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Jeong S, Jeong SH. [Patient Safety Management Activities of Korean Nurses: A Meta-Analytic Path Analysis]. J Korean Acad Nurs 2022; 52:363-377. [PMID: 36117299 DOI: 10.4040/jkan.22022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/17/2022] [Accepted: 08/11/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to test a hypothetical model of Korean nurses' patient safety management activities using meta-analytic path analysis. METHODS A systematic review, meta-analysis, and meta-analytic path analysis were conducted following the PRISMA and MOOSE guidelines. Seventy-four studies for the meta-analysis and 92 for the meta-analytic path analysis were included. The R software program (Version 3.6.3) was used for data analysis. RESULTS Four variables out of 49 relevant variables were selected in the meta-analysis. These four variables showed large effect sizes (ESr = .54) or median effect sizes (ESr = .33~.40) with the highest k (number of studies) in the individual, job, and organizational categories. The hypothetical model for the meta-analytic path analysis was established using these variables and patient safety management activities. Twelve hypothetical paths were set and tested. Finally, the perception of the importance of patient safety management and patient safety competency directly affected patient safety management activities. In addition, self-efficacy, the perception of the importance of patient safety management, patient safety competency, and patient safety culture, indirectly affected patient safety management activities. CONCLUSION Self-efficacy, the perception of the importance of patient safety management, patient safety competency, and the organization's patient safety culture should be enhanced to improve nurses' patient safety management activities.
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Affiliation(s)
- Seohee Jeong
- Quality Improvement Team, Jeonbuk National University Hospital, Jeonju, Korea
| | - Seok Hee Jeong
- College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Korea.
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Mossburg SE, Dennison Himmelfarb C. The Association Between Professional Burnout and Engagement With Patient Safety Culture and Outcomes: A Systematic Review. J Patient Saf 2021; 17:e1307-e1319. [PMID: 29944601 DOI: 10.1097/pts.0000000000000519] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In the last 20 years, there have been numerous successful efforts to improve patient safety, although recent research still shows a significant gap. Researchers have begun exploring the impact of individual level factors on patient safety culture and safety outcomes. This review examines the state of the science exploring the impact of professional burnout and engagement on patient safety culture and safety outcomes. METHODS A systematic search was conducted in CINAHL, PubMed, and Embase. Studies included reported on the relationships among burnout or engagement and safety culture or safety outcomes. RESULTS Twenty-two studies met inclusion criteria. Ten studies showed a relationship between both safety culture and clinical errors with burnout. Two of 3 studies reported an association between burnout and patient outcomes. Fewer studies focused on engagement. Most studies exploring engagement and safety culture found a moderately strong positive association. The limited evidence on the relationship between engagement and errors depicts inconsistent findings. Only one study explored engagement and patient outcomes, which failed to find a relationship. CONCLUSIONS The burnout/safety literature should be expanded to a multidisciplinary focus. Mixed results of the relationship between burnout and errors could be due to a disparate relationship with perceived versus observed errors. The engagement/safety literature is immature, although high engagement seems to be associated with high safety culture. Extending this science into safety outcomes would be meaningful, especially in light of the recent focus on an abundance-based approach to safety.
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Affiliation(s)
- Sarah E Mossburg
- From the Johns Hopkins University School of Nursing, Baltimore, Maryland
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Let's be civil: Elaborating the link between civility climate and hospital performance. Health Care Manage Rev 2020; 44:196-205. [PMID: 28837502 DOI: 10.1097/hmr.0000000000000178] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The importance of interpersonal behavior at the workplace is increasingly recognized in the health care industry and related literature. An unresolved issue in the existing health care research is how a climate of courteous interpersonal behavior may form the foundation for strong hospital care performance. PURPOSE The aim of this study was to test the link between a climate of courteous interpersonal behavior, termed "civility climate," and hospital care performance. We conceptualize a multidimensional model of care performance by contrasting two dimensions: performance as perceived by employees and performance as perceived by patients. Furthermore, for both performance perspectives, we test an intermediate variable (error orientation climate) that may explain the relationship between civility climate and hospital care performance. METHODOLOGY The 2011 study sample comprised responses from 6,094 nurses and 38,627 patients at 123 Veterans Health Administration acute care inpatient hospitals in the United States. We developed and empirically tested a theoretical model using regression modeling, and we used a bootstrap method to test for mediation. RESULTS The results indicate a direct effect of civility climate on employee perceptions of care performance and an indirect effect mediated by error orientation climate. With regard to patient perceptions of care performance, the analyses reveal a direct effect of civility climate. The indirect effect mediated by error orientation climate was not supported. PRACTICE IMPLICATIONS Our findings point to the importance of strengthening interpersonal interactions for ensuring and improving both employees' and patients' perceptions of care, which constitute key success factors in the increasingly competitive hospital market. The insights may further stimulate discussion regarding interventions to foster a strong civility climate in hospitals.
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Kim SH, Weng SJ. Incorporating work experience of medical staff into patient safety climate management: a multi-group analysis. BMC Health Serv Res 2018; 18:919. [PMID: 30509281 PMCID: PMC6276268 DOI: 10.1186/s12913-018-3747-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background This study aims to provide insights on how to incorporate the work experience of medical staff into safety climate management based on the relationships among several safety-related constructs such as teamwork climate, working condition, and job satisfaction. Methods A cross-sectional study was conducted in a regional hospital in Taichung City, Taiwan using a Safety Attitude Questionnaire (SAQ)-based questionnaire. The relationships among the constructs were modeled by a structural equation model, and a multi-group analysis was performed. Among the employees participating in the survey, only physicians and nurses were considered in the analysis, accounting for 1596 out of 2277 responses. The key measures were the difference between the unconstrained and fully constrained structural models, the statistically different coefficients, and their strengths across the high and low-experience groups. Results Our multi-group analysis showed that the effects of management leadership on job satisfaction and of teamwork climate on safety climate were statistically stronger for low-experience medical staff, whereas the effect of working conditions on safety climate was statistically stronger for high-experience medical staff. Conclusions The findings demonstrate how to incorporate the work experience of medical staff into safety climate management. In summary, by focusing on different safety constructs for the less and more experienced staff—job satisfaction and teamwork climate for the less experienced, working conditions for the more experienced—management may be able to improve the organizational safety climate. Our suggestions in this study can be leveraged, should management implement the initiatives and action plans for safety climate improvement.
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Affiliation(s)
- Seung-Hwan Kim
- Department of Business Administration, Ajou University, Suwon, 443-749, South Korea
| | - Shao-Jen Weng
- Executive Master Program for Health Administration, Tunghai University, Taichung City, Taiwan, 40704. .,Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung City, Taiwan, 40704.
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Soh SE, Morello R, Rifat S, Brand C, Barker A. Nurse perceptions of safety climate in Australian acute hospitals: a cross-sectional survey. AUST HEALTH REV 2018; 42:203-209. [DOI: 10.1071/ah16172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/15/2017] [Indexed: 11/23/2022]
Abstract
Objectives
The aim of the present study was to explore nurse perceptions of safety climate in acute Australian hospitals.
Methods
Participants included 420 nurses who have worked on 24 acute wards from six Australian hospitals. The Safety Attitudes Questionnaire (SAQ) Short Form was used to quantify nurse perceptions of safety climate and benchmarked against international data. Generalised linear mixed models were used to explore factors that may influence safety climate.
Results
On average, 53.5% of nurses held positive attitudes towards job satisfaction followed by teamwork climate (50.5%). There was variability in SAQ domain scores across hospitals. The safety climate and perceptions of hospital management domains also varied across wards within a hospital. Nurses who had worked longer at a hospital were more likely to have poorer perceptions of hospital management (β = –5.2; P = 0.014). Overall, nurse perceptions of safety climate appeared higher than international data.
Conclusions
The perceptions of nurses working in acute Victorian and New South Wales hospitals varied between hospitals as well as across wards within each hospital. This highlights the importance of surveying all hospital wards and examining the results at the ward level when implementing strategies to improve patient safety and the culture of safety in organisations.
What is known about the topic?
Prior studies in American nursing samples have shown that hospitals with higher levels of safety climate have a lower relative incidence of preventable patient complications and adverse events. Developing a culture of safety in hospitals may be useful in targeting efforts to improve patient safety.
What does this paper add?
This paper has shown that the perceptions of safety climate among nurses working in acute Australian hospitals varied between hospitals and across wards within a hospital. Only half the nurses also reported positive attitudes towards job satisfaction and teamwork climate.
What are the implications for practitioners?
Programs or strategies that aim to enhance teamwork performance and skills may be beneficial to improving the culture of safety in hospitals. Wards may also have their own safety ‘subculture’ that is distinct from the overall hospital safety culture. This highlights the importance of tailoring and targeting quality improvement initiatives at the ward level.
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Lee SE, Scott LD, Dahinten VS, Vincent C, Lopez KD, Park CG. Safety Culture, Patient Safety, and Quality of Care Outcomes: A Literature Review. West J Nurs Res 2017; 41:279-304. [DOI: 10.1177/0193945917747416] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This integrative literature review was conducted to examine the relationships between safety culture and patient safety and quality of care outcomes in hospital settings and to identify directions for future research. Using a search of six electronic databases, 17 studies that met the study criteria were selected for review. This review revealed semantic inconsistencies, infrequent use of a theory or theoretical framework, limited discussions of validity of instruments used, and significant methodological variations. Most notably, this review identified a large array of nonsignificant and inconsistent relationships between safety culture and patient safety and quality of care outcomes. To improve understanding of the relationships, investigators should consider using a theoretical framework and valid measures of the key concepts. Researchers should also give more attention to selecting appropriate sampling and data collection methods, units of analysis, levels of data measurement and aggregation, and statistical analyses.
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Abstract
OBJECTIVE To provide ICU clinicians with evidence-based guidance on safe medication use practices for the critically ill. DATA SOURCES PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and ISI Web of Science for relevant material to December 2015. STUDY SELECTION Based on three key components: 1) environment and patients, 2) the medication use process, and 3) the patient safety surveillance system. The committee collectively developed Population, Intervention, Comparator, Outcome questions and quality of evidence statements pertaining to medication errors and adverse drug events addressing the key components. A total of 34 Population, Intervention, Comparator, Outcome questions, five quality of evidence statements, and one commentary on disclosure was developed. DATA EXTRACTION Subcommittee members were assigned selected Population, Intervention, Comparator, Outcome questions or quality of evidence statements. Subcommittee members completed their Grading of Recommendations Assessment, Development, and Evaluation of the question with his/her quality of evidence assessment and proposed strength of recommendation, then the draft was reviewed by the relevant subcommittee. The subcommittee collectively reviewed the evidence profiles for each question they developed. After the draft was discussed and approved by the entire committee, then the document was circulated among all members for voting on the quality of evidence and strength of recommendation. DATA SYNTHESIS The committee followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation system to determine quality of evidence and strength of recommendations. CONCLUSIONS This guideline evaluates the ICU environment as a risk for medication-related events and the environmental changes that are possible to improve safe medication use. Prevention strategies for medication-related events are reviewed by medication use process node (prescribing, distribution, administration, monitoring). Detailed considerations to an active surveillance system that includes reporting, identification, and evaluation are discussed. Also, highlighted is the need for future research for safe medication practices that is specific to critically ill patients.
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Patrician PA, Loan LA, McCarthy MS, Swiger P, Breckenridge-Sproat S, Brosch LR, Jennings BM. Twenty years of staffing, practice environment, and outcomes research in military nursing. Nurs Outlook 2017; 65:S120-S129. [DOI: 10.1016/j.outlook.2017.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 12/12/2022]
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Ching D, Anastasiadis E, Patel P, Sahu M, Sandhu S. A culture of open reporting results in improved quality of bladder tumour resections: a closed loop audit. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816642695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Bladder cancer is the commonest cancer of the urinary tract. Transurethral Resection of Bladder Tumour (TURBT) is the gold standard for diagnosis and treatment of non-muscle invasive bladder cancer. The absence of muscle in a TURBT specimen is associated with a significantly higher risk of residual disease, early recurrence and tumour under staging. Materials and methods: TURBT and bladder biopsy specimens were examined before and after the introduction of an open reporting system as a quality improvement exercise. All specimens from the 4th quarter (between 2010 and 2014) were examined to determine the effect of open reporting on our inadequate resection rates. Results: A total of 244 cases were performed under the care of 5 consultant urologists. Analysis revealed a significant improvement in quality of both T1 and Ta resections (p=0.04*; p=0.02*) after the introduction of open reporting. The total number of TURBT cases increased per year, however the percentage of inadequate resections has significantly decreased (p=0.02*). Conclusion: Individual reporting provided surgeons with direct, personal and timely feedback on their performance. It did not negatively impact on trainee participation, but led to improved training outcomes. We have demonstrated that our simple intervention has improved quality of patient care.
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Affiliation(s)
- Daniel Ching
- Department of Urology, Kingston Hospital NHS Foundation Trust, UK
| | | | - Pareeta Patel
- Department of Urology, Kingston Hospital NHS Foundation Trust, UK
| | - Mahua Sahu
- Department of Urology, Kingston Hospital NHS Foundation Trust, UK
| | - Sarb Sandhu
- Department of Urology, Kingston Hospital NHS Foundation Trust, UK
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Abstract
CONTEXT In the past 13 years since the Institute of Medicine report, To Err is Human, was published, considerable attention was placed on the relationship between patient safety culture and patient outcomes. Research to understand this relationship has been conducted; however, now, it is important to systematically review these studies to determine if there are tools, levels of measure and outcomes that have been shown to result in significant correlations. OBJECTIVE The purpose of this review is to evaluate the state of research connecting patient safety culture and patient outcomes to determine nurse-sensitive patient outcomes that have been significantly correlated to culture of safety and commonly used tools to measure culture of safety in the studies with significant correlations. DATA SOURCES Published English only research articles were considered for the review. Only studies that directly measured patient outcomes in relationship to patient safety culture in hospitals involving registered nurses as a participant were included. RESULTS Evidence of relationships between patient safety culture and patient outcomes exist at the hospital and nursing unit level of analysis; however, the number of studies finding statistically significant correlations particularly using nurse-sensitive outcomes is limited. CONCLUSIONS The findings from this review suggest that there are emerging trends indicating that the specific patient safety culture measurement tools, the level of analysis, and selection of outcome measures are important considerations in study design. More research is needed to determine interventions that improve patient safety culture and outcomes.
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Hung CC, Lee BO, Liang HF, Chu TP. Factors influencing nurses' attitudes and intentions toward medication administration error reporting. Jpn J Nurs Sci 2016; 13:345-54. [PMID: 26782627 DOI: 10.1111/jjns.12113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/09/2015] [Indexed: 12/01/2022]
Abstract
AIM The aims of this study were to explore the factors that influence nurses' attitudes and intentions toward medication administration error (MAE) reporting. METHODS The theory of planned behavior was used as the framework for this study. A cross-sectional design was used, and data were obtained from self-administered questionnaires. A total of 596 staff nurses who worked in a regional hospital for at least 3 months were invited to participate in this study. The researchers used exploratory factor analysis and confirmatory factor analysis to test the psychometric properties of each measurement scale. The 1 week data collection period was between September and November 2013. Descriptive statistics were used to examine the demographic and job characteristics of the participants and multiple linear regression was used to test the hypotheses. RESULTS Of the 596 nurses invited to participate, 548 (92%) completed and returned a valid questionnaire. The findings indicated that altruism, and nurse managers' and co-workers' attitudes are predictors for nurses' attitudes toward MAE reporting, and nurses' attitudes and co-workers' attitudes affect nurses' intention to report MAE. No connection was found between report control and nurses' intentions toward MAE reporting. CONCLUSION The findings reflected that altruism, and nurse managers' and co-workers' attitude, and nurses' attitudes toward MAE reporting are predictors of nurses' intentions toward MAE reporting. The authors strongly recommended the healthcare system to institute an open communication and learning culture.
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Affiliation(s)
- Chang-Chiao Hung
- Chang Gung University of Science and Technology at ChiaYi Campus, Nursing Department, Chronic Diseases and Health Promotion Research Center, Puzi City, Taiwan
| | - Bih-O Lee
- Chang Gung University of Science and Technology at ChiaYi Campus, Nursing Department, Chronic Diseases and Health Promotion Research Center, Puzi City, Taiwan
| | - Hwey-Fang Liang
- Chang Gung University of Science and Technology at ChiaYi Campus, Nursing Department, Chronic Diseases and Health Promotion Research Center, Puzi City, Taiwan
| | - Tsui-Ping Chu
- ChiaYi Chang Gung Memorial Hospital, Department of Nursing, Puzi City, Taiwan
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Hung CC, Chu TP, Lee BO, Hsiao CC. Nurses’ attitude and intention of medication administration error reporting. J Clin Nurs 2015; 25:445-53. [DOI: 10.1111/jocn.13071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Chang-Chiao Hung
- Nursing Department; Chronic Diseases and Health Promotion Research Center; ChiaYi Campus; Chang Gung University of Science and Technology; Chiayi Taiwan
| | - Tsui-Ping Chu
- Department of Nursing; ChiaYi Chang Gung Memorial Hospital; Chiayi Taiwan
| | - Bih-O Lee
- Nursing Department; Chronic Diseases and Health Promotion Research Center; ChiaYi Campus; Chang Gung University of Science and Technology; Chiayi Taiwan
| | - Chia-Chi Hsiao
- Department of Nursing; ChiaYi Chang Gung Memorial Hospital; Chiayi Taiwan
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Everhart D, Schumacher JR, Duncan RP, Hall AG, Neff DF, Shorr RI. Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics. Health Care Manage Rev 2014; 39:352-60. [PMID: 24566249 PMCID: PMC4277236 DOI: 10.1097/hmr.0000000000000013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. PURPOSE The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. METHODOLOGY/APPROACH We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. FINDINGS A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group. PRACTICE IMPLICATIONS Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able to reduce fall rates by maintaining greater nurse staffing ratios as well as fostering an environment consistent with that of Magnet hospitals.
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Affiliation(s)
- Damian Everhart
- Damian Everhart, PhD, RN, is Assistant Professor, Brooks College of Health, University of North Florida, Jacksonville. E-mail: . Jessica R. Schumacher, PhD, MS, is Associate Director of Analytics, Department of Population Health Sciences, University of Wisconsin-Madison. R. Paul Duncan, PhD, MS, is Malcom and Christine Randall Professor and Chair, Department of Health Services Research, Management and Policy, University of Florida, Gainesville. Allyson G. Hall, PhD, MBA, MHS, is Associate Professor, Department of Health Services Research, Management and Policy, University of Florida, Gainesville. Donna F. Neff, PhD, RN, DSNAP, is Associate Professor, College of Nursing, University of Central Florida, Orlando. Ronald I. Shorr, MD, MS, is Professor, Department of Epidemiology, University of Florida, Gainesville
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Medication errors in the intensive care unit: literature review using the SEIPS model. AACN Adv Crit Care 2014; 24:389-404. [PMID: 24153217 DOI: 10.1097/nci.0b013e3182a8b516] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.
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Hickey JV, Unruh LY, Newhouse RP, Koithan M, Johantgen M, Hughes RG, Haller KB, Lundmark VA. Credentialing: The need for a national research agenda. Nurs Outlook 2014; 62:119-27. [DOI: 10.1016/j.outlook.2013.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 10/09/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
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Hung CC, Lee BO, Tsai SL, Tseng YS, Chang CH. Structure determines medication errors in nursing units: a mechanistic approach. West J Nurs Res 2013; 37:299-319. [PMID: 24326310 DOI: 10.1177/0193945913513849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medication errors have long been considered critical in global health care systems. However, few studies have been conducted to explore the effects of nursing unit structure on medication errors. The purpose of this study, therefore, was to determine the effects of structural factors on medication errors in nursing units. A total of 977 staff nurses and 62 head nurses participated in this cross-sectional design study. The findings show that professional autonomy (β = .53, t = 6.03, p < .01), technology (β = .25, t = 3.02, p < .01), and nursing experts (β = .52, t = 5.99, p < .01) are predictors of medication error rates. This study shows that the structural factors influence medication administration and the mechanistic approach is specifically in relation of low medication error rates. The author suggests that head nurses should consider strategies that require adjustments to unit control mechanisms.
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Affiliation(s)
- Chang-Chiao Hung
- Chang Gung University of Science and Technology, ChiaYi Campus, Taiwan, Republic of China
| | - Bih-O Lee
- Chang Gung University of Science and Technology, ChiaYi Campus, Taiwan, Republic of China
| | - Shu-Ling Tsai
- Chang Gung University of Science and Technology, ChiaYi Campus, Taiwan, Republic of China
| | - Yun Shan Tseng
- I-Shou University, Yanchao Campus, Taiwan, Republic of China
| | - Chia-Hao Chang
- Chang Gung University of Science and Technology, ChiaYi Campus, Taiwan, Republic of China
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Abstract
Medication errors in intensive care units put patients at risk for injury or death every day. Safety requires an organized and systematic approach to improving the tasks, technology, environment, and organizational culture associated with medication systems. The Systems Engineering Initiative for Patient Safety model can help leaders and health care providers understand the complicated and high-risk work associated with critical care. Using this model, the author combines a human factors approach with the well-known structure-process-outcome model of quality improvement to examine research literature. The literature review reveals that human factors, including stress, high workloads, knowledge deficits, and performance deficits, are associated with medication errors. Factors contributing to medication errors are frequent interruptions, communication problems, and poor fit of health information technology to the workflow of providers. Multifaceted medication safety interventions are needed so that human factors and system problems can be addressed simultaneously.
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Affiliation(s)
- Karen H. Frith
- Karen H. Frith is Professor, College of Nursing, University of Alabama in Huntsville, 301 Sparkman Dr, Huntsville, AL 35899
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Abrahamson K, Ramanujam R, Anderson JG. Co-worker characteristics and nurses' safety-climate perceptions. Int J Health Care Qual Assur 2013; 26:447-54. [PMID: 23905304 DOI: 10.1108/ijhcqa-07-2011-0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Previous research indicates that nurses' safety-climate perceptions are influenced by individual nurse characteristics, leadership, staffing levels and workplace structure. No literature was identified that explored the relationship between nurses' safety climate perceptions and staffing composition in a particular hospital unit. This paper aims to fill some of the gaps in the research in this area. DESIGN/METHODOLOGY/APPROACH Data supplied by 430 registered nurses working in two Midwestern US hospitals were analyzed to co-worker characteristics such as education, licensure, experience and full- or part-time status. FINDINGS Registered nurses working in hospitals with proportionally more-experienced nurses perceived their workplaces to be significantly safer for patients. Surprisingly, co-worker licensure, education and full- or part-time status did not significantly influence nurses' safety climate perceptions. PRACTICAL IMPLICATIONS Findings indicate that safety-climate perceptions vary significantly between hospital units and experienced nurses may act as a resource that promotes a positive safety climate. Hospitals retaining experienced nurses may potentially reduce errors. ORIGINALITY/VALUE The paper illustrates that the results highlight the importance of providing nurses with an environment that encourages retention and creates a workplace where experienced nurses' skills are best utilized.
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Affiliation(s)
- Kathleen Abrahamson
- Department of Public Health, Western Kentucky University, Bowling Green, Kentucky, USA.
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Abstract
Patient safety continues to be a serious health concern in acute-care hospitals. Safety culture has been a frequent target for patient safety improvement over the past decade, based on recommendations from the Institute of Medicine and its use in industry. However, the relationship between safety culture and patient safety in acute-care hospitals has yet to be systematically examined. Thus, a meta-analysis was devised to examine the relationship between patient safety outcomes and safety culture in that setting. Due to the limited empirical research reports available, five small pilot meta-analyses were conducted, examining the relationship between safety culture and each of the following: pressure ulcers, falls, medication errors, nurse-sensitive outcomes, and post-operative outcomes. No significant relationships of any size were identified. An assessment of the relevant literature is presented, offering potential explanations for this surprising finding and an agenda for future research.
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Gates MG, Mark BA. Demographic diversity, value congruence, and workplace outcomes in acute care. Res Nurs Health 2012; 35:265-76. [PMID: 22377771 DOI: 10.1002/nur.21467] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2012] [Indexed: 11/10/2022]
Abstract
Nursing scholars and healthcare administrators often assume that a more diverse nursing workforce will lead to better patient and nurse outcomes, but this assumption has not been subject to rigorous empirical testing. In a study of nursing units in acute care hospitals, the influence of age, gender, education, race/ethnicity, and perceived value diversity on nurse job satisfaction, nurse intent to stay, and patient satisfaction were examined. Support was found for a negative relationship between perceived value diversity and all outcomes and for a negative relationship between education diversity and intent to stay. Additionally, positive relationships were found between race/ethnicity diversity and nurse job satisfaction as well as between age diversity and intent to stay. From a practice perspective, the findings suggest that implementing retention, recruitment, and management practices that foster a strong shared value system among nurses may lead to better workplace outcomes.
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Affiliation(s)
- Michael G Gates
- School of Nursing, San Diego State University, 5500 Campanile Drive, San Diego, CA 92812-4158, USA
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Abstract
OBJECTIVES There has been very limited research linking staff perceptions of hospital patient safety culture with rates of adverse clinical events. This exploratory study examined relationships between the Agency for Healthcare Research and Quality's (AHRQ) Hospital Survey of Patient Safety Culture and rates of in-hospital complications and adverse events as measured by the AHRQ Patient Safety Indicators (PSIs). The general hypothesis was that hospitals with a more positive patient safety culture would have lower PSI rates. METHODS We performed multiple regressions to examine the relationships between 15 patient safety culture variables and a composite measure of adverse clinical events based on 8 risk-adjusted PSIs from 179 hospitals, controlling for hospital bed size and ownership. All patient safety culture data were collected in 2005 and 2006 (except 1 late 2004 hospital), and all PSI data were collected in 2005. RESULTS Nearly all of the relationships tested were in the expected direction (negative), and 7 (47%) of the 15 relationships were statistically significant. All significant relationships were of moderate size, with standardized regression coefficients ranging from -0.15 to -0.41, indicating that hospitals with a more positive patient safety culture scores had lower rates of in-hospital complications or adverse events as measured by PSIs. CONCLUSIONS Our findings support the idea that a more positive patient safety culture is associated with fewer adverse events in hospitals. Further research is needed to determine the generalizability of these results to larger sets of hospitals and to examine the causal relationship between patient safety culture and clinical patient outcomes.
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Breckenridge-Sproat S, Johantgen M, Patrician P. Influence of unit-level staffing on medication errors and falls in military hospitals. West J Nurs Res 2011; 34:455-74. [PMID: 21540354 DOI: 10.1177/0193945911407090] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined unit-level associations of nurse staffing and workload, and the effect of the practice environment on adverse patient events. A secondary analysis was conducted of a longitudinal data set of 23 Army inpatient units from the Military Nursing Outcomes Database. Generalized Linear Mixed Modeling accommodated nested, nonparametric data. Staff category was found to be a significant predictor of medication errors and patient falls, but the relationship varied by unit type. Patient census had no effect on either outcome; however, a higher patient acuity was associated with an increase in both adverse events. The nursing practice environment mediated medication errors but not falls, in all unit types. Skill mix is important; however, additional components of staffing need consideration in producing positive patient outcomes.
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Abstract
OBJECTIVE Voluntary safety event reporting often produces poorly defined data points, which complicate data analyses across health care settings. Such data should be restructured into a standard patient safety language translatable within and outside health care organizations. We designed and implemented a "best-of-breed" patient safety classification for data created by the Duke University Health System Safety Reporting System. METHODS We report our approach for patient fall classification. Our strategy was to deploy the International Classification for Patient Safety Framework of the World Health Organization augmented with additional data points of interest, thereby allowing for data translatability while maintaining local practices. System interface redesign using the "best-of-breed" fall classification was mindful of workflows and known reporting barriers. Custom aggregate reports were also developed. RESULTS We estimated the impact of the redesigned portal on Safety Reporting System usage before and after classification through comparisons of fall report volume and report completion time. When normalized as falls per day, the rate of falls only changed slightly, indicating that the enhancement had little effect on reporting desire. Report completion time increased modestly but not significantly from a practical standpoint. The presence of structured data eliminated substantial hours dedicated to manual data management and enabled evaluation of quality improvement interventions within and outside our organization. CONCLUSIONS Creation and implementation of a "best-of-breed" patient safety classification for voluntary reporting requires multidisciplinary collaboration between clinical experts, frontline clinicians, and functional and technical analysts. Formal usability evaluations of reporting systems are needed to ensure design facilitates effective data collection.
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Abstract
Patient outcomes are linked to nurse staffing. Although charge nurses are responsible for intrashift staffing decisions, little is known about their decision-making behaviors. This study describes the behaviors of charge nurses from the perspective of charge nurses, nurse managers, and staff nurses. This qualitative descriptive study was conducted with a sample of 24 nurses. The findings revealed that staffing the unit was the most important role for charge nurses. Charge nurses reported spending up to 90% of a shift resolving intrashift staffing issues. Five effective decision-making behaviors emerged: (a) resourcefulness, (b) tactful communication, (c) flexibility, (d) decisiveness, and (e) awareness of the big picture. These behaviors of charge nurses are similar to mindful behaviors of workers in hazardous work environments, and are therefore described as mindful staffing. Practice implications and considerations for the education of charge nurses in relation to safe intrashift staffing are suggested by the findings of this study.
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Lake ET, Shang J, Klaus S, Dunton NE. Patient falls: Association with hospital Magnet status and nursing unit staffing. Res Nurs Health 2010; 33:413-25. [PMID: 20824686 DOI: 10.1002/nur.20399] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The relationships between hospital Magnet® status, nursing unit staffing, and patient falls were examined in a cross-sectional study using 2004 National Database of Nursing Quality Indicators (NDNQI®) data from 5,388 units in 108 Magnet and 528 non-Magnet hospitals. In multivariate models, the fall rate was 5% lower in Magnet than non-Magnet hospitals. An additional registered nurse (RN) hour per patient day was associated with a 3% lower fall rate in ICUs. An additional licensed practical nurse (LPN) or nursing assistant (NA) hour was associated with a 2-4% higher fall rate in non-ICUs. Patient safety may be improved by creating environments consistent with Magnet hospital standards.
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Affiliation(s)
- Eileen T Lake
- Center for Health Outcomes & Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Lopez KD, Gerling GJ, Cary MP, Kanak MF. Cognitive work analysis to evaluate the problem of patient falls in an inpatient setting. J Am Med Inform Assoc 2010; 17:313-21. [PMID: 20442150 DOI: 10.1136/jamia.2009.000422] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To identify factors in the nursing work domain that contribute to the problem of inpatient falls, aside from patient risk, using cognitive work analysis. DESIGN A mix of qualitative and quantitative methods were used to identify work constraints imposed on nurses, which may underlie patient falls. MEASUREMENTS Data collection was done on a neurology unit staffed by 27 registered nurses and utilized field observations, focus groups, time-motion studies and written surveys (AHRQ Hospital Survey on Patient Culture, NASA-TLX, and custom Nursing Knowledge of Fall Prevention Subscale). RESULTS Four major constraints were identified that inhibit nurses' ability to prevent patient falls. All constraints relate to work processes and the physical work environment, opposed to safety culture or nursing knowledge, as currently emphasized. The constraints were: cognitive 'head data', temporal workload, inconsistencies in written and verbal transfer of patient data, and limitations in the physical environment. To deal with these constraints, the nurses tend to employ four workarounds: written and mental chunking schemas, bed alarms, informal querying of the previous care nurse, and informal video and audio surveillance. These workarounds reflect systemic design flaws and may only be minimally effective in decreasing risk to patients. CONCLUSION Cognitive engineering techniques helped identify seemingly hidden constraints in the work domain that impact the problem of patient falls. System redesign strategies aimed at improving work processes and environmental limitations hold promise for decreasing the incidence of falls in inpatient nursing units.
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Affiliation(s)
- Karen Dunn Lopez
- Department of Health Systems Science, College of Nursing, The University of Illinois Chicago, Chicago, Illinois, USA
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Patrician PA, Shang J, Lake ET. Organizational determinants of work outcomes and quality care ratings among Army Medical Department registered nurses. Res Nurs Health 2010; 33:99-110. [PMID: 20151409 DOI: 10.1002/nur.20370] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and several single-item measures were administered to registered nurses (RNs) working within 23 U.S.-based Army Medical Department (AMEDD) hospitals. Data were analyzed with logistic regression for nested data. Unfavorable nursing practice environments had a substantial association with job dissatisfaction (OR 13.75, p < .01), emotional exhaustion (OR 12.70, p < .01), intent to leave (OR 3.03, p < .01), and fair to poor quality of care (OR 10.66, p < .01). This study provides the first system-wide analyses of nursing practice environments in AMEDD hospitals in the U.S. Similar to findings in civilian samples, poor quality work environments are associated with less favorable RN work outcomes and quality of care ratings.
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Affiliation(s)
- Patricia A Patrician
- University of Alabama at Birmingham School of Nursing, NB324, 1530 3rd Ave. S., Birmingham, AL 35294-1210, USA
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Mark BA, Jones CB, Lindley L, Ozcan YA. An examination of technical efficiency, quality, and patient safety in acute care nursing units. Policy Polit Nurs Pract 2009; 10:180-6. [PMID: 20008398 DOI: 10.1177/1527154409346322] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using an innovative statistical approach-data envelopment analysis-the authors examined the technical efficiency of 226 medical, surgical, and medical-surgical nursing units in 118 randomly selected acute care hospitals. The authors used the inputs of registered nurse, licensed practical nurse, and unlicensed hours of care; operating expenses; and number of beds on the unit. Outputs included case mix adjusted discharges, patient satisfaction (as a quality measure), and the rates of medication errors and patient falls (as measures of patient safety). This study found that 60% of units were operating at less than full efficiency. Key areas for improvement included slight reductions in labor hours and large reductions in medication errors and falls. The study findings indicate the importance of improving patient safety as a mechanism to simultaneously improve nursing unit efficiency.
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Kendall-Gallagher D, Blegen MA. Competence and certification of registered nurses and safety of patients in intensive care units. Am J Crit Care 2009; 18:106-13; quiz 114. [PMID: 19255100 DOI: 10.4037/ajcc2009487] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adverse events that place patients at risk for harm are common in intensive care units. Clinicians' level of knowledge and judgment appear to play a role in the prevention, mitigation, and creation of adverse advents. Research suggests a possible association between nurses' specialty certification and clinical expertise. The relationship between specialty certification and clinical competence of registered nurses and safety of patients is a relatively new area of inquiry in nursing. OBJECTIVE To explore the relationship between the proportion of certified staff nurses in a unit and risk of harm to patients. METHODS Hierarchical linear modeling was used in a secondary data analysis of 48 intensive care units from a random sample of 29 hospitals to examine the relationships between unit certification rates, organizational nursing characteristics (magnet status, staffing, education, and experience), and rates of medication administration errors, falls, skin breakdown, and 3 types of nosocomial infections. Medicare case mix index was used to adjust for patient risk. RESULTS Unit proportion of certified staff registered nurses was inversely related to rate of falls, and total hours of nursing care was positively related to medication administration errors. The mean number of years of experience of registered nurses in the unit was inversely related to frequency of urinary tract infections; however, the small sample size requires that caution be exercised when interpreting results. CONCLUSIONS Specialty certification and competence of registered nurses are related to patients' safety. Further research on this relationship is needed.
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Affiliation(s)
- Deborah Kendall-Gallagher
- Deborah Kendall-Gallagher is a postdoctoral research fellow at the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, in Philadelphia.Mary A. Blegenis a professor in community health systems and director of the Center for Patient Safety in the School of Nursing at the University of California, San Francisco
| | - Mary A. Blegen
- Deborah Kendall-Gallagher is a postdoctoral research fellow at the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, in Philadelphia.Mary A. Blegenis a professor in community health systems and director of the Center for Patient Safety in the School of Nursing at the University of California, San Francisco
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