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Fiol-deRoque MA, Valderas JM, Arias de la Torre J, Serrano-Ripoll MJ, Gens-Barberà M, Sánchez-Freire E, Martín-Luján FM, Olry de Labry A, Ricci-Cabello I. Evaluation of the psychometric performance of the Spanish and Catalan versions of the patient reported experiences and Outcomes of Safety in Primary Care (PREOS-PC)-Compact questionnaire. Eur J Gen Pract 2024; 30:2296573. [PMID: 38197321 PMCID: PMC10783822 DOI: 10.1080/13814788.2023.2296573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Patients provide a unique, irreplaceable, and essential perspective in evaluating patient safety. The suite of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) tools are a notable exception to the scarcity of patient-reported patient safety measures. Full evaluation of their performance has only been attempted for the English version, thereby limiting its international applicability. OBJECTIVES To assess the psychometric performance of the Spanish and Catalan versions of the PREOS-PC-Compact. METHODS Cross-sectional validation study. We used Classical Test Theory methods to examine scale score distribution, internal consistency, and construct validity; and Item Response Theory (IRT) methods to further explore construct validity. RESULTS 3287 patients completed the Spanish version, and 1007 the Catalan version. Similar results were obtained for both versions. Confirmatory Factor Analysis supported a single construct for each scale. The correlations between PREOS-PC-Compact scales and known group analysis suggested adequate construct validity (inconclusive for known groups at the provider level). All four multi-item scales demonstrated adequate internal consistency reliability (α > 0.7), which was only confirmed for test-retest reliability for 'Practice activation.' A sample between 60-90 patients per practice was estimated sufficient to produce scores with reliability > 0.7 for all scales except for harm scales. IRT models showed disordered thresholds for 'Practice activation' and 'Harm burden' but showed excellent fit after reducing the response categories. CONCLUSION The Spanish and Catalan versions of the PREOS-PC-Compact are broadly valid and reliable tools to measure patient safety in Spanish primary care centres; confirmation of lower-than-expected test-rest reliability merits further examination .
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Affiliation(s)
- Maria A. Fiol-deRoque
- Research Group in Primary Care and Promotion – Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - José M. Valderas
- Centre for Research in Health Systems Performance, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Jorge Arias de la Torre
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- CIBER Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain
- Institute of Biomedicine, University of Leon, Leon, Spain
| | - Maria J. Serrano-Ripoll
- Research Group in Primary Care and Promotion – Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Montserrat Gens-Barberà
- Quality and Patient Safety Central Functional Unit, Gerència d‘Atenció Primària Camp de Tarragona, Catalan Institute of Health (ICS), Tarragona, Spain
- Research Group in Quality and Patient Safety, Institut Universitari d’Investigació en l’Atenció Primària-IDIAP Jordi Gol, Catalan Institute of Health (ICS), Tarragona, Spain
| | - Encarna Sánchez-Freire
- Quality and Patient Safety Unit, Gerència d‘Atenció Primària Catalunya Central, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Francisco M. Martín-Luján
- Primary Healthcare Research Support Unit-Camp de Tarragona, Institut Universitari d’Investigació en l’Atenció Primària-IDIAP Jordi Gol, Catalan Institute of Health (ICS), Tarragona, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Antonio Olry de Labry
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Research Group in Health and Gender, Andalusian School of Public Health, Granada, Spain
| | - Ignacio Ricci-Cabello
- Research Group in Primary Care and Promotion – Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Luu HS, Campbell WS, Cholan RA, Edgerton ME, Englund A, Keller A, Korte ED, Mitchell SH, Watkins GT, Westervelt L, Wyman D, Powell S. Analysis of laboratory data transmission between two healthcare institutions using a widely used point-to-point health information exchange platform: a case report. JAMIA Open 2024; 7:ooae032. [PMID: 38660616 PMCID: PMC11042873 DOI: 10.1093/jamiaopen/ooae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/31/2024] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
Objective The objective was to identify information loss that could affect clinical care in laboratory data transmission between 2 health care institutions via a Health Information Exchange platform. Materials and Methods Data transmission results of 9 laboratory tests, including LOINC codes, were compared in the following: between sending and receiving electronic health record (EHR) systems, the individual Health Level Seven International (HL7) Version 2 messages across the instrument, laboratory information system, and sending EHR. Results Loss of information for similar tests indicated the following potential patient safety issues: (1) consistently missing specimen source; (2) lack of reporting of analytical technique or instrument platform; (3) inconsistent units and reference ranges; (4) discordant LOINC code use; and (5) increased complexity with multiple HL7 versions. Discussion and Conclusions Using an HIE with standard messaging, SHIELD (Systemic Harmonization and Interoperability Enhancement for Laboratory Data) recommendations, and enhanced EHR functionality to support necessary data elements would yield consistent test identification and result value transmission.
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Affiliation(s)
- Hung S Luu
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Walter S Campbell
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Raja A Cholan
- Deloitte Consulting LLP, Washington, DC 20004, United States
| | - Mary E Edgerton
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Andrea Englund
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE 68198, United States
| | - Alana Keller
- Synensys, LLC, Peachtree, GA 30269, United States
| | | | | | - Greg T Watkins
- Deloitte Consulting LLP, Washington, DC 20004, United States
| | | | - Daniel Wyman
- Synensys, LLC, Peachtree, GA 30269, United States
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Gómez-Moreno C, Vélez-Vélez E, Garrigues Ramón M, Rojas Alfaro M, García-Carpintero Blas E. Patient safety in surgical settings: A study on the challenges and improvement strategies in adverse event reporting from a nursing perspective. J Clin Nurs 2024; 33:2324-2336. [PMID: 38308406 DOI: 10.1111/jocn.17047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/06/2023] [Accepted: 01/19/2024] [Indexed: 02/04/2024]
Abstract
AIMS To explore adverse event reporting in the surgical department through the nurses' experiences and perspectives. DESIGN An exploratory, descriptive qualitative study was conducted with a theoretical-methodological orientation of phenomenology. METHODS In-depth interviews were conducted with 15 nurses, followed by an inductive thematic analysis. RESULTS Themes include motives for reporting incidents, consequences, feelings and motivational factors. Key facilitators of adverse event reporting were effective communication, knowledge sharing, a non-punitive culture and superior feedback. CONCLUSION The study underscores the importance of supportive organisational culture for reporting, communication and feedback mechanisms, and highlights education and training in enhancing patient safety. IMPLICATIONS It suggests the need for strategies that foster incident reporting, enhance patient safety and cultivate a supportive organisational culture. IMPACT This study provides critical insights into adverse event reporting in surgical departments from nurses' lived experience, leading to two primary impacts: It offers specific solutions to improve adverse event reporting, which is crucial for surgical departments to develop more effective and tailored reporting strategies. The research underscores the importance of an open, supportive culture in healthcare, which is vital for transparent communication and effective reporting, ultimately advancing patient safety. REPORTING METHOD The study followed the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines. PATIENTS OR PUBLIC CONTRIBUTION No patients or public contribution.
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Affiliation(s)
- Cristina Gómez-Moreno
- Fundación Jiménez Díaz School of Nursing - Health Research Institute-Fundación, Jiménez Díaz University Hospital - UAM (IIS-FJD, UAM), Madrid, Spain
| | - Esperanza Vélez-Vélez
- Fundación Jiménez Díaz School of Nursing - Health Research Institute-Fundación, Jiménez Díaz University Hospital - UAM (IIS-FJD, UAM), Madrid, Spain
| | - Marta Garrigues Ramón
- Fundación Jiménez Díaz School of Nursing - Health Research Institute-Fundación, Jiménez Díaz University Hospital - UAM (IIS-FJD, UAM), Madrid, Spain
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Yahalom S, Manias E. Nurses engaging with referral letters and discharge summaries: A qualitative study. J Clin Nurs 2024; 33:2309-2323. [PMID: 38304996 DOI: 10.1111/jocn.17054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/30/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
AIMS To investigate the ways that nurses engage with referral letters and discharge summaries, and the qualities of these documents they find valuable for safe and effective practice. DESIGN This study comprised a qualitative, case-study design within a constructivist paradigm using convenience sampling. METHODS Interviews were conducted with nurses to investigate their practices relating to referral letters and discharge summaries. Data collection also involved nurses' examination and evaluation of a diverse range of 10 referral letters and discharge summaries from medical records at two Australian hospitals through focus-group sessions. The data were transcribed and analysed inductively. RESULTS In all, 67 nurses participated in interviews or focus groups. Nurses indicated they used referral letters and discharge summaries to inform their work when caring for patients at different times throughout their hospitalisation. These documents assisted them with verbal handovers, to enable them to educate patients about their condition and treatment and to provide a high standard of care. The qualities of referral letters and discharge summaries that they most valued were language and communication, an awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. CONCLUSION Nurses relied on referral letters and discharge summaries to ensure safe and effective patient care. They used these documents to enhance their verbal handovers, contribute to patient care and to educate the patient about their condition and treatment. They identified several qualities of these documents that assisted them in maintaining patient safety including clarity and conciseness of information. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE It is important that referral letters and discharge summaries are written clearly, concisely and comprehensively because nurses use them as key sources of evidence in planning and delivering care, and in communicating with other health professionals in relaying goals of care and implementing treatment plans. IMPACT Nurses reported that they regularly used referral letters and discharge summaries as valuable sources of evidence throughout their patients' hospitalisation. The qualities of these documents which they most valued were language and communication styles, awareness of audience and clinical knowledge, as well as balancing conciseness with comprehensiveness of information. This research has important impact on the patient experience in relation to encouraging effective referral letter and discharge summary writing. REPORTING METHOD We have adhered to the relevant EQUATOR guidelines through the SRQR reporting method. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Sharon Yahalom
- Faculty of Medicine, Nursing and Health Sciences, Student Academic Support Unit, Monash University, Melbourne, Victoria, Australia
- Faculty of Arts, School of Languages and Linguistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Cai Y, Liu Y, Wang C, Liu S, Zhang M, Jiang Y. Patient and family engagement interventions for hospitalized patient safety: A scoping review. J Clin Nurs 2024; 33:2099-2111. [PMID: 38323678 DOI: 10.1111/jocn.17022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/02/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024]
Abstract
AIM To summarize existing studies that focused on improving hospitalized patient safety through patient and family engagement interventions to identify priorities and gaps. DESIGN A scoping review. METHODS Eight databases and citations of important reviews were searched on 30 September 2022. Two researchers independently screened the records. Then, two researchers extracted the data and cross-checked. The results were synthesized narratively, and a comparison was performed for studies from China and those from other countries. RESULTS Ninety-eight studies were included. The results indicated that patient and family engagement interventions were applied to decrease the incidence of patient safety incidents, and to improve the healthcare providers' and patients' knowledge, attitude or practice of patient safety. Most studies only engaged patients and families at the direct care level, and the engagement strategies at the organization and health system levels were insufficient. For stakeholders, many studies failed to consider patients' perspectives in intervention design and report taking staff training as a supportive strategy. Healthcare providers, especially nurses, were the main implementers of current interventions. Certain differences were observed between studies from China and those from other countries in the above aspects. CONCLUSIONS International interest in engaging patient and family for patient safety is growing. Future studies should enhance the patient and family engagement as a partner in various patient safety at the direct care level, and further explore the engagement at the organization and health system levels. RELEVANCE TO CLINICAL PRACTICE Nurses, as the main formal caregivers for patients, should promote patient and family engagement in patient safety, especially at direct care level. Nurse should also incorporate the perspectives of patients in the design and implementation of interventions. REPORTING METHOD PRISMA-ScR Checklist.
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Affiliation(s)
- Yan Cai
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Liu
- Department of Neurosurgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Cong Wang
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shanshan Liu
- Evidence-based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mingming Zhang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Jiang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
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Blakeney EAR, Chu F, White AA, Randy Smith G, Woodward K, Lavallee DC, Salas RME, Beaird G, Willgerodt MA, Dang D, Dent JM, Tanner E“I, Summerside N, Zierler BK, O’Brien KD, Weiner BJ. A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals. J Interprof Care 2024; 38:411-426. [PMID: 34632913 PMCID: PMC8994791 DOI: 10.1080/13561820.2021.1980379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 08/13/2021] [Accepted: 08/29/2021] [Indexed: 01/22/2023]
Abstract
Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.
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Affiliation(s)
- Erin Abu-Rish Blakeney
- Department of Biobehavioral Nursing and Health Informatics,
School of Nursing, University of Washington
| | | | - Andrew A. White
- Department of Medicine, University of Washington School of
Medicine
| | | | | | | | | | | | - Mayumi A. Willgerodt
- Department of Family and Child Nursing, School of Nursing,
University of Washington
| | | | | | | | | | - Brenda K. Zierler
- Department of Biobehavioral Nursing and Health
Informatics, School of Nursing, University of Washington
| | | | - Bryan J. Weiner
- Departments of Global Health and Health Services, School
of Public Health, University of Washington
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Hanmer SB, Tsai MH, Sherrer DM, Pandit JJ. Modelling the economic constraints and consequences of anaesthesia associate expansion in the UK National Health Service: a narrative review. Br J Anaesth 2024; 132:867-876. [PMID: 38341282 DOI: 10.1016/j.bja.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/07/2024] [Accepted: 01/15/2024] [Indexed: 02/12/2024] Open
Abstract
Shortages in the physician anaesthesia workforce have led to proposals to introduce new staff groups, notably in the UK National Health Service (NHS) Anaesthesia Associates (AAs) who have shorter training periods than doctors and could potentially contribute to workflow efficiencies in several ways. We analysed the economic viability of the most efficient staffing model, previously endorsed by both the UK Royal College of Anaesthetists and the Association of Anaesthetists, wherein one physician supervises two AAs across two operating lists (1:2 model). For this model to be economically rational (something which neither national organisation considered), the employment cost of the two AAs should be equal to or less than that of a single supervisor physician (i.e. AAs should be paid <50% of the supervisor's salary). As the supervisor can be an autonomous specialty and specialist (SAS) doctor, this sets the economically viable AA salary envelope at less than £40,000 per year. However, we report that actual advertised AA salaries greatly exceed this, with even student AAs paid up to £48,472. Economically, one way to justify such salaries is for AAs to become autonomous such that they eventually replace SAS doctors at a lower cost. We discuss some other options that might increase AA productivity to justify these salaries (e.g. ≥1:3 staffing ratios), but the medico-political consequences of each of them are also profound. Alternatively, the AA programme should be terminated as economically nonviable. These results have implications for any country seeking to introduce new models of working in anaesthesia.
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Affiliation(s)
- Stuart B Hanmer
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mitchell H Tsai
- Department of Anesthesiology, Orthopedics and Rehabilitation, and Surgery, Larner College of Medicine, University of Vermont, Burlington, VT, USA; Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Anesthesiology and Perioperative Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | - Daniel M Sherrer
- Department of Anesthesiology and Perioperative Medicine, University of Alabama Birmingham, Birmingham, AL, USA
| | - Jaideep J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Brás CPDC, Figueiredo MDCABD, Ferreira MMC. Safety culture in maternity hospital: Perception of nurse-midwives. J Adv Nurs 2024; 80:2091-2105. [PMID: 38012856 DOI: 10.1111/jan.15969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
AIM To explore nurse-midwives' perceptions of safety culture in maternity hospitals. DESIGN A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research. METHODS Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis. FINDINGS Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication. CONCLUSION The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential. IMPACT Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves.
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Affiliation(s)
| | | | - Manuela Maria Conceição Ferreira
- Higher School of Health of Viseu, Polytechnic Institute of Viseu, Health Sciences Research Unit: Nursing (UICISA: E/ESEnfC-ESSV/IPV), Viseu, Portugal
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Steinhorn B. Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis. Response to Br J Anaesth 2023; 131: 682-686. Br J Anaesth 2024; 132: 822-3. Br J Anaesth 2024; 132:993-994. [PMID: 38448270 DOI: 10.1016/j.bja.2024.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Affiliation(s)
- Benjamin Steinhorn
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
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Webster CS. Psychology in the operating theatre: the importance of colour and cognition in the redesign of clinical systems for medication safety. Br J Anaesth 2024; 132:837-839. [PMID: 38418333 DOI: 10.1016/j.bja.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 02/06/2024] [Indexed: 03/01/2024] Open
Abstract
Medication errors in anaesthesia remain a leading cause of patient harm. Compared with conventional methods, use of the international colour-code standard on syringes and medication trays allows significantly more errors to be detected, and does so under conditions of cognitive load. Testing methods from experimental psychology provide important new insights for human factors research in anaesthesia and health care.
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Affiliation(s)
- Craig S Webster
- Department of Anaesthesiology and Centre for Medical and Health Sciences Education, School of Medicine, University of Auckland, Auckland, New Zealand.
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Kumar MM, Choksey F, Jones A, Carroll C, Brownhill B, Cairns E, Bark J, Coffey K, Webster L, Wood L, Chambers M, Haynes S, Gormley S. Intraoperative cell salvage: a survey of UK practice. Br J Anaesth 2024; 132:995-997. [PMID: 38471988 DOI: 10.1016/j.bja.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
| | | | - Alister Jones
- Blood Health Adviser, Welsh Blood Service, Llantrisant, UK
| | | | | | - Elmarie Cairns
- Blood Conservation Coordinator, North Bristol NHS Trust, Bristol, UK
| | | | | | | | - Louisa Wood
- Scottish National Blood Transfusion Service, Edinburgh, UK
| | | | - Sarah Haynes
- Manchester University NHS Foundation Trust, Manchester, UK
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Mcvey L, Alvarado N, Zaman H, Healey F, Todd C, Issa B, Woodcock D, Dowding D, Hardiker NR, Lynch A, Davison E, Frost T, Abdulkader J, Randell R. Interactions that support older inpatients with cognitive impairments to engage with falls prevention in hospitals: An ethnographic study. J Clin Nurs 2024; 33:1884-1895. [PMID: 38240045 DOI: 10.1111/jocn.17006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/13/2023] [Accepted: 01/07/2024] [Indexed: 02/22/2024]
Abstract
AIMS To explore the nature of interactions that enable older inpatients with cognitive impairments to engage with hospital staff on falls prevention. DESIGN Ethnographic study. METHODS Ethnographic observations on orthopaedic and older person wards in English hospitals (251.25 h) and semi-structured qualitative interviews with 50 staff, 28 patients and three carers. Findings were analysed using a framework approach. RESULTS Interactions were often informal and personalised. Staff qualities that supported engagement in falls prevention included the ability to empathise and negotiate, taking patient perspectives into account. Although registered nurses had limited time for this, families/carers and other staff, including engagement workers, did so and passed information to nurses. CONCLUSIONS Some older inpatients with cognitive impairments engaged with staff on falls prevention. Engagement enabled them to express their needs and collaborate, to an extent, on falls prevention activities. To support this, we recommend wider adoption in hospitals of engagement workers and developing the relational skills that underpin engagement in training programmes for patient-facing staff. IMPLICATIONS FOR PROFESSION AND PATIENT CARE Interactions that support cognitively impaired inpatients to engage in falls prevention can involve not only nurses, but also families/carers and non-nursing staff, with potential to reduce pressures on busy nurses and improve patient safety. REPORTING METHOD The paper adheres to EQUATOR guidelines, Standards for Reporting Qualitative Research. PATIENT OR PUBLIC CONTRIBUTION Patient/public contributors were involved in study design, evaluation and data analysis. They co-authored this manuscript.
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Affiliation(s)
- Lynn Mcvey
- Centre for Digital Innovations in Health and Social Care, Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Natasha Alvarado
- Centre for Digital Innovations in Health and Social Care, Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
| | - Hadar Zaman
- School of Pharmacy and Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Frances Healey
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | - Dawn Dowding
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Nicholas R Hardiker
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Alison Lynch
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | | | - Rebecca Randell
- Centre for Digital Innovations in Health and Social Care, Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
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Silva TL, dos Santos LM, Kusahara DM, Burciaga LVB, Biazus Dalcin C, de Souza S, Bitencourt ADS, Rocha PK. Factors associated with the disinfection of devices attached to peripheral intravenous catheters performed by the nursing team in pediatric units. J Infect Prev 2024; 25:66-72. [PMID: 38584710 PMCID: PMC10998550 DOI: 10.1177/17571774241231675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/21/2024] [Indexed: 04/09/2024] Open
Abstract
Background Peripheral intravenous catheterization, as well as drug administration through it, represents one of the most performed procedures by the Nursing team and, for that, precautions need to be adopted to offer harm-free care. Objective To verify the association of Nursing professionals' work shift and training time with proper disinfection of intravenous catheter devices in pediatric units. Methods A cross-sectional and analytical study conducted between June and August 2021 in three hospitalization units of a Pediatric Hospital. The inclusion criterion was drug administration via peripheral intravenous catheters performed by Nursing professionals. The data were analyzed according to inferential statistics, adopting p ≤ .05 as significance level. Results There were a total of 385 observations of drug administration procedures. The device was not disinfected in 60.3% of the cases, there was no friction at the suitable time in 86.3%, and the disinfectant was not allowed to dry in 72.5%. The work shift exerted no influence on performance of the disinfection procedure (p = .376). However, longer training time was associated with a lower rate in performing such procedure (p < .001). Conclusion Performing friction below the recommended time can cause a false sense of prevention of catheter-associated bloodstream infection; therefore, training sessions and strategies for adherence to the disinfection procedures should be considered, mainly for professionals with more training time.
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Affiliation(s)
- Thiago Lopes Silva
- Postgraduate Program in Nursing, Nursing Department, Health Sciences Centre, Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Luciano Marques dos Santos
- Postgraduate Program in Nursing, Health Department, Universidade Estadual de Feira de Santana, Feira de Santana, Brazil
| | - Denise Miyuki Kusahara
- Postgraduate Program in Nursing, Sao Paulo School of Nursing, Universidade Federal de São Paulo, Sao Paulo, Brazil
| | | | | | - Sabrina de Souza
- Postgraduate Program in Nursing, Nursing Department, Health Sciences Centre, Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Aline de Souza Bitencourt
- Postgraduate Program in Nursing, Nursing Department, Health Sciences Centre, Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Patrícia Kuerten Rocha
- Postgraduate Program in Nursing, Nursing Department, Health Sciences Centre, Universidade Federal de Santa Catarina, Florianopolis, Brazil
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14
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Park J, Jeon H, Choi EK. Digital health intervention on patient safety for children and parents: A scoping review. J Adv Nurs 2024; 80:1750-1760. [PMID: 37950382 DOI: 10.1111/jan.15954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/19/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023]
Abstract
AIM To explore digital health interventions on patient safety for children and their parents. DESIGN A scoping review. METHODS The PCC 'Participants, Concepts, and Contexts' guided the selection of studies that focused on children under 19 years of age or their parents, patient safety interventions for children, and digital health technology for patient safety interventions. This study was conducted using the Arksey and O'Malley framework's five steps. We reported the review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. DATA SOURCES PubMed, CINAHL, Embase, Web of Science, and Cochrane were searched for articles published up to November 2022. RESULTS A total of 13 articles were included and categorized according to the following criteria to describe the results: intervention characteristics, type of digital technology, and outcome characteristics. Regarding intervention characteristics, we identified two categories, prevention and risk management. Additionally, we identified four types of digital technology, mobile applications, web-based technologies, computer kiosks and electronic health records. Finally, in studies focussing on child safety, parental safety behaviours were used to assess injury risk or detect changes related to prevention. CONCLUSION Patient safety interventions provided through appropriate digital technologies should be developed to enhance continuum of care for children from hospitalization to home after discharge. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Digital health interventions can bolster the role of healthcare providers in patient safety in and out of hospitals, thus improving children's safety and quality of care. IMPACT What problem did the study address? Although the various advantages of digital health technology have been demonstrated, the potential role of digital technology in patient safety interventions for children has not been explored. What were the main finding? Preventive patient safety interventions and risk management for children have been developed. Where and on whom will the research have an impact? Digital health interventions on patient safety can improve children's safety and quality of care by promoting non-face-to-face engagement of children and parents after discharge and expanding healthcare providers' roles. TRIAL AND PROTOCOL REGISTRATION Registered on the Open Science Framework (https://osf.io/dkvst). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Jisu Park
- Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
| | - Heejung Jeon
- Department of Nursing, Graduate School, Yonsei University, Seoul, South Korea
| | - Eun Kyoung Choi
- College of Nursing, Yonsei University, Seoul, South Korea
- Mo-Im Kim Nursing Research Institute College of Nursing, Yonsei University, Seoul, South Korea
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15
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Arredondo Montero J, Bardají Pascual C. From Aviation to Pediatric Surgery. Clin Pediatr (Phila) 2024; 63:557-559. [PMID: 37246755 DOI: 10.1177/00099228231176631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Aviation is a tremendously complex process involving multiple factors that can be subsidiary to human error. The implementation of checklists, tools that reduce this risk, has often been extrapolated to other fields, especially medicine. Through this reflection, we comment on the critical and relevant aspects of pediatric surgical patient safety, briefly discussing the existing literature and analyzing potential areas for improvement.
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Affiliation(s)
| | - Carlos Bardají Pascual
- Pediatric Surgery Department, Hospital Universitario de Navarra, Pamplona, Navarra, Spain
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16
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Demir M, Håkansson E, Drott J. Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study. J Adv Nurs 2024; 80:2080-2090. [PMID: 37975326 DOI: 10.1111/jan.15966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/26/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
AIM To describe nurses' and specialist nurses' experiences of moral distress and how it affects daily work in surgical care. DESIGN A qualitative descriptive study design was used. METHODS A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis. FINDINGS Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care. CONCLUSIONS The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk. IMPACT Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution.
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Affiliation(s)
- Maria Demir
- Department of Surgery, Department of Biomedicine and Clinical Sciences, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Elin Håkansson
- Department of Surgery, Regional Hospital of Växjö, Växjö, Sweden
| | - Jenny Drott
- Department of Surgery, Department of Biomedicine and Clinical Sciences, County Council of Östergötland, Linköping University, Linköping, Sweden
- Division of Nursing Science and Reproductive Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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17
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Wahr JA, Abernathy JH. Too loud to hear myself think: deleterious effects of noise in the operating room. Br J Anaesth 2024; 132:840-842. [PMID: 38448271 DOI: 10.1016/j.bja.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/12/2024] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Noise is part of daily life in the operating room, and too often is viewed as a necessary evil. However, much of the noise in operating rooms (ORs) is unnecessary, such as extraneous conversations and music, and could be reduced. At the least, noise is known to increase staff stress and to hamper effective communication; at the worst, it adversely affects patient outcomes. Every member of the OR team should be cognisant of this and work to reduce unnecessary noise.
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Affiliation(s)
- Joyce A Wahr
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.
| | - James H Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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18
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Hansel J, Jones SJ. Anaesthetic rooms are no longer needed. Anaesthesia 2024; 79:465-468. [PMID: 38214405 DOI: 10.1111/anae.16224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Affiliation(s)
- J Hansel
- Acute Intensive Care Unit, Wythenshawe Hospital, Manchester, UK
- Division of Immunology, Immunity to Infection and Respiratory Medicine, University of Manchester, Manchester, UK
| | - S J Jones
- Department of Anaesthesia, Northumbria Healthcare NHS Foundation Trust, UK
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19
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Fleming RJ, Wain ECE. Modelling the economic constraints and consequences of Anaesthesia Associate expansion in the UK National Health Service. Response by the Association of Anaesthetists SAS Committee to Br J Anaesth 2024; 132: 867-76. Br J Anaesth 2024; 132:967-968. [PMID: 38508945 DOI: 10.1016/j.bja.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Robert J Fleming
- Department of Anaesthesia, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield, UK.
| | - Emma C E Wain
- Department of Anaesthesia, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, UK
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20
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Pinho RH, Nasr-Esfahani M, Pang DSJ. Medication errors in veterinary anesthesia: a literature review. Vet Anaesth Analg 2024; 51:203-226. [PMID: 38570267 DOI: 10.1016/j.vaa.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 12/18/2023] [Accepted: 01/16/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To provide an overview of medication errors (MEs) in veterinary medicine, with a focus on the perianesthetic period; to compare MEs in veterinary medicine with human anesthesia practice, and to describe factors contributing to the risk of MEs and strategies for error reduction. DATABASES USED PubMed and CAB abstracts; search terms: [("patient safety" or "medication error∗") AND veterin∗]. CONCLUSIONS Human anesthesia is recognized as having a relatively high risk of MEs. In veterinary medicine, MEs were among the most commonly reported medical error. Predisposing factors for MEs in human and veterinary anesthesia include general (e.g. distraction, fatigue, workload, supervision) and specific factors (e.g. requirement for dose calculations when dosing for body mass, using several medications within a short time period and preparing syringes ahead of time). Data on MEs are most commonly collected in self-reporting systems, which very likely underestimate the true incidence, a problem acknowledged in human medicine. Case reports have described a variety of MEs in the perianesthetic period, including prescription, preparation and administration errors. Dogs and cats were the most frequently reported species, with MEs in cats more commonly associated with harmful outcomes compared with dogs. In addition to education and raising awareness, other strategies described for reducing the risk of MEs include behavioral, communication, identification, organizational, engineering and cognitive aids.
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Affiliation(s)
- Renata H Pinho
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada.
| | - Maryam Nasr-Esfahani
- University of Calgary, Cumming School of Medicine, Department of Obstetrics and Gynecology, Alberta Health Services, Calgary, AB, Canada
| | - Daniel S J Pang
- Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada; Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Montreal, PQ, Canada
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21
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Galatzan BJ, Johnson E, Judson T, Shan L. Linguistic dissection of nursing handoffs: Implications for patient safety in varied-acuity hospital settings. J Clin Nurs 2024. [PMID: 38661339 DOI: 10.1111/jocn.17190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/06/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
AIM This study examines the intricate language and communication patterns of nurse-to-nurse handoffs across three units with varying patient acuity levels and nurse-patient ratios, seeking to identify linguistic factors that may affect the quality of information transfer and patient outcomes. DESIGN A mixed-methods cross-sectional design. METHODS This study used the Nurse-to-Nurse Transition of Care Communication Model to explore the content and meaning of language in nursing handoffs within a large academic medical centre. Data were collected on three units through digital audio recordings of 20 handoffs between June and September 2022, which were transcribed and analysed using the Linguistic Inquiry Word Count programme. Trustworthiness was established by adhering to COREQ and STROBE guidelines for qualitative and quantitative research, respectively. RESULTS Analysis revealed a preference for casual, narrative language across all units, with ICU nurses demonstrating a higher confidence and leadership in communication. Cognitive processes such as insight and causation were found to be underrepresented, indicating a potential area for miscommunication. Communication motives driven by affiliation were more pronounced in ICU settings, suggesting a strong collaborative nature. No significant differences were observed among the units post multiple testing adjustments. Speech dysfluencies were most pronounced in ICU handoffs, reflecting possible stress and cognitive overload. CONCLUSION The study highlights the need for improved communication strategies such as interventions to enhance language clarity and incorporating technological tools into handoff processes to mitigate potential miscommunications and errors. The findings advance nursing science by highlighting the critical role of nuanced language in varied-acuity hospital settings and the necessity for structured nurse education in handoff communication and standardized handoff procedures. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE This study underscores the critical role of language in nurse-to-nurse handoffs. It calls for enhanced communication strategies, technology integration and training to reduce medical errors, improving patient outcomes in high-acuity hospital settings. PATIENT OR PUBLIC CONTRIBUTION Nurses only.
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Affiliation(s)
- Benjamin J Galatzan
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Tonya Judson
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Liang Shan
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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22
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Michelson KA, McGarghan FLE, Patterson EE, Samuels-Kalow ME, Waltzman ML, Greco KF. Delayed diagnosis of serious paediatric conditions in 13 regional emergency departments. BMJ Qual Saf 2024; 33:293-300. [PMID: 36180208 DOI: 10.1136/bmjqs-2022-015314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate rates, risk factors and outcomes of delayed diagnosis of seven serious paediatric conditions. METHODS This was a retrospective, cross-sectional study of children under 21 years old visiting 13 community and tertiary emergency departments (EDs) with appendicitis, bacterial meningitis, intussusception, mastoiditis, ovarian torsion, sepsis or testicular torsion. Delayed diagnosis was defined as having a previous ED encounter within 1 week in which the condition was present per case review. Patients with delayed diagnosis were each matched to four control patients without delay by condition, facility and age. Conditional logistic regression models evaluated risk factors of delay. Complications were compared between by delayed diagnosis status. RESULTS Among 14 972 children, delayed diagnosis occurred in 1.1% (range 0.3% for sepsis to 2.6% for ovarian torsion). Hispanic (matched OR 2.71, 95% CI 1.69 to 4.35) and non-Hispanic black (OR 2.40, 95% CI 1.21 to 4.79) race/ethnicity were associated with delayed diagnosis, whereas Asian and other race/ethnicity were not. Public (OR 2.21, 95% CI 1.42 to 3.44) and other (OR 2.43, 95% CI 1.50 to 3.93) insurance were also associated with delay. Non-English language was associated with delay (OR 1.65, 95% CI 1.02 to 2.69). Abnormal vital signs were associated with a lower likelihood of delay (OR 0.15, 95% CI 0.09 to 0.25). In an adjusted model, Hispanic race/ethnicity, other insurance, abnormal vital signs and complex chronic conditions (CCCs) were associated with delay. The odds of a complication were 2.5-fold (95% CI 1.6 to 3.8) higher among patients with a delay. CONCLUSION Delayed diagnosis was uncommon across 13 regional EDs but was more likely among children with Hispanic ethnicity, CCCs or normal vital signs. Delays were associated with a higher risk of complications.
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Affiliation(s)
- Kenneth A Michelson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, South Shore Hospital, Weymouth, Massachusetts, USA
| | - Finn L E McGarghan
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emma E Patterson
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Mark L Waltzman
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, South Shore Hospital, Weymouth, Massachusetts, USA
| | - Kimberly F Greco
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
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23
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Sama SR, Quinn MM, Gore RJ, Galligan CJ, Kriebel D, Markkanen PK, Lindberg JE, Fallon PJ. The Safe Home Care Intervention Study: Implementation Methods and Effectiveness Evaluation. J Appl Gerontol 2024:7334648241246472. [PMID: 38652665 DOI: 10.1177/07334648241246472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Home care (HC) aides experience numerous safety hazards in clients' homes; many hazards also put clients at risk. We hypothesized that safety coaching led by nurse managers (NMs) during their initial HC needs assessment could prompt clients to improve safety conditions in their homes. Following a 2-arm proof-of-concept intervention study design, intervention NMs used motivational interviewing (MI), facilitated by a safety handbook and video, to coach clients on home safety improvements. Control arm NMs performed intake assessments with no changes to usual practices. Intervention effectiveness was assessed by NMs and aides. Three HC agencies and two elder services contributed 35 intervention and 23 control homes. NMs coached 97% of clients and reported that 94% were engaged; 63% implemented improvements. NMs' and aides' assessments were consistent; homes with clients reported by NMs as resistant to safety changes had higher aides' hazard scores. Client coaching can be effective for improving HC safety.
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Affiliation(s)
- Susan R Sama
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Margaret M Quinn
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Rebecca J Gore
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Catherine J Galligan
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - David Kriebel
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Pia K Markkanen
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - John E Lindberg
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Pamela J Fallon
- Safe Home Care Project, Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, USA
- Employee Health and Wellness, Southern New Hampshire Health, Nashua, NH, USA
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24
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Bachnick S, Unbeck M, Ahmadi Shad M, Falta K, Grossmann N, Holle D, Bartakova J, Musy SN, Hellberg S, Dillner P, Atoof F, Khorasanizadeh M, Kelly-Pettersson P, Simon M. TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) Project: Protocol for an International Longitudinal Multicenter Study. JMIR Res Protoc 2024; 13:e56262. [PMID: 38648083 DOI: 10.2196/56262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Nursing-sensitive events (NSEs) are common, accounting for up to 77% of adverse events in hospitalized patients (eg, fall-related harm, pressure ulcers, and health care-associated infections). NSEs lead to adverse patient outcomes and impose an economic burden on hospitals due to increased medical costs through a prolonged hospital stay and additional medical procedures. To reduce NSEs and ensure high-quality nursing care, appropriate nurse staffing levels are needed. Although the link between nurse staffing and NSEs has been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing patient-level exposure to nurse staffing during the hospital stay. Few studies have assessed nurse staffing and patient outcomes using a single-center longitudinal design, with limited generalizability. There is a need for multicenter longitudinal studies with improved potential for generalizing the association between individual nurse staffing levels and NSEs. OBJECTIVE This study aimed (1) to determine the prevalence, preventability, type, and severity of NSEs; (2) to describe individual patient-level nurse staffing exposure across hospitals; (3) to assess the effect of nurse staffing on NSEs in patients; and (4) to identify thresholds of safe nurse staffing levels and test them against NSEs in hospitalized patients. METHODS This international multicenter study uses a longitudinal and observational research design; it involves 4 countries (Switzerland, Sweden, Germany, and Iran), with participation from 14 hospitals and 61 medical, surgery, and mixed units. The 16-week observation period will collect NSEs using systematic retrospective record reviews. A total of 3680 patient admissions will be reviewed, with 60 randomly selected admissions per unit. To be included, patients must have been hospitalized for at least 48 hours. Nurse staffing data (ie, the number of nurses and their education level) will be collected daily for each shift to assess the association between NSEs and individual nurse staffing levels. Additionally, hospital data (ie, type, teaching status, and ownership) and unit data (ie, service line and number of beds) will be collected. RESULTS As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all 4 countries. Data analyses are planned to be completed by spring 2024, with the first results expected to be published in late 2024. CONCLUSIONS This study will provide comprehensive information on NSEs, including their prevalence, preventability, type, and severity, across countries. Moreover, it seeks to enhance understanding of NSE mechanisms and the potential impact of nurse staffing on these events. We will evaluate within- and between-hospital variability to identify productive strategies to ensure safe nurse staffing levels, thereby reducing NSEs in hospitalized patients. The TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) study will focus on the optimization of scarce staffing resources. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56262.
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Affiliation(s)
- Stefanie Bachnick
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Maryam Ahmadi Shad
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Katja Falta
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Nicole Grossmann
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Daniela Holle
- Department of Nursing Science, University of Applied Sciences, Bochum, Germany
| | - Jana Bartakova
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
- Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
| | - Sarah N Musy
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sarah Hellberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Stockholm, Sweden
| | - Pernilla Dillner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Fatemeh Atoof
- Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Paula Kelly-Pettersson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Stockholm, Sweden
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
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Kaplan A, Ozdemir C, Bulbul E. Nurses' level of sleepiness during night shift. Int Nurs Rev 2024. [PMID: 38650476 DOI: 10.1111/inr.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/23/2024] [Indexed: 04/25/2024]
Abstract
AIMS This study aimed to determine the peak hours of sleepiness and the factors affecting the sleepiness levels of nurses. BACKGROUND Sleepiness is commonly seen in individuals working night shifts. However, in case of nurses, this sleepiness can be a major threat to patient and staff safety. METHOD This was a prospective cross-sectional study. Data were collected between July and September 2023, and a stratified sampling method was used according to the departments in which the nurses worked. Data were collected using the Personal Information Form and Visual Analog Scale. Nurses reported their sleepiness levels at the beginning of each hour between midnight and 8:00 am. EQUATOR CHECKLIST The study adhered to the STROBE checklist for reporting. RESULTS The mean sleepiness levels of emergency department nurses, intensive care nurses, internal or surgical clinic nurses, and all nurses were 59.75 ± 15.50, 43.53 ± 20.49, 44.67 ± 18.88, and 49.15 ± 19.67, respectively. The highest sleepiness level of the nurses was at 05:00 am. A significant correlation was found between the variables of age, gender, marital status, sleep quality, number of patients cared, working style and satisfaction with working in the department, and sleepiness level (P < 0.05). CONCLUSION Nurses working night shifts experience sleepiness (highest at 5:00 am). In addition, the sleepiness levels of nurses are affected by some personal and clinical factors. IMPLICATIONS FOR NURSING AND NURSING POLICY Based on the results, there is a need for necessary policies regarding nurses' working hours and working conditions. To protect patient and employee safety, necessary strategies should be devised regarding the hours when nurses experience the highest sleepiness and the factors affecting sleepiness levels.
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Affiliation(s)
- Ali Kaplan
- University of Kayseri, İncesu Ayşe and Saffet Arslan Health Services Vocational School, Department of Medical Services and Techniques, Kayseri, Türkiye
| | - Cevriye Ozdemir
- University of Kayseri, İncesu Ayşe and Saffet Arslan Health Services Vocational School, Department of Medical Services and Techniques, Kayseri, Türkiye
| | - Emre Bulbul
- University of Erciyes, Faculty of Medicine, Department of Emergency Medicine, Kayseri, Türkiye
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Faurø KK, Antonsen S, Nybo M. Critical test result management at Danish hospital laboratories: a national survey. Scand J Clin Lab Invest 2024:1-9. [PMID: 38648389 DOI: 10.1080/00365513.2024.2343906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/12/2024] [Indexed: 04/25/2024]
Abstract
Critical test results in clinical laboratories are crucial for timely patient care, serving as indicators of potentially life-threatening conditions. Despite their importance, a notable heterogeneity in management practices exists globally. This study investigates the current practices of managing critical results at Danish clinical biochemistry laboratories and identifies areas prone for improvement. A comprehensive online survey was distributed to all 21 Danish clinical biochemistry laboratories regarding their critical result management, including documentation practices, critical limit selection, and quality assurance measures. A total of 17 laboratories (81%) responded. The answers revealed a generally uniform approach to managing critical results, with all laboratories having 24-h reporting, local instructions and using the telephone as communication channel. However, variations were noted in documentation practices and critical limit selection. Notably, 23.5% of the laboratories reported that one out of every ten critical results was not reported, indicating a significant risk of delayed critical results. This is further complicated by the limited use of predefined timeframes for reporting and also, only few laboratories actively monitored response times. The findings emphasize the need for more standardized documentation and evaluation practices to align with international standards and to enhance patient safety. While the laboratories showed a commitment to standardized procedures, the study emphasizes the necessity of a National or Nordic guideline to supplement the ISO 15189:2022. This study is a step towards optimizing critical result management, not only in Danish clinical biochemistry laboratories but also across various laboratory specialties, thereby improving overall laboratory quality, efficiency, and patient safety.
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Affiliation(s)
- Kaja Kastberg Faurø
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | - Steen Antonsen
- Department of Clinical Biochemistry, Odense University Hospital Svendborg, Svendborg, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Hedqvist AT, Praetorius G, Ekstedt M, Lindberg C. Entangled in complexity: An ethnographic study of organizational adaptability and safe care transitions for patients with complex care needs. J Adv Nurs 2024. [PMID: 38641975 DOI: 10.1111/jan.16203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
AIM The aim of this study was to visualize vulnerabilities and explore the dynamics of inter-professional collaboration and organizational adaptability in the context of care transitions for patients with complex care needs. DESIGN An ethnographic design using multiple convergent data collection techniques. METHODS Data collection involved document review, participant observations and interviews with healthcare and social care professionals (HSCPs). Narrative analysis was employed to construct two illustrative patient scenarios, which were then examined using the Functional Resonance Analysis Method (FRAM). Thematic analysis was subsequently applied to synthesize the findings. RESULTS Inconsistencies in timing and precision during care transitions pose risks for patients with complex care needs as they force healthcare systems to prioritize structural constraints over individualized care, especially during unforeseen events outside regular hours. Such systemic inflexibility can compromise patient safety, increase the workload for HSCPs and strain resources. Organizational adaptability is crucial to managing the inherent variability of patient needs. Our proposed 'safe care transition pathway' addresses these issues, providing proactive strategies such as sharing knowledge and increasing patient participation, and strengthening the capacity of professionals to meet dynamic care needs, promoting safer care transitions. CONCLUSION To promote patient safety in care transitions, strategies must go beyond inter-professional collaboration, incorporating adaptability and flexible resource planning. The implementation of standardized safe care transition pathways, coupled with the active participation of patients and families, is crucial. These measures aim to create a resilient, person-centred approach that may effectively manage the complexities in care transitions. IMPLICATIONS The recommendations of this study span the spectrum from policy-level changes aimed at strategic resource allocation and fostering inter-professional collaboration to practical measures like effective communication, information technology integration, patient participation and family involvement. Together, the recommendations offer a holistic approach to enhance care transitions and, ultimately, patient outcomes. REPORTING METHOD Findings are reported per the Consolidated Criteria for Reporting Qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Ann-Therese Hedqvist
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
- Ambulance Service, Region Kalmar County, Västervik, Sweden
| | - Gesa Praetorius
- Swedish National Road and Transport Research Institute, Linköping, Sweden
- Department of Maritime Operations, University of South-Eastern Norway, Norway
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
- Department of Learning, Informatics, Management and Ethics, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Catharina Lindberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar/Växjö, Sweden
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Guerrero JG, Alqarni AS, Cordero RP, Aljarrah I, Almahaid MA. Perceived Causes and Effects of Overcrowding Among Nurses in the Emergency Departments of Tertiary Hospitals: A Multicenter Study. Risk Manag Healthc Policy 2024; 17:973-982. [PMID: 38660020 PMCID: PMC11041959 DOI: 10.2147/rmhp.s454925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose Emergency department (ED) overcrowding is a significant concern in many hospitals in Saudi Arabia, resulting in long waiting times, delays in treating patients who need urgent care, and, consequently, decreased patient satisfaction. Additionally, ED overcrowding has been linked to increased nurse turnover rates. Therefore, this study aimed to assess nurses' perceived causes and effects of overcrowding in the EDs of five tertiary hospitals in Saudi Arabia. Methods This study used a descriptive cross-sectional design. We surveyed 311 nurses working in the EDs of five tertiary hospitals in Saudi Arabia using the convenience sampling technique. The self-administered questionnaires used in the study were developed by the researchers. The study was conducted from October 16 to November 10, 2022. Consensus-Based Checklist for Reporting of Survey Studies was followed. Results The results revealed that the primary perceived causes of ED overcrowding in five tertiary hospitals were unnecessary visits due to a lack of standard procedures (mean = 2.70; SD = 0.58) and lack of inpatients beds (mean = 2.69; SD = 0.65). The perceived effect of overcrowding was stress and burnout among nurses (mean = 2.85; SD = 0.47). The perceived causes and effects of overcrowding in the ED were found to be highly significant (p <0.001) based on Pearson correlation and Spearman's rank correlation. Conclusion Unnecessary visits due to a lack of standard procedures lead to overcrowding. In addition, a lack of inpatient beds in the ED affects the care provided to patients seeking immediate medical attention. This may prolong patient waiting time, causing their conditions to deteriorate and prolonging hospital stay. Overcrowding leads to increased stress and burnout among nurses. The results of this study can be used to develop a comprehensive action plan to address ED overcrowding and its effects on patients, staff, and ED flow.
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Affiliation(s)
| | | | - Rock Parreno Cordero
- Emergency Health Services Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | - Imad Aljarrah
- Faculty of Nursing, Philadelphia University, Amman, Jordan
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Daujatas DM, Eischen E, Quinn AL. REMS: Time to reevaluate. Am J Health Syst Pharm 2024; 81:e206-e207. [PMID: 38146990 DOI: 10.1093/ajhp/zxad338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
| | - Edward Eischen
- Northwestern Medicine Palos Hospital, Palos Heights, IL, USA
| | - Andrea L Quinn
- Northwestern Medicine Palos Hospital, Palos Heights, IL, USA
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Shehab N, Alschuler L, McILvenna S, Gonzaga Z, Laing A, deRoode D, Dantes RB, Betz K, Zheng S, Abner S, Stutler E, Geimer R, Benin AL. The National Healthcare Safety Network's digital quality measures: CDC's automated measures for surveillance of patient safety. J Am Med Inform Assoc 2024; 31:1199-1205. [PMID: 38563821 PMCID: PMC11031211 DOI: 10.1093/jamia/ocae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE This article presents the National Healthcare Safety Network (NHSN)'s approach to automation for public health surveillance using digital quality measures (dQMs) via an open-source tool (NHSNLink) and piloting of this approach using real-world data in a newly established collaborative program (NHSNCoLab). The approach leverages Health Level Seven Fast Healthcare Interoperability Resources (FHIR) application programming interfaces to improve data collection and reporting for public health and patient safety beginning with common, clinically significant, and preventable patient harms, such as medication-related hypoglycemia, healthcare facility-onset Clostridioides difficile infection, and healthcare-associated venous thromboembolism. CONCLUSIONS The NHSN's FHIR dQMs hold the promise of minimizing the burden of reporting, improving accuracy, quality, and validity of data collected by NHSN, and increasing speed and efficiency of public health surveillance.
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Affiliation(s)
- Nadine Shehab
- Lantana Consulting Group, East Thetford, VT 05043, United States
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Liora Alschuler
- Lantana Consulting Group, East Thetford, VT 05043, United States
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Sean McILvenna
- Lantana Consulting Group, East Thetford, VT 05043, United States
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Zabrina Gonzaga
- Lantana Consulting Group, East Thetford, VT 05043, United States
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Andrew Laing
- Lantana Consulting Group, East Thetford, VT 05043, United States
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - David deRoode
- Lantana Consulting Group, East Thetford, VT 05043, United States
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Raymund B Dantes
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
- Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, United States
| | - Kristina Betz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Shuai Zheng
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Sheila Abner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Elizabeth Stutler
- Lantana Consulting Group, East Thetford, VT 05043, United States
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Rick Geimer
- Lantana Consulting Group, East Thetford, VT 05043, United States
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
| | - Andrea L Benin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States
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D'Andrea V, Pittiruti M, Prontera G, Vento G, Barone G. The SIECC protocol: A novel insertion bundle to minimize the complications related to epicutaneo-cava catheters in neonates. J Vasc Access 2024:11297298241239699. [PMID: 38641817 DOI: 10.1177/11297298241239699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024] Open
Abstract
Epicutaneo-cava catheters are the most widely used central venous catheters in the neonate, but their insertion and management are potentially associated with several complications, both during placement (failure to proceed with the catheter, primary malposition, etc.) and during maintenance (infection, venous thrombosis, catheter dislocation, secondary malposition, etc.). Recent studies have identified methods and techniques that may be effective in minimizing the risk of most of these complications. This paper proposes a structured, sequential insertion bundle-nicknamed "the SIECC protocol" (SIECC = Safe Insertion of Epicutaneo-Cava Catheters)-which includes seven evidence-based strategies which have been proven to increase the safety, effectiveness, and cost-effectiveness of the procedure.
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Affiliation(s)
- Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Giorgia Prontera
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Gianni Vento
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Lazio, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL della Romagna, Rimini, Emilia-Romagna, Italy
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32
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Bush A, Coutts J, Langley R. Vaping in pregnancy: Caution required! Addiction 2024. [PMID: 38637903 DOI: 10.1111/add.16510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Andrew Bush
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Jonathan Coutts
- Neonatal Department, Royal Hospital for Children, Glasgow, UK
| | - Ross Langley
- Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Children, Glasgow, UK
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Jabin MSR, Samuriwo R, Chilaka M, Yaroson EV. Effectiveness and Experiences of Quality Improvement Interventions in Older Adult Care: Protocol for a Mixed Methods Systematic Review. JMIR Res Protoc 2024; 13:e56346. [PMID: 38635311 DOI: 10.2196/56346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults. OBJECTIVE This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families. METHODS The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed. RESULTS A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses. CONCLUSIONS This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/56346.
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Affiliation(s)
| | - Ray Samuriwo
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Marcus Chilaka
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Emilia Vann Yaroson
- Logistics, Transport, Operations and Analytics, Huddersfield Business School, University of Huddersfield, Huddersfield, United Kingdom
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Subramanian V, Soni BM. Value and Limitations of Urethrotech Catheterisation Device to Manage Difficult Urethral Catheterisation in Male Spinal Cord Injury Patients. Med Devices (Auckl) 2024; 17:143-150. [PMID: 38644958 PMCID: PMC11032119 DOI: 10.2147/mder.s457784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/08/2024] [Indexed: 04/23/2024] Open
Abstract
Methods We used a Urethrotech catheterisation device in 57 male patients with spinal cord injury, in whom urethral catheterisation was unsuccessful or previous catheterisation was difficult. Results Urethrotech catheter could be inserted in 51 patients. No patient developed urinary tract infection. In one patient, the guidewire could not be introduced into the bladder, and a coude Foley catheter was inserted. In two patients, the guidewire was inserted into the bladder, but a 16 CH catheter could not be advanced over the guidewire. Emergency suprapubic cystostomy was performed in one case; in the other, urethral stricture was dilated; a size 12 CH catheter was inserted. In three patients, the guidewire curled back into the urethra because of severe spasm of the urethral sphincter. Catheterisation with a Tiemann catheter was successful after administration of diazepam and/or stretching of the anal sphincter by another health professional, which caused reflex relaxation of the urethral sphincter. Complications of Urethrotech catheterisation included urethral bleeding, haematuria, pain, doubling back of the guidewire due to spasm of the urethral sphincter or from an empty bladder. We adopted variations in technique, eg filling the bladder with saline prior to catheterisation when feasible, insertion of the guidewire by the side of the old catheter, use of Tiemann tip catheters, administration of antibiotics, diazepam to control spasms, nifedipine to control autonomic dysreflexia, analgesics, stretching of the anal sphincter to induce reflex relaxation of the urethral sphincter, urgent imaging studies to confirm correct positioning of the catheter, omitting anticoagulants and monitoring patients, who developed bleeding. Conclusion Use of Urethrotech in spinal injury patients warranted adaptations to the technique, which required expertise, experience, and backup facilities. To ensure patient safety, Urethrotech catheter should be used in a hospital setting, and by medical personnel with experience in the management of spinal cord injury patients.
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Affiliation(s)
- Vaidyanathan Subramanian
- Northwest Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Southport, UK
| | - Bakulesh Madhusudan Soni
- Northwest Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Southport, UK
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Bos K, van der Laan MJ, Groeneweg J, Kamps GJ, Legemate DA, Leistikow I, Dongelmans DA. Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation improvement matrix. BMJ Open Qual 2024; 13:e002592. [PMID: 38626939 PMCID: PMC11029212 DOI: 10.1136/bmjoq-2023-002592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The goal of sentinel event (SE) analysis is to prevent recurrence. However, the rate of SEs has remained constant over the past years. Research suggests this is in part due to the quality of recommendations. Currently, standards for the selection of recommendations are lacking. Developing a method to grade recommendations could help in both designing and selecting interventions most likely to improve patient safety. The aim of this study was to (1) develop a user-friendly method to grade recommendations and (2) assess its applicability in a large series of Dutch perioperative SE analysis reports. METHODS Based on two grading methods, we developed the recommendation improvement matrix (RIM). Applicability was assessed by analysing all Dutch perioperative SE reports over a 12-month period. After which interobserver agreement was studied. RESULTS In the RIM, two elements are crucial: whether the recommendation intervenes before or after an SE and whether it eliminates or controls the hazard. Applicability was evaluated in 115 analysis reports, encompassing 161 recommendations. Recommendation quality varied from the highest, category A, to the lowest, category D, with category A accounting for 44%, category B for 35%, category C for 2% and category D for 19% of recommendations. There was a fair interobserver agreement. CONCLUSION The RIM can be used to grade recommendations in SE analysis and could possibly help in both designing and selecting interventions. It is relatively simple, user-friendly and has the potential to improve patient safety. The RIM can help formulate effective and sustainable recommendations, a second key objective of the RIM is to foster and facilitate constructive dialogue among those responsible for patient safety.
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Affiliation(s)
- Kelly Bos
- Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Jop Groeneweg
- Delft University of Technology, TU Delft, Delft, The Netherlands
- University of Leiden, Leiden, The Netherlands
| | - Gert Jan Kamps
- Intergo International Centre for Safety Ergonomics and Human Factors, Amersfoort, The Netherlands
| | - Dink A Legemate
- Department of Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Ian Leistikow
- Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Dave A Dongelmans
- Department of Intensive Care Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Fedor M, Fónyad B, Nemes R, Asztalos L, Fülesdi B, Pongrácz A. [Evaluation of monitoring and reversal habits of neuromuscular blockade by anesthesiologists in Hungary]. Orv Hetil 2024; 165:574-583. [PMID: 38619890 DOI: 10.1556/650.2024.33010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/20/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Marianna Fedor
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Aneszteziológiai és Intenzív Terápiás Klinika Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Bettina Fónyad
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Aneszteziológiai és Intenzív Terápiás Klinika Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Réka Nemes
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Aneszteziológiai és Intenzív Terápiás Klinika Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - László Asztalos
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Aneszteziológiai és Intenzív Terápiás Klinika Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Béla Fülesdi
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Aneszteziológiai és Intenzív Terápiás Klinika Debrecen, Nagyerdei krt. 98., 4032 Magyarország
| | - Adrienn Pongrácz
- 1 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Aneszteziológiai és Intenzív Terápiás Klinika Debrecen, Nagyerdei krt. 98., 4032 Magyarország
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Louch G, Berzins K, Walker L, Wormald G, Blackwell K, Stephens M, Brown M, Baker J. Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool. JMIR Form Res 2024; 8:e53726. [PMID: 38607663 DOI: 10.2196/53726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. OBJECTIVE This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. METHODS The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. RESULTS We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, "getting worse" or "getting better"; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. CONCLUSIONS Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively.
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Affiliation(s)
- Gemma Louch
- School of Healthcare, University of Leeds, Leeds, United Kingdom
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, United Kingdom
| | - Kathryn Berzins
- Health Technology Assessment Unit, Applied Health Research Hub, Implementation and Capacity Building Team, NIHR Applied Research Collaboration North West Coast, University of Central Lancashire, Preston, United Kingdom
| | - Lauren Walker
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Gemma Wormald
- Thrive by Design, Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Kirstin Blackwell
- Thrive by Design, Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | | | - Mark Brown
- Social Spider CIC, London, United Kingdom
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, United Kingdom
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Hemmerich C, Corcoran A, Johnson AL, Wilson A, Orris O, Arellanes R, Vassar M. Reporting of Complications in Rhinoplasty Randomized Controlled Trials: An Analysis Using the CONSORT Extension for Harms Checklist. Otolaryngol Head Neck Surg 2024. [PMID: 38613190 DOI: 10.1002/ohn.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/02/2024] [Accepted: 02/05/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE This study aimed to assess the completeness of adverse event (AE) reporting in randomized control trials (RCTs) focused on rhinoplasty, using the Consolidated Standards for Reporting (CONSORT) Extension for Harms checklist. STUDY DESIGN A cross-sectional design was employed to review RCTs related to rhinoplasty published between January 1, 2005, and January 28, 2022. SETTING The study analyzed clinical trials on rhinoplasty retrieved from PubMed. METHODS We performed a comprehension search on PubMed, blind and duplicate screening, and data extraction. Adherence to the 18 recommendations of the CONSORT Extension for Harms was evaluated, with 1 point assigned for each adhered item. Percent adherence was calculated based on the 18 points, taking into account the multiple subcategories within some recommendations. Descriptive statistics were used to summarize adherence-including frequencies, percentages, and 95% confidence intervals. RESULTS Our search returned 240 articles, of which 56 met inclusion criteria. No RCTs adhered to all 18 CONSORT Extension for Harms items. Twenty-six (26/56, 46.4%) adhered to ≥50% of the items, and 30 (30/56, 53.6%) adhered to ≥33.3% of the items. Seven (7/56, 12.5%) RCTs adhered to no items. Across all RCTs, the average number of CONSORT-Harms items adhered to was 7.2 (7.2/18, 40.0%). The most adhered to item was item 10. Discussion balanced with regard to efficacy and AEs (80.4%, [70.0-90.8]). CONCLUSION This study highlights the inadequacy of AE reporting in rhinoplasty RCTs according to CONSORT-Harms guidelines. Urgent efforts are required to bridge this reporting gap and enhance transparency in surgical research, ultimately safeguarding patient well-being.
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Affiliation(s)
- Christian Hemmerich
- Department of Medical Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Adam Corcoran
- Department of Otolaryngology, Mclaren Oakland, Detroit, Michigan, USA
| | - Austin L Johnson
- Department of Otolaryngology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Andrew Wilson
- Department of Medical Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Olivia Orris
- Department of Medical Research, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA
| | - Russell Arellanes
- Department of Otolaryngology, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Matt Vassar
- Department of Medical Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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O'Brien N, Fernandez Crespo R, O'Driscoll F, Prendergast M, Chana D, Darzi A, Ghafur S. Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study. JMIR Form Res 2024; 8:e50968. [PMID: 38603777 DOI: 10.2196/50968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care-specific resources to help organizations at different levels of maturity develop their cybersecurity practices. OBJECTIVE This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. METHODS A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams' networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. RESULTS A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. CONCLUSIONS The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone's responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed.
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Affiliation(s)
- Niki O'Brien
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | | | - Fiona O'Driscoll
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Mabel Prendergast
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Deeph Chana
- Institute for Security Science and Technology, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Saira Ghafur
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Lippi G, Harbatsevich M, Zayats V. Analysis of thicknesses of blood collection needle by scanning electron microscopy reveals wide heterogeneity. Diagnosis (Berl) 2024; 0:dx-2023-0171. [PMID: 38590083 DOI: 10.1515/dx-2023-0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/16/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES The preanalytical phase in clinical laboratory diagnostics is currently receiving more and more attention. This term describes one part of actions and aspects of the "brain-to-brain cycle" of the medical laboratory diagnostic procedure that take place before the analytical phase. However, the preanalytical activities, the handling of unsuitable samples and the reporting procedures are neither fully standardized nor harmonized worldwide. The influence of the properties of the blood collection needle must be acknowledged. In this work, we focused on the investigation of the internal structure and size of standardized 21G blood collection needles. METHODS All parameters were measured with a scanning electron microscope using a Jeol model JSM-6000PLUS. Our. RESULTS The obtained data shows that the internal surfaces of the needles vary greatly from manufacturer to manufacturer (by around 35 %), and this may play an important role in influencing blood flow and even the risk of blood cell injury (especially hemolysis) during blood drawing. CONCLUSIONS The differential actual needle diameters can vary greatly between needle manufactures and this variety may have a significant impact on laboratory values and may also lead to specimen rejection.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, 19051 University of Verona , Verona, Italy
| | - Maksim Harbatsevich
- Section of Clinical Biochemistry, 19051 University of Verona , Verona, Italy
| | - Vera Zayats
- Section of Clinical Biochemistry, 19051 University of Verona , Verona, Italy
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Bahadurzada H, Kerrissey M, Edmondson AC. Speaking Up and Taking Action: Psychological Safety and Joint Problem-Solving Orientation in Safety Improvement. Healthcare (Basel) 2024; 12:812. [PMID: 38667574 DOI: 10.3390/healthcare12080812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Healthcare organizations face stubborn challenges in ensuring patient safety and mitigating clinician turnover. This paper aims to advance theory and research on patient safety by elucidating how the role of psychological safety in patient safety can be enhanced with joint problem-solving orientation (JPS). We hypothesized and tested for an interaction between JPS and psychological safety in relation to safety improvement, leveraging longitudinal survey data from a sample of 14,943 patient-facing healthcare workers. We found a moderation effect, in which psychological safety was positively associated with safety improvement, and the relationship was stronger in the presence of JPS. Psychological safety and JPS also interacted positively in predicting clinicians' intent to stay with the organization. For theory and research, our findings point to JPS as a measurable factor that may enhance the value of psychological safety for patient safety improvement-perhaps because voiced concerns about patient safety often require joint problem-solving to produce meaningful change. For practice, our conceptual framework, viewing psychological safety and JPS as complementary factors, can help organizations adopt a more granular approach towards assessing the interpersonal aspect of their safety climate. This will enable organizations to obtain a more nuanced understanding of their safety climate and identify areas for improvement accordingly.
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Affiliation(s)
- Hassina Bahadurzada
- Harvard Business School, Harvard University, Soldiers Field Road, Boston, MA 02162, USA
| | - Michaela Kerrissey
- Harvard TH Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, MA 02115, USA
| | - Amy C Edmondson
- Harvard Business School, Harvard University, Soldiers Field Road, Boston, MA 02162, USA
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Larsman P, Pousette A, Törner M. The impact of a climate of perceived organizational support on nurses' well-being and healthcare-unit performance: A longitudinal questionnaire study. J Adv Nurs 2024. [PMID: 38591844 DOI: 10.1111/jan.16188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/10/2024] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
AIM To investigate the relationship between nurses' climate of perceived organizational support, and their well-being and healthcare-unit performance. DESIGN A two-wave cohort questionnaire study among nurses within six hospitals in Sweden. METHODS Hypotheses were tested using cross-lagged path models on the individual (organizational support, job satisfaction, burnout, intention to stay) and aggregate levels (care-unit organizational support, team effectiveness, patient safety climate and patient safety). Analyses were based on 1.817 nurses in 228 care-units (T1), 1.362 nurses in 213 care-units (T2) and longitudinal samples of 711 nurses and 140 care-units. RESULTS Organizational support (T1) positively influenced job satisfaction (T2) and tended to decrease burnout (T2) but did not affect turnover intent. Reversed relationships were also found. No statistically significant prospective effects were found on the aggregate level. CONCLUSION The results indicated a prospective reciprocally reinforcing relationship between organizational support and job satisfaction. Burnout and intention to stay were predictors rather than outcomes of the organizational support climate. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE A climate where nurses perceive that their organization values their contributions and cares about their well-being is beneficial for their job satisfaction and health, which, according to previous research, may influence nurse retention. IMPACT The study addressed perceived organizational support as a potential predictor of nurses' well-being and healthcare-unit performance. A mutually reinforcing relation was indicated between organizational support and nurses' job satisfaction and health. Job dissatisfaction, burnout symptoms and turnover intentions were prospectively negatively related to the organizational support. Identifying and implementing a variety of practical measures to support perceptions of organizational support may be an effective way for healthcare management to start and sustain the development of a healthier work environment for healthcare professionals. REPORTING METHOD STROBE statement for cohort studies. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Pernilla Larsman
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Anders Pousette
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Marianne Törner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ko CJ, Gehlhausen JR, Cohen JM, Croskerry P. Cognitive Bias in the Patient Encounter: Part I. Background and significance. J Am Acad Dermatol 2024:S0190-9622(24)00557-7. [PMID: 38588821 DOI: 10.1016/j.jaad.2024.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 04/10/2024]
Abstract
Cognitive bias may lead to diagnostic error in the patient encounter. There are hundreds of different cognitive biases, but certain biases are more likely to affect patient diagnosis and management. As during morbidity and mortality rounds, retrospective evaluation of a given case, with comparison to an optimal diagnosis, can pinpoint errors in judgment and decision-making. The study of cognitive bias also illuminates how we might improve the diagnostic process. In Part 1 of this series, cognitive bias is defined and placed within the background of dual process theory, emotion, heuristics, and the more neutral term judgment and decision-making bias.
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Ko CJ, Gehlhausen JR, Cohen JM, Jiang Y, Myung P, Croskerry P. Cognitive Bias in the Patient Encounter: Part II. Debiasing using an adaptive toolbox. J Am Acad Dermatol 2024:S0190-9622(24)00558-9. [PMID: 38588820 DOI: 10.1016/j.jaad.2024.02.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 04/10/2024]
Abstract
Cognitive bias may lead to medical error, and awareness of cognitive pitfalls is a potential first step to addressing the negative consequences of cognitive bias (see Part 1). For decision-making processes that occur under uncertainty, which encompass most physician decisions, a so-called "adaptive toolbox" is beneficial for good decisions. The adaptive toolbox is inclusive of broad strategies like cultural humility, emotional intelligence, and self-care that help combat implicit bias, negative consequences of affective bias, and optimize cognition. Additionally, the adaptive toolbox includes situational-specific tools such as heuristics, narratives, cognitive forcing functions, and fast and frugal trees. Such tools may mitigate against errors due to cultural, affective, and cognitive bias. Part 2 of this two-part series covers metacognition and cognitive bias in relation to broad and specific strategies aimed at better decision-making.
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Pandit JJ, Hanmer SB. Economic analysis of anaesthesia associates and specialty and specialist (SAS) doctors. Comment on Br J Anaesth 2024. Br J Anaesth 2024:S0007-0912(24)00137-5. [PMID: 38582722 DOI: 10.1016/j.bja.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 04/08/2024] Open
Affiliation(s)
- Jaideep J Pandit
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Stuart B Hanmer
- Department of Anaesthesia, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Forbes J, Arrieta A. Comparing hospital leadership and front-line workers' perceptions of patient safety culture: an unbalanced panel study. BMJ Lead 2024:leader-2023-000922. [PMID: 38569892 DOI: 10.1136/leader-2023-000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/21/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND/AIM This article examines the relationships between workers' hospital leadership status, hospital front-line status and patient safety culture in hospitals throughout the USA. By identifying possible disparities in perception, targeted interventions can aim at decreasing differences between the two groups to increase the quality of healthcare. METHOD Data from 1 739 083 individuals, spreading across 1810 hospitals between 2008 and 2017 were collected. 115 228 (6.63%) self-identified as leaders, and 772 505 (44.42%) self-identified as front-line workers. The participants also filled in information describing their demographics in reference to the hospital, such as how long they have worked at the facility, their working unit and their occupation. RESULTS Results showed that leaders responded more positively to items that are directly related to management, such as 'my supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures' (0.33, p<0.01), where 0.33 signifies that leaders had an average response more positive by 0.33 compared with all other occupations on a Likert scale of 1-5. Based on multiple F-tests, all items have shown a statistical significance between leadership and front-line groups. CONCLUSION The findings highlight a compelling link between leadership roles and patient safety culture in hospitals, as well as between front-line worker status and patient safety culture. Moreover, a pronounced divergence in viewpoints regarding patient safety culture exists between hospital leaders and front-line staff. An in-depth investigation is necessary to comprehend the ramifications of these outcomes.
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Affiliation(s)
- Jayson Forbes
- Nova Southeastern University - Fort Lauderdale/Davie Campus, Fort Lauderdale, Florida, USA
| | - Alejandro Arrieta
- Department of Global Health, Florida International University, Miami, Florida, USA
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Hellblom A, Miller WP, Soller M, Samuelsson C. Malignant hyperthermia safety - A nationwide survey of publicly funded Swedish healthcare. Acta Anaesthesiol Scand 2024. [PMID: 38566397 DOI: 10.1111/aas.14417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Malignant hyperthermia (MH) is a rare pharmacogenetic disorder that can lead to a life-threatening reaction during general anaesthesia with triggering agents. Prompt life-saving treatment includes the immediate administration of the antidote dantrolene. This study investigated Swedish healthcare providers' awareness and adherence to guidelines and recommendations with respect to MH and whether adherence to safe MH-praxis varies with hospital care-complexity level and private versus public management form. METHOD Agreements and procurement specifications between all 21 Swedish County Councils and privately run surgical care providers were reviewed alongside with questionnaire-aided collection of information from 62 publicly funded health care providers (both privately and publicly run). RESULTS No procurement requirement specification or contract contained requirements on anaesthesia or aspects of MH. All publicly run hospitals stocked dantrolene and 28 out of 52 (54%) stocked the recommended amount. Seven out of nine (78%) of the privately run institutions stocked dantrolene, and one stocked the recommended amount. Publicly run hospitals adhered to recommendations to a greater extent than privately run institutions, both with respect to stocking of dantrolene (p = .02) and to stocking the recommended amount (p = .03). CONCLUSIONS Contracts between Swedish county councils and private surgical care subcontractors rarely outline expectations of standards for the safe practice of anaesthesia such as preparedness to handle a life-threatening MH reaction. Among Swedish publicly funded anaesthesia providers there is room for improvement in adherence to the EMHG guideline on dantrolene availability. Publicly run hospitals seem to have better compliance with these recommendations than privately run institutions. Raising awareness about current guidelines is important to improve safety for known and unknown MH-susceptible individuals.
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Affiliation(s)
- Anna Hellblom
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
- Department of Laboratory Medicine, Clinical Genetics, Lund University, Lund, Sweden
| | | | - Maria Soller
- Department of Laboratory Medicine, Clinical Genetics, Lund University, Lund, Sweden
- Department of Clinical Genetics and Genomics, Karolinska University Hospital, Stockholm, Sweden
| | - Carolina Samuelsson
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Halland Hospitals, Region Halland, Halland, Sweden
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48
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Mitchell C, Butler L, Holloway AD, Ra JH, Adapa K, Greenberg C, Marks LB, Ivester T, Mazur L. Analysis of patient safety event report categories at one large academic hospital. Front Health Serv 2024; 4:1337840. [PMID: 38628575 PMCID: PMC11018909 DOI: 10.3389/frhs.2024.1337840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/26/2024] [Indexed: 04/19/2024]
Abstract
Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4,000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts.
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Affiliation(s)
- Cody Mitchell
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Logan Butler
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Alexa D Holloway
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jin H Ra
- Division of Acute Care Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Karthik Adapa
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Caprice Greenberg
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lawrence B Marks
- Department of Radiation Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- UNC Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Thomas Ivester
- UNC Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lukasz Mazur
- Division of Healthcare Engineering, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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49
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Jayakumar N, Hagroo A, Kennion O, Holliman D. A cross-sectional survey of patient perceptions of the National Neurosurgical Audit Programme (NNAP). Br J Neurosurg 2024:1-4. [PMID: 38562086 DOI: 10.1080/02688697.2024.2334433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The National Neurosurgical Audit Programme (NNAP) publishes mortality outcomes of consultants and neurosurgical units across the United Kingdom. It is unclear how useful outcomes data is for patients and whether it influences their decision-making process. Our aim was to identify patients' perceptions and understanding of the NNAP data and its influences. MATERIALS AND METHODS This single-centre study was conducted in the outpatient neurosurgery clinics at a regional neurosurgical centre. All adult (age ≥ 18) neurosurgical patients, with capacity, were invited to take part. Native and non-native English speakers were eligible. Statistical analyses were performed on SPSS v28 (IBM). Ethical approval was obtained. RESULTS A total of 84 responses were received (54.7% females). Over half (51.0%) of respondents felt that they understood a consultant's mortality outcomes. Educational level determines respondents' understanding (χ2(8) = 16.870; p = .031). Most respondents were unaware of the NNAP (89.0%). Only a third of respondents (35.1%) understood the funnel plot used to illustrate mortality. CONCLUSIONS Most patients were unaware of the NNAP and most did not understand the data on the website. Understanding of mortality data seemed to be related to respondents' educational level which would be important to keep in mind when planning how to depict mortality data.
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Affiliation(s)
- Nithish Jayakumar
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Aasim Hagroo
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Oliver Kennion
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Damian Holliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Hubbard GP, Van Wyk J, Grinyer L, Onley R, White S, Fleming CA, Baxter J, Forwood L, Stratton RJ. Appropriate handling and storage reduce the risk of bacterial growth in enteral feeding systems reused within 24 hours. Nutr Clin Pract 2024; 39:437-449. [PMID: 37635446 DOI: 10.1002/ncp.11058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/27/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Enteral tube feeding can require considerable amounts of plastic equipment including delivery sets and containers, often disposed of after a single feeding session because of bacterial contamination concerns. The aim of this research was to assess whether reuse of delivery sets and containers for up to 24 h is safe from a microbiological perspective. METHODS Four enteral tube feeding systems (FS) were tested under hygienic controlled or repeated inoculation challenge conditions using key foodborne pathogens, to assess bacterial growth over time (FS1: ready-to-hang, closed 1-L system with delivery set reused, stored at room temperature [RT]; FS2: a prepared, powdered, open 1-L system with delivery set and container reused, stored at RT; FS3 and FS4: prepared, powdered, open 200-ml bolus systems with delivery set and container reused, stored at RT [FS3] and refrigeration [FS4]). Feed samples were cultured at 0.5, 6.5, 12.5, 18.5, and 24.5 h with >2 Δlog considered significant bacterial growth. RESULTS Under hygienic control, FS1, FS3, and FS4 were below the level of enumeration (<5 CFU/g) for all bacteria tested, at all time points. In FS2, significant bacterial growth was observed from 18.5 h. Under repeated bacterial inoculation challenge, no significant growth was observed in FS1 and FS4 over 24.5 h; however, significant growth was observed in FS2 after 6.5 h and in FS3 after 10-12 h. CONCLUSION With hygienic handling technique, there is limited bacterial growth with reuse of delivery sets and containers over 24 h. Refrigeration between feeding sessions and using boluses of reconstituted powdered feed reduce bacterial growth risk.
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Affiliation(s)
| | | | | | | | - Sean White
- Department of Dietetics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Carole-Anne Fleming
- NHSGGC Adult Acute Dietetic Service, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Rebecca J Stratton
- Nutricia Ltd, Trowbridge, UK
- School of Medicine, University of Southampton, Southampton, UK
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