Incidents reporting: barriers and strategies to promote safety culture

Perception of the safety culture in a critical area

INTRODUCTION

Critical care Area (CCA) is one of the most complex in the hospital system, requiring a high number of interventions and handling of amounts of information. Therefore, these areas are likely to experience more incidents that compromise patient safety (PS).

AIM

To determine the perception of the healthcare team in a critical care area about the patient safety culture.

METHOD

Cross-sectional descriptive study, September 2021, in a polyvalent CCA with 45 beds, 118 health workers (physicians, nurses, auxiliary nursing care technicians). Sociodemographic variables, knowledge of the person in charge in PS and their general training in PS and incident notification system were collected. The validated Hospital Survey on Patient Safety Culture questionnaire, measuring 12 dimensions was used. Positive responses with an average score ≥75%, were defined as an area of strength while ≥50% negative responses were defined as an area of weakness. Descriptive statistics and bivariate analysis: X2 and t-Student tests, and ANOVA. Significance p ≤ 0.05.

RESULTS

94 questionnaires were collected (79.7% sample). The PS score was 7.1 (1.2) range 1-10. The rotational staff scored the PS with 6.9 (1.2) compared to 7.8 (0.9) for non-rotational staff (p = 0.04). A 54.3% (n = 51) was familiar with the incident reporting procedure, 53% (n = 27) of which had not reported any in the last year. No dimension was defined as strength. There were three dimensions that behaved like a weakness: security perception: 57.7% (95% CI: 52.7-62.6), staffing: 81.7% (95% CI: 77.4-85.2) and management support: 69 .9% (95% CI: 64.3-74.9).

CONCLUSIONS

The assessment of PS in the CCA is moderately high, although the rotational staff has a lower appreciation. Half of the staff do not know the procedure for reporting an incident. The notification rate is low. The weaknesses detected are perception of security, staffing and management support. The analysis of the patient safety culture can be useful to implement improvement measures.

The effect of refresher training on fact description in medical incident report writing in the Japanese language

To maintain the effectiveness of the training (1st-Training Session: 1st-TS) to accurate describe facts in the medical incident reports (IRs) in Japanese, a refresher TS was designed and its effectiveness was examined. First, textual analysis showed that IRs' accuracy significantly decreased six months after the 1st-TS. Based on this result, the refresher TS was designed and conducted with 64 residents. To verify the refresher TS' effectiveness, IRs after the 1st-TS, six months later, and after the refresher TS were compared via text analysis. The results showed that the refresher TS restored the description rate of patient's background, safety check procedures, original work procedures, information on equipment used, reporter's actions, and post-incident response. The questionnaire was also administered and showed that the refresher TS contributed to residents' motivation to learn about IRs. In conclusion, the refresher TS contributed to sustaining the effect of the 1st-TS on accurately describing IRs.

Barriers and facilitators to improving patient safety learning systems: a systematic review of qualitative studies and meta-synthesis

BACKGROUND

The implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although substantial efforts have sought to improve these systems, there is a need to more comprehensively understand critical success factors. This study aims to summarise the barriers and facilitators perceived by hospital staff and physicians to influence the reporting, analysis, learning and feedback within PSLS in hospitals.

METHODS

We performed a systematic review and meta-synthesis by searching MEDLINE (Ovid), EMBASE (Ovid), CINAHL, Scopus and Web of Science. We included English-language manuscripts of qualitative studies evaluating effectiveness of the PSLS and excluded studies evaluating specific individual adverse events, such as systems for tracking only medication side effects, for example. We followed the Joanna Briggs Institute methodology for qualitative systematic reviews.

RESULTS

We extracted data from 22 studies, after screening 2475 for inclusion/exclusion criteria. The included studies focused on reporting aspects of the PSLS, however, there were important barriers and facilitators across the analysis, learning and feedback phases. We identified the following barriers for effective use of PSLS: inadequate organisational support with shortage of resources, lack of training, weak safety culture, lack of accountability, defective policies, blame and a punitive environment, complex system, lack of experience and lack of feedback. We identified the following enabling factors: continuous training, a balance between accountability and responsibility, leaders as role models, anonymous reporting, user-friendly systems, well-structured analysis teams, tangible improvement.

CONCLUSION

Multiple barriers and facilitators to uptake of PSLS exist. These factors should be considered by decision makers seeking to enhance the impact of PSLS.

ETHICS AND DISSEMINATION

No formal ethical approval or consent were required as no primary data were collected.

Training residents in medical incident report writing to improve incident investigation quality and efficiency enables accurate fact gathering

We assessed whether training on writing readable and accurate medical incident reports (IRs) improves the quality of fact description. In this training, 124 residents created fictional IRs. We provided tips, including using When, Where, Who, What, Why, How. We compared the fictional IRs with and without tips, and the trainees' and non-trainees' IRs submitted in the first five months after training. Results indicated that the subject words in IRs were more clarified and the readability was improved. The fictional IRs using tips were more accurate, with increased descriptions of the patient's background, reporter's actions, team members' actions and conversations, safety check procedures, result of the error, and post-incident response. The reporter's actions, work procedures, and environment were more clarified in the trainees' IRs than in the non-trainees' IRs. This training may help analysts comprehend the sequence of and underlying factors for reporter's actions based on IRs.

Perceptions and knowledge of nurses on incident reporting systems: Exploratory study in three Northeastern Italian Departments

Reporting of adverse clinical events (IRs) is believed to be an effective methodology for optimizing health care safety, however, only 1%-3% of incidents are reported by healthcare professionals, lack of information resulting from errors/adverse events/near misses limits the development of safety and improvement measures. This study aimed to identify barrier factors/incentives to report adverse events and find possible improvement strategies and possible correlations between the population under examination and the willingness to report through Incident Reporting. An ad hoc questionnaire was used and administered to 122 nurses belonging to three different departments of an Italian hospital. The frequency with which improvement interventions are noted following an IR report (p = 0.014) and the support received from their managers (p = 0.014) in reporting are among the factors that can have the greatest impact on the use of IR among the respondents. The no-blame policies and the attention that nursing managers place on clinical risk management can influence the culture of safety among nurses. Involving nurse managers in the dissemination of the IR can represent a possible strategy to be undertaken by corporate clinical risk managers in order to increase the culture of safety among nurses.

Experience and support of Chinese healthcare professionals as second victims of patient safety incidents: A cross-sectional study

PURPOSE

To describe the experience and support of Chinese healthcare professionals as second victims of PSIs.

DESIGN AND METHODS

A cross-sectional study with anonymous online self-report questionnaires was adopted. A total of 1357 Chinese healthcare professionals participated in this study. The Chinese version of the Second Victim Experience and Support Tool (C-SVEST) was used to evaluate the experience of second victims and the quality of support resources. Descriptive and inferential statistics were employed to analyze the data.

FINDINGS

This study showed that 350 participants (25.8%) had been involved in PSIs during their careers. The majority of respondents who had experienced PSIs agreed they suffered more from psychological distress, followed by professional self-efficacy distress, and physical distress. Besides, they regarded colleague support and management support as the most desirable support. Statistically significant differences were reported in some items. First, compared with medical staff without professional titles, staff with professional titles suffered more from psychological distress but gained more support from colleagues.

PRACTICE IMPLICATIONS

The second victim phenomenon deserves further attention. The programs focusing on training qualified colleagues to provide emotional support should be developed, implemented, and evaluated. Moreover, it is necessary to build a better patient safety culture with nonpunitive responses and encourage the disclosure and reporting of PSIs.

Clinical incident reporting behaviors and associated factors among health professionals in Dessie comprehensive specialized hospital, Amhara Region, Ethiopia: a mixed method study

Background

Understanding the type and causes of errors are necessary for the prevention of occurrence or reoccurrence. Therefore addressing the behavior of health professionals on reporting clinical incidents is crucial to create spontaneous knowledge from mistakes and enhance patient safety.

Method

A mixed type institution-based cross-sectional study design was conducted from March 1 - 30, 2020 in Dessie comprehensive specialized hospital among 319 and 18 participants for the quantitative and qualitative study, respectively. The professions and participants with their assigned proportions were selected using a simple random sampling technique. For quantitative and qualitative data, semi structured questionnaires and interviewer-guided questions were used to collect data, respectively. Finally, qualitative findings were used to supplement the quantitative result.

Result

The finding showed that the proportion of clinical incident reporting behavior among health professionals was 12.4%. Having training (AOR=3.6, 95% CI, 1.15-11.45), incident reporting help to minimize errors (AOR=2.8, 95% CI, 1.29-6.02), fear of legal penalty (AOR= 0.3, 95% CI, 0.13-0.82), and lack of feedback (AOR=0.3, 95% CI, 0.11-0.90) were identified as significant factors for clinical incident reporting behavior of the health professionals.

Conclusions

This study showed that the clinical incident reporting behavior of the health professionals was very low. Therefore health professionals should get training on clinical incident reporting and the hospital should have an incident reporting system and guideline.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07350-y.

Practical and Cultural Barriers to Reporting Incidents Among Health Workers in Indonesian Public Hospitals

Purpose

This study investigated the practical and cultural barriers of reporting patient safety incidents in three accredited public hospitals in East Java, Indonesia.

Methods

This study employed a mixed methods approach using a convergent parallel design. We surveyed 1121 health workers and interviewed 27 managerial staff members from the sampled hospitals. A chi-square analysis was performed to evaluate differences in demographic factors, barriers to reporting, and practices of reporting between those who had reported an incident and those who had witnessed an incident but had not reported it. NVivo 11 software was used to perform the qualitative data analysis.

Results

This study had a 76.53% response rate. The quantitative evaluation identified significant differences in professions and work units and in participation in quality and safety training between the reporting group and the non-reporting group. The analysis of practical barriers displayed significant differences between the groups with the following responses: “did not know how to report,” “did not know where to report,” and “lack of feedback”. For cultural barriers, a significant difference was shown only for the response “did not want conflict.” In the qualitative assessment, most of the interview participants reported lack of knowledge and lack of socialization or training as practical barriers in reporting incidents. Furthermore, reluctance and fear to report were mentioned as cultural barriers by most of the interviewees.

Conclusion

Because there were conflicting findings in the barriers of reporting incidents, these barriers must be identified, discussed, and resolved by health workers and their managers or supervisors to improve incident reporting. Managers must foster open communication and build positive connections with health workers. Further research is necessary to focus on possible ways of addressing the barriers to reporting.

Harmonization of Pharmacovigilance Regulation in Brazil: Opportunities to Improve Risk Communication

Brazilian pharmacovigilance regulations involve 3 spheres: health services, Marketing Authorization Holders (MAHs), and sanitary agency. Drug tolerability began to be effectively assessed in Brazil after the founding of the National Agency of Sanitary Surveillance, which developed the Sentinel Network Project. The objective of the Sentinel Network Project is to increase the adverse drug reaction (ADR) reporting rate by health care professionals in the hospital setting. Pharmacovigilance practices became mandatory for MAHs, and patient tolerability issues were considered in drug policy in Brazil only as recently as 2000. However, despite recent events, the regulatory advancements in pharmacovigilance in Brazil are only equivalent to international practices (ie, those of the European Union). The pharmacovigilance system in the European Union integrates the national authorities, the European Commission, and the European Medicines Agency, which is responsible for the scientific evaluation, supervision, and safety monitoring of medicines for human and veterinary use in the European Union. Furthermore, ADR patient reporting is included in the new EU pharmacovigilance regulations. Numerous possible ways are available to improve the Brazilian pharmacovigilance system, mainly through regulations of biosimilar, nanotechnology, and veterinary medicines or by training health care professionals and patients to report nonserious cases and quality deviations. It is necessary to encourage and develop strategies for decentralizing pharmacovigilance actions in the whole country, as is common practice in several EU countries. Motivating and considering ADR reports by patients and improving feedback and audit practices in health care services and MAHs are also necessary measures. With the inclusion of Brazil as a member of the International Conference of Harmonization, significant changes in pharmacovigilance regulation are expected; these updates, which will consider international standards, will improve signal detection and risk communication.