Awareness of reporting practices and barriers to incident reporting among nurses

Construction of a Multi-Label Classifier for Extracting Multiple Incident Factors From Medication Incident Reports in Residential Care Facilities: Natural Language Processing Approach

BACKGROUND

Medication safety in residential care facilities is a critical concern, particularly when nonmedical staff provide medication assistance. The complex nature of medication-related incidents in these settings, coupled with the psychological impact on health care providers, underscores the need for effective incident analysis and preventive strategies. A thorough understanding of the root causes, typically through incident-report analysis, is essential for mitigating medication-related incidents.

OBJECTIVE

We aimed to develop and evaluate a multilabel classifier using natural language processing to identify factors contributing to medication-related incidents using incident report descriptions from residential care facilities, with a focus on incidents involving nonmedical staff.

METHODS

We analyzed 2143 incident reports, comprising 7121 sentences, from residential care facilities in Japan between April 1, 2015, and March 31, 2016. The incident factors were annotated using sentences based on an established organizational factor model and previous research findings. The following 9 factors were defined: procedure adherence, medicine, resident, resident family, nonmedical staff, medical staff, team, environment, and organizational management. To assess the label criteria, 2 researchers with relevant medical knowledge annotated a subset of 50 reports; the interannotator agreement was measured using Cohen κ. The entire data set was subsequently annotated by 1 researcher. Multiple labels were assigned to each sentence. A multilabel classifier was developed using deep learning models, including 2 Bidirectional Encoder Representations From Transformers (BERT)-type models (Tohoku-BERT and a University of Tokyo Hospital BERT pretrained with Japanese clinical text: UTH-BERT) and an Efficiently Learning Encoder That Classifies Token Replacements Accurately (ELECTRA), pretrained on Japanese text. Both sentence- and report-level training were performed; the performance was evaluated by the F1-score and exact match accuracy through 5-fold cross-validation.

RESULTS

Among all 7121 sentences, 1167, 694, 2455, 23, 1905, 46, 195, 1104, and 195 included "procedure adherence," "medicine," "resident," "resident family," "nonmedical staff," "medical staff," "team," "environment," and "organizational management," respectively. Owing to limited labels, "resident family" and "medical staff" were omitted from the model development process. The interannotator agreement values were higher than 0.6 for each label. A total of 10, 278, and 1855 reports contained no, 1, and multiple labels, respectively. The models trained using the report data outperformed those trained using sentences, with macro F1-scores of 0.744, 0.675, and 0.735 for Tohoku-BERT, UTH-BERT, and ELECTRA, respectively. The report-trained models also demonstrated better exact match accuracy, with 0.411, 0.389, and 0.399 for Tohoku-BERT, UTH-BERT, and ELECTRA, respectively. Notably, the accuracy was consistent even when the analysis was confined to reports containing multiple labels.

CONCLUSIONS

The multilabel classifier developed in our study demonstrated potential for identifying various factors associated with medication-related incidents using incident reports from residential care facilities. Thus, this classifier can facilitate prompt analysis of incident factors, thereby contributing to risk management and the development of preventive strategies.

Exploring the safety reporting culture among healthcare practitioners in Saudi hospitals: a comprehensive 2022 national study

BACKGROUND

With the rise in medical errors, establishing a strong safety culture and an effective incident reporting system is crucial. As part of the Saudi National Health Transformation Vision of 2030, multiple projects have been initiated to periodically assess healthcare quality measures and ensure a commitment to continuous improvement. Among these is the Hospital Survey on Patient Safety Culture National Project (HSPSC), conducted regularly by the Saudi Patient Safety Center (SPSC). However, comprehensive tools for assessing reporting culture are lacking. Addressing this gap can enhance reporting, efficiency, and health safety.

OBJECTIVE

This paper aims to investigate the reporting practices among healthcare professionals (HCPs) in Saudi Arabian hospitals and examine the relationship between reporting culture domains and other variables such as hospital bed capabilities and HCPs' work positions.

METHODS

The study focuses on measuring the reporting culture-related items measures and employs secondary data analysis using information from the Hospital Survey on Patient Safety Culture conducted by the Saudi Center for Patient Safety in 2022, encompassing hospitals throughout Saudi Arabia. Data incorporated seven items in total: four items related to the Response to Error Domain, two related to the Reporting Patient Safety Events Domain, and one associated with the number of events reported in the past 12 months.

RESULTS

The sample for the analyzed data included 145,657 HCPs from 392 hospitals. The results showed that the average positive response rates for reporting culture-related items were between 50% and 70%. In addition, the research indicated that favorable response rates were relatively higher among managerial and quality/patient safety/risk management staff. In contrast, almost half had not reported any events in the preceding year, and a quarter reported only 1 or 2 events. Pearson correlation analysis demonstrates a strong negative correlation between bed capacity and reporting safety events, response to error, and number of events reported (r = -0.935, -0.920, and - 0.911, respectively; p < 0.05), while a strong positive correlation is observed between reporting safety events and response to error (r = 0.980; p < 0.01).

CONCLUSIONS

Almost 75% of the HCPs reported fewer safety events over the last 12 months, indicating an unexpectedly minimal recorded occurrence variance ranging from 0 to 2 incidents.

The influence of hospital accreditation on nurses' perceptions of patient safety culture

OBJECTIVES

Hospitals' accreditation process is carried out to enhance the quality of hospitals' care and patient safety practices as well. The current study aimed to investigate the influence of hospitals' accreditation on patient safety culture as perceived by Jordanian hospitals among nurses.

METHODS

A descriptive cross-sectional correlational survey was used for the current study, where the data were obtained from 395 nurses by convenient sampling technique who were working in 3 accredited hospitals with 254 nurses, and 3 non-accredited hospitals with 141 nurses, with a response rate of 89%.

RESULTS

The overall patient safety culture was (71.9%). Moreover, the results of the current study revealed that there were no statistically significant differences between the perceptions of nurses in accredited and non-accredited hospitals in terms of perceptions of patient safety culture.

CONCLUSION

The current study will add new knowledge about nurses' perceptions of patient safety culture in both accredited and non-accredited hospitals in Jordan which in turn will provide valid evidence to healthcare stakeholders if the accreditation status positively affects the nurses' perceptions of patient safety culture or not. Continuous evaluation of the accreditation application needs to be carried out to improve healthcare services as well as quality and patient safety.

Knowledge, attitudes, and practices toward Patient Safety among nurses in health centers

OBJECTIVE

To assess knowledge, attitudes, and practices (KAPs) toward patient safety among nurses working at primary and comprehensive health care centers in Jordan; to identify factors that predict KAPs among nurses.

METHODS

A descriptive cross-sectional design was conducted using a convenience sample of 307 primary health care nurses in Jordan. A self-reported questionnaire (KAPs) toward patient safety was distributed to the nurses between August 2022 and October 2022.

RESULTS

The results revealed that the mean score of knowledge was 9.51 out of 11 (SD = 1.35), the mean score of attitudes was 57.66 out of 75 (SD = 9.17), and the mean score of practices was 5.64 out of 8 (SD = 1.72). Where 59% of participants reported good knowledge about patient safety. 61% of participants reported positive attitudes toward patient safety. A significant regression equation was found (R² = 0.073, F= (2.94), p = 0 0.003). Age and having information on patient safety during continuing education were significant predictors of the attitude score (p ≤ 0.05).

CONCLUSION

It is necessary to implement patient safety education programs and training.

Assessment of the organizational factors in incident management practices in healthcare: A tree augmented Naive Bayes model

Despite the exponential transformation occurring in the healthcare industry, operational failures pose significant challenges in the delivery of safe and efficient care. Incident management plays a crucial role in mitigating these challenges; however, it encounters limitations due to organizational factors within complex and dynamic healthcare systems. Further, there are limited studies examining the interdependencies and relative importance of these factors in the context of incident management practices. To address this gap, this study utilized aggregate-level hospital data to explore the influence of organizational factors on incident management practices. Employing a Bayesian Belief Network (BBN) structural learning algorithm, Tree Augmented Naive (TAN), this study assessed the probabilistic relationships, represented graphically, between organizational factors and incident management. Significantly, the model highlighted the critical roles of morale and staff engagement in influencing incident management practices within organizations. This study enhances our understanding of the importance of organizational factors in incident management, providing valuable insights for healthcare managers to effectively prioritize and allocate resources for continuous quality improvement efforts.

Risk Management and Patient Safety in the Artificial Intelligence Era: A Systematic Review

BACKGROUND

Healthcare systems represent complex organizations within which multiple factors (physical environment, human factor, technological devices, quality of care) interconnect to form a dense network whose imbalance is potentially able to compromise patient safety. In this scenario, the need for hospitals to expand reactive and proactive clinical risk management programs is easily understood, and artificial intelligence fits well in this context. This systematic review aims to investigate the state of the art regarding the impact of AI on clinical risk management processes. To simplify the analysis of the review outcomes and to motivate future standardized comparisons with any subsequent studies, the findings of the present review will be grouped according to the possibility of applying AI in the prevention of the different incident type groups as defined by the ICPS.

MATERIALS AND METHODS

On 3 November 2023, a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out using the SCOPUS and Medline (via PubMed) databases. A total of 297 articles were identified. After the selection process, 36 articles were included in the present systematic review.

RESULTS AND DISCUSSION

The studies included in this review allowed for the identification of three main "incident type" domains: clinical process, healthcare-associated infection, and medication. Another relevant application of AI in clinical risk management concerns the topic of incident reporting.

CONCLUSIONS

This review highlighted that AI can be applied transversely in various clinical contexts to enhance patient safety and facilitate the identification of errors. It appears to be a promising tool to improve clinical risk management, although its use requires human supervision and cannot completely replace human skills. To facilitate the analysis of the present review outcome and to enable comparison with future systematic reviews, it was deemed useful to refer to a pre-existing taxonomy for the identification of adverse events. However, the results of the present study highlighted the usefulness of AI not only for risk prevention in clinical practice, but also in improving the use of an essential risk identification tool, which is incident reporting. For this reason, the taxonomy of the areas of application of AI to clinical risk processes should include an additional class relating to risk identification and analysis tools. For this purpose, it was considered convenient to use ICPS classification.

Assessment of the quality of nursing work life and its related factors among critical care nurses

Background

Quality of work life (QWL) refers to the degree to which employees contribute to the organization's goals while also experiencing personal and professional satisfaction. This study conducted to evaluate the quality of nursing work life (QNWL) level and its associated factors among nurses working in critical care units.

Methods

A convenience sample technique among critical care nurses in Jordan by using a cross-sectional, descriptive design. A self-reported questionnaire was used. A Pittsburgh Sleep Quality Index (PSQI), and the Andersson and Lindgren questionnaires scale were used in data collection.

Results

The total mean scores of QNWL were M = 86.17 (SD = 35.12), which is slightly below the expected middle value (87.5). The nurses have a higher psychological relation, M = 18.28 (SD = 8.99), whereas they have the lowest competence development, M = 11.44 (SD = 5.56). There was statistical significance between workplace noise, and workplace sources of noise, quality of sleep and QNWL.

Conclusion

The outcomes also highlighted the significance of undertaking additional interventional research studies in the future in order to identify practical strategies to improve nurses QNWL. As a result, the nursing care given to the patients and their families may be improved.

Metrics Matter

There is limited evidence to substantially describe the state of Patient Safety (PS) in the Philippines.1,2 With most publications reflecting respondent-based assessments of institutional patient safety culture, patient-sensitive and records-based indicators are scarce. 3 Despite the Institute of Medicine’s4 call to action to address preventable errors and the publication of patient safety indicators5 , there has been slow progress in patient safety in the country. The Department of Health’s release of the National Policy on Patient Safety (Administrative Order 2008-0023) 6 and the creation of the National Patient Safety Committee (NPSC) were pivotal in elevating patient safety as priority in Philippine healthcare facilities. The creation of PS committees across hospitals and the mainstreaming of patient safety through campaigns and conferences helped push institution-level research and design programs to reduce events.7,8 The National Policy on Patient Safety in Health Facilities (Administrative Order 2020-0007) 9 presented specific guidelines and strategies for the full implementation of PS programs, including directives on the roles and responsibilities of patient safety officers, strategies to address patient safety issues, and indicators for monitoring. The above national and institutional efforts to promote patient safety strategies are gaining momentum, but without metrics, it is impossible to determine if these initiatives result in real-world changes. Accurate, reliable, and timely patient safety-sensitive indicators feed learning systems. 10,11 Metrics for patient safety allow for accurate analysis that translate to responsive actions to mitigate risks, ensure continuous improvement, monitor progress, and impact patient-, organization-, and health worker-related outcomes. However, the findings of incapacitated patientsafety committees, missing risk management and patient-centered initiatives, and inconsistent reporting systems are highly concerning. While hospitals have complied with the activities stipulated in the national policies, the superficial compliance reflects the lack of investment in patient safety architecture. The committee chairs and members are burdened with competing priorities, leaving them with little time to fulfil their roles in policy development, data analysis, and system improvements. These responsibilities are mere add-ons to their already brimming schedules, and the meager budget, if any, further hinders program implementation and their engagement in essential training. Inadequate time dedicated to engaging in patient safety-focused activities of frontline healthcare personnel 12 could also explain why some patient and direct care indicators receive lower reporting than others like falls, medication errors, adverse drug events, and missed care. Reporting and contributing to learning systems can become a burden for nurses and physicians with inhumane workloads, 13-15 further exacerbating the issue. Inconsistencies in available data can be attributed to the lack of a mature patient safety culture, resulting in reluctance to report indicators. These indicators are often regarded as a reflection of poor performance or incompetence.16,17 Moreover, commendations for low adverse event reports and high patient satisfaction ratings perpetuate the practice of not disclosing an organization’s shortcomings. A reliable baseline that indicates the severity of the situation is crucial for good results to have any significance. Without a balanced system that encourages reporting, feedback, and actionable practice changes, reports will continue to be inconsistent. The study makes sound recommendations to use a unified set of patient safety indicators and protocols for regular measurement, analysis, and improvements integrated into a national reporting system. This system would guide collection, collation, classification, and analysis of patient safety problems that will guide improvements.10 It starts with investing in reliable structures (personnel, funding, policies) and clear processes at the country and facility level. A culture and mindset shift are also essential to optimize patient safety structures and processes that includes a blame-free environment, the practice of enhanced feedback, champions and role models, and education and training 12,18 on core concepts in patient safety and how to analyze data to generate meaningful outcomes. Our goal of establishing a comprehensive patient safety learning system is an arduous and complex undertaking. Achieving a high-reliability learning system necessitates the cultivation of a safety-oriented culture, which takes time to develop. However, implementing a metric for reporting and monitoring patient safety issues in hospitals would be a vital initial step toward this goal. Ultimately, the establishment of a patient safety learning system that addresses the needs of patients and healthcare workers would result in a significant improvement in patient safety outcomes.

Factors affecting the quality of working life among nurses caring for Syrian refugee camps in Jordan

OBJECTIVES

The global refugee crisis, exacerbated by the Syrian war, has placed tremendous strain on Jordan's healthcare system and infrastructure, notably impacting nurses working in refugee camps. The aim to identify factors influencing nurses' Quality of life at work (QWL) and understand their significance in crisis healthcare environments.

METHODOLOGY

A cross-sectional study was conducted in multiple healthcare facilities within Syrian refugee camps. A convenient sample of 166 nurses participated, and data were collected using the Brook's Quality of Nursing Work Life Survey. Data analysis included descriptive and inferential (one-way ANOVA) statistics. Significance level was set at 0.05.

RESULTS

Nurses in this study generally reported a moderate QWL, with an average score of 152.85, indicating that their overall work experience falls into the moderate range. The study found that nurses perceived their work-life/home-life balance (mean score 25.79), work design (mean score 35.71), work context (mean score 71.37), and work world (mean score 19.96) at levels indicative of moderate satisfaction. There were no statistically significant differences in QWL among participating nurses, suggesting that factors other than demographic characteristics may play a more influential role in determining nurses' QWL in the unique context of refugee caregiving.

CONCLUSION

This study underscores that working within refugee healthcare missions and recommends targeted interventions to enhance their well-being.

Perceived Relationship Between Horizontal Violence and Patient Safety Culture Among Nurses

Objective

Despite the value of undertaking patient safety culture, its association with horizontal violence in nursing workplace is still understudied. This study aimed to investigate the association between the perceived patient safety culture and its relationship with horizontal violence among nurses working in Jordan.

Methods

A cross-sectional correlational design was used. Nurses working in major governmental hospitals in Jordan were conveniently recruited to complete an online self-administered questionnaire, which included the following tools: Hospital Survey on Patient Safety Culture and Negative Behaviours in Healthcare (NBHC) Survey. The survey was designed to measure attitudes and perceptions on patient safety culture at multiple levels of a healthcare organization with ten dimensions. The Negative Behaviours in Healthcare (NBHC) survey was developed as an adaptation of the Lateral Violence in Nursing Survey (LVNS) with 25 items and two open-ended questions.

Results

A total of 330 nurses responded to the questionnaire. Nurses moderately perceived patient safety culture (HSOPS mean = 3.5, SD = 1.1). Low incidence of horizontal violence was claimed (mean = 2.1, SD = 1.1). However, it was associated with moderate negative correlation with patient safety culture (r = -0.53, p < 0.001). Regression model revealed that patient safety culture explained an additional 53% of the variance of horizontal violence after controlling the effects of age and length of clinical experience (R-square change: 0.560, SE: 19.7, P: 0.001, CI: 1.21-1.57).

Conclusion

Despite its low incidence, patient safety culture was found influential to the horizontal violence based on the perspectives of nurses in Jordan. Patient safety culture can be incorporated with other factors that contribute to the development of horizontal violence in nursing workplace.