Background: Advanced medical technologies (AMTs), such as respiratory support or suction devices, are increasingly used in home settings and incidents may well result in patient harm. Information about risks and incidents can contribute to improved patient safety, provided that those are reported and analysed systematically. Objectives: To identify the frequency of incidents when using AMTs in home settings, the effects on patient outcomes and the actions taken by nurses following identification of incidents. Methods: A cross-sectional study of 209 home care nurses in the Netherlands working with infusion therapy, parenteral nutrition or morphine pumps, combining data from a questionnaire and registration forms covering more than 13 000 patient contacts. Descriptive statistics were used. Results: We identified 140 incidents (57 adverse events; 83 near misses). The frequencies in relation to the number of patient contacts were 2.7% for infusion therapy, 1.3% for parenteral nutrition and 2.6% for morphine pumps. The main causes were identified as related to the product (43.6%), the organisation of care (27.9%), the nurse as a user (15.7%) and the environment (12.9%). 40% of all adverse events resulted in mild to severe harm to the patient. Incidents had been discussed in the team (70.7%), with the patient/informal caregiver(s) (50%), or other actions had been taken (40.5%). 15.5% of incidents had been formally reported according to the organisation's protocol. Conclusions: Most incidents are attributed to product failures. Although such events predominantly cause no harm, a significant proportion of patients do suffer some degree of harm. There is considerable underreporting of incidents with AMTs in home care. This study has identified a discrepancy in quality circles: learning takes place at the team level rather than at the organisational level.
This paper describes a concept where products are equipped with agents that will assist in recycling and repairing the product. These so-called product agents represent the product in cyberspace and are capable to negotiate with other products in case of recycling or repair. Some product agents of broken products will offer spare parts, other agents will look for spare parts to repair a broken product. On the average this will enlarge the lifetime of a product and in some cases prevent wasting resources. Apart from reuse of spare parts these agents will also help to locate rare elements in a device, so these elements can be recycled more easily.
Author supplied: The production system described in this paper in an implementation of an agile agent-based production system. This system is designed to meet the requirements of modern production, where short time to market, requirementdriven production and low cost small quantity production are important issues. The production is done on special devices called equiplets. A grid of these equiplets connected by a fast network is capable of producing a variety of different products in parallel. The multi-agent-based software infrastructure is responsible for the agile manufacturing. A product agent is responsible for the production of a single product and equiplet agents will perform the production steps to assemble the product. This paper describes this multiagent-based production system with the focus on the product agent. Presented at EUMAS 2013 ( 11th European Workshop on Multi-Agent Systems) , At Toulouse.
