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Mphaphuli LME, Coetzee SK, Tau B, Ellis SM. Nursing categories' perceptions of the practice environment and quality of care in North West Province: a cross-sectional survey design. BMC Nurs 2024; 23:390. [PMID: 38844993 PMCID: PMC11155092 DOI: 10.1186/s12912-024-01998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 05/07/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND There is a substantial amount of literature on the perception of the practice environment and quality of care as perceived by registered nurses and community services nurses in South Africa and worldwide, but there is little to no research that could be found regarding other categories of nurses, and how these perceptions differ between the different categories. Therefore, the aim of this study is to describe the different nursing categories' perceptions of the practice environment and quality of care and the association between the variables. METHODS This study applied a cross-sectional survey design. Data were collected in April 2021 in the public sector of the North West Province. Multiphase sampling was applied to all categories of nurses who worked in an in-patient unit in the selected hospital for at least 3 months (n = 236). RESULTS All nursing categories perceived the practice environment as negative, regarding nurse participation in hospital affairs; nurse manager ability, leadership, and support of nurses and staffing and resource adequacy. Perceived quality of care and patient safety items were perceived as neutral and good. However, in all instances, the perceptions of community service nurses and registered nurses were most negative, and enrolled nurse assistants most positive. Adverse events towards patients and nurses were perceived to only occur a few times a year. Overall, nurse perceptions of quality of care and patient safety were most correlated with the subscale of nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses. Adverse events towards patients were most correlated with the collegial nurse-physician relationship subscale, while adverse events towards nurses were correlated with the foundations of quality of care subscale. CONCLUSION Improving the practice environment, especially regarding the subscale nurse foundations of quality of care and nurse manager ability, leadership, and support of nurses, is associated with improved quality of care. Nurses with higher qualifications, registered nurses and community service nurses rated quality of care lower than other categories of nurses, contributing to literature that higher qualified staff are more competent to assess the practice environment and quality of care.
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Affiliation(s)
- Lufuno M E Mphaphuli
- NuMIQ Research Focus Area, School of Nursing Science, North-West University, Private Bag X6001, Potchefstroom, South Africa
| | - Siedine K Coetzee
- NuMIQ Research Focus Area, School of Nursing Science, North-West University, Private Bag X6001, Potchefstroom, South Africa.
| | - Babalwa Tau
- NuMIQ Research Focus Area, School of Nursing Science, North-West University, Private Bag X6001, Potchefstroom, South Africa
| | - Suria M Ellis
- Unit for Business, Mathematics and Informatics, North-West University, Potchefstroom, South Africa
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PÕLLUSTE K, Calsbeek H, Orrego C, Ballester M, Suñol R, Vall-Roqué H, Kangasniemi M, Läänelaid S, Starkopf J, van Tuijl A, Wollersheim H, Freimann T, Mägi L, Bañeres J, Fernández-Maillo MDM, Emond Y, Lember M. Developing the University of Tartu in Estonia into a well-networked Patient Safety Research Centre (PATSAFE): A study protocol. OPEN RESEARCH EUROPE 2023; 2:107. [PMID: 38915310 PMCID: PMC11195608 DOI: 10.12688/openreseurope.15024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 06/26/2024]
Abstract
Background Patient safety (PS) is a serious global public health problem affecting all countries. Estimates show that around 10 percent of the patients are harmed during hospital care, resulting in 23 million disability-adjusted life years lost per year. Experts emphasize research advancements as a key precondition for safer care. Aim The Patient Safety Research Centre (PATSAFE) project enhances the Institute of Clinical Medicine of the University of Tartu's (ICM-UT) research potential and capacities in PS in order to improve and strengthen knowledge and skills in methods, techniques and experience for PS research. Methods A strategic partnership with Avedis Donabedian Research Institute in Spain, and IQ Healthcare in the Netherlands, both international leaders in PS research, enables the development of a long-lasting knowledge exchange, allowing the ICM-UT to capitalise on its current achievements and to overcome gaps in scientific excellence in the field of PS research. These twining activities will strengthen and raise the research profile of the ICM-UT academic staff and early-stage researchers (ESRs), by implementing the hands-on training on methods, techniques, and experience in PS research. The project also encourages the active participation of ESRs in PS research by increasing their soft skills, to ensure the continuity and sustainability of PS research in ICM-UT. Finally, development of the research strategy on PS contributes to the long-term sustainability of PS research in Estonia. To implement these activities, PATSAFE foresees a comprehensive strategy consisting of knowledge exchange, soft research skills capacity building, strategic planning, and strong dissemination and exploitation efforts. Expected results As a result of the project, ICM-UT will have the capacity to carry out PS research using the appropriate methodology and the competences to apply state-of-the-art evidence-based strategies for PS research.
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Affiliation(s)
- Kaja PÕLLUSTE
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, 50406, Estonia
| | - Hiske Calsbeek
- IQ healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Universitat Autònoma de Barcelona, Barcelona, 08037, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Universitat Autònoma de Barcelona, Barcelona, 08037, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Universitat Autònoma de Barcelona, Barcelona, 08037, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Helena Vall-Roqué
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Universitat Autònoma de Barcelona, Barcelona, 08037, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Mari Kangasniemi
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, 50411, Estonia
- University of Turku, Turku, 20500, Finland
| | - Siim Läänelaid
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, 50406, Estonia
| | - Joel Starkopf
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, 50406, Estonia
- Tartu University Hospital, Tartu, 50406, Estonia
| | - Anne van Tuijl
- IQ healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands
| | - Hub Wollersheim
- IQ healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands
| | - Tiina Freimann
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, 50406, Estonia
- Tartu Health Care College, Tartu, 50411, Estonia
| | - Liisi Mägi
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, 50406, Estonia
| | - Joaquim Bañeres
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Universitat Autònoma de Barcelona, Barcelona, 08037, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - María del Mar Fernández-Maillo
- Avedis Donabedian Research Institute (FAD), Barcelona, 08037, Spain
- Universitat Autònoma de Barcelona, Barcelona, 08037, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Yvette Emond
- IQ healthcare, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, 6500 HB, The Netherlands
| | - Margus Lember
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, 50406, Estonia
- Tartu University Hospital, Tartu, 50406, Estonia
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Varpula J, Välimäki M, Lantta T, Berg J, Soininen P, Lahti M. Safety hazards in patient seclusion events in psychiatric care: A video observation study. J Psychiatr Ment Health Nurs 2022; 29:359-373. [PMID: 34536315 DOI: 10.1111/jpm.12799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. IMPLICATIONS FOR PRACTICE?: Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm ABSTRACT: Introduction Seclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. Aim To identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. Method A descriptive design with non-participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. Results Safety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. Discussion This is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for Practice Being better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya School of Nursing, Central South University, Hunan, China
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
| | | | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Sciences, Turku, Finland
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Tabibzadeh M, Patel Z. Reducing unintended retained foreign objects in operating rooms: a proactive risk assessment framework to improve patient safety. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211044608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
According to a study by Johns Hopkins, an average of 251,454 Americans die annually from medical errors. Medical error is the third leading cause of death in the U.S. after heart disease and cancer. Unintended retained foreign objects (URFOs) has been identified as the most common sentinel event by The Joint Commission. This paper proposes a proactive risk assessment framework to enhance patient safety in operating rooms by addressing the URFOs issue. This framework is developed by integrating the 10 traits of a positive safety culture, initially introduced by the nuclear industry and later adopted by other industries, with an accident investigation methodology called AcciMap, originally developed by Rasmussen. The AcciMap is a hierarchical framework consisting of several layers: government and regulatory bodies, company (hospital), (surgery division) management, (operating room) staff, and work. Thirty main categories of socio-technical contributing causes of URFOs were captured across the AcciMap layers. Organizational factors were identified as the root cause of questionable decisions made by staff and management. Financial and budget constraints, inadequate training infrastructure, absence of a risk management infrastructure, and leadership failure are the most influential organizational factors contributed to URFOs. Our mapping of the aforementioned positive safety culture traits on the AcciMap depicted that the four traits of Work Processes, Leadership Safety Values and Actions, Effective Communication, and Continuous Learning had the most influence on the URFOs issue. Associated recommendations to these findings are provided to contribute to reducing risks of URFOs instances.
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Affiliation(s)
- Maryam Tabibzadeh
- Department of Manufacturing Systems Engineering and Management, California State University, Northridge, 18111 Nordho Street, Northridge, CA 91330, USA
| | - Zarna Patel
- Department of Manufacturing Systems Engineering and Management, California State University, Northridge, 18111 Nordho Street, Northridge, CA 91330, USA
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Balbale SN, Cao L, Trivedi I, Stulberg JJ, Suda KJ, Gellad WF, Evans CT, Lambert BL, Jordan N, Keefer LA. High-Dose Opioid Use Among Veterans with Unexplained Gastrointestinal Symptoms Versus Structural Gastrointestinal Diagnoses. Dig Dis Sci 2021; 66:3938-3950. [PMID: 33385263 PMCID: PMC8245587 DOI: 10.1007/s10620-020-06742-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND In a cohort of Veterans dually enrolled in the Department of Veterans Affairs (VA) and Medicare Part D, we sought to describe high-dose daily opioid use among Veterans with unexplained gastrointestinal (GI) symptoms and structural GI diagnoses and examine factors associated with high-dose use. METHODS We used linked national patient-level data from the VA and Centers for Medicare and Medicaid Services (CMS). We grouped patients into 3 subsets: those with unexplained GI symptoms (e.g., chronic abdominal pain); structural GI diagnoses (e.g., chronic pancreatitis); and those with a concurrent unexplained GI symptom and structural GI diagnosis. High-dose daily opioid use levels were examined as a binary variable [≥ 100 morphine milligram equivalents (MME)/day] and as an ordinal variable (50-99 MME/day, 100-119 MME/day, or ≥ 120 MME/day). RESULTS We identified 141,805 chronic GI patients dually enrolled in VA and Part D. High-dose opioid use was present in 11% of Veterans with unexplained GI symptoms, 10% of Veterans with structural GI diagnoses, and 15% of Veterans in the concurrent GI group. Compared to Veterans with only an unexplained GI symptom or structural diagnosis, concurrent GI patients were more likely to have higher daily opioid doses, more opioid days ≥ 100 MME, and higher risk of chronic use. Factors associated with high-dose use included opioid receipt from both VA and Part D, younger age, and benzodiazepine use. CONCLUSIONS A significant subset of chronic GI patients in the VA are high-dose opioid users. Efforts are needed to reduce high-dose use among Veterans with concurrent GI symptoms and diagnoses.
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Affiliation(s)
- Salva N Balbale
- Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- Center of Innovation for Complex Chronic Healthcare, Health Services Research and Development, Edward Hines, Jr. VA Hospital, Hines, IL, USA.
| | - Lishan Cao
- Center of Innovation for Complex Chronic Healthcare, Health Services Research and Development, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Itishree Trivedi
- Division of Gastroenterology and Hepatology, University of Illinois At Chicago, Chicago, IL, USA
| | - Jonah J Stulberg
- Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Surgical Outcomes and Quality Improvement Center (SOQIC), Division of Gastrointestinal Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katie J Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Walid F Gellad
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Charlesnika T Evans
- Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Health Services Research and Development, Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bruce L Lambert
- Center for Communication and Health, Northwestern University School of Communication, Chicago, IL, USA
| | - Neil Jordan
- Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Health Services Research and Development, Edward Hines, Jr. VA Hospital, Hines, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Laurie A Keefer
- Division of Gastroenterology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
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6
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Conn RL, Tully MP, Shields MD, Carrington A, Dornan T. Characteristics of Reported Pediatric Medication Errors in Northern Ireland and Use in Quality Improvement. Paediatr Drugs 2020; 22:551-560. [PMID: 32627136 DOI: 10.1007/s40272-020-00407-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND To protect children from harm, clinicians, educators, and patient safety champions need information to direct improvement efforts. Critical incident data could provide this but are often disregarded as a source of evidence because under-reporting makes them an inaccurate measure of error rates. OBJECTIVE Our aim was to identify key targets for pediatric healthcare quality improvement. The objective was to evaluate the types, characteristics, and areas of risk within reported medication errors in pediatric patients. METHODS We conducted a retrospective study of a large regional dataset of 1522 pediatric medication errors reported from secondary care between 2011 and 2015, including all hospitals and community pediatric settings in Northern Ireland. The following characteristics were included: error severity, patient age, drug involved, error type, and area of practice. Two academic pediatricians, a senior medicines governance pharmacist, a Reader in Pharmacy Practice, and a Professor of Medical Education analyzed the data. Validity checks included comparing the findings against key published literature and discussion by a practitioner panel representing five multidisciplinary stakeholder groups. RESULTS Neonates, particularly in intensive care, were implicated in 19% of all errors. The medications most represented in risk were antimicrobials, paracetamol, vaccines, and intravenous fluids. The error types most implicated were dosing errors (32%) and omissions (21%). CONCLUSIONS Incident reports identified neonates, a shortlist of drugs, and specific error types, associated with modifiable behaviors, as priority improvement targets. These findings direct further study and inform intervention development, such as specific training in calculations to prevent dosing errors. Involving experienced practitioners both endorsed the findings and engaged the practice community in their future implementation. The utility of incident reports to direct improvement efforts may offset the limitations in their representativeness.
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Affiliation(s)
- Richard L Conn
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, UK.
| | - Mary P Tully
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Michael D Shields
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Angela Carrington
- Medicines Governance Team, Belfast Health and Social Care Trust, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, UK
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Steven A, Tella S, Turunen H, Flores Vizcaya-Moreno M, Pérez-Cañaveras RM, Porras J, Bagnasco A, Sasso L, Myhre K, Sara-Aho A, Ringstad Ø, Pearson P. Shared learning from national to international contexts: a research and innovation collaboration to enhance education for patient safety. J Res Nurs 2019; 24:149-164. [PMID: 34394520 PMCID: PMC7932281 DOI: 10.1177/1744987118824628] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patient safety is key for healthcare across the world and education is critical in improving practice. We drew on existing links to develop the Shared LearnIng from Practice to improve Patient Safety (SLIPPS) group. The group incorporates expertise in education, research, healthcare, healthcare organisation and computing from Norway, Spain, Italy, the UK and Finland. In 2016 we received co-funding from the Erasmus + programme of the European Union for a 3-year project. AIM SLIPPS aims to develop a tool to gather learning events related to patient safety from students in each country, and to use these both for further research to understand practice, and to develop educational activities (virtual seminars, simulation scenarios and a game premise). STUDY OUTLINE The SLIPPS project is well underway. It is underpinned by three main theoretical bodies of work: the notion of diverse knowledge contexts existing in academia, practice and at an organisational level; the theory of reflective practice; and experiential learning theory. The project is based on recognition of the unique position of students as they navigate between contexts, experience and reflect on important learning events related to patient safety. To date, we have undertaken the development of the SLIPPS Learning Event Recording Tool (SLERT) and have begun to gather event descriptions and reflections. CONCLUSIONS Key to the ongoing success of SLIPPS are relationships and reciprocal openness to view things from diverse perspectives and cultures.
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Affiliation(s)
- Alison Steven
- Associate Professor, Department of Nursing Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, UK
| | - Susanna Tella
- Senior Lecturer, Faculty of Health Care and Social Services, Saimaa University of Applied Sciences, Finland
| | - Hannele Turunen
- Professor of Nursing, Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Finland
| | | | | | - Jari Porras
- Professor, Lappeenranta University of Technology, Finland
| | | | - Loredana Sasso
- Professor, Department of Health Sciences, University of Genoa, Italy
| | - Kristin Myhre
- Associate Professor, Faculty of Health and Welfare Sciences, Østfold University College, Norway
| | | | - Øystein Ringstad
- Associate Professor, Faculty of Health and Welfare Sciences, Østfold University College, Norway
| | - Pauline Pearson
- Professor of Nursing, Department of Nursing Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, UK
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O'Connell D, Thomas DH, Lewis JH, Hasse K, Santhanam A, Lamb JM, Cao M, Tenn S, Agazaryan N, Lee PP, Low DA. Safety-oriented design of in-house software for new techniques: A case study using a model-based 4DCT protocol. Med Phys 2019; 46:1523-1532. [PMID: 30656699 DOI: 10.1002/mp.13386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In-house software is commonly employed to implement new imaging and therapy techniques before commercial solutions are available. Risk analysis methods, as detailed in the TG-100 report of the American Association of Physicists in Medicine, provide a framework for quality management of processes but offer little guidance on software design. In this work, we examine a novel model-based four-dimensional computed tomography (4DCT) protocol using the TG-100 approach and describe two additional methods for promoting safety of the associated in-house software. METHODS To implement a previously published model-based 4DCT protocol, in-house software was necessary for tasks such as synchronizing a respiratory signal to computed tomography images, deformable image registration (DIR), model parameter fitting, and interfacing with a treatment planning system. A process map was generated detailing the workflow. Failure modes and effects analysis (FMEA) was performed to identify critical steps and guide quality interventions. Software system safety was addressed through writing "use cases," narratives that characterize the behavior of the software, for all major operations to elicit safety requirements. Safety requirements were codified using the easy approach to requirements syntax (EARS) to ensure testability and eliminate ambiguity. RESULTS Sixty-one failure modes were identified and assigned risk priority numbers using FMEA. Resultant quality management interventions include integration of a comprehensive reporting and logging system into the software, mandating daily and monthly equipment quality assurance procedures, and a checklist to be completed at image acquisition. Use cases and resulting safety requirements informed the design of needed in-house software as well as a suite of tests performed during the image generation process. CONCLUSIONS TG-100 methods were used to construct a process-level quality management program for a 4DCT imaging protocol. Two supplemental tools from the field of requirements engineering facilitated elicitation and codification of safety requirements that informed the design and testing of in-house software necessary to implement the protocol. These general tools can be applied to promote safety when in-house software is needed to bring new techniques to the clinic.
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Affiliation(s)
- Dylan O'Connell
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
| | - David H Thomas
- Department of Radiation Oncology, University of Colorado School of Medicine, 1665 Aurora Court Anschutz Cancer Pavilion, Aurora, CO, 80045, USA
| | - John H Lewis
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
| | - Katelyn Hasse
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
| | - Anand Santhanam
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
| | - James M Lamb
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
| | - Stephen Tenn
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
| | - Nzhde Agazaryan
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
| | - Percy P Lee
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
| | - Daniel A Low
- Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Suite B265, Los Angeles, California, 90095, USA
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Simsekler MCE, Ward JR, Clarkson PJ. Evaluation of system mapping approaches in identifying patient safety risks. Int J Qual Health Care 2018; 30:227-233. [PMID: 29346654 DOI: 10.1093/intqhc/mzx176] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 12/06/2017] [Indexed: 11/13/2022] Open
Abstract
Objective While many system mapping approaches (SMAs) have been broadly used in safety-critical industries, few have so far been employed in the healthcare field to assist in the identification of patient safety risks. In this study, we evaluated a set of system modelling approaches to assess their potential contribution to the identification of risks affecting patient safety. The aim was to gain a greater understanding of the practical application of system modelling approaches with the help of the risk categorization framework developed in this study. Setting We conducted this study in a newly established Adult Attention Deficit Hyperactivity Disorder (ADHD) service at Cambridge and Peterborough Foundation Trust. Study participants Eight key stakeholders of the chosen service, including clinicians, managers and administrative staff, were individually asked to evaluate a set of pre-defined six SMAs according to their usefulness in identifying patient safety risks through interview-based questionnaires. Results It was found that each SMA could be useful in the chosen healthcare service in different ways. Further, specific types of diagrams were selected by stakeholders as more useful than others in identifying different sources of risks within the given system. Conclusions The results of the evaluation showed that the system diagram is the most useful SMA in risk identification within the given system, while limited time, resources and experience of stakeholders with SMAs may present possible obstacles for their potential use in the healthcare field in future.
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Affiliation(s)
- Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi Campus, Abu Dhabi 127788, United Arab Emirates.,School of Management, University College London, 1 Canada Square, London E14 5AA, UK
| | - James R Ward
- Engineering Department, Engineering Design Centre, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK
| | - P John Clarkson
- Engineering Department, Engineering Design Centre, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK
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O'Brien B, Andrews T, Savage E. Anticipatory vigilance: A grounded theory study of minimising risk within the perioperative setting. J Clin Nurs 2017; 27:247-256. [DOI: 10.1111/jocn.13881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Brid O'Brien
- Department of Nursing & Midwifery; Faculty of Education & Health Science; University of Limerick; Limerick Ireland
| | - Tom Andrews
- School of Nursing and Midwifery; University Collect Cork; Cork Ireland
| | - Eileen Savage
- School of Nursing and Midwifery; University Collect Cork; Cork Ireland
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Varndell W, Fry M, Elliott D. Exploring how nurses assess, monitor and manage acute pain for adult critically ill patients in the emergency department: protocol for a mixed methods study. Scand J Trauma Resusc Emerg Med 2017; 25:75. [PMID: 28764789 PMCID: PMC5540572 DOI: 10.1186/s13049-017-0421-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/26/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many critically ill patients experience moderate to severe acute pain that is frequently undetected and/or undertreated. Acute pain in this patient cohort not only derives from their injury and/or illness, but also as a consequence of delivering care whilst stabilising the patient. Emergency nurses are increasingly responsible for the safety and wellbeing of critically ill patients, which includes assessing, monitoring and managing acute pain. How emergency nurses manage acute pain in critically ill adult patients is unknown. The objective of this study is to explore how emergency nurses manage acute pain in critically ill patients in the Emergency Department. METHODS In this paper, we provide a detailed description of the methods and protocol for a multiphase sequential mixed methods study, exploring how emergency nurses assess, monitor and manage acute pain in critically ill adult patients. The objective, method, data collection and analysis of each phase are explained. Justification of each method and data integration is described. DISCUSSION Synthesis of findings will generate a comprehensive picture of how emergency nurses' perceive and manage acute pain in critically ill adult patients. The results of this study will form a knowledge base to expand theory and inform research and practice.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, Randwick, NSW 2031 Australia
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007 Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007 Australia
- Director Research and Practice Development Nursing and Midwifery Directorate NSLHD, Level 7 Kolling Building, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Doug Elliott
- Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007 Australia
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Lindfield R, Knight A, Bwonya D. An approach to assessing patient safety in hospitals in low-income countries. PLoS One 2015; 10:e0121628. [PMID: 25894554 PMCID: PMC4403808 DOI: 10.1371/journal.pone.0121628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 01/06/2015] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of the study was to assess non-technical aspects of patient safety practices using non-participant observation in different clinical areas. Design Qualitative study using non-participant observation and thematic analysis. Setting Two eye care units in Uganda. Participants Staff members in each hospital. Main outcome measures A set of observations of patient safety practices by staff members in clinical areas that were then coded using thematic analysis. Results Twenty codes were developed that explained patient safety practices in the hospitals based on the observations. These were grouped into four themes: the team, the environment, patient-centred care and the process. The complexity of patient safety in each hospital was described using narrative reports to support the thematic analysis. Overall both hospitals demonstrated good patient safety practices however areas for improvement were staff-patient communication, the presence and use of protocols and a focus on consistent practice. Conclusions This is the first holistic assessment of patient safety practices in a low-income setting. The methods allowed the complexity of patient safety to be understood and explained with areas of concern highlighted. The next step will be to develop a useful and easy to use tool to measure patient safety practices in low-income settings.
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Affiliation(s)
- Robert Lindfield
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Abigail Knight
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Bwonya
- Ophthalmology Department, Ruharo Mission Hospital, Mbarara, Uganda
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Simsekler MCE, Card AJ, Ruggeri K, Ward JR, Clarkson PJ. A comparison of the methods used to support risk identification for patient safety in one UK NHS foundation trust. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/1356262215580224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In healthcare, various methods are available to support risk identification in risk management process. However, there is no clear evidence on their contribution to risk identification. In this study, different methods used to support risk identification were therefore analysed to compare their contribution to overall risk identification. The study was conducted at Cambridge University Hospitals Foundation Trust, UK. Three main methods were selected to compare their support in risk identification: incident reports through their Risk Management Information System, risk registers through their Risk Registers system, and safety walkabouts through their internal patient safety assessment process. Where possible, simple comparison tests were run between the different methods of identifying risks as well as by the type of risks identified. It was found that each method has contributed to the risk identification by adding different sets of risk sources despite some overlaps. However, they produced discrete assessments from different aspects and none of them, on its own, could produce adequate results for effective risk identification. In any healthcare setting, having a system to put all risk information in one picture would help maximise the contribution of each method within the scope risk management process. Future studies may benefit from broader use of multiple and system-based risk identification approaches, and coding methods for more powerful analytical test.
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Affiliation(s)
- MC Emre Simsekler
- Department of Management Science and Innovation, University College London, London, UK
| | - Alan J Card
- Evidence-Based Health Solutions, LLC, Notre Dame, IN, USA
| | - Kai Ruggeri
- Engineering Department, Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - James R Ward
- Engineering Department, Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - P John Clarkson
- Engineering Department, Engineering Design Centre, University of Cambridge, Cambridge, UK
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Sendlhofer G, Mosbacher N, Karina L, Kober B, Jantscher L, Berghold A, Pregartner G, Brunner G, Kamolz LP. Implementation of a surgical safety checklist: interventions to optimize the process and hints to increase compliance. PLoS One 2015; 10:e0116926. [PMID: 25658317 PMCID: PMC4319744 DOI: 10.1371/journal.pone.0116926] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/16/2014] [Indexed: 11/30/2022] Open
Abstract
Background A surgical safety checklist (SSC) was implemented and routinely evaluated within our hospital. The purpose of this study was to analyze compliance, knowledge of and satisfaction with the SSC to determine further improvements. Methods The implementation of the SSC was observed in a pilot unit. After roll-out into each operating theater, compliance with the SSC was routinely measured. To assess subjective and objective knowledge, as well as satisfaction with the SSC implementation, an online survey (N = 891) was performed. Results During two test runs in a piloting unit, 305 operations were observed, 175 in test run 1 and 130 in test run 2. The SSC was used in 77.1% of all operations in test run 1 and in 99.2% in test run 2. Within used SSCs, completion rates were 36.3% in test run 1 and 1.6% in test run 2. After roll-out, three unannounced audits took place and showed that the SSC was used in 95.3%, 91.9% and 89.9%. Within used SSCs, completion rates decreased from 81.7% to 60.6% and 53.2%. In 2014, 164 (18.4%) operating team members responded to the online survey, 160 of which were included in the analysis. 146 (91.3%) consultants and nursing staff reported to use the SSC regularly in daily routine. Conclusion These data show that the implementation of new tools such as the adapted WHO SSC needs constant supervision and instruction until it becomes self-evident and accepted. Further efforts, consisting mainly of hands-on leadership and training are necessary.
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Affiliation(s)
- Gerald Sendlhofer
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University Graz, Graz, Austria
- * E-mail:
| | - Nina Mosbacher
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University Graz, Graz, Austria
| | - Leitgeb Karina
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Brigitte Kober
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Lydia Jantscher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | | | - Lars Peter Kamolz
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University Graz, Graz, Austria
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Hebballi NB, Ramoni R, Kalenderian E, Delattre VF, Stewart DCL, Kent K, White JM, Vaderhobli R, Walji MF. The dangers of dental devices as reported in the Food and Drug Administration Manufacturer and User Facility Device Experience Database. J Am Dent Assoc 2015; 146:102-10. [PMID: 25637208 PMCID: PMC4313571 DOI: 10.1016/j.adaj.2014.11.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/29/2014] [Accepted: 11/07/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The authors conducted a study to determine the frequency and type of adverse events (AEs) associated with dental devices reported to the Food and Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database. METHODS The authors downloaded and reviewed the dental device-related AEs reported to MAUDE from January 1, 1996, through December 31,2011. RESULTS MAUDE received a total of 1,978,056 reports between January 1, 1996, and December 31, 2011. Among these reports, 28,046 (1.4%) AE reports were associated with dental devices. Within the dental AE reports that had event type information, 17,261 reported injuries, 7,777 reported device malfunctions, and 66 reported deaths. Among the 66 entries classified as death reports, 52 reported a death in the description; the remaining were either misclassified or lacked sufficient information in the report to determine whether a death had occurred. Of the dental device-associated AEs, 53.5% pertained to endosseous implants. CONCLUSIONS A plethora of devices are used in dental care. To achieve Element 1 of Agency for Healthcare Research and Quality's Patient Safety Initiative, clinicians and researchers must be able to monitor the safety of dental devices. Although MAUDE was identified by the authors as essentially the sole source of this valuable information on adverse events, their investigations led them to conclude that MAUDE had substantial limitations that prevent it from being the broad-based patient safety sentinel the profession requires. PRACTICAL IMPLICATIONS As potential contributors to MAUDE, dental care teams play a key role in improving the profession's access to information about the safety of dental devices.
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Plint AC, Stang AS, Calder LA. Establishing research priorities for patient safety in emergency medicine: a multidisciplinary consensus panel. Int J Emerg Med 2015; 8:1. [PMID: 25852771 PMCID: PMC4384522 DOI: 10.1186/s12245-014-0049-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 12/24/2014] [Indexed: 11/30/2022] Open
Abstract
Background Patient safety in the context of emergency medicine is a relatively new field of study. To date, no broad research agenda for patient safety in emergency medicine has been established. The objective of this study was to establish patient safety-related research priorities for emergency medicine. These priorities would provide a foundation for high-quality research, important direction to both researchers and health-care funders, and an essential step in improving health-care safety and patient outcomes in the high-risk emergency department (ED) setting. Methods A four-phase consensus procedure with a multidisciplinary expert panel was organized to identify, assess, and agree on research priorities for patient safety in emergency medicine. The 19-member panel consisted of clinicians, administrators, and researchers from adult and pediatric emergency medicine, patient safety, pharmacy, and mental health; as well as representatives from patient safety organizations. In phase 1, we developed an initial list of potential research priorities by electronically surveying a purposeful and convenience sample of patient safety experts, ED clinicians, administrators, and researchers from across North America using contact lists from multiple organizations. We used simple content analysis to remove duplication and categorize the research priorities identified by survey respondents. Our expert panel reached consensus on a final list of research priorities through an in-person meeting (phase 3) and two rounds of a modified Delphi process (phases 2 and 4). Results After phases 1 and 2, 66 unique research priorities were identified for expert panel review. At the end of phase 4, consensus was reached for 15 research priorities. These priorities represent four themes: (1) methods to identify patient safety issues (five priorities), (2) understanding human and environmental factors related to patient safety (four priorities), (3) the patient perspective (one priority), and (4) interventions for improving patient safety (five priorities). Conclusion This study established expert, consensus-based research priorities for patient safety in emergency medicine. This framework could be used by researchers and health-care funders and represents an essential guiding step towards enhancing quality of care and patient safety in the ED. Electronic supplementary material The online version of this article (doi:10.1186/s12245-014-0049-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy C Plint
- Department of Pediatrics, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1Y 4E9 Canada ; Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital - Civic Campus, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9 Canada ; The Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario K1H 8 L1 Canada
| | - Antonia S Stang
- Department of Pediatrics, University of Calgary, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 4Z6 Canada ; Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada ; The Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta T3B 6A8 Canada
| | - Lisa A Calder
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital - Civic Campus, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9 Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital - Civic Campus, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9 Canada
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Schoonover H, Corbett CF, Weeks DL, Willson MN, Setter SM. Predicting Potential Postdischarge Adverse Drug Events and 30-Day Unplanned Hospital Readmissions From Medication Regimen Complexity. J Patient Saf 2014; 10:186-91. [DOI: 10.1097/pts.0000000000000067] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Guise V, Anderson J, Wiig S. Patient safety risks associated with telecare: a systematic review and narrative synthesis of the literature. BMC Health Serv Res 2014; 14:588. [PMID: 25421823 PMCID: PMC4254014 DOI: 10.1186/s12913-014-0588-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 11/10/2014] [Indexed: 12/04/2022] Open
Abstract
Background Patient safety risk in the homecare context and patient safety risk related to telecare are both emerging research areas. Patient safety issues associated with the use of telecare in homecare services are therefore not clearly understood. It is unclear what the patient safety risks are, how patient safety issues have been investigated, and what research is still needed to provide a comprehensive picture of risks, challenges and potential harm to patients due to the implementation and use of telecare services in the home. Furthermore, it is unclear how training for telecare users has addressed patient safety issues. A systematic review of the literature was conducted to identify patient safety risks associated with telecare use in homecare services and to investigate whether and how these patient safety risks have been addressed in telecare training. Methods Six electronic databases were searched in addition to hand searches of key items, reference tracking and citation tracking. Strict inclusion and exclusion criteria were set. All included items were assessed according to set quality criteria and subjected to a narrative synthesis to organise and synthesize the findings. A human factors systems framework of patient safety was used to frame and analyse the results. Results 22 items were included in the review. 11 types of patient safety risks associated with telecare use in homecare services emerged. These are in the main related to the nature of homecare tasks and practices, and person-centred characteristics and capabilities, and to a lesser extent, problems with the technology and devices, organisational issues, and environmental factors. Training initiatives related to safe telecare use are not described in the literature. Conclusions There is a need to better identify and describe patient safety risks related to telecare services to improve understandings of how to avoid and minimize potential harm to patients. This process can be aided by reframing known telecare implementation challenges and user experiences of telecare with the help of a human factors systems approach to patient safety.
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Affiliation(s)
- Veslemøy Guise
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway.
| | - Janet Anderson
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway. .,Florence Nightingale School of Nursing and Midwifery, Kings College London, London, UK.
| | - Siri Wiig
- Department of Health Studies, University of Stavanger, Kjell Arholms gate, 4036, Stavanger, Norway.
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Sendlhofer G, Brunner G, Tax C, Falzberger G, Smolle J, Leitgeb K, Kober B, Kamolz LP. Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers. Wien Klin Wochenschr 2014; 127:1-11. [PMID: 25392253 DOI: 10.1007/s00508-014-0620-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND For health care systems in recent years, patient safety has increasingly become a priority issue. National and international strategies have been considered to attempt to overcome the most prominent hazards while patients are receiving health care. Thereby, clinical risk management (CRM) plays a dominant role in enabling the identification, analysis, and management of potential risks. CRM implementation into routine procedures within complex hospital organizations is challenging, as in the past, organizational change strategies using a top-down approach have often failed. Therefore, one of our main objectives was to educate a certain number of risk managers in facilitating CRM using a bottom-up approach. METHODS To achieve our primary purpose, five project strands were developed, and consequently followed, introducing CRM: corporate governance, risk management (RM) training, CRM process, information, and involvement. The core part of the CRM process involved the education of risk managers within each organizational unit. To account for the size of the existing organization, we assumed that a minimum of 1 % of the workforce had to be trained in RM to disseminate the continuous improvement of quality and safety. Following a roll-out plan, CRM was introduced in each unit and potential risks were identified. RESULTS Alongside the changes in the corporate governance, a hospital-wide CRM process was introduced resulting in 158 trained risk managers correlating to 2.0 % of the total workforce. Currently, risk managers are present in every unit and have identified 360 operational risks. Among those, 176 risks were scored as strategic and clustered together into top risks. Effective meeting structures and opportunities to share information and knowledge were introduced. Thus far, 31 units have been externally audited in CRM. CONCLUSION The CRM approach is unique with respect to its dimension; members of all health care professions were trained to be able to identify potential risks. A network of risk managers supported the centrally coordinated CRM process. There is a strong commitment among management, academia, clinicians, and administration to foster cooperation. The introduction of CRM led to a visible shift with regard to patient safety culture throughout the entire organization. Still, there is a long way to go to keep people engaged in CRM and work on national and international patient safety initiatives to continuously decrease potential hazards.
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Affiliation(s)
- Gerald Sendlhofer
- Department of Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036, Graz, Styria, Austria,
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Ackroyd-Stolarz S, Bowles SK, Giffin L. Validating administrative data for the detection of adverse events in older hospitalized patients. Drug Healthc Patient Saf 2014; 6:101-8. [PMID: 25143755 PMCID: PMC4137915 DOI: 10.2147/dhps.s64359] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED Older hospitalized patients are at risk of experiencing adverse events including, but not limited to, hospital-acquired pressure ulcers, fall-related injuries, and adverse drug events. A significant challenge in monitoring and managing adverse events is lack of readily accessible information on their occurrence. PURPOSE The objective of this retrospective cross-sectional study was to validate diagnostic codes for pressure ulcers, fall-related injuries, and adverse drug events found in routinely collected administrative hospitalization data. METHODS All patients 65 years of age or older discharged between April 1, 2009 and March 31, 2011 from a provincial academic health sciences center in Canada were eligible for inclusion in the validation study. For each of the three types of adverse events, a random sample of 50 patients whose records were positive and 50 patients whose records were not positive for an adverse event was sought for review in the validation study (n=300 records in total). A structured health record review was performed independently by two health care providers with experience in geriatrics, both of whom were unaware of the patient's status with respect to adverse event coding. A physician reviewed 40 records (20 reviewed by each health care provider) to establish interrater agreement. RESULTS A total of 39 pressure ulcers, 56 fall-related injuries, and 69 adverse drug events were identified through health record review. Of these, 34 pressure ulcers, 54 fall-related injuries, and 47 adverse drug events were also identified in administrative data. Overall, the diagnostic codes for adverse events had a sensitivity and specificity exceeding 0.67 (95% confidence interval [CI]: 0.56-0.99) and 0.89 (95% CI: 0.72-0.99), respectively. CONCLUSION It is feasible and valid to identify pressure ulcers, fall-related injuries, and adverse drug events in older hospitalized patients using routinely collected administrative hospitalization data. The information is relatively inexpensive and easy to access with no impact on clinical staff.
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Affiliation(s)
- Stacy Ackroyd-Stolarz
- Performance Excellence Portfolio, Capital District Health Authority, Halifax, Nova Scotia, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan K Bowles
- Geriatric Medicine, Capital District Health Authority, Halifax, Nova Scotia, Canada
- College of Pharmacy and Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pharmacy at Capital District Health Authority, Halifax, Nova Scotia, Canada
| | - Lorri Giffin
- South Shore Family Health, Bridgewater, Nova Scotia, Canada
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Tvedt C, Sjetne IS, Helgeland J, Bukholm G. An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities. BMJ Qual Saf 2014; 23:757-64. [PMID: 24728887 PMCID: PMC4145461 DOI: 10.1136/bmjqs-2013-002781] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital. Methods In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses’ perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse–physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined. Results Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival. Conclusions This study showed that perceived staffing adequacy and nurses’ assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals.
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Affiliation(s)
- Christine Tvedt
- Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingeborg Strømseng Sjetne
- Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Jon Helgeland
- Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Geir Bukholm
- Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Aas, Norway
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Ginsburg LR, Tregunno D, Norton PG, Mitchell JI, Howley H. 'Not another safety culture survey': using the Canadian patient safety climate survey (Can-PSCS) to measure provider perceptions of PSC across health settings. BMJ Qual Saf 2013; 23:162-70. [PMID: 24122954 PMCID: PMC3913119 DOI: 10.1136/bmjqs-2013-002220] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The importance of a strong safety culture for enhancing patient safety has been stated for over a decade in healthcare. However, this complex construct continues to face definitional and measurement challenges. Continuing improvements in the measurement of this construct are necessary for enhancing the utility of patient safety climate surveys (PSCS) in research and in practice. This study examines the revised Canadian PSCS (Can-PSCS) for use across a range of care settings. Methods Confirmatory factor analytical approaches are used to extensively test the Can-PSCS. Initial and cross-validation samples include 13 126 and 6324 direct care providers from 119 and 35 health settings across Canada, respectively. Results Results support a parsimonious model of direct care provider perceptions of patient safety climate (PSC) with 19 items in six dimensions: (1) organisational leadership support for safety; (2) incident follow-up; (3) supervisory leadership for safety; (4) unit learning culture; (5) enabling open communication I: judgement-free environment; (6) enabling open communication II: job repercussions of error. Results also support the validity of the Can-PSCS across a range of care settings. Conclusions The Can-PSCS has several advantages: (1) it is a theory-based instrument with a small number of actionable dimensions central to the construct of PSC; (2) it has robust psychometric properties; (3) it is validated for use across a range of care settings, therefore suitable for use in regionalised health delivery systems and can help to raise expectations about acceptable levels of PSC across the system; (4) it has been tested in a publicly funded universal health insurance system and may be suitable for similar international systems.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy and Management, , York University, Toronto, Ontario, Canada
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Smith MW, Davis Giardina T, Murphy DR, Laxmisan A, Singh H. Resilient actions in the diagnostic process and system performance. BMJ Qual Saf 2013; 22:1006-13. [PMID: 23813210 DOI: 10.1136/bmjqs-2012-001661] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Systemic issues can adversely affect the diagnostic process. Many system-related barriers can be masked by 'resilient' actions of frontline providers (ie, actions supporting the safe delivery of care in the presence of pressures that the system cannot readily adapt to). We explored system barriers and resilient actions of primary care providers (PCPs) in the diagnostic evaluation of cancer. METHODS We conducted a secondary data analysis of interviews of PCPs involved in diagnostic evaluation of 29 lung and colorectal cancer cases. Cases covered a range of diagnostic timeliness and were analysed to identify barriers for rapid diagnostic evaluation, and PCPs' actions involving elements of resilience addressing those barriers. We rated these actions according to whether they were usual or extraordinary for typical PCP work. RESULTS Resilient actions and associated barriers were found in 59% of the cases, in all ranges of timeliness, with 40% involving actions rated as beyond typical. Most of the barriers were related to access to specialty services and coordination with patients. Many of the resilient actions involved using additional communication channels to solicit cooperation from other participants in the diagnostic process. DISCUSSION Diagnostic evaluation of cancer involves several resilient actions by PCPs targeted at system deficiencies. PCPs' actions can sometimes mitigate system barriers to diagnosis, and thereby impact the sensitivity of 'downstream' measures (eg, delays) in detecting barriers. While resilient actions might enable providers to mitigate system deficiencies in the short run, they can be resource intensive and potentially unsustainable. They complement, rather than substitute for, structural remedies to improve system performance. Measures to detect and fix system performance issues targeted by these resilient actions could facilitate diagnostic safety.
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Affiliation(s)
- Michael W Smith
- Houston VA HSR&D Center of Excellence and The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, , Houston, Texas, USA
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Smits M, Wagner C, Spreeuwenberg P, Timmermans DRM, van der Wal G, Groenewegen PP. The role of patient safety culture in the causation of unintended events in hospitals. J Clin Nurs 2012; 21:3392-401. [DOI: 10.1111/j.1365-2702.2012.04261.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Andermann A, Ginsburg L, Norton P, Arora N, Bates D, Wu A, Larizgoitia I. Core competencies for patient safety research: a cornerstone for global capacity strengthening. BMJ Qual Saf 2012; 20:96-101. [PMID: 21228081 PMCID: PMC3022363 DOI: 10.1136/bmjqs.2010.041814] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Tens of millions of patients worldwide suffer disabling injuries or death every year due to unsafe medical care. Nonetheless, there is a scarcity of research evidence on how to tackle this global health priority. The shortage of trained researchers is a major limitation, particularly in developing and transitional countries. Objectives As a first step to strengthen capacity in this area, the authors developed a set of internationally agreed core competencies for patient safety research worldwide. Methods A multistage process involved developing an initial framework, reviewing the existing literature relating to competencies in patient safety research, conducting a series of consultations with potential end users and international experts in the field from over 35 countries and finally convening a global consensus conference. Results An initial draft list of competencies was grouped into three themes: patient safety, research methods and knowledge translation. The competencies were considered by the WHO Patient Safety task force, by potential end users in developing and transitional countries and by international experts in the field to be relevant, comprehensive, clear, easily adaptable to local contexts and useful for training patient safety researchers internationally. Conclusions Reducing patient harm worldwide will require long-term sustained efforts to build capacity to enable practical research that addresses local problems and improves patient safety. The first edition of Competencies for Patient Safety Researchers is proposed by WHO Patient Safety as a foundation for strengthening research capacity by guiding the development of training programmes for researchers in the area of patient safety, particularly in developing and transitional countries, where such research is urgently needed.
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Affiliation(s)
- Anne Andermann
- Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA
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Shever LL, Titler MG. Multidisciplinary treatments, patient characteristics, context of care, and adverse incidents in older, hospitalized adults. Nurs Res Pract 2012; 2012:350830. [PMID: 22530112 PMCID: PMC3316955 DOI: 10.1155/2012/350830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 12/03/2011] [Accepted: 12/03/2011] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to examine factors that contribute to adverse incidents by creating a model that included patient characteristics, clinical conditions, nursing unit context of care variables, medical treatments, pharmaceutical treatments, and nursing treatments. Data were abstracted from electronic, administrative, and clinical data repositories. The sample included older adults hospitalized during a four-year period at one, academic medical facility in the Midwestern United States who were at risk for falling. Relational databases were built and a multistep, statistical model building analytic process was used. Total registered nurse (RN) hours per patient day (HPPD) and HPPDs dropping below the nursing unit average were significant explanatory variables for experiencing an adverse incident. The number of medical and pharmaceutical treatments that a patient received during hospitalization as well as many specific nursing treatments (e.g., restraint use, neurological monitoring) were also contributors to experiencing an adverse incident.
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Affiliation(s)
- Leah L. Shever
- Nursing Research, Quality, and Innovation, University of Michigan Health System, 300 North Ingalls, Room NI 5A07, Ann Arbor, MI 48109-5446, USA
| | - Marita G. Titler
- University of Michigan School of Nursing and University of Michigan Health System, 400 North Ingalls, Suite 4170, Ann Arbor, MI 48109-5482, USA
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Tvedt C, Sjetne IS, Helgeland J, Bukholm G. A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety. BMJ Open 2012; 2:bmjopen-2012-001967. [PMID: 23263021 PMCID: PMC3533052 DOI: 10.1136/bmjopen-2012-001967] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The purpose of this study was to identify organisational processes and structures that are associated with nurse-reported patient safety and quality of nursing. DESIGN This is an observational cross-sectional study using survey methods. SETTING Respondents from 31 Norwegian hospitals with more than 85 beds were included in the survey. PARTICIPANTS All registered nurses working in direct patient care in a position of 20% or more were invited to answer the survey. In this study, 3618 nurses from surgical and medical wards responded (response rate 58.9). Nurses' practice environment was defined as organisational processes and measured by the Nursing Work Index Revised and items from Hospital Survey on Patient Safety Culture. OUTCOME MEASURES Nurses' assessments of patient safety, quality of nursing, confidence in how their patients manage after discharge and frequency of adverse events were used as outcome measures. RESULTS Quality system, nurse-physician relation, patient safety management and staff adequacy were process measures associated with nurse-reported work-related and patient-related outcomes, but we found no associations with nurse participation, education and career and ward leadership. Most organisational structures were non-significant in the multilevel model except for nurses' affiliations to medical department and hospital type. CONCLUSIONS Organisational structures may have minor impact on how nurses perceive work-related and patient-related outcomes, but the findings in this study indicate that there is a considerable potential to address organisational design in improvement of patient safety and quality of care.
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Affiliation(s)
- Christine Tvedt
- Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ingeborg Strømseng Sjetne
- Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Jon Helgeland
- Department of Quality Measurement and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Geir Bukholm
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Centre for Laboratory Medicine, Østfold Hospital Trust, Fredrikstad, Norway
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Introduction. PATIENT SAFETY 2011. [DOI: 10.1201/b11273-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stichler JF. Patient Safety as the Number One Priority in Healthcare Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2011; 5:73-6. [DOI: 10.1177/193758671100500107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liu W, Manias E, Gerdtz M. Understanding medication safety in healthcare settings: a critical review of conceptual models. Nurs Inq 2011; 18:290-302. [PMID: 22050615 DOI: 10.1111/j.1440-1800.2011.00541.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Understanding medication safety in healthcare settings: a critical review of conceptual models Communication can impact on the way in which medications are managed across healthcare settings. Organisational cultures and the environmental context provide an added complexity to how communication occurs in practice. The aims of this paper are: to examine six models relating to medication safety in various hospital and community settings, to consider the strengths and limitations of each model and to explore their applications to medication safety practices. The models examined for their ability to address the complexity of the medication communication process include causal models, such as the Human Error Model and the System Analysis to Clinical Incidents Model, and exploratory models, such as the Shared Decision-Making Model, the Medication Decision-Making and Management Model, the Partnership Model and the Medication Communication Model. The Medication Communication Model provides particular insights into possible interactions between aspects that influence medication safety practices. The implications of all six models for healthcare practice and future research are also discussed.
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Affiliation(s)
- Wei Liu
- The University of Melbourne, Carlton, Vic., Australia
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Merten H, Lubberding S, van Wagtendonk I, Johannesma PC, Wagner C. Patient safety in elderly hip fracture patients: design of a randomised controlled trial. BMC Health Serv Res 2011; 11:59. [PMID: 21418630 PMCID: PMC3071310 DOI: 10.1186/1472-6963-11-59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 03/21/2011] [Indexed: 01/22/2023] Open
Abstract
Background The clinical environment in which health care providers have to work everyday is highly complex; this increases the risk for the occurrence of unintended events. The aim of this randomised controlled trial is to improve patient safety for a vulnerable group of patients that have to go through a complex care chain, namely elderly hip fracture patients. Methods/design A randomised controlled trial that consists of three interventions; these will be implemented in three surgical wards in Dutch hospitals. One surgical ward in another hospital will be the control group. The first intervention is aimed at improving communication between care providers using the SBAR communication tool. The second intervention is directed at stimulating the role of the patient within the care process with a patient safety card. The third intervention consists of a leaflet for patients with information on the most common complications for the period after discharge. The primary outcome measures in this study are the incidence of complications and adverse events, mortality rate within six months after discharge and functional mobility six months after discharge. Secondary outcome measures are length of hospital stay, quality and completeness of information transfer and patient satisfaction with the instruments. Discussion The results will give insight into the nature and scale of complications and adverse events that occur in elderly hip fracture patients. Also, the implementation of three interventions aimed at improving the communication and information transfer provides valuable possibilities for improving patient safety in this increasing patient group. This study combines the use of three interventions, which is an innovative aspect of the study. Trial registration The Netherlands National Trial Register NTR1562
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Affiliation(s)
- Hanneke Merten
- NIVEL, Netherlands institute for health services research, PO Box 1568, 3500 BN Utrecht, The Netherlands.
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Dy S, Gurses AP. Care pathways and patient safety: key concepts, patient outcomes and related interventions. ACTA ACUST UNITED AC 2010. [DOI: 10.1258/jicp.2010.010021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although care pathways often target efficiency of care through mapping and standardizing care processes, care can also be improved by reducing patient safety events, such as complications. In this paper, the authors review key concepts and literature relevant to parallels between patient safety and pathway interventions, as well as patient safety issues that should be considered in pathway development and implementation. Both care pathways and patient safety interventions are more likely to be effective when based on a theoretical framework related to human or systems factors or behaviour. Care pathways can target patient safety outcomes, but can also produce new hazards, through applying standards too broadly, reducing adaptability to complex situations or changing care processes in unforeseen ways. Both pathways and safety interventions must also be efficient and consider the opportunity costs of the time needed for providers to implement the intervention. Further research should explore how best to standardize care when needed, while evaluating how best to prevent and monitor hazards, allow for innovation and adaptability to customize care when appropriate, and continue to develop new methods for improving quality.
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Affiliation(s)
- Sydney Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Ayse P Gurses
- Department of Anesthesiology and Critical Care Medicine, Quality and Safety Research Group, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Pitchforth E, Lilford RJ, Kebede Y, Asres G, Stanford C, Frost J. Assessing and understanding quality of care in a labour ward: a pilot study combining clinical and social science perspectives in Gondar, Ethiopia. Soc Sci Med 2010; 71:1739-48. [PMID: 20855142 DOI: 10.1016/j.socscimed.2010.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 07/29/2010] [Accepted: 08/03/2010] [Indexed: 10/19/2022]
Abstract
Ensuring high quality intrapartum care in developing countries is a crucial component of efforts to reduce maternal and neonatal mortality and morbidity. Conceptual frameworks for understanding quality of care have broadened to reflect the complexity of factors affecting quality of health care provision. Yet, the role of social sciences within the assessment and understanding of quality of care in this field has focused primarily on seeking to understand the views and experiences of service users and providers. In this pilot study we aimed to combine clinical and social science perspectives and methods to best assess and understand issues affecting quality of clinical care and to identify priorities for change. Based in one referral hospital in Ethiopia, data collection took place in three phases using a combination of structured and unstructured observations, interviews and a modified nominal group process. This resulted in a thorough and pragmatic methodology. Our results showed high levels of knowledge and compliance with most aspects of good clinical practice, and non-compliance was affected by different, inter-linked, resource constraints. Considering possible changes in terms of resource implications, local stakeholders prioritised five areas for change. Some of these changes would have considerable resources implications whilst others could be made within existing resources. The discussion focuses on implications for informing quality improvement interventions. Improvements will need to address health systems issues, such as supply of key drugs, as well as changes in professional practice to promote the rational use of drugs. Furthermore, the study considers the need to understand broader organizational factors and inter-professional relationships. The potential for greater integration of social science perspectives as part of currently increasing monitoring and evaluation activity around intrapartum care is highlighted.
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Affiliation(s)
- Emma Pitchforth
- LSE Health, London School of Economics and Political Science, London, UK.
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van Wagtendonk I, Smits M, Merten H, Heetveld MJ, Wagner C. Nature, causes and consequences of unintended events in surgical units. Br J Surg 2010; 97:1730-40. [DOI: 10.1002/bjs.7201] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Several studies have shown that the rate of unintended harm is higher in surgical than in non-surgical care. To improve patient safety in surgery, information about the underlying causes is needed. This observational study examined the nature, causes and consequences of unintended events in surgical units, and the completeness of event reporting.
Methods
Ten surgical units in the Netherlands participated. The study period per unit was 8–14 weeks, during which healthcare providers reported unintended events. Event reports were analysed with a root cause analysis tool (PRISMA). In addition, an independent surgeon reviewed about 40 patient records of patients in each surgical unit to examine whether an unintended event had occurred.
Results
A total of 881 unintended events were reported and analysed, of which 33·0 per cent were categorized as medication events. Most root causes were human (72·3 per cent), followed by organizational (16·1 per cent) and technical (5·7 per cent). More than half of the events had consequences for the patient. Sixty-four unintended events were identified in a review of 320 patient records. Only one of these events was also reported by a healthcare provider.
Conclusion
Event reporting and patient record review provide insight into diverse types of unintended events and complement each other. The information on unintended events from both sources may help target research and interventions to increase patient safety.
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Affiliation(s)
- I van Wagtendonk
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - M Smits
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - H Merten
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - M J Heetveld
- Department of Surgery, Kennemer Gasthuis, Haarlem, The Netherlands
| | - C Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
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Wischet W, Eitzinger C. [Quality management and safety culture in medicine: context and concepts]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2010; 103:530-5. [PMID: 19998781 DOI: 10.1016/j.zefq.2009.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The publication of the IOM report "To err is human: building a safer health system" in 1999 put spotlight on the primacy of the principle of primum non nocere and made patient safety a central topic of quality management. A key conclusion of the report was the need for a well-developed safety culture. While concepts of quality management have evolved along the lines of ISO and Total Quality Management over the last decades patient safety still has not got the same amount of attention (PubMed). Evidence from other safety-critical areas but also from the field of medicine itself suggests that an efficient culture of safety is a conditio sine qua non for the sustainable improvement of patient safety. Considering these arguments the present paper aims at emphasizing the importance of an efficient culture of safety for patient safety and quality management in healthcare. In addition, key instruments of safety culture as well as their limitations will be presented.
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Affiliation(s)
- Werner Wischet
- UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Osterreich.
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Wong DR, Torchiana DF, Vander Salm TJ, Agnihotri AK, Bohmer RMJ, Ali IS. Impact of cardiac intraoperative precursor events on adverse outcomes. Surgery 2007; 141:715-22. [PMID: 17560247 DOI: 10.1016/j.surg.2007.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 01/03/2007] [Accepted: 01/27/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although extensive study has been directed at the influence of patient factors and comorbidities on cardiac surgical outcomes, less attention has been focused on process. We sought to examine the relationship between intraoperative precursor events (those events that precede and are requisite for the occurrence of an adverse event) and adverse outcomes themselves. METHODS Anonymous, prospectively collected intraoperative data was merged with database outcomes for 450 patients undergoing major adult cardiac operations. Precursor events were categorized by type, person most affected, severity, and compensation. Number and categories of precursor events were analyzed as predictors of a composite outcome combining death or near miss complications (DNM), using logistic regression. RESULTS Precursor events occurred more frequently in cases with a DNM outcome than in those with no adverse event (2.7 +/- 2.4 vs 2.0 +/- 2.3/procedure, P = .005). After adjustment for other patient characteristics, the number of precursor events remained an independent predictor of DNM (RR, 1.14 per event [1.04 to 1.24]). Of 990 events, 35.6% related to management, 28.8% were technical, and 22.8% were environment-related. The surgeon was most affected in 40.8%, and 16.5% were of major severity. When categories of precursor events were analyzed, major severity events and those most affecting the surgeon were independent predictors of DNM. CONCLUSIONS More detailed study of process in complex operations may lead to improved quality of care and patient safety. Special attention must be paid particularly to high risk patients and high risk precursor events.
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Nuckols TK, Bell DS, Liu H, Paddock SM, Hilborne LH. Rates and types of events reported to established incident reporting systems in two US hospitals. Qual Saf Health Care 2007; 16:164-8. [PMID: 17545340 PMCID: PMC2464990 DOI: 10.1136/qshc.2006.019901] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2007] [Indexed: 11/03/2022]
Abstract
BACKGROUND US hospitals have had voluntary incident reporting systems for many years, but the effectiveness of these systems is unknown. To facilitate substantial improvements in patient safety, the systems should capture incidents reflecting the spectrum of adverse events that are known to occur in hospitals. OBJECTIVE To characterise the incidents from established voluntary hospital reporting systems. DESIGN Observational study examining about 1000 reports of hospitalised patients at each of two hospitals. PATIENTS AND SETTING 16 575 randomly selected patients from an academic and a community hospital in the US in 2001. MAIN OUTCOME MEASURES Rates of incidents reported per hospitalised patient and characteristics of reported incidents. RESULTS 9% of patients had at least one reported incident; 17 incidents were reported per 1000 patient-days in hospital. Nurses filed 89% of reports, physicians 1.9% and other providers 8.9%. The most common types were medication incidents (29%), falls (14%), operative incidents (15%) and miscellaneous incidents (16%); 59% seemed preventable and preventability was not clear for 32%. Among the potentially preventable incidents, 43% involved nurses, 16% physicians and 19% other types of providers. Qualitative examination of reports indicated that very few involved prescribing errors or high-risk procedures. CONCLUSIONS Hospital reporting systems receive many reports, but capture a spectrum of incidents that differs from the adverse events known to occur in hospitals, thereby substantially underdetecting physician incidents, particularly those involving operations, high-risk procedures and prescribing errors. Increasing the reporting of physician incidents will be essential to enhance the effectiveness of hospital reporting systems; therefore, barriers to reporting such incidents must be minimised.
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Armitage G, Newell R, Wright J. Reporting drug errors in a British acute hospital trust. ACTA ACUST UNITED AC 2007. [DOI: 10.1108/14777270710741465] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Education and training are important elements in patient safety, both as a potential contributing factor to risks and hazards of healthcare associated injury or harm and as an intervention to be used in eliminating or preventing such harm. All too often we have relied on training as the only interventions for patient safety without examining other alternatives or realizing that, in some cases, the training systems themselves are part of the problem. One way to ensure safety by design is to apply established design principles to education and training. Instructional systems design (ISD) is a systematic method of development of education and training programs for improved learner performance. The ISD process involves five integrated steps: analysis, development, design, implementation, and evaluation (ADDIE). The application of ISD using the ADDIE approach can eliminate or prevent education and training from being a contributing factor of health associated injury or harm, and can also be effective in preventing injury or harm.
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Affiliation(s)
- J B Battles
- Agency for Healthcare Research and Quality (AHRQ), Center for Quality Improvement and Patient Safety, 540 Gather Road, Rockville, MD 20850, USA.
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Carayon P, Schoofs Hundt A, Karsh BT, Gurses AP, Alvarado CJ, Smith M, Flatley Brennan P. Work system design for patient safety: the SEIPS model. Qual Saf Health Care 2007; 15 Suppl 1:i50-8. [PMID: 17142610 PMCID: PMC2464868 DOI: 10.1136/qshc.2005.015842] [Citation(s) in RCA: 865] [Impact Index Per Article: 50.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Models and methods of work system design need to be developed and implemented to advance research in and design for patient safety. In this paper we describe how the Systems Engineering Initiative for Patient Safety (SEIPS) model of work system and patient safety, which provides a framework for understanding the structures, processes and outcomes in health care and their relationships, can be used toward these ends. An application of the SEIPS model in one particular care setting (outpatient surgery) is presented and other practical and research applications of the model are described.
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Affiliation(s)
- P Carayon
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin 53726, USA.
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Karsh BT, Holden RJ, Alper SJ, Or CKL. A human factors engineering paradigm for patient safety: designing to support the performance of the healthcare professional. Qual Saf Health Care 2007; 15 Suppl 1:i59-65. [PMID: 17142611 PMCID: PMC2464866 DOI: 10.1136/qshc.2005.015974] [Citation(s) in RCA: 220] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The goal of improving patient safety has led to a number of paradigms for directing improvement efforts. The main paradigms to date have focused on reducing injuries, reducing errors, or improving evidence based practice. In this paper a human factors engineering paradigm is proposed that focuses on designing systems to improve the performance of healthcare professionals and to reduce hazards. Both goals are necessary, but neither is sufficient to improve safety. We suggest that the road to patient and employee safety runs through the healthcare professional who delivers care. To that end, several arguments are provided to show that designing healthcare delivery systems to support healthcare professional performance and hazard reduction should yield significant patient safety benefits. The concepts of human performance and hazard reduction are explained.
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Affiliation(s)
- B-T Karsh
- Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA.
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Abstract
Rather than continuing to try to measure the width and depths of the quality chasm, a legitimate question is how does one actually begin to close the quality chasm? One way to think about the problem is as a design challenge rather than as a quality improvement challenge. It is time to move from reactive measurement to a more proactive use of proven design methods, and to involve a number of professions outside health care so that we can design out system failure and design in quality of care. Is it possible to actually design in quality and design out failure? A three level conceptual framework design would use the six quality aims laid out in Crossing the quality chasm. The first or core level of the framework would be designing for patient centered care, with safety as the second level. The third design attributes would be efficiency, effectiveness, timeliness, and equity. Design methods and approaches are available that can be used for the design of healthcare organizations and facilities, learning systems to train and maintain competency of health professionals, clinical systems, clinical work, and information technology systems. In order to bring about major improvements in quality and safety, these design methods can and should be used to redesign healthcare delivery systems.
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Affiliation(s)
- J B Battles
- Agency for Healthcare Research and Quality (AHRQ), Center for Quality Improvement and Patient Safety, 540 Gather Road, Rockville, MD 20850, USA.
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Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients. 1991. Qual Saf Health Care 2007. [PMID: 15933322 DOI: 10.1136/qshc.2002.002972] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients. 1991. Qual Saf Health Care 2007; 14:221-5; discussion 225-6. [PMID: 15933322 PMCID: PMC1744018 DOI: 10.1136/qshc.2002.002972/10.1136/qshc.2005.014522] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Olden PC, McCaughrin WC. Designing healthcare organizations to reduce medical errors and enhance patient safety. Hosp Top 2007; 85:4-9. [PMID: 18171648 DOI: 10.3200/htps.85.4.4-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Medical errors and patient safety are urgent healthcare management challenges. To date, not enough has occurred to provide a systematic organizational design framework for reducing medical errors and improving patient safety. The authors offer such a framework by integrating multiple organizational factors and using well-accepted organization theory, citing relevant empirical research studies of medical errors and patient safety to support specific organizational factors. They discuss organizational design implications and recommendations for healthcare executives.
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Affiliation(s)
- Peter C Olden
- Graduate Health Administration Program, University of Scranton, Pennsylvania, USA
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Battles JB, Dixon NM, Borotkanics RJ, Rabin-Fastmen B, Kaplan HS. Sensemaking of patient safety risks and hazards. Health Serv Res 2006; 41:1555-75. [PMID: 16898979 PMCID: PMC1955349 DOI: 10.1111/j.1475-6773.2006.00565.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In order for organizations to become learning organizations, they must make sense of their environment and learn from safety events. Sensemaking, as described by Weick (1995), literally means making sense of events. The ultimate goal of sensemaking is to build the understanding that can inform and direct actions to eliminate risk and hazards that are a threat to patient safety. True sensemaking in patient safety must use both retrospective and prospective approach to learning. Sensemaking is as an essential part of the design process leading to risk informed design. Sensemaking serves as a conceptual framework to bring together well established approaches to assessment of risk and hazards: (1) at the single event level using root cause analysis (RCA), (2) at the processes level using failure modes effects analysis (FMEA) and (3) at the system level using probabilistic risk assessment (PRA). The results of these separate or combined approaches are most effective when end users in conversation-based meetings add their expertise and knowledge to the data produced by the RCA, FMEA, and/or PRA in order to make sense of the risks and hazards. Without ownership engendered by such conversations, the possibility of effective action to eliminate or minimize them is greatly reduced.
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Affiliation(s)
- James B Battles
- United States Department of Health and Human Services, Agency for Healthcare Quality and Research, Center for Quality Improvement and Patient Safety, 540 Gaither Road, Rockville, MD 20850, USA
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Ginsburg L, Norton PG, Casebeer A, Lewis S. An educational intervention to enhance nurse leaders' perceptions of patient safety culture. Health Serv Res 2005; 40:997-1020. [PMID: 16033489 PMCID: PMC1361187 DOI: 10.1111/j.1475-6773.2005.00401.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To design a training intervention and then test its effect on nurse leaders' perceptions of patient safety culture. STUDY SETTING Three hundred and fifty-six nurses in clinical leadership roles (nurse managers and educators/CNSs) in two Canadian multi-site teaching hospitals (study and control). STUDY DESIGN A prospective evaluation of a patient safety training intervention using a quasi-experimental untreated control group design with pretest and posttest. Nurses in clinical leadership roles in the study group were invited to participate in two patient safety workshops over a 6-month period. Individuals in the study and control groups completed surveys measuring patient safety culture and leadership for improvement prior to training and 4 months following the second workshop. EXTRACTION METHODS Individual nurse clinical leaders were the unit of analysis. Exploratory factor analysis of the safety culture items was conducted; repeated-measures analysis of variance and paired t-tests were used to evaluate the effect of the training intervention on perceived safety culture (three factors). Hierarchical regression analyses looked at the influence of demographics, leadership for improvement, and the training intervention on nurse leaders' perceptions of safety culture. PRINCIPAL FINDINGS A statistically significant improvement in one of three safety culture measures was shown for the study group (p<.001) and a significant decline was seen on one of the safety culture measures for the control group (p<.05). Leadership support for improvement was found to explain significant amounts of variance in all three patient safety culture measures; workshop attendance explained significant amounts of variance in one of the three safety culture measures. The total R(2) for the three full hierarchical regression models ranged from 0.338 and 0.554. CONCLUSIONS Sensitively delivered training initiatives for nurse leaders can help to foster a safety culture. Organizational leadership support for improvement is, however, also critical for fostering a culture of safety. Together, training interventions and leadership support may have the most significant impact on patient safety culture.
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Affiliation(s)
- Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, ON, Canada
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Battles JB, Wilkinson SL, Lee SJ. Using standardised patients in an objective structured clinical examination as a patient safety tool. Qual Saf Health Care 2004. [PMID: 15465955 DOI: 10.1136/qshc.2004.009803] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Standardised patients (SPs) are a powerful form of simulation that has now become commonplace in training and assessment in medical education throughout the world. Standardised patients are individuals, with or without actual disease, who have been trained to portray a medical case in a consistent manner. They are now the gold standard for measuring the competence of physicians and other health professionals, and the quality of their practice. A common way in which SPs are used in performance assessment has been as part of an objective structured clinical examination (OSCE). The use of an SP based OSCE can be a powerful tool in measuring continued competence in human reliability and skill performance where such skills are a critical attribute to maintaining patient safety. This article will describe how an OSCE could be used as a patient safety tool based on cases derived from actual events related to postdonation information in the blood collection process. The OSCE was developed as a competency examination for health history takers. Postdonation information events in the blood collection process account for the majority of errors reported to the US Food and Drug Administration. SP based assessment is an important patient safety tool that could be applied to a variety of patient safety settings and situations, and should be considered an important weapon in the war on medical error and patient harm.
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Affiliation(s)
- J B Battles
- University of Texas Southwestern Medical Center at Dallas, USA.
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