Incidence and preventability of adverse events in adult patients admitted to a Brazilian teaching hospital

Development of entrustable professional activities for novice nurses: A modified Delphi study

AIM

This study aimed to develop a tailored EPA framework for novice nurses to support their integration and performance in hospital settings.

BACKGROUND

Novice nurses often struggle with the transition from education to practice due to the gap between theoretical knowledge and practical skills. EPAs help bridge this gap by defining and assessing key competencies, but a framework specific to novice nurses is needed to address their unique challenges.

DESIGN

A modified Delphi method was used.

METHODS

Conducted from October 2023 to March 2024, the study followed a four-stage process: team formation, identification, revision and evaluation of EPAs. Initial EPAs were identified through literature reviews, clinical guidelines and focus groups, then refined using the EQual rubric. Two Delphi rounds were conducted for validation. Experts rated the importance of EPAs in the first round, followed by online discussions, with the second round focusing on dimensions including Focus, Observable, Realistic, Generalizable and Multiple competencies.

RESULTS

The final framework included 12 EPAs: 1) Manage Admission and Discharge, 2) Provide Basic Care, 3) Collect Specimens, 4) Administer Medications, 5) Perform Non- Medication Therapies, 6) Monitor Conditions, 7) Respond to Emergencies, 8) Educate Patients, 9) Prevent Adverse Events, 10) Conduct Handovers, 11) Document Care and 12) Operate Equipment.

CONCLUSION

This EPA framework integrates theory and practice to improve training and assessment. Future research should focus on its implementation and refinement in diverse clinical settings to ensure broader applicability.

Identification of risk factors for adverse drug events in a general hospital

Adverse events (AEs), and particularly adverse drug events (ADEs), represent a health problem as they can cause permanent damage or death. Understanding the frequency, location, and causes of ADEs can prevent harm to patients. The Global Trigger Tool, produced by the Institute for Healthcare Improvement (GTT/IHI), is widely used to identify AEs. Recognizing the profile of patients who suffer ADEs can reveal clinical or individual characteristics that predispose to the occurrence of AEs. A cross-sectional study was carried out through a retrospective analysis of 120 medical charts of patients discharged from hospital between October 2020 and April 2021. Patients over 18 years old, with a length of stay of more than 24 h, were included. The list of triggers used was from the medication module of the GTT/IHI, which was adapted for use in the institution. Two primary reviewers and a medical reviewer applied this tool. The primary reviewers independently assessed the randomized charts. A meeting to achieve consensus among the reviewers was held every 2 weeks to validate the identified ADEs; classifications were based on harm severity. Multivariate logistic regression was utilized to assess the variables that predicted the occurrence of ADEs, using the backward stepwise method. A total of 43 ADEs were identified, with a frequency of 36 per 100 admissions (43/120). Of these, five ADEs (12%) were responsible for patients being admitted to hospital. In the case of in-hospital ADEs, there were 42.2 per 1000 patients/day. The clinical manifestation of altered kidney function (16%) and the anatomical drug group of the nervous system (33%) were the most frequent ADEs. The multivariate logistic regression model was significant (×2 = 44.960, P < .001), indicating that factors such as: known drug allergy [odds ratio 5.728; 95% confidence interval (CI): 1.249, 26.274, P = .025]; being clinically hospitalized (odds ratio 7.504; 95% CI: 1.654, 34.037; P = .009); number of medicines used (odds ratio 1.100; 95% CI: 1.054, 1.148; P < .001); and being under the care of internal medicine (odds ratio 3.633; 95% CI: 1.257, 10.511; P = .017) were predictor variables associated with the occurrence of ADEs. A significant percentage of hospitalized patients experienced at least one ADE, with rates surpassing those found in similar studies. The GTT/IHI effectively assessed medication-related harm, emphasizing the need for tailored triggers based on population characteristics. Predictor variables can inform preventive strategies. Overall, the tool facilitated a localized risk assessment of medication use.

Validation in the Greek Language of the Patients' Perception of the Surgical Safety Questionnaire

Introduction Adverse events in the operating room are considered unintended injuries or harm caused by healthcare rather than the patient's disease, leading to death, disability, or prolonged hospital stays. Methods A cross-sectional design was conducted following the random sampling method, on 200 surgical patients. A self-completed questionnaire was used, translated, and adapted into the Greek language. Results Most of the sample (57%) was male. The mean age was 67 years, and 52% were elementary school graduates. Upon analysis, significant correlations were observed between the two-administration (p<0.001) facts (intraclass correlation coefficient = 0.567), which reveal that the scale is stable through time. In addition, Cronbach's alpha had a value of 0.824 suggesting good internal consistency of the scale. Regarding the subscale, the first factor "safety regarding surgical procedure" was found 0.847, the second factor "effective communication and understanding" was 0.792, and finally the third factor "emotional security" was 0.506. A statistically significant difference found between the dimensions of safety in the operating room and the age of the patients was in the factor of emotional security, revealing that patients aged more than 70 were feeling more secure compared to younger patients (198) = 2.374, p=0.019. Conclusions The internal consistency of the Patients' Perspectives of Surgical Safety Scale (PPSS), weighted in a sample of the Greek population, is deemed satisfactory. The safety perceptions of surgical patients are at high levels.

Perceptions of Clinical Adverse Event Reporting by Nurses and Midwives

The level of safety in healthcare units is mainly characterized by the occurrence of medical adverse events. The aim of the study was to present the experiences of reporting clinical adverse events and the perceptions of nurses working in internal medicine wards, surgical wards and midwives on these issues. The cross-sectional survey was conducted from October 2022 to April 2023. The study used the Author's Survey Questionnaire and sampling by assessment was applied. The study included nurses working in internal medicine wards and surgical wards as well as midwives at nine hospitals in a large provincial city in Poland, amounting to 745 participants. A one-way analysis of variance ANOVA and a post-hoc test (Fisher's NIR) were used. The significance level (p) did not exceed 0.05. Nurses working in surgical wards, internal medicine wards and midwives thought that clinical adverse events should be reported, and perceived this as an important and useful activity in ensuring patient safety. The most common adverse events reported by respondents were falls F(2.742) = 52.07; p = 0.001, bedsores F(2.742) = 19.62; p = 0.001, patient disappearances F(2.742) = 3.98; p = 0.019, and hospital-acquired infections F(2.742) = 3.88; p = 0.021. The most frequently selected factors influencing the abandonment of adverse event reporting were excessively complex paperwork, no or little harm to the patient or a fear of the negative consequences. The study suggests that an important way to overcome the barriers to nurses and midwives reporting adverse events would be to create a supportive atmosphere in which they could report errors and the reasons for them honestly and without fear, and to improve the way adverse events are reported at the personal and institutional levels.

Moral Resilience Reduces Levels of Quiet Quitting, Job Burnout, and Turnover Intention among Nurses: Evidence in the Post COVID-19 Era

The aim of the study was to examine the impact of moral resilience on quiet quitting, job burnout, and turnover intention among nurses. A cross-sectional study was implemented in Greece in November 2023. The revised Rushton Moral Resilience Scale was used to measure moral resilience among nurses, the Quiet Quitting Scale to measure levels of quiet quitting, and the single-item burnout measure to measure job burnout. Moreover, a valid six-point Likert scale was used to measure turnover intention. All multivariable models were adjusted for the following confounders: gender, age, understaffed department, shift work, and work experience. The multivariable analysis identified a negative relationship between moral resilience and quiet quitting, job burnout, and turnover intention. In particular, we found that increased response to moral adversity and increased moral efficacy were associated with decreased detachment score, lack of initiative score, and lack of motivation score. Additionally, personal integrity was associated with reduced detachment score, while relational integrity was associated with reduced detachment score, and lack of initiative score. Moreover, response to moral adversity was associated with reduced job burnout. Also, increased levels of response to moral adversity were associated with lower probability of turnover intention. Moral resilience can be an essential protective factor against high levels of quiet quitting, job burnout, and turnover intention among nurses. This study was not registered.

Occurrence and preventability of adverse events in hospitals: a retrospective study

OBJECTIVES

to analyze the incidence of preventable adverse events related to health care in adult patients admitted to public hospitals in Brazil.

METHODS

observational, analytical, retrospective study based on medical records review.

RESULTS

medical records from 370 patients were evaluated, 58 of whom had at least one adverse event. The incidence of adverse events corresponded to 15.7%. Adverse events were predominantly related to healthcare-related infection (47.1%) and procedures (24.5%). Regarding the adverse event severity, 13.7% were considered mild, 51.0% moderate, and 35.3% severe. 99% of adverse events were classified as preventable. Patients admitted to the emergency room had a 3.73 times higher risk for adverse events.

CONCLUSIONS

this study's results indicate a high incidence of avoidable adverse events and highlight the need for interventions in care practice.

Translation, cross-cultural adaptation and content validation of the Global Trigger Tool surgical module

OBJECTIVE

to translate, cross-culturally adapt and validate the Global Trigger Tool surgical module content for Brazil.

METHOD

this is methodological research, carried out between March/2018 and February/2019, following the steps of translation, synthesis, back-translation, validation by the Delphi technique, pre-test and presentation to developers. Two translators, two back-translators, six professionals participated in the expert committee. A pre-test was carried out with a retrospective analysis of 244 medical records of adult patients. The content validity index and Cronbach's alpha were determined for data analysis.

RESULTS

the translation and cross-cultural adaptation allowed adjustments of items for use in Brazil. The mean Content Validity Index was 1.38, and the degree of agreement among experts was 92.4%. Cronbach's alpha was 0.83 for the 11 surgical triggers and their guidelines.

CONCLUSION

the module was translated, cross-culturally adapted for Brazil, with high reliability to identify surgical adverse events.

Tradução, adaptação transcultural e validação de conteúdo do módulo cirúrgico do Global Trigger Tool

RESUMO Objetivo: traduzir, adaptar transculturalmente e validar o conteúdo do módulo cirúrgico do Global Trigger Tool para o Brasil. Método: pesquisa metodológica, realizada entre março/2018 e fevereiro/2019, seguindo os passos de tradução, síntese, retrotradução, validação pela técnica Delphi, pré-teste e apresentação para os desenvolvedores. Participaram dois tradutores, dois retrotradutores, seis profissionais para o comitê de especialistas. Realizou-se o pré-teste com análise retrospectiva de 244 prontuários de pacientes adultos. Determinou-se o índice de validade de conteúdo e alfa de Cronbach para análise dos dados. Resultados: a tradução e a adaptação transcultural permitiram ajustes dos itens para uso no Brasil. O Índice de Validade de Conteúdo médio foi 1,38, e grau de concordância entre os especialistas, 92,4 %. O alfa de Cronbach foi 0,83 para os 11 triggers cirúrgicos e respectivas orientações. Conclusão: o módulo foi traduzido e adaptado transculturalmente para o Brasil, com alta confiabilidade para identificar eventos adversos cirúrgicos.