Do safety briefings improve patient safety in the acute hospital setting? A systematic review

Enhancing security in patient medical information exchange: A qualitative study

BACKGROUND

The digital transition has changed the practice of exchanging patient medical information between health professionals. Challenges include the involvement of multiple professionals with varying communication styles, the exponential growth of diverse data types, interoperability issues due to non-integrated tools, and heightened security risks stemming from the use of unsecured applications and personal devices. Here, we aimed to understand how to help health surgeons to better consider security during data exchange.

METHODS

We conducted a qualitative research with 20 interviews with surgeons working in wards of several French institutions. The verbatims were analyzed manually by two researchers using an iterative thematic approach, resulting in a framework to improve practitioners' security awareness.

RESULTS

Our findings emphasize the necessity of a multifaceted strategy, as a single secure application is not sufficient. Effective solutions require combining tailored digital tools with educational initiatives and institutional support. The proposed application must meet specific requirements; and simultaneously, hospitals must provide clear regulations, financial investment, and continuous support to reduce professional constraints.

CONCLUSION

This study underscores the need for a holistic approach, spanning education, institutional backing, and advanced technology, to enhance data security in healthcare. Future studies could extend our framework by considering other healthcare settings and patient perspectives.

The Effect of Toolbox Trainings on Nursing Sensitive Quality Indicators: A Randomized Controlled Trial

INTRODUCTION

Toolbox training or toolbox talks is short-term training to improve occupational health and safety practices in various sectors. These on-the-job trainings provide employees with opportunities to ask questions and share experiences, facilitating the enhancement of workplace safety practices. The aim of this study is to determine the impact of toolbox trainings provided to nurses on nursing-sensitive quality indicators (pain management, pressure ulcer, patient falls, peripheral venous catheter complications, and adverse event reporting) in the workplace.

DESIGN

Randomized controlled, pre-test, post-test, and control group design.

METHODS

Before the toolbox training, pretest measurement instruments were used for the nurses in both the experimental and control groups, and the nursing-sensitive quality indicators were monitored by two independent observers. Toolbox training was provided to nurses in the intervention group on their shift in the respective units. Both groups were followed up at the 8th and 12th weeks after the training. Descriptive tests, independent sample t-tests for intergroup comparisons, and repeated and mixed ANOVA for intragroup comparisons were utilized in data analysis.

RESULTS

Significant differences were found between pre-test and post-test scores of the nurses in the group who received toolbox training in terms of falls, pressure ulcers, pain management, peripheral venous catheter, and adverse event reporting (p < 0.01). It was observed that the application scores significantly differed among all nurses who received toolbox training according to the findings of both observers, generally increasing in the second follow-up compared to the first, but decreasing in the third follow-up (p < 0.05). Evaluated according to unit quality indicators, it was determined that the number of patient falls (mean 4.04, 2.32, and 1.95 respectively), pressure ulcer occurrences (mean 4.48, 2.69, and 2.45 respectively), and the number of patients experiencing peripheral venous catheter complications decreased (mean 26.79, 16.46, and 15.42 respectively) in the units where nurses who received toolbox training worked. The average number of correctly managed pain patients (mean 37.82, 71.61, 69.07 respectively) and the number of reported adverse events (mean 2.79, 6.60, 6.42 respectively) were observed to increase in the second follow-up but decrease in the third follow-up.

CONCLUSIONS

As a result, it was determined that on-the-job trainings increased nurses' knowledge level regarding nursing-sensitive quality indicators, improved their practices, and enhanced unit quality indicators. According to the findings of this study, on-the-job trainings provided to nurses were found to be an effective method, and it is recommended to use them in addition to traditional training methods in nurses' in-service education.

CLINICAL RELEVANCE

There is a growing demand for shorter and different training methods in nurses' education. In addition to classical in-service training methods, this training method, which was applied for the first time in the field of nursing, contributed to the improvement of quality indicators sensitive to nursing. Our findings emphasize that it will be useful to use this training method in future studies on improving and developing nursing-sensitive quality indicators.

TRAIL REGISTRATION

The study has been registered with ClinicalTrials.gov (NCT05853588).

Learning from patient safety incidents: The Green Cross method

BACKGROUND

Hospitals can improve how they learn from patient safety incidents. The Green Cross method, a proactive reporting and learning method, is one strategy to meet this challenge. In it, nurses play a key role. However, describing its impact on learning from the users' perspective is important.

AIM

This study aimed to describe nurses' experiences of learning from patient safety incidents before and 3 months after implementing the Green Cross method in a postanaesthesia care unit.

STUDY DESIGN

A qualitative study with an inductive descriptive design with focus group interviews was conducted before and 3 months after implementing the Green Cross method to assess its impact. The data were analysed using qualitative content analysis. The study was conducted in a postanaesthesia care unit in a Norwegian hospital trust.

RESULTS

Before implementing the Green Cross method, participants indicated limited openness and learning, including the subcategories 'Lack of openness hampers learning', 'Adverse events were taken seriously' and 'Insufficient visible improvements'. After implementing the Green Cross method, participants indicated the emergence of a learning environment, including the subcategories 'Transparency increases learning', 'Increased patient safety awareness' and 'Committed to quality improvements'.

CONCLUSIONS

Implementing the Green Cross method in a postanaesthesia care unit positively impacted openness and nurses' patient safety awareness, which is crucial for learning and improving quality.

RELEVANCE TO CLINICAL PRACTICE

The Green Cross method could be useful for organizational learning and facilitating learning from patient safety incidents through transparency, discussion and involvement of nursing staff.

Effect of the Green Cross method on patient safety culture in a postanaesthesia care unit: a longitudinal quasi-experimental study

BACKGROUND

Hospitals should adopt multiple methods to monitor incidents for a comprehensive review of the types of incidents that occur. Contrary to traditional incident reporting systems, the Green Cross (GC) method is a simple visual method to recognise incidents based on teamwork and safety briefings. Its longitudinal effect on patient safety culture has not been previously assessed. This study aimed to explore whether the implementation of the GC method in a postanaesthesia care unit changed nurses' perceptions of different factors associated with patient safety culture over 4 years.

METHODS

A longitudinal quasi-experimental pre-post intervention design with a comparison group was used. The intervention unit and the comparison group, which consisted of nurses, were recruited from the surgical department of a Norwegian university hospital. The intervention unit implemented the GC method in February 2019. Both groups responded to the staff survey before and then annually between 2019 and 2022 on the factors 'work engagement', 'teamwork climate' and 'safety climate'. The data were analysed using logistic regression models.

RESULTS

Within the intervention unit, relative to the changes in the comparison group, the results indicated significant large positive changes in all factor scores in 2019, no changes in 2020, significant large positive changes in 'work engagement' and 'safety climate' scores in 2021 and a significant medium positive change in 'work engagement' in 2022. At baseline, the comparison group had a significantly lower score in 'safety climate' than the intervention unit, but no significant baseline differences were found between the groups regarding 'work engagement' and 'teamwork climate'.

CONCLUSION

The results suggest that the GC method had a positive effect on the nurses' perception of factors associated with patient safety culture over a period of 4 years. The positive effect was completely sustained in 'work engagement' but was somewhat less persistent in 'teamwork climate' and 'safety climate'.

Stop the Line: Interventions to Prevent Retained Surgical Items

The surgical team works collaboratively to prevent the occurrence of retained surgical items (RSIs). The purpose of this quality improvement project was to increase compliance with facility policies and improve teamwork skills to prevent the occurrence of RSIs. The project team implemented an evidence-based communication protocol, updated hospital network policies, introduced just-in-time job aids, and facilitated leader support through a daily huddle to address identified practice gaps. The TeamSTEPPS Teamwork Attitudes Questionnaire was used to measure the change in staff members' attitudes about teamwork before and after project implementation. Additional process and outcome measures included the number of near misses and actual RSIs, compliance with the daily huddle, and completion of the communication training. Results included improved perceived teamwork attitude scores and zero reports of actual RSI events over 7.5 weeks.

Development and Evaluation of a Nurse Practitioner Huddles Toolkit for Long Term Care Homes

Long-term care homes (LTCHs) were disproportionately affected by the coronavirus disease (COVID-19) pandemic, creating stressful circumstances for LTCH employees, residents, and their care partners. Team huddles may improve staff outcomes and enable a supportive climate. Nurse practitioners (NPs) have a multifaceted role in LTCHs, including facilitating implementation of new practices. Informed by a community-based participatory approach to research, this mixed-methods study aimed to develop and evaluate a toolkit for implementing NP-led huddles in an LTCH. The toolkit consists of two sections. Section one describes the huddles' purpose and implementation strategies. Section two contains six scripts to guide huddle discussions. Acceptability of the intervention was evaluated using a quantitative measure (Treatment Acceptability Questionnaire) and through qualitative interviews with huddle participants. Descriptive statistics and manifest content analysis were used to analyse quantitative and qualitative data. The project team rated the toolkit as acceptable. Qualitative findings provided evidence on design quality, limitations, and recommendations for future huddles.

Increasing staff time for patient facing care on an inpatient geriatric unit through modification of multidisciplinary board rounds: a quality improvement project

BACKGROUND

NHS staff recruitment and retention have failed to keep pace with service demands and workforce burn-out is of significant concern. This quality improvement project (QIP) aimed to increase staff time for patient facing care through reducing duplication of hospital board rounds within a 36-bedded NHS inpatient geriatric ward.

INTERVENTION

Thirty-minute board rounds were reduced from twice daily (Monday-Friday) at 08:30 hours and midday to once daily at midday with the aim of freeing up staff time for patient care. A multidisciplinary team (MDT) safety briefing at 08:30 hours lasting 5-10 min was implemented to enable review of shift pressures and identification of patients who are unwell, newly admitted or due for discharge. Safety briefing format was amended to further support staff prioritisation.

METHODS

This QIP was underpinned by the model for improvement, using Plan-Do-Study-Act cycles. Data were collected through a staff questionnaire alongside calculation of staff time spent at board rounds and safety huddles. Staff verbal feedback and questionnaire results were also used to improve and modify process'. Patient discharge data were collated via trust metrics as a balancing measure.

RESULTS

Through board round modification, 25 hours of MDT time was saved each week, with all responding staff reporting increased time for patient facing care following QIP implementation. >85% of questionnaire respondents agreed that board round changes resulted in improvement. Balancing measures collected as part of the project also revealed an increase in weekly ward discharges from an average of 15.75-17.5 confirming no negative impact on patient flow following board round amendments.

CONCLUSION

While significant staffing shortages continue, local innovations focused on staff time may have the potential to support effective use of limited resources.

Daily huddle best practice: An Evidence-Based guide

BACKGROUND

Daily huddles positively influence staff satisfaction and perception; standardization of a daily huddle should be prioritized to benefit from its effects.

AIM

The aim of this project initiative was to implement an evidence-based, standardized daily huddle on an inpatient medical-surgical oncology unit.

IMPLEMENTATION PLAN

A searchable question was developed, and the identified literature was critically appraised and synthesized for evidence-based recommendations. The recommendations for the structure and content of a daily huddle were implemented using a standardized format.

OUTCOMES

Pre-implementation and post-implementation staff perception and satisfaction surveys yielded positive results. Improvements in effective communication and staff satisfaction were identified.

IMPLICATIONS FOR PRACTICE

An effective daily huddle is essential for communicating pertinent information that can affect workflows and patient safety, as well as promoting teamwork and staff satisfaction.

[Impact of the "daily huddle" on the safety of pediatric hospitalized patients]

INTRODUCTION

In 2017, the Joint Commission proposed daily meetings called "huddle" as an indicator of quality of care. They are brief daily meetings of the multidisciplinary team, where security problems of the last 24h are shared and risks are anticipated. The objectives were to describe the most frequent safety events in Pediatric wards, implement improvements in patient safety, improve team communication, implement international safety protocols, and measure the satisfaction of the staff involved.

MATERIAL AND METHODS

Prospective, longitudinal and analytical design (June 2020-February 2022), with previous educational intervention. Safety incidents, data related to unequivocal identification, allergy and pain records, data from the Scale for the Early Detection of Deficiencies (SAPI) and the Scale for the Secure Transmission of Information (SBAR) were collected. The degree of satisfaction of the professionals was evaluated.

RESULTS

Three hundred forty-eight security incidents were recorded. Medication prescription or administration errors stood out (n=103). Drug prescription or administration errors stood out (n=103), especially those related to high-risk medication: acetaminophen (n=14) (×10 doses of acetaminophen; n=6), insulin (n=6), potassium (n=5) and morphic (n=5). An improvement was observed in the pain record; 5% versus 80% (P<.01), in the SAPI registry 5% versus 70% (P<.01), in SBAER scale 40% vs 100% (P<.01), in unequivocal identification of the patient 80% versus 100%; (P<.01) and in the application of analgesic techniques 60% versus 85% (P=.01). In the survey of professionals, a degree of satisfaction of 8 (7-9.5)/10 was obtained.

CONCLUSIONS

Huddles made it possible to learn about security events in our environment and increase the safety of hospitalized patients, and improved communication and the relationship of the multidisciplinary team.

Guidelines on human factors in critical situations 2023

OBJECTIVE

To provide guidelines to define the place of human factors in the management of critical situations in anaesthesia and critical care.

DESIGN

A committee of nineteen experts from the SFAR and GFHS learned societies was set up. A policy of declaration of links of interest was applied and respected throughout the guideline-producing process. Likewise, the committee did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based.

METHODS

We aimed to formulate recommendations according to the GRADE® methodology for four different fields: 1/ communication, 2/ organisation, 3/ working environment and 4/ training. Each question was formulated according to the PICO format (Patients, Intervention, Comparison, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology.

RESULTS

The experts' synthesis work and application of the GRADE® method resulted in 21 recommendations. Since the GRADE® method could not be applied in its entirety to all the questions, the guidelines used the SFAR "Recommendations for Professional Practice" A means of secured communication (RPP) format and the recommendations were formulated as expert opinions.

CONCLUSION

Based on strong agreement between experts, we were able to produce 21 recommendations to guide human factors in critical situations.

A Safety Huddle Intervention in In-Patient Surgical Units: A Mixed-Methods Study

Open communication about patient safety concerns is necessary to enable a learning environment where lessons can be learned to improve patient safety, but nurses often hesitate to speak up even in situations where their patients may be at risk. One way to create a safe environment for speaking up is through the use of unit-level daily huddles. This study aimed to assess the effects of a 12-week huddle intervention on nine unit, nurse and patient care outcomes and describe nurses' experiences with the intervention. We used a single group, pre- and post-test mixed-methods design, with a dominant quantitative thread, and a final sample of 89 staff nurses. The intervention was conducted in four surgical units in a tertiary teaching hospital in Seoul, Korea. The intervention included two educational workshops for huddle leaders, two workshops for staff nurses, and 12-week huddles with coaching visits. We collected quantitative data on nine outcomes using online surveys before and after the intervention and qualitative data on nurse experiences of the intervention after the intervention. Paired t-tests were used for quantitative data analysis, and content analysis was used for qualitative data. We examined four unit-level outcomes (organizational learning, situation monitoring, mutual support, and speaking-up climate), three nurse-level outcomes (promotive and prohibitive voice behaviors and job satisfaction), and two patient care outcomes (patient safety and quality of care). Significant improvements were found in six of the nine outcomes. Findings from the qualitative data confirmed the benefits of the intervention but also identified challenges to huddle participation. Patient safety huddles can contribute to a learning environment by flattening hierarchies and encouraging nurses to speak up regarding safety issues. Leadership is a key in role modelling and creating the foundation for a more collaborative patient safety culture in healthcare organizations, for example, through the use of daily huddles.

Assessing the Value of Huddle Implementation in the Perioperative Setting

Communication is essential for safe, effective patient care. In perioperative services, where interdisciplinary teamwork is crucial, communication breakdowns may lead to increased errors, decreased staff member satisfaction, and poor team performance. This process improvement project focused on instituting perioperative huddles for two months and measuring the effect that they had on staff members' satisfaction, engagement, and communication effectiveness. We used validated, Likert-style survey tools to gauge participants' satisfaction, level of engagement, communication practices, and opinions about the value of huddles before and after implementation, in addition to an open-ended descriptive question in the postsurvey. Sixty-one participants completed the presurvey and 24 participants completed the postsurvey. Scores across all categories increased post huddle implementation. Benefits of the huddles noted by participants included timely and consistent messaging, sharing essential information, and increased feelings of connection between perioperative leaders and staff members.

A multidisciplinary safety briefing for acutely ill and deteriorating patients: A quality improvement project

BACKGROUND

Safety briefings can help promoting situational awareness, interprofessional communication and improve patient safety.

LOCAL PROBLEM

A clinical survey highlighted that 90% of the participants including the medical team and the critical care outreach team nurses perceived the meeting for escalating acutely ill and deteriorating patients during the out-of-hours period (20.00 to 08.00) to have unconstructive and unwelcoming atmosphere with belittling, hostility and unhelpful criticisms. The participants reported that the communication across teams lacked in structure and clear information given; but staff also self-reported lacking confidence in communicating key issues.

METHOD

A quality improvement project with Plan-Do-Study-Act was adopted to design and implement a dedicated multidisciplinary safety briefing with a structured format.

RESULTS

The multidisciplinary safety briefing was to 90% of clinicians, and it took a median of 10 min to complete. Delayed referrals to the critical care outreach team were reduced by 46%. Positive changes included increased situational awareness and clearer communication across teams. Barriers identified were variable usage and need for face-to-face presence. Considering all the findings and the time constraint during the SARS-CoV-2 pandemic, we changed to a telephonic safety briefing directly to the team leaders.

CONCLUSION

A structured multidisciplinary safety briefing can improve patient safety and support management of deteriorating and acutely ill patients on the wards during the out-of-hours period.

Falls as the result of interplay between nurses, patient and the environment: Using text-mining to uncover how and why falls happen

Objectives

This study aimed to explore, from the perspectives of nurses, how patients, the environment, and the practice of nurses interact with each other to contribute to patient falls.

Methods

A retrospective review of incident reports on patient falls, registered by nurses between 2016 and 2020, was conducted. The incident reports were retrieved from the database set up for the project of the Japan Council for Quality Health Care. The text descriptions of the "background of falls" were extracted verbatim, and analyzed by using a text-mining approach.

Results

A total of 4,176 incident reports on patient falls were analyzed. Of these falls, 79.0% were unwitnessed by nurses, and 8.7% occurred during direct nursing care. Document clustering identified 16 clusters. Four clusters were related to patients, such as the decline in their physiological/cognitive function, a loss of balance, and their use of hypnotic and psychotropic agents. Three clusters were related to nurses, and these included a lack of situation awareness, reliance on patient families, and insufficient implementation of the nursing process. Six clusters were concerned with patients and nurses, including the unproductive use of a bed alarm and call bells, the use of inappropriate footwear, the problematic use of walking aids and bedrails, and insufficient understanding of patients' activities of daily living. One cluster, chair-related falls, involved both patient and environmental factors. Finally, two clusters involved patient, nurse, and environmental factors, and these falls occurred when patients were bathing/showering or using a bedside commode.

Conclusions

Falls were caused by a dynamic interplay between patients, nurses, and the environment. Since many of the patient factors are difficult to modify in a short time, the focus has to be placed on nursing and environmental factors to reduce falls. In particular, improving nurses' situation awareness is of foremost importance, as it influences their decisions and actions to prevent falls.

Impact of Falls Within 3 Months on the Short-Term Prognoses of Elderly Patients in Intensive Care Units: A Retrospective Cohort Study Using Stabilized Inverse Probability Treatment Weighting

BACKGROUND

Falls are a major public health problem in the older adults that can lead to poor clinical outcomes. There have been few reports on the short-term prognoses of older critically ill patients, and so we sought to determine the impact of falls on elderly patients in intensive care units (ICUs).

PATIENTS AND METHODS

This retrospective study of 4503 patients (aged 65 years or older) analyzed data in the Medical Information Mart for Intensive Care-III critical care database. Of those, 2459 (54.6%) older adults are males, and 2044 (45.4%) older adults are females. Based on information from the medical care record assessment forms, patients were classified into the following two groups based on whether they had a fall within the previous 3 months: falls (n=1142) and nonfalls (n=3361). The primary outcomes of this study were 30- and 90-day mortality. Associations between the results of the Kaplan-Meier (KM) survival analysis, Cox proportional-hazards regression models, and subgroup analysis and its outcomes were analyzed using stabilized inverse probability treatment weighting (IPTW).

RESULTS

KM survival curves with stabilized IPTW indicated that 30- and 90-day survival rates were significantly lower in elderly critically ill patients with a history of falls within the previous 3 months than in those patients without a history of falls (all p<0.001). Multivariate Cox proportional-hazards regression analysis indicated that 30- and 90-day mortality rates were 1.35 times higher (95% confidence interval [CI]=1.16-1.57, p<0.001) and 1.36 times higher (95% CI=1.19-1.55, p<0.001), respectively, in elderly critically ill patients with a history of falls within the previous 3 months than in those patients without a history of falls.

CONCLUSION

Experience of falls within the previous 3 months prior to ICU admission increased the risk of short-term mortality and affected the prognoses of elderly patients. Falls should therefore receive adequate attention from clinical healthcare providers and management decision-makers.

Implementation of the 'PicNic' handover huddle: A quality improvement project to improve the transition of infants between paediatric and neonatal intensive care units

AIMS

Thorough handover and effective communication are crucial to the transfer of clinical information between different intensive care units. Following a sentinel patient safety event, an improvement project was initiated to reduce patient safety risks associated with the transfer of complex patients between the neonatal and paediatric intensive care.

METHODS

A handover tool was implemented over a 4-month period, guiding handover through means of a handover huddle. The tool ensured a full ISBAR (Introduction, Situation, Background, Assessment, Response) handover, with a specified attendance register. It acknowledged specific safety points inclusive of outstanding investigations, procedural history and medication transcription. Post implementation, huddle checklist sheets were audited for compliance and a staff satisfaction survey was conducted.

RESULTS

Thirty-nine handovers took place during this trial period, of which 69% were captured in the huddle process. Senior medical and nursing staff attendance was greater than 95% throughout the process, and 100% of huddles attended to a full ISBAR handover. Sixty staff satisfaction survey responses were received, 90% of which identified the process to improve the safety of patient handover. Responses also identified safety issues such as discontinuity of medication transcription between the units, and inappropriate patient transfers occurring outside of working hours. Qualitative feedback highlighted how the tool improved interdepartmental educational and collaboration opportunities.

CONCLUSIONS

The 'PicNic' huddle effectively facilitated a standardised handover between paediatric and neonatal intensive care. It also recognised the importance of interdepartmental collaboration and education surrounding culturally different clinical practices. Further improvement cycles continue to progress the tool and initiate a digital format for ongoing use.

The Effectiveness of Multidisciplinary Team Huddles in Healthcare Hospital-Based Setting

Objective

Huddles are short, regular debriefings that are designed to provide frontline staff and bedside caregivers environments to share problems and identify solutions. Daily huddle implementation could improve medical safety work, problem identification and improvement, situation awareness and teamwork enhancement, the collaboration and communication between professionals and departments, and patient safety. This study aimed evaluated the effectiveness of a hospital-based huddle at a general medical ward in Taiwan.

Methods

A Continuous Integration team was conducted by combining multidisciplinary frontline staff to huddle at a 74-bed general medical ward. Team Huddles started twice a week. A physical huddle run board was created, which contained four parts, including idea submitted, idea approved, working on an idea and standardizing. Problems were submitted to the board to be identified, and the solutions were evaluated through huddle discussion. We divided the problems into two groups: quick hits (resolved within 24-48hrs) and complex issues (resolved >48hrs). An anonymous questionnaire was designed to evaluate the huddle response.

Results

A total of 44 huddles occurred from September 9th, 2020, to September 30th, 2021, and 81 issues were identified and resolved. The majority issues were policy documentation (n=23; 28.4%). Sixty-seven (82.7%) issues were defined as quick hits, and the other fourteen (17.3%) issues were complex. The mean hours to the resolution of quick hits was 5.17 hours, median 3.5 hours, and range from 0.01-15.4 hours. The mean days to resolve completion issues were 19.73 days, median 7.5 days, and range 3.57-26.14 days. An overwhelming 92.9% of staff responded that huddles help to expedite the process to reach treatment goals, reduce clinical mistakes, near misses, reduce patient incidences, and help teamwork enhancement, with rating of 4.52 (on a 5-point Likert scale).

Conclusion

Implementing of multidisciplinary team huddle improved the accountability of issue identification, problem-solving and teamwork enhancement.

A qualitative exploration of cultural safety in nursing from the perspectives of Advanced Practice Nurses: meaning, barriers, and prospects

BACKGROUND

Cultural safety requires healthcare professionals and organisations to improve healthcare, facilitate patient access to healthcare, and achieve equity within the workforce.

METHODS

This ethnomethodological study, which consisted of two phases, explored the concept of cultural safety from the perspective of Advanced Practice Nurses. Semi-structured interviews and the nominal group technique were used to prioritise challenges related to cultural safety, identify barriers to clinical practise and assess educational needs. The data collected was subjected to thematic analysis.

RESULTS

Nurses working in Austria, Germany and Switzerland were recruited (N = 29). Accordingly, the phenomenon of cultural safety in health care is not generally known and there is little prior knowledge about it. The most frequently discussed themes were communication difficulties, lack of knowledge, the treatment of people with insufficient language skills and expectations of treatment goals and outcomes, which can lead to conflicts and accusations of unequal treatment due to diverse cultural backgrounds.

CONCLUSION

Diverse cultures are encountered in German-speaking healthcare settings. Cultural safety is also about healthcare staff, as nurses with different socialisations encounter prejudice, discrimination and racism. Although the issue of power was not discussed, academic nurses were willing to make an effort to change. Only a minority were aware that lasting change requires challenging one's own cultural structures and adapted behaviours, rather than pushing for the mere acquisition of cultural competence. Organisations were encouraged to introduce self-reflection sessions and provide better access to translation services to improve equity and support nurses.

“Debriefing and Organizational Lessons Learned” (DOLL): A Qualitative Study to Develop a Classification Framework for Reporting Clinical Debriefing Results

Background

The COVID-19 crisis has radically affected our healthcare institutions. Debriefings in clinical settings provide a time for the clinicians to reflect on the successes (pluses) and difficulties (deltas) encountered. Debriefings tend to be well-received if included in the broader management of the unit. The goal of this study was to develop a framework to categorize these debriefings and to assess its worthiness.

Methods

A qualitative approach based on a grounded theory research method was adopted resulting in the “Debriefing and Organizational Lessons Learned” (DOLL) framework. Debriefings were conducted within two Emergency Departments of a Belgian University Hospital during an 8-week period. In the first step, three researchers used debriefing transcripts to inductively develop a tentative framework. During the second step, these three researchers conducted independent categorizations of the debriefings using the developed framework. In step 3, the team analyzed the data to understand the utility of the framework. Chi-square was conducted to examine the associations between the item types (pluses and deltas) and the framework's dimensions.

Results

The DOLL is composed of seven dimensions and 13 subdimensions. Applied to 163 debriefings, the model identified 339 items, including 97 pluses and 242 deltas. Results revealed that there was an association between the frequency of pluses and deltas and the dimensions (p &lt; 0.001). The deltas were mainly related to the work environment (equipment and maintenance) (p &lt; 0.001) while the pluses identified tended to be related to the organization of the unit (communication and roles) (p &lt; 0.001). With leadership's support and subsequent actions, clinicians were more enthusiastic about participating and the researchers anecdotally detected a switch toward a more positive organizational learning approach.

Conclusion

The framework increases the potential value of clinical debriefings because it organizes results into actionable areas. Indeed, leadership found the DOLL to be a useful management tool. Further research is needed to investigate how DOLL may work in non-crisis circumstances and further apply the DOLL into incident reporting and risk management process of the unit.

Monitoring Preventable Adverse Events and Near Misses: Number and Type Identified Differ Depending on Method Used

OBJECTIVES

This study aimed to investigate how many preventable adverse events (PAEs) and near misses are identified through the methods structured record review, Web-based incident reporting (IR), and daily safety briefings, and to distinguish the type of events identified by each method.

METHODS

One year of retrospective data from 2017 were collected from one patient cohort in a 422-bed acute care hospital. Preventable adverse events and near misses were collected from the hospital's existing resources and presented descriptively as number per 1000 patient-days.

RESULTS

The structured record review identified 19.9 PAEs; the IR system, 3.4 PAEs; and daily safety briefings, 5.4 PAEs per 1000 patient-days. The most common PAEs identified by the record review method were drug-related PAEs, pressure ulcers, and hospital-acquired infections. The most common PAEs identified by the IR system and daily safety briefings were fall injury and pressure ulcers, followed by skin/superficial vessel injuries for the IR system and hospital-acquired infections for the daily safety briefings. Incident reporting and daily safety briefings identified 7.8 and 31.9 near misses per 1000 patient-days, respectively. The most common near misses were related to how care is organized.

CONCLUSIONS

The different methods identified different amounts and types of PAEs and near misses. The study supports that health care organizations should adopt multiple methods to get a comprehensive review of the number and type of events occurring in their setting. Daily safety briefings seem to be a particularly suitable method for assessing an organization's inherent security and may foster a nonpunitive culture.

Interventions to reduce falls in hospitals: a systematic review and meta-analysis

BACKGROUND

Falls remain a common and debilitating problem in hospitals worldwide. The aim of this study was to investigate the effects of falls prevention interventions on falls rates and the risk of falling in hospital.

DESIGN

Systematic review and meta-analysis.

PARTICIPANTS

Hospitalised adults.

INTERVENTION

Prevention methods included staff and patient education, environmental modifications, assistive devices, policies and systems, rehabilitation, medication management and management of cognitive impairment. We evaluated single and multi-factorial approaches.

OUTCOME MEASURES

Falls rate ratios (rate ratio: RaR) and falls risk, as defined by the odds of being a faller in the intervention compared to control group (odds ratio: OR).

RESULTS

There were 43 studies that satisfied the systematic review criteria and 23 were included in meta-analyses. There was marked heterogeneity in intervention methods and study designs. The only intervention that yielded a significant result in the meta-analysis was education, with a reduction in falls rates (RaR = 0.70 [0.51-0.96], P = 0.03) and the odds of falling (OR = 0.62 [0.47-0.83], P = 0.001). The patient and staff education studies in the meta-analysis were of high quality on the GRADE tool. Individual trials in the systematic review showed evidence for clinician education, some multi-factorial interventions, select rehabilitation therapies, and systems, with low to moderate risk of bias.

CONCLUSION

Patient and staff education can reduce hospital falls. Multi-factorial interventions had a tendency towards producing a positive impact. Chair alarms, bed alarms, wearable sensors and use of scored risk assessment tools were not associated with significant fall reductions.

Management Actions for Prevention and Control of Healthcare-associated Infections: A Grounded Theory approach

AIM

To understand the management actions for prevention and control of healthcare-associated infections performed by health professionals.

BACKGROUND

Prevention of nosocomial infections has evidence-based practice at its essence, but not all institutions are successful in implementing prevention methodology.

METHODS

Qualitative research with Grounded Theory methodological framework. The research was carried out in two southern Brazilian hospitals. Data collected was employed through open interviews with twenty-one health professionals and managers. This process occurred concurrently with the data analysis, through constant comparative analysis.

RESULTS

The understanding of the co-responsibility of managerial actions emerged as a central phenomenon of the theoretical model. Management actions for the prevention and control of healthcare-associated infections are a collective phenomenon, in which co-responsibility sustains the effectiveness of the offered assistance. The behaviors of health teams in the face of structural and human weaknesses influence the construction of a supportive relationship in the effectiveness of patient safety actions.

CONCLUSIONS

The sharing of responsibilities between professionals, and the actions of prevention and control of healthcare-associated infections arising from this conduct, positively influence the promotion of safer and improved quality care.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing managers should consider applying the tools to prevent and control HAIs and generate in-depth discussion to promote institution's cultural changes.

Effect of Daily Multidisciplinary Team Reflection in Ambulatory Care: A Qualitative Analysis

Purpose

Participants and Methods

Results

Conclusion

Implementation of the Frailty Care Bundle (FCB) to promote mobilisation, nutrition and cognitive engagement in older people in acute care settings: protocol for an implementation science study

Background: Older people are among the most vulnerable patients in acute care hospitals. The hospitalisation process can result in newly acquired functional or cognitive deficits termed hospital associated decline (HAD).  Prioritising fundamental care including mobilisation, nutrition, and cognitive engagement can reduce HAD risk. Aim: The Frailty Care Bundle (FCB) intervention aims to implement and evaluate evidence-based principles on early mobilisation, enhanced nutrition and increased cognitive engagement to prevent functional decline and HAD in older patients. Methods: A hybrid implementation science study will use a pragmatic prospective cohort design with a pre-post mixed methods evaluation to test the effect of the FCB on patient, staff, and health service outcomes.  The evaluation will include a description of the implementation process, intervention adaptations, and economic costs analysis. The protocol follows the Standards for Reporting Implementation Studies (StaRI). The intervention design and implementation strategy will utilise the behaviour change theory COM-B (capability, motivation, opportunity) and the Promoting Action on Research Implementation in Health Services (i-PARIHS). A clinical facilitator will use a co-production approach with staff. All patients will receive care as normal, the intervention is delivered at ward level and focuses on nurses and health care assistants (HCA) normative clinical practices. The intervention will be delivered in three hospitals on six wards including rehabilitation, acute trauma, medical and older adult wards. Evaluation: The evaluation will recruit a volunteer sample of 180 patients aged 65 years or older (pre 90; post 90 patients). The primary outcomes are measures of functional status (modified Barthel Index (MBI)) and mobilisation measured as average daily step count using accelerometers. Process data will include ward activity mapping, staff surveys and interviews and an economic cost-impact analysis. Conclusions: This is a complex intervention that involves ward and system level changes and has the potential to improve outcomes for older patients.

Huddles and their effectiveness at the frontlines of clinical care: a scoping review

BACKGROUND

Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research.

METHODS

A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts.

RESULTS

Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%).

DISCUSSION

Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes.

STUDY REGISTRATION

This scoping review was registered with the Open Science Framework on 18 January 2019 ( https://osf.io/bdj2x/ ).

Quality and safety in the time of Coronavirus: design better, learn faster

The COVID-19 pandemic has required health systems to change much faster than normal. Many staff have experienced training in quality improvement and patient safety methods which can be used to support the design of new systems and to accelerate learning about new and adapted practices. This article sets out the principles of quality improvement and patient safety science, applying them in a selection of approaches, methods and tools, which may be useful in crisis situations such as the current pandemic. The article also makes reference to several resources which may be of use to those keen to advance their knowledge.

Enabling patient safety awareness using the Green Cross method: A qualitative description of users' experience

AIM

The Green Cross method was developed to support healthcare staff in daily patient safety work. The aim of this study was to describe users' experiences of the method when working with patient safety and their views on the core elements.

BACKGROUND

Patient safety systems need to be user-friendly to facilitate learning from adverse events. The Green Cross method is described as a simple visual method to recognise risks and preventable adverse events (PAEs) in real time. There are no previous studies describing users' experiences of the Green Cross method.

DESIGN

A qualitative descriptive design.

METHODS

32 healthcare workers and managers from different specialties in a Swedish hospital were interviewed, from May-September 2018 about their experiences of the Green Cross method; either individually or as part of a group. The interviews were analysed using thematic analysis. The study follows the COREQ guidelines for qualitative data.

RESULTS

Participants associated the Green Cross method with patient safety, but no core elements of the method were identified. Instead, the opportunity to be engaged in patient safety work in a systematic way was underlined by all study participants. Highlighted key areas were the simplicity and the systematic framework of the method along with a need of distinct leadership. The daily meetings promoted trust and dialogue and developed the patient safety mindset. Daily meetings, together with the visualisation of the cross, were emphasised as important by users who otherwise had limited knowledge of the entire method.

CONCLUSION

This study offers valuable information that can help deepen the understanding of how the method specifically supports patient safety work.

RELEVANCE TO CLINICAL PRACTICE

Healthcare workers are expected to report patient safety issues. This study presents user-friendly aspects of the method as well as limitations, relevant for present and future users.

Exploring the feasibility of patient safety huddles in general practice

Background:

Patient safety is a key priority for healthcare systems. Patient safety huddles have been advocated as a way to improve safety. We explored the feasibility of huddles in general practice.

Methods:

We invited all general practices in West Yorkshire to complete an online survey and interviewed practice staff.

Results:

Thirty-four out of 306 practices (11.1%) responded to our survey. Of these, 22 practices (64.7%) reported having breaks for staff to meet and eight (23.5%) reported no longer having breaks in their practices. Seven interviewees identified several barriers to safety huddles including time and current culture; individuals felt meetings or breaks would not be easily integrated into current primary care structure.

Discussion:

Despite their initial promise, there are major challenges to introducing patient safety huddles within the current context of UK general practice. General practice staff may need more convincing of potential benefits.

Use of huddles among frontline staff in clinical settings: a scoping review protocol

OBJECTIVE

This scoping review aims to provide an overview of the current evidence on huddles in healthcare settings involving frontline staff.

INTRODUCTION

Team-based models are gaining prominence as the preferred method for delivering coordinated, cost-effective, high-quality health care. Huddles are a powerful method for building relationships among frontline staff members. Currently, no reviews have described huddles used among frontline staff in clinical settings. There is therefore a need to identify gaps in the literature on evidence informing this practice for a greater understanding of the resources available for frontline staff to implement huddles.

INCLUSION CRITERIA

This scoping review will consider qualitative studies, experimental and quasi-experimental studies, analytic observational studies and descriptive cross-sectional studies that explore the use of frontline staff huddles to improve quality of care in a clinical setting.

METHODS

An initial limited search of PubMed and CINAHL Plus with Full Text will be performed, followed by analysis of the title, abstract and MeSH used to describe the article. Second, searches of PubMed, EBSCOhost and ProQuest will be conducted, followed by searches in reference lists of all articles that meet the inclusion criteria. Studies published in English from inception to the present will be considered. Retrieved papers will be screened for inclusion by at least two reviewers. Data will be extracted and presented in tabular form and a narrative summary that align with the review's objective.