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Karami M, Hafizi N, Nickfarjam AM, Refahi S. Development of minimum data set and dashboard for monitoring adverse events in radiology departments. Heliyon 2024; 10:e30054. [PMID: 38707457 PMCID: PMC11068645 DOI: 10.1016/j.heliyon.2024.e30054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background To reduce the risk of errors, patient safety monitoring in the medical imaging department is crucial. Interventions are required and these can be provided as a framework for documenting, reporting, evaluating, and recognizing events that pose a threat to patient safety. The aim of this study was to develop minimum data set and dashboard for monitoring adverse events in radiology departments. Material and methods This developmental research was conducted in multiple phases, including content determination using the Delphi technique; database designing using SQL Server; user interface (UI) building using PHP; and dashboard evaluation in three aspects: the accuracy of calculating; UI requirements; and usability. Results This study identified 26 patient safety (PS) performance metrics and 110 PS-related significant data components organized into 14 major groupings as the system contents. The UI was built with three tabs: pre-procedure, intra-procedure, and post-procedure. The evaluation results proved the technical feasibility of the dashboard. Finally, the dashboard's usability was highly rated (76.3 out of 100). Conclusion The dashboard can be used to supplement datasets to obtain a more accurate picture of the PS condition and to draw attention to characteristics that professionals might otherwise overlook or undervalue.
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Affiliation(s)
- Mahtab Karami
- Clinical Research Development Center of Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Health Information Technology and Management, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasrin Hafizi
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Ali-Mohammad Nickfarjam
- Health Information Management Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Health Information Technology and Management, School of Allied-Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Soheila Refahi
- Department of Medical Physics, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
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2
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Madden C, Lydon S, Murphy AW, O'Connor P. Patients' perception of safety climate in Irish general practice: a cross-sectional study. BMC FAMILY PRACTICE 2021; 22:257. [PMID: 34961484 PMCID: PMC8710927 DOI: 10.1186/s12875-021-01603-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Although patients have the potential to provide important information on patient safety, considerably fewer patient-report measures of safety climate (SC) have been applied in the primary care setting as compared to secondary care. Our aim was to examine the application of a patient-report measure of safety climate in an Irish population to understand patient perceptions of safety in general practice and identify potential areas for improvement. Specifically, our research questions were: 1. What are patients' perceptions of SC in Irish general practice? 2. Do patient risk factors impact perceptions of SC? 3. Do patient responses to an open-ended question about safety enhance our understanding of patient safety beyond that obtained from a quantitative measure of SC? METHODS The Patient Perspective of Safety in General Practice (PPS-GP) survey was distributed to primary care patients in Ireland. The survey consisted of both Likert-response items, and free-text entry questions in relation to the safety of care. A series of five separate hierarchical regressions were used to examine the relationship between a range of patient-related variables and each of the survey subscales. A deductive content analysis approach was used to code the free-text responses. RESULTS A total of 584 completed online and paper surveys were received. Respondents generally had positive perceptions of safety across all five SC subscales of the PPS-GP. Regarding patient risk factors, younger age and being of non-Irish nationality were consistently associated with more negative SC perceptions. Analysis of the free-text responses revealed considerably poorer patient perceptions (n = 85, 65.4%) of the safety experience in primary care. CONCLUSION Our findings indicate that despite being under-utilised, patients' perceptions are a valuable source of information for measuring SC, with promising implications for safety improvement in general practice. Further consideration should be given to how best to utilise this data in order to improve safety in primary care.
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Affiliation(s)
- Caoimhe Madden
- Department of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Lower Newcastle, Galway, Ireland.
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland.
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Andrew W Murphy
- Department of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Lower Newcastle, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Lower Newcastle, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
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3
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O'Connor P, Madden C, O'Dowd E, Byrne D, Lydon S. A meta-review of methods of measuring and monitoring safety in primary care. Int J Qual Health Care 2021; 33:6353929. [PMID: 34405231 PMCID: PMC8397923 DOI: 10.1093/intqhc/mzab117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 01/01/2023] Open
Abstract
Background A major barrier to safety improvement in primary care is a lack of safety data. The aims of this systematic meta-review (registration: CRD42021224367) were to identify systematic reviews of studies that examine methods of measuring and monitoring safety in primary care; classify the methods of measuring and monitoring safety in the included systematic reviews using the five safety domains of Vincent et al.’s framework and use this information to make recommendations for improving the measurement and monitoring of safety in primary care. Methods Four databases (Medline, Academic Search Complete, Web of Science and CINAHL) and the grey literature were screened in November 2020, with searches updated in January 2021. Systematic reviews were included if they addressed the measurement of patient safety in primary care and were published in English. Studies were assessed using the Critical Appraisal Skills Programme for systematic reviews. Results A total of 6904 papers were screened, with 13 systematic reviews included. A commonly reported method of measuring ‘past harm’ was through patient record review. The most frequent methods for assessing the ‘reliability of safety critical processes’ were checklists, observations and surveys of staff. Methods used to assess ‘sensitivity to operations’ included observation, staff surveys, interviews, focus groups, active monitoring and simulated patients. Safety climate surveys were a commonly used as an approach to assess ‘anticipation and preparedness’. A number of the reviews concluded that safety data could, and should, be used for ‘integration and learning’. The main limitation of the meta-review was that it was of systematic reviews only. Conclusions Many of the methods for measuring and monitoring safety are readily available, quick to administer, do not require external involvement and are inexpensive. However, there is still a need to improve the psychometric properties of many measures. Researchers must support the development of psychometrically sound safety measures that do not over burden primary care practitioners. Policymakers must consider how primary care practitioners can be supported to implement these measures.
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Affiliation(s)
- Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland
| | - Caoimhe Madden
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland
| | - Emily O'Dowd
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland.,School of Medicine, National University of Ireland Galway, Co Galway H91 TK33, Ireland
| | - SinÉad Lydon
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland
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4
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Lydon S, Cupples ME, Murphy AW, Hart N, O'Connor P. A Systematic Review of Measurement Tools for the Proactive Assessment of Patient Safety in General Practice. J Patient Saf 2021; 17:e406-e412. [PMID: 28376058 DOI: 10.1097/pts.0000000000000350] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary care physicians have reported a difficulty in understanding how best to measure and improve patient safety in their practices. OBJECTIVES The aims of the study were to identify measures of patient safety suitable for use in primary care and to provide guidance on proactively monitoring and measuring safety. METHODS Searches were conducted using Medline, Embase, CINAHL and PsycInfo in February 2016. Studies that used a measure assessing levels of or attitudes toward patient safety in primary care were considered for inclusion. Only studies describing tools focused on the proactive assessment of safety were reviewed. Two independent reviewers extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs. RESULTS More than 2800 studies were screened, of which 56 were included. Most studies had used healthcare staff survey or interviews to assess patient safety (n = 34), followed by patient chart audit (n = 14) or use of a practice assessment checklist (n = 7). Survey or interview of patients, active monitoring systems, and simulated patients were used with less frequency. CONCLUSIONS A lack of appropriate measurement tools has been suggested to limit the ability to monitor patient safety in primary care and to improve patient care. There is no evident "best" method of measuring patient safety in primary care. However, many of the measures are readily available, quick to administer, do not require external involvement, and are inexpensive. This synthesis of the literature suggests that it is possible for primary care physicians to take a proactive approach to measuring and improving safety.
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Affiliation(s)
| | | | | | - Nigel Hart
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
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5
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Continuous, risk-based, consultation peer review in out-of-hours general practice: a qualitative interview study of the benefits and limitations. Br J Gen Pract 2021; 71:e797-e805. [PMID: 33979302 PMCID: PMC8366781 DOI: 10.3399/bjgp.2021.0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/26/2021] [Indexed: 12/21/2022] Open
Abstract
Background Systems to detect and minimise unwarranted variation in clinician practice are crucial to ensure increasingly multidisciplinary healthcare workforces are supported to practise to their full potential. Such systems are limited in English general practice settings, with implications for the efficiency and safety of care. Aim To evaluate the benefits and limitations of a continuous, risk-based, consultation peer-review system used for 10 years by an out-of-hours general practice service in Bristol, UK. Design and setting A qualitative study in South West England. Method Semi-structured interviews with intervention users (clinicians, peer reviewers, and clinical management), analysed by inductive thematic analysis and integrated into a programme theory. Results Twenty clinicians were interviewed between September 2018 and January 2019. Interviewees indicated that the intervention supported clinician learning through improved peer feedback, highlighting learning needs and validating practice. It was compared favourably with existing structures of ensuring clinician competence, supporting standardisation of supervision, clinical governance, and learning culture. These benefits were potentially limited by intervention factors such as differential feedback quality between clinician groups, the efficiency of methods to identify learning needs, and limitations of assessments based on written clinical notes. Contextual factors such as clinician experience, motivation, and organisational learning culture influenced the perception of the intervention as a support or a stressor. Conclusion The findings demonstrate the potential of continuous, risk-based, consultation peer review to support clinicians in an increasingly multidisciplinary general practice workforce to efficiently and safely practise to their full potential. The programme theory provides a theoretical basis to maximise the benefits and accommodate the potential limitations of this methodology
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6
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O'Dowd E, Lydon S, Madden C, O'Connor P. A systematic review of patient complaints about general practice. Fam Pract 2020; 37:297-305. [PMID: 31742596 DOI: 10.1093/fampra/cmz082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Health care complaints are an underutilized resource for quality and safety improvement. Most research on health care complaints is focused on secondary care. However, there is also a need to consider patient safety in general practice, and complaints could inform quality and safety improvement. OBJECTIVE This review aimed to synthesize the extant research on complaints in general practice. METHODS Five electronic databases were searched: Medline, Web of Science, CINAHL, PsycINFO and Academic Search Complete. Peer-reviewed studies describing the content, impact of and motivation for complaints were included and data extracted. Framework synthesis was conducted using the Healthcare Complaints Analysis Tool (HCAT) as an organizing framework. Methodological quality was appraised using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). RESULTS The search identified 2960 records, with 21 studies meeting inclusion criteria. Methodological quality was found to be variable. The contents of complaints were classified using the HCAT, with 126 complaints (54%) classified in the Clinical domain, 55 (23%) classified as Management and 54 (23%) classified as Relationships. Motivations identified for making complaints included quality improvement for other patients and monetary compensation. Complaints had both positive and negative impacts on individuals and systems involved. CONCLUSION This review highlighted the high proportion of clinical complaints in general practice compared to secondary care, patients' motivations for making complaints and the positive and negative impacts that complaints can have on health care systems. Future research focused on the reliable coding of complaints and their use to improve quality and safety in general practice is required.
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Affiliation(s)
- Emily O'Dowd
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Caoimhe Madden
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
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Williams SP, Panigyraki A, Purkayastha S, Chaturvedi S, Benn J, Darzi A. Defining a Healthy Organisation in Primary Care: A Qualitative Interview Study. Hosp Top 2020; 98:68-79. [PMID: 32568622 DOI: 10.1080/00185868.2020.1778590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aimed to qualitatively develop a conceptual framework for organizational health, within the setting of GP practices in the UK, through a qualitative interview study utilizing aspects from grounded theory. Data saturation was reached after 33 interviews revealing six themes: Strategy, Resources, Leadership, Staff Wellbeing, Capacity for change and Ways of working. The structure of each theme is discussed in detail. By unpicking the elements of organizational health in GP practices in this way, we hope to shift focus from considering down-stream clinical outcomes in isolation to practices taking a more long-term view centered around fostering ongoing high performance.
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Affiliation(s)
- Stephen P Williams
- Department of Surgery and Cancer, St Mary's Campus, Imperial College London, London, UK
| | | | - Sanjay Purkayastha
- Department of Surgery and Cancer, St Mary's Campus, Imperial College London, London, UK
| | | | - Jonathan Benn
- Department of Surgery and Cancer, St Mary's Campus, Imperial College London, London, UK
| | - Ara Darzi
- Department of Surgery and Cancer, St Mary's Campus, Imperial College London, London, UK
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9
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Curran C, Lydon S, Kelly ME, Murphy AW, O'Connor P. An analysis of general practitioners' perspectives on patient safety incidents using critical incident technique interviews. Fam Pract 2019; 36:736-742. [PMID: 30926981 DOI: 10.1093/fampra/cmz012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND General practitioners report difficulty in knowing how to improve patient safety. OBJECTIVES To analyse general practitioners' perspectives of contributing factors to patient safety incidents by collecting accounts of incidents, identifying the contributory factors to these incidents, assessing the impact and likelihood of occurrence of these incidents and examining whether certain categories of contributory factors were associated with the occurrence of high-risk incidents. METHODS Critical incident technique interviews were carried out with 30 general practitioners in Ireland about a patient safety incident they had experienced. The Yorkshire Contributory Factors Framework was used to classify the contributory factors to incidents. Seven subject matter experts rated the impact and likelihood of occurrence of each incident. RESULTS A total of 26 interviews were analysed. Almost two-thirds of the patient safety incidents were rated as having a major-to-extreme impact on the patient, and over a third were judged as having at least a bimonthly likelihood of occurrence. The most commonly described active failures were 'Medication Error' (34.6%) and 'Diagnostic Error' (30.8%). 'Situational Domain' was identified as a contributory domain in all patient safety incidents. 'Communication' breakdown at both practice and other healthcare-provider interfaces (69.2%) was also a commonly cited contributory factor. There were no significant differences in the levels of risk associated with the contributory factors. CONCLUSIONS Critical incident technique interviews support the identification of contributory factors to patient safety incidents. There is a need to explore the use of the resulting data for quality and safety improvement in general practice.
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Affiliation(s)
- Ciara Curran
- Department of General Practice, School of Medicine, Ireland.,Irish Centre for Applied Patient Safety and Simulation, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, Ireland.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | | | - Paul O'Connor
- Department of General Practice, School of Medicine, Ireland.,Irish Centre for Applied Patient Safety and Simulation, Ireland
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10
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Meurk C, Harris M, Wright E, Reavley N, Scheurer R, Bassilios B, Salom C, Pirkis J. Systems levers for commissioning primary mental healthcare: a rapid review. Aust J Prim Health 2019; 24:29-53. [PMID: 29338836 DOI: 10.1071/py17030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/23/2017] [Indexed: 11/23/2022]
Abstract
Primary Health Networks (PHNs) are a new institution for health systems management in the Australian healthcare system. PHNs will play a key role in mental health reform through planning and commissioning primary mental health services at a regional level, specifically adopting a stepped care approach. Selected PHNs are also trialling a healthcare homes approach. Little is known about the systems levers that could be applied by PHNs to achieve these aims. A rapid review of academic and grey literature published between 2006 and 2016 was undertaken to describe the use of systems levers in commissioning primary care services. Fifty-six documents met the inclusion criteria, including twelve specific to primary mental healthcare. Twenty-six levers were identified. Referral management, contracts and tendering processes, and health information systems were identified as useful levers for implementing stepped care approaches. Location, enrolment, capitation and health information systems were identified as useful in implementing a healthcare homes approach. Other levers were relevant to overall health system functioning. Further work is needed to develop a robust evidence-base for systems levers. PHNs can facilitate this by documenting and evaluating the levers that they deploy, and making their findings available to researchers and other commissioning bodies.
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Affiliation(s)
- Carla Meurk
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Meredith Harris
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Eryn Wright
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Nicola Reavley
- The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia
| | - Roman Scheurer
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Bridget Bassilios
- The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia
| | - Caroline Salom
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, Qld 4108, Australia
| | - Jane Pirkis
- The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia
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Madden C, Lydon S, Cupples ME, Hart ND, Curran C, Murphy AW, O’Connor P. Safety in primary care (SAP-C): a randomised, controlled feasibility study in two different healthcare systems. BMC FAMILY PRACTICE 2019; 20:22. [PMID: 30700257 PMCID: PMC6352328 DOI: 10.1186/s12875-019-0909-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 01/16/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patient safety research is conducted predominantly in hospital settings, with a dearth of insight from primary care, despite suggestions that 2.2% of primary care consultations result in a patient safety incident. This study aimed to assess the feasibility of an intervention intended to improve patient safety in general practice. METHODS A randomised controlled feasibility study was conducted with general practices in the Republic of Ireland (N = 9) and Northern Ireland (N = 2), randomly assigned to the intervention (N = 5) or control (N = 6) group. The nine-month intervention consisted of: 1) repeated safety climate (SC) measurement (using GP-SafeQuest questionnaire) and feedback (comparative anonymised practice-level SC data), and 2) patient record reviews using a specialised trigger tool to identify instances of undetected patient harm. For control practices, SC was measured at baseline and study end only. The intervention's perceived usefulness and feasibility were explored via an end-of-study questionnaire and semi-structured interviews. RESULTS Thirteen practices were invited; 11 participated; 10 completed the study. At baseline, 84.8% of intervention practice staff (39/46) and 77.8% (42/54) of control practice staff completed the SC questionnaire; at the study terminus, 78.3% (36/46) of intervention practice staff and 68.5% (37/54) of control practice staff did so. Changes in SC scores, indicating improvement, were observed among the intervention practices but not in the control group. The trigger tool was applied to 188 patient records; patient safety incidents of varying severity were detected in 19.1% (36/188). Overall, 59% of intervention practice team members completed the end-of-study questionnaire, with the majority in both healthcare systems responding positively about the intervention. Interviews (N = 9) identified the intervention's usefulness in informing practice management and patient safety issues, time as a barrier to its use, and the value of group discussion of feedback. CONCLUSION This feasibility study suggests that a definitive randomised controlled trial of the intervention is warranted. Our findings suggest that the intervention is feasible, useful, and sustainable. Practices were willing to be recruited into the study, response and retention rates were acceptable, and there is possible evidence of a positive effect of the intervention. TRIAL REGISTRATION The trial registration number is: ISRCTN11426121 (retrospectively registered 12th June 2018).
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Affiliation(s)
- Caoimhe Madden
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway, Galway, Ireland
| | - Margaret E. Cupples
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- Centre for Public Health, School of Medicine, Dentristry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Nigel D. Hart
- Centre for Medical Education, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ciara Curran
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway, Galway, Ireland
| | - Andrew W. Murphy
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Paul O’Connor
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway, Galway, Ireland
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12
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Madden C, Lydon S, Curran C, Murphy AW, O'Connor P. Potential value of patient record review to assess and improve patient safety in general practice: A systematic review. Eur J Gen Pract 2019; 24:192-201. [PMID: 30112925 PMCID: PMC6104614 DOI: 10.1080/13814788.2018.1491963] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: There is limited research, and guidance, on how to address safety in general practice proactively. Objectives: This review aimed to synthesize the literature describing the use of patient record review (PRR) to measure and improve patient safety in primary care. The PRR methodologies utilized and the resulting outcomes were examined. Methods: Searches were conducted using Medline, Embase, CINAHL and PsycINFO in February 2017. Reference lists of included studies and existing review papers were also screened. English language, peer-reviewed studies that utilized PRR to identify patient safety incidents (PSIs) occurring in general practice were included. Two researchers independently extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs. Results: A total of 3265 studies were screened, with 15 included. Trigger tools were the most frequent method used for the PRRs (n = 6). The mean number of safety incidents per 100 records was 12.6. Within studies, a mean of 30.6% of incidents were associated with severe harm (range 8.6–50%), and a mean of 55.6% of incidents was considered preventable (range 32.7–93.5%). The most commonly identified types of PSIs related to medication and prescribing, diagnosis, communication and treatment. Three studies reported on improvement actions taken after the PRRs. Conclusion: This review suggests that PRR may be a promising means of proactively identifying patient safety incidents and informing improvements.
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Affiliation(s)
- Caoimhe Madden
- a Department of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b HRB Primary Care Clinical Trials Network Ireland , National University of Ireland Galway , Galway , Ireland
| | - Sinéad Lydon
- c School of Medicine , National University of Ireland Galway , Galway , Ireland
| | - Ciara Curran
- a Department of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland
| | - Andrew W Murphy
- a Department of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b HRB Primary Care Clinical Trials Network Ireland , National University of Ireland Galway , Galway , Ireland
| | - Paul O'Connor
- a Department of General Practice, School of Medicine , National University of Ireland Galway , Galway , Ireland.,b HRB Primary Care Clinical Trials Network Ireland , National University of Ireland Galway , Galway , Ireland
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13
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Abdulah R, Insani WN, Destiani DP, Rohmaniasari N, Mohenathas ND, Barliana MI. Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities. Ther Clin Risk Manag 2018; 14:1591-1597. [PMID: 30233194 PMCID: PMC6129028 DOI: 10.2147/tcrm.s170475] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The geriatric population is particularly vulnerable to being prescribed potentially inappropriate medication (PIM); however, the prevalence of this occurrence remains poorly investigated in Indonesia. Thus in this research, we focused on investigating the prevalence and predictors of PIM among the Indonesian geriatric population in a primary health care setting. Methods A retrospective observational study was conducted in 25 primary health care facilities in Karawang District, Indonesia. The medical prescriptions of patients aged ≥60 years during January–December 2014 were documented, and the PIM was assessed based on Beers and McLeod criteria. The influence of age, sex, number of diseases, and polypharmacy toward PIM was assessed using a logistic regression model. A P-value of <0.05 defined statistical significance. Results A total of 3,819 subjects were included in the study. PIM was highly prevalent (52.2%) among the Indonesian elderly. Chlorpheniramine, mefenamic acid, ibuprofen, and nifedipine were the most commonly prescribed PIM. Polypharmacy (odds ratio: 1.2 [0.6, 2.1]) was the only factor associated with the use of PIM, while sex, age, and multiple diseases did not show significant association. Conclusion PIM is a concern in the Indonesian geriatric population. Health care professionals are encouraged to review the medications of their geriatric patients using updated safety guidelines to prevent risks associated with PIM.
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Affiliation(s)
- Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Widya N Insani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Dika P Destiani
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Nurul Rohmaniasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Nithya D Mohenathas
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia,
| | - Melisa I Barliana
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
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14
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Panagioti M, Blakeman T, Hann M, Bower P. Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study. BMJ Open 2017; 7:e013524. [PMID: 28559454 PMCID: PMC5729978 DOI: 10.1136/bmjopen-2016-013524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions. METHODS The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents. RESULTS Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97). CONCLUSIONS We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents.
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Affiliation(s)
- Maria Panagioti
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Mark Hann
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, UK
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15
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Lydon S, Cupples ME, Hart N, Murphy AW, Faherty A, O'Connor P. The safety climate in primary care (SAP-C) study: study protocol for a randomised controlled feasibility study. Pilot Feasibility Stud 2016; 2:56. [PMID: 27965872 PMCID: PMC5154125 DOI: 10.1186/s40814-016-0096-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Research on patient safety has focused largely on secondary care settings, and there is a dearth of knowledge relating to safety culture or climate, and safety climate improvement strategies, in the context of primary care. This is problematic given the high rates of usage of primary care services and the myriad of opportunities for clinical errors daily. The current research programme aimed to assess the effectiveness of an intervention derived from the Scottish Patient Safety Programme in Primary Care. The intervention consists of safety climate measurement and feedback and patient chart audit using the trigger review method. The purpose of this paper is to describe the background to this research and to present the methodology of this feasibility study in preparation for a future definitive RCT. Methods The SAP-C study is a feasibility study employing a randomised controlled pretest-posttest design that will be conducted in 10 general practices in the Republic of Ireland and Northern Ireland. Five practices will receive the safety climate intervention over a 9-month period. The five practices in the control group will continue care as usual but will complete the GP-SafeQuest safety climate questionnaire at baseline (month 1) and at the terminus of the intervention (month 9). The outcomes of the study include process evaluation metrics (i.e. rates of participant recruitment and retention, rates of completion of safety climate measures, qualitative data regarding participants’ perceptions of the intervention’s potential efficacy, acceptability, and sustainability), patient safety culture in intervention and control group practices at posttest, and instances of undetected patient harm identified through patient chart audit using the trigger review method. Discussion The planned study investigates an intervention to improve safety climate in Irish primary care settings. The resulting data may inform our knowledge of the frequency of undetected patient safety incidents in primary care, may contribute to improved patient safety practices in primary care settings, and may inform future research on patient safety improvement initiatives. Electronic supplementary material The online version of this article (doi:10.1186/s40814-016-0096-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sinéad Lydon
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Margaret E Cupples
- Department of General Practice and Primary Care, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK ; UKCRC Centre of Excellence for Public Health Research (NI), Queen's University, Belfast, UK
| | - Nigel Hart
- Department of General Practice and Primary Care, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Aileen Faherty
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Paul O'Connor
- Discipline of General Practice, National University of Ireland, Galway, Ireland
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