1
|
Allan J, Webster E, Chambers B, Nott S. "This is streets ahead of what we used to do": staff perceptions of virtual clinical pharmacy services in rural and remote Australian hospitals. BMC Health Serv Res 2021; 21:1306. [PMID: 34863164 PMCID: PMC8645070 DOI: 10.1186/s12913-021-07328-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of medications is the most common intervention in healthcare. However, unsafe medication practices and medication errors are a leading cause of injury and avoidable harm in healthcare systems across the world. A Virtual Clinical Pharmacy Service (VCPS) was introduced in rural and remote New South Wales public hospitals to support safe and effective use of medications. In this model clinical pharmacy services are delivered via a telehealth cart at the patient's bedside and through electronic medical and pharmaceutical record systems. The aim of this research was to understand healthcare staff perspectives of the VCPS and identify areas for improvement. METHODS A qualitative approach informed by Appreciative Inquiry was used to investigate healthcare staff perceptions of the VCPS. Focus group discussions (n = 15) with hospital staff and medical officers were conducted via videoconference at each study site. Focus groups explored issues, benefits and barriers 3 months after service implementation. Transcribed data were analysed using thematic analysis and team discussion to synthesise themes. RESULTS Focus group participants identified the value of the VCPS to patients, to the health service and to themselves. They also identified enhancements to increase value for each of these groups. Perceived benefits to patients included access to specialist medication advice and improved medication knowledge. Staff valued access to an additional, trusted workforce who provided back-up and guidance. Staff also reported confidence in improved patient safety and identification of medication errors. Enhanced compliance with antimicrobial stewardship and hospital accreditation standards were beneficial to the health service. Suggested improvements included extending virtual service hours and widening patient eligibility to include aged care patients. CONCLUSIONS The VCPS brought a positive, collegiate culture regarding medications. Healthcare staff perceived the VCPS was effective and an efficient way for the health service to supply pharmacy services to smaller hospitals. The ease of use, model of delivery, availability, local knowledge and responsiveness of highly skilled pharmacists was the key to user satisfaction. TRIAL REGISTRATION ANZCTR ACTRN12619001757101 , 11/12/2019.
Collapse
Affiliation(s)
- Julaine Allan
- School of Health and Society, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Emma Webster
- School of Rural Health, University of Sydney, Dubbo, Australia
| | | | - Shannon Nott
- Western NSW Local Health District, Dubbo, Australia
| |
Collapse
|
2
|
Keriel-Gascou M, Brami J, Chanelière M, Haeringer-Cholet A, Larrieu C, Villebrun F, Robert T, Michel P. [Which definition and taxonomy of incident to use for a French reporting system in primary care settings?]. Rev Epidemiol Sante Publique 2014; 62:41-52. [PMID: 24439084 DOI: 10.1016/j.respe.2013.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 09/17/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND There is no widely accepted definition of incident for primary care doctors in France and no taxonomic classification system for epidemiological use. In preparation for a future epidemiological study on primary care incidents in France (the ESPRIT study), this work was designed to identify the definitions and taxonomic classifications used internationally along with the usual methods and results in terms of frequency in the literature. The goal was to determine a French definition and taxonomy. DESIGN Systematic review of the literature and consensus methods. METHOD An exhaustive search of epidemiological surveys was performed. A structured grid was used. After having identified the definitions used in the literature, a definition was chosen using the focus groups method. Taxonomies identified in the literature were classified by relationship, architecture, code number, and number of studies published. Subsequently, a consensus among experts, who independently tested these taxonomies on six incidents, was reached for choosing the most appropriate for epidemiological data collection (little information on a large number of cases). RESULTS Twenty-four papers reporting 17 studies were selected among 139 articles. Five definitions and eight taxonomies were found. The chosen definition of incident was based on the WHO definition "A patient safety incident is an event or circumstance that could have resulted, or did result, in harm to a patient, and whose wish it is not repeated again". The test of incidents resulted in the choice of the TAPS version of the International Taxonomy of Medical Error in Primary Care for a reproducible and internationally recognized codification and the tempos method for its current use in French general practice. DISCUSSION The definitions, taxonomies, data collection characteristics and frequency of incidents results in the international literature on incidents in primary care are key components for the preparation of an epidemiological survey on incidents in primary care.
Collapse
Affiliation(s)
- M Keriel-Gascou
- Département de médecine générale, EA 4128 santé, individu, société, université Lyon I, 8, avenue Rockefeller, 69373 Lyon, France.
| | - J Brami
- Faculté de médecine Paris-Descartes, Haute Autorité de santé, 75005 Paris, France.
| | - M Chanelière
- Département de médecine générale, EA 4128 santé, individu, société, université Lyon I, 8, avenue Rockefeller, 69373 Lyon, France.
| | - A Haeringer-Cholet
- RéQua réseau qualité en Franche-Comté, 26, rue Proudhon, 25000 Besançon, France.
| | - C Larrieu
- Faculté de médecine Paris-Descartes, 75005 Paris, France.
| | - F Villebrun
- Département de médecine générale, université Paris Est Créteil, 94000 Créteil, France; Centres municipaux de santé, 93000 Saint-Denis, France.
| | - T Robert
- Comité de coordination de l'évaluation clinique et de la qualité en Aquitaine (CCECQA), 33604 Pessac, France.
| | - P Michel
- Comité de coordination de l'évaluation clinique et de la qualité en Aquitaine (CCECQA), 33604 Pessac, France.
| |
Collapse
|
3
|
Westfall JM, Zittleman L, Staton EW, Parnes B, Smith PC, Niebauer LJ, Fernald DH, Quintela J, Van Vorst RF, Dickinson LM, Pace WD. Card studies for observational research in practice. Ann Fam Med 2011; 9:63-8. [PMID: 21242563 PMCID: PMC3022048 DOI: 10.1370/afm.1199] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Observational studies that collect patient-level survey data at the point-of-care are often called card studies. Card studies have been used to describe clinical problems, management, and outcomes in primary care for more than 30 years. In this article we describe 2 types of card studies and the methods for conducting them. METHODS We undertook a descriptive review of card studies conducted in 3 Colorado practice-based research networks and several other networks throughout the United States. We summarized experiences of the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP). RESULTS Card studies can be designed to study specific conditions or care (clinicians complete a card when they encounter patients who meet inclusion criteria) and to determine trends and prevalence of conditions (clinicians complete a card on all patients seen during a period). Data can be collected from clinicians and patients and can be linked. CONCLUSIONS Card studies provide cross-sectional descriptive data about clinical care, knowledge and behavior, perception of care, and prevalence of conditions. Card studies remain a robust method for describing primary care.
Collapse
Affiliation(s)
- John M Westfall
- Department of Family Medicine, University of Colorado, Denver School of Medicine, Aurora, CO, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Waterson P. A critical review of the systems approach within patient safety research. ERGONOMICS 2009; 52:1185-1195. [PMID: 19787499 DOI: 10.1080/00140130903042782] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The application of concepts, theories and methods from systems ergonomics within patient safety has proved to be an expanding area of research and application in the last decade. This paper aims to take a step back and examine what types of research have been conducted so far and use the results to suggest new ways forward. An analysis of a selection of the patient safety literature suggests that research has so far focused on human error, frameworks for safety and risk and incident reporting. The majority of studies have addressed system concerns at an individual level of analysis with only a few analysing systems across multiple system boundaries. Based on the findings, it is argued that future research needs to move away from a concentration on errors and towards an examination of the connections between systems levels. Examples of how this could be achieved are described in the paper. The outcomes from the review of the systems approach within patient safety provide practitioners and researchers within health care (e.g. the UK National Health Service) with a picture of what types of research are currently being investigated, gaps in understanding and possible future ways forward.
Collapse
Affiliation(s)
- Patrick Waterson
- Department of Human Sciences, Loughborough University, Loughborough, UK.
| |
Collapse
|
5
|
Rim SH, Zittleman L, Westfall JM, Overholser L, Froshaug D, Coughlin SS. Knowledge, attitudes, beliefs, and personal practices regarding colorectal cancer screening among health care professionals in rural Colorado: a pilot survey. J Rural Health 2009; 25:303-8. [PMID: 19566617 DOI: 10.1111/j.1748-0361.2009.00234.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study reports the baseline knowledge, attitudes, beliefs, and personal practices of health care professionals regarding colorectal cancer (CRC) screening in the High Plains Research Network (HPRN) of rural Colorado prior to a community-based educational intervention. It also examines the association between health care staff members' knowledge, attitudes, beliefs, and personal practices for CRC screening and patient screening levels by practice. METHODS Surveys were mailed to health care professionals in the HPRN. Participating clinics (n = 21) distributed patient surveys on CRC screening to persons aged > or =50 for a 2-week period in 2006. RESULTS The survey response rate was 81% for providers (n = 46) and 90% for nursing staff (n = 63). Only 54% of health care professionals knew CRC is a leading cause of cancer deaths. When surveyed on their attitudes toward colon cancer, 92%"strongly agreed" or "agreed" that colon cancer is preventable. About 99% (n = 107) of providers and nurses "strongly agreed" or "agreed" that testing could identify problems before colon cancer starts. Most health care professionals (61%) aged > or =50 years had previously been tested and were up-to-date (52%) with screening. Provider knowledge was significantly associated with higher patient screening (P = .02), but provider attitudes and beliefs were not. Moreover, personal screening practices of health care professionals did not correlate with more patients screened. CONCLUSION Background knowledge of CRC among HPRN health care professionals could be improved. The RESULTS of this pilot study may help focus effective approaches such as increasing provider knowledge to enhance CRC screening in the relevant population.
Collapse
Affiliation(s)
- Sun Hee Rim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS K-55, Atlanta, GA 30341-3724, USA.
| | | | | | | | | | | |
Collapse
|
6
|
Klingner J, Moscovice I, Tupper J, Coburn A, Wakefield M. Implementing Patient Safety Initiatives in Rural Hospitals. J Rural Health 2009; 25:352-7. [DOI: 10.1111/j.1748-0361.2009.00243.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Longo DR, Hewett JE, Ge B, Schubert S. Rural Hospital Patient Safety Systems Implementation in Two States. J Rural Health 2007; 23:189-97. [PMID: 17565518 DOI: 10.1111/j.1748-0361.2007.00090.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT AND PURPOSE With heightened attention to medical errors and patient safety, we surveyed Utah and Missouri hospitals to assess the "state of the art" in patient safety systems and identify changes over time. This study examines differences between urban and rural hospitals. METHODS Survey of all acute care hospitals in Utah and Missouri at 2 points in time (2002 and 2004). Factor analysis was used to develop 7 latent variables to summarize the data, comparing rural and urban hospitals at each point in time and on change between the 2 survey times. FINDINGS On 3 of the 7 latent variables, there was a statistically significant difference between rural and urban hospitals at the first survey, with rural hospitals indicating lower levels of implementation. The differences remained present on 2 of those latent variables at the second survey. In both cases, 1 of those variables was computerized physician order entry (CPOE) systems. Rural hospitals reported more improvement in systems implementation between the 2 survey times, with the difference statistically significant on 1 of the 7 latent variables; the greatest improvement was in implementation of "root cause analysis." CONCLUSIONS Adoption of patient safety systems overall is low. Although rates of adoption among rural versus urban hospitals appear lower, most differences are not statistically significant; the gap between rural and urban hospitals relative to quality measures is narrowing. Change in rural and urban hospitals is in the right direction, with the rate of change higher in rural hospitals for many systems.
Collapse
Affiliation(s)
- Daniel R Longo
- Department of Family Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
| | | | | | | |
Collapse
|
8
|
Parnes B, Fernald D, Quintela J, Araya-Guerra R, Westfall J, Harris D, Pace W. Stopping the error cascade: a report on ameliorators from the ASIPS collaborative. Qual Saf Health Care 2007; 16:12-6. [PMID: 17301195 PMCID: PMC2464918 DOI: 10.1136/qshc.2005.017269] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To present a novel examination of how error cascades are stopped (ameliorated) before they affect patients. DESIGN Qualitative analysis of reported errors in primary care. SETTING Over a three-year period, clinicians and staff in two practice-based research networks voluntarily reported medical errors to a primary care patient safety reporting system, Applied Strategies for Improving Patient Safety (ASIPS). The authors found a number of reports where the error was corrected before it had an adverse impact on the patient. RESULTS Of 754 codeable reported events, 60 were classified as ameliorated events. In these events, a participant stopped the progression of the event before it reached or affected the patient. Ameliorators included doctors, nurses, pharmacists, diagnostic laboratories and office staff. Additionally, patients or family members may be ameliorators by recognising the error and taking action. Ameliorating an event after an initial error requires an opportunity to catch the error by systems, chance or attentiveness. Correcting the error before it affects the patient requires action either directed by protocols and systems or by vigilance, power to change course and perseverance on the part of the ameliorator. CONCLUSION Despite numerous individual and systematic methods to prevent errors, a system to prevent all potential errors is not feasible. However, a more pervasive culture of safety that builds on simple acts in addition to more costly and complex electronic systems may improve patient outcomes. Medical staff and patients who are encouraged to be vigilant, ask questions and seek solutions may correct otherwise inevitable wrongs.
Collapse
Affiliation(s)
- Bennett Parnes
- Department of Family Medicine, University of Colorado at Denver and Health Sciences Center, Aurora, CO 80045-0508, USA.
| | | | | | | | | | | | | |
Collapse
|
9
|
Gazewood JD, Rollins LK, Galazka SS. Beyond the horizon: the role of academic health centers in improving the health of rural communities. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:793-7. [PMID: 16936482 DOI: 10.1097/01.acm.0000233009.96164.83] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Academic health centers (AHCs) face increasing pressures from federal, state, and community stakeholders to fulfill their social missions to the communities they serve. Yet, in the 21st century, rural communities in the United States face an array of health care problems, including a shortage of physicians, health problems that disproportionately affect rural populations, a need to improve quality of care, and health disparities related to disproportionate levels of poverty and shifting demographics. AHCs have a key role to play in addressing these issues. AHCs can increase physician supply by targeting their admissions policies and educational programs. Specific health concerns of rural populations can be further addressed through increased use of telemedicine consultations. By partnering with providers in rural areas and through the use of innovative technologies, AHCs can help rural providers increase the quality of care. Partnerships with rural communities provide opportunities for participatory research to address health disparities. In addition, collaboration between AHCs, regional planning agencies, and rural communities can lead to mutually beneficial outcomes. At a time when many AHCs are operating in an environment with dwindling resources, it is even more critical for AHCs to build creative partnerships to help meet the needs of their regional communities.
Collapse
Affiliation(s)
- John D Gazewood
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
| | | | | |
Collapse
|
10
|
Baldwin DM, Quintela J, Duclos C, Staton EW, Pace WD. Patient preferences for notification of normal laboratory test results: a report from the ASIPS Collaborative. BMC FAMILY PRACTICE 2005; 6:11. [PMID: 15755328 PMCID: PMC555570 DOI: 10.1186/1471-2296-6-11] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 03/08/2005] [Indexed: 11/28/2022]
Abstract
Background Many medical errors occur during the laboratory testing process, including lost test results. Patient inquiry concerning results often represents the final safety net for locating lost results. This qualitative study sought to identify, from a patient perspective, specific preferences and factors that influence the process of communicating normal (negative) laboratory test results to patients. Methods We conducted 30-minute guided interviews with 20 adult patients. Patients were recruited from two practice-based research networks in Colorado that were participating in a medical errors study. A semi-structured interview elicited the participant's experience with and preference for laboratory test result notification. Quantitative descriptive statistics were generated for demographic and preference data. Qualitative results were analyzed by a team of experienced qualitative researchers using multiple styles of qualitative analyses, including a template approach and an editing approach. Results Ninety percent of participants wanted to be notified of all tests results. Important issues related to notification included privacy, responsive and interactive feedback, convenience, timeliness, and provision of details. Telephone notification was preferred, followed by regular mail. Electronic notification was perceived as uncomfortable because it was not secure. While 65% preferred being notified by a provider, participants acknowledge that this may be impractical; thus, they wanted to be notified by someone knowledgeable enough to answer questions. Participants do not normally discuss their preferences for test result notification with their providers. Conclusion Privacy, responsive and interactive feedback, convenience, and timeliness with detailed information may be critical for patient satisfaction and for improving patient safety, and are features that may be incorporated into emerging communication channels.
Collapse
Affiliation(s)
| | - Javán Quintela
- Department of Family Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
| | | | - Elizabeth W Staton
- Department of Family Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
| | - Wilson D Pace
- Department of Family Medicine, University of Colorado at Denver and Health Sciences Center, Denver, Colorado, USA
| |
Collapse
|
11
|
|