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Schnipper JL, Raffel KE, Keniston A, Burden M, Glasheen J, Ranji S, Hubbard C, Barish P, Kantor M, Adler-Milstein J, Boscardin WJ, Harrison JD, Dalal AK, Lee T, Auerbach A. Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: A multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients. J Hosp Med 2023; 18:1072-1081. [PMID: 37888951 PMCID: PMC10964432 DOI: 10.1002/jhm.13230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/29/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Few hospitals have built surveillance for diagnostic errors into usual care or used comparative quantitative and qualitative data to understand their diagnostic processes and implement interventions designed to reduce these errors. OBJECTIVES To build surveillance for diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates. METHODS AND ANALYSIS Achieving diagnostic excellence through prevention and teamwork (ADEPT) is a multicenter, real-world quality and safety program utilizing interrupted time-series techniques to evaluate outcomes. Study subjects will be a randomly sampled population of medical patients hospitalized at 16 US hospitals who died, were transferred to intensive care, or had a rapid response during the hospitalization. Surveillance for diagnostic errors will occur on 10 events per month per site using a previously established two-person adjudication process. Concurrent reviews of patients who had a qualifying event in the previous week will allow for surveys of clinicians to better understand contributors to diagnostic error, or conversely, examples of diagnostic excellence, which cannot be gleaned from medical record review alone. With guidance from national experts in quality and safety, sites will report and benchmark diagnostic error rates, share lessons regarding underlying causes, and design, implement, and pilot test interventions using both Safety I and Safety II approaches aimed at patients, providers, and health systems. Safety II approaches will focus on cases where diagnostic error did not occur, applying theories of how people and systems are able to succeed under varying conditions. The primary outcome will be the number of diagnostic errors per patient, using segmented multivariable regression to evaluate change in y-intercept and change in slope after initiation of the program. ETHICS AND DISSEMINATION The study has been approved by the University of California, San Francisco Institutional Review Board (IRB), which is serving as the single IRB. Intervention toolkits and study findings will be disseminated through partners including Vizient, The Joint Commission, and Press-Ganey, and through national meetings, scientific journals, and publications aimed at the general public.
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Affiliation(s)
- Jeffrey L. Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Katie E. Raffel
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Institute for Healthcare Quality, Safety, and Efficiency, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Angela Keniston
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marisha Burden
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jeffrey Glasheen
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Institute for Healthcare Quality, Safety, and Efficiency, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sumant Ranji
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Colin Hubbard
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
| | - Peter Barish
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
| | - Molly Kantor
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research (CLIIR), University of California, San Francisco, California, USA
| | - W. John Boscardin
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - James D. Harrison
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
| | - Anuj K. Dalal
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Tiffany Lee
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
| | - Andrew Auerbach
- Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, California, USA
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Singh H, Mushtaq U, Marinez A, Shahid U, Huebner J, McGaffigan P, Upadhyay DK. Developing the Safer Dx Checklist of Ten Safety Recommendations for Health Care Organizations to Address Diagnostic Errors. Jt Comm J Qual Patient Saf 2022; 48:581-590. [PMID: 36109312 DOI: 10.1016/j.jcjq.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Most health care organizations (HCOs) find diagnostic errors hard to address. The research team developed a checklist (the Safer Dx Checklist) of 10 high-priority safety practices HCOs can use to conduct a proactive risk assessment to address diagnostic error. METHODS First, the team identified potential practices based on reviews of recent literature, reports by national and international organizations, and interviews with quality/safety leaders. Then a Delphi panel was conducted, followed by an online expert panel, to prioritize 10 practices. The prioritization process considered impact on safety and feasibility of practice implementation within a one- to three-year time frame. Finally, cognitive walkthroughs were conducted for a face-validity check with end users. The team also conducted content analysis in each step to look for themes that influenced prioritization or checklist implementation. RESULTS A total of 71 practices for prioritization were identified through the Delphi panel of 28 experts; 65% of participants reached consensus on 28 practices. A multidisciplinary panel of 10 experts helped prioritize and refine the top 10 practices, which were then developed into a checklist paired with implementation guidance. Practices included themes related to creating organizational and leadership accountability for improving diagnosis, including patients in diagnostic safety work, and developing and implementing organizational infrastructure for measurement and improvement activities. Qualitative analysis revealed insights for implementation. End users at three different HCOs helped refine implementation guidance for the checklist. CONCLUSION The researchers identified 10 safety practices to help organizations conduct a proactive, systematic assessment of risks to timely and accurate diagnosis. The Safer Dx Checklist can enable HCOs to begin implementing strategies to address diagnostic error.
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Olin K, Göras C, Nilsson U, Unbeck M, Ehrenberg A, Pukk-Härenstam K, Ekstedt M. Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study. BMJ Open 2022; 12:e052283. [PMID: 35045998 PMCID: PMC8772415 DOI: 10.1136/bmjopen-2021-052283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 01/05/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care. OBJECTIVE To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process. METHODS Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool. RESULTS High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia. CONCLUSION The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.
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Affiliation(s)
- Karolina Olin
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Administration Centre, Tyks and Hospital District of Southwest Finland, Turku, Finland
| | - Camilla Göras
- Faculty of Medicine, School of Education, Health and Social Studies, Örebro University, Orebro, Sweden
- Center for Clinical Research Dalarna, Falun, Sweden
- Department of Anaesthesia and Intensive Care Unit, Falu Hospital, Falun, Sweden
| | - Ulrica Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Maria Unbeck
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Karin Pukk-Härenstam
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Astrid Lindgren's Children's Hospital, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Mirjam Ekstedt
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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Garfield S, Wheeler C, Boucher C, Etkind M, Lloyd J, Norton J, Ogunleye D, Taylor A, Williams M, Grimes T, Kelly D, Franklin BD. Medicines management at home during the COVID-19 pandemic: a qualitative study exploring the UK patient/carer perspective. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:458-464. [PMID: 34343311 PMCID: PMC8436399 DOI: 10.1093/ijpp/riab050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 07/09/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore home medicine practices and safety for people shielding and/or over the age of 70 during the COVID-19 pandemic and to create guidance, from the patient/carer perspective, for enabling safe medicine practices for this population. METHODS Semi-structured interviews were carried out with 50 UK participants who were shielding and/or over the age of 70 and who used medicines for a long-term condition, using telephone or video conferencing. Participants were recruited through personal/professional networks and through patient/carer organisations. Participants were asked about their experiences of managing medicines during the pandemic and how this differed from previous practices. Data were analysed using inductive thematic analysis. KEY FINDINGS Patients' and their families' experiences of managing medicines safely during the pandemic varied greatly. Analysis suggests that this was based on the patient's own agency, the functioning of their medicines system pre-pandemic and their relationships with family, friends, community networks and pharmacy staff. Medicine safety issues reported included omitted doses and less-effective formulations being used. Participants also described experiencing high levels of anxiety related to obtaining medicines, monitoring medicines and feeling at risk of contracting COVID-19 while accessing healthcare services for medicine-related issues. Effects of the pandemic on medicines adherence were reported to be positive by some and negative by others. CONCLUSIONS Pharmacy staff have a key role to play by establishing good relationships with patients and their families, working with prescribers to ensure medicines systems are as joined up as possible, and signposting to community networks that can help with medicines collection.
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Affiliation(s)
- Sara Garfield
- Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK.,UCL School of Pharmacy, London, UK
| | - Carly Wheeler
- Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK
| | - Charles Boucher
- Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK
| | - Mike Etkind
- Imperial College Healthcare NHS Trust, London, UK
| | - Jill Lloyd
- Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK
| | - John Norton
- Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK
| | | | - Alex Taylor
- Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK
| | | | - Tamasine Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland.,ULCaN, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Bryony Dean Franklin
- Imperial College Healthcare NHS Trust, London, UK.,NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, UK.,UCL School of Pharmacy, London, UK
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Bowie P, Baylis D, Price J, Bradshaw P, McNab D, Ker J, Carson-Stevans A, Ross A. Is the 'never event' concept a useful safety management strategy in complex primary healthcare systems? Int J Qual Health Care 2021; 33:25-30. [PMID: 33432982 DOI: 10.1093/intqhc/mzaa101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/11/2020] [Indexed: 11/12/2022] Open
Abstract
WHY IS THE AREA IMPORTANT? A sub-group of rare but serious patient safety incidents, known as 'never events,' is judged to be 'avoidable.' There is growing interest in this concept in international care settings, including UK primary care. However, issues have been raised regarding the well-intentioned coupling of 'preventable harm' with zero tolerance 'never events,' especially around the lack of evidence for such harm ever being totally preventable. WHAT IS ALREADY KNOWN AND GAPS IN KNOWLEDGE? We consider whether the ideal of reducing preventable harm to 'never' is better for patient safety than, for example, the goal of managing risk materializing into harm to 'as low as reasonably practicable,' which is well-established in other complex socio-technical systems and is demonstrably achievable.We reflect on the 'never event' concept in the primary care context specifically, although the issues and the polarized opinion highlighted are widely applicable. Recent developments to validate primary care 'never event' lists are summarized and alternative safety management strategies considered, e.g. Safety-I and Safety-II. FUTURE AREAS FOR ADVANCING RESEARCH AND PRACTICE Despite their rarity, if there is to be a policy focus on 'never events,' then specialist training for key workforce members is necessary to enable examination of the complex system interactions and design issues, which contribute to such events. The 'never event' term is well intentioned but largely aspirational-however, it is important to question prevailing assumptions about how patient safety can be understood and improved by offering alternative ways of thinking about related complexities.
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Affiliation(s)
- Paul Bowie
- Medical Directorate, NHS Education for Scotland, 102 West Port, Edinburgh, Scotland, UK EH3 9DN.,Institute of Health and Wellbeing, University Avenue, University of Glasgow, Scotland, UK G12 8QQ.,Department of Nursing and Midwifery, School of Health and Social Care, Staffordshire University, College Road, Stoke-On-Trent, UK ST4 2DE
| | - Diane Baylis
- Education and Risk Department, Medical Protection Society, (www.medicalprotection.org), 2 Victoria Place, Leeds, England, UK LS11 5AE
| | - Julie Price
- Education and Risk Department, Medical Protection Society, (www.medicalprotection.org), 2 Victoria Place, Leeds, England, UK LS11 5AE
| | - Pallavi Bradshaw
- Education and Risk Department, Medical Protection Society, (www.medicalprotection.org), 2 Victoria Place, Leeds, England, UK LS11 5AE
| | - Duncan McNab
- Medical Directorate, NHS Education for Scotland, 102 West Port, Edinburgh, Scotland, UK EH3 9DN.,Institute of Health and Wellbeing, University Avenue, University of Glasgow, Scotland, UK G12 8QQ
| | - Jean Ker
- Medical Directorate, NHS Education for Scotland, 102 West Port, Edinburgh, Scotland, UK EH3 9DN
| | - Andrew Carson-Stevans
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, Wales, UK CF10 3AT
| | - Alastair Ross
- Dental School, University of Glasgow, 378 Sauchiehall Street, Scotland, UK Glasgow G2 3JZ
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Grimes TC, Garfield S, Kelly D, Cahill J, Cromie S, Wheeler C, Franklin BD. Household medication safety practices during the COVID-19 pandemic: a descriptive qualitative study protocol. BMJ Open 2020; 10:e044441. [PMID: 33234663 PMCID: PMC7688439 DOI: 10.1136/bmjopen-2020-044441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Those who are staying at home and reducing contact with other people during the COVID-19 pandemic are likely to be at greater risk of medication-related problems than the general population. This study aims to explore household medication practices by and for this population, identify practices that benefit or jeopardise medication safety and develop best practice guidance about household medication safety practices during a pandemic, grounded in individual experiences. METHODS AND ANALYSIS This is a descriptive qualitative study using semistructured interviews, by telephone or video call. People who have been advised to 'cocoon'/'shield' and/or are aged 70 years or over and using at least one long-term medication, or their caregivers, will be eligible for inclusion. We will recruit 100 patient/carer participants: 50 from the UK and 50 from Ireland. Recruitment will be supported by our patient and public involvement (PPI) partners, personal networks and social media. Individual participant consent will be sought, and interviews audio/video recorded and/or detailed notes made. A constructivist interpretivist approach to data analysis will involve use of the constant comparative method to organise the data, along with inductive analysis. From this, we will iteratively develop best practice guidance about household medication safety practices during a pandemic from the patient's/carer's perspective. ETHICS AND DISSEMINATION This study has Trinity College Dublin, University of Limerick and University College London ethics approvals. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and for publication in peer-reviewed journals. We will create a list of helpful strategies that participants have reported and share this with participants, PPI partners and on social media.
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Affiliation(s)
- Tamasine C Grimes
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - Sara Garfield
- UCL School of Pharmacy, University College London, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Joan Cahill
- Centre for Innovative Human Systems (CIHS), School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Sam Cromie
- Centre for Innovative Human Systems (CIHS), School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Carly Wheeler
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | - Bryony Dean Franklin
- UCL School of Pharmacy, University College London, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
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Parikh K, Hochberg E, Cheng JJ, Lavette LB, Merkeley K, Fahey L, Shah RK. Apparent Cause Analysis: A Safety Tool. Pediatrics 2020; 145:peds.2019-1819. [PMID: 32327450 DOI: 10.1542/peds.2019-1819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 11/24/2022] Open
Abstract
Causal analysis is a core function of safety programs. Although established protocols exist for conducting root cause analysis for serious safety events, there is limited guidance for apparent cause analysis (ACA) in health care. At our institution, through a novel facilitated ACA approach, we aim to improve safety culture and provide a clear approach to address precursor safety events and near-miss safety events. We define facilitated ACA as limited investigation (scope and duration) of a safety event that resulted in little to no harm. These investigations require fewer resources and focus on preventive strategies. Our facilitated ACA model, with an operational algorithm and structured process, was developed and implemented at our tertiary-care, freestanding, urban pediatric hospital in 2018. Sixty-four ACAs were completed, and 83% were identified with the algorithm. Process measures, including time from event reporting to ACA launch (median 3 days; interquartile range 2-6 days), are tracked. Patient safety consultants averaged 5 hours to complete a facilitated ACA. A median of 3 disciplines or departments participated in each facilitated ACA. Through an iterative process, we implemented a structured process for facilitated ACA, and the model's strength includes (1) right event, (2) right team, (3) right analysis, and (4) right action plans. This novel facilitated ACA model may support organizational cause analysis and improve safety culture with higher-reliability processes.
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Affiliation(s)
- Kavita Parikh
- Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Evan Hochberg
- Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Jenhao Jacob Cheng
- Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Laura Beth Lavette
- Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Kathryn Merkeley
- Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Lisbeth Fahey
- Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
| | - Rahul K Shah
- Children's National Hospital and School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia
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Iflaifel MH, Lim R, Ryan K, Crowley C, Iedema R. Understanding safety differently: developing a model of resilience in the use of intravenous insulin infusions in hospital in-patients-a feasibility study protocol. BMJ Open 2019; 9:e029997. [PMID: 31296514 PMCID: PMC6624105 DOI: 10.1136/bmjopen-2019-029997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Intravenous insulin infusions are considered the treatment of choice for critically ill patients and non-critically ill patients with persistent raised blood glucose who are unable to eat, to achieve optimal blood glucose levels. The benefits of using intravenous insulin infusions as well as the problems experienced are well described in the scientific literature. Traditional approaches for improving patient safety have focused on identifying errors, understanding their causes and designing solutions to prevent them. Such approaches do not take into account the complex nature of healthcare systems, which cannot be controlled solely by following standards. An emerging approach called Resilient Healthcare proposes that, to improve safety, it is necessary to focus on how work can be performed successfully as well as how work has failed. METHODS AND ANALYSIS The study will be conducted at Oxford University Hospitals NHS Foundation Trust and will involve three phases. Phase I: explore how work is imagined by analysing intravenous insulin infusion guidelines and conducting focus group discussions with guidelines developers, managers and healthcare practitioners. Phase II: explore the interplay between how work is imagined and how work is performed using mixed methods. Quantitative data will include blood glucose levels, insulin infusion rates, number of hypoglycaemic and hyperglycaemic events from patients' electronic records. Qualitative data will include video reflexive ethnography: video recording healthcare practitioners using intravenous insulin infusions and then conducting reflexive meetings with them to discuss selected video footage. Phase III: compare findings from phase I and phase II to develop a model for using intravenous insulin infusions. ETHICS AND DISSEMINATION Ethical approvals have been granted by the South Central-Oxford C Research Ethics Committee, Oxford University Hospitals NHS Foundation Trust and University of Reading. The results will be disseminated through presentations at appropriate conferences and meetings, and publications in peer-reviewed journals.
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Affiliation(s)
- Mais Hasan Iflaifel
- Reading School of Pharmacy, Whiteknights, Reading, University of Reading, Reading, Berkshire, UK
| | - Rosemary Lim
- Reading School of Pharmacy, Whiteknights, Reading, University of Reading, Reading, Berkshire, UK
| | - Kath Ryan
- Reading School of Pharmacy, Whiteknights, Reading, University of Reading, Reading, Berkshire, UK
| | - Clare Crowley
- Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Rick Iedema
- Centre for Team Based Practice & Learning in Health Care, King's College London, London, UK
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Mannion R, Braithwaite J. Where is Patient Safety Research and Practice Heading? A Response to Recent Commentaries. Int J Health Policy Manag 2019; 8:136-137. [PMID: 30980628 PMCID: PMC6462207 DOI: 10.15171/ijhpm.2018.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/12/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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