Igniting Flammable Liquids with Cigarettes

Igniting Flammable Liquids with Cigarettes Cigarettes seem like a probable ignition source for flammable liquids. Cigarettes have been blamed for the cause of many fires, far more than they should. But Cigarettes are more than tobacco wrapped in paper. They are in fact carefully engineered to burn in a certain way Cigarettes vary considerably from brand to brand in their burning characteristics. Modern cigarettes contain an engineered chemistry of additives to control the burning rates and moisture content of the tobacco and paper and anyone who has been a smoker knows the fact that manufactured Cigarettes go on burning when not being puffed. This spares smokers the trouble of lighting up again unlike with rolled up cigarettes and Cigars where the smoker has to keep smoking for the combustion of the tobacco to remain lit. This is good for the cigarette companies and pays off in higher sales from cigarettes. So yes this does mean that a cigarette rolling off onto a mattress or into the crack of a sofa can smoulder undetected f or 30 to 40 minutes before bursting into flames. Smouldering is a form of flameless combustion which can occur in materials capable of charring. Smouldering can occur at very low oxygen concentrations then proceeds at a very slow rate before flaming occurs. This makes people understand the real hazard of manufactured cigarettes. But that is found out through the visual fact of witnessing a cigarette stay lit and burn. So people will believe most of what they see as fact, but when many people sit down in their local theatre to watch the latest Hollywood movie they usual see the spectacular visual effects of a character throwing a lit cigarette on to a puddle of fuel and watching a large fire ball appear before their eyes which causes an amazing explosion. Igniting puddles of petrol for example with cigarettes in movies is a common device. The character takes a few puffs and tosses the glowing cigarette in the puddle. Immediately the petrol ignites. But Experiments with flammable gases and vapours have shown that many of the most commonly-encountered substances, including methane and petrol vapour, were not ignited by a lighted cigarette[1] So Petrol vapour cannot normally be ignited by glowing cigarettes, a fact which has been verified by many experiments. Cigarettes are rather uncommon as the source of ignition for a successful structure fire. If they are set to ignite liquid flammables, they will almost certainly fail[2] This paper looks to answer why a lighted cigarette when tested against the ignition of common flammable vapours such as petrol fail but other more volatile liquids tested are capable of ignition. Previous work carried out on cigarette ignition, related research in this field of combustion and ignition of flammable gases and liquids will be studied and researched to give the author a better understanding of the fallacy that a lit cigarette can be a danger that can readily ignite flammable liquids or gases. But not to underestimate the potential danger of such an ignition source in circumstances where many factors can come together to form self sustained combustion. Flammable substances and liquids are used for a wide variety of purposes and are commonly found in the home. Petrol is the most common, but there are other flammable and combustible liquids and gases used Table shows other flammable liquids commonly found around the home Lighter fluid Oil Propane Butane Aerosol Cans Diesel fuel Wood preservatives Kerosene White spirits Flammable materials found in the gaseous form will burn whenever mixed with the proper amount of air and properly ignited. A flammable liquid in its liquid state will not burn. It will only ignite when the vapours from the liquid evaporate in air. All flammable liquids give off vapours that can ignite and burn when an ignition source is introduced. Flammable liquids require an initial energy input to produce an air/vapour mixture within the limits of flammability (niamh mc daid) Ignition is the transition from a nonreactive to a reactive state in which external actions lead to thermo chemical runaway followed by rapid transition to self sustained combustion The usual conditions for ignition are given by a 3t rule of thumb. The three Ts stand for: Temperature. Must be high enough to cause significant chemical reactions and/or pyrolysis Time. Must be long enough to allow the heat input to be absorbed by the reactants so that a runaway thermo chemical process can occur Turbulence. Must be high enough so that there is good mixing between fuel and oxidizer and heat can be transferred from the reacted media to the unreacted media (cite the book) Ignition will occur when the process of a rapid exothermic reaction is started, which then gains momentum and causes the fuel to undergo change. When a flammable liquid is poured or spilled on a surface it is the vapours that are actually ignited. Vapours from liquids are what directly support the flame. To understand how volatile certain flammable liquids are it is useful to be familiar with the terms used to describe their chemical properties. Vapour density This is a property of a vapour that predicts its behaviour when released in air. when calculating the vapour density of a liquid fuel the molecular weight of gas of the vapour by that of air in normal conditions. (approx 29) (niamh mc daid) Flash point The flash point is the lowest temperature at which a liquid fuel will produce a flammable vapour. A liquid fuel must be able to generate a vapour in sufficient quantity to reach that lower limit in air before it can burn. This flash point is measured in two different ways, first being a closed cup measurement and the latter being an open cup. Flammable ranges Petrol has a narrow flammable range. Thus petrol vapour mixed with air has a lower flammability limit of just over 1% and an upper limit of 6% by volume petrol vapour in air, at normally encountered temperatures. (hollyhead) Flammable range refers to the percentage of a flammable liquid in its gaseous state to air to create an explosive mixture. Mixtures of flammable vapours with air will combust only when they are within particular ranges of vapour/air concentration. Outside of these limits the fuel-air mixture is either too lean or too rich to ignite (niamh mc daid) This varies with different flammable liquids. Gasoline has a flammability range of 1.4 to 7.6 percent. This means it will ignite when there is 1.4 parts of gasoline mixed with 100 parts air Ignition temperatures This is the temperature at which a particular flammable liquid gives off vapours and evaporates in air and therefore can ignite. Gasoline will ignite when a heat source or electrical spark of at least 853 degrees comes in contact with it. Natural gas (methane) needs an ignition temperature of around 1000 degrees Auto-ignition temperature (AIT) This is the temperature at which a fuel will ignite on its own without any additional source of ignition. (Niamh mcdaid) Fires will occur because there is high temperature introduced to an area in which there is a fuel-air mixture within its flammability range. There are so atmospheric factors that affect the Auto-ignition temperature e.g. Oxygen levels in the area of the mixture. But so long as the heat energy can be transferred from the source to the fuel ignition fire may result Flammability In Hollyheads paper he mentions the flammability of certain liquids e.g., kerosene, white spirit and diesel oil, which are flammable liquids with flash point temperatures above normal ambient. So therefore, an ignition source has to ignite not only the flammable mixture of fuel vapour but to generate this mixture in the first place by heating the bulk liquid. (hollyhead) Cigarette Components Modern manufactured cigarette comprise of different components. The components combined can affect the performance of the cigarette including the emissions of toxicants. In British manufactured cigarettes the tobacco used is Virginia. There are two other main types used in commercial cigarettes which are Burley and Oriental.   Each has different characteristics.  These tobacco types will also vary depending on their variety, in what environment they are cultivated and how that cultivation is carried out. The paper around the tobacco of commercial cigarettes in modified in different brands. It can be more porous in some brands so that the amount of air passing through the paper affects the yield of a puff. The more air that can pass through the paper the more the smoke constituents passing through the cigarette are weakened which then result in lower yields of various smoke products. Just as Baker describes when a cigarette burns, thousands of products are formed. They are distrib uted between the gas phase and aerosol particles which make up smoke. (baker) Modern commercial cigarettes are made with a filter. The filter is different on most brands. The way the filter is designed can affect the amount of filtration. Different cigarette brands can regulate the taste and smoking experience. Introducing vents in the paper surrounding the filter end can allow for dilution of smoke in lighter branding cigarettes. The bigger the length results in longer fibres and also the materials used for the fibres all play a part in making a certain cigarette different from other brands in the market. Figure shows the different components of a manufactured cigarette, how smoke moves through the tobacco and filter and how air moves through the paper (bat) Cigarette Combustion Many of the components identified in tobacco have also been identified in its smoke because they transfer in part from tobacco to its smoke during the smoking process. Many other identified tobacco components are not found in smoke because they decompose during the smoking process. (cite tobacco book) There has been work carried out to measure the burning temperature of a cigarette particularly those by Dr Richard R Baker have provided fundamental knowledge about the combustion/pyrolysis processes during smouldering and puffing of a cigarette. Dr Richard R. Baker has established the distributions of combustion temperature, gas velocity and key smoke constituents inside a burning cigarette. These experiments have become the foundation for the study of cigarette combustion. Dr Barkers paper studied the process of thermo physical concurrencies inside and around a burning cigarette (barker) Figure 2 shows combustion of a cigarette when being smoked (bat) The formation of smoke from a burning cigarette depends on a series of mechanisms, including generation of products by pyrolysis and combustion, aerosol formation, and physical mass transfer and filtration processes. Each mechanism, and their interactions, has a profound effect on the levels of chemical constituents in tobacco smoke. An enormous amount of research has been done on these subjects over the last 50 years. (barker) Figure 2 describes the two types of burning that take place when the cigarette is puffed. There is also a natural smoulder occurring between the puffs by the smoker. There are two main regions at the tip on the coal, namely the combustion zone A and the pyrolysis and distillation zone B. Combustible vapours are produced in zone B prior to ignition in zone A. During puffing, air is drawn into the cigarette through the paper and at the paper bum line. When a smoker draws on a lit cigarette, the temperature of the cigarette coal rises rapidly from its resting smo uldering temperature of around 600  °C.   Peak puff  temperatures at the periphery of the coal can exceed 900  °C  during a 35 mL, 2-sec puff. The high temperature inside the coal causes an increase in the viscosity of the air flowing through and a concomitant increase in the resistance to the draw of air through the coal.   This effect forces air to be drawn primarily into the periphery of the coal around the paper burn line, which causes more complete combustion in this peripheral region.   The depletion of oxygen due to combustion results in the formation of a region immediately behind the coal where the temperatures remain high enough for thermal decomposition of tobacco (the pyrolysis/distillation zone).   Large amounts of volatile and semi-volatile smoke constituents are produced in this region. A small amount of air is drawn in along the tobacco rod through permeable cigarette paper and smoke temperature decreases rapidly to produce a supersaturated aerosol. The smoke thus formed during a puff is subjected to filtration by the remaining tobacco rod and cigarette filter, as well as dilution by any filter ventilation holes. Some proportion of the light gases (such as CO) will diffuse out of the highly permeable cigarette paper. The smoke that leaves the mouth end of the cigarette is called mainstream smoke.   Between puffs, hot smoke escapes from the top of the cigarette and forms the sidestream smoke. In the authors research for this paper the general opinion that cigarettes are the cause of fires is truthful, as there is no question that many fires are started by cigarettes and the careless smoker is usually the reason for the high number of fires originating from smoking cigarettes. Despite advances in the fire retardant foams in furnishings and mattresses, smoking in bed remains a threat to the safety of people. But it is a common occurrence to hear theories about how smoking caused a fire when the alleged ignition would not have been successful under certain circumstances. No one combustion parameter alone can be used to explain why gasoline (petrol) vapour and methane are not ignited by cigarettes whereas hydrogen and carbon disulphide are. In fact, the parameters themselves are inter-related and taken as a whole can express the propensity of a substance to react with oxygen to form combustion products. This is directly related to the ease with which chemical bonds are broken to lead to the formation of the more stable products of carbon dioxide and water, which result from the combustion of most of these fuels. hollyhead Recent tests by the ATF Fire research Laboratory involved contact of burning tobacco cigarettes of different brands with petrol vapour from a pool at room temperature. A total of 137 attempts were made using both smouldering and actively drawn puffs with no ignitions observed. De haan Tests have shown the oxygen levels in cigarettes in the vicinity of combustion to be very low and carbon dioxide levels to be very high, both factors reducing the chances of vapour ignition The conditions in the combustion zone of a cigarette, which is deficient in oxygen and rich in hydrogen and carbon dioxide, together with the rapid and efficient tobacco-oxy- preparation of the oxygen reaction conspire to allow only the most reactive of substances to be ignited, and result in flame propagation to the vapour air mixtures outside the cigarette coal. Repeated attempts to cause explosions by inserting a lit cigarette into an explosive fuel vapour-air mixture have resulted in failure over many experiments. Hollyhead The residence time of airborne vapours in the cigarette being puffed is so short that there is not enough time for any but the most reactive species to ignite. The fuel elements in a commercially manufactured cigarette is such that quenching distance of all but most reactive gases is not exceeded, suppressing any sustained ignition. Experimental evidence and consideration of the cigarette combustion process, alongside ignition parameters of substances, show that mixtures in air of petrol and methane are not ignited by a lighted cigarette. It is very likely, therefore, that many fires have been wrongly attributed to a lighted cigarette; such a cause fire can often be the refuge of the uninitiated No Smoking regimes at chemical plants, oil gas installations and indeed petrol filling stations is, therefore, not in vain. Although a cigarette may not be an immediate problem, the lighted match or cigarette lighter flame used to light it, certainly could Occasionally contaminates or faults from the manufacture of the cigarettes, may it be in the tobacco filling or paper can cause some brief tiny flames. Given the right conditions and such an atmosphere where there is a fault and a perfect fuel-air mixture. Such flames would be a suitable ignition source. So even though many tests have proved that it is virtually impossible for a lit cigarette or cigar to ignite most flammable vapours, this could ensure the ignition of a fire, explosion or both. In study for this paper the author came across a message board where a guy was irate at the fact he seen another person smoke a cigarette on the fore court of a filling station. To his dismay when confronting the person in question about the stupidity of his action he promptly got the reply that cigarettes dont lit petrol, I seen it on myth busters. Goes to show that what some people see on Television is believed as fact, just like in the Movies. Some things will never change[1] 1. www.wikilaw3k.org/forum. Cars-Transportation-Safety/Smoking-at-the-gas-pump. [cited 2010 4/11]; Available from: http://www.wikilaw3k.org/forum/Cars-Transportation-Safety/Smoking-at-the-gas-pump-345109.htm.

High performance work system :: essays research papers

High performance work system entails greater level of involvement, skill development, commitment, and competencies of all employees regardless of their function or level in the organization. In other words, they are simply work practice that can be deliberately introduced in order to improved organizational performance. A high performance work system would consist 1.  Ã‚  Ã‚  Ã‚  Ã‚  Training. 2.  Ã‚  Ã‚  Ã‚  Ã‚  Performance management. 3.  Ã‚  Ã‚  Ã‚  Ã‚  Compensation and benefits. 4.  Ã‚  Ã‚  Ã‚  Ã‚  Career development. Employee training is important in any organizations. Employee skills have to be updated and altered regularly. There are seven types of major training that organizations provide. They are interpersonal skills, technical, business, mandatory, personal management, problem solving or decision making and personal. In Kassim Baba scenario, they should provide training in terms of performance management and problem solving or decision making whereas it will help employee improve work performance and making decision regarding any particular problems. Performance management is a process establishing performance standards and appraising employee. Performance appraisal is a critical part of performance management. Some of the method are written essay, critical incidents, graphic rating scales behaviourally anchored rating scales, multiperson comparisons, objectives, and 360-degree appraisals. Graphic rating scales are suitable for Kassim Baba’s operation. This method rates each employee in quantity and quality of work, job knowledge, cooperation, loyalty, attendance, honesty, and initiative. Effective and appropriate compensation system can help attract and retain competent and talented individuals who help the organization accomplish its mission and goals. There are many kind or rewards and benefits such as base wages and salaries, wage and salary add-ons, and incentive payments. A good way to reward employees for the job skills and competencies they can demonstrate is skill-based pay system in which skills define his or her pay category. However, there are several factors that influence compensation and benefits; they are employee’s tenure and performance, kind of job performed, kind of business, unionization, labour or capital intensive, management philosophy, geographical location, company profitability and size of company. Career development is more focus on the employee as an individual where it has been described as a boundary less career in which individuals rather than organizations define career progression, organizational loyalty, important skills, and marketplace value. High performance work system :: essays research papers High performance work system entails greater level of involvement, skill development, commitment, and competencies of all employees regardless of their function or level in the organization. In other words, they are simply work practice that can be deliberately introduced in order to improved organizational performance. A high performance work system would consist 1.  Ã‚  Ã‚  Ã‚  Ã‚  Training. 2.  Ã‚  Ã‚  Ã‚  Ã‚  Performance management. 3.  Ã‚  Ã‚  Ã‚  Ã‚  Compensation and benefits. 4.  Ã‚  Ã‚  Ã‚  Ã‚  Career development. Employee training is important in any organizations. Employee skills have to be updated and altered regularly. There are seven types of major training that organizations provide. They are interpersonal skills, technical, business, mandatory, personal management, problem solving or decision making and personal. In Kassim Baba scenario, they should provide training in terms of performance management and problem solving or decision making whereas it will help employee improve work performance and making decision regarding any particular problems. Performance management is a process establishing performance standards and appraising employee. Performance appraisal is a critical part of performance management. Some of the method are written essay, critical incidents, graphic rating scales behaviourally anchored rating scales, multiperson comparisons, objectives, and 360-degree appraisals. Graphic rating scales are suitable for Kassim Baba’s operation. This method rates each employee in quantity and quality of work, job knowledge, cooperation, loyalty, attendance, honesty, and initiative. Effective and appropriate compensation system can help attract and retain competent and talented individuals who help the organization accomplish its mission and goals. There are many kind or rewards and benefits such as base wages and salaries, wage and salary add-ons, and incentive payments. A good way to reward employees for the job skills and competencies they can demonstrate is skill-based pay system in which skills define his or her pay category. However, there are several factors that influence compensation and benefits; they are employee’s tenure and performance, kind of job performed, kind of business, unionization, labour or capital intensive, management philosophy, geographical location, company profitability and size of company. Career development is more focus on the employee as an individual where it has been described as a boundary less career in which individuals rather than organizations define career progression, organizational loyalty, important skills, and marketplace value.

Sentinel Event

A1. Sentinel Event Review of the medical record for the specified patient (SP) was completed 09/16/12. The medical record revealed that the SP was a minor child with a diagnosis of history of frequent and recurrent tonsillitis and was scheduled to have the tonsils and adenoids removed 09/14/12 at 10:30 AM as an outpatient procedure. Review of the medical record for the day of 09/14/12 revealed that the SP was admitted to the pre-admission testing area at 9:00 AM. At 10:00 AM the SP was in the pre-operative area with the peripheral intravenous line in place and the pre-operative medications were being administered.At 10:30 AM the SP was in the operating room (OR) and the procedure was performed as scheduled. At 11:15 AM, the SP was moved from the OR to the post anesthesia care unit (PACU). At 12:15 PM, the SP was successfully recovered from the procedure and both the surgeon and the anesthesiologist cleared the SP to go home. The medical record revealed a nurse’s note by the pr e-operative nurse on 09/14/12 at 10:30 AM that documented a conversation between the pre-operative nurse and the SP’s mother where the mother stated she was leaving to run an errand involving an older sibling and left a cellular telephone number.The only documented instruction from the mother was for the nurse to call if the SP got out of surgery sooner than expected. In an interview with the PACU nurse conducted on 09/15/12 at 10:00 AM, the PACU nurse stated that on 09/14/12 at approximately 12:30 PM, the patient was released for home to her father, who was identified by his driver’s license; the PACU nurse stated that she provided written instructions for the patient’s post-operative care and follow up appointment to the father.The PACU nurse stated that the patient’s father verbalized understanding of the discharge instructions and left with the patient. The medical record lacked documentation of this encounter. The medical record also lacked documenta tion of any restrictions as to which parent was permitted to take the patient home. The patient’s mother arrived at the hospital on 09/14/12 at approximately 1:00 PM to take the patient home and was extremely distraught when she discovered her daughter was not in the PACU as she expected.There was a shift change at 1:00 PM and the oncoming nurses did not know that the patient was released to her father. As a result, security was called and a hospital-wide child abduction alert (code pink) was activated. In addition to hospital security, local law enforcement was also notified of the missing child. The SP’s mother told the hospital security officer that she and the SP’s father were divorced and she had full custody of the SP and the SP’s siblings. On 09/14/12 at approximately 1:30 PM, the SP was located at the father’s residence, in the care of the father.The SP’s father stated that he took the SP to his residence to wait for the SP’s mother to arrive. No charges were filed against the SP’s father. The hospital management and security personnel assured the SP’s mother that this incident would be investigated and processes would be put in place to prevent it from happening in the future. A2. Personnel There were several employees who had interactions with the SP and her mother during the outpatient hospital procedure. The first person was the hospital registrar who took the SP’s demographic information from the SP’s mother.The next person was the pre-operative nurse who took obtained the SP’s clinical information and medical history from the SP’s mother, performed the initial physical assessment (height, weight, vital signs, cardio-pulmonary, and head to toe), and obtained peripheral intravenous access. The people who then interacted with the SP were the surgeon, the anesthesiologist, and the operating room nurses. The surgeon also had an office visit with the SP and her m other in the days leading up to the surgery. The OR nurse took over care when the SP was moved from the pre-operative area to the OR.The OR nurse made the SP comfortable until she was under the anesthesia and began the recovery process after the surgery was completed. The next person who interacted with the SP was the post anesthesia care unit (PACU) nurse. The PACU nurse was responsible for monitoring the SP during the recovery phase when she was coming out from under the anesthesia. During the post anesthesia phase, the surgeon and the SP assessed and evaluated the SP. Both the surgeon and the anesthesiologist had to sign the papers to release the patient to the discharge nurse. Finally, the patient was transferred to the care of the discharge nurse.The discharge nurse released the SP to her father. After the SP’s mother came back to the hospital and reported the SP was missing, the Chief Nursing Officer (CNO) was immediately involved. The CNO met with the SP’s mothe r and alerted the security team and local police to the disappearance of the child. The local police were able to locate the SP at her father’s house approximately 30 minutes after she was reported missing. The CNO had the responsibility to the SP’s mother to launch the investigation into the cause of her disappearance and to implement a plan of correction so the incident could be prevented in the future. A3.Personnel Issues Several factors negatively affected the coordination of patient care by the employees on 09/14/12. First, the communication between the admission personnel and the SP’s mother was ineffective when the registrar failed to obtain privacy information and/or ask about any custody situation. Second, the pre-operative nurse did obtain the custody information and the mother’s cellular telephone number and documented these on her clip board. However, the pre-operative nurse failed to report this as important information to the operating room nurse upon transfer of the SP from the pre-operative area to the operating room.As a result, the operating room nurse did not alert the PACU nurse to this important information upon transfer of the SP from the OR to the PACU area. The hospital failed to have hand off policies and procedures in place when a patient was moved from one area of surgery to another. They depended solely on their electronic record and did not have any reporting requirements in place when a patient was moved from the admission to pre-operative to operative to post-operative areas. There was a cultural/language barrier between the PACU nurse and the Hispanic discharge nurse making verbal communication very difficult.Other factors of poor communication were staffing ratios and the perspectives and attitudes of the staff. In interviews conducted with the registrar, the pre-operative nurse, the PACU nurse, and the discharge nurse after the sentinel event, they all had a negative, finger pointing attitude of doi ng the minimum to get by and not taking responsibility for the sentinel event. There was also a cumulative feeling among the staff of fear of reprimand or of being ignored in expressing thoughts about the security of pediatric patients in the surgery area, â€Å"Organizational structure has a direct impact n the communication within an organization. The way the hierarchy of an organization is designed either invites feedback, open-mindedness and effective communication or stifles, controls and restricts the ability of subordinates to freely express thoughts, feelings and ideas (Papa 2012). † In the post sentinel event interview, the pre-operative nurse expressed an idea about matching hospital wrist bands for both the child and the parent. This was a good idea, but no system for matching wrist bands was in place.The pre-operative and post-operative areas were understaffed that day making communication among the nurses hurried and ineffective, ultimately creating gaps in commu nication and contributing to the sentinel event. The fact that the surgical area was so short staffed left very little time for the nurses to give hand off reports. As a result, many important details were overlooked. The CNO failed to ensure that the required monthly staffing meetings were held among the surgical team members.Finally, the security personnel were not even called for several minutes after the SP was reported as missing and the security manager failed to perform the â€Å"code pink† child abduction drills on a quarterly basis as required by the hospital’s policy. A3a. Improve Interactions The initiative to improve interactions among the personnel working on 09/14/12 included a new policy implemented on 10/01/12 regarding obtaining custody information and privacy information at the point of registration for any minor child whether it is in the emergency room, inpatient, or outpatient areas of the hospital.This policy included a stipulation that three thin gs are established: a list of people who are permitted private information, a list of people who are permitted to take the patient out of the hospital, and a four digit pin number established by the parent. Information and/or the patient themselves will only be released strictly to a person who is both on the privacy list and who have the pin number. A policy and procedure was also implemented on 10/01/12 in the outpatient surgery area which included detailed procedures for patient hand off when the patient was moved from one area to the next.A new patient hand off form was created which included basic demographic data, medical history, allergies, medication profile, the privacy list, pin number, and any other pertinent custody information for minor children. The registrar must document that both a verbal report and the written report were given to the pre-operative nurse. The pre-operative nurse must then document this same information was relayed both verbally and in writing to th e OR nurse and the OR nurse is also required to document this same information was relayed both verbally and in writing to the PACU nurse.The hand off forms must be signed by both the person reporting off and the person receiving the report and filed in the patient’s paper chart or scanned into the patient’s electronic medical record. A mandatory in-service meeting for all staff was held on 09/28/12 to teach the staff the new policy and procedures. Also, the required monthly staff meetings for the entire surgical team (including physicians) will be implemented to serve as a town hall approach discussion to get any complaints or suggestions by the staff out in the open.In addition to the monthly staff meeting, there will be required in-service education for the staff for the next twelve months including patient safety, child abduction prevention, improvisational workshops to prompt discussion among staff, patient hand-off, time out before discharge, patient rights, dive rsity training, verbal communication, nonverbal communication, shift change reporting, patient satisfaction, and patient education. A4. Quality Improvement The identification and data gathering quality improvement method was used in the root cause analysis of the sentinel event.First the problem was identified; the processes needing improvement were pediatric safety and staff communication. These processes were identified through the post sentinel event interviews of the staff, administrative staff post sentinel event huddles, and surgery staff post sentinel event huddle (including security staff). The data was gathered from the SP’s medical records and a timeline was created starting when the SP entered the hospital and ending when the SP left the hospital with her father. This timeline included an analysis of what was actually done by each employee and also what should have been done to prevent the sentinel event.The question of why was asked when inactions were determined to be what resulted in the sentinel event. Along with the SP’s medical record, all other medical records for minor children who received outpatient surgery at the hospital during the first two weeks in September were also analyzed to determine that the inactions on the part of the outpatient surgery staff were a systemic problem and that this was not an isolated case. Staffing ratio policies were reviewed and security policies on â€Å"code pink† drills were also reviewed.Staff meetings were held weekly where feedback was provided to staff during the root cause analysis process regarding performance indicators and benchmarking against other hospitals of similar size in the areas of patient hand offs, staff to patient ratios and performance of security drills including child abduction drills. After the data was gathered, all involved in the sentinel event were gathered and a list of causes of the sentinel event was created. This list was used in creating the recommendat ions to improve staff communication and creating the process change to ensure that the sentinel even does not recur.B1. Risk Management Program The process of obtaining custody information and privacy information at the point of registration for any minor child, in all areas of the hospital, will be managed and directed by the head Quality Improvement Officer of the hospital. The new policy also has a requirement to prevent the sentinel event from happening again; at the point of registration any minor child under the age of 18 will have a bar-coded band put on their wrist or if they are less than four years old, on their ankle.The parent(s) or legal guardian(s) will be required to wear a wrist band with a matching bar code. Before the child is discharged home, both wrist bands will be scanned with the computer bar code scanner to ensure the wrist bands match. Only the parent(s) or guardian(s) with proof of legal custody will have the wrist band. Additionally, at the point of regist ration, the parent(s) or guardian(s) will be asked to choose a four digit pin number which will be noted in the electronic medical record under the security tab.At the point of discharge, the parent(s) or guardian(s) will be required to give the four digit pin number before the child is released to them for discharge. These measures are to be implemented by 10/05/12 with 100% compliance expected by 10/12/12. Starting on 10/05/12, the Quality Improvement Officer will audit 25% of all admission paperwork on a weekly basis to ensure compliance with the new policy. The Quality Improvement Officer will keep a log of this audit process and the outcomes of the audits. If a registrar is found to be out of compliance with the requirement, disciplinary action will occur.Starting 10/05/12, the Nurse Manager of the outpatient surgery area is required to audit 25% of the outpatient medical records on a weekly basis for compliance with the new patient hand off policy and procedure which applies t o adult and minor child patients. She will also keep a log of this audit process and the outcomes of the audits. The Quality Improvement Officer and the Nurse Manager of the outpatient surgery area will hold bi-weekly meetings with the heads of each department in the hospital to review the audit results and to obtain feedback from each department regarding the new policies and procedures.The Nurse Manager of the outpatient surgery area will hold bi-weekly meetings with the outpatient surgery staff to review the audit results and to obtain feedback on the new admission process for minor children and the new patient hand off process for all patients. Starting 10/01/12, the Nurse Manager of the outpatient surgery area will also be responsible for closely monitoring the daily staffing ratios and ensuring that adequate staff is working during each shift.Also starting 10/01/12, the head of the security department will be responsible for performing the â€Å"code pink† drills monthl y and documenting these in the security log book. New security cameras will also be installed in the outpatient surgery area, at all exit doors, by 10/12/12. B1a. Resources The resources needed to support the changes to prevent the sentinel event from recurring are the medical staff, corporate compliance staff, administrative staff, human resources, and outside compliance consultants.The legal team was immediately involved in the sentinel event to minimize the risk involved in an event such as child abduction. The finance department will provide the financial resources to purchase the new bar coded band system and the new security cameras. The staff will need to be trained on the new policies and procedures by the education department. Also, it is essential that each shift and each department have an adequate staffing ratio which is the responsibility of the hospital administration and the CNO.Human resources, administration, and the CNO were involved in interviewing and counseling the staff involved in the sentinel event. They will have an ongoing responsibility to follow up with the staff to ensure compliance with the new policies and procedures. Outside compliance consultants were also utilized in completing the root cause analysis, creation of the plan of correction, and implementing the plan of correction. C. Sources Papa, J. (2012, May 9). General format. Retrieved from http://www. ehow. com/about_6071356_communication-organizational-structure. html

Media Fragmentations Effects on Democracy - 2121 Words

Media Fragmentation’s Effect on Democracy The emergence of new media and the rise of different forms of media outlets have greatly changed global media, providing audiences with multiple novel options for news consumption. This extremely high choice environment undoubtedly has some major implications with respect to politically charged news. Before the advent of radio, cable news channels, and most recently, the Internet, local newspapers and evening news broadcasts served as the primary outlets for political news. Moreover, the dynamics of how audiences consume -and now, even produce- media are changing, in addition to the ways in which media industries define their audiences. New media technologies at the heart of all of these changes such as print, broadcast television, cable news and even the internet give audiences increased control and increased choice over when, where, and how they consume mass media that is slowly transforming the relationship between audiences and the media. Concurrently, new technologies for measu ring and monitoring audience behavior are revealing aspects of how and why audiences consume different forms of media that previously were unknown. As a result, there is a commonality to the news people consume regardless of their geographic location, issue positions, or ideological stance. It is clear that there are many more choices for media consumers to interact with in the present. Moreover, this drastic shift made more visible when one views