Safety attributes in primary care: understanding the needs of patients, health professionals, and managers

Patient safety culture in home care settings in Sweden: a cross-sectional survey among home care professionals

BACKGROUND

The connection between a weak patient safety culture and adverse patient events is well known, but although most long-term care is provided outside of hospitals, the focus of patient safety culture is most commonly on inpatient care. In Sweden, more than a third of people who receive care at home have been affected by adverse events, with the majority judged to be preventable. The aim of this study was to investigate the patient safety culture among care professionals working in care at home with older people.

METHODS

This cross-sectional study used a purposive sample of 66 municipal care workers, health care professionals, and rehabilitation staff from five municipal care units in two districts in western Sweden who provided care at home for older people and had been employed for at least six months. The participants completed the Hospital Survey on Patient Safety Culture (HSOPSC) self-report questionnaire, which assessed aspects of patient safety culture-norms, beliefs, and attitudes. Logistic regression analysis was used to test how the global ratings of Patient safety grade in the care units and Reporting of patient safety events were related to the dimensions of safety culture according to the staff's professions and years of work experience.

RESULTS

The most positively rated safety culture dimension was Teamwork within care units (82%), which indicates good cooperation with the closest co-workers. The least positively rated dimensions were Handoffs and transitions among care units (37%) and Management support (37%), which indicate weaknesses in the exchange of patient information across care units and limited support from top-level managers. The global rating of Patient safety grade was associated with Communication openness and Management support (p < 0.01 and p = 0.03, respectively). Staff with less work experience evaluated the Patient safety grade higher than those with more work experience.

CONCLUSIONS

This study suggests that improvements are needed in care transitions and in support from top-level managers and that awareness of patient safety should be improved in staff with less work experience. The results also highlight that an open communication climate within the care unit is important for patient safety.

Interruption in the work of nursing professionals: conceptual analysis

OBJECTIVES

to analyze the concept of "interruption in the work of nursing professionals".

METHODS

conceptual study according to the method proposed by Walker and Avant through integrative literature review. The study searched the databases using the descriptors: "Attention", "Attention Bias", "Health Personnel", "Nurses", "Patient Safety" and "Medical Malpractices". The sample consisted of 36 studies.

RESULTS

the antecedents were alarms, answering phone calls, providing patient care, and lack of material/medicine. The defining attributes were pause, suspension, breakage, and intrusion. In relation to the consequences, the study highlighted the increase in frequency and severity of medication errors and change of focus.

FINAL CONSIDERATIONS

theconceptual analysis identified the attributes, antecedents, and consequences and allowed to build an operational definition for "interruption in the work of nursing professionals". It will contribute to the improvement of the work process and the creation of strategies that ensure safer care for the patient.

The impact of human error on medical procedures

BACKGROUND

Human error has been studied for large decades with special application to critical infrastructures and processes where the impact of such errors can induce severe or catastrophic consequences. In this sense it is of utmost importance to extend this type of analysis to other fields as medicine.

OBJECTIVE

This study proposes a semi-quantitative human error risk assessment methodology, including the analysis of the so-called Performance Shaping Factors (PSFs), in order to contribute to health services improvement.

METHODS

A questionnaire including the considered PSFs is answered in order to determine the impact of each PSF and its influence on human error. It allows performing a Human Error Risk Assessment (HERA) for both the patient (HERAp) and the quality of the service (HERAq).

RESULTS

The results show the PSFs with the highest impact factor. After applying corrective measures, it is possible to observe the impact on the reduction of the risk for patient and for the quality of the service.

CONCLUSIONS

The application of the methodology with the inclusion of the impact of PSFs allows minimizing or mitigating failure modes with greater risk as well as increasing patient safety and promoting a better quality of medical procedures.

Management and patient safety of complex elderly patients in primary care during the COVID-19 pandemic in the UK-Qualitative assessment

OBJECTIVES

The study aims to investigate GPs' experiences of how UK COVID-19 policies have affected the management and safety of complex elderly patients, who suffer from multimorbidity, at the primary care level in North West London (NWL).

DESIGN

This is a service evaluation adopting a qualitative approach.

SETTING

Individual semi-structured interviews were conducted between 6 and 22 May 2020, 2 months after the introduction of the UK COVID-19 Action Plan, allowing GPs to adapt to the new changes and reflect on their impact.

PARTICIPANTS

Fourteen GPs working in NWL were interviewed, until data saturation was reached.

OUTCOME MEASURES

The impact of COVID-19 policies on the management and safety of complex elderly patients in primary care from the GPs' perspective.

RESULTS

Participants' average experience was fourteen years working in primary care for the NHS. They stated that COVID-19 policies have affected primary care at three levels, patients' behaviour, work conditions, and clinical practice. GPs reflected on the impact through five major themes; four of which have been adapted from the Safety Attitudes Questionnaire (SAQ) framework, changes in primary care (at the three levels mentioned above), involvement of GPs in policy making, communication and coordination (with patients and in between medical teams), stressors and worries; in addition to a fifth theme to conclude the GPs' suggestions for improvement (either proposed mitigation strategies, or existing actions that showed relative success). A participant used an expression of "infodemic" to describe the GPs' everyday pressure of receiving new policy updates with their subsequent changes in practice.

CONCLUSION

The COVID-19 pandemic has affected all levels of the health system in the UK, particularly primary care. Based on the GPs' perspective in NWL, changes to practice have offered opportunities to maintain safe healthcare as well as possible drawbacks that should be of concern.

Patient safety culture in primary and home care services

Background

Safety culture is still a poorly studied subject in primary care and home care, although these settings are considered gateways to access to healthcare. This study aims to evaluate safety culture in primary and home care settings.

Methods

An observational cross-sectional study was carried out with 147 professionals from nine districts covered by one home care program and six primary healthcare centres. The Safety Attitudes Questionnaire (SAQ) was used to evaluate the safety culture, in which scores ≥75 are indicative of a positive safety culture.

Results

A total of 56 (86,1%) questionnaires returned from the home care professionals and 91 (86,6%) from the primary care professionals. The Job satisfaction domain was the best evaluated, achieving a score of 88.8 in home care and 75.1 in primary care. The achievement of high scores on Safety Climate, Job Satisfaction, Teamwork Climate, and Total SAQ was related to male gender, and time of professional experience of three to 4 years. Perception of management and Working conditions had the lowest scores, and this result was related with long time of experience.

Conclusions

It is concluded that professionals working in home care gave higher scores for safety culture in their workplace than the primary care workers.