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Witt JM, Cillessen LM, Gubbins PO. Barriers to medication error reporting in a federally qualified health center. J Am Pharm Assoc (2003) 2024; 64:102079. [PMID: 38556246 DOI: 10.1016/j.japh.2024.102079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To explore the National Coordinating Council for Medication Error Reporting and Prevention Categories of Errors health professionals are most likely to report and characterize what barriers to medication error reporting influence decisions to report and the extent they do so at a large federally qualified health center (FQHC). DESIGN Prospective, cross-sectional, survey. SETTING AND PARTICIPANTS A total of 161 medical professionals at a large FQHC clinic with a small pharmacy team. OUTCOME MEASURES Survey responses to explore respondent understanding of medication error categories and the influence of barriers to medication error reporting on their decision to report. RESULTS Thirty-six (22.4%) respondents completed the survey. Nearly 40% of respondents would not report a near-miss error and were influenced by workplace/environmental barriers significantly more than those who would report. Regardless of reporting experience or patient-care role, assessed barrier categories influence the decision to report similarly. CONCLUSION Near-miss medication errors are inconsistently reported. Efforts to improve reporting should emphasize addressing workplace/environmental barriers.
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Kane J, Munn L, Kane SF, Srulovici E. Defining Speaking Up in the Healthcare System: a Systematic Review. J Gen Intern Med 2023; 38:3406-3413. [PMID: 37670070 PMCID: PMC10682351 DOI: 10.1007/s11606-023-08322-0] [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: 03/23/2023] [Accepted: 07/03/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Communication issues have been shown to contribute to healthcare errors. For years healthcare professionals have been told to "speak up." What "speak up" means is unclear, as it has been defined and operationalized in many ways. Thus, this study aimed to systematically review the literature regarding definitions and measurements of speaking up in the healthcare system and to develop a single, comprehensive definition and operationalization of the concept. METHODS PubMed, CINAHL, PsychoInfo, and Communication/Mass Media Complete databases were searched from 1999 to 2020. Publications were included if they mentioned speaking up for patient safety or any identified synonyms. Articles that used the term speaking up concerning non-health-related topics were excluded. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 294 articles met the inclusion criteria, yet only 58 articles focused on speaking up. While the most common synonym terms identified were "speak up" and "raise concern," only 43 articles defined speaking up. Accordingly, a modified definition was developed for speaking up-A healthcare professional identifying a concern that might impact patient safety and using his or her voice to raise the concern to someone with the power to address it. DISCUSSION Speaking up is considered important for patient safety. Yet, there has been a lack of agreement on the definition and operationalization of speaking up. This review demonstrates that speaking up should be reconceptualized to provide a single definition for speaking up in healthcare.
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Affiliation(s)
- Julia Kane
- School of Nursing, Fayetteville State University, Fayetteville, NC, USA
| | - Lindsay Munn
- Clinical and Translational Science Institute, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shawn F Kane
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Einav Srulovici
- The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.
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Yu T, Zhang X, Wang Q, Zheng F, Wang L. Communication openness and nosocomial infection reporting: the mediating role of team cohesion. BMC Health Serv Res 2022; 22:1416. [PMID: 36434720 PMCID: PMC9701000 DOI: 10.1186/s12913-022-08646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 10/07/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The states of IPC (Infection Prevention and Control) is serious under the COVID-19 pandemic. Nosocomial infection reporting is of great significance to transparent management of IPC in regard to the COVID-19 pandemic. We aimed to explore the relationship between communication openness and nosocomial infection reporting, explore the mediating effect of team cohesion in the two, and provide evidence-based organizational perspective for improving IPC management in the hospitals. METHOD A questionnaire was used to collect data on communication openness, team cohesion and nosocomial infection reporting in 3512 medical staff from 239 hospitals in Hubei, China. Structural Equation Model (SEM) was conducted to examine the hypothetical model. RESULT Communication openness was positively related to nosocomial infection reporting (β = 0.540, p < 0.001), and was positively related to team cohesion (β = 0.887, p < 0.001). Team cohesion was positively related to nosocomial infection reporting (β = 0.328, p < 0.001). The partial mediating effect of team cohesion was significant (β = 0.291, SE = 0.055, 95% CI = [ 0.178,0.392 ]), making up 35.02% of total effect. CONCLUSION Communication openness was not only positively related to nosocomial infection reporting. Team cohesion can be regarded as a mediator between communication openness and nosocomial infection reporting. It implies that strengthening communication openness and team cohesion is the strategy to promote IPC management from the new organizational perspective.
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Affiliation(s)
- Tiantian Yu
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Xinping Zhang
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Qianning Wang
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Feiyang Zheng
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Lu Wang
- grid.33199.310000 0004 0368 7223School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei China
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Gampetro PJ, Segvich JP, Hughes AM, Kanich C, Schlaeger JM, McFarlin BL. Associations between safety outcomes and communication practices among pediatric nurses in the United States. J Pediatr Nurs 2022; 63:20-27. [PMID: 34942469 DOI: 10.1016/j.pedn.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To gain a deeper understanding of RNs communication related to patient safety. RESEARCH AIMS To determine: (1) the associations between the communication of registered nurses (RNs) within their health care teams and the frequency that they reported safety events; (2) the associations between RNs' communication within their health care teams and their perceptions of safety within the hospital unit; and (3) whether RNs' communication had improved from 2016 to 2018. THEORETICAL FRAMEWORK AND METHODS We used the United Kingdom's Safety Culture model as the theoretical framework for this study. Our secondary data analysis from the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture included 2016 (n = 5298) and 2018 (n = 3476) using multiple regression models to determine associations between responses for Communication Openness and Feedback & Communication About Error, and outcome responses for Frequency of Events Reported and Overall Perceptions of Safety. RESULTS Our findings were: 1). In both 2016 and 2018 datasets, Feedback About Error had a greater impact on Reporting Frequency than Open Communication; 2). Feedback About Error had a greater impact on Safety Perceptions than Open Communication; 3). Open Communication and Feedback About Error and their associations with Reporting Frequency and Safety Perceptions showed little change; and, 4). The proportion of variance was low, indicating factors other than Open Communication and Feedback About Error were involved with Reporting Frequency and Safety Perceptions. CONCLUSION Pediatric RNs' communication, reporting, and perceptions of patient safety have not improved. (245 words).
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Affiliation(s)
- Pamela J Gampetro
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, 845 S. Damen Avenue, Chicago, IL 60612, United States.
| | - John P Segvich
- Statistical Consultant, 14524 Kolin Avenue, Midlothian, IL 60445, United States
| | - Ashley M Hughes
- University of Illinois Chicago, College of Applied Health Sciences, Department of Biomedical & Health Information Sciences, Director, Systems-based Approach for Enhancing Teamwork (SAFE-T) lab, 1919 W. Taylor Street, Chicago, IL 60612, United States.
| | - Chris Kanich
- University of Illinois Chicago, College of Engineering, Department of Computer Science, 851 S. Morgan Street, Chicago, IL 60607, United States.
| | - Judith M Schlaeger
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, 845 S. Damen Avenue, Chicago, IL 60612, United States.
| | - Barbara L McFarlin
- University of Illinois Chicago, College of Nursing, Department of Human Development Nursing Science, 845 S. Damen Avenue, Chicago, IL 60612, United States.
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Aljabari S, Kadhim Z. Common Barriers to Reporting Medical Errors. ScientificWorldJournal 2021; 2021:6494889. [PMID: 34220366 PMCID: PMC8211515 DOI: 10.1155/2021/6494889] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Medical errors are the third leading cause of death in the United States. Reporting of all medical errors is important to better understand the problem and to implement solutions based on root causes. Underreporting of medical errors is a common and a challenging obstacle in the fight for patient safety. The goal of this study is to review common barriers to reporting medical errors. METHODS We systematically reviewed the literature by searching the MEDLINE and SCOPUS databases for studies on barriers to reporting medical errors. The preferred reporting items for systematic reviews and meta-analyses guideline was followed in selecting eligible studies. RESULTS Thirty studies were included in the final review, 8 of which were from the United States. The majority of the studies used self-administered questionnaires (75%) to collect data. Nurses were the most studied providers (87%), followed by physicians (27%). Fear of consequences is the most reported barrier (63%), followed by lack of feedback (27%) and work climate/culture (27%). Barriers to reporting were highly variable between different centers.
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Affiliation(s)
- Salim Aljabari
- Child Health Department, University of Missouri-Columbia, Columbia, MO, USA
| | - Zuhal Kadhim
- Department of Family and Community Medicine, University of Missouri-Columbia, Columbia, MO, USA
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A Multilevel Analysis of U.S. Hospital Patient Safety Culture Relationships With Perceptions of Voluntary Event Reporting. J Patient Saf 2021; 16:187-193. [PMID: 27820722 DOI: 10.1097/pts.0000000000000336] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient safety events offer opportunities to improve patient care, but, unfortunately, events often go unreported. Although some barriers to event reporting can be reduced with electronic reporting systems, insight on organizational and cultural factors that influence reporting frequency may help hospitals increase reporting rates and improve patient safety. The purpose of this study was to evaluate the associations between dimensions of patient safety culture and perceived reporting practices of safety events of varying severity. METHODS We conducted a cross-sectional survey study using previously collected data from The Agency for Healthcare Research and Quality Hospital Survey of Patient Safety Culture as predictors and outcome variables. The dataset included health-care professionals in U.S. hospitals, and data were analyzed using multilevel modeling techniques. RESULTS Data from 223,412 individuals, 7816 work areas/units, and 967 hospitals were analyzed. Whether examining near miss, no harm, or potential for harm safety events, the dimension feedback about error accounted for the most unique predictive variance in the outcome frequency of events reported. Other significantly associated variables included organizational learning, nonpunitive response to error, and teamwork within units (all P < 0.001). As the perceived severity of the safety event increased, more culture dimensions became significantly associated with voluntary reporting. CONCLUSIONS To increase the likelihood that a patient safety event will be voluntarily reported, our study suggests placing priority on improving event feedback mechanisms and communication of event-related improvements. Focusing efforts on these aspects may be more efficient than other forms of culture change.
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Campione JR, Mardon RE, McDonald KM. Patient Safety Culture, Health Information Technology Implementation, and Medical Office Problems That Could Lead to Diagnostic Error. J Patient Saf 2020; 15:267-273. [PMID: 30138158 DOI: 10.1097/pts.0000000000000531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment or by leading to unnecessary or harmful treatment. OBJECTIVES The aim of the study was to investigate the relationship between patient safety culture, health information technology (IT) implementation, and the frequency of problems that could lead to diagnostic errors in the medical office setting, such as unavailable test results, unavailable medical records, or unpursued abnormal results. METHODS We used survey data from 925 medical offices nationwide that voluntarily submitted results to the 2012 Agency for Healthcare Research and Quality Medical Office Surveys on Patient Safety Culture database. At the office level, we ran a multivariate regression model to estimate the effect of culture on problem frequency while controlling for office-reported implementation levels of health IT, office characteristics such as the number of locations, and survey characteristics such as the percent of respondents that were physicians. RESULTS The most frequent problem was "results from a lab or imaging test were not available when needed"; across 925 offices, the average was 15% reporting that it happened daily or weekly. Higher overall culture scores were significantly associated with fewer occurrences of each problem assessed. Compared with offices with completed health IT implementation, offices in the process of health IT implementation had higher frequency of problems. CONCLUSIONS This study offers insight into how patient safety culture and health IT implementation in medical offices can influence the frequency of breakdowns in processes of care, thereby identifying potential vulnerabilities that can increase diagnostic errors.
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Affiliation(s)
| | | | - Kathryn M McDonald
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
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Noureldin M, Noureldin MA. Reporting frequency of three near-miss error types among hospital pharmacists and associations with hospital pharmacists' perceptions of their work environment. Res Social Adm Pharm 2020; 17:381-387. [PMID: 32247681 DOI: 10.1016/j.sapharm.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/05/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Medical error reporting is one of the main strategies health care institutions utilize to evaluate and improve patient safety. Many factors can influence error reporting frequency, including work environment. The study objectives were to: 1) explore hospital pharmacists' reporting frequency of three distinct near-miss errors types and 2) examine the association between near-miss error reporting frequency and work environment perceptions, specifically pharmacists' perceptions of managers' actions to promote patient safety, teamwork, and staffing issues. METHODS Pharmacist data from the 2016 AHRQ Hospital Survey on Patient Safety Culture were analyzed. Near-miss errors included errors that occurred: 1) with no potential to harm the patient, 2) that could harm the patient, but did not, and 3) that were caught and corrected before harming the patient. Pharmacists' perceptions of the three patient safety culture domains (i.e., managers' actions to promote safety, teamwork, staffing) were assessed by calculating positive response percentages, with higher percentages indicating positive perceptions of their institutions' safety culture. Descriptive statistics and bivariate and mixed effects multivariate regression analyses were conducted. RESULTS When an error occurred, it was always reported by 32.0% of pharmacists if the error could have harmed the patient, 17.6% of pharmacists if the error had no potential to harm the patient, and 12.3% of pharmacists if it was corrected before reaching the patient. Higher near-miss error reporting frequency was significantly associated with positive perceptions related to managers' actions to promote safety, teamwork, and staffing if the error could have harmed the patient (OR 1.50; OR 1.27; OR 1.18, p < 0.05 respectively) and errors that were caught/corrected before reaching the patient (OR 1.32, OR 1.26, OR 1.07, p < 0.05 respectively). CONCLUSION Differences in reporting frequency suggests that pharmacists may prioritize near-miss error reporting based on perceived importance. A positive work environment was associated with higher near-miss error reporting rates.
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Affiliation(s)
- Marwa Noureldin
- College of Pharmacy, Natural and Health Sciences, Manchester University, 10627 Diebold Rd, Fort Wayne, Indiana, USA, 46845.
| | - Maryam A Noureldin
- Ambulatory Care Medication Safety Pharmacist, Parkview Health, 11109 Parkview Plaza Drive, Fort Wayne, Indiana, 46845, USA.
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Tolley CL, Forde NE, Coffey KL, Sittig DF, Ash JS, Husband AK, Bates DW, Slight SP. Factors contributing to medication errors made when using computerized order entry in pediatrics: a systematic review. J Am Med Inform Assoc 2018; 25:575-584. [PMID: 29088436 DOI: 10.1093/jamia/ocx124] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/05/2017] [Indexed: 02/05/2023] Open
Abstract
Objective To identify and understand the factors that contribute to medication errors associated with the use of computerized provider order entry (CPOE) in pediatrics and provide recommendations on how CPOE systems could be improved. Materials and Methods We conducted a systematic literature review across 3 large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Three independent reviewers screened the titles, and 2 authors then independently reviewed all abstracts and full texts, with 1 author acting as a constant across all publications. Data were extracted onto a customized data extraction sheet, and a narrative synthesis of all eligible studies was undertaken. Results A total of 47 articles were included in this review. We identified 5 factors that contributed to errors with the use of a CPOE system: (1) lack of drug dosing alerts, which failed to detect calculation errors; (2) generation of inappropriate dosing alerts, such as warnings based on incorrect drug indications; (3) inappropriate drug duplication alerts, as a result of the system failing to consider factors such as the route of administration; (4) dropdown menu selection errors; and (5) system design issues, such as a lack of suitable dosing options for a particular drug. Discussion and Conclusions This review highlights 5 key factors that contributed to the occurrence of CPOE-related medication errors in pediatrics. Dosing support is the most important. More advanced clinical decision support that can suggest doses based on the drug indication is needed.
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Affiliation(s)
- Clare L Tolley
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,School of Medicine, Pharmacy and Health, Durham University, Durham, UK.,Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Niamh E Forde
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | | | - Dean F Sittig
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Andrew K Husband
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - David W Bates
- Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard School of Public Health, Boston, MA, USA
| | - Sarah P Slight
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK.,Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK.,Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Alswat K, Abdalla RAM, Titi MA, Bakash M, Mehmood F, Zubairi B, Jamal D, El-Jardali F. Improving patient safety culture in Saudi Arabia (2012-2015): trending, improvement and benchmarking. BMC Health Serv Res 2017; 17:516. [PMID: 28764780 PMCID: PMC5540485 DOI: 10.1186/s12913-017-2461-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 07/19/2017] [Indexed: 12/04/2022] Open
Abstract
Background Measuring patient safety culture can provide insight into areas for improvement and help monitor changes over time. This study details the findings of a re-assessment of patient safety culture in a multi-site Medical City in Riyadh, Kingdom of Saudi Arabia (KSA). Results were compared to an earlier assessment conducted in 2012 and benchmarked with regional and international studies. Such assessments can provide hospital leadership with insight on how their hospital is performing on patient safety culture composites as a result of quality improvement plans. This paper also explored the association between patient safety culture predictors and patient safety grade, perception of patient safety, frequency of events reported and number of events reported. Methods We utilized a customized version of the patient safety culture survey developed by the Agency for Healthcare Research and Quality. The Medical City is a tertiary care teaching facility composed of two sites (total capacity of 904 beds). Data was analyzed using SPSS 24 at a significance level of 0.05. A t-Test was used to compare results from the 2012 survey to that conducted in 2015. Two adopted Generalized Estimating Equations in addition to two linear models were used to assess the association between composites and patient safety culture outcomes. Results were also benchmarked against similar initiatives in Lebanon, Palestine and USA. Results Areas of strength in 2015 included Teamwork within units, and Organizational Learning—Continuous Improvement; areas requiring improvement included Non-Punitive Response to Error, and Staffing. Comparing results to the 2012 survey revealed improvement on some areas but non-punitive response to error and Staffing remained the lowest scoring composites in 2015. Regression highlighted significant association between managerial support, organizational learning and feedback and improved survey outcomes. Comparison to international benchmarks revealed that the hospital is performing at or better than benchmark on several composites. Conclusion The Medical City has made significant progress on several of the patient safety culture composites despite still having areas requiring additional improvement. Patient safety culture outcomes are evidently linked to better performance on specific composites. While results are comparable with regional and international benchmarks, findings confirm that regular assessment can allow hospitals to better understand and visualize changes in their performance and identify additional areas for improvement.
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Affiliation(s)
- Khalid Alswat
- King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Maher Abdelraheim Titi
- King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Maram Bakash
- King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Faiza Mehmood
- King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Beena Zubairi
- King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Diana Jamal
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL-209, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
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Rodriquez LI, Smaka TJ, Mahla M, Epstein RH. Default Drug Doses in Anesthesia Information Management Systems. Anesth Analg 2017; 125:255-260. [DOI: 10.1213/ane.0000000000001611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Garcí;a-de-León-Chocano R, Sáez C, Muñoz-Soler V, Garcí;a-de-León-González R, García-Gómez JM. Construction of quality-assured infant feeding process of care data repositories: definition and design (Part 1). Comput Biol Med 2015; 67:95-103. [DOI: 10.1016/j.compbiomed.2015.09.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/24/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022]
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Slight SP, Berner ES, Galanter W, Huff S, Lambert BL, Lannon C, Lehmann CU, McCourt BJ, McNamara M, Menachemi N, Payne TH, Spooner SA, Schiff GD, Wang TY, Akincigil A, Crystal S, Fortmann SP, Bates DW. Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities. JMIR Med Inform 2015; 3:e30. [PMID: 26385598 PMCID: PMC4704893 DOI: 10.2196/medinform.4457] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 06/02/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022] Open
Abstract
Background With the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for “meaningful use” (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems. Objective The Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy. Methods We gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed and agreed on as a group. Results Stakeholders’ knowledge and experiences from implementing MU requirements fell into 6 domains: (1) accuracy of medication lists and medication reconciliation, (2) problem list accuracy and the shift in HIT priorities, (3) accuracy of allergy lists and allergy-related standards development, (4) support of safer and effective prescribing for children, (5) considerations for rural communities, and (6) general issues with achieving MU. Standards are needed to better facilitate the exchange of data elements between health care settings. Several organizations felt that their preoccupation with fulfilling MU requirements stifled innovation. Greater emphasis should be placed on local HIT configurations that better address population health care needs. Conclusions Although MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize that integrated models may achieve information-sharing goals in alternate ways. Future certification rules and requirements should enhance EHR functionalities critical for safer prescribing of medications in children.
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Affiliation(s)
- Sarah Patricia Slight
- Division of Pharmacy, School of Medicine Pharmacy and Health, Durham University, Durham, United Kingdom
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Sendlhofer G, Wölfler C, Pregartner G. Patient safety culture within a university hospital: feasibility trial. ACTA ACUST UNITED AC 2015. [DOI: 10.1186/s40886-015-0004-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Williams SD, Phipps DL, Ashcroft D. Examining the attitudes of hospital pharmacists to reporting medication safety incidents using the theory of planned behaviour. Int J Qual Health Care 2015; 27:297-304. [PMID: 26142282 DOI: 10.1093/intqhc/mzv044] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To assess the effect of factors within hospital pharmacists' practice on the likelihood of their reporting a medication safety incident. DESIGN Theory of planned behaviour (TPB) survey. SETTING Twenty-one general and teaching hospitals in the North West of England. PARTICIPANTS Two hundred and seventy hospital pharmacists (response rate = 45%). INTERVENTION Hospital pharmacists were invited to complete a TPB survey, based on a prescribing error scenario that had resulted in serious patient harm. Multiple regression was used to determine the relative influence of different TPB variables, and participant demographics, on the pharmacists' self-reported intention to report the medication safety incident. MAIN OUTCOME MEASURES The TPB variables predicting intention to report: attitude towards behaviour, subjective norm, perceived behavioural control and descriptive norm. RESULTS Overall, the hospital pharmacists held strong intentions to report the error, with senior pharmacists being more likely to report. Perceived behavioural control (ease or difficulty of reporting), Descriptive Norms (belief that other pharmacists would report) and Attitudes towards Behaviour (expected benefits of reporting) showed good correlation with, and were statistically significant predictors of, intention to report the error [R = 0.568, R(2) = 0.323, adjusted R(2) = 0.293, P < 0.001]. CONCLUSIONS This study suggests that efforts to improve medication safety incident reporting by hospital pharmacists should focus on their behavioural and control beliefs about the reporting process. This should include instilling greater confidence about the benefits of reporting and not harming professional relationships with doctors, greater clarity about what/not to report and a simpler reporting system.
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Affiliation(s)
- Steven David Williams
- Department of Pharmacy, University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK
| | - Denham L Phipps
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
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Abstract
In the past 3 years, the Health Information Technology for Economic and Clinical Health Act accelerated the adoption of electronic health records (EHRs) with providers and hospitals, who can claim incentive monies related to meaningful use. Despite the increase in adoption of commercial EHRs in pediatric settings, there has been little support for EHR tools and functionalities that promote pediatric quality improvement and patient safety, and children remain at higher risk than adults for medical errors in inpatient environments. Health information technology (HIT) tailored to the needs of pediatric health care providers can improve care by reducing the likelihood of errors through information assurance and minimizing the harm that results from errors. This technical report outlines pediatric-specific concepts, child health needs and their data elements, and required functionalities in inpatient clinical information systems that may be missing in adult-oriented HIT systems with negative consequences for pediatric inpatient care. It is imperative that inpatient (and outpatient) HIT systems be adapted to improve their ability to properly support safe health care delivery for children.
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Impact of simulation training on self-efficacy of outpatient health care providers to use electronic health records. Int J Med Inform 2015; 84:423-9. [PMID: 25746460 DOI: 10.1016/j.ijmedinf.2015.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 02/06/2015] [Accepted: 02/10/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To examine whether simulation training enhanced self-efficacy of physicians and nurses who work in the outpatient setting to use electronic medical records, and whether the training changed their perceptions about the importance of electronic medical records (EMRs) in helping patients and improving patients' safety. METHODS Two-hundred and ninety-three physicians and 94 nurses participated in the study. Participants first attended two computer classroom training sessions on how to use EMRs. Subsequently, the participants attended simulation training and practiced application of EMRs while encountering standardized patients. They answered questionnaires on a seven-point Likert-type scale prior to and immediately after simulation training. The questionnaires assessed their perceptions about the importance of EMRs in helping patients and improving patients' safety and their confidence and preparedness level to use EMRs. RESULTS The overall self-efficacy of physicians and nurses to use EMRs increased after simulation training as compared to before simulation training. The physicians' and nurses' ratings about importance of EMRs to help patients' and improve patients' safety after simulation training were relatively unchanged compared to the ratings before simulation training. Additionally, participants described simulation training as exceptional, because it was an interactive learning opportunity to use EMRs within a simulated clinical setting with a simulated patient. CONCLUSIONS Simulation training in the current study enhanced physicians' and nurses' level of self-confidence and preparedness to use EMRs. To train health care providers how to use EMRs, simulation training should be considered as an interactive and effective method of teaching prior to implementation of EMRs in medical institutions.
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Gibbons MC, Lowry SZ, Patterson ES. Applying Human Factors Principles to Mitigate Usability Issues Related to Embedded Assumptions in Health Information Technology Design. JMIR Hum Factors 2014; 1:e3. [PMID: 27025349 PMCID: PMC4797669 DOI: 10.2196/humanfactors.3524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/07/2014] [Indexed: 11/30/2022] Open
Abstract
Background There is growing recognition that design flaws in health information technology (HIT) lead to increased cognitive work, impact workflows, and produce other undesirable user experiences that contribute to usability issues and, in some cases, patient harm. These usability issues may in turn contribute to HIT utilization disparities and patient safety concerns, particularly among “non-typical” HIT users and their health care providers. Health care disparities are associated with poor health outcomes, premature death, and increased health care costs. HIT has the potential to reduce these disparate outcomes. In the computer science field, it has long been recognized that embedded cultural assumptions can reduce the usability, usefulness, and safety of HIT systems for populations whose characteristics differ from “stereotypical” users. Among these non-typical users, inappropriate embedded design assumptions may contribute to health care disparities. It is unclear how to address potentially inappropriate embedded HIT design assumptions once detected. Objective The objective of this paper is to explain HIT universal design principles derived from the human factors engineering literature that can help to overcome potential usability and/or patient safety issues that are associated with unrecognized, embedded assumptions about cultural groups when designing HIT systems. Methods Existing best practices, guidance, and standards in software usability and accessibility were subjected to a 5-step expert review process to identify and summarize those best practices, guidance, and standards that could help identify and/or address embedded design assumptions in HIT that could negatively impact patient safety, particularly for non-majority HIT user populations. An iterative consensus-based process was then used to derive evidence-based design principles from the data to address potentially inappropriate embedded cultural assumptions. Results Design principles that may help identify and address embedded HIT design assumptions are available in the existing literature. Conclusions Evidence-based HIT design principles derived from existing human factors and informatics literature can help HIT developers identify and address embedded cultural assumptions that may underlie HIT-associated usability and patient safety concerns as well as health care disparities.
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Affiliation(s)
- Michael C Gibbons
- Johns Hopkins University, Departments of Medicine, Public Health, and Health Informatics, Baltimore, MD, United States.
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Stacey S, Coombes I, Wainwright C, Klee B, Miller H, Whitfield K. Characteristics of adverse medication events in a children's hospital. J Paediatr Child Health 2014; 50:966-71. [PMID: 25049060 DOI: 10.1111/jpc.12684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/29/2022]
Abstract
AIM To compare adverse medication events (AMEs) reported in children, via the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) coding with events reported via other data sources. METHOD AME reports were retrieved using codes Y40-Y59 and X40-X44 over 6 months. Patients' charts were manually reviewed to identify events associated with error and/or harm with medicines during a hospital admission. Medication name, group, error, harm and alert documentation were recorded. Clinical incidents and pharmacist interventions were reviewed for the same period. RESULTS Two hundred sixty-three events from January to June 2011 were recorded by ICD-10 coding in 180 patients. After duplicated, missing or unrelated events were excluded and 146 AMEs remained. In the same period, 117 AMEs were reported as incidents and 190 as pharmacist interventions. In total, 276 children with 447 events were reported via all sources. Little duplication between data sources was evident. In total, 158 events involved harm, with 135 of these from ICD-10 coding, 16 from incident reports and 2 pharmacist interventions (including 6 events from multiple sources). Error was involved in 3% of ICD10 reports, 97% of incidents and 100% of interventions. Only 14% of harm-related events from ICD-10 were documented on the medical record clinical alert. Chemotherapy accounted for 31% of harm-related events, antimicrobials 18%, corticosteroids 14% and narcotics 12%. CONCLUSION Of the harm-related events, 85% were documented via ICD-10 coding with few documented in other databases. Review of ICD-10-coded AMEs can provide valuable information to improve patient safety and quality.
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Affiliation(s)
- Sonya Stacey
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia; Royal Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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Exploring the concept of a team approach to wound care: Managing wounds as a team. J Wound Care 2014; 23 Suppl 5b:S1-S38. [DOI: 10.12968/jowc.2014.23.sup5b.s1] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Lalor DJ, Chen TF, Walpola R, George RA, Ashcroft DM, Fois RA. An exploration of Australian hospital pharmacists' attitudes to patient safety. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:67-76. [PMID: 24766559 DOI: 10.1111/ijpp.12115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/02/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore the attitudes of Australian hospital pharmacists towards patient safety in their work settings. METHODS A safety climate questionnaire was administered to all 2347 active members of the Society of Hospital Pharmacists of Australia in 2010. Part of the survey elicited free-text comments about patient safety, error and incident reporting. The comments were subjected to thematic analysis to determine the attitudes held by respondents in relation to patient safety and its quality management in their work settings. KEY FINDINGS Two hundred and ten (210) of 643 survey respondents provided comments on safety and quality issues related to their work settings. The responses contained a number of dominant themes including issues of workforce and working conditions, incident reporting systems, the response when errors occur, the presence or absence of a blame culture, hospital management support for safety initiatives, openness about errors and the value of teamwork. A number of pharmacists described the development of a mature patient-safety culture - one that is open about reporting errors and active in reducing their occurrence. Others described work settings in which a culture of blame persists, stifling error reporting and ultimately compromising patient safety. CONCLUSION Australian hospital pharmacists hold a variety of attitudes that reflect diverse workplace cultures towards patient safety, error and incident reporting. This study has provided an insight into these attitudes and the actions that are needed to improve the patient-safety culture within Australian hospital pharmacy work settings.
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Affiliation(s)
- Daniel J Lalor
- Medication Safety, Clinical Excellence Commission, Sydney, NSW, Australia
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