Patient safety culture at a surgical center: the nursing perception

Measuring operating theatre nurses' perceptions of safety culture using the SCORE questionnaire

BACKGROUND

Tackling operating theatre waiting lists may focus healthcare organisations' attention on increased productivity while downplaying safety concerns.

AIM

To explore safety culture in a perioperative department from operating theatre practitioners' perspective.

METHOD

Cross-sectional pen-and-paper survey among nurses in an operating theatre department in Malta using the Safety, Communication, Operational Reliability and Engagement questionnaire.

FINDINGS

The response rate was 71.2% (n = 146). Engagement domains and Organisational Safety Culture domains were perceived to be at an average level, apart from Unit Leadership which was perceived to be low. Burnout domains were perceived to be high or very high. Correlation analysis showed that leaders' recognition of staff feedback and input is associated with improved safety culture perceptions.

CONCLUSION

An organisational win-win situation is achievable, whereby safety culture perceptions are improved, not necessarily by decreasing job demands such as tackling waiting lists, but by recognising operating theatre staff's input and involving them in work-related decisions.

Patient safety culture in a COVID-19 ICU compared to a clinical-surgical ICU in the Brazilian Eastern Amazon: A cross-sectional study

BACKGROUND

The COVID-19 pandemic highlighted the need for a new dynamic in the organization and practices of health services, as it required rapid restructuring to promote safe and harm-free assistance.

OBJECTIVE

To assess the dimensions of the patient safety culture (PSC) from the perspective of the health team professionals in clinical-surgical ICU (G1) compared to a COVID-19 ICU (G2).

METHODS

Cross-sectional, analytical, descriptive and inferential study, using the "Hospital Survey on Patient Safety Culture" questionnaire.

RESULTS

The domain "Supervisor/Manager Expectations and Actions Promoting Patient Safety (PS)" was a potential weakness for G1 (p = 0.003). G2 was most positive on improving PS, being informed about errors, considering PS as a top priority to management, and that the units work together to provide the best care (p > 0.05). G1 was most negative about the work culture with staff from other units, exchange of information across units, and shift changes (p > 0.05). The highest PS grade was related to greater communication, and a smaller frequency of events was reported only for G2 (p > 0.05).

CONCLUSION

There must be a balance in terms of attention focused on PS between different ICUs in times of crisis, especially regarding the supervisors/managers actions.

Patient Safety Culture in Latin American Hospitals: A Systematic Review with Meta-Analysis

INTRODUCTION

Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America.

PURPOSE

Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC).

METHODS

This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated.

RESULTS

In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66).

CONCLUSIONS

Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.

Cultura de Segurança do Paciente Oncológico na Perspectiva da Equipe Multiprofissional

Introdução: A cultura de segurança origina-se da cultura organizacional, sendo descrita como o conjunto de percepções, competências, atitudes e valores, tanto individuais quanto coletivas, em prol de uma organização comprometida com a gestão da segurança do paciente. Em cenários como complexos oncológicos/Unidade de Alta Complexidade em Oncologia (Unacon), onde os pacientes estão mais vulneráveis e a rotina diária da equipe multiprofissional e fundamentada por vários processos de trabalho, e necessário que seja avaliada a cultura de segurança em busca de pontos a serem aperfeiçoados. Objetivo: Analisar a cultura de segurança do paciente em um complexo oncológico na perspectiva da equipe multiprofissional. Método: Estudo descritivo-exploratório, de natureza quantitativa, do tipo transversal, desenvolvido em um complexo oncológico no Sul do Brasil, com 46 profissionais da equipe multiprofissional. Os dados foram coletados entre julho e setembro de 2021, por meio da aplicação do questionário Hospital Survey on Patient Safety Culture (HSOPSC). Na analise e interpretação de dados, foram seguidas as orientações da Agency for Healthcare Research and Quality. Resultados: Os dados obtidos demonstraram maior frequência de positividade para “trabalho em equipe da unidade” (61,9%) e “expectativas e ações do supervisor/chefe para a promoção da segurança do paciente” (60,9%). Conclusão: Os resultados indicam que a cultura de segurança precisa ser fortalecida no local do estudo nas 12 dimensões avaliadas, com especial atenção aquelas dimensões com avaliação com menor taxa de positividade.

Patient safety culture in Palestine: university hospital nurses' perspectives

Background

Understanding the perspectives of healthcare workers toward patient safety-related activities is critical in maintaining a healthy safety climate. The objectives of this research are 1) to examine the perception of Patient Safety Culture (PSC) at a university hospital in Palestine, and to highlight areas in need of improvement, and 2) to assess the relationship between the outcome dimensions (frequency of events reported, and overall perceptions of safety) and the other dimensions of PSC, and 3) to determine the relationship among selected demographic variables (gender, age, hospital tenure, work tenure, profession tenure, and hours worked per week) and nurses’ perceptions of PSC.

Methods

A cross-sectional study design was used with a convenience sample of 107 nurses. Nurses were asked by email to complete the Arabic version of the Hospital Survey of Patients’ Safety Culture (HSOPSC) using the SurveyMonkey® online account form within two weeks. The survey data were analyzed using descriptive and inferential statistics. Univariate and multiple regression were used to examine the relationships.

Results

The dimensions of patient safety with the highest positive response were organizational learning and continuous improvement (87%) and teamwork within units (86%). The dimension with the lowest positive score was the nonpunitive response to error (22%). Multiple regression revealed that the dimension of communication openness was a predictor of the overall perceptions of safety (β = 0.257, p = 0.019). In addition, the dimension of feedback and communication about error was a predictor of the frequency of the reported events (β = 0.334, p = 0.005). Furthermore, age was found to be a predictor of PSC (p < 0.05).

Conclusions

This study provides a general assessment of perceived safety among nurses in a hospital. However, we found that nurses negatively perceive a nonpunitive response to error. Therefore, strenuous efforts are required by hospital management to improve the culture of incident reporting.

Patient Safety Incidents and the second victim phenomenon among nursing students

OBJECTIVE

To map the factors involved in incidents that harm patient safety and contribute to the second victim phenomenon among nursing students.

METHOD

Qualitative, exploratory-descriptive study addressing 23 nursing students attending a Federal University in the South of Brazil. The interviews were analyzed using text and discoursive analysis. The Iramuteq software supported the processing of texts.

RESULTS

Communication failures within the health staff, a lack of protocols and equipment that prioritize patient safety, and factors related to the teaching-learning process favor the occurrence of patient safety incidents and the second victim phenomenon among nursing students.

CONCLUSION

Addressing the topic concerning patient safety in nursing programs can promote the patient safety culture by encouraging reporting and admitting the possibility of errors and learning from them, strategies that can mitigate second victim effects.

Assessment of patient safety culture in Brazilian hospitals through HSOPSC: a scoping review

OBJECTIVES

to describe, from literature, the characteristics of patient safety culture in Brazilian hospitals that applied the Hospital Survey on Patient Safety Culture.

METHODS

this is a scoping review. A search was performed in the databases LILACS, PubMed, SciELO, CINAHL, Web of Science, Scopus and in the CAPES Dissertations and Theses Database in September and October 2020.

RESULTS

thirty-six studies were identified. Nine studies identified strengthened areas such as: "teamwork within the units", "expectations of supervisor/boss and actions promoting safety", "organizational learning", "support of hospital management for patient safety" and "frequency of report of events". As a critical area, the dimension "non-punitive response to error" was evidenced in 30 of 36 studies.

CONCLUSIONS

the identification of areas of strength and critical areas of safety culture is relevant to encourage improvement of patient safety problems in an institution.

Cultura de segurança do paciente entre profissionais de Enfermagem em um hospital filantrópico de Minas Gerais

Introdução: Diferentes iniciativas têm sido realizadas com vistas à melhoria da qualidade do cuidado e segurança do paciente no Brasil. Contudo, o cumprimento dessas normas como uma série de requisitos parece não corresponder à real incorporação de mudanças e melhoria na segurança. Objetivos: Avaliar a cultura de segurança do paciente em um hospital filantrópico de Minas Gerais, observando, ainda, possíveis diferenças por turnos de trabalho, diurno e noturno. Métodos: Trata-se de um estudo observacional do tipo transversal. A população de estudo foi constituída por profissionais de Enfermagem atuantes nessa instituição filantrópica. Para a avaliação da cultura de segurança foi utilizado o Inquérito Hospitalar sobre Cultura de Segurança do Paciente (HSOPSC), criado pela Agency for Healthcare Research and Quality (AHRQ), validado, traduzido e adaptado transculturalmente no Brasil. Na análise e interpretação dos dados foram seguidas as orientações da AHRQ, sendo observadas dimensões fortalecidas e fragilizadas. Este trabalho foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: Foram incluídos 118 participantes no estudo, sendo 17,2% desse total enfermeiros e o restante técnicos de Enfermagem. Nenhuma dimensão da cultura de segurança foi identificada como fortalecida na instituição. Foram consideradas como áreas frágeis: a “abertura à comunicação”, o “trabalho em equipe entre as unidades hospitalares”, a “adequação de pessoal”, as “mudanças de turno e transição entre as unidades”, e as “respostas não punitivas aos erros”. Em algumas dimensões foram observadas diferenças por turno de trabalho, diurno e noturno. Conclusão: A análise da cultura de segurança nesse hospital pode contribuir para um melhor direcionamento de condutas com vistas a garantir uma assistência mais segura.