Circulating CTRP1 in Adults with Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Reducing the risk of patient harm during anesthesia medication administration in perioperative settings has been a long-term goal in patient safety. Medication safety incidents – such as delivering the wrong drug, dose, concentration, route or mislabeling – remain relatively common (). Individual errors, which may lead to harm in certain contexts, occur in the administration of as many as one in twenty perioperative medications, with around 80 % considered preventable (). A variety of interventions have been suggested (), mostly concerned with tools and technology (e.g., barcode scanners, clinical decision support, smart infusion pumps), standardization (of labels, concentrations, medication storage and prefilled syringes), and better communication and teamwork (to improve situational awareness, coordination, and cross-checking) (; ). However, few interventions have had widespread success in reducing medication harm (; ), and only one randomized controlled interventional trial has been performed (). A more sophisticated, comprehensive understanding of medication delivery systems may offer insights into successful intervention and implementation approaches. Systems engineering analysis techniques can offer new ways to understand the perioperative drug delivery process, leading to new approaches to intervention (). Both Failure Modes Effects Analysis (FMEA) () and Systems-Theoretic Process Analysis (STPA) () have been applied to medication delivery before. While FMEA can be useful when exploring individual component failures in known, linear, engineered systems (), or interactions between a device and human (), it may not effectively account for adaptations, local individual variation, or non-linear effects in broader systems. A prior STPA analysis recommended double checks at the frontline, formalized communication channels when making management decisions for patient care, and changes to supplies and room design at the leadership level (). Rather than focusing on errors or harm events alone, a rich an nuanced perspective can also be developed by exploring more generally how systems-of-work function to successfully every day achieve their goals. The Systems Engineering Initiative for Patient Safety (SEIPS) model (, ; ), has become one of the most well used models for healthcare systems safety but has yet to be applied to the perioperative medication delivery process. Conceptually, it represents the interconnectedness of and interactions between the people, tools and technology, tasks, and environment within a healthcare system (, ; ). It has supported successful intervention design and implementation, most notably in outpatient surgery, cardiac surgical care, intensive care units and nursing homes (; ). The recent publication of the SEIPS 101 tools () developed seven simple tools that offer a relatively straightforward approach to mapping clinical systems. SEIPS 101’s People, Environment, Tools and Tasks (PETT) Scan models the various facilitators and barriers. The People Map explores the range of relevant individuals involved. The Task x Tools Matrix depicts the various jobs and equipment used. The Journey Map describes the general path of the patient. The Anesthesia Work System Interactions Map identifies the interactions necessary. The Outcome Matrix describes the various stakeholder experiences and outcomes.