Assessing the patient safety culture and ward error reporting in public sector hospitals of Pakistan

An Overview of Nursing Errors Using the Taxonomy of Error, Root Cause Analysis, and Practice-Responsibility Research Tool

Nursing errors significantly impact patient safety and care quality, necessitating effective error recognition and analysis techniques. The Taxonomy of Error, Root Cause Analysis, and Practice-Responsibility (TERCAP) tool aims to systematically classify and address nursing errors, though its application and usefulness remain uncertain. This systematic review provides an overview of nursing errors using the TERCAP instrument, evaluating its applicability, strengths, and opportunities for improvement. A comprehensive literature search was conducted across databases such as PubMed, CINAHL, and Scopus to identify studies employing the TERCAP tool for nursing error analysis. Inclusion criteria encompassed peer-reviewed articles, studies with quantitative or qualitative data, and English-language publications. Data were extracted and analyzed to assess the tool's validity, reliability, impact on patient outcomes, and integration into clinical practice. The review identified a limited number of studies utilizing the TERCAP instrument, indicating its early stage of implementation. Findings suggest that the TERCAP tool provides a structured approach to error categorization and root cause analysis, potentially benefiting patient safety. However, challenges such as inconsistency in tool use, integration issues with electronic health records, and the need for further validation were noted. Additionally, nurses' perceptions of the tool and training needs emerged as crucial factors influencing its effectiveness. The TERCAP tool shows promise in improving nursing error reporting and analysis. Nonetheless, further research is essential to confirm its reliability, optimize its integration into clinical workflows, and understand its long-term impact on patient outcomes and safety culture. Addressing these gaps will be crucial in harnessing the TERCAP tool's full potential to reduce nursing errors and enhance healthcare quality.

Practices Used to Improve Patient Safety Culture Among Healthcare Professionals in a Tertiary Care Hospital

Introduction

A patient safety culture primarily refers to the values, beliefs, attitudes, and behaviors within a healthcare setup in a community that assists in prioritizing patient safety and encouraging the reporting of errors and near-misses in that facility. There is a direct impact of patient safety culture on how well patient safety and quality improvement programs work. The aim of this cross-sectional descriptive study was to investigate the practices to improve patient safety culture and adverse event reporting practices among healthcare professionals in a tertiary care hospital located in Mirpur Azad Jammu and Kashmir.

Methods

In the non-probability convenience sampling of this cross-sectional study, Divisional Headquarters Teaching Hospital in Mirpur, Azad Kashmir used the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture Hospital Survey to collect data about the perceptions of healthcare professionals regarding patient safety culture within their hospital to assess the trends of patient safety culture by obtaining longitudinal data. A pre-validated questionnaire that has undergone a rigorous trial of testing to maximize the reliability and accuracy of the outcomes was distributed among clinical staff (healthcare professionals who interact with patients on a daily basis, such as nurses, doctors, pharmacists, and laboratory technicians) and administrative staff (medical superintendent, deputy medical superintendent, assistant medical superintendent, heads of departments).

Results

A total of 312 questionnaires were returned (response rate, 76%). The study found that the dimension "supervisor/manager expectation and action promoting safety" had the highest positive response rate (65.16%), and "nonpunitive response" had the lowest (27.4%). Higher scores in "nonpunitive response to error" were associated with lower rates of medication errors, pressure ulcers, and surgical site infections, and higher scores in "frequency of event reporting" were associated with lower rates of medication errors, pressure ulcers, falls, hospital-acquired infections, and urinary tract infections.

Conclusion

We suggest that in order for hospital staff to continue providing excellent, clinically safe treatment, a well-structured hospital culture promoting patient safety is necessary. Moreover, further study is needed to determine strategies to improve patient safety expertise and awareness, and lower the frequency of adverse occurrences.

Measuring the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC)

BACKGROUND

Patient safety is a top priority for many healthcare organisations worldwide. However, most of the initiatives aimed at the measurement and improvement of patient safety culture have been undertaken in developed countries. The purpose of this study was to measure the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC).

METHODS

The HSOPSC was used to measure the patient safety culture across 12 dimensions at Aga Khan University Hospital, Karachi. 2,959 individuals, who had been working at the hospital, were administered the HSOPSC in paper form between June and September 2019.

RESULTS

The response rate of the survey was 50%. In the past 12 months, 979 respondents (33.1%) had submitted at least one event report. Results showed that the personnel viewed the patient safety culture at their hospital favourably. Overall, respondents scored highest in the following dimensions: 'feedback and communication on error' (91%), 'organisational learning and continuous improvement' (85%), 'teamwork within units' (83%), 'teamwork across units' (76%). The dimensions with the lowest positive per cent scores included 'staffing' (40%) and 'non-punitive response to error' (41%). Only the reliability of the 'handoffs and transitions', 'frequency of events reported', 'organisational learning' and 'teamwork within units' was higher than Cronbach's alpha of 0.7. Upon regression analysis of positive responses, physicians and nurses were found to have responded less favourably than the remaining professional groups for most dimensions.

CONCLUSION

The measurement of safety culture is both feasible and informative in developing countries and could be broadly implemented to inform patient safety efforts. Current data suggest that it compares favourably with benchmarks from hospitals in the USA. Like the USA, high staff workload is a significant safety concern among staff. This study lays the foundation for further context-specific research on patient safety culture in developing countries.

Perception of Health Teams on the Implementation of Strategies to Decrease Nursing Errors and Enhance Patient Safety

Background

Patient care is a public health issue all over the world, with nursing errors in hospitals being a significant source of harm to patients and a hindrance to the healthcare system's efficiency.

Purpose

The purpose of this study was to investigate health teams' perceptions of strategies used to reduce nursing error that affects patient safety.

Patients and Methods

A descriptive study was conducted from January to March 2022 at Najran University Hospital and KKH to better understand the issue. The study included 400 healthcare team members, including nurses, physicians, nurse aides, health workers, and others. The data was collected through the analysis of the health team's characteristics, nursing errors, and strategies for error reduction.

Results

The results of the study led to the development of five strategies and 28 interventions aimed at reducing nursing errors. The study revealed that two-thirds of the participants had a high perception of strategies for reducing nursing errors, while one-third had a low perception.

Conclusion

The study highlights the importance of addressing nursing errors in the healthcare system and provides evidence-based strategies and interventions to reduce them. The findings emphasize the need for ongoing efforts to enhance the perception and understanding of healthcare professionals in reducing errors and improving patient care.

A Comparative Analysis of Public Hospital Pharmacy Systems in Norway and Pakistan: A Pilot Implementation of the American Society of Health-System Pharmacists' (ASHP) Guidelines

The objective of the study was to analyze and compare public hospital pharmacy practices in Pakistan and Norway. In addition, the study intended to identify the challenges to improving the public hospital pharmacy system and to propose recommendations that could help reform the practice to enhance patient safety and compliance. A cross-sectional study was conducted to understand public hospital pharmacies' organizational structure and determine their practices in Norway and Pakistan. The results of the research showed differences in 11 main areas of the pharmacy systems of the sampled hospitals. When compared to Norway, the study found that the public hospital pharmacy system in Pakistan could be improved in nine main areas. The results show that hospital pharmacies in Pakistan could benefit from the experience of similar international structures in relation to universal standards and practices.

Exploring Pakistani Physicians' Knowledge and Practices Regarding High Alert Medications: Findings and Implications

Introduction: While many low-middle income countries (LMICs), including Pakistan, try and ensure patient safety within available resources, there are considerable concerns with medication use. Unsafe and inappropriate medication use, especially high alert medications (HAMs), is one of the important factors compromising patient safety and quality of care. Besides economic loss, HAMs contribute to greater morbidity, hospitalization, and mortality. Physicians as key members of the provision of healthcare are expected to be well aware of the administration and regulations surrounding HAMs. However, the current status is unknown in Pakistan. Consequently, the objectives of this study were to evaluate the knowledge of Pakistani physicians about the administration, regulation, and practices related to HAMs. This builds on our recently published study with nurses.

Methods: An online cross-sectional study design was used, and data were gathered from the physicians throughout Pakistan using previously used self-administered questionnaires during a period of 5 months (January 1 to May 30, 2021). All data were entered and analyzed using SPSS 22 for Windows.

Results: Physicians (847) who provided consent were enrolled in the study. Most physicians (62.2%) were male, aged between 25 and 30 years (75.2%) and had 2- to 5-year work experience (50.9%). About 27% were working in the emergency departments. The median (IQR) knowledge score for HAMs administration and regulation was 5 (3) and 5 (2), respectively. About 46.4% of respondents were found to have moderate knowledge about HAMs; increasing age, work experience, and higher qualifications were significantly associated (p < 0.05) with better HAMs knowledge. Around 58% had good practices relating to HAMs during their routine work. Median practice scores increased significantly (p < 0.05) with age, work experience, and postgraduate qualification.

Conclusion: Most Pakistani physicians possess moderate knowledge about HAMs administration and regulations. However, their practices relating to the HAMs administration and regulations are typically sub-optimal. Consequently, HAMs awareness needs to be improved by including course content in the current curriculum, provision of hospital-based continuous training programs about patient safety and care, and establishment of multi-disciplinary health care teams, including board-certified pharmacists and specialized nurses, for the effective execution of medication use process in Pakistani hospitals in the future.

Organizational resilience process: integrated model of safety culture

Purpose

The purpose of the study is to create substantial awareness for safety precautions and safety parameters to lessen occupational injuries and accidents. Utilization of safety culture phenomenon with its fundamental understanding has imperative consideration for safety compliance and participation behaviors. Thoughtful aim of this study is the extension of knowledge related to safety orientation particularly in primary health-care workforce.

Design/methodology/approach

Only slips and trips accounted for 40% of workplace injuries in nursing professionals. To identity, the data were collected through structured surveys from nursing professionals of public and private hospitals in Pakistan. To evaluate that data for current study, standardized regression coefficients (parameter estimation) with 95% confidence interval and 5,000 bootstrap samples were subjected. Confirmatory factor analysis was also used to measure the validity of study constructs.

Findings

The potential findings of present study have assured the presence of safety culture at workplace has potential to influences negative safety outcomes. In addition, safety compliance and safety participation as mediation paths would be the strengthening addition to safety model. These findings have extended the existing understanding of compliance and participation behaviors from single factor to two different constructs of safety orientation. This safety culture model offers an evidence-based approach to nursing practitioners and nursing managers with implications for nurse’s safety, education and training.

Originality/value

Occupational injuries and accidental happenings have adversely affecting the quality of care, patient’s recovery spam, satisfaction level and psychological health in care agents. This study has proposed a comprehensive model for understanding the mechanism of possible and reliable safety implications at health-care units. Prior knowledge has limitation to the inevitable effects of occupational injuries only rather than focusing on corrective actions against this phenomenon.

Perceptions of Patient Safety Culture and Medication Error Reporting among Early- and Mid-Career Female Nurses in South Korea

Reporting medication errors is crucial for improving quality of care and patient safety in acute care settings. To date, little is known about how reporting varies between early and mid-career nurses. Thus, this study used a cross-sectional, secondary data analysis design to investigate the differences between early (under the age of 35) and mid-career (ages 35-54) female nurses by examining their perceptions of patient safety culture using the Korean Hospital Survey on Patient Safety Culture (HSPSC) and single-item self-report measure of medication error reporting. A total of 311 hospital nurses (260 early-career and 51 mid-career nurses) completed questionnaires on perceived patient safety culture and medication error reporting. Early-career nurses had lower levels of perception regarding patient safety culture (p = 0.034) compared to mid-career nurses. A multiple logistic regression analysis showed that relatively short clinical experience (<3 years) and a higher level of perceived patient safety culture increased the rate of appropriate medication error reporting among early-career nurses. However, there was no significant association between perception of patient safety culture and medication error reporting among mid-career nurses. Future studies should investigate the role of positive perception of patient safety culture on reporting errors considering multidimensional aspects, and include hospital contextual factors among early-, mid-, and late-career nurses.

Challenges in providing surgical procedures during the COVID-19 pandemic: Qualitative study among Operating Department Practitioners in Pakistan

The surgical theatre is associated with the highest mortality rates since the onslaught of the COVID-19 pandemic. However, Operating Department Practitioners (ODPs) are neglected human resources for health in regards to both professional development and research for patient safety; even though they are key practitioners with respect to infection control during surgeries. Therefore, this study aims to describe challenges faced by ODPs during the pandemic. The secondary aim is to use empirical evidence to inform the public health sector management about both ODP professional development and improvement in surgical procedures, with a specific focus on pandemics. A qualitative study has been conducted. Data collection was based on an interview guide with open-ended questions. Interviews with 39 ODPs in public sector teaching hospitals of Pakistan who have been working during the COVID-19 pandemic were part of the analysis. Content analysis was used to generate themes. Ten themes related to challenges faced by ODPs in delivering services during the pandemic for securing patient safety were identified: (i) Disparity in training for prevention of COVID-19; (ii) Shortcomings in COVID-19 testing; (iii) Supply shortages of personal protective equipment; (iv) Challenges in maintaining physical distance and prevention protocols; (v) Human resource shortages and role burden; (vi) Problems with hospital administration; (vii) Exclusion and hierarchy; (viii) Teamwork limitations and other communication issues; (ix) Error Management; and (x) Anxiety and fear. The public health sector, in Pakistan and other developing regions, needs to invest in the professional development of ODPs and improve resources and structures for surgical procedures, during pandemics and otherwise.

Assessing Patient Safety Culture in Hospital Settings

The current knowledge about patient safety culture (PSC) in the healthcare industry, as well as the research tools that have been used to evaluate PSC in hospitals, is limited. Such a limitation may hamper current efforts to improve patient safety worldwide. This study provides a systematic review of published research on the perception of PSC in hospitals. The research methods used to survey and evaluate PSC in healthcare settings are also explored. A list of academic databases was searched from 2006 to 2020 to form a comprehensive view of PSC's current applications. The following research instruments have been applied in the past to assess PSC: the Hospital Survey on Patient Safety Culture (HSPSC), the Safety Attitudes Questionnaire (SAQ), the Patient Safety Climate in Health Care Organizations (PSCHO), the Modified Stanford Instrument (MSI-2006), and the Scottish Hospital Safety Questionnaire (SHSQ). Some of the most critical factors that impact the PSC are teamwork and organizational and behavioral learning. Reporting errors and safety awareness, gender and demographics, work experience, and staffing levels have also been identified as essential factors. Therefore, these factors will need to be considered in future work to improve PSC. Finally, the results reveal strong evidence of growing interest among individuals in the healthcare industry to assess hospitals' general patient safety culture.