:The re-engineering process for the required changes, standardizing and updating the blood transfusion procedure, root cause analysis of blood transfusion catastrophic events, patient identification bracelet, training classes and educational pamphlets for raising awareness of personnel, and monthly gathering of transfusion medicine committee have all been considered as executive strategies in work agenda in pediatric emergency.

Background: Presenting educational and communicational programs for patients is considered to be one of the most significant executive roles of hospitals. Studying the status of patients' training services, identifying the barriers, and the organizational factors that affect these in the hospitals affiliated to the Mashhad University of Medical Sciences (MUMS) was the aim of this study. Method: This was a descriptive cross-sectional study. The participants were 441 patients, 200 physicians, 185 nurses, and 70 supervisors as well as the managers of the MUMS hospitals during the year 2008. Data were gathered using questionnaires and interviews. SPSS software (version 2), and ANOVA were used to analyze the data. Results: Only 42% of patients received the necessary training and 94% of them were not satisfied with the amount of training received (which was less than 5 min in 83.3% of cases) or with the content (i.e. mainly related to the method of treating the disease). Of the physicians, 79.4% considered lack of time to be the most important barrier to patient' training and 72% of the hospital managers ruled out the possibility of role play training by nurses under current conditions. Conclusions: Underestimating the role of nurses in patient education by the patients themselves and barriers such as high workload, lack of suitable space, lack of appropriate educational materials, and lack of emphasis by managers, were the most influential factors in terms of patient training. Therefore, reviewing the job description for staff, developing retraining programs for medical staff, boosting educational facilities and encouraging the provision of patient training as part of current hospital services could have an influence on promoting staff capability in the patient education process.

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BackgroundOne of the effective strategies in the fair distribution of human resources is the use of estimation norm of human workforce. A norm is a coefficient or an indicator for estimating the required human resources in an organization. Due to the changes in the available working hours of nurses in recent years and to use of a standard method, the Iranian Ministry of Health decided to update nursing estimation norm in hospitals in 2014–2015. This study aimed to design a nurse-required estimation norm for educational and non-educational hospitals based on the workload indicator in Iran.MethodsThis was a descriptive cross-sectional study, carried out from December 2015 to November 2016 in 49 wards in 12 educational and 17 non-educational hospitals in Mashhad, Iran. The wards and hospitals who had the best performance in nursing care quality indicators were selected. Focus group, work study, consensus, interview, and reviewing documents, staff and patient records, and the calculations of modified Workload Indicators of Staffing Needs (WISN) were used to collect the data.ResultsPatient care, cardiopulmonary resuscitation, and transfer out of the hospital were identified as the main activities of holding focus groups. Interviews and reviewing documents led to the identification of 10 factors associated with nurses’ available working time. In both educational and non-educational hospitals, the annual working time of all nurses except nurses working in the burn and psychiatric, burn ICU, and pediatric psychiatry wards, which was 1302 h per year, was 1411 h per year. The calculations of the modified WISN method showed that the lowest norm in educational hospitals was for psychiatric, eye surgery, and dermatology wards (0.53) and in non-educational hospitals was for ENT ward (0.57). The highest norm in educational and non-educational hospitals was for burn ICU (3.95) and general ICU (3.07) wards, respectively.ConclusionThe nursing estimation norm in different wards of the hospital varies, considering that the time available to nurses and their workload in different wards and hospitals are different, and each ward has its special norm therefore, a single norm for all wards and hospitals cannot be used for a fair distribution of nurses.