Introduction: Documentation of patient care in medical record formats is always emphasized. These documents are used as a means to go on treating the patients, staff in their own defense, assessment, care, any legal proceedings and medical science education. Therefore, in this study, each of the data elements available in patients' records are important and filling them indicates the importance put by the documenting teams, so it has been dealt with the documentation the patient records in the hospitals of Mazandaran province. Method: This cross-sectional study aimed to review medical records in 16 hospitals of Mazandaran University of Medical Sciences (MazUMS). In order to collection data, a check list was prepared based on the data elements including four forms of the admission, summary, patients' medical history and progress note. The data recording was defined as "Yes" with the value of 1, lack of recording was defined as "No" with the value of 2, and "Not applied" with the value of 0 for the cases in which the mentioned variable medical records are not applied. Results: The overall evaluation of the documentation was considered as 95-100% equal to "good", 75-94% equal to "average" and below -75% equal to "poor". Using the stratified random sample volume formula, 381 cases were reviewed. The data were analyzed by the SPSS version 19 and descriptive statistics. Results: The results showed that %62 of registration and all the four forms were in the "poor" category. There was no big difference in average registration among the hospitals. Among the educational groups Gynecology and Infectious were equal and had the highest average of documentation of %68. In the data categories, the highest documentation average belonged to the verification, %91. Conclusion: According to the overall assessment in which the rate of documentation was in the category "week", we should make much more efforts to reach better conditions. Even if a data element is recognized meaningless, unnecessary and repetitive by the in charge of documentation, it should not be neglected and skipped. In order to solve the problems of these types, it is suggested to discuss the medical records forms and elements that seem unnecessary in the related committees.

Introduction:Discharge against medical advice from the hospital is an important issue from point of view of treatment management, health costs as well as the side effects of treatment stop on patients and their accompanying. Therefore, health managers and planners should consider the predisposing factors that change patient’s mind in this regard. Since, there has been no study to carefully assess the rate and causes of self-discharge in this province, so this study is aimed to fill this gap.Methods and Materials:This descriptive and cross-sectional study was carried out in 6 months period, from 23 July 2010 till 20 January 2011 in all public hospitals of Mazandaran province. A form was set out for data collection and those patients willing to self-discharge were asked to participate in the study. Patients’ demographic information was filled using their medical record and by the help of department personnel. Furthermore, the form was completed by parents for patients over 18 year-old or by the help of first-rank relative for those having psychiatric disorders or anybody who wasn’t able to complete the form. In order to identify the causes of self-discharge, 18 variables were determined which were categorized in three general items and five main groups. Data were entered into the SPSS15 and were analyzed using descriptive statistics indices.Results:According to the results, 94441 were discharged from the university hospitals which 7967 patients (8.4 %) of them were self-discharged during the 6 month study period. Regarding admission type, 269 (3.3 %), (54.5 %) were admitted into the hospital by pre-determined appointment and as usual patients, respectively, and the rest were admitted by emergency department. Also, 31.4%(2504) were hospitalized in surgery ward, 63% (5026) in medical ward, 4.6% (374) in intensive care unit (ICU) and the rest were hospitalized in the psychiatric ward. The most important reasons for self-discharge were related to: 1-factors affecting patient illness (54.3%), 2-environmental issues as well as patients’ accompanying (37.6%) and 3-managerial and medical reasons(7.9%), respectively.Conclusion:Our study showed the same results for Discharge against medical advice rate as the others. From the view point of treatment management, its causes should be considered and practices should be done to improve the conditions. Meanwhile, the current self-discharge form doesn’t reflect the causes of the problem and it should be revised.

Introduction:Since children neither comprehended nor contribute to the decision, discharge against medical advice is a challenge of health care systems in the world. Therefore, the current study was designed to determine the rate and causes of discharge against medical advice.Methods:This descriptive cross-sectional study was done by reviewing the medical records by census method. Data was analyzed using SPSS software and x2 statistics was used to determine the relationship between variables. The value of P<0.05 was considered significant.Results:Rate of discharged against medical advice was 108 (2.2%). Mean of age and length of stay were 2.8±4 (SD).3 years old and 3.7±5.4 (SD) days, respectively. Totally, 95 patients (88.7%) had health insurance and 65 (60.2%) patients lived in urban areas. History of psychiatric disease and addiction in 22 (20.6%) of the parents were negative. In addition, 100 (92.3%) patients admitted for medical treatment and the others for surgery. The relationship of the signatory with patients (72.3%) was father. Of 108 patients discharged against medical advice, 20 (12%) were readmitted. The relationship between the day of discharge and discharge against medical advice was significant (ρ =0/03).Conclusion:Rate of discharge against medical advice in Boo-ali hospital is the same as the other studies in the same range. The form which is used for this purpose did not have suitable data elements about description of consequence of such discharge, and it has not shown the real causes of discharge against medical advice.

Introduction:Every year million people have poisoning. Most of them will duo to severity of complications. Identifying the pattern of poisoning will help to prevent of them. Because of the non-medicine substance have a wide variety range and easily is used among people, so the aim of this study was to determine frequency of non-medicinal poisoning according to 10th revision of International Classification of Diseases (ICD-10) in hospitalized patient.Method:This is a descriptive cross section study. The medical records of inpatient hospitalized in hospitals of Mazandaran University of Medical Sciences during 2010-2011 were reviewed. The ICD-10 codes for retrieval patient records were T51-T65 which was included alcohol, organic solvent, halogen derivatives, corrosive substance, detergent, metals, inorganic substance, carbon monoxide, gases, fumes and vapors, pesticide, noxious substance has eaten as seafood, noxious substance has eaten as food, unspecified substances. The data were analyzed with SPSS and descriptive and X2 statistics.Results:Of the 1546 in patient with diagnosed poisoning, the 581(37.5%) were non medicine poisoning. Median of age 29±17 years, 231(51.6%) female, 300(51.6%) are intentional, and the most material were insecticide276 (47.5%), sting 96(16.3%) and alcohol 76(13%) and organic solvent 40 cases and the 38(95%) of them was children.Conclusion:According the result of this study the most cause of poisoning was insecticides. Preventive program for all the groups are suggested and for intentional self-harms and suicide attempted the program of consultation is necessary.

Introduction:Absconding from a psychiatric ward (leaving without permission) is a costly event in many ways.Objectives:Some risks of absconding include missed treatment which results in longer rehabilitation time or lack of treatment altogether.Aim:To investigate the motivation and characteristics of patients absconding from a psychiatric ward in Iran.Methods:A prospective study was conducted for patients who absconded from psychiatric ward in the period between July 2010 and July 2011. The variables were patients’ age, gender, hospital stay, substance abuse, psychiatric diagnosis and site of absconding. All patients were interviewed to assess their motivation for absconding.Results:Over a one-year period of data collection 56 absconding events were recorded, with the incidence rate of 4.24%. The mean age of absconders was 31+8.4 years, 47 (83.9%) absconders were males, 28 (50.9%) absconds happened through the park fence.Bipolar mood disorder or schizophrenia was the diagnosis of 23 (41%) absconders. The mean number of days of hospitalization in patients who left the wards was 11 days. The main motivation to abscond was boredom from the ward environment and missing the family.Conclusion:The risk of absconding is highest in the early days of admission especially in male, young patients with diagnosis of bipolar mood disorder or schizophrenia.