Safety culture in intensive care internationally and in Australia: A narrative review of the literature

Students' safety culture at tertiary level academic institutes in Bangladesh: A cross-sectional study

This study aims to investigate the safety culture of tertiary-level students in Bangladesh and identify the factors that influence it. A cross-sectional survey was conducted among 1676 students from 16 universities and medical colleges in Bangladesh to gather data. The survey consisted of a paper-based structured questionnaire with three scales: a 17-item safety beliefs and values scale, a 10-item safety perception and awareness scale, and a 14-item safety attitudes scale. The results showed that tertiary-level students generally exhibit moderate levels of safety beliefs and values, safety perception and awareness, and safety attitudes. Female students had better safety perception and awareness [β = -0.083; 95%CI = -0.140, -0.025] and safety attitudes [β = -0.173; 95%CI = -0.230, -0.117], while male students had stronger safety beliefs and values [β = 0.047; 95%CI = 0.005, 0.089]. Students with physical disabilities and those who had experienced accidents had significantly higher levels of safety perception and awareness, as well as safety attitudes, compared to their peers. Additionally, students in private institutions had lower levels of safety perception and awareness [β = -0.130; 95%CI = -0.189, -0.070] as well as safety attitudes [β = -0.058; 95%CI = -0.116, -0.001], than public institution students. Age, gender, and type of institute were significantly associated with all three components of safety culture. Accident experience was also significantly linked to safety perception and awareness [β = 0.054; 95%CI = 0.002, 0.105], and safety attitudes [β = -0.093; 95%CI = -0.143, 0.043]. Based on these findings, it is recommended that tertiary educational institutions in Bangladesh develop intervention strategies that consider the age, gender, and physical disability of students to enhance their safety culture.

Development and prioritisation of policy recommendations for medication safety improvement for intensive care units: a European Association of Hospital Pharmacists Special Interest Group Delphi Study

OBJECTIVES

Medication errors (MEs) are a leading cause of morbidity and mortality in the healthcare system. Patients admitted to intensive care units (ICUs) are potentially more susceptible to MEs due to severity of illness, the complexity of treatments they receive and the challenging nature of the ICU setting. The European Association of Hospital Pharmacists established a Special Interest Group (SIG) to undertake a programme of work to develop and prioritise recommendations to support medication safety improvement in ICUs across Europe.

METHODS

Initial policy recommendations for medication safety within the ICU environment were developed following reviews of the literature and engagement with relevant stakeholders. A Delphi panel of 21 members of the SIG, that comprised healthcare professionals (HCPs) with expertise in ICU and/or medication safety, was convened in 2022. We conducted two rounds using a modified Delphi technique whereby participants anonymously ranked on a 9-point Likert Scale the policy recommendations according to their priority for implementation.

RESULTS

In total, 32 policy recommendations were developed. In Delphi Round 1, 19 HCPs participated; consensus was achieved on most recommendations and partial consensus on six. In Delphi Round 2, 18 HCPs participated. After two Delphi rounds, consensus was achieved on all 32 recommendations. All recommendations were considered 'high priority' except one that was considered 'medium priority'.

CONCLUSIONS

Through this study it was possible to develop and prioritise evidence-based policy recommendations to enhance medication safety, which may contribute to reducing MEs in ICUs across Europe. All recommendations were considered 'high priority' for implementation except one, indicating the perceived value of these recommendations in improving medication safety through preventing MEs in ICUs.

Guidelines on human factors in critical situations 2023

OBJECTIVE

To provide guidelines to define the place of human factors in the management of critical situations in anaesthesia and critical care.

DESIGN

A committee of nineteen experts from the SFAR and GFHS learned societies was set up. A policy of declaration of links of interest was applied and respected throughout the guideline-producing process. Likewise, the committee did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based.

METHODS

We aimed to formulate recommendations according to the GRADE® methodology for four different fields: 1/ communication, 2/ organisation, 3/ working environment and 4/ training. Each question was formulated according to the PICO format (Patients, Intervention, Comparison, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology.

RESULTS

The experts' synthesis work and application of the GRADE® method resulted in 21 recommendations. Since the GRADE® method could not be applied in its entirety to all the questions, the guidelines used the SFAR "Recommendations for Professional Practice" A means of secured communication (RPP) format and the recommendations were formulated as expert opinions.

CONCLUSION

Based on strong agreement between experts, we were able to produce 21 recommendations to guide human factors in critical situations.

Safety culture in emergency medicine: An exploratory qualitative study

BACKGROUND

Safety culture in Emergency Departments (EDs) requires special attention due to unique operational feature of the ED environment. Which may influence a culture of patients' safety in the ED.

OBJECTIVE

To identify the factors that influence patient safety culture in EDs.

METHODS

A qualitative study using semi-structured interviews with 12 ED staff was carried out in two Australian EDs. The data was thematically analysed to identify and describe the factors perceived by staff as influencing patient safety culture.

RESULTS

The findings revealed four super-ordinate themes and 19 categories. The themes were the following: (1) Environmental and Organisational; (2) Healthcare Professional (3) Managerial factors; and (4) Patients factors.

CONCLUSIONS

Safety culture in the ED is influenced by complex set of factors. The results of this study may help ED workers with improving patient safety culture and healthcare quality in the ED.

Contribution of PCA/K-means methods to the mixed assessment of patient safety culture

Purpose

The assessment of patient safety culture (PSC) is a major priority for healthcare providers. It is often realized using quantitative approaches (questionnaires) separately from qualitative ones (patient safety culture maturity model (PSCMM)). These approaches suffer from certain major limits. Therefore, the aim of the present study is to overcome these limits and to propose a novel approach to PSC assessment.

Design/methodology/approach

The proposed approach consists of evaluating PSC in a set of healthcare establishments (HEs) using the HSOPSC questionnaire. After that, principal component analysis (PCA) and K-means algorithm were applied on PSC dimensional scores in order to aggregate them into macro dimensions. The latter were used to overcome the limits of PSC dimensional assessment and to propose a quantitative PSCMM.

Findings

PSC dimensions are grouped into three macro dimensions. Their capitalization permits their association with safety actors related to PSC promotion. Consequently, a quantitative PSC maturity matrix was proposed. Problematic PSC dimensions for the studied HEs are “Non-punitive response to error”, “Staffing”, “Communication openness”. Their PSC maturity level was found underdeveloped due to a managerial style that favors a “blame culture”.

Originality/value

A combined quali-quantitative assessment framework for PSC was proposed in the present study as recommended by a number of researchers but, to the best of our knowledge, few or no studies were devoted to it. The results can be projected for improvement and accreditation purposes, where different PSC stakeholders can be implicated as suggested by international standards.

Exploring patient safety culture in emergency departments: A Tunisian perspective

BACKGROUND

Emergency departments (EDs) are considered a high-risk environment because of the high frequency of adverse events that occur within. Measuring patient safety culture is an important step that assists healthcare facilities in planning actions to improve the quality of care provided to patients. This study aims to assess patient safety culture within EDs and to determine its associated factors.

METHODS

A cross-sectional study conducted among professionals from all the EDs of public and private healthcare institutions in Tunisia. It spread from June to September 2017. We used the validated French version of the Hospital Survey on Patient Safety Culture questionnaire.

RESULTS

In total, 11 EDs were included in the study, with 442 participants and a participation rate of 80.35%. All the ten dimensions of patient safety culture were in need of improvement. 'Teamwork within units' scored the highest with 46%, however, the lowest score was attributed to 'the frequency of adverse events reporting' (19.6%). Several factors have been found significantly related to safety culture. Private EDs have shown significantly higher scores regarding nine patient safety culture dimensions.

CONCLUSION

This study showed a concerning perception held by participants about the lack of a patient safety culture in their EDs. Also, it provided baseline results giving a clearer vision of the aspects of safety that need improvement.

A baseline assessment of patient safety culture and its associated factors from the perspective of critical care nurses: Results from 10 hospitals

INTRODUCTION

Critical care nurses are considered the key to patient safety improvement and play a vital role in enhancing quality of care in intensive care units (ICUs) where adverse events are frequent and have severe consequences. Moreover, there is recognition of the importance of the assessment and the development of patient safety culture (PSC) as a strategic focus for the improvement of patient safety and healthcare quality, notably in critical care settings.

OBJECTIVES

This study aimed to assess critical care nurses' perception of PSC and to determine its associated factors.

METHODS

This cross-sectional study was conducted among nurses working in the ICUs of the Tunisian centre (six Tunisian governorates). The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture questionnaire, comprising 10 dimensions and a total of 50 items.

RESULTS

A total of 249 nurses from 18 ICUs participated in the study, with a participation rate of 87.36%. The dimensions scores ranged between 17.2% for the dimension "frequency of events reported" and 50.1% for the dimension "teamwork within units". Multivariable logistic regression indicated that respondents who worked in private hospitals were five times more likely to have a developed PSC (adjusted odds ratio [AOR]: 5.34; 95% confidence interval [CI], [2.28, 12.51]; p < 10^-3). Similarly, participants who worked in a certified hospital were two times more likely to have a more developed PSC than respondents who work in noncertified hospitals (AOR: 2.51; 95% CI, [.92-6.82]; p = 0.041). In addition, an increased nurse-per-patient ratio (i.e., reduced workload) increased PSC (AOR: 1.10; 95% CI, [1.02-1.12]; p = 0.018).

CONCLUSION

This study has shown that the state of critical care nurses' PSC is critically low and these baseline results can help to form a plan of actions for improvements.

Adverse events during nursing care procedure in intensive care unit: The PREVENIR study

OBJECTIVES

Intensive care unit patients undergo several nursing care procedures (NCP) every day. These procedures involve a risk for adverse events (AE). Yet, their prevalence, intensity, and predisposing risk factors remain poorly established. The main objective of the study was to measure the incidence and severity of NCP related AE.

DESIGN

This prospective observational multicentre study was conducted in 9 ICUs. All NCP were recorded for four consecutive weeks. For each NCP, the following were collected: patients' baseline characteristics, type of NCP, characteristics of the NCP, AE and therapeutic responses.

RESULTS

5849 NCP occurred in 340 patients. Among the 340 patients included, 292 (85.9%) were affected by at least one AE, and 141 (41.5%) by an SAE during a NCP. Thirty % of NCP were associated with at least one AE: hemodynamic AE in 17.1%, respiratory AE in 13.6%, agitation and pain (3.7% and 3.3%). Eight invasive devices were accidentally removed. Severe Adverse Events (SAE) occurred in 5.5% of NCP. The main risk factor associated with SAE was pain/agitation at the beginning of the NCP.

CONCLUSION

AE are frequent during NCP in ICU. We identified several risk factors, some of them preventable, that could be considered for the development of recommendations for the nursing care of critically ill patients.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02881645.