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Nyame L, Hu Y, Xue H, Fiagbey EDK, Li X, Tian Y, Fan L, Du W. Variation of adverse drug events in different settings in Africa: a systematic review. Eur J Med Res 2024; 29:333. [PMID: 38880895 PMCID: PMC11181533 DOI: 10.1186/s40001-024-01934-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND Adverse drug events (ADEs) represent challenges affecting Africa's healthcare systems owing to the increased healthcare expenditure and negative health outcomes of ADEs. OBJECTIVES We aimed to systematically review published studies on ADEs and synthesize the existing evidence of ADE prevalence in Africa. METHODS Studies reporting on ADE occurrence in African settings and published from Jan 1, 2000 to Oct 1, 2023 were identified by searching PubMed, EBSCO, Science Direct, and Web of Science. Studies that either articulately investigated ADEs caused by clinical condition (such as HIV patients) or ADEs caused by exposure to specific drug(s) (such as antibiotics) were considered specific and the remaining were general. Grouped ADE prevalence rates were described using median and interquartile range (IQR). PROSPERO registration (CRD42022374095). RESULTS We included 78 observational studies from 15 African countries that investigated the prevalence of ADEs leading to hospital admissions (17 studies), developed during hospitalizations (30 studies), and captured in the outpatient departments (38 studies) or communities (4 studies). Twelve studies included multiple settings. The median prevalence of ADE during hospitalization was 7.8% (IQR: 4.2-21.4%) and 74.2% (IQR: 54.1-90.7%) in general and specific patients, respectively. The ADE-related fatality rate was 0.1% and 1.3% in general and specific patients. The overall median prevalence of ADEs leading to hospital admissions was 6.0% (IQR: 1.5-9.0%); in general, patients and the median prevalence of ADEs in the outpatient and community settings were 22.9% (IQR: 14.6-56.1%) and 32.6% (IQR: 26.0-41.3%), respectively, with a median of 43.5% (IQR: 16.3-59.0%) and 12.4% (IQR: 7.1-28.1%) of ADEs being preventable in general and specific patients, respectively. CONCLUSIONS The prevalence of ADEs was significant in both hospital and community settings in Africa. A high ADE prevalence was observed in specific patients, emphasizing important areas for improvement, particularly in at-risk patient groups (e.g., pediatrics, HIV, and TB patients) in various settings. Due to limited studies conducted in the community setting, future research in this setting is encouraged.
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Affiliation(s)
- Linda Nyame
- School of Public Health, Southeast University, Nanjing, China.
| | - Yuhua Hu
- School of Public Health, Southeast University, Nanjing, China
| | - Hui Xue
- School of Public Health, Southeast University, Nanjing, China
| | - Emmanuel D K Fiagbey
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Xi Li
- Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Yong Tian
- School of Public Health, Southeast University, Nanjing, China
| | - Lijun Fan
- School of Public Health, Southeast University, Nanjing, China
| | - Wei Du
- School of Public Health, Southeast University, Nanjing, China.
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Tlili MA, Aouicha W, Gambashidze N, Ben Cheikh A, Sahli J, Weigl M, Mtiraoui A, Chelbi S, Said Laatiri H, Mallouli M. A retrospective analysis of adverse events reported by Tunisian intensive care units' professionals. BMC Health Serv Res 2024; 24:77. [PMID: 38229159 DOI: 10.1186/s12913-024-10544-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024] Open
Abstract
INTRODUCTION Adverse events (AEs) that occur in hospitals remain a challenge worldwide, and especially in intensive care units (ICUs) where they are more likely to occur. Monitoring of AEs can provide insight into the status and advances of patient safety. This study aimed to examine the AEs reported during the 20 months after the implementation of the AE reporting system. METHODS We conducted a retrospective analysis of a voluntary ICU AE reporting system. Incidents were reported by the staff from ten ICUs in the Sahloul University Hospital (Tunisia) between February 2020 and September 2021. RESULTS A total of 265 reports were received, of which 61.9% were deemed preventable. The most frequently reported event was healthcare-associated infection (30.2%, n = 80), followed by pressure ulcers (18.5%, n = 49). At the time of reporting, 25 patients (9.4%) had died as a result of an AE and in 51.3% of cases, the event had resulted in an increased length of stay. Provider-related factors contributed to 64.2% of the events, whilst patient-related factors contributed to 53.6% of the events. As for criticality, 34.3% of the events (n = 91) were unacceptable (c3) and 36.3% of the events (n = 96) were 'acceptable under control' (c2). CONCLUSIONS The reporting system provided rich information on the characteristics of reported AEs that occur in ICUs and their consequences and may be therefore useful for designing effective and evidence-based interventions to reduce the occurrence of AEs.
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Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Nikoloz Gambashidze
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus-1, 53127, Bonn, Germany
| | - Asma Ben Cheikh
- Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Matthias Weigl
- Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus-1, 53127, Bonn, Germany
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Souad Chelbi
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Houyem Said Laatiri
- Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse, Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
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Ul Hassan SS, Asif F, Haque G, Ayub F, Munir T, Khan F, Siddiqi S, Latif A. Estimating the frequency of inpatient adverse events using a two-step retrospective chart review: a study protocol. BMJ Open 2023; 13:e076971. [PMID: 38056938 PMCID: PMC10711861 DOI: 10.1136/bmjopen-2023-076971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Adverse events are a major cause of patient harm in the hospitalised setting. Low-income and middle-income countries account for a disproportionate share of the global burden of adverse events. However, patient safety research is still centred around high-income countries and high-resource health systems. The methods and data produced from these efforts are ill-suited to low-income and middle-income systems due to the social and technical differences between these settings. We aim to use our pilot-tested, locally developed methodology to estimate the frequency and characteristics of adverse events in hospitalised patients in a lower-middle-income country to inform patient safety policies and initiatives. METHODS AND ANALYSIS This multi-centre study will employ a two-step chart review methodology to identify adverse events in a representative sample of patients admitted at five hospitals between 1 January 2019 and 31 December 2019. The first step will include assessing patient files against a list of triggers to detect adverse events and the second step will involve an in-depth review of the events to capture pertinent characteristics. The triggers have been adapted from validated tools used in other studies. The reviewing team will be trained on the use of research tools and operational definitions to ensure that data are collected uniformly. The main outcome of interest is the rate at which adverse events occur in hospitalised patients. Further analysis will look to identify and quantify associations between the main outcome of interest and a variety of variables such as patient age and gender using tests of independence and regression techniques. ETHICS AND DISSEMINATION This study protocol has been approved by the Ethics Review Committee at Aga Khan University (Reference number: 2023-6324-24566). The findings of this study will be published in a peer-reviewed journal and disseminated to the public through national and international conferences, workshops, websites and social media.
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Affiliation(s)
| | - Fozia Asif
- Centre for Patient Safety, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Ghazal Haque
- Centre for Patient Safety, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Farwa Ayub
- Centre for Patient Safety, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Tahir Munir
- Department of Anaesthesiology, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Fauzia Khan
- Department of Anaesthesiology, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Asad Latif
- Centre for Patient Safety, The Aga Khan University, Karachi, Sindh, Pakistan
- Department of Anaesthesiology, The Aga Khan University, Karachi, Sindh, Pakistan
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
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Kapira S, Aron MB, Mphande I, Chonongera G, Khongo BD, Zaniku HR, Mkandawire S, Nkhoma W, Tengatenga L, Munyaneza F, Kachimanga C. Evaluating the uptake and effect of Surgical Safety Checklist implementation in a rural hospital, Neno District, Malawi. BMJ Open Qual 2023; 12:e002426. [PMID: 37989354 PMCID: PMC10661078 DOI: 10.1136/bmjoq-2023-002426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The WHO introduced the Surgical Safety Checklist (SSC) in 2008, which has been proven to enhance collaboration and patient safety before, during and after surgical procedures. However, the impact of using SSC has not been assessed in a rural setting in Malawi. We aimed to evaluate the uptake of SSC in Neno District, Malawi. METHODS We conducted a cross-sectional hospital-based retrospective chart review of 468 surgical cases from July 2021 to March 2022 in two hospitals in Neno District. We collected data using Excel and used R software for analysis. We used descriptive statistics to characterise the surgeries. We used χ2 test and Wilcoxon signed-rank test to test the association between SSC use and independent variables. We fitted logistic regression to assess predictors of SSC use and complications. RESULTS Of 468 surgical cases, 92% (n=431) were done as emergency procedures. The median age was 23 years (IQR: 19-29) and 94% (n=439) were female. Overall, 38% of surgeries (n=176) used the SSC and of these, 98% were in emergency procedures. We found an association between the use of SSC and the age of the client (p=0.018), type of procedure, name of the procedure, healthcare worker cadre, time procedure performed and complications (p<0.001). However, no association was observed between SSC use and outcome (p>0.05). The odds of using SSC were higher in emergency surgeries, surgeries performed at night; however, they were lower among temporary employees and anaesthetists with a diploma (p<0.001). The odds of experiencing complications were 1.71 times greater when using SSC compared with surgeries without SSC (p=0.029). CONCLUSIONS The use of an SSC in a rural area was promising, despite its fluctuating use and this needs programme improvement. Further studies are highly recommended to understand the fluctuation in the use of the SSC.
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Affiliation(s)
| | - Moses Banda Aron
- Monitoring and Evaluation, Partners In Health, Neno, Malawi
- Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | | | | | - Haules Robbins Zaniku
- Neno District Health Office, Ministry of Health, Neno, Malawi
- Kamuzu University of Health Sciences, School of Global and Public Health, Blantyre, Malawi
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Alemu W, Cimiotti JP. Meta-Analysis of Medication Administration Errors in African Hospitals. J Healthc Qual 2023; 45:233-241. [PMID: 37276257 DOI: 10.1097/jhq.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT The incidence of medication administration errors (MAEs) and associated patient harm continue to plague hospitals worldwide. Moreover, there is a lack of evidence to address this problem, especially in Africa. This research synthesis was intended to provide current evidence to decrease the incidence of MAEs in Africa. Standardized search criteria were used to identify primary studies that reported the incidence and/or predictors of MAEs in Africa. Included studies met specifications and were validated with a quality-appraisal tool. The pooled incidence of MAEs in African hospitals was estimated to be 0.56 (CI: 0.4324-0.6770) with a 0.13-0.93 prediction interval. The primary estimates were highly heterogeneous. Most MAEs are explained by system failure and patient factors. The contribution of system factors can be minimized through adequate and ongoing training of nurses on the aspects of safe medication administration. In addition, ensuring the availability of drug use guidelines in hospitals, and minimizing disruptions during the medication process can decrease the incidence of MAEs in Africa.
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Bante A, Mersha A, Aschalew Z, Ayele A. Medication errors and associated factors among pediatric inpatients in public hospitals of gamo zone, southern Ethiopia. Heliyon 2023; 9:e15375. [PMID: 37123938 PMCID: PMC10130860 DOI: 10.1016/j.heliyon.2023.e15375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Background Medication errors are the most common medical errors in the world. In particular, pediatric patients are more susceptible to severe injuries and death. Despite their multidimensional impact, medication errors are not recognized well in developing nations, including Ethiopia. Thus, this study aimed to assess the prevalence of medication errors and associated factors among pediatric inpatients in public hospitals of Gamo zone, southern Ethiopia. Methods A facility-based cross-sectional study was conducted among 416 pediatric inpatients from August 1, 2020, to February 30, 2021. Open data kit tools and Stata version 16.0 were used for data collection and analysis, respectively. Bivariable and multivariable analyses were performed to identify factors associated with medication errors. An adjusted odds ratio with a 95% confidence interval was computed and a P-value of <0.05 in the multivariable analysis was set to declare statistical significance. Results Overall, 69.5% (95% CI: 64.80, 73.86) of pediatric inpatients experienced medication errors. Unsuitable working environment (aOR: 2.40, 95% CI: 1.48, 3.91), child weight <5 Kg (aOR: 3.72, 95% CI: 1.79, 7.73), medication administered by diploma professionals (aOR: 2.10, 95% CI: 1.31, 3.36), parent involvement (aOR: 0.55, 95% CI: 0.33, 0.95), non-adherence with medication administration rights (aOR: 2.68, 95% CI: 1.32, 5.44) and hospital stay for >5 days (aOR: 1.83, 95% CI: 1.15, 2.93) were significantly associated with medication errors. Conclusion Medication errors were high among pediatric inpatients as compared to previous national studies. To reduce the occurrences of medication errors, it is critical to create a suitable working environment, arrange education and training opportunities for providers, involve families in the medication administration process, and strictly adhere to medication administration rights.
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Affiliation(s)
- Agegnehu Bante
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- Corresponding author.
| | - Abera Mersha
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Zeleke Aschalew
- School of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Aklilu Ayele
- Department of Pharmacy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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7
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Dillner P, Eggenschwiler LC, Rutjes AWS, Berg L, Musy SN, Simon M, Moffa G, Förberg U, Unbeck M. Incidence and characteristics of adverse events in paediatric inpatient care: a systematic review and meta-analysis. BMJ Qual Saf 2023; 32:133-149. [PMID: 36572528 PMCID: PMC9985739 DOI: 10.1136/bmjqs-2022-015298] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/08/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Adverse events (AEs) cause suffering for hospitalised children, a fragile patient group where the delivery of adequate timely care is of great importance. OBJECTIVE To report the incidence and characteristics of AEs, in paediatric inpatient care, as detected with the Global Trigger Tool (GTT), the Trigger Tool (TT) or the Harvard Medical Practice Study (HMPS) method. METHOD MEDLINE, Embase, Web of Science and Google Scholar were searched from inception to June 2021, without language restrictions. Studies using manual record review were included if paediatric data were reported separately. We excluded studies reporting: AEs for a specific disease/diagnosis/treatment/procedure, or deceased patients; study protocols with no AE outcomes; conference abstracts, editorials and systematic reviews; clinical incident reports as the primary data source; and studies focusing on specific AEs only. Methodological risk of bias was assessed using a tool based on the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Primary outcome was the percentage of admissions with ≥1 AEs. All statistical analyses were stratified by record review methodology (GTT/TT or HMPS) and by type of population. Meta-analyses, applying random-effects models, were carried out. The variability of the pooled estimates was characterised by 95% prediction intervals (PIs). RESULTS We included 32 studies from 44 publications, conducted in 15 countries totalling 33 873 paediatric admissions. The total number of AEs identified was 8577. The most common types of AEs were nosocomial infections (range, 6.8%-59.6%) for the general care population and pulmonary-related (10.5%-36.7%) for intensive care. The reported incidence rates were highly heterogeneous. The PIs for the primary outcome were 3.8%-53.8% and 6.9%-91.6% for GTT/TT studies (general and intensive care population). The equivalent PI was 0.3%-33.7% for HMPS studies (general care). The PIs for preventable AEs were 7.4%-96.2% and 4.5%-98.9% for GTT/TT studies (general and intensive care population) and 10.4%-91.8% for HMPS studies (general care). The quality assessment indicated several methodological concerns regarding the included studies. CONCLUSION The reported incidence of AEs is highly variable in paediatric inpatient care research, and it is not possible to estimate a reliable single rate. Poor reporting standards and methodological differences hinder the comparison of study results.
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Affiliation(s)
- Pernilla Dillner
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden .,Division of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Luisa C Eggenschwiler
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne W S Rutjes
- Department of Medical and Surgical Sciences SMECHIMAI, University of Modena and Reggio Emilia, Modena, Italy.,Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Lena Berg
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sarah N Musy
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Giusi Moffa
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Ulrika Förberg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Maria Unbeck
- School of Health and Welfare, Dalarna University, Falun, Sweden.,Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Ezzi O, Mahjoub M, Omri N, Ammar A, Loghmari D, Chelly S, Mtira A, Rhimi S, Njah M. Patient safety in medical education: Tunisian students’ attitudes. Libyan J Med 2022; 17:2122159. [PMID: 36093793 PMCID: PMC9481112 DOI: 10.1080/19932820.2022.2122159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Health care delivery continues to be unsafe despite major patient safety (PS) improvement efforts over the past decade. Medical school education plays an important role in promoting this culture during initial training. To determine undergraduate medical students’ attitudes toward PS at a Tunisian medical school. We carried out a cross-sectional study among undergraduate medical students at Ibn Al Jazzar Medical School in Sousse, Tunisia, using a self-administered questionnaire inspired from the valid tool: Attitudes to Patient Safety Questionnaire (APSQ III). A total of 178 medical students responded to the questionnaire. Medical students tend to have an overall positive perceptions of PS culture with a global mean score 5.33 ± 0.5. Among the individual domains ‘Working hours as a cause of error’ earned the highest score (6.38 ± 1.0) followed in order by ‘Team functioning’ (6.24 ± 0.8), ‘Error inevitability’ (5.91 ± 1.0) and ‘Patient involvement in reducing error’ (5.50 ± 1.0). The lowest score was for ‘Professional incompetence as a cause of error’ (4.01 ± 1.0). A PS domain’s mean scores comparison based on socio-demographic variables: gender, age, academic year and on PS training revealed a statistically significant difference (p < 0.05) for five PS key dimensions: ‘ Error reporting confidence ’, ‘ Working hours as a cause of error ’, ‘ Professional incompetence as a cause of error ’, ‘ Team functioning ’ and ‘PS training received’. Tunisian medical students showed positive attitude towards PS. Nevermore, intensive in terms of frequency and duration sessions, based on various teaching methods may be needed to fulfill students’ educational needs.
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Affiliation(s)
- Olfa Ezzi
- Department of Infection Control, Farhat Hached University Hospital_Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Mohamed Mahjoub
- Department of Infection Control, Farhat Hached University Hospital_Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Nihel Omri
- Department of Infection Control, Farhat Hached University Hospital_Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Asma Ammar
- Department of Infection Control, Farhat Hached University Hospital_Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Dorra Loghmari
- Faculty of Medicine of Sousse, Sousse, Tunisia
- Emergency Medical Services_Sahloul University Hospital_Sousse, Sousse, Tunisia
| | - Souhir Chelly
- Department of Infection Control, Farhat Hached University Hospital_Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Abir Mtira
- Department of Infection Control, Farhat Hached University Hospital_Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Sana Rhimi
- Department of Infection Control, Farhat Hached University Hospital_Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Mansour Njah
- Department of Infection Control, Farhat Hached University Hospital_Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, Sousse, Tunisia
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Kim MJ, Seo HJ, Koo HM, Ock M, Hwang JI, Lee SI. The Korea National Patient Safety Incidents Inquiry Survey: Characteristics of Adverse Events Identified Through Medical Records Review in Regional Public Hospitals. J Patient Saf 2022; 18:382-388. [PMID: 35948288 PMCID: PMC9329043 DOI: 10.1097/pts.0000000000000944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In 2019, the Korean National Patient Safety Incidents Inquiry was conducted in the Republic of Korea to identify the national-level incidence of adverse events. This study determined the incidence and detailed the characteristics of adverse events at 15 regional public hospitals in the Republic of Korea. METHODS Medical records data of 500 randomly selected patients (discharged in 2016) were extracted from each of the 15 studied hospitals and reviewed in 3 stages. First, for each hospital, 2 nurses independently reviewed the medical records, using 41 screening criteria. Second, 2 physicians independently reviewed the records of those patients with at least 1 screening criterion from the first stage for adverse events occurrence and their characteristics. Third, a 9-member committee conducted a final review and compiled the final adverse event report. RESULTS Among 7500 patients, 4159 (55.5%) had at least 1 screening criterion; 745 (9.9%) experienced 901 adverse events (incidence, 12.0%). By type of institution, adverse event incidence varied widely from 1.2% to 45.6%. In 1032 adverse events, the majority (33.5%) were "patient care-related." By severity, the majority (638; 70.8%) were temporary, requiring intervention, whereas 38 (4.2%) resulted in death. The preventability score was high for "patient care-related" and "diagnosis-related" adverse events. Duration of hospitalization was extended for 463 (44.9%) adverse events, with "diagnosis-related" (30.8%) and "surgery/procedural-related" (30.1%) types extended by at least 21 days. CONCLUSIONS A review of medical records aids in identifying adverse events in medical institutions with varying characteristics, thus helping prioritize interventions to reduce their incidence.
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Affiliation(s)
- Min Ji Kim
- From the Korea Institute for Healthcare Accreditation, Seoul
| | - Hee Jung Seo
- From the Korea Institute for Healthcare Accreditation, Seoul
| | - Hong Mo Koo
- From the Korea Institute for Healthcare Accreditation, Seoul
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan
- Department of Preventive Medicine, University of Ulsan College of Medicine
| | - Jee-In Hwang
- Department of Nursing Management, College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Sang-Il Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine
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Khalid KH, Yamamoto E, Hamajima N, Kariya T. Rates and Factors Associated With Serious Outcomes of Patient Safety Incidents in Malaysia: An Observational Study. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2022; 5:31-38. [PMID: 37260835 PMCID: PMC10229002 DOI: 10.36401/jqsh-21-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 06/02/2023]
Abstract
Introduction This study aimed to examine the reporting rate and the factors associated with serious outcomes of patient safety incidents at public hospitals in Malaysia. Methods All patient safety incidents reported in the e-Incident-Reporting System from January to December 2019 were included in the study. A descriptive study was used to describe the characteristics of incidents, and logistic models were used to identify factors associated with low reporting rates and severe harm or death outcomes of incidents. Results There were 9431 patient safety incidents reported in the system in 2019. The mean reporting rate was 2.1/1000 patient bed-days or 1.5% of hospital admissions. The major category of incidents was drug-related incidents (32.4%). No-harm incidents contributed to 56.1% of all the incidents, while 1.1% resulted in death. More hospitals in the eastern (odds ratio [OR], 12.1) and southern regions (OR, 6.1) had low reporting rates compared to the central region. Incidents with severe harm or death outcomes were associated with more males (OR, 1.4) than females and with the emergency department (OR, 10.6), internal medicine (OR, 5.7), obstetrics and gynecology (OR, 2.4), and surgical department (OR, 5.0) more than the pharmacy department. Compared to drug-related incidents, operation-related (OR, 3.0), procedure-related (OR, 3.5), and therapeutic-related (OR, 4.8) incidents had significantly more severe harm or death outcomes, and patient falls (OR, 0.4) had less severe harm or death outcomes. Conclusion The mean reporting rate was 2.1/1000 patient bed-days or 1.5% of hospital admissions. More hospitals in the eastern and southern regions had low reporting rates. Certain categories of incidents had significantly more severe outcomes.
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Affiliation(s)
- Khairulina Haireen Khalid
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Medical Development Division, Ministry of Health, Malaysia
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
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11
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Tlili MA, Aouicha W, Sahli J, Ben Cheikh A, Mtiraoui A, Ajmi T, Zedini C, Chelbi S, Ben Rejeb M, Mallouli M. Assessing patient safety culture in 15 intensive care units: a mixed-methods study. BMC Health Serv Res 2022; 22:274. [PMID: 35232452 PMCID: PMC8887118 DOI: 10.1186/s12913-022-07665-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Within hospitals, intensive care units (ICUs) are particularly high-risk areas for medical errors and adverse events that could occur due to the complexity of care and the patients' fragile medical conditions. Assessing patient safety culture (PSC) is essential to have a broad view on patient safety issues, to orientate future improvement actions and optimize quality of care and patient safety outcomes. This study aimed at assessing PSC in 15 Tunisian ICUs using mixed methods approach. METHODS A cross-sectional mixed methods approach using a sequential explanatory design was conducted from December 2019 to January 2020. The first quantitative stage was conducted in 15 ICUs belonging to the two university hospitals in the region of Sousse (Tunisia). All the 344 healthcare professionals (clinical staff) working for more than 1 month in these ICUs were contacted in order to take part in the study. In the second qualitative stage 12 participants were interviewed based on purposive sampling. RESULTS All of the PSC dimensions had a score of less than 50%. The developed dimension was 'teamwork within units' (48.8%). The less developed dimensions were 'frequency of event reporting' (20.8%), 'communication openness' (22.2%) and 'non-punitive response to error' (19.7%). Interviews' thematic analysis revealed four main themes including "Hospital management/system failure", "Teamwork and communication", "Error management" and "Working conditions". CONCLUSION This research revealed that PSC is still in need of improvement and provided a clearer picture of the patient safety issues that require specific attention. Improving PSC through the use of quality management and error reporting systems may help to improve patient safety outcomes.
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Affiliation(s)
- Mohamed Ayoub Tlili
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia. .,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia. .,Higher School of Health Sciences and Techniques of Sousse, University of Sousse, 4054, Sousse, Tunisia.
| | - Wiem Aouicha
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia.,Higher School of Health Sciences and Techniques of Sousse, University of Sousse, 4054, Sousse, Tunisia
| | - Jihene Sahli
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Asma Ben Cheikh
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Ali Mtiraoui
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Thouraya Ajmi
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Chekib Zedini
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
| | - Souad Chelbi
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Higher School of Health Sciences and Techniques of Sousse, University of Sousse, 4054, Sousse, Tunisia
| | - Mohamed Ben Rejeb
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Prevention and Care Safety, Sahloul University Hospital, 4054, Sousse, Tunisia
| | - Manel Mallouli
- Faculty of Medicine of Sousse, University of Sousse, 4002, Sousse, Tunisia.,Department of Family and Community Medicine, LR12ES03, 4002, Sousse, Tunisia
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12
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Sauro KM, Machan M, Whalen-Browne L, Owen V, Wu G, Stelfox HT. Evolving Factors in Hospital Safety: A Systematic Review and Meta-Analysis of Hospital Adverse Events. J Patient Saf 2021; 17:e1285-e1295. [PMID: 34469915 DOI: 10.1097/pts.0000000000000889] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to estimate the frequency of hospital adverse events (AEs) and explore the rate of AEs over time, and across and within hospital populations. METHODS Validated search terms were run in MEDLINE and EMBASE; gray literature and references of included studies were also searched. Studies of any design or language providing an estimate of AEs within the hospital were eligible. Studies were excluded if they only provided an estimate for a specific AE, a subgroup of hospital patients or children. Data were abstracted in duplicate using a standardized data abstraction form. Study quality was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis estimated the occurrence of hospital AEs, and meta-regression explored the association between hospital AEs, and patient and hospital characteristics. RESULTS A total of 45,426 unique references were identified; 1,265 full-texts were reviewed and 94 studies representing 590 million admissions from 25 countries from 1961 to 2014 were included. The incidence of hospital AEs was 8.6 per 100 patient admissions (95% confidence interval [CI], 8.3 to 8.9; I2 = 100%, P < 0.001). Half of the AEs were preventable (52.6%), and a third resulted in moderate/significant harm (39.7%). The most evaluated AEs were surgical AEs, drug-related AEs, and nosocomial infections. The occurrence of AEs increased by year (95% CI, -0.05 to -0.04; P < 0.001) and patient age (95% CI = -0.15 to -0.14; P < 0.001), and varied by country income level and study characteristics. Patient sex, hospital type, hospital service, and geographical location were not associated with AEs. CONCLUSIONS Hospital AEs are common, and reported rates are increasing in the literature. Given the increase in AEs over time, hospitals should reinvest in improving hospital safety with a focus on interventions targeted toward the more than half of AEs that are preventable.
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Affiliation(s)
| | | | | | - Victoria Owen
- Department of Community Health Sciences & O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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Lorkowski J, Maciejowska-Wilcock I, Pokorski M. Compliance with the Surgery Safety Checklist: An Update on the Status. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1374:1-9. [PMID: 34773633 DOI: 10.1007/5584_2021_661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
WHO has recommended the implementation of the Surgery Safety Checklist (SSC) to reign in often simple logistic errors that lead to numerous complications, some of them being fatal, in the perioperative period. This study aims to discuss doubts presented in the medical literature concerning the effectiveness of SSC in the currently existing form. The article is based on the literature search performed in PubMed using the command phrase "Surgery Safety Checklist". The search yielded 1,476 articles up to March 2021. Out of this group, we selected 811 articles for further detailed analysis. The selection was based on the meritorious SSC-related topicality and scrutinized content of the articles. Out of these articles, we identified 59 studies that specifically raised the issue of the effectiveness of SSC use in its current form, which we discussed herein in detail. The review distinctly indicates that the SSC reduces perioperative complications including fatalities. However, there are issues reported with the itemized content of the checklist that hardly corresponds to the diverseness of patients' conditions and operating room settings. Further, it is unclear if a reduction in the complications stems from the use of SSC or the algorithms for performing procedures it contains. The consensus arises that SSC should be periodically updated so that it would catch up with the advances in medical knowledge and the emerging technologies, which would safeguard the SSC from becoming just another paperwork nuisance for the operating room staff.
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Affiliation(s)
- Jacek Lorkowski
- Department of Orthopedics, Traumatology and Sports Medicine, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Poland. .,Faculty of Health Sciences, Medical University of Mazovia, Warsaw, Poland.
| | | | - Mieczyslaw Pokorski
- Institute of Health Sciences, Opole University, Opole, Poland.,Faculty of Health Sciences, The Jan Długosz University in Częstochowa, Częstochowa, Poland
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14
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Zanetti ACB, Dias BM, Bernardes A, Capucho HC, Balsanelli AP, de Moura AA, Soato R, Gabriel CS. Incidence and preventability of adverse events in adult patients admitted to a Brazilian teaching hospital. PLoS One 2021; 16:e0249531. [PMID: 33857137 PMCID: PMC8049336 DOI: 10.1371/journal.pone.0249531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To analyze the incidence and preventability of adverse events related to health care in adult patients admitted to a Brazilian teaching hospital. Methods A retrospective cohort study, in which the incidence and preventability of adverse events related to health care were based on a two-stage retrospective review of 368 medical records (nurses and pharmacist review of medical records, followed by physicians review of triggered medical records) of adult patients whose hospitalizations occurred during 2015 in a high-complexity public teaching hospital located in Brazil. Data were collected from February 2018 to February 2019. Results A total of 266 adverse events were observed in 124 patients. The incidence of adverse events related to health care was 33.7% (95% CI 0.29–0.39), and the incidence density was 4.97 adverse events per 100 patient-days. Adverse events were responsible for 701 additional days of hospitalization, and the estimated length of additional hospital stay attributable to them was, on average, 6.8 days per event. The most common types of events were related to general care (60; 22.6%), medications (50; 18.8%), nosocomial infection (35; 13.2%), any other type (11; 4.1%), and diagnoses (2; 0.8%). Regarding the severity of adverse events, it was found that 168 (63.2%) were mild, 55 (20.7%) were moderate, and 43 (16.2%) were severe. In addition, it was estimated that 155 (58.3%) events were preventable. The length of a patient’s hospital stay was identified as a risk factor for the occurrence of adverse events (RR 1.20; 95% CI 1.04–1.39). Conclusions Through knowledge of the incidence, nature, severity, preventability, and risk factors for the occurrence of adverse events, it is possible to create the opportunities to prioritize the implementation of strategies for mitigating specific events based on reliable data and concrete information.
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Affiliation(s)
- Ariane Cristina Barboza Zanetti
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
- * E-mail:
| | - Bruna Moreno Dias
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Andrea Bernardes
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Helaine Carneiro Capucho
- Department of Pharmacy, Faculty of Health Sciences, University of Brasilia, Brasília, Distrito Federal, Brazil
| | - Alexandre Pazetto Balsanelli
- Department of Administration of Health and Nursing Services, Paulista School of Nursing, Federal University of São Paulo – UNIFESP, São Paulo – SP, Brazil
| | - André Almeida de Moura
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Soato
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
| | - Carmen Silvia Gabriel
- Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, São Paulo, Brazil
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15
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Bara A, Tougri H, Belrhiti Z, Baguiya A, Ouedraogo AM, Compaoré R, Kouanda S. [Performance analysis of a privately managed public hospital in Burkina Faso]. SANTE PUBLIQUE 2021; 32:519-523. [PMID: 33723957 DOI: 10.3917/spub.205.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Hospitals in Sub-Saharan Africa face many challenges. Burkina Faso has experimented a private operating system in a public hospital, in order to improve its performance. AIM To assess the Tengandogo Teaching Hospital's (TTH's) performance in Ouagadougou. Burkina Faso. METHOD We carried out a mixed-method cross-sectional study. We collected data in April 2017 using document review and quantitative data (key performance indicators), individual interviews with key informants. The analytical framework covered services continuity, health department efficiency and staff working environment safety. RESULTS Our study findings indicated that the performance of TTH hospital is hampered by frequent shortages in medicine and medical consumables, deteriorating facilities, poor coordination of care and lack of data on patients and staff security. CONCLUSION Private management of public hospitals is not sufficient to improve the performance of hospitals in Burkina Faso. More attention should be paid to improving supply management of medicine, consumables and ensuring a safe work environment for health workers.
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16
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Lorkowski J, Maciejowska-Wilcock I, Pokorski M. Causes and Effects of Introducing Surgery Safety Checklist: A Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1335:53-62. [PMID: 33797735 DOI: 10.1007/5584_2021_631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The medical treatment process, particularly surgery, is inescapably bound to potential complications or undesirable adverse events. This narrative review aims to present the causes and effects of the introduction of the WHO Surgery Safety Checklist (SSC), the use of which is expected to reduce the number of perioperative errors, complications, and mortality. To achieve this objective, we performed a bibliometric analysis of medical citations indexed in the PubMed database using the SSC subject heading. Findings revealed a total of 1441 articles meeting inclusion status, with 1171 published during the last decade. After the screening of titles and abstracts, the members of the research team selected 75 articles, deemed most relevant for inclusion in the review, which were then thoroughly analyzed. All in all, the findings were that the use of SSC appreciably reduced the number of simple logistic errors in the perioperative period decreasing the frequency of resulting complications and mortality.
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Affiliation(s)
- Jacek Lorkowski
- Department of Orthopedics, Traumatology and Sports Medicine, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Warsaw, Poland. .,Faculty of Health Sciences, Medical University of Mazovia, Warsaw, Poland.
| | | | - Mieczysław Pokorski
- Institute of Health Sciences, Opole University, Opole, Poland.,Faculty of Health Sciences, The Jan Długosz University in Częstochowa, Częstochowa, Poland
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17
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Aouicha W, Tlili MA, Sahli J, Dhiab MB, Chelbi S, Mtiraoui A, Latiri HS, Ajmi T, Zedini C, Ben Rejeb M, Mallouli M. Exploring patient safety culture in emergency departments: A Tunisian perspective. Int Emerg Nurs 2020; 54:100941. [PMID: 33341462 DOI: 10.1016/j.ienj.2020.100941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 09/17/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Wiem Aouicha
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia.
| | - Mohamed Ayoub Tlili
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia.
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Mohamed Ben Dhiab
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Souad Chelbi
- University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Houyem Said Latiri
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Sahloul University Hospital, Department of Prevention and Care Safety, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Chekib Zedini
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Sahloul University Hospital, Department of Prevention and Care Safety, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine Ibn El Jazzar, Sousse, Tunisia; Laboratory of research « Qaulité des soins et management des services de santé maternelle LR12ES03 », Tunisia
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18
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Kim S, Shin HG, Jo AEJ, Min A, Ock M, Hwang JI, Jeong Y, Park MS, Lee JB, Chang TIK, Song E, Kim H, Lee SI. Variation between hospitals and reviewers in detection of adverse events identified through medical record review in Korea. Int J Qual Health Care 2020; 32:495-501. [PMID: 32696047 DOI: 10.1093/intqhc/mzaa079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study utilized the method of medical record review to determine characteristics of adverse events that occurred in the inpatient units of hospitals in Korea as well as the variations in adverse events between institutions. DESIGN A two-stage retrospective medical record review was conducted. The first stage was a nurse review, where two nurses reviewed medical records of discharged patients to determine if screening criteria had been met. In the second stage, two physicians independently reviewed medical records of patients identified in the first stage, to determine whether an adverse event had occurred. SETTING Inpatient units of six hospitals. PARTICIPANTS Medical records of 2 596 patients randomly selected were reviewed in the first stage review. INTERVENTION(S) N/A. MAIN OUTCOME MEASURE(S) Adverse events. RESULTS A total of 277 patients (10.7%) were confirmed to have had one or more adverse event(s), and a total of 336 adverse events were identified. Physician reviewers agreed about whether an adverse event had occurred for 141 patients (5.4%). The incidence rate of adverse events was at least 1.3% and a maximum of 19.4% for each hospital. Most preventability scores were less than four points (non-preventable), and there were large variations between reviewers and institutions. CONCLUSIONS Given the level of variation in the identified adverse events, further studies that include more medical institutions in their investigations are needed, and a third-party committee should be involved to address the reliability issues regarding the occurrence and characteristics of the adverse events.
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Affiliation(s)
- Sukyeong Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Ho Gyun Shin
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - A E Jeong Jo
- National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Ari Min
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.,Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jee-In Hwang
- Department of Nursing Management, College of Nursing Science, Kyung Hee University, Seoul, Republic of Korea
| | - Youngjin Jeong
- Department of Family Medicine, Veterans Health Service (VHS) Medical center, Seoul, Republic of Korea
| | - Moon Sung Park
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Gyeonggi-do, Republic of Korea
| | - Jong Bouk Lee
- Department of Urology, National Medical Center, Seoul, Republic of Korea
| | - Tae I K Chang
- Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea
| | - Eunhyang Song
- Department of Neurology, Seoul Metropolitan Seobuk Hospital, Seoul, South Korea
| | - Heungseon Kim
- Department of Quality Improvement, Mediplex Sejong Hospital, Incheon, Republic of Korea
| | - Sang-Il Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea
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19
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Tlili MA, Aouicha W, Sahli J, Zedini C, Ben Dhiab M, Chelbi S, Mtiraoui A, Said Latiri H, Ajmi T, Ben Rejeb M, Mallouli M. A baseline assessment of patient safety culture and its associated factors from the perspective of critical care nurses: Results from 10 hospitals. Aust Crit Care 2020; 34:363-369. [PMID: 33121872 DOI: 10.1016/j.aucc.2020.09.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle» - University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle» - University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | - Chekib Zedini
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | | | - Souad Chelbi
- University of Sousse, Faculty of Medicine of Sousse (Tunisia) - University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | - Houyem Said Latiri
- University of Sousse, Faculty of Medicine of Sousse (Tunisia)- University Hospital Sahloul (Sousse,Tunisia), Department of Prevention and Safety Care, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine of Sousse (Tunisia)- University Hospital Sahloul (Sousse,Tunisia), Department of Prevention and Safety Care, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse (Tunisia), Department of Community and Family Health, Laboratory of Research LR12ES03 «Qualité des soins et management des services de santé maternelle», Tunisia
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Ghali H, Cheikh AB, Bhiri S, Fredj SB, Layouni S, Khefacha S, Dhidah L, Rejeb MB, Latiri HS. [Adverse events in a Tunisian university hospital: incidence and risk factors]. SANTE PUBLIQUE 2020; 32:189-198. [PMID: 32989948 DOI: 10.3917/spub.202.0189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the incidence and risk factors of adverse events (AE) in a Tunisian university hospital. METHOD We carried out a longitudinal observational study in 2016 over a period of 3 months in the Sahloul university hospital of Sousse, Tunisia. Data were collected using a pretested form filled by doctors previously trained in the collection methodology, upon each visit to all hospitalized patients. RESULTS Overall, 1,357 patients were eligible. We identified 168 AEs in 131 patients with AEs incidence of 12.4% (95% CI: [7.41 – 17.38]), and patient incidence of 9.7% (95% CI: [4.63 – 14.76]). The incidence density of AEs was 1.8 events per 100 days of hospitalization. Hospital acquired infection and unplanned readmission related to previous healthcare management were the most common AEs (43.4 and 12.5% respectively). Multivariate analysis revealed as independent factors of AEs: surgery (P = 0.013; RR = 1.68; CI: [1.11-2.54]), the use of central-venous-catheter (P < 10–3; RR = 4.1 ; CI: [2.1-8]), tracheotomy (P = 0.001; RR = 21.8; CI: [3.7-127.8]), transfusion (P = 0.014; RR = 2.1; CI: [1.16-3.87]) and drug intake (P = 0.04; RR = 2.2; CI: [1.04-4.7]). CONCLUSION The present study showed a high incidence of AEs and the involvement of invasive devices in their occurrence. Thus, targeted interventions are needed.
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Zanetti ACB, Gabriel CS, Dias BM, Bernardes A, Moura AAD, Gabriel AB, Lima Júnior AJD. Assessment of the incidence and preventability of adverse events in hospitals: an integrative review. Rev Gaucha Enferm 2020; 41:e20190364. [PMID: 32667424 DOI: 10.1590/1983-1447.2020.20190364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/12/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To highlight the scientific production related to the use of the retrospective chart review methods to assess the incidence and preventability of adverse events in hospitals. METHOD An integrative review in the MEDLINE, LILACS, SCOPUS, Web of Science and EMBASE databases conducted in May 2019 with the following guiding question: What is known about the retrospective chart review methods to assess the incidence and preventability of adverse events in hospitals? Subsequently, the categorization, synthesis, and classification of the evidence levels of the included publications were performed. RESULTS In the 13 selected studies, the instruments adopted to assess the occurrence of adverse events were the Harvard Medical Practice Study, the Canadian Adverse Event Study, the Quality in Australian Health Care Study, and the Global Trigger Tool. Incidence ranged from 5.7 to 14.2%, while preventability ranged from 31 to 83%. CONCLUSION Differences in incidence and preventability were found, showing different results in the quality of care provided, the information registered in medical records, the screening criteria used, and the assessments of the reviewers.
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Affiliation(s)
- Ariane Cristina Barboza Zanetti
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Carmen Silvia Gabriel
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Bruna Moreno Dias
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Andrea Bernardes
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - André Almeida de Moura
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Andréia Boldrini Gabriel
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Antônio José de Lima Júnior
- Departamento de Enfermagem Geral e Especializada, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
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22
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Gunderson CG, Bilan VP, Holleck JL, Nickerson P, Cherry BM, Chui P, Bastian LA, Grimshaw AA, Rodwin BA. Prevalence of harmful diagnostic errors in hospitalised adults: a systematic review and meta-analysis. BMJ Qual Saf 2020; 29:1008-1018. [DOI: 10.1136/bmjqs-2019-010822] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 01/13/2023]
Abstract
BackgroundDiagnostic error is commonly defined as a missed, delayed or wrong diagnosis and has been described as among the most important patient safety hazards. Diagnostic errors also account for the largest category of medical malpractice high severity claims and total payouts. Despite a large literature on the incidence of inpatient adverse events, no systematic review has attempted to estimate the prevalence and nature of harmful diagnostic errors in hospitalised patients.MethodsA systematic literature search was conducted using Medline, Embase, Web of Science and the Cochrane library from database inception through 9 July 2019. We included all studies of hospitalised adult patients that used physician review of case series of admissions and reported the frequency of diagnostic adverse events. Two reviewers independently screened studies for inclusion, extracted study characteristics and assessed risk of bias. Harmful diagnostic error rates were pooled using random-effects meta-analysis.ResultsTwenty-two studies including 80 026 patients and 760 harmful diagnostic errors from consecutive or randomly selected cohorts were pooled. The pooled rate was 0.7% (95% CI 0.5% to 1.1%). Of the 136 diagnostic errors that were described in detail, a wide range of diseases were missed, the most common being malignancy (n=15, 11%) and pulmonary embolism (n=13, 9.6%). In the USA, these estimates correspond to approximately 249 900 harmful diagnostic errors yearly.ConclusionBased on physician review, at least 0.7% of adult admissions involve a harmful diagnostic error. A wide range of diseases are missed, including many common diseases. Fourteen diagnoses account for more than half of all diagnostic errors. The finding that a wide range of common diagnoses are missed implies that efforts to improve diagnosis must target the basic processes of diagnosis, including both cognitive and system-related factors.PROSPERO registration numberCRD42018115186.
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Tlili MA, Aouicha W, Ben Rejeb M, Sahli J, Ben Dhiab M, Chelbi S, Mtiraoui A, Said Laatiri H, Ajmi T, Zedini C, Mallouli M. Assessing patient safety culture in 18 Tunisian adult intensive care units and determination of its associated factors: A multi-center study. J Crit Care 2020; 56:208-214. [PMID: 31952015 DOI: 10.1016/j.jcrc.2020.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This study aimed to assess patient safety culture (PSC) in intensive care units (ICUs) and to determine the factors affecting it. MATERIALS AND METHODS This is a cross-sectional study, conducted from October to November 2017 among professionals practicing in the ICUs of the Tunisian center. After obtaining institutional ethics committee's approval and administrative authorizations, an anonymous paper-based questionnaire was distributed to the participants after obtaining their consent to take part in the study. The measuring instrument used is the French validated version of the "Hospital Survey on Patient Safety Culture" questionnaire. RESULTS A total of 402 professionals, from 18 ICUs and 10 hospitals, participated in the study with a participation rate of 82.37%. All dimensions were to be improved. The most developed dimension was teamwork within the unit (47.87%) and the least developed dimension was the non-punitive response to error (18.6%). Seven dimensions were significantly more developed in private institutions than in public ones. Results also show that when workload is reduced, the PSC was significantly increased. CONCLUSION This study has shown that the PSC in ICUs needs improvement and provided a baseline results to get a clearer vision of the aspects of security that require special attention.
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Affiliation(s)
- Mohamed Ayoub Tlili
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia.
| | - Wiem Aouicha
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia
| | - Mohamed Ben Rejeb
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University Hospital of Sahloul, Department of Prevention and Care Safety, Tunisia
| | - Jihene Sahli
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | | | - Souad Chelbi
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University of Sousse, Higher School of Health Sciences and Techniques of Sousse, Tunisia
| | - Ali Mtiraoui
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | - Houyem Said Laatiri
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; University Hospital of Sahloul, Department of Prevention and Care Safety, Tunisia
| | - Thouraya Ajmi
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | - Chekib Zedini
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
| | - Manel Mallouli
- University of Sousse, Faculty of Medicine of Sousse, Tunisia; Laboratory of research LR12ES03, Tunisia; Department of Community and Family Health, Faculty of Medicine of Sousse, Tunisia
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Banguti PR, Mvukiyehe JP, Durieux ME. The World Health Organization Surgical Safety Checklist: Happy 10th Birthday! Anesth Analg 2019; 127:1283-1284. [PMID: 30433916 DOI: 10.1213/ane.0000000000003732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Paulin R Banguti
- From the Department of Anesthesiology, University of Rwanda, Kigali, Rwanda
| | | | - Marcel E Durieux
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
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Ghali H, Ben Rejeb O, Bouafia N, Ammar A, Njah M, Ernez S, Mahdhaoui A, Jeridi G. Incidence and risk factors of peripheral venous catheter-related adverse events in cardiology department of a Tunisian university hospital: A prospective observational study. Ann Cardiol Angeiol (Paris) 2018; 68:207-214. [PMID: 30293799 DOI: 10.1016/j.ancard.2018.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
AIM The purpose of our study was to determine the incidence and risk factors of Peripheral Venous Catheter-Related Adverse Events (PVCAEs) in a cardiology department of a university hospital. PATIENTS AND METHODS We carried out a prospective observational study from Mars 2017 to May 2017 in the cardiology department of the University Hospital of Farhat Hached in Sousse, Tunisia. During this period, we actively followed-up all inserted PVCs (every 12hours) from insertion up to 48hours after removal. Regression analyses were applied and significance limits were set at P<0.05. RESULTS Data were analysed for 210 PVCs (794 PVC-days) in 148 patients. The incidence of PVCAEs was 33.33% with density of incidence of 8.81/1000 PVC-days. PVCAEs were mainly pain (50%) and mechanical events (31.42%). Infections accounted for 11.42%. The most frequent mechanical PVCAEs, was haematoma (15.71%). Multivariate analysis revealed as independent factors for the occurrence of PVCAEs: the hydro electrolytic nature of the injected product (OR=13.42, P<10-3), the medicinal nature of the injected product (OR=5.08, P=0.003), bad cutaneous state (OR=8.08, P=0.003), admission during nightshift (OR=3.76; P=0.014) and advanced age (OR=1.04, P=0.042). CONCLUSION Multicenter studies would be very useful to better analyze risk factors associated with PVCAEs.
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Affiliation(s)
- H Ghali
- Infection Prevention and Control Department, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia.
| | - O Ben Rejeb
- Department of Cardiology, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia; Research Laboratory LR14ES05, Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Tunisia.
| | - N Bouafia
- Infection Prevention and Control Department, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia; Infection Control Consultant, King Faycal Medical Complex, Taif, Saudi Arabia.
| | - A Ammar
- Infection Prevention and Control Department, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia.
| | - M Njah
- Infection Prevention and Control Department, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia.
| | - S Ernez
- Department of Cardiology, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia.
| | - A Mahdhaoui
- Department of Cardiology, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia; Research Laboratory LR14ES05, Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Tunisia.
| | - G Jeridi
- Department of Cardiology, University Hospital Farhat Hached, Faculty of Medecine of Sousse, University of Sousse, Tunisia; Research Laboratory LR14ES05, Interactions of the Cardiopulmonary System, Faculty of Medicine of Sousse, University of Sousse, Tunisia.
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Adverse Events in Korean Traditional Medicine Hospitals: A Retrospective Medical Record Review. J Patient Saf 2018; 14:157-163. [DOI: 10.1097/pts.0000000000000190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Schwendimann R, Blatter C, Dhaini S, Simon M, Ausserhofer D. The occurrence, types, consequences and preventability of in-hospital adverse events - a scoping review. BMC Health Serv Res 2018; 18:521. [PMID: 29973258 PMCID: PMC6032777 DOI: 10.1186/s12913-018-3335-z] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/27/2018] [Indexed: 11/19/2022] Open
Abstract
Background Adverse events (AEs) seriously affect patient safety and quality of care, and remain a pressing global issue. This study had three objectives: (1) to describe the proportions of patients affected by in-hospital AEs; (2) to explore the types and consequences of observed AEs; and (3) to estimate the preventability of in-hospital AEs. Methods We applied a scoping review method and concluded a comprehensive literature search in PubMed and CINAHL in May 2017 and in February 2018. Our target was retrospective medical record review studies applying the Harvard method–or similar methods using screening criteria–conducted in acute care hospital settings on adult patients (≥18 years). Results We included a total of 25 studies conducted in 27 countries across six continents. Overall, a median of 10% patients were affected by at least one AE (range: 2.9–21.9%), with a median of 7.3% (range: 0.6–30%) of AEs being fatal. Between 34.3 and 83% of AEs were considered preventable (median: 51.2%). The three most common types of AEs reported in the included studies were operative/surgical related, medication or drug/fluid related, and healthcare-associated infections. Conclusions Evidence regarding the occurrence of AEs confirms earlier estimates that a tenth of inpatient stays include adverse events, half of which are preventable. However, the incidence of in-hospital AEs varied considerably across studies, indicating methodological and contextual variations regarding this type of retrospective chart review across health care systems. For the future, automated methods for identifying AE using electronic health records have the potential to overcome various methodological issues and biases related to retrospective medical record review studies and to provide accurate data on their occurrence.
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Affiliation(s)
- René Schwendimann
- University Hospital Basel, Patient Safety Office, Spitalstr. 22, 4031, Basel, Switzerland. .,Department Public Health Institute of Nursing Science, University of Basel, Basel, Switzerland.
| | - Catherine Blatter
- Department Public Health Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Suzanne Dhaini
- Department Public Health Institute of Nursing Science, University of Basel, Basel, Switzerland.,American University of Beirut, School of Nursing, Beirut, Lebanon
| | - Michael Simon
- Department Public Health Institute of Nursing Science, University of Basel, Basel, Switzerland.,Inselspital Bern University Hospital, Nursing Research Unit, Bern, Switzerland
| | - Dietmar Ausserhofer
- Department Public Health Institute of Nursing Science, University of Basel, Basel, Switzerland.,College of Health Care-Professions Claudiana, Bozen, Italy
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Mendes W, Pavão ALB, Martins M, Travassos C. The application of Iberoamerican study of adverse events (IBEAS) methodology in Brazilian hospitals. Int J Qual Health Care 2018; 30:480-485. [PMID: 29617861 DOI: 10.1093/intqhc/mzy055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 03/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Walter Mendes
- Department of Health Management and Planning, National School of Public Health, Oswaldo Cruz Foundation, Fiocruz, Brazil
| | - Ana Luiza Braz Pavão
- Health Information Laboratory, Institute of Scientific and Technological Information and Communication in Health, Oswaldo Cruz Foundation, Fiocruz, Brazil
| | - Mônica Martins
- Department of Health Management and Planning, National School of Public Health, Oswaldo Cruz Foundation, Fiocruz, Brazil
| | - Cláudia Travassos
- Health Information Laboratory, Institute of Scientific and Technological Information and Communication in Health, Oswaldo Cruz Foundation, Fiocruz, Brazil
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Mekonnen AB, Alhawassi TM, McLachlan AJ, Brien JAE. Adverse Drug Events and Medication Errors in African Hospitals: A Systematic Review. Drugs Real World Outcomes 2017; 5:1-24. [PMID: 29138993 PMCID: PMC5825388 DOI: 10.1007/s40801-017-0125-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Medication errors and adverse drug events are universal problems contributing to patient harm but the magnitude of these problems in Africa remains unclear. Objective The objective of this study was to systematically investigate the literature on the extent of medication errors and adverse drug events, and the factors contributing to medication errors in African hospitals. Methods We searched PubMed, MEDLINE, EMBASE, Web of Science and Global Health databases from inception to 31 August, 2017 and hand searched the reference lists of included studies. Original research studies of any design published in English that investigated adverse drug events and/or medication errors in any patient population in the hospital setting in Africa were included. Descriptive statistics including median and interquartile range were presented. Results Fifty-one studies were included; of these, 33 focused on medication errors, 15 on adverse drug events, and three studies focused on medication errors and adverse drug events. These studies were conducted in nine (of the 54) African countries. In any patient population, the median (interquartile range) percentage of patients reported to have experienced any suspected adverse drug event at hospital admission was 8.4% (4.5–20.1%), while adverse drug events causing admission were reported in 2.8% (0.7–6.4%) of patients but it was reported that a median of 43.5% (20.0–47.0%) of the adverse drug events were deemed preventable. Similarly, the median mortality rate attributed to adverse drug events was reported to be 0.1% (interquartile range 0.0–0.3%). The most commonly reported types of medication errors were prescribing errors, occurring in a median of 57.4% (interquartile range 22.8–72.8%) of all prescriptions and a median of 15.5% (interquartile range 7.5–50.6%) of the prescriptions evaluated had dosing problems. Major contributing factors for medication errors reported in these studies were individual practitioner factors (e.g. fatigue and inadequate knowledge/training) and environmental factors, such as workplace distraction and high workload. Conclusion Medication errors in the African healthcare setting are relatively common, and the impact of adverse drug events is substantial but many are preventable. This review supports the design and implementation of preventative strategies targeting the most likely contributing factors. Electronic supplementary material The online version of this article (10.1007/s40801-017-0125-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alemayehu B Mekonnen
- Faculty of Pharmacy, University of Sydney, S114, Pharmacy Building A15, Sydney, NSW, 2006, Australia.
- School of Pharmacy, University of Gondar, Gondar, Ethiopia.
| | - Tariq M Alhawassi
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, S114, Pharmacy Building A15, Sydney, NSW, 2006, Australia
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, NSW, Australia
| | - Jo-Anne E Brien
- Faculty of Pharmacy, University of Sydney, S114, Pharmacy Building A15, Sydney, NSW, 2006, Australia
- Faculty of Medicine, St Vincent's Hospital Clinical School, University of New South Wales, Sydney, NSW, Australia
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Albolino S, Tartaglia R, Bellandi T, Bianchini E, Fabbro G, Forni S, Cernuschi G, Biggeri A. Variability of adverse events in the public health-care service of the Tuscany region. Intern Emerg Med 2017. [PMID: 28646442 DOI: 10.1007/s11739-017-1698-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objective of the study is to analyze the variation of adverse events (AEs) according to the different structure of hospitals. The study is a multicenter, retrospective study. It involves 4 teaching hospitals (THs) and 32 community hospitals, distributed in 12 local trusts (LTs), of the Tuscany Regional Healthcare Service (RHS). A random sample of the clinical records of patients admitted in LTs and THs in 2008 was selected from the database of the hospital discharge records of the centers. Among 11,293 clinical records included, a total of 354 adverse events were identified. There was a significant higher incidence of AEs in the male and elderly (>65 years) population, and the incidence of AEs was more relevant in the THs (5.3, 95% CI 4.7-6.1) than in the LTs (1.8, 95% CI 1.5-2.2). AEs related to falls were significantly more preventable in THs (OR 19.22, 95% CI 2.45-151.02), while in LTs, AEs related to infections were the most preventable (OR 6.22, 95% CI 1.35-28.67). Concerning the consequence of AE, death is significantly more probable for AEs related to unexpected cardiac arrest in LTs, while disability and prolongation of the stay are significantly more probable consequences associated with re-admission in THs, and to transfer to ICU or HDU in LTs. Re-interventions, surgical complications and falls are the factors more correlated with AEs. In conclusion, the study shows a higher risk of incurring adverse events for the THs compared to the LTs, presumably connected with a major complexity of the clinical cases. Furthermore, the preventability of AEs is higher in the LTs (56.1 vs 42.2%), and this might be associated with lower expertise in managing complications in these settings. Concerning specialties, there are no significant differences in AEs distribution.
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Affiliation(s)
- Sara Albolino
- Centre for Clinical Risk Management and Patient Safety, Tuscany Region, Villa La Quiete alle Montalve, Via Pietro Dazzi, 1, 50141, Florence, Italy.
| | - Riccardo Tartaglia
- Centre for Clinical Risk Management and Patient Safety, Tuscany Region, Villa La Quiete alle Montalve, Via Pietro Dazzi, 1, 50141, Florence, Italy
| | - Tommaso Bellandi
- Centre for Clinical Risk Management and Patient Safety, Tuscany Region, Villa La Quiete alle Montalve, Via Pietro Dazzi, 1, 50141, Florence, Italy
| | | | | | - Silvia Forni
- Regional Agency for Quality in Healthcare, Florence, Italy
| | - Giulia Cernuschi
- Department of Medicine, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy
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A Prospective Assessment of Adverse Events in 3 Digestive Surgery Departments From Central Tunisia. J Patient Saf 2017; 16:299-303. [DOI: 10.1097/pts.0000000000000401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Mallouli M, Tlili MA, Aouicha W, Ben Rejeb M, Zedini C, Salwa A, Mtiraoui A, Ben Dhiab M, Ajmi T. Assessing patient safety culture in Tunisian operating rooms: A multicenter study. Int J Qual Health Care 2017; 29:176-182. [DOI: 10.1093/intqhc/mzw157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 12/24/2016] [Indexed: 12/25/2022] Open
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Mekonnen AB, McLachlan AJ, Brien JAE, Mekonnen D, Abay Z. Medication reconciliation as a medication safety initiative in Ethiopia: a study protocol. BMJ Open 2016; 6:e012322. [PMID: 27884844 PMCID: PMC5168529 DOI: 10.1136/bmjopen-2016-012322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Medication related adverse events are common, particularly during transitions of care, and have a significant impact on patient outcomes and healthcare costs. Medication reconciliation (MedRec) is an important initiative to achieve the Quality Use of Medicines, and has been adopted as a standard practice in many developed countries. However, the impact of this strategy is rarely described in Ethiopia. The aims of this study are to explore patient safety culture, and to develop, implement and evaluate a theory informed MedRec intervention, with the aim of minimising the incidence of medication errors during hospital admission. METHODS AND ANALYSES The study will be conducted in a resource limited setting. There are three phases to this project. The first phase is a mixed methods study of healthcare professionals' perspectives of patient safety culture and patients' experiences of medication related adverse events. In this phase, the Hospital Survey on Patient Safety Culture will be used along with semi-structured indepth interviews to investigate patient safety culture and experiences of medication related adverse events. The second phase will use a semi-structured interview guide, designed according to the 12 domains of the Theoretical Domains Framework, to explore the barriers and facilitators to medication safety activities delivered by hospital pharmacists. The third phase will be a single centre, before and after study, that will evaluate the impact of pharmacist conducted admission MedRec in an emergency department (ED). The main outcome measure is the incidence and potential clinical severity of medication errors. We will then analyse the differences in the incidence and severity of medication errors before and after initiation of an ED pharmacy service.
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Affiliation(s)
- Alemayehu B Mekonnen
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
- School of Pharmacy, University of Gondar, Gondar, Ethiopia
| | - Andrew J McLachlan
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Jo-Anne E Brien
- Faculty of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
| | - Desalew Mekonnen
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zenahebezu Abay
- Department of Internal Medicine, University of Gondar, Gondar, Ethiopia
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Epiu I, Tindimwebwa JVB, Mijumbi C, Ndarugirire F, Twagirumugabe T, Lugazia ER, Dubowitz G, Chokwe TM. Working towards safer surgery in Africa; a survey of utilization of the WHO safe surgical checklist at the main referral hospitals in East Africa. BMC Anesthesiol 2016; 16:60. [PMID: 27515450 PMCID: PMC4982013 DOI: 10.1186/s12871-016-0228-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Mortality from anaesthesia and surgery in many countries in Sub-Saharan Africa remain at levels last seen in high-income countries 70 years ago. With many factors contributing to these poor outcomes, the World Health Organization (WHO) launched the “Safe Surgery Saves Lives” campaign in 2007. This program included the design and implementation of the “Surgical Safety Checklist”, incorporating ten essential objectives for safe surgery. We set out to determine the knowledge of and attitudes towards the use of the WHO checklist for surgical patients in national referral hospitals in East Africa. Methods A cross-sectional survey was conducted at the main referral hospitals in Mulago (Uganda), Kenyatta (Kenya), Muhimbili (Tanzania), Centre Hospitalier Universitaire de Kigali (Rwanda) and Centre Hospitalo-Universitaire de Kamenge (Burundi). Using a pre-set questionnaire, we interviewed anaesthetists on their knowledge and attitudes towards use of the WHO surgical checklist. Results Of the 85 anaesthetists interviewed, only 25 % regularly used the WHO surgical checklist. None of the anaesthetists in Mulago (Uganda) or Centre Hospitalo-Universitaire de Kamenge (Burundi) used the checklist, mainly because it was not available, in contrast with Muhimbili (Tanzania), Kenyatta (Kenya), and Centre Hospitalier Universitaire de Kigali (Rwanda), where 65 %, 19 % and 36 %, respectively, used the checklist. Conclusion Adherence to aspects of care embedded in the checklist is associated with a reduction in postoperative complications. It is therefore necessary to make the surgical checklist available, to train the surgical team on its importance and to identify local anaesthetists to champion its implementation in East Africa. The Ministries of Health in the participating countries need to issue directives for the implementation of the WHO checklist in all hospitals that conduct surgery in order to improve surgical outcomes.
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Affiliation(s)
- Isabella Epiu
- Fogarty Global Health Fellow, University of California Global Health Institute (UCGHI), San Francisco, California, USA. .,Department of Anaesthesia, Makerere University College of Health Sciences, P.O. BOX 7072, Kampala, Uganda.
| | | | | | | | | | | | | | - Thomas M Chokwe
- Department of Anaesthesia, University of Nairobi, Nairobi, Kenya
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Fermo VC, Radünz V, da Rosa LM, Marinho MM. Patient safety culture in a bone marrow transplantation unit. Rev Bras Enferm 2015; 68:1139-46. [PMID: 26676438 DOI: 10.1590/0034-7167.2015680620i] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/16/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE evaluate the patient safety culture in the perspective of health professionals from a bone marrow transplantation unit of an oncology research center, at a reference hospital for cancer treatment in Santa Catarina, Brazil. METHOD a quantitative cross-sectional study that used the Safety Attitudes Questionnaire was conducted between August and September 2013. The study analyzed 33 professional surveys. Statistical data analysis used descriptive and inferential statistics. RESULTS among the dimensions analyzed, only "job satisfaction" reached a mean score above 75, considered positive in terms of patient safety culture. CONCLUSION the dimensions of safety culture present in the survey have to be valued by professionals and managers to allow safe patient care.
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Affiliation(s)
- Vivian Costa Fermo
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Vera Radünz
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Luciana Martins da Rosa
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
| | - Monique Mendes Marinho
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
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Shenvi EC, El-Kareh R. Clinical criteria to screen for inpatient diagnostic errors: a scoping review. ACTA ACUST UNITED AC 2015; 2:3-19. [PMID: 26097801 DOI: 10.1515/dx-2014-0047] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diagnostic errors are common and costly, but difficult to detect. "Trigger" tools have promise to facilitate detection, but have not been applied specifically for inpatient diagnostic error. We performed a scoping review to collate all individual "trigger" criteria that have been developed or validated that may indicate that an inpatient diagnostic error has occurred. We searched three databases and screened 8568 titles and abstracts to ultimately include 33 articles. We also developed a conceptual framework of diagnostic error outcomes using real clinical scenarios, and used it to categorize the extracted criteria. Of the multiple criteria we found related to inpatient diagnostic error and amenable to automated detection, the most common were death, transfer to a higher level of care, arrest or "code", and prolonged length of hospital stay. Several others, such as abrupt stoppage of multiple medications or change in procedure, may also be useful. Validation for general adverse event detection was done in 15 studies, but only one performed validation for diagnostic error specifically. Automated detection was used in only two studies. These criteria may be useful for developing diagnostic error detection tools.
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Affiliation(s)
- Edna C Shenvi
- Division of Biomedical Informatics, University of California, San Diego, 9500 Gilman Dr. MC 0728, La Jolla, CA 92093-0728, USA
| | - Robert El-Kareh
- Divisions of Biomedical Informatics and Hospital Medicine, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Hwang JI, Chin HJ, Chang YS. Characteristics associated with the occurrence of adverse events: a retrospective medical record review using the Global Trigger Tool in a fully digitalized tertiary teaching hospital in Korea. J Eval Clin Pract 2014; 20:27-35. [PMID: 23890097 DOI: 10.1111/jep.12075] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to examine the performance of the Global Trigger Tool and to investigate characteristics associated with the occurrence of adverse events (AEs). STUDY DESIGN Retrospective medical record review. SETTING A tertiary teaching hospital, Korea. METHOD We employed two-stage review of a random sample of 630 charts for patients discharged between January and June 2011. Two quality improvement specialists reviewed the presence of AEs using 53 triggers developed by the Institute for Healthcare Improvement. Two physicians reviewed and validated the findings of adverse events. Positive predictive values for individual triggers were calculated. Logistic regression analysis was performed to determine factors associated with AEs. RESULTS Of 629 patients, 45 (7%) experienced at least one AE during their hospitalization. Among the observed AEs, 61% were preventable. The frequent types of AEs were 'procedure-related' and 'medication-related'. Six triggers had positive predictive values of greater than 50.0%: 'health care-associated infection', 'any procedure complication', 'medication: other', 'return to surgery', 'occurrence of any operative complication' and 'intubation/reintubation'. Significant factors associated with the occurrence of AEs were length of stay (OR 1.13; 95% CI 1.07 to 1.20) and the number of triggers (OR 1.49; 95% CI 1.11 to 1.98). CONCLUSION The Global Trigger Tool was useful for the detection of adverse events in a Korean hospital setting. Triggers with high positive predictive values should have priority for incorporation into routine screening systems. Furthermore, patients who stay longer in the hospital need to be closely monitored using triggers to improve patient safety.
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Affiliation(s)
- Jee-In Hwang
- Department of Nursing, Kyung Hee University, Seoul, South Korea
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Bouafia N, Bougmiza I, Bahri F, Letaief M, Astagneau P, Njah M. [Magnitude and impact of serious adverse events related to treatment: study of incidence in a hospital in East Central Tunisia]. Pan Afr Med J 2013; 16:68. [PMID: 24711868 PMCID: PMC3976656 DOI: 10.11604/pamj.2013.16.68.1161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 08/07/2012] [Indexed: 11/21/2022] Open
Abstract
Introduction La prévention des événements indésirables représente une priorité de santé du fait de leur fréquence et de leur gravité potentielle. Ce travail a été mené afin d'avoir un diagnostic de la situation épidémiologique relative aux événements indésirables survenant dans notre hôpital. Méthodes Une étude prospective a été menée auprès de tous les patients qui ont été hospitalisés au CHU Farhat Hached - Sousse (Tunisie) sur une période d'un mois dans quatorze services de l'hôpital. La détection d'évènement indésirable grave (EIG) était basée sur les critères adoptés dans différentes études. Les tests T et Chi 2 ont été utilisés pour identifier les facteurs contribuant à l'apparition d'évènements indésirables. Résultats Au total, 162 EIG ont été identifiés pendant la période. 45% de ces évènements étaient des infections nosocomiales. Ces EIG ont eu comme conséquences un décès chez 9,2% des patients, la mise en jeu du pronostic vital de 26% des patients et la prolongation de la durée de séjour chez 61,7% d'entre eux. L'admission dans des circonstances particulières et l'exposition à des soins invasifs étaient identifiés comme des facteurs de risque potentiels EIG. Conclusion Le renforcement de la stratégie de gestion des risques sanitaires en ciblant préférentiellement le risque infectieux constitue une étape fondamentale dans l'amélioration de la sécurité des patients au sein de notre établissement de santé.
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Affiliation(s)
| | - Iheb Bougmiza
- Département de médecine préventive et communautaire, Faculté de médecine de Sousse, Tunisie
| | | | - Mondher Letaief
- Service d'épidémiologie, CHU Fattouma Bourguiba de Monastir, Tunisie
| | - Pascal Astagneau
- Centre de coordination et de lutte contre les infections nosocomiales (CCLIN) Paris Nord, France
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Características de eventos adversos evitáveis em hospitais do Rio de Janeiro. Rev Assoc Med Bras (1992) 2013; 59:421-8. [DOI: 10.1016/j.ramb.2013.03.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 02/26/2013] [Accepted: 03/23/2013] [Indexed: 11/19/2022] Open
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Anderson O, Davis R, Hanna GB, Vincent CA. Surgical adverse events: a systematic review. Am J Surg 2013; 206:253-62. [PMID: 23642651 DOI: 10.1016/j.amjsurg.2012.11.009] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 10/25/2012] [Accepted: 11/05/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this systematic review is to quantify potentially preventable patient harm from the frequency, severity, and preventability of the consequences and causes of surgical adverse events to help target patient safety improvement efforts. DATA SOURCES Two authors independently reviewed articles retrieved from systematic searches of the Cochrane library, MEDLINE, Embase, PsycINFO, and Cumulative Index to Nursing & Allied Health Literature databases for inclusion and exclusion criteria, methodology, and end points. All retrospective record review studies of adverse events were included. The primary end point was the frequency of general surgery adverse events. The secondary end points were the severity and preventability of consequences and causes. CONCLUSIONS Fourteen record review studies incorporating 16,424 surgical patients were included. Adverse events occurred in 14.4% of patients (interquartile range [IQR], 12.5% to 20.1%), and potentially preventable adverse events occurred in 5.2% (IQR, 4.2% to 7.0%). The consequences of 3.6% of adverse events (IQR, 3.1% to 4.4%) were fatal, those of 10.4% (IQR, 8.5% to 12.3%) were severe, those of 34.2% (IQR, 29.2% to 39.2%) were moderate, and those of 52.5% (IQR, 49.8% to 55.3%) were minor. Errors in nonoperative management caused more frequent adverse events than errors in surgical technique.
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Affiliation(s)
- Oliver Anderson
- Clinical Safety Research Unit, Centre for Patient Safety and Service Quality, Imperial College London, London, UK.
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