Patientensicherheit: Welchen Beitrag können Patienten leisten?

Predictors of nurses’ response to informal carers’ interventions in medication safety and their collaboration with nurse colleagues and physicians: a cross-sectional factorial survey from Switzerland / Prädiktoren der Reaktion von Pflegefachpersonen auf Interventionen von betreuenden Angehörigen zur Medikationssicherheit und ihre Zusammenarbeit mit pflegerischem und ärztlichem Personal: eine faktorielle Querschnittstudie aus der Schweiz

Background

Informal carers contribute significantly to healthcare delivery in Switzerland. Many of them are experienced in everyday practice and perform medication management procedures. Medication is a vital topic in patient safety; however, there is little knowledge about carers’ involvement in the medication process.

Design

As a part of a larger study with a sequential mixed-methods design, this quantitative cross-sectional factorial online survey explored nurses’ responses towards carers’ interventions in medication safety, as well as their collaboration with nurse colleagues and/or physicians.

Method

285 nurses from a chapter of the Swiss Nurses’ Association evaluated case vignettes in which carers approached them regarding (supposed) medication errors at the hospital. The data were analysed by fractional, ordered and multinomial logistic regression models, and robustness was tested by a probit model and an ordinary least squares model.

Results

Nurses were significantly less likely to approve carers’ interventions if the relationship between the carer and the cared-for person was unclear to them, or if approached in an accusatory way. Prior experience in similar situations and higher education had the opposite effect. Higher age of the nurse and regular contact with carers increased collaboration with other nurses and physicians in verifying the carers’ claims.

Conclusion

The results highlight the importance of experience with and communication shaped to carers, emphasising an overarching perspective of the medication process by the nurse, including validating the carers’ claims in intra- and interprofessional collaboration. These competencies cannot be taken for granted. They must be taught and trained, as well as supported by carer-friendly executive management.

[Assessment of the severity of postoperative complications from the patient and doctor perspective]

AIM OF THE STUDY

This study compares doctors' and patients' assessments of the severity of postoperative complications reported by patients. Within the context of quality assurance and patient safety, the study aims to contribute to developing instruments to include patients' views for measuring postoperative complications.

METHODS

In a questionnaire development study 474 patients who had undergone different kinds of surgery were given a questionnaire and asked whether postoperative complications occurred, and if so, to describe these complications in free text and assesses their severity as "slight, temporary" or "extensive". In an additional study, the patients' written descriptions of their complications were presented independently to two doctors (general practitioner [GP], orthopaedic surgeon) who were asked to assess the severity from their point of view. The physicians were not aware of the patients' or the other physician's assessments.

RESULTS

23.5 % of the patients participating in the survey reported postoperative complications in the questionnaire. Feedback from 80 of these patients included sufficient information for data analysis concerning the study's aim, including the description of their complication in free text. 47 (58.7 %) of these patients assessed their postoperative complications as being "slight, temporary", 33 (41.3 %) as being "extensive". The doctors, on the other hand, assessed the severity of the complications described by the patients much less often as "extensive" (GP: 20.0 %, orthopaedic surgeon: 11.3 %). In only 4 (12.0 %) of the 33 cases where the patient chose "extensive" both doctors also chose the assessment item "extensive". In 10 cases (30.3 %), one doctor's "extensive" assessment matched the patient's assessment, and in 19 cases (57.6 %) the patients but none of the doctors assessed the complications as being "extensive". There was a higher correlation between the GP's and the patients' assessments than between the orthopaedic surgeon's and the patients' ratings. Examples of patients' descriptions of their postoperative complications in free text as well as the corresponding assessments of patients and doctors are presented.

CONCLUSIONS

Patients' views and assessments of postoperative complications are different from doctors' views. Adequate instruments for measuring the occurrence and severity of postoperative complications should be developed bringing the patients' perspectives into the doctors' assessments. Also, it might be useful to include questions addressing information received pre- and postoperatively about the expected postoperative course as well as communication with patients in the case of complications.

[Errors and complications associated with lower limb amputation]

BACKGROUND

The newly launched "German law of patients' rights" strenghthens the rights of patients and places special emphasis on the right to full information. This includes information on errors, mistakes and complications due to surgery.

ASSESSMENT

Surgery complications and mistakes are of main importance especially in the area of amputation because rehabilitation chances are dependent on good surgical quality. Therefore, it is necessary that surgeons know about these problems. Complications may be hematomas, bleeding, dysvascular problems, skin- or muscle-necrosis, and infections and wound healing problems, as well as neuromas or calcification of soft tissues. They are not totally preventable.

CONSEQUENCES

Surgical mistakes may involve insufficient shaping of the bony stump end, incorrect treatment of soft tissue, wrong decisions regarding the amputation level, insufficient treatment of nerves and wound closure under tension of soft tissue. All surgical mistakes negatively influence the end-bearing capability of the stump and, therefore, the prosthetic fit, and with this reduce rehabilitation chances.

PURPOSE

It is necessary that surgeons know about these problems in order to avoid them. Therefore the typical complications and errors are demonstrated with case reports.