Reporting of Clinical Adverse Events Scale: a measure of doctor and nurse attitudes to adverse event reporting

The Relationship between Clinical Environment and Adverse Events Reporting: Evidence from Lithuania

BACKGROUND

The clinical environment plays a crucial role in patient safety, as it encompasses the physical, organizational, and cultural aspects of healthcare delivery. Adverse events, such as active errors, can often be attributed to systemic issues within the clinical environment. Addressing and improving environmental factors is essential for minimizing adverse events and enhancing overall patient care quality.

METHODS

A descriptive, cross-sectional design was applied. The study utilized two questionnaires: the Reporting of Clinical Adverse Events Scale (RoCAES) and the Revised Professional Practice Environment (RPPE) scale. A total of 1388 questionnaires were fully filled out, with a response rate of 71 percent.

RESULTS

Nurses who expressed higher levels of satisfaction with various aspects of the clinical environment were more inclined to indicate their intention to report adverse events in the future. These positive relationships suggest that a contented clinical environment fosters a greater willingness among nurses to report adverse event occurrences.

CONCLUSION

The findings of our study support the evidence that demonstrated that the clinical environment plays a significant role in influencing the reporting of adverse events in healthcare settings. It significantly influences nurses' attitudes, quality of care, and adverse event reporting rate.

Attitudes of Internal Medicine Nurses, Surgical Nurses and Midwives towards Reporting of Clinical Adverse Events

Understanding the attitudes of medical staff contributes to shaping a culture of safety in health care. The aim of this study was the measurement of attitudes of nurses and midwives towards reporting clinical adverse events. Various research tools were used, including the Reporting of Clinical Adverse Events Scale (RoCAES; Polish: P-RoCAES), the Justice Sensitivity Inventory, the Feelings in Moral Situations Scale, the Perceived Stress at Work Scale and the Author's Survey Questionnaire. The cross-sectional survey was conducted from October 2022 to April 2023. The study used assessment-based sampling. The study included 745 midwives and nurses working in internal medicine-surgical wards in nine hospitals in a large provincial city in Poland. One-way analysis of variance ANOVA, post hoc test (Fisher's NIR), and r-Spearman correlation test were used. The level of significance (p) did not exceed 0.05. Respondents did not differ in terms of sensitivity to justice, moral feelings, and perceived stress at work, all of which variables were at moderate levels. Respondents' attitudes towards reporting clinical adverse events in the P-RoCAES were positive (surgical nurses 71.10; internal medicine nurses 72.04; midwives 71.26; F(2.741) = 1.14, p = 0.319), especially those with a master's degree, longer work experience and older age. Respondents with a master's degree were most likely to perceive a benefit from reporting adverse events (P-RoCAES subscale) (F(2.737) = 8.45, p = 0.001). The longer employment tenure (F(3.716) = 4.63, p = 0.003) and having a master's degree (F(2.737) = 3.10, p = 0.045) were associated with a higher feeling of guilt among the respondents (P-RoCAES subscale). The longer the participants worked, the more positive their attitude became towards the importance of transparency in procedures (F(2.741) = 3.56, p = 0.029), but the more negative their attitude was towards the benefits of reporting adverse events (P-RoCAES subscale) (r(686) = -0.08, p = 0.037). Individual attitudes of nurses and midwives as well as their age, length of service or education can influence the formation of a culture of safety in health care (including the reporting of clinical adverse events). Attitudes can motivate corrective action, can be reinforced and shaped by educational programs, good quality management and monitoring system solutions.

Comparison of Perceptions About Patient Safety Culture Between Physicians and Nurses in Public Hospitals in Vietnam

Introduction

Patient safety culture (PSC) is a vital component in ensuring high-quality and safe patient care. Assessment of physicians' and nurses' perceptions of existing hospital PSC is the first step to promoting PSC. This paper is aimed to assess physicians' and nurses' perceptions of PSC in 5 public general hospitals in Hanoi, Vietnam.

Methods

This cross-sectional study surveyed 410 physicians and 824 nurses utilizing the validated Hospital Survey on Patient Safety Culture in an online format.

Results

The composite positive physician's perception of PSC varied from 47.8 to 89.6% with the lowest composite score of patient safety for "staffing" (47.8%) and the highest composite score for "teamwork within units" (89.6%). The composite positive responses for perception among nurses varied from 51.3 to 94.2% with the lowest composite score of patient safety for "staffing" (51.3%) and the highest composite score for "teamwork within units" (94.2%).

Conclusion

The mean scores for "supervisor/manager expectations"; "staffing", "management support for patient safety", "teamwork across units", "handoffs and transitions" among nurses were significantly higher than that among physicians (p<0.05). About two-thirds of physicians and nurses reported no event in the past 12 months (62.8 and 71.7%, respectively). The nurses reported significantly higher patient grades (every good and excellent) than physicians (75% vs 67.1%, p <0.001). Hospitals could develop and implement intervention programs to improve patient safety, including providing interventions on teamwork and communication, encouraging staff to notify incidents, and avoiding punitive responses.

Effect of Patient Safety Training Program of Nurses in Operating Room

PURPOSE

This study developed an in-service training program for patient safety and aimed to evaluate the impact of the program on nurses in the operating room (OR).

METHODS

A pretest-posttest self-controlled survey was conducted on OR nurses from May 6 to June 14, 2020. An in-service training program for patient safety was developed on the basis of the knowledge-attitude-practice (KAP) theory through various teaching methods. The levels of safety attitude, cognition, and attitudes toward the adverse event reporting of nurses were compared to evaluate the effect of the program. Nurses who attended the training were surveyed one week before the training (pretest) and two weeks after the training (posttest).

RESULTS

A total of 84 nurses participated in the study. After the training, the scores of safety attitude, cognition, and attitudes toward adverse event reporting of nurses showed a significant increase relative to the scores before the training (p < .001). The effects of safety training on the total score and the dimensions of safety attitude, cognition, and attitudes toward nurses' adverse event reporting were above the moderate level.

CONCLUSION

The proposed patient safety training program based on KAP theory improves the safety attitude of OR nurses. Further studies are required to develop an interprofessional patient safety training program. In addition to strength training, hospital managers need to focus on the aspects of workflow, management system, department culture, and other means to promote safety culture.

An Intervention to Optimize Attitudes Toward Adverse Events Reporting Among Tunisian Critical Care Nurses

OBJECTIVE

This study aimed at evaluating the impact of a combined-strategies intervention on ICUs nurses' attitudes toward AE reporting.

METHODS

We conducted a quasi-experimental study from January to October 2020 which consisted of an intervention to improve attitudes toward incident reporting among nurses working in 10 intensive care units at a university hospital using the Reporting of Clinical Adverse Events Scale. The intervention consisted of a 2-hour educational presentation for nurse unit managers and a 30-minute in-units educational training for intensive care unit nurses, which encompassed technical aspects of reporting, the reporting process, a nonpunitive environment, and the importance of submitting reports. The educational presentation was reinforced with distributing posters and brochures and biweekly patient safety rounds that inquired about events, reinforced education, and provided follow-up to incident reports.

RESULTS

All dimensions were significantly improved. Score increased from 27.4% to 42.1% ( P < 0.01) for perceived blame, from 35.2% to 52.5% for perceived criteria for identifying events that should be reported ( P < 0.01), from 34.3% to 46% for perceptions of colleagues' expectations ( P = 0.04), from 37.1% to 51.4% for perceived benefits of reporting ( P = 0.01), and from 29.2% to 51.4% for perceived clarity of reporting procedures ( P < 0.01).

CONCLUSIONS

Interventions using a combination of several strategies such as training, safety round, and messaging can be effective and should be considered by hospitals attempting to increase adverse events reporting. Results reinforce the assumption that a nonpunitive environment and the resulting feeling of safety and reassurance are crucial to foster the submission of reports.

Analysis of Factors Influencing Safety Attitudes of Operating Room Nurses and Their Cognition and Attitudes toward Adverse Event Reporting

Operating room nurses play a critical role in patient safety. The evaluation of safety attitudes of operating room nurses reflects their awareness and belief of patient safety. Currently, however, the research on the safety attitudes of operating room nurses is hard to track in the existing literature in China. Therefore, this paper was conducted to explore the factors influencing the safety attitudes of operating room nurses and their cognition and attitudes toward adverse event reporting. A total of 711 operating room nurses from 16 tertiary hospitals in Sichuan Province from March 1, 2018, to 2019 were selected. The general information of operating room nurses, such as age, gender, and years of service in the operating room, was obtained through the basic information questionnaire. The Chinese version of the Safety Attitudes Questionnaire (C-SAQ) was used to evaluate the safety attitude of operating room nurses, and the cognition and attitude of the subjects to adverse event reports were assessed through the questionnaire of cognition and attitude toward adverse event reporting. The average score of safety attitudes of operating room nurses was 4.20 ± 0.49. The two dimensions with a lower positive reaction rate of the safety attitudes of operating room nurses were stress recognition and working conditions. The main factors affecting the safety attitude of operating room nurses were night shifts, as well as cognition and attitudes toward adverse event reporting. There was a positive correlation between the total score of C-SAQ and the total score of cognition and attitudes toward adverse event reporting (P < 0.01, r = 0.445). The safety attitude of operating room nurses is at the upper-middle level, but the stress recognition and working conditions need to be improved. Through the allocation of nursing human resources, the strengthening of hospital logistics support, and the establishment of nonpunitive nursing adverse event reporting system, the operating room safety can be significantly enhanced.

Investigating Barriers to Accident Precursor Reporting in East Azerbaijan Gas Company from the Perspective of HSE Officers - A Qualitative Study

BackgroundInvestigating the root causes of under-reporting these cases is very important. The aim of this study was investigating barriers to near-misses reporting in East Azerbaijan Gas Company from the perspective of Health, Safety and Environment (HSE) officers.MethodsThe semi-structured individual interviews were used and 21 interviews were conducted with HSE officers. Inductive content analysis was used for analyzing interviews. After analyzing the interviews, the codes in the interviews were categorized.ResultsIn general, two categories of code were created: 1- Reasons for non-reporting of accident precursors 2- Suggested solutions to improve the reporting system of accident precursors. However, two main categories were found for not reporting: individual reasons such as lack of commitment to the job, lack of attention to social responsibility, forgetfulness and laches in reporting etc and organization reasons such as job instability among employees, lack of sufficient training, Failure to provide feedback by the organization etc.ConclusionIn this study, it was found that the opinions of people working in the organization can be very effective in promoting reporting, so any organization can choose the appropriate strategy to increase the number and quality of reports by examining the opinions of managers, HSE officers and workers working in the organization.

An assessment of the reliability and validity of the Chinese version of the Reporting of Clinical Adverse Events Scale for nursing interns: A cross-cultural adaptation of scales and online investigation

AIM

The Reporting of Clinical Adverse Events Scale is a tool for evaluating the attitudes of medical staff toward reporting adverse events in clinical practice. This study aimed to assess the reliability and validity of the Reporting of Clinical Adverse Events Scale translated into Chinese used with trainee nurses in mainland China.

DESIGN

The Chinese version of the Reporting of Clinical Adverse Events Scale was developed following guidelines for the cross-cultural adaptation of self-reporting measures.

METHODS

The reliability and validity of the Chinese version of the Reporting of Clinical Adverse Events Scale was tested on 773 nursing interns by online investigation. Confirmatory factor analysis was performed on 350 questionnaires completed by the participants while exploratory factor analysis was performed on 423 questionnaires to test the structural validity of the scale.

RESULTS

There were 23 items included in the Chinese version of the Reporting of Clinical Adverse Events Scale. The Cronbach's α-coefficient for the internal consistency of the total score was found to be 0.84 with a test-retest reliability value of 0.82, indicating a high level of reliability. Five common factors were extracted. The structural validity on the Kaiser-Meyer-Olkin test was 0.87 and the contribution rate of cumulative variance was 58.51%. The content validity values ranged between 0.86 and 1.00.

CONCLUSION

The Chinese version of the Reporting of Clinical Adverse Events Scale is a valid and reliable tool for evaluating nursing interns' attitudes toward reporting clinical adverse events in China. This validation of the Chinese version of the scale also extends the use of the scale to a different population.

TWEETABLE ABSTRACT

Nursing interns are responsible for a relatively high incidence of adverse events and their attitude to reporting these is crucial to patient safety. The Chinese version of the Reporting of Clinical Adverse Events Scale will be helpful for evaluating the reporting attitude of nursing interns.

The Cutaneous Procedures Adverse Events Reporting (CAPER) Registry

The CAPER Registry is a voluntary, national safety reporting program that gathers patients' adverse events encountered during dermatologic procedures. This registry is intended as an aid for practitioners, patients, industry, and government regulators, and aims to facilitate safety monitoring for the specialty by identifying resource, process, education, and other systemic gaps associated with adverse events, as well as any potential risk factors for adverse events. CAPER will provide new or corroborating information to help dermatologists improve clinical practices, improve safety and effectiveness, and treat and prevent adverse events. The data generated will also help industry partners and regulatory bodies prevent adverse events from going unnoticed.

Willingness to Report Medical Incidents in Healthcare: a Psychological Model Based on Organizational Trust and Benefit/Risk Perceptions

Many healthcare organizations have incident reporting systems to reduce and prevent medical errors. However, many systems have failed or not been implemented due to medical professionals' reluctance to report errors made by themselves or others. This study investigated the factors influencing their willingness to report incidents voluntarily. A psychological model based on the trust heuristic was proposed, hypothesizing that organizational trust could affect willingness to report based on the perceived benefits and risks of incident reporting or directly influence willingness to report. Three hundred twenty participants were recruited from 19 provinces in China to participate in an online survey conducted between June and July 2018. Participants included doctors, nurses, medical technicians, medical service staff, and administrative staff from different hospitals. All had access to incident reporting systems. Partial least squares structural equation modeling (PLS-SEM) was applied to examine the proposed psychological model. Participants had a modest willingness of reporting. Organizational trust was found to, directly and indirectly, affect participants' willingness to report their own incidents. Compared with perceived risk, perceived benefit was a more important predictor for willingness of reporting and a more important mediator in the effect of organizational trust on willingness of reporting. Our results highlight the importance of increasing the perceived benefit from incident reporting and building a "trust culture" for improving incident reporting.

German translation and validation of the Reporting of Clinical Adverse Events Scale (RoCAES-D)

Background

Reporting of adverse events is an important aspect of patient safety management in hospitals, which may help to prevent future adverse events. Yet, only a small proportion of such events is actually reported in German hospitals. Therefore, it is crucial to evaluate attitudes of clinical staff towards reporting of adverse events. The aim of this study was to translate the Reporting of Clinical Adverse Events Scale (RoCAES) developed by Wilson, Bekker and Fylan (2008) and validate it in a sample of German-speaking health professionals.

Methods

The questionnaire covers five factors (perceived blame, perceived criteria for identifying events that should be reported, perceptions of colleagues’ expectations, perceived benefits of reporting, and perceived clarity of reporting procedures) and was translated into German language according to translation guidelines. Within a cross-sectional study in a sample of 120 health professionals in German hospitals, internal consistency (omega) and construct validity (confirmatory factor analysis) of the German scale RoCAES-D was assessed.

Results

The reliability was high (omega = 0.87) and the factor analysis showed a poor model fit (RMSEA: 0.074, χ²/df: 1.663, TLI: 0.690). Resulting from lower model fit of the original model (RMSEA: 0.082, χ²/df: 1.804, TLI: 0.606), one item was deleted due to low factor loadings and a low R² (0.001), and two items were reallocated from the factor ‘perceived benefits’ to ‘perceived blame’.

Conclusion

The successful translation and initial validation of the RoCAES-D might be a good starting point for further research. A cultural adaptation of the scale needs to be done to initiate a large-scale usage of the questionnaire.

Physicians' and Nurses' Perceptions of and Attitudes Toward Incident Reporting in Palestinian Hospitals

OBJECTIVES

Underreporting of incidents that happen in health care services undermines the ability of the systems to improve patient safety. This study assessed the attitudes of physicians and nurses toward incident reporting and the factors influencing reporting in Palestinian hospitals. It also examined clinicians' views about the preferred features of incident reporting system.

METHODS

Cross-sectional self-administered survey of 475 participants, 152 physicians and 323 nurses, from 11 public hospitals in the West Bank; response rate, 81.3%.

RESULTS

There was a low level of event reporting among participants in the past year (40.3%). Adjusted for sex and age, physicians were 2.1 times more likely to report incidents than nurses (95% confidence interval, 1.32-3.417; P = 0.002). Perceived main barriers for reporting were grouped under lack of proper structure for reporting, prevalence of blame, and punitive environment. The clinicians indicated fear of administrative sanctions, social and legal liability, and of their competence being questioned (P > 0.05). Getting help for patients, learning from mistakes, and ethical obligation were equally indicated motivators for reporting (P > 0.05). Meanwhile, clinicians prefer formal reporting (77.8%) of all type of errors (65.5%), disclosure of reporters (52.7%), using reports to improve patient safety (80.3%), and willingness to report to immediate supervisors (57.6%).

CONCLUSION

Clinicians acknowledge the importance of reporting incidents; however, prevalence of punitive culture and inadequate reporting systems are key barriers. Improving feedback about reported errors, simplifying procedures, providing clear guidelines on what and who should report, and avoiding blame are essential to enhance reporting. Moreover, health care organizations should consider the opinions of the clinicians in developing reporting systems.

Medical Error Reporting: Status Quo and Perceived Barriers in an Orthopedic Center in Iran

Background:

Medical error reporting is fundamental for improving patient safety. We surveyed healthcare professionals to evaluate their experience of adverse events witness and reporting, knowledge about adverse events, attitude toward own and colleagues' errors, and perceived barriers in reporting errors.

Methods:

This cross-sectional study was conducted on healthcare professionals from May to October 2017 at Chamran hospital, which is the largest referral orthopedic center in southern Iran. The self-administered questionnaire comprised 32 items covering five domains: (1) demographic and professional characteristics, (2) medical error witness and reporting, (3) actual and perceived knowledge regarding type of events and the status of completed training courses, (4) attitude toward reporting one's own and colleagues' errors, and (5) perceived barriers in error reporting. Questionnaire validity and reliability was proven in our previous study.

Results:

From a total of 210 participants, 164 returned completed questionnaires (response rate = 78.1%); 87 (53%) were physicians and 77 (47%) were nurses. Underreporting was common, particularly among physicians. Out of physicians and nurses, 57.1% and 49.4% had poor knowledge, respectively. Participants reported their own or colleagues' errors alike, but physicians tended to only provide verbal warning to their colleagues (36.8%), and nurses stated they would report the colleagues' errors, if it was serious (32.4%). Fear of blame and punishment and fear of legal ramification were the most important perceived barriers.

Conclusions:

Improvements in current medical error registry system, implementing effective educational courses, and modifying the curricula for students seem to be necessary to resolve the problem of underreporting and poor knowledge level.

Using a Second Stakeholder-Driven Variance Reporting System Improves Pediatric Perioperative Safety

Despite recognizing the occurrence of variances, we noted a low rate of reporting with the established computer variance program. Therefore, we developed and introduced a simple, handwritten variance reporting system. The goal of this study was to compare our pediatric perioperative handwritten variance cards to our established computerized variance reporting system.

Methods

We developed a handwritten variance card program through a stakeholder-driven quality-improvement initiative. We collected variances from handwritten cards in 4 perioperative locations and also from the established computerized variance system. We analyzed the variances and categorized them into 6 safety domains and 5 variance categories.

Results

Over 6 consecutive years, 3,434 variances were reported (687 computerized and 2,747 handwritten). For safety domains, the computerized system was more likely to capture adverse events and near-misses (8.7% vs. 1.1%, P < 0.001; 23.5% vs. 8.6%, P < 0.001, respectively) while the handwritten system was more likely to identify the safety process and other non-safety issues (20.1% vs. 38.3%, P < 0.001). Both systems addressed policy/process issues most often, with 37.9% of the handwritten cards and 66.6% of the computerized variance reports. Of the handwritten cards with a patient identifier (n = 1,407), only 5.1% (n = 72) also had a computerized variance filed about the same event. Thus, staff reported >1,300 additional variances that were not identified with the computerized variance system alone.

Conclusion

The handwritten, stakeholder-driven variance reporting system was essential to identify local and system issues that would not have been identified by the computerized variance reporting system alone.

The co-design, implementation and evaluation of a serious board game 'PlayDecide patient safety' to educate junior doctors about patient safety and the importance of reporting safety concerns

BACKGROUND

We believe junior doctors are in a unique position in relation to reporting of incidents and safety culture. They are still in training and are also 'fresh eyes' on the system providing valuable insights into what they perceive as safe and unsafe behaviour. The aim of this study was to co-design and implement an embedded learning intervention - a serious board game - to educate junior doctors about patient safety and the importance of reporting safety concerns, while at the same time shaping a culture of responsiveness from senior medical staff.

METHODS

A serious game based on the PlayDecide framework was co-designed and implemented in two large urban acute teaching hospitals. To evaluate the educational value of the game voting on the position statements was recorded at the end of each game by a facilitator who also took notes after the game of key themes that emerged from the discussion. A sample of players were invited on a voluntary basis to take part in semi-structured interviews after playing the game using Flanagan's Critical Incident Technique. A paper-based questionnaire on 'Safety Concerns' was developed and administered to assess pre-and post-playing the game reporting behaviour. Dissemination workshops were held with senior clinicians to promote more inclusive leadership behaviours and responsiveness to junior doctors raising of safety concerns from senior clinicians.

RESULTS

The game proved to be a valuable patient safety educational tool and proved effective in encouraging deep discussion on patient safety. There was a significant change in the reporting behaviour of junior doctors in one of the hospitals following the intervention.

CONCLUSION

In healthcare, limited exposure to patient safety training and narrow understanding of safety compromise patients lives. The existing healthcare system needs to value the role that junior doctors and others could play in shaping a positive safety culture where reporting of all safety concerns is encouraged. Greater efforts need to be made at hospital level to develop a more pro-active safe and just culture that supports and encourages junior doctors and ultimately all doctors to understand and speak up about safety concerns.

[The vision of nursing provided by Léonie Chaptal: a strategic mistake in the development of nursing science in France ?]

The issue of the development of the discipline displayed by nursing sciences in France is crucial, especially since the Law of Modernization of the Health System has established a legal framework for advanced practice since 2016. This article presents a discussion on the important role that Léonie Chaptal has played in the development of nursing care in France, based on a purely professional vision, guaranteeing the subordination of the nurses to the medical physicians the in the spirit of the law of November 30, 1892 which had established a stranglehold of medical profession on health. We have drawn from this discussion some lessons that we consider essential for the future development of a true discipline of nursing in France, in the context of the deep organizational transformation initiated by the health system.

Factors contributing to voluntariness of incident reporting among hospital nurses

PURPOSE

This study aimed to (a) test the hypothesized model for hospital nurses' voluntariness of incident reporting (VIR) and (b) determine the extent to which reporting culture factors, nursing safety practices and perceptions of work predict VIR.

DESIGN AND METHODS

A cross-sectional survey was applied to 1,380 frontline nurses recruited from six teaching hospitals in Taiwan. Data were collected using self-administered questionnaires. Correlation analyses and path analyses using structured equation modelling were used.

FINDINGS

More than half of the nurses did not display a voluntary attitude towards reporting. VIR was correlated with factors of reporting culture, nursing safety practices and perceptions of work. Through path analyses, the safety practices mediated on the relationship between the reporting culture and VIR.

CONCLUSIONS

Nurses still have modest willingness of reporting. The factors of reporting culture and nursing safety practices are critical determinants of VIR. Within more behavioural involvement in the safety practices, the reporting culture can support nurses to report voluntarily.

IMPLICATIONS FOR NURSING MANAGEMENT

Strengthening nurses' engagement in safety practices can advance the reporting voluntariness and agreement with reporting culture concurrently. Nurse leaders should continue to optimize workload management and job satisfaction, which is advantageous to the safety practices enacted.

Patient safety culture among nurses at a tertiary government hospital in the Philippines

AIM

To assess the patient safety culture (PSC) among nurses at a government hospital BACKGROUND: Culture of patient safety is acknowledged as a critical component to the quality of health care. Despite the increasing curiosity on PSC, little studies are available in the Philippine context.

METHODS

A descriptive, cross-sectional, single-center study using total population sampling technique was conducted. PSC was assessed using the Hospital Survey on Patient Safety Culture (HSOPSC) among Registered Nurses. Descriptive statistics were employed to express demographic data and composites of safety culture.

RESULTS

292 nurses completed the survey, yielding a response rate of 86.65%. Of the 12 composites evaluated, Teamwork within Units (91.50%) was the highest positively-rated followed by Organizational Learning - Continuous Improvement (86.89%) while Nonpunitive Response to Error (17.65%) was the least positively-rated. Most (71.48%) of the respondents had not reported any event within the past 12 months. Majority (45%) reported that the overall patient safety grade of the hospital was very good and no one thought that it was failing.

CONCLUSIONS

This study showed that nurses value Teamwork within Units and Organizational Learning-Continuous Improvement as important aspects of PSC. Nonpunitive Response to Error was the area that requires improvement. Determining PSC level should be a continuous process. The first step should be obtaining the support of the administration and assuming a non-punitive approach to those who make and report medical errors. If the problem of personnel not reporting events is to be resolved, any barriers to reporting should be identified and addressed.

Is imperfection becoming easier to live with for doctors?

OBJECTIVE

Being involved in serious patient injury is devastating for most doctors. During the last two decades, several efforts have been launched to improve Norwegian doctors' coping with adverse events and complaints.

METHODS

The method involved survey to a representative sample of 1792 Norwegian doctors in 2012. The questions on adverse events and its effects were previously asked in 2000.

RESULTS

Response rate was 71%. More doctors reported to have been involved in episodes with serious patient harm in 2012 (35%) than in 2000 (28%), and more of the episodes were reported as required by law. Doctors below age 50 report better support from colleagues, more collegial retrospective discussion on the event and less patient/family blame. In all, 27% of the doctors had been reported to the Norwegian Board of Health Supervision; 79% of these complaints were rejected; 73% of the doctors who had received a reaction from the health authorities found the reaction reasonable, but almost one out of five practiced more testing and referrals after a complaint and 25% claimed that the complaint had made them into a more fearful doctor.

CONCLUSION

Our results indicate that adverse events are being met more openly in 2012 than in 2000, and that coping with imperfection and patient complaints is less devastating for new generations of doctors.

Pharmacovigilance practices for better healthcare delivery: knowledge and attitude study in the national malaria control programme of India

Objective. With large scale rollout of artemisinin based therapy in the National Malaria Control Programme of India, a risk management plan is needed. This depends on adverse drug reaction (ADR) reporting by the healthcare professionals (HCPs). For the programme to be successful, an understanding of the mindset of HCPs is critical. Hence, the present study was designed to assess and compare the ADR reporting beliefs of HCPs involved in the National Malaria Control Programme of India. Methods. A cross–sectional survey was conducted amongst the HCPs who manage malaria up to the district level in India. A 5-point Likert scale-based questionnaire was developed as a study tool. Results. A total of 154 HCPs participated in the study (age: 42.4 ± 10.1 years with 33.8% being females). About 61% felt that only medically qualified HCPs are responsible for ADR reporting. Likeliness to report in future was mentioned by 45% HCPs. The knowledge score was relatively lower for life science graduates (P = 0.09). Knowledge correlated positively with attitude (r² = 0.114; P < 0.0001). Conclusion. Based on the caveats identified, a specific and targeted in-service education with hands-on training on ADR monitoring and reporting needs to be designed to boost real time pharmacovigilance in India.

A survey of attitude of frontline clinicians and nurses towards adverse events

BACKGROUND

It is often said that doctors are only human. However, technological wonders, apparent precision of diagnostic tests and scientific innovation have created an expectation of perfection from medical science. Patient safety and prevalence of adverse events on the hospital floor have become issues of serious concern for the healthcare environment.

METHOD

The study had cross-sectional design, done over a period of one year at a teaching medical college and its affiliated hospitals. The study instrument was an anonymous, voluntary 5-point Likert scaled questionnaire and study sample was selected by simple random sampling into two groups of front-line clinicians (n = 175) and nurses (n = 60). The questionnaire was analysed for its reliability, construct and content validity. Subsequently, the data was entered into an Excel Spreadsheet and further analysed by statistical software SPSS version 16.

RESULTS

Total of 175 front-line clinicians and 60 nurses completed the survey for response rate of 96%. The study instrument was suitably validated for its psychometric properties. Statistically significant differences were observed between the two study samples across certain attitudinal statements, the important ones being responsibility for reporting and comfort level towards disclosing adverse events. Surgical site infections, Medication errors and Patient Falls were the commonly observed adverse events and lack of communication among team members was identified as a major factor leading to adverse events.

CONCLUSION

Effective attitude-based interventions need to be developed, where the attitude and culture of front-line healthcare workers can be explicitly targeted for inducing desirable behavioural changes towards improved patient safety.

Assessment of patient safety culture in Palestinian public hospitals

OBJECTIVE

To assess the prevalent patient safety culture in Palestinian public hospitals.

DESIGN

A cross-sectional design, Arabic translated version of the Hospital Survey on Patient Safety Culture was used.

SETTING

All the 11 general public hospitals in the West Bank.

PARTICIPANTS

A total of 1460 clinical and non-clinical hospital staff.

INTERVENTION(S)

No.

MAIN OUTCOME MEASURES

Twelve patient safety culture composites and 2 outcome variables (patient safety grade and events reported in the past year) were measured.

RESULTS

Most of the participants were nurses and physicians (69.2%) with direct contact with patients (92%), mainly employed in medical/surgical units (55.1%). The patient safety composites with the highest positive scores were teamwork within units (71%), organizational learning and continuous improvement (62%) and supervisor/manager expectations and actions promoting patient safety (56%). The composites with the lowest scores were non-punitive response to error (17%), frequency of events reported (35%), communication openness (36%), hospital management support for patient safety (37%) and staffing (38%). Although 53.2% of the respondents did not report any event in the past year, 63.5% rated patient safety level as 'excellent/very good'. Significant differences in patient safety scores and outcome variables were found between hospitals of different size and in relation to staff positions and work hours.

CONCLUSIONS

This study highlights the existence of a punitive and blame culture, under-reporting of events, lack of communication openness and inadequate management support that are key challenges for patient safe hospital care. The baseline survey results are valuable for designing and implementing the patient safety program and for measuring future progress.