3101
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Abstract
BACKGROUND Because patients are at the frontline of care where safety climate is closely tied to safety events, understanding patient perceptions of safety climate is crucial. We sought to develop and evaluate a parent-reported version of the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture and to relate parent-reported responses to parental need to watch over their child's care to ensure mistakes are not made. METHODS Parents (n=172) were surveyed about perceptions of hospital safety climate (14 items representing four domains-overall perceptions of safety, openness of staff and parent communication, and handoffs and transitions) and perceived need to watch over their child's care. Confirmatory factor analysis (CFA) was used to validate safety climate domain measures. Logistic regression was used to relate need to watch over care to safety climate domains. RESULTS CFA indices suggested good model fit for safety climate domains. Thirty-nine per cent of parents agreed or strongly agreed they needed to watch over care. In adjusted models, need to watch over care was significantly related to overall perceptions of safety (OR 0.20, 95% CI 0.11 to 0.37) and to handoffs and transitions (0.25, 0.14 to 0.46), but not to openness of staff (0.67, 0.40 to 1.12) or parent (0.83, 0.48 to 1.45) communication. CONCLUSIONS Findings suggest parents can provide valuable data on specific safety climate domains. Opportunities exist to improve our safety climate's impact on parent burden to watch over their child's care, such as targeting overall perceptions of safety as well as handoffs and transitions.
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Affiliation(s)
- Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
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3102
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Abstract
A real clinical case reported to SENSAR is presented. A patient admitted to the surgical intensive care unit following a lung resection, suffered arterial hypotension. The nurse was asked to give the patient 1 mL of phenylephrine. A few seconds afterwards, the patient experienced a hypertensive crisis, which resolved spontaneously without damage. Thereafter, the nurse was interviewed and a dosing error was identified: she had mistakenly given the patient 1 mg of phenylephrine (1 mL) instead of 100 mcg (1 mL of the standard dilution, 1mg in 10 mL). The incident analysis revealed latent factors (event triggers) due to the lack of protocols and standard operating procedures, communication errors among team members (physician-nurse), suboptimal training, and underdeveloped safety culture. In order to preempt similar incidents in the future, the following actions were implemented in the surgical intensive care unit: a protocol for bolus and short lived infusions (<30 min) was developed and to close the communication gap through the adoption of communication techniques. The protocol was designed by physicians and nurses to standardize the administration of drugs with high potential for errors. To close the communication gap, repeated checks about saying and understanding was proposed ("closed loop"). Labeling syringes with the drug dilution was also recommended.
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3103
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Harrison R, Birks Y, Hall J, Bosanquet K, Harden M, Iedema R. The contribution of nurses to incident disclosure: a narrative review. Int J Nurs Stud 2013; 51:334-45. [PMID: 23910400 DOI: 10.1016/j.ijnurstu.2013.07.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 10/25/2012] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore (a) how nurses feel about disclosing patient safety incidents to patients, (b) the current contribution that nurses make to the process of disclosing patient safety incidents to patients and (c) the barriers that nurses report as inhibiting their involvement in disclosure. DESIGN A systematic search process was used to identify and select all relevant material. Heterogeneity in study design of the included articles prohibited a meta-analysis and findings were therefore synthesised in a narrative review. DATA SOURCES A range of text words, synonyms and subject headings were developed in conjunction with the York Centre for Reviews and Dissemination and used to undertake a systematic search of electronic databases (MEDLINE; EMBASE; CENTRAL; PsycINFO; Health Management and Information Consortium; CINAHL; ASSIA; Science Citation Index; Social Science Citation Index; Cochrane Database of Systematic Reviews; Database of Abstracts of Reviews of Effects; Health Technology Assessment Database; Health Systems Evidence; PASCAL; LILACS). Retrieval of studies was restricted to those published after 1980. Further data sources were: websites, grey literature, research in progress databases, hand-searching of relevant journals and author contact. REVIEW METHODS The title and abstract of each citation was independently screened by two reviewers and disagreements resolved by consensus or consultation with a third person. Full text articles retrieved were further screened against the inclusion and exclusion criteria then checked by a second reviewer (YB). Relevant data were extracted and findings were synthesised in a narrative empirical synthesis. RESULTS The systematic search and selection process identified 15 publications which included 11 unique studies that emerged from a range of locations. Findings suggest that nurses currently support both physicians and patients through incident disclosure, but may be ill-prepared to disclose incidents independently. Barriers to nurse involvement included a lack of opportunities for education and training, and the multiple and sometimes conflicting roles within nursing. CONCLUSIONS Numerous potential benefits were identified that may result from nurses having a greater contribution to the disclosure process, but the provision of support and training is essential to overcome the reported barriers faced by nurses internationally.
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Affiliation(s)
- Reema Harrison
- Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, England, United Kingdom.
| | - Yvonne Birks
- University of York, York, England, United Kingdom
| | - Jill Hall
- University of York, York, England, United Kingdom
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3104
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Abstract
BACKGROUND There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure-'missed care'. AIM To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. METHODS Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. RESULTS Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of 'missed care' (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as 'failing' on patient safety, compared with 2.4 where patient safety was rated as 'excellent' (p < 0.001). CONCLUSIONS Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of 'missed care' as an early warning measure to identify wards with inadequate nurse staffing.
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Affiliation(s)
- Jane E Ball
- National Nursing Research Unit, Florence Nightingale School of Nursing and Midwifery, King's College London, , London, UK
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3105
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Abstract
Although healthcare quality and patient safety have longstanding international attention, the target of reducing diagnostic errors has only recently gained prominence, even though numerous patients, families and professional caregivers have suffered from diagnostic mishaps for a long time. Similarly, patients have always been involved in their own care to some extent, but only recently have patients sought more opportunities for engagement and participation in healthcare improvements. This paper brings these two promising trends together, analysing strategies for patient involvement in reducing diagnostic errors in an individual's own care, in improving the healthcare delivery system's diagnostic safety, and in contributing to research and policy development on diagnosis-related issues.
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Affiliation(s)
- Kathryn M McDonald
- Stanford University School of Medicine and University of California, School of Public Health, , Berkeley, California, USA
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3106
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Paradis E, Leslie M, Gropper MA, Aboumatar HJ, Kitto S, Reeves S. Interprofessional care in intensive care settings and the factors that impact it: results from a scoping review of ethnographic studies. J Crit Care 2013; 28:1062-7. [PMID: 23890936 DOI: 10.1016/j.jcrc.2013.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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: 11/09/2012] [Revised: 05/22/2013] [Accepted: 05/27/2013] [Indexed: 11/30/2022]
Abstract
At the heart of safe cultures are effective interactions within and between interprofessional teams. Critical care clinicians see severely ill patients who require coordinated interprofessional care. In this scoping review, we asked: "What do we know about processes, relationships, organizational and contextual factors that shape the ability of clinicians to deliver interprofessional care in adult ICUs?" Using the 5-stage process established by Levac et al. (2010), we reviewed 981 abstracts to identify ethnographic articles that shed light on interprofessional care in the intensive care unit. The quality of selected articles is assessed using best practices in ethnographic research; their main insights evaluated in light of an interprofessional framework developed by Reeves et al (Interprofessional Teamwork for Health and Social Care. San Francisco, CA: Wiley-Blackwell; 2010). Overall, studies were of mixed quality, with an average (SD) score of 5.8 out of 10 (1.77). Insights into intensive care unit cultures include the importance of paying attention to workflow, the nefarious impact of hierarchical relationships, the mixed responses to protocols imposed from the top down, and a general undertheorization of sex and race. This review highlights several lessons for safe cultures and argues that more needs to be known about the context of critical care if quality and safety interventions are to succeed.
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Affiliation(s)
- Elise Paradis
- Center for Innovation in Interprofessional Education, University of California, San Francisco, CA, USA
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3107
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Abstract
Numerous studies have shown that diagnostic failure depends upon a variety of factors. Psychological factors are fundamental in influencing the cognitive performance of the decision maker. In this first of two papers, we discuss the basics of reasoning and the Dual Process Theory (DPT) of decision making. The general properties of the DPT model, as it applies to diagnostic reasoning, are reviewed. A variety of cognitive and affective biases are known to compromise the decision-making process. They mostly appear to originate in the fast intuitive processes of Type 1 that dominate (or drive) decision making. Type 1 processes work well most of the time but they may open the door for biases. Removing or at least mitigating these biases would appear to be an important goal. We will also review the origins of biases. The consensus is that there are two major sources: innate, hard-wired biases that developed in our evolutionary past, and acquired biases established in the course of development and within our working environments. Both are associated with abbreviated decision making in the form of heuristics. Other work suggests that ambient and contextual factors may create high risk situations that dispose decision makers to particular biases. Fatigue, sleep deprivation and cognitive overload appear to be important determinants. The theoretical basis of several approaches towards debiasing is then discussed. All share a common feature that involves a deliberate decoupling from Type 1 intuitive processing and moving to Type 2 analytical processing so that eventually unexamined intuitive judgments can be submitted to verification. This decoupling step appears to be the critical feature of cognitive and affective debiasing.
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Affiliation(s)
- Pat Croskerry
- Department of Pediatrics, Division of Medical Education, Dalhousie University, , Halifax, Nova Scotia, Canada
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3108
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Murphy DR, Laxmisan A, Reis BA, Thomas EJ, Esquivel A, Forjuoh SN, Parikh R, Khan MM, Singh H. Electronic health record-based triggers to detect potential delays in cancer diagnosis. BMJ Qual Saf 2013; 23:8-16. [PMID: 23873756 DOI: 10.1136/bmjqs-2013-001874] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [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: 01/10/2023]
Abstract
BACKGROUND Delayed diagnosis of cancer can lead to patient harm, and strategies are needed to proactively and efficiently detect such delays in care. We aimed to develop and evaluate 'trigger' algorithms to electronically flag medical records of patients with potential delays in prostate and colorectal cancer (CRC) diagnosis. METHODS We mined retrospective data from two large integrated health systems with comprehensive electronic health records (EHR) to iteratively develop triggers. Data mining algorithms identified all patient records with specific demographics and a lack of appropriate and timely follow-up actions on four diagnostic clues that were newly documented in the EHR: abnormal prostate-specific antigen (PSA), positive faecal occult blood test (FOBT), iron-deficiency anaemia (IDA), and haematochezia. Triggers subsequently excluded patients not needing follow-up (eg, terminal illness) or who had already received appropriate and timely care. Each of the four final triggers was applied to a test cohort, and chart reviews of randomly selected records identified by the triggers were used to calculate positive predictive values (PPV). RESULTS The PSA trigger was applied to records of 292 587 patients seen between 1 January 2009 and 31 December 2009, and the CRC triggers were applied to 291 773 patients seen between 1 March 2009 and 28 February 2010. Overall, 1564 trigger positive patients were identified (426 PSA, 355 FOBT, 610 IDA and 173 haematochezia). Record reviews revealed PPVs of 70.2%, 66.7%, 67.5%, and 58.3% for the PSA, FOBT, IDA and haematochezia triggers, respectively. Use of all four triggers at the study sites could detect an estimated 1048 instances of delayed or missed follow-up of abnormal findings annually and 47 high-grade cancers. CONCLUSIONS EHR-based triggers can be used successfully to flag patient records lacking follow-up of abnormal clinical findings suspicious for cancer.
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Affiliation(s)
- Daniel R Murphy
- Houston VA Health Services Research & Development Center of Excellence, and The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, both at the Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research and Development, , Houston, Texas, USA
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3109
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Hamdan M. Measuring safety culture in Palestinian neonatal intensive care units using the Safety Attitudes Questionnaire. J Crit Care 2013; 28:886.e7-14. [PMID: 23871504 DOI: 10.1016/j.jcrc.2013.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 01/01/2013] [Revised: 05/27/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to measure safety culture, examine variations among neonatal intensive care units (NICUs), and assess the associations with caregiver characteristics. MATERIALS AND METHODS A cross-sectional design was used, utilizing the Arabic version of the Safety Attitudes Questionnaire, administered to all 305 nurses and physicians working in the 16 NICUs in the West Bank. RESULTS There were 204 participants, comprising of mainly nurses (80.4%), women (63%), 30 years or younger (62.6%), holding a bachelor's degree or more (66.7%), and with at least 5 years of experience in the profession (60.3%). Safety Attitudes Questionnaire mean domain scores ranged from 71.22 for job satisfaction to 63 for stress recognition on a 100-point scale; the scores varied significantly among NICUs (P<.05). About 85% of the participants rated the safety grade either excellent or very good; 71.0% did not report any event in the past year. CONCLUSIONS We found large variations in safety culture within and between a comprehensive sample of Palestinian NICUs. The findings suggest the need for a customized approach that builds on existing strengths and targets areas of opportunities for improvement to optimize health care delivery to the most vulnerable of patients, sick newborns in the NICU setting.
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Affiliation(s)
- Motasem Hamdan
- School of Public Health, Al-Quds University, PO Box 51000, East Jerusalem, Palestinian Territory.
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3110
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Abstract
The two forces that have driven the increase in accreditation of outpatient ambulatory surgery centers (ASC's) in the United States are reimbursement of facility fees by Medicare and commercial insurance companies, which requires either accreditation, Medicare certification, or state licensure, and state laws which mandate one of these three options. Accreditation of ASC's internationally has been driven by national requirements and by the competitive forces of "medical tourism." The three American accrediting organizations have all developed international programs to meet this increasing demand outside of the United States.
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3111
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Abstract
The two forces that have driven the increase in accreditation of outpatient ambulatory surgery centers (ASC's) in the United States are reimbursement of facility fees by Medicare and commercial insurance companies, which requires either accreditation, Medicare certification, or state licensure, and state laws which mandate one of these three options. Accreditation of ASC's internationally has been driven by national requirements and by the competitive forces of "medical tourism." The three American accrediting organizations have all developed international programs to meet this increasing demand outside of the United States.
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Affiliation(s)
- Michael F McGuire
- Department of Surgery, Division of Plastic Surgery, University of Southern California, 1520 San Pablo Street, Los Angeles, CA 90033, USA.
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3112
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Abstract
Patient safety is the mission of the American Association for Accreditation of Ambulatory Surgery Facilities, Inc (AAAASF). Well-crafted standards are at the foundation of attaining successful Ambulatory Surgical Facility outcomes. Without expert inspection practices and administrative processes supporting these standards, they are powerless to protect patients. This 2-part approach is used by AAAASF to ensure 100% compliance of all surgical standards.
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3113
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Blais R, Sears NA, Doran D, Baker GR, Macdonald M, Mitchell L, Thalès S. Assessing adverse events among home care clients in three Canadian provinces using chart review. BMJ Qual Saf 2013; 22:989-97. [PMID: 23828878 PMCID: PMC3888609 DOI: 10.1136/bmjqs-2013-002039] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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] [Indexed: 11/17/2022]
Abstract
Objectives The objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where AEs were found. Methods This was a retrospective cohort study based on expert chart review of a random sample of 1200 charts of clients discharged in fiscal year 2009–2010 from publicly funded HC programmes in Manitoba, Quebec and Nova Scotia, Canada. Results The results show that 4.2% (95% CI 3.0% to 5.4%) of HC patients discharged in a 12-month period experienced an AE. Adjusting to account for clients with lengths of stay in HC of less than 1 year, the AE incidence rate per client-year was 10.1% (95% CI 8.4% to 11.8%); 56% of AEs were judged preventable. The most frequent AEs were injuries from falls, wound infections, psychosocial, behavioural or mental health problems and adverse outcomes from medication errors. More comorbid conditions (OR 1.15; 95% CI 1.05 to 1.26) and a lower instrumental activities of daily living score (OR 1.54; 95% CI 1.16 to 2.04) were associated with a higher risk of experiencing an AE. Clients’ decisions or actions contributed to 48.4% of AEs, informal caregivers 20.4% of AEs, and healthcare personnel 46.2% of AEs. Only 17.3% of charts with an AE contained documentation that indicated an incident report was completed, while 4.8% of charts without an AE had such documentation. Conclusions Client safety is an important issue in HC, as it is in institutionalised care. HC includes the planned delivery of self-care by clients and care provision by family, friends and other individuals often described as ‘informal’ caregivers. As clients and these caregivers can contribute to the occurrence of AEs, their involvement in the delivery of healthcare interventions at home must be considered when planning strategies to improve HC safety.
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Affiliation(s)
- Régis Blais
- Department of Health Administration, University of Montreal, , Montréal, Québec, Canada
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3114
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Kelay T, Kesavan S, Collins RE, Kyaw-Tun J, Cox B, Bello F, Kneebone RL, Sevdalis N. Techniques to aid the implementation of novel clinical information systems: a systematic review. Int J Surg 2013; 11:783-91. [PMID: 23831751 DOI: 10.1016/j.ijsu.2013.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 10/11/2012] [Revised: 06/14/2013] [Accepted: 06/19/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND This systematic review identifies and evaluates techniques that aid the implementation of novel clinical information systems (CIS) within healthcare. METHODS We searched electronic databases (MEDLINE, EMBASE, PsycINFO and HMIC Health Management Information Consortium). Desktop reviews for all potentially eligible studies were also conducted via reference lists and forward citation searches. 14,198 abstracts were identified through the initial electronic search. 63 articles were retained following title and abstract reviews, and submitted for full text evaluation. Of these, 18 papers met eligibility criteria. RESULTS The 5 techniques that emerged from the review and that can assist CIS implementation were: system piloting, eliciting acceptance, use of simulation, training and education, and provision of incentives. These techniques were evaluated with a range of study endpoints (including system utilisation, clinical effectiveness, user satisfaction, attitudes towards system training, and attitudes towards implementation). Consideration of the clinical context in which the CIS was implemented was a consistent theme in the evidence-base. CONCLUSIONS Although some evidence is available for the effectiveness of the 5 implementation techniques found in this review, the variable endpoints and the non-comparable study designs mean that the evidence-base needs further developing. We discuss the potential role of simulation and clinical leadership, particularly in relation to surgeons, in CIS implementation and we propose practical advice for CIS implementation and evaluation within hospital settings.
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Affiliation(s)
- Tanika Kelay
- Department of Surgery and Cancer, Imperial College London, UK.
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3115
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Beckett DJ, Inglis M, Oswald S, Thomson E, Harley W, Wilson J, Lloyd RC, Rooney KD. Reducing cardiac arrests in the acute admissions unit: a quality improvement journey. BMJ Qual Saf 2013; 22:1025-31. [PMID: 23828879 PMCID: PMC3888590 DOI: 10.1136/bmjqs-2012-001404] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 2010, the acute admissions unit (AAU) at Stirling Royal Infirmary had the highest number of cardiac arrests of any ward. A quality improvement project was undertaken to reduce this to <1/1000 admissions by December 2011. METHODS In January 2011, based on initial needs assessment, we selected three initiatives to improve cardiac arrest rate: (1) structured response to deteriorating patients; (2) analysis of adverse events; and (3) improved end-of-life decision-making. We performed a failure modes effects analysis to identify reasons for the failure of early recognition and response. Ward staff conducted weekly safety meetings to engage unit staff and promote a safety culture of continuous improvement. Additionally, in July 2011 the unit adopted a ward-based clinical team structure with twice daily consultant ward rounds. Our primary outcome measure, cardiac arrests per 1000 admissions, was measured from January 2011 to August 2012. RESULTS Over 17 months, the number of cardiac arrests per 1000 admissions fell from a baseline of 2.8/1000 admissions to 0.8/1000 admissions (71% reduction), referrals to palliative care increased by 22 to 37/1000 admissions per month (68% increase) and the 30-day mortality of patients admitted to the AAU fell from 6.3% to 4.8% (24% relative reduction). CONCLUSIONS Through adoption of a shared goal, application of improvement methodology including the model for improvement to test new innovations, and promotion of a safety culture in the AAU, cardiac arrests were successfully reduced to <1/1000 admissions per month with an associated significant fall in mortality. This was achieved with negligible cost.
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Affiliation(s)
- Daniel J Beckett
- Department of Acute Medicine, Forth Valley Royal Hospital, , Larbert, Stirlingshire, UK
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3116
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Gazarian PK. Nurses' response to frequency and types of electrocardiography alarms in a non-critical care setting: a descriptive study. Int J Nurs Stud 2013; 51:190-7. [PMID: 23810495 DOI: 10.1016/j.ijnurstu.2013.05.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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: 11/25/2012] [Revised: 05/27/2013] [Accepted: 05/30/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND An important role of the registered nurse is to identify patient deterioration by monitoring the patient condition and vital signs. Increasingly, this is supplemented with continuous electrocardiographic (ECG) monitoring. Continuous monitoring is inefficient in identifying deterioration because of the high number of false and nuisance alarms. Lack of strong evidence or formal guidelines for the care of patients receiving ECG monitoring has led clinicians to rely too heavily on this technology without consideration of its limitations. The nursing workload associated with alarm management remains unexamined. OBJECTIVE To describe nurses' routine practices related to continuous ECG monitoring, frequency and types of alarms, their associated nursing interventions, and the impact on the patient's plan of care. METHODS Design. Prospective, descriptive, observational study. Setting and participants. Between January 2011 and March 2011 we observed nine Registered Nurses providing care for patients receiving continuous ECG monitoring in non-critical care areas. The PI and two research assistants observed each nurse for two 3-h observation periods and recorded data on a researcher designed observation tool. At the end of each observation period, the observers printed the alarm events as recorded by the central monitoring computer. RESULTS Nurses responded to 46.8% of all alarms. During the observation period, there were no dysrhythmia adverse events. One patient had a change in condition requiring transfer to a higher level of care. A range of nursing interventions occurred in response to alarms. CONCLUSION Nurses routine practices related to monitoring continue to reveal gaps in practice related to alarm management. Observations of practice also revealed the difficulties and complexities of managing alarm systems and the range of nursing interventions associated with managing alarms.
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Affiliation(s)
- Priscilla K Gazarian
- School of Nursing and Health Sciences, Simmons College, 300 The Fenway, Boston, MA 02115, United States.
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3117
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Abstract
OBJECTIVES Systemic issues can adversely affect the diagnostic process. Many system-related barriers can be masked by 'resilient' actions of frontline providers (ie, actions supporting the safe delivery of care in the presence of pressures that the system cannot readily adapt to). We explored system barriers and resilient actions of primary care providers (PCPs) in the diagnostic evaluation of cancer. METHODS We conducted a secondary data analysis of interviews of PCPs involved in diagnostic evaluation of 29 lung and colorectal cancer cases. Cases covered a range of diagnostic timeliness and were analysed to identify barriers for rapid diagnostic evaluation, and PCPs' actions involving elements of resilience addressing those barriers. We rated these actions according to whether they were usual or extraordinary for typical PCP work. RESULTS Resilient actions and associated barriers were found in 59% of the cases, in all ranges of timeliness, with 40% involving actions rated as beyond typical. Most of the barriers were related to access to specialty services and coordination with patients. Many of the resilient actions involved using additional communication channels to solicit cooperation from other participants in the diagnostic process. DISCUSSION Diagnostic evaluation of cancer involves several resilient actions by PCPs targeted at system deficiencies. PCPs' actions can sometimes mitigate system barriers to diagnosis, and thereby impact the sensitivity of 'downstream' measures (eg, delays) in detecting barriers. While resilient actions might enable providers to mitigate system deficiencies in the short run, they can be resource intensive and potentially unsustainable. They complement, rather than substitute for, structural remedies to improve system performance. Measures to detect and fix system performance issues targeted by these resilient actions could facilitate diagnostic safety.
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Affiliation(s)
- Michael W Smith
- Houston VA HSR&D Center of Excellence and The Center of Inquiry to Improve Outpatient Safety Through Effective Electronic Communication, , Houston, Texas, USA
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3118
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Bostwick DG. Radiofrequency identification specimen tracking in anatomical pathology: pilot study of 1067 consecutive prostate biopsies. Ann Diagn Pathol 2013; 17:391-402. [PMID: 23796559 DOI: 10.1016/j.anndiagpath.2013.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Abstract
Improved methods such as radiofrequency identification (RFID) are needed to optimize specimen tracking in anatomical pathology. We undertook a study of RFID in an effort to optimize specimen tracking and patient identification, including the following: (1) creation of workflow process maps, (2) evaluation of existing RFID hardware technologies, (3) creation of Web-based software to support the RFID-enabled workflow, and (4) assessment of the impact with a series of prostate biopsies. We identified multiple steps in the workflow process in which RFID enhanced specimen tracking. Multiple product choices were found that could withstand the harsh heat and chemical environments encountered in pathology processing, and software that was compatible with our laboratory information system was designed in-house. A total of 1067 prostate biopsies were received, and 78.3% were successfully processed with the RFID system. Radiofrequency identification allowed dynamic specimen tracking throughout the workflow process in anatomical pathology.
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3119
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Ocloo J, O'Shea A, Fulop N. Empowerment or rhetoric? Investigating the role of NHS Foundation Trust governors in the governance of patient safety. Health Policy 2013; 111:301-10. [PMID: 23764151 DOI: 10.1016/j.healthpol.2013.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 07/26/2012] [Revised: 04/29/2013] [Accepted: 05/13/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Involving patients and the public in patient safety is seen as central to health reform internationally. In England, NHS Foundation Trusts are seen as one way to achieve inclusive governance by involving local communities. We analysed these arrangements by studying lay governor involvement in the formal governance structures to improve patient safety. METHODS Interviews with key informants, observations of meetings and documentary analysis were conducted at a case study site. A national survey was conducted with all acute Foundation Trusts (n=90), with a response rate of 40% (n=36). Follow up telephone interviews were conducted with seven of these. RESULTS The case-study revealed a complex governance context for patient safety involving board, safety and various sub-committees. Governors were mainly not involved in these formal mechanisms, with participation being seen to pose a conflict of interest with the governors' role. Findings from the survey showed some involvement of governors in the governance of patient safety. CONCLUSIONS This study revealed a lack of inclusivity by Foundation Trusts of lay governors in patient safety governance. It suggests action is needed to empower governors to undertake their statutory duties more effectively and particularly through clarification of their role and the provision of targeted training and support to facilitate their involvement in the governance of patient safety.
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Affiliation(s)
- Josephine Ocloo
- The King's Fund, Policy Department, 11-13 Cavendish Square, London, W1G 0AN, UK.
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Abstract
BACKGROUND Patient involvement in patient safety is widely advocated but knowledge regarding implementation of the concept in clinical practice is sparse. OBJECTIVE To investigate existing practices for patient involvement in patient safety, and opportunities and barriers for further involvement. DESIGN A qualitative study of patient safety involvement practices in patient trajectories for prostate, uterine and colorectal cancer in Denmark. Observations from four hospital wards and interviews with 25 patients with cancer, 11 hospital doctors, 10 nurses, four general practitioners and two private practicing gynaecologists were conducted using ethnographic methodology. FINDINGS Patient safety was not a topic of attention for patients or dominant in communication between patients and healthcare professionals. The understanding of patient safety in clinical practice is almost exclusively linked to disease management. Involvement of patients is not systematic, but healthcare professionals and patients express willingness to engage. Invitation and encouragement of patients to become involved could be further systematised and developed. Barriers include limited knowledge of patient safety, of specific patient safety involvement techniques and concern regarding potential negative impact on doctor-patient relationship. CONCLUSIONS Involvement of patients in patient safety must take into account that despite stated openness to the idea of involvement, patients and health professionals may not in practice show immediate concern. Lack of systematic involvement can also be attributed to limited knowledge about how to implement involvement beyond the focus of self-monitoring and compliance and a concern about the consequences of patient involvement for treatment outcomes. To realise the potential of patients' and health professionals' shared openness towards involvement, there is a need for more active facilitation and concrete guidance on how involvement can be practiced by both parties.
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Affiliation(s)
- Helle Max Martin
- KORA, Danish Institute for Local and Regional Government Research, , Copenhagen, Denmark
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3121
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Vollman KM. Interventional patient hygiene: discussion of the issues and a proposed model for implementation of the nursing care basics. Intensive Crit Care Nurs 2013; 29:250-5. [PMID: 23746440 DOI: 10.1016/j.iccn.2013.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 04/09/2013] [Accepted: 04/15/2013] [Indexed: 11/21/2022]
Abstract
More than 140 years ago, Florence Nightingale wrote "It may seem a strange principal to enunciate as the very first requirement in a Hospital that it should do the sick no harm." Data suggests that 63% of all preventable errors are related to clinical problems that are within nursing's independent scope of practice. Many of these fall in the category of "interventional hygiene" activities and include prevention of skin injury, post-operative respiratory complications and failure to rescue. As nurses we are called upon to assure higher levels of safety and quality for our patients by our governments, professional organisations and hospital administrations. It is essential that we implement evidence based nursing care strategies to reduce avoidable errors in care so that clinical outcomes improve. The author of this paper, who coined the team "interventional patient hygiene", discusses the science related to many of these care issues and proposes an Interventional Care Model for use by nurses in redesigning how we approach nurse sensitive care practices in the future. Additionally, a change framework called "Sustaining Nursing Clinical Practice" is described to ensure reintroduction and valuing of evidence basic nursing care in conjunction with the right resources and systems to sustain the new practice.
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Pozo Muñoz F, Padilla Marín V. [Assessment of the patient-safety culture in a healthcare district]. Rev Calid Asist 2013; 28:329-36. [PMID: 23731575 DOI: 10.1016/j.cali.2013.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/23/2013] [Accepted: 03/26/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES 1) To describe the frequency of positive attitudes and behaviours, in terms of patient safety, among the healthcare providers working in a healthcare district; 2) to determine whether the level of safety-related culture differs from other studies; and 3) to analyse negatively valued dimensions, and to establish areas for their improvement. MATERIAL AND METHODS A descriptive, cross-sectional study based on the results of an evaluation of the safety-related culture was conducted on a randomly selected sample of 247 healthcare providers, by using the Spanish adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) designed by the Agency for Healthcare Research and Quality (AHRQ), as the evaluation tool. Positive and negative responses were analysed, as well as the global score. Results were compared with international and national results. RESULTS A total of 176 completed survey questionnaires were analysed (response rate: 71.26%); 50% of responders described the safety climate as very good, 37% as acceptable, and 7% as excellent. Strong points were: «Teamwork within the units» (80.82%) and «Supervisor/manager expectations and actions» (80.54%). Dimensions identified for potential improvement included: «Staffing» (37.93%), «Non-punitive response to error» (41.67%), and «Frequency of event reporting» (49.05%). CONCLUSIONS Strong and weak points were identified in the safety-related culture of the healthcare district studied, together with potential improvement areas. Benchmarking at the international level showed that our safety-related culture was within the average of hospitals, while at the national level, our results were above the average of hospitals.
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Affiliation(s)
- F Pozo Muñoz
- Médico especialista en Medicina Familiar y Comunitaria, Hospital Regional Universitario Carlos Haya de Málaga, Málaga, España.
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Simon ACR, Holleman F, Gude WT, Hoekstra JBL, Peute LW, Jaspers MWM, Peek N. Safety and usability evaluation of a web-based insulin self-titration system for patients with type 2 diabetes mellitus. Artif Intell Med 2013; 59:23-31. [PMID: 23735522 DOI: 10.1016/j.artmed.2013.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 06/30/2012] [Revised: 04/08/2013] [Accepted: 04/24/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The rising incidence of type 2 diabetes mellitus (T2DM) induces severe challenges for the health care system. Our research group developed a web-based system named PANDIT that provides T2DM patients with insulin dosing advice using state of the art clinical decision support technology. The PANDIT interface resembles a glucose diary and provides advice through pop-up messages. Diabetes nurses (DNs) also have access to the system, allowing them to intervene when needed. The objective of this study was to establish whether T2DM patients can safely use PANDIT at home. To this end, we assessed whether patients experience usability problems with a high risk of compromising patient safety when interacting with the system, and whether PANDIT's insulin dosing advice are clinically safe. RESEARCH DESIGN AND METHODS The study population consisted of patients with T2DM (aged 18-80) who used a once daily basal insulin as well as DNs from a university hospital. The usability evaluation consisted of think-aloud sessions with four patients and three DNs. Video data, audio data and verbal utterances were analyzed for usability problems encountered during PANDIT interactions. Usability problems were rated by a physician and a usability expert according to their potential impact on patient safety. The usability evaluation was followed by an implementation with a duration of four weeks. This implementation took place at the patients' homes with ten patients to evaluate clinical safety of PANDIT advice. PANDIT advice were systematically compared with DN advice. Deviating advice were evaluated with respect to patient safety by a panel of experienced physicians, which specialized in diabetes care. RESULTS We detected seventeen unique usability problems, none of which was judged to have a high risk of compromising patient safety. Most usability problems concerned the lay-out of the diary, which did not clearly indicate which data entry fields had to be entered in order to obtain an advice. 27 out of 74 (36.5%) PANDIT advice differed from those provided by DNs. However, only one of these (1.4%) was considered unsafe by the panel. CONCLUSION T2DM patients with no prior experience with the web-based self-management system were capable of consulting the system without encountering significant usability problems. Furthermore, the large majority of PANDIT advice were considered clinically safe according to the expert panel. One advice was considered unsafe. This could however easily be corrected by implementing a small modification to the system's knowledge base.
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Affiliation(s)
- Airin C R Simon
- Department of Medical Informatics, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Department of Internal Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Merseburger AS, Herrmann TRW, Shariat SF, Kyriazis I, Nagele U, Traxer O, Liatsikos EN. EAU guidelines on robotic and single-site surgery in urology. Eur Urol 2013; 64:277-91. [PMID: 23764016 DOI: 10.1016/j.eururo.2013.05.034] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 05/15/2013] [Indexed: 12/19/2022]
Abstract
CONTEXT This is a short version of the European Association of Urology (EAU) guidelines on robotic and single-site surgery in urology, as created in 2013 by the EAU Guidelines Office Panel on Urological Technologies. OBJECTIVE To evaluate current evidence regarding robotic and single-site surgery in urology and to provide clinical recommendations. EVIDENCE ACQUISITION A comprehensive online systematic search of the literature according to Cochrane recommendations was performed in July 2012, identifying data from 1990 to 2012 regarding robotic and single-site surgery in urology. EVIDENCE SYNTHESIS There is a lack of high-quality data on both robotic and single-site surgery for most upper and lower urinary tract operations. Mature evidence including midterm follow-up data exists only for robot-assisted radical prostatectomy. In the absence of high-quality data, the guidelines panel's recommendations were based mostly on the review of low-level evidence and expert opinions. CONCLUSIONS Robot-assisted urologic surgery is an emerging and safe technology for most urologic operations. Further documentation including long-term oncologic and functional outcomes is deemed necessary before definite conclusions can be drawn regarding the superiority or not of robotic assistance compared with the conventional laparoscopic and open approaches. Laparoendoscopic single-site surgery is a novel laparoscopic technique providing a potentially superior cosmetic outcome over conventional laparoscopy. Nevertheless, further advantages offered by this technology are still under discussion and not yet proven. Due to the technically demanding character of the single-site approach, only experienced laparoscopic surgeons should attempt this technique in clinical settings. PATIENT SUMMARY This work represents the shortened version of the 2013 European Association of Urology guidelines on robotic and single-site surgery. The authors systematically evaluated published evidence in these fields and concluded that robotic assisted surgery is possible and safe for most urologic operations. Whilst laparoendoscopic single-site surgery is performed using the fewest incisions, the balance between risk and benefit is currently unclear. The evidence to support the conclusions in this guideline was generally poor, but best for robotic assisted radical prostatectomy. As such, these recommendations were based upon expert opinion, and further high-quality research is needed in this field.
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Affiliation(s)
- Axel S Merseburger
- Department of Urology and Urologic Oncology Medical School of Hanover (MHH), Hanover, Germany.
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Abstract
OBJECTIVE To characterise the safety hazards related to e-prescribing in community pharmacies. METHODS The sociotechnical systems framework was used to investigate the e-prescribing technology interface in community pharmacies by taking into consideration the social, technical and environmental work elements of a user's interaction with technology. This study focused specifically on aspects of the social subsystem. STUDY DESIGN AND SETTING The study employed a cross-sectional qualitative design and was conducted in seven community pharmacies in Wisconsin. Direct observations, think aloud protocols and group interviews were conducted with 14 pharmacists and 16 technicians, and audio recorded. Recordings were transcribed and subjected to thematic content analysis guided by the sociotechnical systems' theoretical framework. RESULTS Three major themes that may increase the potential for medication errors with e-prescribing were identified and described. The three themes included: (1) increased cognitive burden on pharmacy staff, such as having to memorise parts of e-prescriptions or having to perform dosage calculations mentally; (2) interruptions during the e-prescription dispensing process; and (3) communication issues with prescribers, patients and among pharmacy staff. Pharmacy staff reported these consequences of e-prescribing increased the likelihood of medication errors. CONCLUSIONS This study is the first of its kind to identify patient safety risks related to e-prescribing in community pharmacies using a sociotechnical systems framework. The findings shed light on potential interventions that may enhance patient safety in pharmacies and facilitate improved e-prescribing use. Future studies should confirm patient safety hazards reported and identify ways to use e-prescribing effectively and safely in community pharmacies.
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Affiliation(s)
- Olufunmilola K Odukoya
- Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin, , Madison, Wisconsin, USA
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Menéndez MD, Alonso J, Miñana JC, Arche JM, Díaz JM, Vazquez F. Characteristics and associated factors in patient falls, and effectiveness of the lower height of beds for the prevention of bed falls in an acute geriatric hospital. Rev Calid Asist 2013; 28:277-84. [PMID: 23684046 DOI: 10.1016/j.cali.2013.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/17/2012] [Accepted: 01/22/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Whereas several studies about patient falls have provided data for long-term healthcare institutions, less information is available for acute care centres. The objective was to analyze the characteristics of the patient falls and associated factors, and the effectiveness of the lower beds' height to reduce the frequency and the harms of the patient falls in an acute geriatric hospital. METHODS A descriptive and retrospective study using a mandatory safety incident report, the IHI Global Trigger Tool, and the claims related to patient falls between 2007 and 2011 in a 200-bed university-associated geriatric hospital. RESULTS The falls rate was 5.4 falls per 1000 patient days (1.3% of falls led to fractures) and there was exitus in 6 patients (0.6%). Nearly half of the falls ocurred during the night shift (42.4%). By wards, falls were more frequent in acute geriatric wards (42.9%). A 7.5% of patients had a fall before admission. 3 (0.2%) claims due to possible clinical negligence were found. A reduction (28.3%) of bed falls with the lower height of the bed and a 1.88 times less falls with harm (RR 0.53; CI 95% 0.83-0.34) (p=0.006) was observed. CONCLUSION The prevention of patient falls is an important task in geriatric units with a potential reduction of harms and costs, some measures such as the lower height of the bed showed a significant reduction of the falls.
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Affiliation(s)
- M D Menéndez
- Servicio de Calidad del Área 4, Hospital Monte Naranco, Oviedo, Spain
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Schmettow M, Vos W, Schraagen JM. With how many users should you test a medical infusion pump? Sampling strategies for usability tests on high-risk systems. J Biomed Inform 2013; 46:626-41. [PMID: 23688827 DOI: 10.1016/j.jbi.2013.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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: 10/15/2012] [Revised: 04/12/2013] [Accepted: 04/25/2013] [Indexed: 11/24/2022]
Abstract
Usability testing is recognized as an effective means to improve the usability of medical devices and prevent harm for patients and users. Effectiveness of problem discovery in usability testing strongly depends on size and representativeness of the sample. We introduce the late control strategy, which is to continuously monitor effectiveness of a study towards a preset target. A statistical model, the LNB(zt) model, is presented, supporting the late control strategy. We report on a case study, where a prototype medical infusion pump underwent a usability test with 34 users. On the data obtained in this study, the LNB(zt) model is evaluated and compared against earlier prediction models. The LNB(zt) model fits the data much better than previously suggested approaches and improves prediction. We measure the effectiveness of problem identification, and observe that it is lower than is suggested by much of the literature. Larger sample sizes seem to be in order. In addition, the testing process showed high levels of uncertainty and volatility at small to moderate sample sizes, partly due to users' individual differences. In reaction, we propose the idiosyncrasy score as a means to obtain representative samples. Statistical programs are provided to assist practitioners and researchers in applying the late control strategy.
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Affiliation(s)
- Martin Schmettow
- Department of Cognitive Psychology and Ergonomics, University of Twente, 7522 NB Enschede, The Netherlands.
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Bjertnaes O, Skudal KE, Iversen HH, Lindahl AK. The Patient-Reported Incident in Hospital Instrument (PRIH-I): assessments of data quality, test-retest reliability and hospital-level reliability. BMJ Qual Saf 2013; 22:743-51. [PMID: 23674692 PMCID: PMC3756465 DOI: 10.1136/bmjqs-2012-001756] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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] [Indexed: 11/26/2022]
Abstract
Background The objective of this study was to test the data quality, test–retest reliability and hospital-level reliability of the Patient-Reported Incident in Hospital Instrument (PRIH-I). Methods 13 incident questions were included in a national patient-experience survey in Norway during the spring of 2011. All questions and a composite incident index were assessed by calculating missing-item rates, test–retest reliability and hospital-level reliability. A multivariate linear regression on a global item regarding incorrect treatment was used to assess the main sources of variation in patient-perceived incorrect treatment at hospitals. Results Five of the 13 patient-incident questions had a missing-item rate of >20%. Only one item met the criterion of 0.7 for test–retest reliability (wrong or delayed diagnosis), seven items had a score of >0.5, while the remainder had a reliability score of <0.5. However, the reliability was >0.7 for six of 10 items tested at the hospital level, and >0.6 for the remaining four items. A patient-incident index based on 12 of the incident items had no missing data, the test–retest reliability was 0.6 and the hospital-level reliability was 0.85. Conclusions The PRIH-I comprises 13 questions about patient-perceived incidents in hospitals, and can be easily and cost-effectively included in national patient-experience surveys with an acceptable increase in respondent burden. Although the missing-item rate and test–retest reliability were poor for several items, the hospital-level reliability was satisfactory for most of the items. The incident items contribute to a patient-reported incident index, with excellent data quality and hospital-level reliability.
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Affiliation(s)
- Oyvind Bjertnaes
- Department for Quality and Patient Safety, The Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
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Bethune R, Soo E, Woodhead P, Van Hamel C, Watson J. Engaging all doctors in continuous quality improvement: a structured, supported programme for first-year doctors across a training deanery in England. BMJ Qual Saf 2013; 22:613-7. [PMID: 23661281 DOI: 10.1136/bmjqs-2013-001926] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The structure of postgraduate medical training rightly puts enormous emphasis on gathering clinical experience and constantly updating knowledge of relevant medical research to use in practice. At most, this can be contrasted with the slight emphasis on clinical leadership and acquiring the skills to effect change and improve the quality of care. Doctors play central roles in orchestrating the clinical management of patients across multiple settings within the healthcare system. They also routinely encounter the many problems within the systems that they work, affecting their own practices as well as those of other healthcare professionals. They thus represent a tremendous resource for identifying solutions to these problems and playing leadership roles in implementing them. However, physician training programs focus almost entirely on the knowledge and skills to manage clinical problems, with almost no training in skills related to healthcare management or effective quality improvement. In this article, we describe one attempt to improve this situation. In four hospitals in the Severn Deanery in the Southwest of England, first-year doctors carry out a structured and supported quality improvement project of their choice throughout their first year of training. To date, 30 such projects have been or are being run. This has significant benefits for both the trusts they are working for as well as for their own professional development. We describe the successes, difficulties and future of this programme.
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Affiliation(s)
- Rob Bethune
- Department of General Surgery, Royal United Hospital Bath NHS Trust, , Bath, UK.
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Allen LC. Role of a quality management system in improving patient safety - laboratory aspects. Clin Biochem 2013; 46:1187-93. [PMID: 23648455 DOI: 10.1016/j.clinbiochem.2013.04.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [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: 01/10/2013] [Revised: 04/21/2013] [Accepted: 04/26/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study is to describe how implementation of a quality management system (QMS) based on ISO 15189 enhances patient safety. DESIGN AND METHODS A literature review showed that several European hospitals implemented a QMS based on ISO 9001 and assessed the impact on patient safety. An Internet search showed that problems affecting patient safety have occurred in a number of laboratories across Canada. The requirements of a QMS based on ISO 15189 are outlined, and the impact of the implementation of each requirement on patient safety is summarized. The Quality Management Program - Laboratory Services in Ontario is briefly described, and the experience of Ontario laboratories with Ontario Laboratory Accreditation, based on ISO 15189, is outlined. RESULTS Several hospitals that implemented ISO 9001 reported either a positive impact or no impact on patient safety. Patient safety problems in Canadian laboratories are described. Implementation of each requirement of the QMS can be seen to have a positive effect on patient safety. Average laboratory conformance on Ontario Laboratory Accreditation is very high, and laboratories must address and resolve any nonconformities. Other standards, practices, and quality requirements may also contribute to patient safety. CONCLUSION Implementation of a QMS based on ISO 15189 provides a solid foundation for quality in the laboratory and enhances patient safety. It helps to prevent patient safety issues; when such issues do occur, effective processes are in place for investigation and resolution. Patient safety problems in Canadian laboratories might have been prevented had effective QMSs been in place. Ontario Laboratory Accreditation has had a positive impact on quality in Ontario laboratories.
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Affiliation(s)
- Lynn C Allen
- Headwaters Health Care Centre, Orangeville, Ontario, Canada.
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Bahadori M, Soltanzadeh P, Salimi M, Raadabadi M, Moghri J, Ravangard R. Application of WHO model for evaluating Patient Safety Friendly Hospital Initiatives (PSFHI) in an Eye hospital in Tehran, Iran. Electron Physician 2013; 5:631-6. [PMID: 26120394 PMCID: PMC4477753 DOI: 10.14661/2013.631-636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Patient safety is one of the major issues concerning the medical community and the World Health Organization (WHO) in most countries. This study aimed to evaluate the patient safety status in an Eye Hospital in Tehran, using the WHO model for Patient Safety Friendly Hospital Initiatives (PSFHI) in 2012. Methods: This Cross-Sectional study was done in an Eye Hospital in Tehran. Measurement tool was a checklist related to the PSFHI, including 140 standards in three groups of critical, core and developmental. It was covering five domains of: a) Leadership and management, b) Patient and public involvement, c) Safe evidence-based clinical practices, d) Safe environment, and e) Lifelong learning. Results: Compliance with critical, core and developmental standards were 77.78%, 75.29%, and 21.42% respectively. The Rates of Meeting Standards in the leadership and management, patient and public involvement, safe evidence-based clinical practices, secure environment and for lifelong learning were 66.89%, 42.85%, 75.68%, 73.68%, and 63.63% respectively. Conclusions: The PSFHI standards play important role in improving patient safety using leadership, safety practices and creating good working conditions and environment for the staff. So focus on these standards is essential in improving the patient safety in hospitals in Iran.
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Affiliation(s)
- Mohammadkarim Bahadori
- Ph.D. of Health Services Management, Assistant Professor, Health Management Research Center, Baqiyatallah University of Medical Science, Tehran, Iran
| | - Parinaz Soltanzadeh
- B.Sc. of Health Services Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Salimi
- B.Sc. of Health Services Management, Student Scientific Research center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Raadabadi
- M.Sc. Candidate of Health Economic, Research Center for Health Services Management, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Javad Moghri
- Ph.D. Candidate of Health Policy, Health Management and Economics Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Ravangard
- Ph.D. of Health Services Management, Assistant Professor, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Hachach-Haram N, Saour S, Alamouti R, Constantinides J, Mohanna PN. Labelling of diathermy consoles when multiple systems are used: should this be part of the WHO checklist? BMJ Qual Saf 2013; 22:775-6. [PMID: 23625385 DOI: 10.1136/bmjqs-2013-001877] [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] [Indexed: 11/03/2022]
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Abstract
Background Interest in human factors has increased across healthcare communities and institutions as the value of human centred design in healthcare becomes increasingly clear. However, as human factors is becoming more prominent, there is growing evidence of confusion about human factors science, both anecdotally and in scientific literature. Some of the misconceptions about human factors may inadvertently create missed opportunities for healthcare improvement. Methods The objective of this article is to describe the scientific discipline of human factors and provide common ground for partnerships between healthcare and human factors communities. Results The primary goal of human factors science is to promote efficiency, safety and effectiveness by improving the design of technologies, processes and work systems. As described in this article, human factors also provides insight on when training is likely (or unlikely) to be effective for improving patient safety. Finally, we outline human factors specialty areas that may be particularly relevant for improving healthcare delivery and provide examples to demonstrate their value. Conclusions The human factors concepts presented in this article may foster interdisciplinary collaborations to yield new, sustainable solutions for healthcare quality and patient safety.
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Affiliation(s)
- Alissa L Russ
- Veterans Affairs (VA) Health Services Research and Development Center on Implementing Evidence-Based Practice, Roudebush VA Medical Center, , Indianapolis, Indiana, USA
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Kalra J, Kalra N, Baniak N. Medical error, disclosure and patient safety: a global view of quality care. Clin Biochem 2013; 46:1161-9. [PMID: 23578740 DOI: 10.1016/j.clinbiochem.2013.03.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022]
Abstract
Medical errors are a prominent issue in health care. Numerous studies point at the high prevalence of adverse events, many of which are preventable. Although there is a range of severity in errors, they all cause harm, to the patient, to the system, or both. While errors have many causes, including human interactions and system inadequacies, the focus on individuals rather than the system has led to an unsuitable culture for improving patient safety. Important areas of focus are diagnostic procedures and clinical laboratories because their results play a major role in guiding clinical decisions in patient management. Proper disclosure of medical errors and adverse events is also a key area for improvement. Globally, system improvements are beginning to take place, however, in Canada, policies on disclosure, error reporting and protection for physicians remain non-uniform. Achieving a national standard with mandatory reporting, in addition to a non-punitive system is recommended to move forward.
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3137
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Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Quality impact on diagnostic blood specimen collection using a new device to relieve venipuncture pain. Indian J Clin Biochem 2013; 28:235-41. [PMID: 24426217 DOI: 10.1007/s12291-013-0319-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 01/25/2013] [Accepted: 03/19/2013] [Indexed: 11/29/2022]
Abstract
A new device called Buzzy(®) has been recently presented that combines a cooling ice pack and a vibrating motor in order to relieve the venipuncture pain. The aim of this study was to evaluate the impact of Buzzy(®) use during diagnostic blood specimen collection by venipuncture for routine immunochemistry tests. Blood was collected from 100 volunteers by a single, expert phlebotomist. A vein was located on the left forearm without applying tourniquet, in order to prevent any interference from venous stasis, and blood samples were collected using a 20-G straight needle directly into 5 mL vacuum tubes with clot activator and gel separator. In sequence, external cold and vibration by Buzzy(®) was applied on the right forearm-5 cm above the chosen puncture site-for 1 min before venipuncture and continued until the end of the same procedure already done in the left forearm. The panel of tests included the following: glucose, total cholesterol, HDL-cholesterol, triglycerides, total protein, albumin, c-reactive protein, urea, creatinine, uric acid, alkaline phosphatase, amylase, AST, ALT, g-glutamyltransferase, lactate dehydrogenase, creatine kinase, total bilirubin, phosphorus, calcium, magnesium, iron, sodium, potassium, chloride, lipase, cortisol, insulin, thyroid-stimulating hormone, total triiodothyronine, free triiodothyronine, total thyroxine, free thyroxine and haemolysis index. Clinically significant differences between samples were found only for: total protein, albumin and transferrin. The Buzzy(®) can be used during diagnostic blood specimens collection by venipuncture for the majority of the routine immunochemistry tests. We only suggest avoiding this device during blood collection when protein, albumin and transferrin determinations should be performed.
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Affiliation(s)
- Gabriel Lima-Oliveira
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Ospedale Policlinico, P.le L.A. Scuro, 37134 Verona, Italy ; Post-Graduate Program of Pharmaceutical Sciences, Department of Medical Pathology, Federal University of Parana, Curitiba, Parana Brazil ; MERCOSUL, Sector Committee of Clinical Analyses and in vitro Diagnostics, CSM 20, Rio de Janeiro, Brazil ; Brazilian Society of Clinical Analyses on Sao Paulo State, Sao Paulo, Brazil
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Department of Pathology and Laboratory Medicine, Academic Hospital of Parma, Parma, Italy
| | - Gian Luca Salvagno
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Ospedale Policlinico, P.le L.A. Scuro, 37134 Verona, Italy
| | - Martina Montagnana
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Ospedale Policlinico, P.le L.A. Scuro, 37134 Verona, Italy
| | - Geraldo Picheth
- Post-Graduate Program of Pharmaceutical Sciences, Department of Medical Pathology, Federal University of Parana, Curitiba, Parana Brazil
| | - Gian Cesare Guidi
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Ospedale Policlinico, P.le L.A. Scuro, 37134 Verona, Italy ; Post-Graduate Program of Pharmaceutical Sciences, Department of Medical Pathology, Federal University of Parana, Curitiba, Parana Brazil
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3138
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Winnik S, Lohmann C, Siciliani G, von Lukowicz T, Kuschnerus K, Kraenkel N, Brokopp CE, Enseleit F, Michels S, Ruschitzka F, Lüscher TF, Matter CM. Systemic VEGF inhibition accelerates experimental atherosclerosis and disrupts endothelial homeostasis--implications for cardiovascular safety. Int J Cardiol 2013; 168:2453-61. [PMID: 23561917 DOI: 10.1016/j.ijcard.2013.03.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 03/09/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study sought to examine the effects and underlying mechanisms of systemic VEGF inhibition in experimental atherosclerosis and aortic endothelial cells. BACKGROUND Pharmacological inhibition of vascular endothelial growth factor (VEGF), a major mediator of angiogenesis, has become a widely applied treatment of certain cancers and multiple ocular diseases including age-related macular degeneration. However, recent clinical trials raise concern for systemic vascular adverse effects, prompting the Food and Drug Administration to revoke the approval of bevacizumab for metastatic breast cancer. METHODS Eight-week old apolipoprotein E knockout mice received a high-cholesterol diet (1.25% cholesterol) for 24 weeks and were exposed to a systemic pan-VEGF receptor inhibitor (PTK787/ZK222584, 50mg/kg/d) or placebo (gavage) for the last 10 weeks. Atherosclerotic lesions were characterized in thoraco-abdominal aortae and aortic arches. Mechanistic analyses were performed in cultured human aortic endothelial cells. RESULTS Systemic VEGF inhibition increased atherosclerotic lesions by 33% whereas features of plaque vulnerability (i.e. necrotic core size, fibrous cap thickness) remained unchanged compared with controls. Aortic eNOS expression was decreased (trend). In human endothelial cells VEGF inhibition induced a dose-dependent increase in mitochondrial superoxide generation with an uncoupling of eNOS, resulting in reduced NO availability and decreased proliferation. CONCLUSION Systemic VEGF inhibition disrupts endothelial homeostasis and accelerates atherogenesis, suggesting that these events contribute to the clinical cardiovascular adverse events of VEGF-inhibiting therapies. Cardiovascular safety profiles of currently applied anti-angiogenic regimens should be determined to improve patient selection for therapy and allow close monitoring of patients at increased cardiovascular risk.
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3139
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Abstract
Laboratories have a major impact on patient safety as 80-90 % of all the diagnosis are made on the basis of laboratory tests. Laboratory errors have a reported frequency of 0.012-0.6 % of all test results. Patient safety is a managerial issue which can be enhanced by implementing active system to identify and monitor quality failures. This can be facilitated by reactive method which includes incident reporting followed by root cause analysis. This leads to identification and correction of weaknesses in policies and procedures in the system. Another way is proactive method like Failure Mode and Effect Analysis. In this focus is on entire examination process, anticipating major adverse events and pre-emptively prevent them from occurring. It is used for prospective risk analysis of high-risk processes to reduce the chance of errors in the laboratory and other patient care areas.
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Affiliation(s)
- Rachna Agarwal
- Department of Neurochemistry, Institute of Human Behaviour & Allied Sciences, Delhi, 110095 India
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3140
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Abstract
BACKGROUND Acute care teams (ACTs) represent action teams, that is, teams in which members with specialised roles must coordinate their actions during intense situations, often under high time pressure and with unstable team membership. Using behaviour observation, patient safety research has been focusing on defining teamwork behaviours-particularly coordination-that are critical for patient safety during these intense situations. As one result of this divergent research landscape, the number, scope and variety of applied behaviour observation taxonomies are growing, making comparison and convergent integration of research findings difficult. AIM To facilitate future ACT research by presenting a framework that provides a shared language of teamwork behaviours, allows for comparing previous and future ACT research and offers a measurement tool for ACT observation. METHOD Based on teamwork theory and empirical evidence, we developed Co-ACT-the Framework for Observing Coordination Behaviour in ACT. Integrating two previous, extensive taxonomies into Co-ACT, we also suggested 12 behavioural codes for which we determined inter-rater reliability by analysing the teamwork of videotaped anaesthesia teams in the clinical setting. RESULTS The Co-ACT framework consists of four quadrants organised along two dimensions (explicit vs implicit coordination; action vs information coordination). Each quadrant provides three categories for which Cohen's κ overall value was substantial; but values for single categories varied considerably. CONCLUSIONS Co-ACT provides a framework for organising behaviour codes and offers respective categories for succinctly measuring teamwork in ACTs. Furthermore, it has the potential to allow for guiding and comparing ACTs study results. Future work using Co-ACT in different research and training settings will show how well it can generally be applied across ACTs.
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Affiliation(s)
- Michaela Kolbe
- Organization, Work, Technology Group, ETH Zurich, Zurich, Switzerland.
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3141
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Damluji A, Zanni JM, Mantheiy E, Colantuoni E, Kho ME, Needham DM. Safety and feasibility of femoral catheters during physical rehabilitation in the intensive care unit. J Crit Care 2013; 28:535.e9-15. [PMID: 23499419 DOI: 10.1016/j.jcrc.2013.01.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [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: 09/05/2012] [Revised: 12/31/2012] [Accepted: 01/13/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Femoral catheters pose a potential barrier to early rehabilitation in the intensive care unit (ICU) due to concerns, such as catheter removal, local trauma, bleeding, and infection. We prospectively evaluated the feasibility and safety of physical therapy (PT) in ICU patients with femoral catheters. DESIGN, SETTING, AND PATIENTS We evaluated consecutive medical ICU patients who received PT with a femoral venous, arterial, or hemodialysis catheter(s) in situ. MEASUREMENTS AND MAIN RESULTS Of 1074 consecutive patients, 239 (22%) received a femoral catheter (81% venous, 29% arterial, 6% hemodialysis; some patients had >1 catheter). Of those, 101 (42%) received PT interventions, while the catheter was in situ, for a total of 253 sessions over 210 medical ICU (MICU) days. On these 210 MICU days, the highest daily activity level achieved was 49 (23%) standing or walking, 57 (27%) sitting, 25 (12%) supine cycle ergometry, and 79 (38%) in-bed exercises. During 253 PT sessions, there were no catheter-related adverse events giving a 0% event rate (95% upper confidence limit of 2.1% for venous catheters). CONCLUSIONS Physical therapy interventions in MICU patients with in situ femoral catheters appear to be feasible and safe. The presence of a femoral catheter should not automatically restrict ICU patients to bed rest.
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3142
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Affiliation(s)
| | - Riaz A Agha
- Department of Plastic Surgery, Stoke Mandeville Hospital, Stoke Mandeville, UK
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3143
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Lee SH, Kim JS, Jeong YC, Kwak DK, Chun JH, Lee HM. Patient safety in spine surgery: regarding the wrong-site surgery. Asian Spine J 2013; 7:63-71. [PMID: 23508946 PMCID: PMC3596588 DOI: 10.4184/asj.2013.7.1.63] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 10/04/2012] [Accepted: 10/04/2012] [Indexed: 11/08/2022] Open
Abstract
Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your site program by the American Academy of Orthopedic Surgeon, the sign, mark and X-ray program by the North American Spine Society, and the Universal Protocol program by the Joint Commission, the incidence of wrong-site surgery has not decreased. To prevent wrong-site surgery in spine surgeries, the spine surgeons must put patient safety first, complying with the hospital policies regarding patient safety. In the operating rooms, the surgeons need to do their best to level the hierarchy, enabling all to speak up if any patient safety concerns are noted. Changing the operating room culture is the essential part of the patient safety concerning spine surgery.
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Affiliation(s)
- Seung-Hwan Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Sup Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo-Chul Jeong
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dae-Kyung Kwak
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ja-Hae Chun
- Department of Quality Improvement and Patient Safety, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan-Mo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
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3144
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Vollman AT, Craig JG, Hulen R, Ahmed A, Zervos MJ, Holsbeeck MV. Review of three magnetic resonance arthrography related infections. World J Radiol 2013; 5:41-44. [PMID: 23494542 PMCID: PMC3596610 DOI: 10.4329/wjr.v5.i2.41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
We report three cases of intra-articular infection which followed injection for magnetic resonance arthrography. In an effort to reduce the risk of arthrogram related infection, representatives from radiology, infectious disease medicine, and microbiology departments convened to analyze the contributing factors. The proposed source was oral contamination from barium swallow studies which preceded the arthrogram injections in the same room. We propose safety measures to reduce incidence of arthrogram related infections.
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3145
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Abstract
BACKGROUND Tools that proactively identify factors that contribute to accidents have been developed within high-risk industries. Although patients provide feedback on their experience of care in hospitals, there is no existing measure which asks patients to comment on the factors that contribute to patient safety incidents. The aim of the current study was to determine those contributory factors from the Yorkshire Contributory Factors Framework (YCFF) that patients are able to identify in a hospital setting and to use this information to develop a patient measure of safety (PMOS). METHODS Thirty-three qualitative interviews with a representative sample of patients from six units in a teaching hospital in the north of England were carried out. Patients were asked either to describe their most recent/current hospital experience (unstructured) or were asked to describe their experience in relation to specific contributory factors (structured). Responses were coded using the YCFF. Face validity of the PMOS was tested with 12 patients and 12 health professionals, using a 'think aloud' approach, and appropriate revisions made. The research was supported by two patient representatives. RESULTS Patients were able to comment on/identify 13 of the 20 contributory factors contained within the YCFF domains. They identified contributory factors relating to communication and individual factors more frequently, and contributory factors relating to team factors, and support from central functions less frequently. In addition, they identified one theme not included in the YCFF: dignity and respect. The draft PMOS showed acceptable face validity. DISCUSSION Patients are able to identify factors which contribute to the safety of their care. The PMOS provides a way of systematically assessing these and has the potential to help health professionals and healthcare organisations understand and identify, safety concerns from the patients' perspective, and, in doing so, make appropriate service improvements.
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Affiliation(s)
- Sally J Giles
- Quality and Safety Research, Bradford Institute for Health Research, Bradford, UK.
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3146
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Kemper PF, van Noord I, de Bruijne M, Knol DL, Wagner C, van Dyck C. Development and reliability of the explicit professional oral communication observation tool to quantify the use of non-technical skills in healthcare. BMJ Qual Saf 2013; 22:586-95. [PMID: 23412933 PMCID: PMC3711364 DOI: 10.1136/bmjqs-2012-001451] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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] [Indexed: 11/04/2022]
Abstract
BACKGROUND A lack of non-technical skills is increasingly recognised as an important underlying cause of adverse events in healthcare. The nature and number of things professionals communicate to each other can be perceived as a product of their use of non-technical skills. This paper describes the development and reliability of an instrument to measure and quantify the use of non-technical skills by direct observations of explicit professional oral communication (EPOC) in the clinical situation. METHODS In an iterative process we translated, tested and refined an existing checklist from the aviation industry, called self, human interaction, aircraft, procedures and environment, in the context of healthcare, notably emergency departments (ED) and intensive care units (ICU). The EPOC comprises six dimensions: assertiveness, working with others; task-oriented leadership; people-oriented leadership; situational awareness; planning and anticipation. Each dimension is specified into several concrete items reflecting verbal behaviours. The EPOC was evaluated in four ED and six ICU. RESULTS In the ED and ICU, respectively, 378 and 1144 individual and 51 and 68 contemporaneous observations of individual staff members were conducted. All EPOC dimensions occur frequently, apart from assertiveness, which was hardly observed. Intraclass correlations for the overall EPOC score ranged between 0.85 and 0.91 and for underlying EPOC dimensions between 0.53 and 0.95. CONCLUSIONS The EPOC is a new instrument for evaluating the use of non-technical skills in healthcare, which is reliable in two highly different settings. By quantifying professional behaviour the instrument facilitates measurement of behavioural change over time. The results suggest that EPOC can also be translated to other settings.
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Affiliation(s)
- Peter F Kemper
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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3147
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Abstract
Sugammadex is a modified gamma-cyclodextrin which is showing favorable outcomes regarding reversal of neuromuscular blockade, especially by rocuronium. It is designed to encapsulate rocuronium and being considered a new class of drugs as selective relaxant binding agents. It has given countless benefits to the patients at risk of incomplete or delayed recovery after neuromuscular block and has renown for another milestone in anesthesia practice. Recurrence of neuromuscular block has not been reported to be associated with the provided doses of sugammadex that are adequate for selected for reversal. Acceptable profiles are brought to light telling safety of sugammadex. However, some questions related to the twitch characteristics those resembled succinylcholine when reversal, the application for rocuronium anaphylaxis, and the hypersensitivity or anaphylaxis to sugammadex remain and are need of further investigation. It is imperative that potential problems that we need attention may include the patient's history of pulmonary disease and allergic disease for using sugammadex.
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Affiliation(s)
- Jin Young Chon
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea School of Medicine, Seoul, Korea
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3148
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Haji Aghajani M, Sistanizad M, Abbasinazari M, Abiar Ghamsari M, Ayazkhoo L, Safi O, Kazemi K, Kouchek M. Potential Drug-drug Interactions in Post-CCU of a Teaching Hospital. Iran J Pharm Res 2013; 12:243-8. [PMID: 24250596 PMCID: PMC3813210] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug-drug interactions (DDIs) can lead to increased toxicity or reduction in therapeutic efficacy. This study was designed to assess the incidence of potential drug interactions (PDI) and rank their clinical value in post coronary care unit (Post-CCU) of a teaching hospital in Tehran, Iran. In this prospective study, three pharmacists with supervision of a clinical pharmacist actively gathered necessary information for detection of DDIs. Data were tabulated according to the combinations of drugs in treatment chart. Verification of potential drug interactions was carried out using the online Lexi-Interact™ 2011. A total of 203 patients (113 males and 90 females) were enrolled in the study. The mean age of patients was 61 ± 12.55 years (range = 26-93). A total of 90 drugs were prescribed to 203 patients and most prescribed drugs were atorvastatin, clopidogrel and metoprolol. Mean of drugs was 11.22 per patient. A total of 3166 potential drug interactions have been identified by Lexi- Interact™, 149 (4.71%) and 55 (1.73%) of which were categorized as D and X, respectively. The most serious interactions were clopidogrel+omeprazole and metoprolol+salbutamol. Drug interactions leading to serious adverse effects are to be cautiously watched for when multiple drugs are used simultaneously. In settings with multiple drug use attendance of a pharmacist or clinical pharmacist, taking the responsibility for monitoring drug interactions and notifying the physician about potential problems could decrease the harm in patient and increase the patient safety.
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Affiliation(s)
- Mohammad Haji Aghajani
- Department of Cardiology, Imam Husain Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Sistanizad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Imam Husain Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Pharmaceutical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad Abbasinazari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahdieh Abiar Ghamsari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ladan Ayazkhoo
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Olia Safi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Katayoon Kazemi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehran Kouchek
- Imam Husain Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Corresponding author: E-mail:
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3149
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Balka E, Tolar M, Coates S, Whitehouse S. Socio-technical issues and challenges in implementing safe patient handovers: insights from ethnographic case studies. Int J Med Inform 2012; 82:e345-57. [PMID: 23218926 DOI: 10.1016/j.ijmedinf.2012.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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: 02/09/2012] [Revised: 10/17/2012] [Accepted: 11/01/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. The purpose of this paper is to broaden our understanding of clinical handover as a patient safety issue, and to identify socio-technical issues which may come to bear on the success of computer based handover tools. METHODS Three in depth ethnographic case studies were undertaken. Field notes were transcribed and analyzed with the aid of qualitative data analysis software. Within case analysis was performed on each case, and subsequently, cross case analyses were performed. RESULTS We identified five types of socio-technical issues which must be addressed if electronic handover tools are to succeed. The inter-dependencies of these issues are addressed in relation to arenas in which health care work takes place. CONCLUSIONS We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover, and issues related to data standards and system interoperability must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care.
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Affiliation(s)
- Ellen Balka
- School of Communication, Simon Fraser University, Canada; Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health, Canada.
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3150
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Walker ST, Sevdalis N, McKay A, Lambden S, Gautama S, Aggarwal R, Vincent C. Unannounced in situ simulations: integrating training and clinical practice. BMJ Qual Saf 2012; 22:453-8. [PMID: 23211281 DOI: 10.1136/bmjqs-2012-000986] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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: 11/04/2022]
Abstract
Simulation-based training for healthcare providers is well established as a viable, efficacious training tool, particularly for the training of non-technical team-working skills. These skills are known to be critical to effective teamwork, and important in the prevention of error and adverse events in hospitals. However, simulation suites are costly to develop and releasing staff to attend training is often difficult. These factors may restrict access to simulation training. We discuss our experiences of 'in situ' simulation for unannounced cardiac arrest training when the training is taken to the clinical environment. This has the benefit of decreasing required resources, increasing realism and affordability, and widening multidisciplinary team participation, thus enabling assessment and training of non-technical team-working skills in real clinical teams. While there are practical considerations of delivering training in the clinical environment, we feel there are many potential benefits compared with other forms of simulation training. We are able to tailor the training to the needs of the location, enabling staff to see a scenario that is relevant to their practice. This is particularly useful for staff who have less exposure to cardiac arrest events, such as radiology staff. We also describe the important benefit of risk assessment for a clinical environment. During our simulations we have identified a number of issues that, had they occurred during a real resuscitation attempt, may have led to patient harm or patient death. For these reasons we feel in situ simulation should be considered by every hospital as part of a patient safety initiative.
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Affiliation(s)
- Susanna T Walker
- Centre for Patient Safety and Service Quality, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
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