Inpatient anticoagulation services can reduce medication errors, reduce hospital costs, and improve patient care. However, before a hospital establishes an inpatient anticoagulation service, it is important to conduct a thoughtful, systematic review of the institution. Two factors that can determine the need for an inpatient anticoagulation service are the number of adverse drug events and the extent of medical-legal liability at the institution. Establishing an inpatient service that reduces these problems can justify the cost of the program. In addition to these factors, the institution's infrastructure and the scope of services to be provided should be evaluated, and parameters should be created to measure the clinical and financial impact of the inpatient anticoagulation service. Numerous publications in the literature have supported the need and positive impact of inpatient anticoagulation services on hospital costs and patient care. The size and scope of the service should be based upon the needs, experiences and resources of a specific institution.
The U. S. Navy uses Rolls-Royce gas turbines for ship service power on the DDG-51 class destroyer and the CG-47 class cruiser. Both engines have duplex thermocouples (T/Cs) and redundant T/C harnesses for turbine temperature monitoring and control. One harness provides an average of all the installed T/Cs, while the other provides the full authority digital control (FADC) with an individual signal from each. The legacy FADC algorithm allows up to four T/Cs to be out of average on the individual harness. Any additional T/C failures will cause the control to ignore the entire individual harness and rely on the averaging harness alone. This logic has inadvertently led to multiple over-temp conditions and subsequent engine removals. A change to control logic has been developed that aims to prevent these over-temp scenarios and is currently being introduced to the fleet. This paper will discuss in depth the cause of the over-temp, the examination of the control logic and the correction that is designed to prevent it from recurring.
In 2008, a US Navy DDG-51 Class destroyer experienced an uncontained failure of a Rolls Royce 250-KS4 turbine engine which serves as a starter for the Ship Service Gas Turbine Generator (SSGTG). This paper discusses the events that preceded the failure, the root cause and contributing factors. It also describes multiple corrective actions, including design improvements that have been implemented with the goal of preventing this type of failure in the future.
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