4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

IARMM 4th World Congress of Clinical Safety
28th – 30th Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria-

Clinical Management and Governance for Healthcare Risk and Crisis -Program (advanced)
One lecture hall (Marie Theresia Room) and one poster presentation space in each of 3 days.
Dinner: Schonbrunn Palace, 18:00-20:00 28 September 2015

EL: Educational lecture (invited),

NA: number of abstract

Onsite registration desk opens from 8:00 to 17:30
Moring oral session launches at 9:00.

【28 September 2015; Oral】
Opening remark
Ryoji Sakai (President of IARMM & WHRMC. Hon. Prof. SU, Former Profs. TWU, EPF, USM, etc., Japan)

Education lecture (1)(EL01/NA176)"Genetic risk factors and duration of prevention of venous thromboembolisms"
Prof. MD Job Harenberg (University of Hidelberg Hospital, Germany)

Panel (12-1): 'Medication safety and drug safety'(NA030) “Preventable Adverse Drug Events analyses in a university hospital”
Victoria Koné MD, MPH1, Robin Lagarrigue1, Gwenaëlle Vidal-Trécan, MD, PhD 1, 2, 3 ,41
Public health unit: Risk Management and Quality of Care, Paris Centre University Hospital Group, AP-HP, Paris, France
2
Equipe Méthodes de l'évaluation thérapeutique des maladies chroniques (U738)
3
Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, France
4
AP-HP, Hôpitaux Universitaires Paris centre, France(NA047) “POLYPHARMACY IN THE ELDERLY : PROMOTING DAILY DRUG CHART REVIEW USING AN ELECTRONIC TEMPLATE”
Dr Danielle Berenson (FY1, Kingston Hospital, United Kingdom, UK),Dr C Lee (Orthogeriatrics Consultant, Kingston Hospital, UK)4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

28 Sep 2015 Oral
(NA100) “Global standards and data capture technologies to help improve medication safety”
Tania Snioch (Director Healthcare, GS1 AISBL, Brussels, Belgium)
Ulrike Kreysa (Vice President Healthcare, GS1 AISBL, Brussels, Belgium)(NA106) “Sodium gualenate hydrate might work for prevention of aspiration intentionally compared than H2
blockade”
Ikusuke Hatsukari, MD. PhD., Motohiko Fukushima, MD. PhD.
(Totsuka Kyoritsu Hospital 1, Kanagawa, Japan)

Panel (2): 'International perspectives for clinical safety'(NA122) “The patient safety law in Korea- current situations and implications for the future “Jeong-Su Park (National Evidence-based Healthcare Collaborating Agency, Korea)
Myoungsoon You (Seoul National University, Korea),
Sukyung Kim, Eunbi Go, Hajin Tchoe (National Evidence-based Healthcare Collaborating Agency, Korea)(NA135)
Union”“Organ Donation and Transplantation: adverse events, patient safety an service quality in the European

Belén Trigo García (Departamento de Dereito común (Área de Dereito civil), Grupo de investigación
Análise xurídico-económica ECO-IURIS, Campus Vida, Santiago de Compostela, Spain)

Education lecture (2)(EL02/NA177)“Basic Strategy of Clinical Safety”
Prof. MD Maria Angeles Cuadrado Cenzual (Complutense University of Madrid, Spain)

Symposium (1): 'Philosophy and strategy of clinical risk/crisis management and governance'(NA010) “BLACK CONGLOMERATES/”MELANCOLIA” AS PHYSICAL PRODUCTS IN THE NORMAL BLOOD: A NEW
ELEMENT THAT HAS NOT YET BEEN DESCRIBED”
Louis Van Hecken (GENERAL PRACTITIONER, Meerhout, Belgium)(NA045)“Evidence-based Risk Management: safety means ‘perception of risk’”.
Prof. Dr. Franz Porzsolt(Institute of Clinical Economics (ICE) e.V., 89081 Ulm/Germanyand Health Care Research, Dept.
General and Visceral Surgery, University Hospital Ulm, Germany)(NA117)“Are regulations becoming a negative factor in pharmaceutical safety? Lessons from Three Mile Island”
Veronika Valdova, DVM (Managing Partner, Arete-Zoe, LLC, Phoenix, 85048 AZ, USA)4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

28 Sep 2015 Oral
(NA121)“Comparing and contrasting patients' and health professionals' perception of hospital safety. “Myoungsoon You (Seoul National University, Korea)
Sukyung Kim, Jeong-Su Park, Eunbi Go, Hajin Tchoe(National Evidence-based Healthcare Collaborating Agency, Korea)(NA125) “Investigation on the reality of Healthcare Safety Management System and the training method of Patients
Safety Managers to develop the Patients Safety and Quality Management Feedback Support System for the purpose of
decreasing in task load of Patients Safety Managers.”
Tatsuya Kitano, Professor&Vice President(Seijoh University, Health Care Management Course,
Faculty of Business Administration Graduate School of Health Care Studies,
Department of Patients Safety & Quality Management, Aichi, Japan)(NA156)“Proposal of “Panic Phenomena Reporting System”
Kazuhiro Okamura, MD, PhD. (Okamura Isshindow Hospital, Okayama, Japan(NA163) “Development of an assessment system “Rapid Assessment System of Evacuation Center Condition feat.
Gonryo and Miyagi（RASECC-GM）” that utilizes mobile devices”
Tadashi Ishii, MD, PhDa, Masaharu Nakayama, MD, PhDb, Kazuma Morino, cMD, PhD,
Jun Yamaderad, Koichiro AmitodaDepartment of Education and Support for Regional Medicine, Tohoku University Hospital, Miyagi, JAPANb
Department of Disaster Medical Informatics, International Research Institute of Disaster Science,
Tohoku University, Miyagi, JAPANc
Emergency Medicine,Yamagata Prefectural Central Hospital, Yamagata, JAPANdEyes, JAPAN Co. Ltd., Fukushima, Japan

Panel (13): 'Clinical safety for emergency healthcare system'(NA087) “Implementation of a dedicated Emergency Surgery Unit: impact on early laparoscopic cholecystectomy foracute cholecystitis.”
Salman Bokhari, Una Walsh, Kamran Qurashi, Lampros Liasis, Manoj Sen, Joseph Watfah, Stuart Gould.
(Northwick Park Hospital, Northwest London Hospitals NHS Trust, Harrow, Middlesex, UK.)

(NA127)“IMPACT OF PATIENT IDENTIFICATION ERRORS ON PATIENT SAFETY AND THE HOSPITAL ORGANIZATION.”
CUADRADO CENZUAL Maia Angels1, DE PEDRO MORO JA2, COLLADO YURRITA L3, GUESSOUS A 1,
DE GRACIA HILS Y1, LOPEZ GARCIA MP1, ALVAREZ GOMEZ S1(1.Hospital Clinico Universitario. 2 USAL Surgery Department. 3 UCM Medicine Department. Madrid Spain)4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

28 Sep 2015 Oral
Education lecture (3)(EL03/NA178)“No Human Factors Competence - No Patient Safety“
Prof. Dr. Norbert Pateisky (Medical University of Vienna, Austria)

Panel (7): 'Simulation and human factor for clinical safety’(NA075)“Are we on the same page? Assessing the similarity of mental models of OR team members”
Ivana Nakarada-Kordic. M.Sc., Centre for Medical and Health Sciences Education, School of Medicine,
University of Auckland, Auckland, New ZealandJennifer M Weller. M.D., MBBS, MClinEd, FANZCA, FRCA, Associate Professor of Medical Education,
University of Auckland and Specialist Anaesthetist, Auckland City Hospital, Auckland, New Zealand
Craig S Webster. PhD., Senior Lecturer, Centre for Medical and Health Sciences Education, School of
Medicine, University of Auckland, Auckland, New Zealand
Alan F Merry. MBChB, FANZCA, FPPMANZCA, Professor of Anaesthesiology, University of Auckland andSpecialist Anaesthetist, Auckland City Hospital, Auckland, New Zealand(NA080)“Simulation in a country with minimal resources and its impact on clinical safety.”
Gillian Pearce, Aisha Alzouebi (Hillingdon Hospital, London, UK)(NA118)“Simulation training for urgent blood transfusion in our hospital”
Maya Takamoto1,3), Yoshihiro Manabe2), Yukio Hiroi3), Tetsu Yano1,2), Shigeru Minowada3)(National Center for Global Health and Medicine, Tokyo, JAPAN)
1) Department of Obstetrics and Gynecology, 2) Department of Clinical Laboratory, 3)Department of Medical Safety4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)【29 September 2015; Oral】
Education lecture (5)(EL05/NA179)“Medication error - Present and future”
29 Moring
Mary P Tully (Manchester Pharmacy School, University of Manchester, Manchester, UK)

Panel (12-2): 'Medication safety and drug safety'(NA111) “Multimodal Pain Management, trends in better medicine and safer outcomes.”Ali Valibeigi, MN, RN,
1) Faculty, Seattle University, School Of Nursing, Seattle, Washington. USA
2) Swedish Orthopedic Institute (Swedish Medical Center), Seattle, Washington, USA(NA134) “Medication Errors: A three year retrospective review of self-reporting in a French University Hospital.”
Matthieu COLOM (5), A JANOLY-DUMENIL (1), A DUCROUX (5), MC KLOTZ (5), S HEDOUX (1),
A RAMBOUR-BOISSEAU (6), V FLATIN (4), C DELRIEU (4), G AULAGNER (1, 5), C STAMM (6)(1) Contrat de Bon Usage du Médicament, COMEDIMS, Hospices Civils de Lyon, France(2) Réanimation pédiatrique, Groupement Hospitalier Est, Hospices Civils de Lyon, France(3) Direction des Soins, Groupement Hospitalier Est, Hospices Civils de Lyon, France(4) Direction Organisation Qualité Relation avec les Usagers, Hospices Civils de Lyon, France(5) Pharmacie, Groupement Hospitalier Est, Hospices Civils de Lyon, France(6) Management de la Qualité de la Prise en Charge Médicamenteuse du Patient, Hospices Civils de Lyon
(NA139) “Prescribing errors with high alert medicines”
Mary P Tully1,2, J Frost1, R Slattery1, S Abdulameer1, AA Twum1, YK Yu1, S Wills2
1
Manchester Pharmacy School, University of Manchester, Manchester, UK
2
Salford Royal Foundation Trust, Salford, UK(NA141) “Nurses’ Medication Work: The Impact of Technology & Discursively Constructed Rules”
Dr. Louise Dyjur (University of Calgary, Calgary, Alberta, Canada)

Panel (3): 'Safety culture in clinical team'(NA014) “RISK OF DEVELOPING PHLEBITIS ASSOCIATED TO THE TIME OF EXPOSURE OF PERIPHERAL INTRAVENOUS
DEVICES: A PROSPECTIVE COHORTS STUDY. CLINICA UNIVERSITARIA RAFAEL URIBE URIBE. CALI VALLE
COLOMBIA”
Arenas Villamizar, Angel Ricardo1. Velasquez Serna, Diana Lorena2. Leon Giraldo Hoover.3(1General Practitioner and Surgeon from Universidad Surcolombiana. MSc in Clinical Epidemiology
obtained at Universidad de la Frontera. Chile. Chief of Hospitalization and Surgery at Clínica Universitaria
Rafael Uribe. Cali Colombia. 2Professional Nurse Graduated from Fundación Universitaria Área Andina.
Specialist in Health Management. Graduated from Universidad Javeriana.3 Statistician. Teaching.
Subdivision of teaching and research at Clínica Universitaria Rafael Uribe Uribe.)4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

29 Sep 2015 Oral
(NA036)“The Rise of the Surgical Care Practitioner in Orthopaedics”
Vivek Gulati, Ashley I. Simpson, Chika Uzoigwe, Matthew Jaggard, Andrew Williams, Charles Gibbons(Chelsea & Westminster Hospital, London, UK)(NA041)“Cost-effectiveness of thrombolysis service for patient with ST segment elevation myocardial infarctionin primary care hospital”
Surasak Saokaew, PharmD, PhD1, Piya Hanvoravongchai, MD, PhD2
1
Center of Health Outcomes Research and Therapeutic Safety (cohorts), School of Pharmaceutical Sciences,
University of Phayao, Thailand
2
Department of Preventive and Social Medicine and Thailand Research Center for Health Services System,
Faculty of Medicine, Chulalongkorn University, Thailand(NA061） “Evaluating clinical practice on medical high dependency unit (MHDU) - timely delivery of anti-microbial
medication”
Sadhia Khan （Salford Royal Hospital、University of Manchester, UK）(NA066)“The Deteriorating Patient QI Project: An Experience on a Respiratory Ward”
Dr S. Kumar, Dr M. Gittus, Dr C. Handalage, Sister L. Boggs(Leeds Teaching Hospital Trust – Respiratory department
St James' University Hospital, Leeds, UK.)

(NA101) “Accidental intrathecal injection with contraindicated contrast media: a review of seven court decisions inJapan”
Masako Sugihara, M.D., M.A. (Department of Psychiatry, National Hospital Organization Kurihama Hospital andAddiction Center, Kanagawa, Japan)
Masayoshi Nagata, M.D., Ph.D. (Department of urology, National Center for Global Health and Medicine Hospital,
Tokyo, Japan)
Tetsuya Tanimoto, M.D. (Navitas Clinic, Tokyo, Japan)(NA102)“Safety-related decisions depend on risks and valences of values”
Prof. Dr. Franz Porzsolt(Institute of Clinical Economics (ICE) e.V., 89081 Ulm/Germanyand Health Care Research,
Dept. General and Visceral Surgery, University Hospital Ulm, Germany)(NA092)“Creating clinical safety culture: past, present and future”
Yukio Seki, Yumiko Kose, Maki Furuo, Yoshitaka Itoh, Miho Kinoshita, Norie Tsuboi, Kyoko Kosato(Department of Clinical Safety Promotion, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan)(NA138) “Changing ward culture: The key to safe management of deteriorating patients. “Anna Winfield, S Arkhipkina, J Sidhu, C Grey, H Collins, A Cracknell, C Pattison, K Bramfitt.
(Leeds Teaching Hospitals NHS Trust, UK)(NA159) “Improving the management of fever and suspected chemotherapy induced neutropenia: a tertiary carecenter experience”
Dr. Reem Al Sudairy, Dr. Mohsen Al Zahrani, Dr. Maha Fayadh, Ms. Mona Al Shami,
Mr. Abdullah Yaqub, Dr. Abdul Rahman Jazieh(King Abdul Aziz Medical City for Ministry of National Guard, Saudi Arabia- Riyadh)4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

29 Sep 2015 Oral
Panel (8): 'Survey and reporting system of clinical errors'(NA128)“PATIENT IDENTIFICATION ERRORS . A CHALLENGE FOR PATIENT SAFETY IN CLINICAL LABORATORY”
CUADRADO CENZUAL Maria Angel1, COLLADO YURRITA L2, DE PEDRO MORO JA3,
CIUDAD CABAÑAS MJ2, GUESSOUS A1, DE GRACIA HILLS Y1, ARROYO FERNANDEZ M1.
1.
( Hospital Clínico Universitario. 2 UCM Medicine Department. 3 USAL Surgery Department. Madrid. Spain)(NA136) “Enhance recovery program for laparoscopic appendicectomy is Safe and cost effective: Prospective Audit
Study:”
Hyder Zargham, (Bart’s and the London NHS Trust, London, UK)

Panel (11): 'Clinical risk management before/after surgical operation and the guidelines’(NA028) “Outcomes of severe adverse events analyses in a university hospital”
Victoria Koné MD, MPH1, Jerôme Lecuen1, Frédérique Le Douarin, RN-SM1, Denis Matray,MSc2,
Theodore Slavin1, Gwenaëlle Vidal-Trécan, MD, PhD 1, 3, 4 ,51
Public health unit: Risk Management and Quality of Care, Paris Centre University Hospital Group, AP-HP, Paris, France2
Direction de la Qualité, de la Gestion des Risques et des Droits du Patient, Paris, France
3
Equipe Méthodes de l'évaluation thérapeutique des maladies chroniques (U738)
4
Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, France.
5
AP-HP, Hôpitaux Universitaires Paris centre, Paris, France(NA115)“Management of achilles tendon injury: A current concepts systematic review”
Vivek Gulati, Ashley I. Simpson, Charles Gibbons, Chinmay Gupta(Chelsea & Westminster Hospital, 369 Fulham Road, London. SW10 9NH, UK)(NA131)“Improving compliance of the WHO Surgical Safety Checklist in a District General Hospital in United Kingdom”
Francesca Colombo, Lawrence Richards, Anthony McLaughlin, Eric Lee, Colin Rogers, Paul
Smith, Katy McErlain, Stelios Vakis;(Queen’s Hospital, Burton-on-Trent, DE13 0RB, United Kingdom)(NA175)“An audit of post-operative instructions for Orthopaedic Surgery at a Major Trauma Centre”
Emma Burke, H. Lendrum, H. Munton, A. Sumption, K. Al-Dadah, D. Griffiths(Imperial College London, UK)(NA181)
Audit””Are the Five Steps to Safer Surgery adequately performed in Paediatric Surgery Theatres? – A Prospective

Omar Nasher1, Iain Moppett2, Bharat More1
Department of Paediatric Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
2
Department of Anaesthesia, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
1

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)【30 September 2015; Oral】
Panel (4): 'Medical informatics and IA in clinical safety'(NA018)“Effectiveness Evaluation of Nursing Handover Information Systems in a Teaching Hospital”
Pi-Chi Wu1、Chii-Jun Chiou2、Hsiu-Hung Wang3、Yu-Pei Ting4、Yu-Fang Huang5、Mei Lan Kao6
(Chiayi Chang Gung Memorial Hospital, Taiwan1.4.5.6 , Kaohsiung Medical University, Taiwan2.3)(NA026) “Analysis of Thirteen Months of Pre-analytical Errors and Their Root Causes at a Large Academic Medical
Center”
Ida Bixho BS1,2, Stacy E. F. Melanson, MD, PhD1,3, Milenko J. Tanasijevic, MD, MBA1,3
1
Department of Pathology, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
2
Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
3
Harvard Medical School, Boston, MA Boston, MA, USA(NA064)“Electronic patient safety data documentation system in a tertiary health care center. “
Dr. Hermann Salmhofer, G. Flaschberger, M. Petschenig, R. Eberl, Stabsstelle(Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria)(NA091) “Identification of Hospitalized Patients on ICUs at High Risk for Healthcare-Associated Infection– Automated Monitoring and Surveillance”
Alexander Blacky (VAMED-KMB, Austria)
Klaus-Peter Adlassnig, Andrea Rappelsberger, and Walter Koller (Medical University of Vienna, Austria)(NA104)“Development & Validation of an assessment method for IEC 80001-11.”
Lucy Ann Kielty,(Clinical Informatics Manager, General Intensive Care Unit, St James’s Hospital, Dublin, Ireland)(NA119) “Healthcare Professionals Perceptions Toward the Recent Merge between Patient Safety and Health
Informatics: A Case Study from Saudi Arabia”
Prof Ahmed Albarrak (Medical Informatics Professor, Medical School, King Saud University, Saudi Arabia)
Mohammed Alhajjy (BSN MSc CPHQ, Clinical Application Specialist, King Faisal Specialist & ResearchCentre, Saudi Arabia)(NA171) “Implementation of a novel electronic medical record format for patient allergy information.”
Masaharu Nakayama, MD, PhD 1, 2 and Ryusuke Inoue, MD, PhD. 1
1
Medical Informatics Center, Tohoku University Hospital, Miyagi, JAPAN
2
Disaster Medical Informatics, International Research Institute of Disaster Science, Tohoku University, Miyagi,JAPAN4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

30 Sep 2015 Oral

Panel (1): 'Clinical communication for clinical safety'(NA016)“Transforming Medical Management of Clinical Trials”
Mohamed El Malt MD, PhD (Chief Medical Consultant, Europital, Ghent, Belgium)(NA071)“Assessment of the introduction of TeamSTEPPS with EQ”
Midori Yokoyama & Chikako Otaki (Department of nursing, Tokyo Takanawa Hospital, Tokyo, Japan)(NA083)“Video Remote Interpreting – a new innovative tool for medical settings?”
Sabine Parrag(Medical anthropologist, Institute for Ethics und Law in Medicine, University of Vienna &Austrian Network for Patient Safety, Vienna, Austria)(NA173) “Evaluation of paediatric handover in a UK Tertiary Children’s Hospital”
Amanda L Newnham1, Dr Danielle Ingham1(1 Leeds Children’s Hospital, Leeds, UK)(NA180)“Ward Rounds in Paediatric Surgery: A Audit on Nursing Participation on the Daily Ward Round”
Omar Nasher, Sofia Labbouz, Paul J Jackson, Shailinder S Singh(Department of Paediatric Surgery, Queen's Medical Centre,
Nottingham University Hospitals NHS Trust, Nottingham, UK)

Education lecture (4)(EL04/NA007)“Clinical Safety and Public Health Education for Measles : Lessons Learned in California” (30min)
Dr. Helda Pinzon-Perez, Ph.D., MPH, FNP(Department of Public Health- California State University, Fresno- USA)Workshop: ‘Educational training of risk/ crisis management for clinical safety’(Summary) This session aims to clarify principals and methods in skill- up of medical staffs and patients to prevent theserious clinical errors and development of better manners of healthcare workers in an emergency case of medical
accidents.
ORGANIZER: Prof. MD Maria Angeles Cuadrado Cenzual (Complutense University of Madrid, Spain)(NA042)“Studying online with their own workplace as a learning arena “Solrun G. Holm, Trude Hartviksen, Berit Sjølie(The Faculty of Professional Studies, University of Nordland, Norway)4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

30 Sep 2015 Oral
(NA013) “Incorporating principles of patient safety in post graduate residency training”
Dr. Sugam Kale, Dr. Khalil Shibli, Dr. Sabina Shibli(Ng Teng Fong Hospital, Jurong Health, Singapore)(NA050)“A trial study of seminars focusing on the medical safety mindset of medical staff to prevent incidents”
Yukiko Kai1), Taisuke Ogawa2), Muneou Suzuki3), Kenji Araki3), Katsuhiro Hayashi1), Mitsuru Ikeda2)
1: School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
2: School of Knowledge Science, Japan Advanced Institute of Science and Technology, Ishikawa, Japan
3: Medical Informatics, University of Miyazaki Hospital, Japan(NA110)“Lessons learned from the horrible accident concerning pediatric renal function examinations in Japan.”
Kazuko Ohno MD Phd (Professor Department of Radiological Technology, Kyoto Collage of Medical Science,
Kyoto, Japan)
Yoshimasa Nagao MD Phd (Professor Nagoya University Hospital, Nagoya, Japan)
Tetsuo Kida (Shiga University of Medical Science Hospital, Shiga, Japan)
Ryutaro Kohno (Professor Jichi Medical University Hospital, Japan)
Yoshifumi Sekimoto (Sekimoto Law Office, Japan)(NA174)“Guiding safer blood transfusions”
Ka Ying Bonnie Ng, Muhammad Umer, Katy O’Shiel, Kathryn Cockett, Brent Bartholomew(Acute Medicine Department, Chelsea and Westminster Hospital, London, UK)

Panel (15): 'Other oral presentation'(NA046)“Medicalization of death, items for discussion and critical analysis from bioethics”
Prof. Norma González González; Prof. Alfredo García Rosas; Aristeo Santos López;Marta Isabel Ángeles Constantino; Marisa Fátima Román.
(Teacher & Research from Universidad Autónoma del Estado de México UAEMEX. Mexico)(NA099) “The Resources of confirmation of good blood return through Central Venous Access Device(CVAD) on cancer patients by using Valsalva’s method”
Terutoshi Nakao＊, Teppei Matsumoto＊, Kohei Kawaguchi＊, Masako Takemoto＊,
Shinpei Ishikawa＊,Teruhiko Hirai＊, Yositaka Tsukamoto＊,Teruhisa Ninoi†(＊Department of Surgery ,†Department of Radiology , PL General Hospital, Osaka, Japan)(NA105) “Reduction of maternal sepsis in a hospital with limited resources”
Gillian Pearce (Midwife, The Hillingdon Hospitals NHS Foundation Trust, Hillingdon, UK)
Aisha Alzouebi (Senior obstetric registrar, Chelsea and Westminster Hospital, London, UK)(NA116)“The seasonality of slipped upper femoral epiphysis - meta-analysis: a possible association with vitamin D”
Vivek Gulati, Ashley I. Simpson, Chika Uzoigwe, Charles Gibbons(Chelsea & Westminster Hospital, 369 Fulham Road, London. SW10 9NH, UK)4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

30 Sep 2015 Oral

(NA162) “Towards the construction of a model to measure stress protectors in the hospital working environment”
Paula Astudillo Díaz1 2., Gras M.E.3, Planes. M3., Suñer R3.
1
Ph.D. program in Medical Science. Department of Surgery and Traumatology. Faculty of Medicine.
Universidad de La Frontera, Chile.
2
Research trainees Ph.D. program in Psychology, Health and Quality of Life . Universidad de Girona, España.
3
Ph.D. program in Psychology, Health and Quality of Life. Universidad de Girona, España.

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)【28 September 2015; Poster】(NA012)“Contribution of Magnetic Resonance Imaging (MRI) in rectal cancer staging and impact of a tumor
board(TB) in the therapeutic trajectory of patients with rectal cancer.”Dre Pascale Audet (Centre Hospitalier de l’Université de Montréal (CHUM), Canada)(NA011)“Molecular mechanisms of bone reconstruction in new dental implant technology”

Aurelian Udristioiu¹, Staniloiu Mihail¹, Manole Cojocaru²¹Emergency County Hospital Targu Jiu & UCB University, Romania,²Titu Maiorescu University, Faculty of Medicine, Physiology Department, Bucharest, Romania.
(NA015)“IMPROVEMENT OF STANDARDIZATION AND ADHERENCE BY THE INFECTION CONTROL PROTOCOL”
J. Y. Park and H. M. JEONG (SEOUL NATIONAL UNIVERSITY HOSPTIAL HEALTHCARE SYSTEMGANGNAM, Seoul, Korea, Republic of Korea)(NA017)“A study on the evaluation of ‘simulation based clinical nursing introduction program’ for nursing student
to improve patient safety competence. ”
Jiin Kim (Assistant professor of Dept. of Nursing, Deagu Healthcare College, Korea)(NA019) “Provider and Pharmacist Collaboration in The Care of Patients”
Roger S. Klotz R.Ph., FASCP,FACA, FCPhA (Associate Professor of Pharmacy Practice and Administration,
Western University of Health Sciences, California, USA)

(NA021) “IMPROVING SAFETY THROUGH DEVELOPMENT OF EMERGENCY TRANSFER PROTOCOL”
Hui-Jeong Hwang, Mi-Hyun Yun, Hyeon-Jeong Kwak, Mia Kim(Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea)(NA039) “Identifying latent safety threats in the emergency departments through a mobile in situ high fidelity
simulation program: an hypothesis for punctual interventions”
Dojmi Di Delupis Francesco;1* & Pisanelli Paolo2
1
M.D. Emergency Department, ASL 10, Piazza di S. Maria Nuova 1 - 50122 Florence, Italy.
2
M.D. Emergency Department, Ospedale Misericordia - ASL 9, via Senese 169, - 58100 Grosseto, Italy(NA053)“Metformin for Treatment of Antipsychotic-Induced Amenorrhea in Female Schizophrenic Patients:
Report of Two Cases”
Duk-In Jon1(1st author), Won-Myong Bahk2 (Corresponding author), Bo-Hyun Yoon3, Sang-Keun Chung4,
Sang-Yeol Lee5, Moon-Doo Kim6, Kwang Heun Lee7 , Young-Joon Kwon8, Kyung-Joon Min91Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, Korea; 2Department of psychiatry, Yeouido
St. Mary’s Hospital, The Catholic University of Korea; 3Department of Psychiatry, Naju National Hospital, Naju, Korea;
4
Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea; 5Department of Psychiatry,
Wonkwang University School of Medicine, Iksan, Korea; 6Department of Psychiatry, College of Medicine, Jeju National
University, Jeju, Korea; 7Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, Korea;
8
Department of Psychiatry, College of Medicine, Soonchunhuang University, Cheonan, Korea; 9Department of Psychiatry,
College of Medicine, Chung-Ang University, Seoul, Korea

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

28 Sep 2015 Poster(NA054)“Mirtazapine-induced sleep related eating behaviour”
Hye-Jin Seo1 , Won-Myong Bahk1 , Bo-Hyun Yoon2, Duk-In Jon3, Sang-Keun Chung4, Sang-Yeol Lee5, Moon6
Doo Kim , Kwang Heun Lee7 , Young-Joon Kwon8(Corresponding author), Kyung-Joon Min9
Affiliations: 1Department of psychiatry, Yeouido St. Mary’s Hospital, The Catholic University of Korea; 2Department of
Psychiatry, Naju National Hospital, Naju, Korea; 3Department of Psychiatry, Sacred Heart Hospital, Hallym University,
Anyang, Korea; 4Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea; 5Department of
Psychiatry, Wonkwang University School of Medicine, Iksan, Korea; 6Department of Psychiatry, College of Medicine, Jeju
National University, Jeju, Korea; 7Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, Korea;
8
Department of Psychiatry, College of Medicine, Soonchunhuang University, Cheonan, Korea; 9Department of Psychiatry,
College of Medicine, Chung-Ang University, Seoul, Korea.

(NA055)“Korean Medication Algorithm for Bipolar Disorder 2014: Safety and Tolerability”
Won-Myong Bahk1 (1st author), Bo-Hyun Yoon2(Corresponding author), Duk-In Jon3, Sang-Keun Chung4,
Sang-Yeol Lee5, Moon-Doo Kim6, Kwang Heun Lee7 , Young-Joon Kwon8Kyung-Joon Min91Department of psychiatry, Yeouido St. Mary’s Hospital, The Catholic University of Korea; 2Department of Psychiatry, Naju
National Hospital, Naju, Korea; 3Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, Korea;
4
Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea; 5Department of Psychiatry,
Wonkwang University School of Medicine, Iksan, Korea; 6Department of Psychiatry, College of Medicine, Jeju National
University, Jeju, Korea; 7Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, Korea;
8
Department of Psychiatry, College of Medicine, Soonchunhuang University, Cheonan, Korea; 9Department of Psychiatry,
College of Medicine, Chung-Ang University, Seoul, Korea;(NA056)“Influence of Perception of Nurse's Work Environments and Patient Safety Culture on Attitudes about Incidence
Reporting “Kyoung Ja Kim1, Moon Sook Yoo 2
1
Assistant professor, Hannam University, Deajeon, Republic of Korea.
2
Professor, Ajou University, Suwon, Republic of Korea.

(NA058)“Safe Handover = Safe Patients: An Audit of SBAR Handovers”
Emma McGonigal & Dr Nina Gill (NHS Lanarkshire, Scotland, UK)(NA062)“An overview of patient safety in Iran”
Tahmine Salehi. Nursing management department. School of nursing & midwifery,
Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Nahid Dehghan Nayeri. Nursing management department. School of nursing & midwifery,
Tehran University of Medical Sciences (TUMS), Tehran, Iran

(NA063)“Quality Improvement Project: Medication Reconciliation”
Asli OZYILDIRIM, MSc Pharmacist, Chief of Pharmacy
Ismail BOZKURT, MD, Chief of Continuous Quality Improvement Department / Medical Director
Fatma KUCUKERENKOY – Patient Safety Manager
Mujgan MUTLU, Head Nurse
Mustafa OZUNAL, MD, Family Physician
Nurgul TUMER, Continuous Quality Improvement Department
Ulku BURGESS, Nursing Manager
Ulker SENER – Pharmacist(American Hospital, Istanbul, TURKEY)4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

28 Sep 2015 Poster(NA068)“Multifactorial fall prevention program to increase patient safety “Park Ihn-Sook, Yoon So-Young, Hong Hee-Jung, Lee Kyung-Yi, Kang Sun-Sil, Kang Geum-Ok, Kim Jeong-Ah,
Son Ihn-Suk, Jung Hee-Jung, Ham Chun-Sun(Nursing department of Seoul Metropolitan Government, Seoul National University
Boramae Medical Center, Korea)(NA073)“Retrospective analysis of adverse events during inpatient stay
- a qualitative examination for improvement in an Austrian hospital”
Marianne Paki, Stabsstelle QM/RM(Betriebswirtin, MA, Zertifizierte klinische Riskmanagerin, Zentrales Befragungs- undBeschwerdemanagement, Gemeinnützige Salzburger Landeskliniken Betriebsgesellschaft mbH
Stabsstelle für Qualitäts- und Riskmanagement, Salzburg, Austria)(NA076)“Effective double-check methods regarding the accuracy and required time of the verification process inmedication preparation”
Kenji Tanaka, Midori Inaba (University of Electro-Communications, Tokyo, Japan)(NA084)“Inherent risk of opening medical care to patients of foreign origin – from seclusion to globalism:
A University of Tokyo Hospital(UTH) experience.”
Hideomi Yamada, Yui Sugano, Sumito Tamura(International Medical Center, The University of Tokyo Hospital, Tokyo, Japan)(NA085)“Role of a Nutrition Support Team in Avoiding the Risk of Malnutrition after Esophagectomy”
Tomoko Shimoda, S. Yoshimura (Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan)(NA088)“KIDUKI” Course as Simulation Training for Patient Safety”
Emiko Asaka12, Hiroshi Okudera1, Masahiro Wakasugi1, Megumi Takahashi1,
Mie Sakamoto1, Keiichi Ikegami3
1 Department of Crisis Medicine and Patient Safety, Graduate School of Medicine, University of Toyama, Toyama, Japan
2 Department of Nursing, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
3 Shock Trauma Center, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan(NA094)“Introduction of a manual to prevent extravasations of drugs”
Maki Furuo, Yumiko Kose, Yaeko Sasa, Tomoko Nonaka, Tomohiko Ogasawara, Yukio Seki
(Department of Clinical Safety Promotion, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan)(NA095) “Does The Northwest London Hospitals NHS Trust comply with the UK’s national guidance on themechanical prevention of venous thromboembolisms (VTE)?”
Fanshawe Angel E, Al-Nahi S, Clarke J, Qurashi K.
(Northwick Park Hospital, Northwest London Hospitals NHS Trust, London, UK)(NA098) “MEDICAL DISPLAYS: RISKS OF LACK OF CALIBRATION”
OLIVEIRA, E. R., JAKUBIAK, R.R
Profª. Dra. Rosangela Requi Jakubiak
Programa de Pós Graduação em Engenharia Biomédica
Universidade Tecnológica Federal do Paraná, Portogal

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

28 Sep 2015 Poster(NA113) “A PILOT PROJECT TO MONITOR, SUPPORT AND MEASURE THE SURGICAL SAFETY CHECKLIST APPLICATIONAND USE”
DI FILIPPO MARIA CARMINA1, MURAGLIA ANGELO2, TOZZI QUINTO3, FABIANI LEILA1
1
Università degli Studi dell’Aquila, Scuola di Specializzazione in Igiene e Medicina Preventiva, L’Aquila, Italy
2
Regione Abruzzo, Dipartimento per la Salute ed il Welfare, Pescara, Italy
3
AGE.NA.S. Agenzia Nazionale Servizi Sanitari Regionali, Roma, Italy(NA123) “Evaluation of the management system using surgical instruments with radio-frequency identification tags:
usage of long-term in a hospital”
Kaori KUSUDA1, Kazuhiko YAMASHITA2, Kiyohito TANAKA3, Takashi OKUBO2, Yuji OHTA1(1 Ochanomizu University, Tokyo, Japan, 2 Tokyo Healthcare University, Tokyo, Japan
3 Kyoto Second Red Cross Hospital, Kyoto, Japan)(NA124)“Survey and reporting system for patient safety at Gastrointestinal Surgical ward in Japan”
Kazuhiko Yamada1,2), C. Yokoi2), M. Takamoto2), T. Fukaya2), K. Doi2), S. Mutsumi2),
Y. Hiroi2), S. Minowada2)
1)( Department of Surgery, 2) Division of Medical Safety, National Center for Global Health and Medicine,Tokyo, Japan)(NA126)“Factors Promoting Workplace Social Capital in Japanese Hospital Nurses”
Authors: Kensuke NORIKOSHI 1,2, Toshio KOBAYASHI 3, Keiji TABUCHI 2,3
1: Faculty of Nursing, Hiroshima International University, Hiroshima, Japan2: Graduate School of Bio-medical and Health Sciences, Hiroshima University, Hiroshima, Japan
3: Institute of Bio-medical and Health Sciences, Hiroshima University, Hiroshima, Japan(NA129)“The Hidden Dangers of Drug-Drug Interactions- Clinical communication for clinical safety”
Rachel MacCann, Paul Hollywood, Prof. Samuel McConkey, David Lorigan(Royal College of Surgeons, Dublin, Ireland)(NA133)“Safe use of biologic treatment for rheumatic diseases – case series”
Liana Chicea (Academic Emergency Hospital, Rheumatology Department, Sibiu, Romania)(NA140)“Health and safety in the practical training of biomedical scientists”
Claudia Lampl, Karin Posch, Monika Kühteubl, Eveline Klinkacek, Manfred Hirnschall, Thomas Pekar(Bachelorstudiengang Biomedizinische Analytik, Gynäkologische Zytodiagnostik
Fachhochschule Wiener Neustadt für Wirtschaft und Technik Ges.m.b.H.
University of Applied Sciences Wiener Neustadt for Business and Engineering Ltd., Austria)(NA150)“Medication Errors: A three year retrospective review of self-reporting in a French University Hospital.”
Matthieu COLOM (5), A JANOLY-DUMENIL (1), A DUCROUX (5), MC KLOTZ (5), S HEDOUX (1),
A RAMBOUR-BOISSEAU (6), V FLATIN (4), C DELRIEU (4), G AULAGNER (1, 5), C STAMM (6)(1) Contrat de Bon Usage du Médicament, COMEDIMS, Hospices Civils de Lyon, France(2) Réanimation pédiatrique, Groupement Hospitalier Est, Hospices Civils de Lyon, France(3) Direction des Soins, Groupement Hospitalier Est, Hospices Civils de Lyon, France(4) Direction Organisation Qualité Relation avec les Usagers, Hospices Civils de Lyon, France(5) Pharmacie, Groupement Hospitalier Est, Hospices Civils de Lyon, France(6) Management de la Qualité de la Prise en Charge Médicamenteuse du Patient, Hospices Civils de Lyon

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

28 Sep 2015 Poster(NA151) “Improving compliance of the WHO Surgical Safety Checklist in a District General Hospital in United Kingdom”
Francesca Colombo, Lawrence Richards, Anthony McLaughlin, Eric Lee, Colin Rogers, Paul
Smith, Katy McErlain, Stelios Vakis;(Queen’s Hospital, Burton-on-Trent, DE13 0RB, United Kingdom)(NA152) “Accidental intrathecal injection with contraindicated contrast media: a review of seven court decisions inJapan”
Masako Sugihara, M.D., M.A. (Department of Psychiatry, National Hospital Organization Kurihama Hospital andAddiction Center, Kanagawa, Japan)
Masayoshi Nagata, M.D., Ph.D. (Department of urology, National Center for Global Health and Medicine Hospital,
Tokyo, Japan)
Tetsuya Tanimoto, M.D. (Navitas Clinic, Tokyo, Japan)(NA168)“The Deteriorating Patient QI Project: An Experience on a Respiratory Ward”
Dr S. Kumar, Dr M. Gittus, Dr C. Handalage, Sister L. Boggs(Leeds Teaching Hospital Trust – Respiratory department, St James' University Hospital, Leeds, UK.)

(NA169)“Decreasing risk in use of tumor marker for patient safey”
E.Eva Moreno-Campoy1,2, Francisco J. Mérida-De la Torre3, Francisco Martos-Crespo4, Mario Plebani5.
1Unidad de Farmacia. Área de Gestión Sanitaria Serranía de Málaga. Spain
2
Universidad de Málaga, Spain
3
Laboratorio Clínico. Área de Gestión Sanitaria Serranía de Málaga. Spain
4
Universidad de Málaga. Facultad de Medicina. Departamento de Farmacología. Spain
5
Laboratorio de Medicina. Hospital de Padua. Italia.

(NA172)“Influence of our new nursing system, the Partnership Nursing System (PNS), on the medical safety”
Naomi Emori¹ Yuko Igarashi ¹ Hironobu Akino ² Tomoko Hasegawa ³
1)Department of Nursing, University of Fukui Hospital, Japan
2) Department of Medical Safety, University of Fukui Hospital, Japan
3) Faculty of Medical Sciences, University of Fukui, Fukui, Japan

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)【29 September 2015; Poster】(NA005)(NA027)“An Exploration for Opioid Analgesics of Pain Control in Terminal Cancer Patient”
Pei-Chun Chou, Pai-Ho Huang, Ying-Hui Su, Chia-Ying Lin, Pei-wen Hsieh(National Taiwan University Hospital Hsin-Chu Branch, Taiwan)“ACTIVITES TO IMPROVE FALLING ACCIDENTS AT PHYSICAL EXAMINATION CENTERS”
JI YUN LEE, HYUN JOO LEE, HYUNG CHUL KIM(Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea)(NA034) “Allergy Documentation: An Audit on Compliance in a Busy Accident & Emergency Department of a Tertiary
Care Hospital in the United Kingdom ”
Israr Haq1, Saher Haq2, Omar Khan1
1New Cross Hospital, Royal Wolverhampton NHS Trust, England, United Kingdom
2Rashid Hospital, Dubai Health Authority, Dubai, UAE(NA051)“Caffeine-induced psychiatric manifestations: A review”
Kyung-Joon Min1(1st author), Won-Myong Bahk2 (Corresponding author), Bo-Hyun Yoon3, Duk-In Jon4,
Sang-Keun Chung5, Sang-Yeol Lee6, Moon-Doo Kim7, Kwang Heun Lee8 , Young-Joon Kwon91
Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea; 2Department of psychiatry, Yeouido
St. Mary’s Hospital, The Catholic University of Korea; 3Department of Psychiatry, Naju National Hospital, Naju, Korea;
4
Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, Korea; 5Department of Psychiatry, Chonbuk
National University Medical School, Jeonju, Korea; 6Department of Psychiatry, Wonkwang University School of Medicine,
Iksan, Korea; 7Department of Psychiatry, College of Medicine, Jeju National University, Jeju, Korea; 8Department of
Psychiatry, College of Medicine, Dongguk University, Gyeongju, Korea; 9Department of Psychiatry, College of Medicine,
Soonchunhuang University, Cheonan, Korea(NA052)“Duloxetine-Induced Burning Paresthesia”
Won-Myong Bahk1 (1st author), Bo-Hyun Yoon2, Duk-In Jon3, Sang-Keun Chung4, Sang-Yeol Lee5,
Moon-Doo Kim6, Kwang Heun Lee7 , Young-Joon Kwon8, Kyung-Joon Min9, Seo-Hye Jin1
1
Department of psychiatry, Yeouido St. Mary’s Hospital, The Catholic University of Korea; 2Department of Psychiatry, Naju
National Hospital, Naju, Korea; 3Department of Psychiatry, Sacred Heart Hospital, Hallym University, Anyang, Korea;
4
Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea; 5Department of Psychiatry,
Wonkwang University School of Medicine, Iksan, Korea; 6Department of Psychiatry, College of Medicine, Jeju National
University, Jeju, Korea; 7Department of Psychiatry, College of Medicine, Dongguk University, Gyeongju, Korea;
8
Department of Psychiatry, College of Medicine, Soonchunhuang University, Cheonan, Korea; 9Department of Psychiatry,
College of Medicine, Chung-Ang University, Seoul, Korea;(NA069)“Hospital Business Continuity Plan Incorporating a Web-based System”
Ruriko Nakahara1) Yoshihara Katsunori2) Miyaji Fujiko2)
1) Kyoritsu Women’s University, Tokyo, Japan
2) Toho University Medical Center Omori Hospital, Tokyo, Japan

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

29 Sep 2015 Poster(NA072)“Alarm-sound intelligibility, a factor associated with a lethal medical incident– from an experience in our hospital–“
Shingo Kasamatsu1), Hironobu Akino2,3), Kimiko Kitahama2,3), Masako Fujii2,3),
Yoshimi Kuwabara2,3), Naomi Emori3)（1.Department of Medical Informatics, 2. Department of Medical Safety,
3. Department of Nursing, University of Fukui, Fukui, Japan）(NA078) “The utility of shock index at triage in predicting admission to monitored units and mortality among adults
with systemic inflammatory response syndrome at the emergency department”
Michelle Wong, Shiang-Hu Ang, Shin-Ying Thng, Ling Tiah (Singapole)(Accident and Emergency Department, Changi General Hospital, Singapore)(NA079)“Creation of the Safety Checklist for IV Management of Japanese Nurses”
Saeko KINUGAWA，１ Ikuko IWAMOTO，２ Masako TAKAHASHＩ３ and Yasue UMEZU４１
Department of Nursing, School of Nursing and Rehabilitation Sciences at Odawara, International University of Health andWelfare, Tokyo, Japan
２
Division of Nursing, Faculty of Nursing ,Tokyo Healthcare University, Tokyo, Japan３
Department of Nursing, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan
４
Division of Nursing ,Tottori College of Nursing, Tottori, Japan(NA081) “Practical evaluation of a protocol sheet to improve and standardize home nursing care and enhancecooperation with physicians in the care of symptoms of dyspnea.”
Yayoi Sato, Miho Tonai (Oita University of Nursing and Health Sciences, Oita, Japan)(NA086) “Hypothermia and rhabdomyolysis associated with oral risperidone in a schizophrenic patient: A case report”
Duk-In Jon1, M.D., Ph.D., Sang-Keun Jung2, M.D., Ph.D., Bo-Hyun Yoon3, M.D., Ph.D., Won-Myoung Bahk4, M.D., Ph.D.
Kyung-Joon Min5, M.D., Ph.D., Moon-Du Kim6, Ph.D., Young-Joon Kwan7, M.D., Ph.D., Kwang-Heun Lee8, M.D., Ph.D., SangYeol Lee9+, M.D., Ph.D.
1. Department of Psychiatry, Hanllym University College of Medicine, Chuncheon, Republic of Korea
2. Department of Psychiarty, Jeonbuk National Graduate School of Medicine, Jeonju, Republic of Korea
3. Department of Psychiatry, Naju National Mental Hospital, Naju, Republic of Korea
4. Department of Psychiatry, Catholic University College of Medicine, Seoul, Republic of Korea
5. Department of Psychiatry, Chungang University College of Medicine, Seoul, Republic of Korea
6. Department of Psychiatry, Jeju National Graduate School of Medicine, Jeju, Republic of Korea
7. Department of Psychiatry, Sungkyungkwang University, College of Medicine, Seoul, Republic of Korea
8. Department of Psychiatry, Dongguk University College of Medicine, Kyoungju, Republic of Korea
9. Department of Psychiatry, Wonkwang University School of Medicine and Hospital, Iksan, Republic of Korea(NA090) “Clinical factors related with treatment adherence in psychotic patients with psychiatric hospitalization
experience”
Jon DI1, Jung MH1, Kwon YJ2, Min KJ3, Yoon BH4, Chung SK5, Lee SY6
1 Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University, Anyang, Korea
2 Department of Psychiatry, College of Medicine Soonchonhyang University, Cheonan, Korea
3 Department of Psychiatry, College of Medicine Chung-Ang University, Seoul, Korea
4 Department of Psychiatry, Naju National Hospital, Naju, Korea
5 Department of Psychiatry, College of Medicine Chonbuk University, Jeonju, Korea
6 Department of Psychiatry, College of Medicine Wonkwang University, Iksan, Korea

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

29 Sep 2015 Poster(NA093)“Introduction of a course of short safety lectures through a year”
Yumiko Kose, Maki Furuo, Tomohiko Ogasawara, Mamoru Nanasato, Yukio Seki
(Department of Clinical Safety Promotion, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan)(NA103)“The Utility of Pharmacy Disaster Manuals in Japan”
Satoko Katsuragi (Hyogo University of Health Sciences, Hyogo, Japan)(NA108)“Applying hierarchical task analysis to prescribing errors in hospitalized children with cancer in Saudi Arabia”
Douha Bannan1, Mohammed Aseeri2, Mary Tully1
1 Manchester Pharmacy School, the University of Manchester, Manchester, UK
2 Pharmacy Department, King Saud bin Abdul Aziz University for Health Sciences, King Abdul Aziz Medical City/ National
Guard Health, Affairs, Jeddah, Saudi Arabia(NA114)“A PHARMACY STUDENTS SURVEY ON KNOWLEDGE AND USE OF MEDICINAL PLANTS”
MARIA CARMINA DI FILIPPO1, LIDIA LEPORINI2, ANNABELLA VITALONE3, LUIGI MENGHINI2
1
School of Specialization in Hygiene and Preventive medicine, University of L’Aquila, L’Aquila, Italy.
2
Department of Pharmacy, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy.
3
Department of Physiology and Pharmacology, University of Rome “Sapienza”, Roma, Italy.

(NA130) “Prevalence and Its Correlates of Night Eating Syndrome in Schizophrenic Outpatients”
Bo-Hyun Yoon, M.D.,1 Won-Myong Bahk, M.D.,2 Moon-Doo Kim, M.D.,3 Young-Jun Kwon, M.D.,4 Duk-In Jon, M,D.,5
Sang-Yol Lee, M.D.,6 Kwang-Hun Lee, M.D.,7 Sang-Keun Chung, M.D.,8 Kyung-Jun Min, M.D.9
1
Department of Psychiatry, Naju National Hospital, 2Department of Psychiatry, College of Medicine, The Catholic
University of Korea, 3Department of Psychiatry, Jeju National University Hospital, 4Department of Psychiatry, Cheonan
Suncheonhyang University Hospital, 5Department of Psychiatry, Hallym University Hospital, 6Department of Psychiatry,
Wonkwang University Hospital, 7Department of Psychiatry, Dongkuk University Hospital, 8Department of Psychiatry,Jeonbuk National University Hospital, 9Department of Psychiatry, Chung-Ang University Hospital., Korea(NA137) “Important Factors against Transplant Coordinators for Practicing Comprehensive Health Management ofTransplant Recipients”
Miho Shingu (Department of Fundamental Nursing, Hiroshima University, Hiroshima, Japan)(NA148)“BLACK CONGLOMERATES/”MELANCOLIA” AS PHYSICAL PRODUCTS IN THE NORMAL BLOOD: A NEW
ELEMENT THAT HAS NOT YET BEEN DESCRIBED”
Louis Van Hecken (GENERAL PRACTITIONER, Meerhout, Belgium)(NA153)“Creating clinical safety culture: past, present and future”
Yukio Seki, Yumiko Kose, Maki Furuo, Yoshitaka Itoh, Miho Kinoshita, Norie Tsuboi, Kyoko Kosato(Department of Clinical Safety Promotion, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan)

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

29 Sep 2015 Poster(NA155)“Analysis of Thirteen Months of Pre-analytical Errors and Their Root Causes at a Large Academic Medical
Center”
Ida Bixho BS1,2, Stacy E. F. Melanson, MD, PhD1,3, Milenko J. Tanasijevic, MD, MBA1,3
1
Department of Pathology, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
2
Department of Medicine, Brigham and Women's Hospital, Harvard University, Boston, MA, USA
3
Harvard Medical School, Boston, MA Boston, MA, USA(NA146)“Studying online with their own workplace as a learning arena “Solrun G. Holm, Trude Hartviksen, Berit Sjølie(The Faculty of Professional Studies, University of Nordland, Norway)(NA147)“Development & Validation of an assessment method for IEC 80001-11.”
Lucy Ann Kielty,(Clinical Informatics Manager, General Intensive Care Unit, St James’s Hospital, Dublin, Ireland)(NA149) “The Resources of confirmation of good blood return through Central Venous Access Device(CVAD) on cancer patients by using Valsalva method”
Terutoshi Nakao＊, Teppei Matsumoto＊, Kohei Kawaguchi＊, Masako Takemoto＊,
Shinpei Ishikawa＊,Teruhiko Hirai＊, Yositaka Tsukamoto＊,Teruhisa Ninoi†(＊Department of Surgery ,†Department of Radiology , PL General Hospital, Osaka, Japan)(NA154)(NA157)“Global standards and data capture technologies to help improve medication safety”
Tania Snioch (Director Healthcare, GS1 AISBL, Brussels, Belgium)
Ulrike Kreysa (Vice President Healthcare, GS1 AISBL, Brussels, Belgium)“Efficacy and Safety of Essential Oils in Aromatherapy: A Randomized Controlled Trial
Acharaporn Duangjaia,b, Surasak Saokaewb *aSchool of Medical Sciences, University of Phayao, Phayao, ThailandbCenter of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences,
University of Phayao, Phayao, Thailand(NA158)“Assessment of the introduction of TeamSTEPPS with EQ
Midori Yokoyama & Chikako Otaki(Department of nursing, Tokyo Takanawa Hospital, Tokyo, Japan)(NA160)“Simulation in a country with minimal resources and its impact on clinical safety.”
Gillian Pearce, Aisha Alzouebi (Hillingdon Hospital, London, UK)4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

29 Sep 2015 Poster(NA161)(NA166)(NA167)“Factors affecting burden of main caregivers in children with epilepsy
1
Moon-Doo Kim, MD, PhD, 2Won-Myong Bahk, MD, PhD, 3Bo-HyunYoon, MD, PhD4 ,Kwanghun Lee, MD, PhD, 5Duk-In Jon, MD, PhD, 6Young-Joon Kwon, MD, PhD,
1
Department of Psychiatry, Jeju National University Hospital, Jeju, Korea
2
Department of Psychiatry, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea,
Seoul, Korea
3
Department of Psychiatry, Naju National Hospital, Naju, Korea
4
Department of Psychiatry, Dongguk University College of Medicine, Gyeongju Hospital, Gyeonju, Korea
5
Department of Psychiatry, Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea
6
Department of Psychiatry, Chunan Soonchunhyang Hospital, Soonchunhyang University, Chunan, Korea“Do we clinical risk management necessary in pre-hospital settings?”
Kazuma Morino (Yamagata Prefectural Medical Center for Emergency, Yamagata, Japan)“Simulation training for urgent blood transfusion in our hospital”
Maya Takamoto1,3), Yoshihiro Manabe2), Yukio Hiroi3), Tetsu Yano1,2), Shigeru Minowada3)(National Center for Global Health and Medicine, Tokyo, JAPAN)
1) Department of Obstetrics and Gynecology, 2) Department of Clinical Laboratory, 3)Department of Medical Safety4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)【30 September 2015; Poster】(NA035) “Importance of Effective Doctor-to-Doctor Handover for Better Patient Care & Safety: A study conducted at
an Accident & Emergency Department in the United Kingdom”
Israr Haq1, Saher Haq2
1New Cross Hospital, Royal Wolverhampton NHS Trust, England, United Kingdom
2Rashid Hospital, Dubai Health Authority, Dubai, UAE(NA037) “Decreasing the incompletion rate for arthroscopy instrument of the nursing staff in the operation room.”
Hsing-Wen Tsai a•Han-Chang Kub•Ya-Fang Liu a•Pao-Hsuan Huang aa:RN, BSN, Operation Room, Chi Mei Medical Center; Taiwan
b:RN, MS, Operation Room, Chi Mei Medical Center. Taiwan(NA038) “The incidence and associated factors of herpes zoster among HIV infected patients: a population-based
retrospective cohort study in Taiwan, 2000 through 2010.”
Han-Chang Ku1, Yen-Chin Chen2, Nai-Ying Ko2.
1
ChiMei Medical Center, Tainan, Taiwan, 2the Department of Nursing; Institute of Allied Health Sciences,
College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan.

(NA049)“Assessment of the Missing Biomonitor During the Body Position Change in the Operation Theatre”
Yusuke Kasuya, Shiori Sakuma, Makoto Ozaki(Department of Anesthesia, Tokyo Women’s Medical University, Tokyo, Japan)(NA057)“Evaluation of the confusion assessment method Chinese version (CAM-EDC) for Emergency Department(ED) patients as a screening tool for delirium in the emergency department in Taiwan：A pilot study”
Ting-Ya Yang, Chia-Jung Hsieh, Kuang-Yang Hsien, Pei-Hsin Kao(Chi-Mei Medical Center, National Taipei University of Nursing and Health Sciences, Taiwan)(NA059)“A Project for Applying Colored Card Warning System to Reduce the Rate of Falls Injury
in A Emergency Department of Medical Center”
Yi-Min Shu, Hsiu-Chi Lin, Su-Chen Ku, Hsu-Hui Ching, Ya-Ting Ke(Emergency Department, Chi-Mei Medical Center, Taiwan)(NA060)“A Project for Improving the Rate of Incontinence-Associated Dermatitis in Respiratory Care Center”
Yu-Ting Su, Mei-Lan Su, Huey-Jeng Yang, Wen-Ling Chuang(Respiratory Care Center, Chi-Mei Medical Center, Taiwan)(NA067)“A study into turnover intention and relevant factors among nursing staff of Generation Z”
I-Fan Shao （Head Nurse , Ministry of Health and Welfare Tainan Hospital, Taiwan）(NA074)“Improve the Rejection Rate of Specimen in Emergency Department through Bar Code Technology System”
Hsiao-Ping Li, Ting-Ya Yang”(Chi-Mei Medical Center, National Taipei University of Nursing and Health Sciences, Taiwan)

4th World Congress of Clinical Safety

28-30 Sep 2015, Schlos Schonbrunn Apothekertrakt, Vienna, Austria
International Association of Risk Management in Medicine (IARMM)

30 Sep 2015 Poster(NA077)“On-the-job Training for Head Nurses to Promote a Culture of Safety
Toshiko Kobayashi, Masako Yoshizawa, Ruriko Nakahara and, Chieko Takeuchi(Toho University Medical Center, Ohasi Hospital, Tokyo, Japan)(NA082)“Practical Knowledge of Mid-Career Nurses In Team Effort in Covering Blind Spots of Fall Prevention”
Masako Yoshizawa, Toshiko Kobayashi, Ruriko Nakahara and Chieko Takeuchi(Toho University Omori Medical Center, Tokyo, Japan)(NA089)“Medical safety in the hospital multidisciplinary cooperation”
Ichiro Kawana, Akiyo Ishida, Jyunichi Iida, Takashi Matsuda, Toshio Imada(Saiseikai Yokohamashi Nanbu Hospital, Kanagawa, Japan)(NA107)
Care”“Enhancing the Quality of Care for Boarding Patients in the Emergency Department through Holistic Health
Shu-Lien HSU, Li-Sheng Chang, Chun-Cheng Zhang, Tzu-Chieh Weng
(Nursing Department, Chi-Mei Medical Center, Tainan, Taiwan)(NA109) “Patient preoperative nutritional status influences the relationship between the Surgical Apgar Score andpostoperative major complications.”
Masao Ogawa, Hideaki Tsuchida(Department of Anesthesiology, Kanazawa Medical University Hospital, Ishikawa, Japan)(NA112)“Efficacy and Safety Analysis of Palliative Care in the Emergency department (ED)”Tzu-Chieh Weng M.D., Ping-Jen Chen M.D, Chien-Chin Hsu M.D./Ph.D.
(Holistic care unit, Emergency medicine, Chi-Mei Medical Center, Taiwan)(NA145)“Improving patient care quality through electronic restraint evaluation form”
Jen-Chun Lin, Chia-Hui Liu, Shwu-Fen Chiou(Nursing Department, National Cheng Kung University Hospital
National Taipei University of Nursing and Health Sciences, Taiwan)(NA132)“Enhancing safety of bariatric inpatients with improved hospital design”
1) Dr.Parna Thakkar, Hinduja Healthcare, Mumbai, India
2) Dr. Aparna Sinha,Max Hospital, Delhi, India
3) Dr. Sugam Kale,Jurong Health, Singapore(NA165)“Maternal and Neonatal Physical Risks and Effects of Freestyle Delivery Positions during the Second Stageof Spontaneous Vaginal Delivery: a Case Control Study”
Yumi Ito 1), RN, CNM, Sadako Yoshimura 2), RN, CNM, PHN, PhD, Tadashi Sagawa 3), MD, PhD
1) Kawakami Women’s Clinic, Hokkaido, JAPAN
2) Department of Fundamental Nursing, Faculty of Health Sciences, Hokkaido University, JAPAN3) Department of Comprehensive Development Nursing, Faculty of Health Sciences, Hokkaido University, JAPAN----- End of all programs ----