Evaluation of the psychometric performance of the Spanish and Catalan versions of the patient reported experiences and Outcomes of Safety in Primary Care (PREOS-PC)-Compact questionnaire

BACKGROUND

Patients provide a unique, irreplaceable, and essential perspective in evaluating patient safety. The suite of Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) tools are a notable exception to the scarcity of patient-reported patient safety measures. Full evaluation of their performance has only been attempted for the English version, thereby limiting its international applicability.

OBJECTIVES

To assess the psychometric performance of the Spanish and Catalan versions of the PREOS-PC-Compact.

METHODS

Cross-sectional validation study. We used Classical Test Theory methods to examine scale score distribution, internal consistency, and construct validity; and Item Response Theory (IRT) methods to further explore construct validity.

RESULTS

3287 patients completed the Spanish version, and 1007 the Catalan version. Similar results were obtained for both versions. Confirmatory Factor Analysis supported a single construct for each scale. The correlations between PREOS-PC-Compact scales and known group analysis suggested adequate construct validity (inconclusive for known groups at the provider level). All four multi-item scales demonstrated adequate internal consistency reliability (α > 0.7), which was only confirmed for test-retest reliability for 'Practice activation.' A sample between 60-90 patients per practice was estimated sufficient to produce scores with reliability > 0.7 for all scales except for harm scales. IRT models showed disordered thresholds for 'Practice activation' and 'Harm burden' but showed excellent fit after reducing the response categories.

CONCLUSION

The Spanish and Catalan versions of the PREOS-PC-Compact are broadly valid and reliable tools to measure patient safety in Spanish primary care centres; confirmation of lower-than-expected test-rest reliability merits further examination .

A scoping review of new implementations of interprofessional bedside rounding models to improve teamwork, care, and outcomes in hospitals

Poor communication within healthcare teams occurs commonly, contributing to inefficiency, medical errors, conflict, and other adverse outcomes. Interprofessional bedside rounds (IBR) are a promising model that brings two or more health professions together with patients and families as part of a consistent, team-based routine to share information and collaboratively arrive at a daily plan of care. The purpose of this systematic scoping review was to investigate the breadth and quality of IBR literature to identify and describe gaps and opportunities for future research. We followed an adapted Arksey and O'Malley Framework and PRISMA scoping review guidelines. PubMed, CINAHL, PsycINFO, and Embase were systematically searched for key IBR words and concepts through June 2020. Seventy-nine articles met inclusion criteria and underwent data abstraction. Study quality was assessed using the Mixed Methods Assessment Tool. Publications in this field have increased since 2014, and the majority of studies reported positive impacts of IBR implementation across an array of team, patient, and care quality/delivery outcomes. Despite the preponderance of positive findings, great heterogeneity, and a reliance on quantitative non-randomized study designs remain in the extant research. A growing number of interventions to improve safety, quality, and care experiences in hospital settings focus on redesigning daily inpatient rounds. Limited information on IBR characteristics and implementation strategies coupled with widespread variation in terminology, study quality, and design create challenges in assessing the effectiveness of models of rounds and optimal implementation strategies. This scoping review highlights the need for additional studies of rounding models, implementation strategies, and outcomes that facilitate comparative research.

Safety culture in maternity hospital: Perception of nurse-midwives

AIM

To explore nurse-midwives' perceptions of safety culture in maternity hospitals.

DESIGN

A descriptive phenomenological study was conducted using focus groups and reported following the Consolidated Criteria for Reporting Qualitative Research.

METHODS

Data were obtained through two online focus group sessions in June 2022 with 13 nurse-midwives from two maternity hospitals in the central region of Portugal. The first focus group comprised 6 nurse-midwives, and the second comprised 7 nurse-midwives. Qualitative data were analysed using content analysis.

FINDINGS

Two main themes emerged from the data: (i) barriers to promoting a safety culture; (ii) safety culture promotion strategies. The first theme is supported by four categories: ineffective communication, unproductive management, instability in teams and the problem of errors in care delivery. The second theme is supported by two categories: managers' commitment to safety and the promotion of effective communication.

CONCLUSION

The study results show that the safety culture in maternity hospitals is compromised by ineffective communication, team instability, insufficient allocation of nurse-midwives, a prevailing punitive culture and underreporting of adverse events. These highlight the need for managers to commit to providing better working conditions, encourage training with the development of a fairer safety culture and encourage reporting and learning from mistakes. There is also a need to invest in team leaders who allow better conflict management and optimization of communication skills is essential.

IMPACT

Disseminating these results will provide relevance to the safety culture problem, allowing greater awareness of nurse-midwives and managers about vulnerable areas, and lead to the implementation of effective changes for safe maternal and neonatal care.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution as the study only concerned service providers, that is, nurse-midwives themselves.

Interactions that support older inpatients with cognitive impairments to engage with falls prevention in hospitals: An ethnographic study

AIMS

To explore the nature of interactions that enable older inpatients with cognitive impairments to engage with hospital staff on falls prevention.

DESIGN

Ethnographic study.

METHODS

Ethnographic observations on orthopaedic and older person wards in English hospitals (251.25 h) and semi-structured qualitative interviews with 50 staff, 28 patients and three carers. Findings were analysed using a framework approach.

RESULTS

Interactions were often informal and personalised. Staff qualities that supported engagement in falls prevention included the ability to empathise and negotiate, taking patient perspectives into account. Although registered nurses had limited time for this, families/carers and other staff, including engagement workers, did so and passed information to nurses.

CONCLUSIONS

Some older inpatients with cognitive impairments engaged with staff on falls prevention. Engagement enabled them to express their needs and collaborate, to an extent, on falls prevention activities. To support this, we recommend wider adoption in hospitals of engagement workers and developing the relational skills that underpin engagement in training programmes for patient-facing staff.

IMPLICATIONS FOR PROFESSION AND PATIENT CARE

Interactions that support cognitively impaired inpatients to engage in falls prevention can involve not only nurses, but also families/carers and non-nursing staff, with potential to reduce pressures on busy nurses and improve patient safety.

REPORTING METHOD

The paper adheres to EQUATOR guidelines, Standards for Reporting Qualitative Research.

PATIENT OR PUBLIC CONTRIBUTION

Patient/public contributors were involved in study design, evaluation and data analysis. They co-authored this manuscript.

Factors associated with the disinfection of devices attached to peripheral intravenous catheters performed by the nursing team in pediatric units

Background

Peripheral intravenous catheterization, as well as drug administration through it, represents one of the most performed procedures by the Nursing team and, for that, precautions need to be adopted to offer harm-free care.

Objective

To verify the association of Nursing professionals' work shift and training time with proper disinfection of intravenous catheter devices in pediatric units.

Methods

A cross-sectional and analytical study conducted between June and August 2021 in three hospitalization units of a Pediatric Hospital. The inclusion criterion was drug administration via peripheral intravenous catheters performed by Nursing professionals. The data were analyzed according to inferential statistics, adopting p ≤ .05 as significance level.

Results

There were a total of 385 observations of drug administration procedures. The device was not disinfected in 60.3% of the cases, there was no friction at the suitable time in 86.3%, and the disinfectant was not allowed to dry in 72.5%. The work shift exerted no influence on performance of the disinfection procedure (p = .376). However, longer training time was associated with a lower rate in performing such procedure (p < .001).

Conclusion

Performing friction below the recommended time can cause a false sense of prevention of catheter-associated bloodstream infection; therefore, training sessions and strategies for adherence to the disinfection procedures should be considered, mainly for professionals with more training time.

Digital health intervention on patient safety for children and parents: A scoping review

AIM

To explore digital health interventions on patient safety for children and their parents.

DESIGN

A scoping review.

METHODS

The PCC 'Participants, Concepts, and Contexts' guided the selection of studies that focused on children under 19 years of age or their parents, patient safety interventions for children, and digital health technology for patient safety interventions. This study was conducted using the Arksey and O'Malley framework's five steps. We reported the review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist.

DATA SOURCES

PubMed, CINAHL, Embase, Web of Science, and Cochrane were searched for articles published up to November 2022.

RESULTS

A total of 13 articles were included and categorized according to the following criteria to describe the results: intervention characteristics, type of digital technology, and outcome characteristics. Regarding intervention characteristics, we identified two categories, prevention and risk management. Additionally, we identified four types of digital technology, mobile applications, web-based technologies, computer kiosks and electronic health records. Finally, in studies focussing on child safety, parental safety behaviours were used to assess injury risk or detect changes related to prevention.

CONCLUSION

Patient safety interventions provided through appropriate digital technologies should be developed to enhance continuum of care for children from hospitalization to home after discharge.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Digital health interventions can bolster the role of healthcare providers in patient safety in and out of hospitals, thus improving children's safety and quality of care.

IMPACT

What problem did the study address? Although the various advantages of digital health technology have been demonstrated, the potential role of digital technology in patient safety interventions for children has not been explored. What were the main finding? Preventive patient safety interventions and risk management for children have been developed. Where and on whom will the research have an impact? Digital health interventions on patient safety can improve children's safety and quality of care by promoting non-face-to-face engagement of children and parents after discharge and expanding healthcare providers' roles.

TRIAL AND PROTOCOL REGISTRATION

Registered on the Open Science Framework (https://osf.io/dkvst).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

From Aviation to Pediatric Surgery

Aviation is a tremendously complex process involving multiple factors that can be subsidiary to human error. The implementation of checklists, tools that reduce this risk, has often been extrapolated to other fields, especially medicine. Through this reflection, we comment on the critical and relevant aspects of pediatric surgical patient safety, briefly discussing the existing literature and analyzing potential areas for improvement.

Nurses' experiences of moral distress and how it affects daily work in surgical care-a qualitative study

AIM

To describe nurses' and specialist nurses' experiences of moral distress and how it affects daily work in surgical care.

DESIGN

A qualitative descriptive study design was used.

METHODS

A qualitative study with 12 interviews with nurses and specialist nurses working in surgical care. All interviews were conducted during October and November 2022 in two hospitals in southeastern Sweden. Data were analysed using conventional qualitative content analysis.

FINDINGS

Three categories and seven subcategories generated from the data analysis. The three categories generated from the analysis were Experiences that lead to moral distress, Perceived consequences of moral distress and Strategies in case of moral distress. The results show that a lack of personnel in combination with people with complex surgical needs is the main source of moral distress. Both high demands on nurses as individuals and the teamwork are factors that generate moral distress and can have severe consequences for the safety of patients, individual nurses and future care.

CONCLUSIONS

The results show that moral distress is a problem for today's nurses and specialist nurses in surgical care. Action is necessary to prevent nurses from leaving surgical care. Prioritizing tasks is perceived as challenging for the profession, and moral distress can pose a patient safety risk.

IMPACT

Surgical care departments should design support structures for nurses, give nurses an authentic voice to express ethical concerns and allow them to practice surgical nursing in a way that does not violate their core professional values. Healthcare organizations should take this seriously and work strategically to make the nursing profession more attractive.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

Effectiveness and Experiences of Quality Improvement Interventions in Older Adult Care: Protocol for a Mixed Methods Systematic Review

BACKGROUND

Quality improvement (QI) interventions are designed to resolve the recurring challenges of care for older individuals, such as working conditions for staff, roles of older individuals in their own care and their families, and relevant stakeholders. Therefore, there is a need to map the impacts of QI interventions in older adult care settings and further improve health and social care systems associated with older adults.

OBJECTIVE

This review aims to compile and synthesize the best available evidence regarding the effectiveness of policy and practice QI interventions in older adult care. The secondary aim is to understand the care of older individuals and QI intervention-related experiences and perspectives of stakeholders, care providers, older individuals, and their families.

METHODS

The mixed methods review will follow the standard methodology used by Joanna Briggs Institute. The published studies will be searched through CINAHL, MEDLINE, PsycINFO, ASSIA, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. This review included both qualitative and quantitative analyses of patients undergoing older adult care and any health and care professionals involved in the care delivery for older adults; a broad range of QI interventions, including assistive technologies, effects of training and education, improved reporting, safety programs, and medical devices; the experiences and perspectives of staff and patients; the context of older adult care setting; and a broad range of outcomes, including patient safety. The standard procedure for reporting, that is, PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, will be followed.

RESULTS

A result-based convergent synthesis design will be used in which both quantitative and qualitative studies will be analyzed separately, and the results of both syntheses will be then integrated during a final (convergent) synthesis. The integration will compare the findings of quantitative and qualitative evidence using tables in light of the results of both syntheses.

CONCLUSIONS

This comprehensive review is expected to reflect on the insights into some QI interventions and their impact, outline some common challenges of quality for older adult care, and benefit both the practical usefulness of care service activities and the society at large.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/56346.

Grading recommendations for enhanced patient safety in sentinel event analysis: the recommendation improvement matrix

OBJECTIVES

The goal of sentinel event (SE) analysis is to prevent recurrence. However, the rate of SEs has remained constant over the past years. Research suggests this is in part due to the quality of recommendations. Currently, standards for the selection of recommendations are lacking. Developing a method to grade recommendations could help in both designing and selecting interventions most likely to improve patient safety. The aim of this study was to (1) develop a user-friendly method to grade recommendations and (2) assess its applicability in a large series of Dutch perioperative SE analysis reports.

METHODS

Based on two grading methods, we developed the recommendation improvement matrix (RIM). Applicability was assessed by analysing all Dutch perioperative SE reports over a 12-month period. After which interobserver agreement was studied.

RESULTS

In the RIM, two elements are crucial: whether the recommendation intervenes before or after an SE and whether it eliminates or controls the hazard. Applicability was evaluated in 115 analysis reports, encompassing 161 recommendations. Recommendation quality varied from the highest, category A, to the lowest, category D, with category A accounting for 44%, category B for 35%, category C for 2% and category D for 19% of recommendations. There was a fair interobserver agreement.

CONCLUSION

The RIM can be used to grade recommendations in SE analysis and could possibly help in both designing and selecting interventions. It is relatively simple, user-friendly and has the potential to improve patient safety. The RIM can help formulate effective and sustainable recommendations, a second key objective of the RIM is to foster and facilitate constructive dialogue among those responsible for patient safety.

Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool

BACKGROUND

Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need.

OBJECTIVE

This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory.

METHODS

The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool.

RESULTS

We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, "getting worse" or "getting better"; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code.

CONCLUSIONS

Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively.

Reporting of Complications in Rhinoplasty Randomized Controlled Trials: An Analysis Using the CONSORT Extension for Harms Checklist

OBJECTIVE

This study aimed to assess the completeness of adverse event (AE) reporting in randomized control trials (RCTs) focused on rhinoplasty, using the Consolidated Standards for Reporting (CONSORT) Extension for Harms checklist.

STUDY DESIGN

A cross-sectional design was employed to review RCTs related to rhinoplasty published between January 1, 2005, and January 28, 2022.

SETTING

The study analyzed clinical trials on rhinoplasty retrieved from PubMed.

METHODS

We performed a comprehension search on PubMed, blind and duplicate screening, and data extraction. Adherence to the 18 recommendations of the CONSORT Extension for Harms was evaluated, with 1 point assigned for each adhered item. Percent adherence was calculated based on the 18 points, taking into account the multiple subcategories within some recommendations. Descriptive statistics were used to summarize adherence-including frequencies, percentages, and 95% confidence intervals.

RESULTS

Our search returned 240 articles, of which 56 met inclusion criteria. No RCTs adhered to all 18 CONSORT Extension for Harms items. Twenty-six (26/56, 46.4%) adhered to ≥50% of the items, and 30 (30/56, 53.6%) adhered to ≥33.3% of the items. Seven (7/56, 12.5%) RCTs adhered to no items. Across all RCTs, the average number of CONSORT-Harms items adhered to was 7.2 (7.2/18, 40.0%). The most adhered to item was item 10. Discussion balanced with regard to efficacy and AEs (80.4%, [70.0-90.8]).

CONCLUSION

This study highlights the inadequacy of AE reporting in rhinoplasty RCTs according to CONSORT-Harms guidelines. Urgent efforts are required to bridge this reporting gap and enhance transparency in surgical research, ultimately safeguarding patient well-being.

How a single perioperative delirium case can make the difference

This report describes how postoperative delirium in an elderly man during COVID-19 pandemic led to a serious event involving a central venous catheter. Delirium is a common cause of perioperative morbidity and mortality, and is characterised by an alteration in consciousness and perception and a reduced ability to focus, sustain or shift attention. The event was analysed by a multidisciplinary committee which developed a risk stratification delirium protocol in order to prevent similar events in the future.

Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study

BACKGROUND

Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care-specific resources to help organizations at different levels of maturity develop their cybersecurity practices.

OBJECTIVE

This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level.

METHODS

A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams' networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts.

RESULTS

A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time.

CONCLUSIONS

The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone's responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed.

Analysis of thicknesses of blood collection needle by scanning electron microscopy reveals wide heterogeneity

OBJECTIVES

The preanalytical phase in clinical laboratory diagnostics is currently receiving more and more attention. This term describes one part of actions and aspects of the "brain-to-brain cycle" of the medical laboratory diagnostic procedure that take place before the analytical phase. However, the preanalytical activities, the handling of unsuitable samples and the reporting procedures are neither fully standardized nor harmonized worldwide. The influence of the properties of the blood collection needle must be acknowledged. In this work, we focused on the investigation of the internal structure and size of standardized 21G blood collection needles.

METHODS

All parameters were measured with a scanning electron microscope using a Jeol model JSM-6000PLUS. Our.

RESULTS

The obtained data shows that the internal surfaces of the needles vary greatly from manufacturer to manufacturer (by around 35 %), and this may play an important role in influencing blood flow and even the risk of blood cell injury (especially hemolysis) during blood drawing.

CONCLUSIONS

The differential actual needle diameters can vary greatly between needle manufactures and this variety may have a significant impact on laboratory values and may also lead to specimen rejection.

The impact of a climate of perceived organizational support on nurses' well-being and healthcare-unit performance: A longitudinal questionnaire study

AIM

To investigate the relationship between nurses' climate of perceived organizational support, and their well-being and healthcare-unit performance.

DESIGN

A two-wave cohort questionnaire study among nurses within six hospitals in Sweden.

METHODS

Hypotheses were tested using cross-lagged path models on the individual (organizational support, job satisfaction, burnout, intention to stay) and aggregate levels (care-unit organizational support, team effectiveness, patient safety climate and patient safety). Analyses were based on 1.817 nurses in 228 care-units (T1), 1.362 nurses in 213 care-units (T2) and longitudinal samples of 711 nurses and 140 care-units.

RESULTS

Organizational support (T1) positively influenced job satisfaction (T2) and tended to decrease burnout (T2) but did not affect turnover intent. Reversed relationships were also found. No statistically significant prospective effects were found on the aggregate level.

CONCLUSION

The results indicated a prospective reciprocally reinforcing relationship between organizational support and job satisfaction. Burnout and intention to stay were predictors rather than outcomes of the organizational support climate.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

A climate where nurses perceive that their organization values their contributions and cares about their well-being is beneficial for their job satisfaction and health, which, according to previous research, may influence nurse retention.

IMPACT

The study addressed perceived organizational support as a potential predictor of nurses' well-being and healthcare-unit performance. A mutually reinforcing relation was indicated between organizational support and nurses' job satisfaction and health. Job dissatisfaction, burnout symptoms and turnover intentions were prospectively negatively related to the organizational support. Identifying and implementing a variety of practical measures to support perceptions of organizational support may be an effective way for healthcare management to start and sustain the development of a healthier work environment for healthcare professionals.

REPORTING METHOD

STROBE statement for cohort studies.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Cognitive Bias in the Patient Encounter: Part I. Background and significance

Cognitive bias may lead to diagnostic error in the patient encounter. There are hundreds of different cognitive biases, but certain biases are more likely to affect patient diagnosis and management. As during morbidity and mortality rounds, retrospective evaluation of a given case, with comparison to an optimal diagnosis, can pinpoint errors in judgment and decision-making. The study of cognitive bias also illuminates how we might improve the diagnostic process. In Part 1 of this series, cognitive bias is defined and placed within the background of dual process theory, emotion, heuristics, and the more neutral term judgment and decision-making bias.

Cognitive Bias in the Patient Encounter: Part II. Debiasing using an adaptive toolbox

Cognitive bias may lead to medical error, and awareness of cognitive pitfalls is a potential first step to addressing the negative consequences of cognitive bias (see Part 1). For decision-making processes that occur under uncertainty, which encompass most physician decisions, a so-called "adaptive toolbox" is beneficial for good decisions. The adaptive toolbox is inclusive of broad strategies like cultural humility, emotional intelligence, and self-care that help combat implicit bias, negative consequences of affective bias, and optimize cognition. Additionally, the adaptive toolbox includes situational-specific tools such as heuristics, narratives, cognitive forcing functions, and fast and frugal trees. Such tools may mitigate against errors due to cultural, affective, and cognitive bias. Part 2 of this two-part series covers metacognition and cognitive bias in relation to broad and specific strategies aimed at better decision-making.

Comparing hospital leadership and front-line workers' perceptions of patient safety culture: an unbalanced panel study

BACKGROUND/AIM

This article examines the relationships between workers' hospital leadership status, hospital front-line status and patient safety culture in hospitals throughout the USA. By identifying possible disparities in perception, targeted interventions can aim at decreasing differences between the two groups to increase the quality of healthcare.

METHOD

Data from 1 739 083 individuals, spreading across 1810 hospitals between 2008 and 2017 were collected. 115 228 (6.63%) self-identified as leaders, and 772 505 (44.42%) self-identified as front-line workers. The participants also filled in information describing their demographics in reference to the hospital, such as how long they have worked at the facility, their working unit and their occupation.

RESULTS

Results showed that leaders responded more positively to items that are directly related to management, such as 'my supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures' (0.33, p<0.01), where 0.33 signifies that leaders had an average response more positive by 0.33 compared with all other occupations on a Likert scale of 1-5. Based on multiple F-tests, all items have shown a statistical significance between leadership and front-line groups.

CONCLUSION

The findings highlight a compelling link between leadership roles and patient safety culture in hospitals, as well as between front-line worker status and patient safety culture. Moreover, a pronounced divergence in viewpoints regarding patient safety culture exists between hospital leaders and front-line staff. An in-depth investigation is necessary to comprehend the ramifications of these outcomes.

Malignant hyperthermia safety - A nationwide survey of publicly funded Swedish healthcare

BACKGROUND

Malignant hyperthermia (MH) is a rare pharmacogenetic disorder that can lead to a life-threatening reaction during general anaesthesia with triggering agents. Prompt life-saving treatment includes the immediate administration of the antidote dantrolene. This study investigated Swedish healthcare providers' awareness and adherence to guidelines and recommendations with respect to MH and whether adherence to safe MH-praxis varies with hospital care-complexity level and private versus public management form.

METHOD

Agreements and procurement specifications between all 21 Swedish County Councils and privately run surgical care providers were reviewed alongside with questionnaire-aided collection of information from 62 publicly funded health care providers (both privately and publicly run).

RESULTS

No procurement requirement specification or contract contained requirements on anaesthesia or aspects of MH. All publicly run hospitals stocked dantrolene and 28 out of 52 (54%) stocked the recommended amount. Seven out of nine (78%) of the privately run institutions stocked dantrolene, and one stocked the recommended amount. Publicly run hospitals adhered to recommendations to a greater extent than privately run institutions, both with respect to stocking of dantrolene (p = .02) and to stocking the recommended amount (p = .03).

CONCLUSIONS

Contracts between Swedish county councils and private surgical care subcontractors rarely outline expectations of standards for the safe practice of anaesthesia such as preparedness to handle a life-threatening MH reaction. Among Swedish publicly funded anaesthesia providers there is room for improvement in adherence to the EMHG guideline on dantrolene availability. Publicly run hospitals seem to have better compliance with these recommendations than privately run institutions. Raising awareness about current guidelines is important to improve safety for known and unknown MH-susceptible individuals.

The National Healthcare Safety Network's digital quality measures: CDC's automated measures for surveillance of patient safety

OBJECTIVE

This article presents the National Healthcare Safety Network (NHSN)'s approach to automation for public health surveillance using digital quality measures (dQMs) via an open-source tool (NHSNLink) and piloting of this approach using real-world data in a newly established collaborative program (NHSNCoLab). The approach leverages Health Level Seven Fast Healthcare Interoperability Resources (FHIR) application programming interfaces to improve data collection and reporting for public health and patient safety beginning with common, clinically significant, and preventable patient harms, such as medication-related hypoglycemia, healthcare facility-onset Clostridioides difficile infection, and healthcare-associated venous thromboembolism.

CONCLUSIONS

The NHSN's FHIR dQMs hold the promise of minimizing the burden of reporting, improving accuracy, quality, and validity of data collected by NHSN, and increasing speed and efficiency of public health surveillance.

Analysis of patient safety event report categories at one large academic hospital

Given the persistent safety incidents in operating rooms (ORs) nationwide (approx. 4,000 preventable harmful surgical errors per year), there is a need to better analyze and understand reported patient safety events. This study describes the results of applying the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) supported by the Teamwork Evaluation of Non-Technical Skills (TENTS) instrument to analyze patient safety event reports at one large academic medical center. Results suggest that suboptimal behaviors stemming from poor communication, lack of situation monitoring, and inappropriate task prioritization and execution were implicated in most reported events. Our proposed methodology offers an effective way of programmatically sorting and prioritizing patient safety improvement efforts.

A cross-sectional survey of patient perceptions of the National Neurosurgical Audit Programme (NNAP)

BACKGROUND

The National Neurosurgical Audit Programme (NNAP) publishes mortality outcomes of consultants and neurosurgical units across the United Kingdom. It is unclear how useful outcomes data is for patients and whether it influences their decision-making process. Our aim was to identify patients' perceptions and understanding of the NNAP data and its influences.

MATERIALS AND METHODS

This single-centre study was conducted in the outpatient neurosurgery clinics at a regional neurosurgical centre. All adult (age ≥ 18) neurosurgical patients, with capacity, were invited to take part. Native and non-native English speakers were eligible. Statistical analyses were performed on SPSS v28 (IBM). Ethical approval was obtained.

RESULTS

A total of 84 responses were received (54.7% females). Over half (51.0%) of respondents felt that they understood a consultant's mortality outcomes. Educational level determines respondents' understanding (χ2(8) = 16.870; p = .031). Most respondents were unaware of the NNAP (89.0%). Only a third of respondents (35.1%) understood the funnel plot used to illustrate mortality.

CONCLUSIONS

Most patients were unaware of the NNAP and most did not understand the data on the website. Understanding of mortality data seemed to be related to respondents' educational level which would be important to keep in mind when planning how to depict mortality data.

Appropriate handling and storage reduce the risk of bacterial growth in enteral feeding systems reused within 24 hours

BACKGROUND

Enteral tube feeding can require considerable amounts of plastic equipment including delivery sets and containers, often disposed of after a single feeding session because of bacterial contamination concerns. The aim of this research was to assess whether reuse of delivery sets and containers for up to 24 h is safe from a microbiological perspective.

METHODS

Four enteral tube feeding systems (FS) were tested under hygienic controlled or repeated inoculation challenge conditions using key foodborne pathogens, to assess bacterial growth over time (FS1: ready-to-hang, closed 1-L system with delivery set reused, stored at room temperature [RT]; FS2: a prepared, powdered, open 1-L system with delivery set and container reused, stored at RT; FS3 and FS4: prepared, powdered, open 200-ml bolus systems with delivery set and container reused, stored at RT [FS3] and refrigeration [FS4]). Feed samples were cultured at 0.5, 6.5, 12.5, 18.5, and 24.5 h with >2 Δlog considered significant bacterial growth.

RESULTS

Under hygienic control, FS1, FS3, and FS4 were below the level of enumeration (<5 CFU/g) for all bacteria tested, at all time points. In FS2, significant bacterial growth was observed from 18.5 h. Under repeated bacterial inoculation challenge, no significant growth was observed in FS1 and FS4 over 24.5 h; however, significant growth was observed in FS2 after 6.5 h and in FS3 after 10-12 h.

CONCLUSION

With hygienic handling technique, there is limited bacterial growth with reuse of delivery sets and containers over 24 h. Refrigeration between feeding sessions and using boluses of reconstituted powdered feed reduce bacterial growth risk.

Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study

INTRODUCTION

Previous research has indicated that community-based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards.

AIM

This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran.

METHOD

An explanatory mixed-methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi-structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis.

RESULTS

The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper-vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'.

DISCUSSION

MHNs employ a hyper-vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance.

IMPLICATIONS FOR MENTAL HEALTH NURSING

According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.

Neutrophil Reactivity Intensity and misclassification of immature granulocytes

INTRODUCTION

Immature granulocyte percentage (IG%) is an important biomarker for infection control. We observed spurious cases where the IG% was dramatically underestimated on the automated Sysmex XN-series hehmatology analyzer compared with manual differential. These cases were associated with high values of "Neutrophil Reactivity Intensity" (NEUT-RI), which should reflect the metabolic activity of the neutrophils.

METHODS

We conducted a three-stage study to evaluate whether NEUT-RI could be utilized to screen for misclassified IG% results defined as the manual differential estimating a 10 percentage points higher IG% compared with the automated Sysmex differential. First, 124 patient samples were selected for 800-cell manual smear analysis based on their NEUT-RI values and compared with the automatic Sysmex IG% results. Next, 11 098 routine 110-cell manual smear analyses were compared with the corresponding Sysmex IG% results. Finally, during a 19-day period 160 additional patient samples underwent smear based on NEUT-RI values ≥56 fluorescence intensity (FI) to screen for misclassified results beyond our current smear practice.

RESULTS

NEUT-RI ≥56 predicted IG% misclassification with 91% sensitivity and 88% specificity, but primarily when the internal Sysmex flag "Abnormal WBC Scattergram" was present. 90.1% of misclassified results were identified by this flag. Beyond our existing smear rules including this flag, NEUT-RI ≥56 FI had a positive predictive value below 1%.

CONCLUSION

Both NEUT-RI and the internal Sysmex flag "Abnormal WBC Scattergram" work well to identify cases of IG% misclassification. However, in our setting NEUT-RI ≥56 FI had no meaningful additional predictive capacity to identify misclassifications beyond our current smear rules.

Development and content validity of EVAD: A novel tool for evaluating and classifying the severity of adverse events for psychotherapeutic clinical trials

OBJECTIVE

Develop and obtain content validity of a new tool for Evaluating and Classifying the Severity of Adverse Events for Psychotherapeutic Clinical Trials (EVAD).

METHOD

Study of the development process of EVAD in four stages: (1) identify the domain and concept definition through a literature review, (2) instrument design, (3) expert judgment of the EVAD items through Gwent's concordance coefficient, and (4) applicability.

RESULTS

In the absence of a consistent conceptual framework of adverse events in psychotherapeutic clinical trials, we have developed a framework and defined it. We have designed EVAD items and their complementary tool for rating adverse events. Content validation by expert judges resulted in CVR = 1.0 for each item and CVI = 0.79 in sufficiency, 0.76 in clarity, 0.91 in coherence and 0.95 in relevance for all items (p < 0.001). Final version of EVAD were applied to three participants for 7 weeks. Overall EVAD seems to be clear and meaningful for participants.

CONCLUSIONS

EVAD is a semistructured interview based on a consistent conceptual framework, and proven content validity following the most important guidelines described in the literature.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03878186.

Hospital-acquired pressure injury prevention in people with a BMI of 30.0 or higher: A scoping review

AIM(S)

To: (1) explore current best practices for hospital-acquired pressure injury prevention in high BMI patients; (2) summarize nurses' experiences in preventing and managing them; (3) explore the association between a high BMI and occurrence and severity of pressure injury.

DESIGN

Exploratory.

METHODS

Scoping review.

DATA SOURCES

Ovid MEDLINE, EBSCO CINAHL Plus, JBI Evidence Synthesis, Scopus, Embase, clinical registries and grey literature (search dates: January 2009 to May 2021).

RESULTS

Overall, 1479 studies were screened. The included studies were published between 2010 and 2022. Five interventional studies and 32 best practice recommendations (Objective 1) reported low-quality evidence. Findings of thematic analysis reported in nine studies (Objective 2) identified nurses' issues as insufficient bariatric equipment, inadequate staffing, weight bias, fatigue, obese-related terminology issues, ethical dilemmas and insufficient staff education in high BMI patients' pressure injury prevention. No association between hospital-acquired pressure injury occurrence and high BMI were reported by 18 out of 28 included studies (Objective 3).

CONCLUSION

Quality of evidence was low for the interventional studies and best practice recommendations.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Current (2019) International Pressure Injury Guideline to be used despite the low quality of evidence of most best practice recommendations.

IMPACT STATEMENT

This study addressed hospital-acquired pressure injury prevention in high BMI patients. Greater proportion of studies in this review found no association between high BMI and occurrence of hospital-acquired pressure injury. Nurses need educational interventions on pressure injury prevention in high body mass index people, sufficient staffing for repositioning and improved availability of bariatric equipment.

REPORTING METHOD

We adhered to relevant EQUATOR guidelines, PRISMA extension for scoping reviews.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Larger clinical trials are needed on repositioning frequency, support surfaces, prophylactic dressings and risk assessment tools to inform clinical practice guidelines on pressure injury prevention in high BMI people.

PROTOCOL REGISTRATION

Wound Practice and Research (https://doi.org/10.33235/wpr.29.3.133-139).

Contaminant Organism Growth in Febrile Infants at Low Risk for Invasive Bacterial Infection

In this multicenter, cross-sectional, secondary analysis of 4042 low-risk febrile infants, nearly 10% had a contaminated culture obtained during their evaluation (4.9% of blood cultures, 5.0% of urine cultures, and 1.8% of cerebrospinal fluid cultures). Our findings have important implications for improving sterile technique and reducing unnecessary cultures.

Why do nurses miss nursing care? A qualitative meta-synthesis

AIM

The aim of this qualitative meta-synthesis was to discover the factors impacting on missed nursing care of nurses through systematic thinking.

BACKGROUND

Although nurses are responsible for high-quality care, missed nursing care is common, endangering patient safety. Understanding of the causes related to missed nursing care could help nursing managers improve the quality of nursing care.

DESIGN

A qualitative meta-synthesis guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).

METHODS

As a method designed to contribute to knowledge development, meta-synthesis allows for integration of qualitative study findings using thematic synthesis. Six databases were searched up to October 2021; nine studies met the inclusion and quality assessment criteria and meta-synthesis were conducted.

RESULTS

Three themes related to the causes why nurses missed nursing care were found. The themes included intrinsic resources (professional and ethical values, ambiguous nurse role, prioritization, education system, and knowledge), system structure (staff and resources shortage, heavy workload but limited time, and organizational management failure), and social environment (communication, working relationship and skill mix, and inappropriate ward layout).

CONCLUSION

The phenomenon of missed nursing care is a global tissue, with variations in its elements but also notable similarities. Meta-synthesis provides evidence of intrinsic and extrinsic factors that contribute to missed nursing care.

RELEVANCE TO CLINICAL PRACTICE

Recognizing and understanding the causes of missed nursing care is essential for nursing managers to ensure patient safety and the provision of high-quality care.

Ethanol Content of Medications and Its Effect on Blood Alcohol Concentration in Pediatric Patients

OBJECTIVE

Ethanol is a common excipient used in liquid medications to enhance solubility and inhibit -bacterial growth. While the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) have released guidance for how much ethanol is acceptable in medicines, many medications contain more than the recommended amount. The objective of this study was to determine what effect these medications would have on blood alcohol concentration (BAC) for pediatric patients, defined as those medications that would increase the BAC by ≥2.5 mg/dL.

METHODS

A list of medications dispensed to pediatric patients from a single hospital over a period of 4 months was obtained. The package inserts of these medications were reviewed to determine ethanol content. Typical doses were used to determine the amount of ethanol pediatric patients weighing 10, 20, and 40 kg would receive. The theoretical BAC was then calculated for each medication containing ethanol.

RESULTS

Seven hundred ninety-six medications were dispensed for pediatric patients during the study period, of which 33 contained ethanol. Seven medications would be projected to increase the BAC above 2.5 mg/dL with a normal pediatric dose.

CONCLUSION

While most medications do not contain ethanol, we found 7 that contained enough ethanol to potentially raise the BAC above 2.5 mg/dL. Health care practitioners should consider the ethanol content of medications prior to recommending them in children and when assessing overdoses.

Variation in response to the coronavirus disease 2019 (COVID-19) at US dental school clinics

PURPOSE

Although the threat of coronavirus disease 2019 (COVID-19) was the same at different US dental schools, the response wasn't. There is no study that documents the variation in mitigation strategies, COVID-19 transmission, and clinical educational changes at US Dental schools during the ongoing pandemic that began in 2020 in the US.

METHODS

The current study was approved as exempt research (project number HUM00199261). Our survey of Associate Dean's of Clinical Operations was individually emailed in July 2021. There were no reminders and descriptive statistics were calculated using Microsoft Excel.

RESULTS

We received 46 completed surveys from the 68 sent out. Note that 65.2% of respondents reported requiring N95 masks for aerosol-generating procedures. Note that 38.9% of respondents said they required student partnering as chairside dental assistants for aerosol-generating procedures. Note that 37.7% of respondents began using alternate cubicles. A total of 6.52% of schools reported a transmission of the severe acute respiratory syndrome coronavirus 2 virus from patient to provider. There were no reported transmissions from provider to patient or from patient to patient.

CONCLUSION

In our study, we found a lot of similarities between the approach taken by Dental School Clinics across the US to mitigate the risks of COVID-19, however, we also observed many differences.

How different countries respond to adverse events whilst patients' rights are protected

Patient safety is high on the policy agenda internationally. Learning from safety incidents is a core component in achieving the important goal of increasing patient safety. This study explores the legal frameworks in the countries to promote reporting, disclosure, and supporting healthcare professionals (HCPs) involved in safety incidents. A cross-sectional online survey was conducted to ascertain an overview of the legal frameworks at national level, as well as relevant policies. ERNST (The European Researchers' Network Working on Second Victims) group peer-reviewed data collected from countries was performed to validate information. Information from 27 countries was collected and analyzed, giving a response rate of 60%. A reporting system for patient safety incidents was in place in 85.2% (N = 23) of countries surveyed, though few (37%, N = 10) were focused on systems-learning. In about half of the countries (48.1%, N = 13) open disclosure depends on the initiative of HCPs. The tort liability system was common in most countries. No-fault compensation schemes and alternative forms of redress were less common. Support for HCPs involved in patient safety incidents was extremely limited, with just 11.1% (N = 3) of participating countries reporting that supports were available in all healthcare institutions. Despite progress in the patient safety movement worldwide, the findings suggest that there are considerable differences in the approach to the reporting and disclosure of patient safety incidents. Additionally, models of compensation vary limiting patients' access to redress. Finally, the results highlight the need for comprehensive support for HCPs involved in safety incidents.

An authentic leadership training programme to increase nurse empowerment and patient safety: A quasi-experimental study

BACKGROUND

Authentic leadership and empowered nurses are necessary if a healthy work environment is to be created and patient safety maintained; however, few studies have examined the impact of authentic leadership, on nurse empowerment and the patient safety climate.

PURPOSE

The aim of the study was to investigate the impact of an educational intervention delivered through a multi-faceted training programme on nurses' perceptions of authentic leadership, nurse empowerment (both structural and psychological) and the patient safety climate.

DESIGN

A quasi-experimental study using a one-group pretest-posttest design consistent with TREND guidelines.

METHODS

The study was conducted in a university hospital between December 2018 and January 2020. Participants were followed for 6 months. The programme involved 36 head nurses (leaders) and 153 nurses (followers). The effectiveness of the programme was evaluated using repeated measures of analysis of variance, dependent sample t-tests and hierarchical regression analysis.

RESULTS

Following the intervention, safety climate and authentic leadership scores increased among both leaders and followers. Structural and psychological empowerment scores also increased among followers. We found that authentic leadership and structural empowerment were predictors of safety climate.

CONCLUSION

The implementation of the education programme resulted in positive changes in participants' perceptions of authentic leadership and empowerment, which can enhance patient safety.

IMPLICATIONS

Healthcare organizations can implement similar multi-faceted training programmes focused on authentic leadership, and nurse empowerment to increase patient safety. Achieving effective results in such programmes can be facilitated by motivating participants with the support of the top management.

PATIENT OR PUBLIC CONTRIBUTION

The study included nurses in the intervention and the data collection processes.

IMPACT

Patient safety is a global concern, and improving patient safety culture/climate is a key strategy in preventing harm. Authentic leadership and nurse empowerment are essential in creating healthy work environments and delivering safe, high-quality care. Training programmes addressing these issues can help bring about improvements in healthcare organizations.

A systematic review of the facilitators and barriers to rapid response team activation

BACKGROUND

Outcomes associated with rapid response teams (RRTs) are inconsistent. This may be due to underlying facilitators and barriers to RRT activation that are affected by team leaders and health systems.

AIMS

The aim of this study was to synthesize the published research about facilitators and barriers to nurse-led RRT activation in the United States (U.S.).

METHODS

A systematic review was conducted. Four databases were searched from January 2000 to June 2023 for peer-reviewed quantitative, qualitative, and mixed methods studies reporting facilitators and barriers to RRT activation. Studies conducted outside the U.S. or with physician-led teams were excluded.

RESULTS

Twenty-five studies met criteria representing 240,140 participants that included clinicians and hospitalized adults. Three domains of facilitators and barriers to RRT activation were identified: (1) hospital infrastructure, (2) clinician culture, and (3) nurses' beliefs, attributes, and knowledge. Categories were identified within each domain. The categories of perceived benefits and positive beliefs about RRTs, knowing when to activate the RRT, and hospital-wide policies and practices most facilitated activation, whereas the categories of negative perceptions and concerns about RRTs and uncertainties surrounding RRT activation were the dominant barriers.

LINKING EVIDENCE TO ACTION

Facilitators and barriers to RRT activation were interrelated. Some facilitators like hospital leader and physician support of RRTs became barriers when absent. Intradisciplinary communication and collaboration between nurses can positively and negatively impact RRT activation. The expertise of RRT nurses should be further studied.

Teamwork matters: team situation awareness to build high-performing healthcare teams, a narrative review

Healthcare today is the prerogative of teams rather than of individuals. In acute care domains such as anaesthesia, intensive care, and emergency medicine, the work is complex and fast-paced, and the team members are diverse and interdependent. Three decades of research into the behaviours of high-performing teams provides us with clear guidance on team training, demonstrating positive effects on patient safety and staff wellbeing. Here we consider team performance through the lens of situation awareness. Maintaining situation awareness is an absolute requirement for safe and effective patient management. Situation awareness is a dynamic process of perceiving cues in the environment, understanding what they mean, and predicting how the situation may evolve. In the context of acute clinical care, situation awareness can be improved if the whole team actively contributes to monitoring the environment, processing information, and planning next steps. In this narrative review, we explore the concept of situation awareness at the level of the team, the conditions required to maintain team situation awareness, and the relationship between team situation awareness, shared mental models, and team performance. Our ultimate goal is to help clinicians create the conditions required for high-functioning teams, and ultimately improve the safety of clinical care.

US businesses engaged in direct-to-consumer marketing of perinatal stem cell interventions following the Food and Drug Administration's enforcement discretion era

BACKGROUND AIMS

The goal of this study was to analyze online marketing representations made by 300 US businesses selling allogeneic perinatal stem cell products. The study was conducted after a period of enforcement discretion by the US Food and Drug Administration (FDA).

METHODS

Data mining and content analysis were used to identify, analyze and categorize marketing claims made on the websites of 300 businesses selling perinatal stem cell interventions.

RESULTS

The study identified types of perinatal interventions companies advertised, geographic locations of clinics selling such products, types of companies operating in this space, diseases and injuries such businesses claim to treat, prices companies charge for such interventions, brand names of advertised perinatal cell products and identities of suppliers.

CONCLUSIONS

A substantial number of US businesses market unapproved perinatal stem cell products for various indications. This widespread commercial activity occurred following the conclusion of a period of enforcement discretion by the FDA and suggests the need for more robust and comprehensive regulatory responses to businesses selling unapproved perinatal stem cell products.

Harnessing In Situ Simulation to Identify Human Errors and Latent Safety Threats in Adult Tracheostomy Care

BACKGROUND

Tracheostomies are associated with high rates of complications and preventable harm. Safe tracheostomy management requires highly functioning teams and systems, but health care providers are poorly equipped with tracheostomy knowledge and resources. In situ simulation has been used as a quality improvement tool to audit multidisciplinary team emergency response in the actual clinical environment where care is delivered but has been underexplored for tracheostomy care.

METHODS

From July 2021 to May 2022, the study team conducted in situ simulations of a tracheostomy emergency scenario at Montefiore Medical Center to identify human errors and latent safety threats (LSTs). Simulations included structured debriefs as well as audiovisual recording that allowed for blind rating of these human errors and LSTs. Provider knowledge deficits were further characterized using pre-simulation quizzes.

RESULTS

Twelve human errors and 15 LSTs were identified over 20 simulations with 88 participants overall. LSTs were divided into the following categories: communication, equipment, and infection control. Only 50.0% of teams successfully replaced the tracheostomy tube within the scenario's five-minute time limit. In addition, knowledge gaps were highly prevalent, with a median pre-simulation quiz score of 46% (interquartile range 36-64) among participants.

CONCLUSION

An in situ simulation-based quality improvement approach shed light on human errors and LSTs associated with tracheostomy care across multiple settings in one health system. This method of engaging frontline health care provider key stakeholders will inform the development, adaptation, and implementation of interventions.

Psychological Safety: What It Is, Why Teams Need It, and How to Make It Flourish

In health care, transforming individuals with diverse skills into an effective, cohesive team is fundamental to delivering and advancing patient care. All teams, however, are not created the same. Psychological safety has emerged as a critical feature of high-performing teams across many industries, including health care. It facilitates patient safety, quality improvement, learning, and innovation. This review presents an overview of psychological safety in medicine, describing its impact on learning, patient safety, and quality improvement. The review also explores interventions and essential leadership behaviors that foster psychological safety in teams.

Perceptions of the Conditions and Barriers in Implementing the Patient Blood Management Standard by Anesthesiologists and Surgeons

Patient Blood Management (PBM) as a multidisciplinary practice and a standard of care for the anemic surgical patient is playing an increasingly important role in reducing transfusions and optimizing both clinical outcomes and costs. The success of PBM implementation depends on staff awareness and involvement in this approach. The main objective of our study was to explore physicians' perceptions of the conditions for implementing PBM in hospitals and the main obstacles they face in detecting and treating anemic patients undergoing elective surgery. This cross-sectional descriptive study includes 113 Romanian health units, representing 23% of health units with surgical wards nationwide. A 12-item questionnaire was distributed to the participants in electronic format. A total of 413 questionnaires representing the perceptions of 347 surgeons and 66 anesthesia and intensive-care specialists were analyzed. Although a lack of human resources was indicated by 23.70% of respondents as the main reason for not adhering the guidelines, the receptiveness of medical staff to implementing the PBM standard was almost 90%. In order to increase adherence to the standard, additional involvement of anesthesia and intensive-care physicians would be necessary from the perception of 35.70% of the responders: 23.60% of surgeons and 18.40% of hematologists.

Assessment of Patient Safety in a Low-Resource Health Care System: Proposal for a Multimethod Study

BACKGROUND

The high prevalence of adverse events (AEs) globally in health care delivery has led to the establishment of many guidelines to enhance patient safety. However, patient safety is a relatively nascent concept in low- and middle-income countries (LMICs) where health systems are already overburdened and underresourced. This is why it is imperative to study the nuances of patient safety from a local perspective to advocate for the judicious use of scarce public health resources.

OBJECTIVE

This study aims to assess the status of patient safety in a health care system within a low-resource setting, using a multipronged, multimethod approach of standardized methodologies adapted to the local setting.

METHODS

We propose purposive sampling to include a representative mix of public and private, rural and urban, and tertiary and secondary care hospitals, preferably those ascribed to the same hospital quality standards. Six different approaches will be considered at these hospitals including (1) focus group discussions on the status quo of patient safety, (2) Hospital Survey on Patient Safety Culture, (3) Hospital Consumer Assessment of Healthcare Providers and Systems, (4) estimation of incidence of AEs identified by patients, (5) estimation of incidence of AEs via medical record review, and (6) assessment against the World Health Organization's Patient Safety Friendly Hospital Framework via thorough reviews of existing hospital protocols and in-person surveys of the facility.

RESULTS

The abovementioned studies collectively are expected to yield significant quantifiable information on patient safety conditions in a wide range of hospitals operating within LMICs.

CONCLUSIONS

A multidimensional approach is imperative to holistically assess the patient safety situation, especially in LMICs. Our low-budget, non-resource-intensive research proposal can serve as a benchmark to conduct similar studies in other health care settings within LMICs.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50532.

An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective

Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.

Evaluation of SINERGIAPS, an intervention to improve patient safety in primary healthcare centers in Spain based on patients' perceptions and experiences: a protocol for a hybrid type I randomized clinical trial

Background

Adverse events in the primary care setting result in a direct cost equivalent to at least 2.5% of total healthcare spending. Across OECD countries, they lead to more than seven million avoidable hospital admissions annually. In this manuscript, we describe the protocol of a trial aimed at evaluating the effectiveness of SinergiAPS (a patient-centered audit and feedback intervention) in reducing avoidable hospital admission and explore the factors that may affect its implementation.

Methods

We will conduct a 24-month, parallel, open-label, multicenter, pragmatic, hybrid type 1 randomized clinical trial. 118 primary healthcare centers with wide geographical distribution in Spain will be randomly assigned (ratio 1:1) to two groups. The intervention group will receive two audits (baseline and intermediate at 12 months) based on information collected through the administration of the PREOS-PC questionnaire (a measure of patient-reported patient safety) to a convenience sample of 100 patients per center. The intervention group will receive reports on the results of both audits, along with educational resources aimed at facilitating the design and implementation of safety improvement plans. The control group will receive care as usual. The primary outcome will be the rate of avoidable hospitalizations (administrative data). Secondary outcomes: patient-reported patient safety experiences and outcomes (PREOS-PC questionnaire); patient safety culture as perceived by professionals (MOSPSC questionnaire); adverse events reported by healthcare professionals (ad hoc questionnaire); the number of safety improvement actions which the re has implemented (ad hoc questionnaire). Outcome data will be collected at baseline and 24 months follow-up. For the evaluation of the implementation of the SinergiAPS intervention, we will draw on the Consolidated Framework for Implementation Research (CFIR). We will collect and analyze qualitative and quantitative data (30 individual interviews, implementation logbooks; questionnaires for professionals from intervention centers, and level of use of the SinergiAPS web tool).

Discussion

This study will expand the scarce body of evidence existing regarding the effects and implementation of interventions aimed at promoting patient and family engagement in primary healthcare, specifically for enhancing patient safety. The study has the potential to produce an impact on clinical practice, healthcare systems, and population health.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT05958108?term=sinergiAPS&rank=1 (NCT05958108).