Assess Patient Safety Research Articles

Teaching M&M rounds skills: enhancing and assessing patient safety competencies using the Ottawa M&M model

BackgroundPostgraduate medical education bodies and national patient safety institutes recommend that trainees develop patient safety competencies such as those for Morbidity and Mortality (M&M) rounds, yet there exists no model...

Assessment of Patient Safety for Quality Improvement Based on Joint Commission International Accreditation Standards in Farabi Eye Hospital of Tehran University of Medical Sciences

Introduction: Quality improvement and patient safety are the most important aspects of health care delivery systems. Improving quality and safety in health care organizations is assured through accreditation. To evaluate patient safety in Farabi Eye Hospital by Joint Commission International (JCI) accreditation standards for quality improvement. Materials and Methods:This descriptive-analytical study was carried out in 2014. The data collection instrument was the translated version of JCI checklist, the validity of which was confirmed by a panel of Iranian experts. The data were obtained through interviews with all heads of departments (n=80) and observation of documentation in each department by appraisers in Farabi Hospital. To analyze the data, Spearman's rank correlation coefficient and Mann-Whitney U tests were run using SPSS Version 16. Results: The highest rate of compliance with JCI standards was 91.1%, pertaining to infection control and adopting an approach to reduce contamination. The lowest rate was associated with management monitoring of patients’ demographic information. In general, Farabi Eye Hospital observed the standards to a high level. Conclusion: Our findings exhibited that Farabi Eye Hospital is relatively efficient as to patient safety as a quality improvement factor. However, there were some shortcomings regarding some standards, which indicate deficient compliance with the JCI standards in this hospital. Absence of comprehensive training programs and defective policies and documentation are the key factors for patient safety quality improvement.

Confirmatory Factor Analysis of Patient Safety Culture in an Iranian Hospital: A Case Study of Fatemeh Zahra Hospital in Najafabad, Iran

Introduction: Transformation of patient safety culture towards developing an open culture can be the greatest challenge for achieving a safe healthcare system. This study aimed to carry out a structural analysis of the Persian translation version of a questionnaire assessing patient safety culture. Materials and Methods: The study was conducted to evaluate the Persian translation of patient safety culture questionnaire, developed by the National Patient Safety Agency. The questionnaire includes seven sections and 43 items investigating 12 dimensions of patient safety culture. The reliability of this questionnaire was confirmed with Cronbach's alpha (α>0.8). The questionnaire was distributed among employees of the Fatemeh Zahra Hospital in Najafabad, Iran, 2015. The collected data were analyzed using SPSS 18 and Amos 18. Results: Sufficiency of the sample size, as determined by Kaiser-Meyer-Olkin measure, was 0.809, which was significantly associated with zero; therefore, performing factor analysis was acceptable and justifiable. The value of Bartlett's test was 696, P-value was less than 0.001, and degree of freedom was equal to 91. In the final model, the relative Chi-square was equal to 1.75 and P-value was less than 0.001. Also, parsimony normed fit index, parsimony-adjusted comparative fit index, and root mean square error of approximation were equal to 0.571, 0.621, and 0.065, respectively. Conclusion: Based on the results of fitting indices for the model and the questionnaire used in the present study for assessing patient safety culture, it can be stated that the Persian translation of this instrument is valid and hospitals can use it to monitor patient safety culture improvement.

Patient safety and patient assessment in pre-hospital care: a study protocol.

BackgroundPatient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to survey patient safety problems in pre-hospital care in Sweden.Methods/DesignThe study is a retro-perspective structured medical record review based on the use of 11 screening criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for pre-hospital care and a newly development instrument designed to compare the pre-hospital assessment with the final hospital assessment. Three different ambulance organisations are participating in the study. Every month, one rater in each organisation randomly collects 30 medical records for review. With guidance from the review instrument, he/she independently reviews the record. Every month, the review team meet for a discussion of problematic reviews. The results will be analysed with descriptive statistics and logistic regression.DiscussionThe findings will make an important contribution to knowledge about patient safety issues in pre-hospital care.

Geometrical deployment for braided stent.

The prediction of flow diverter stent (FDS) implantation for the treatment of intracranial aneurysms (IAs) is being increasingly required for hemodynamic simulations and procedural planning. In this paper, a deployment model was developed based on geometrical properties of braided stents. The proposed mathematical description is first applied on idealized toroidal vessels demonstrating the stent shortening in curved vessels. It is subsequently generalized to patient specific vasculature predicting the position of the filaments along with the length and local porosity of the stent. In parallel, in-vitro and in-vivo FDS deployments were measured by contrast-enhanced cone beam CT (CBCT) in idealized and patient-specific geometries. These measurements showed a very good qualitative and quantitative agreement with the virtual deployments and provided experimental validations of the underlying geometrical assumptions. In particular, they highlighted the importance of the stent radius assessment in the accuracy of the deployment prediction. Thanks to its low computational cost, the proposed model is potentially implementable in clinical practice providing critical information for patient safety and treatment outcome assessment.

Patient Safety Assessment at Primary Health Care Centers in Cairo, Egypt

Background: Patient safety at primary health care centers (PHCC) is rarely assessed, particularly in developing countries. Objectives: This study aimed to assess some items of patient safety program at primary health care centers, Cairo, Egypt. Methods: A cross sectional study was carried out on primary health care centers (PHCC) in Cairo, from January through March 2016 to assess the quality of some patient safety items. Two PHCC were selected randomly from the health affairs directorate of Nasr city, Eastern Cairo (El-Hagana family medicine center and 6th district family medicine center). The data were collected through interviewing and observing technique using structured questionnaire containing the quality items. The used questionnaire and interview checklist were developed and formulated according to the WHO patient safety and OSHA self inspection checklist. Scoring of the studied items are done and compared between the two studied centers using statistical test with p value of significance was set at ≤ 0.05. Results: There were statistically significant differences between the studied family medicine centers with regard to some studied patient safety goals where the higher compliance was achieved in the 6th district center. For the studied quality improvement requirements, however, there was no statistically significant difference between the studied centers for almost all studied items. Comparison of compliance of the studied centers with the criteria of access, there was statistically significant difference regarding most of the studied items of this topic with the highest compliance was observed in6th district center, although no one of the studied centers has met all the studied characteristics of that topic. Assessing the availability and uses of personal protective equipment (PPE), the study findings showed a variation among the studied centers. Only one third of the clinics of El-Hagana center showed a compliance with PPE. Conclusion: Patient safety at primary health care centers has to be reviewed and assessed periodically. There are need to carry national large study to assess quality of patient safety program in PHCC all over the country.

Neue Wege zur Evaluierung von patientensicherheitsrelevanten Aspekten: Feedback-Patientensicherheit

Patient safety has become a hot topic, and there are numerous initiatives ongoing to improve patient-relevant processes. But how can both the effectiveness and sustainability of these initiatives be evaluated? The aim of the present paper was to describe the development of an instrument to assess patient safety aspects which can be used for normal hospital ward and intensive care unit rounds or in the operating room. All relevant patient safety guidelines and checklists of the University Hospital Graz were screened. Subsequently, questions were extracted from these documents which can be used in a checklist for "real-time" ward rounds by local observers. Based on the document screening two sets of criteria were prepared, one for operating rooms and one for normal hospital wards and intensive care units. Using a survey tool two checklists were then generated on the basis of these criteria, which can be used for the so-called "patient-safety feedback" from the observers. Whether guidelines or checklists, which should theoretically improve patient safety, are properly understood and applied as intended by healthcare professionals can only be evaluated by using methods like monitoring the respective processes. The checklists for conducting the so-called "patient-safety feedback" seem to be an effective instrument to assess patient safety-relevant processes in "real-time".

Nursing handover from ICU to cardiac ward: Standardised tools to reduce safety risks

BackgroundStandardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. ObjectivesAdapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. MethodsA three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. ResultsStage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. ConclusionClinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.

Seguridad del paciente: glosario

Patient safety and quality of care has become a challenge for health systems. Health care is an increasingly complex and risky activity, as it represents a combination of human, technological and organizational processes. It is necessary, therefore, to take effective actions to reduce the adverse events and mitigate its impact. This glossary is a local adaptation of key terms and concepts from the international bibliographic sources. The aim is providing a common language for assessing patient safety processes and compare them.

Systematic assessment of surgical complications in laparoscopically assisted vaginal hysterectomy for pelvic organ prolapse

ObjectiveTo assess patient safety and complication rates in native tissue vaginal prolapse repair combined with laparoscopically assisted vaginal hysterectomy and prophylactic salpingectomy/salpingoophorectomy. Study designThis was a single-centre retrospective study conducted at the University Hospital, Urogynaecological Unit, with a certified urogynaecological surgeon. A cohort of 321 consecutive patients received laparoscopically assisted vaginal hysterectomy for pelvic organ prolapse grade II–IV combined with defect-specific vaginal native tissue repair. Analysis of the total cohort and subgroups according to prolapse grade and concomitant laparoscopic procedures was performed. Student's t-tests and chi-squared tests were used for descriptive statistical analysis. Surgical complications were classified using the Clavien–Dindo (CD) classification system of surgical complications. ResultsComplications were classified as CD I (1.87%), CD II (13.39%), CD IIIa (0.62%), and CD IIIb (1.87%); no CD IV or CD V complication occurred. One (0.31%) intraoperative bladder lesion, but no rectal lesion, ureter lesion, or intraoperative haemorrhage requiring blood transfusion, was noted. The overall morbidity rate, including the intraoperative bladder lesion and the CD I complication, was 18.06%. All (n=321) patients underwent prophylactic salpingectomy. Additional oophorectomy was performed in 222 post-menopausal patients. Pelvic adhesions were found in 123 (38.31%) patients and 148 (46%) patients presented grade IV prolapse. Operating time was longer for grade IV than for grade II/III prolapse (p<0.01), but CD III complication rates did not differ between these groups. Operating time was longer when laparoscopic adhesiolysis was performed (p=0.025), but this factor did not affect CD III complication rates. ConclusionsThe combination of vaginal site-specific prolapse repair with laparoscopically assisted hysterectomy leads to low complication rates. Prophylactic salpingectomy or salpingoophorectomy can be performed safely in combination with hysterectomy for pelvic organ prolapse. In terms of surgical safety laparoscopy seems to be a meaningful addition to vaginal native tissue prolapse surgery.

Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

ABSTRACTBackground: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture.Objective: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care.Methods: Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care.Results: The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events.Conclusion: Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care.

Is researching adverse events in hospital deaths a good way to describe patient safety in hospitals: a retrospective patient record review study

ObjectiveAdverse event studies often use patient record review as a way to assess patient safety. As this is a time-consuming method, hospitals often study inpatient deaths. In this article we...

Translation and adaptation of a questionnaire to assess patient safety in primary health care

The objective of this study was to describe the translation and adaptation of the questionnaire used in the Primary Care International Study of Medical Errors (PCISME) for application in primary health care in a local health district in Rio de Janeiro State, Brazil. The process included organization of an expert panel that adapted the questionnaire using a modified Delphi method. The adapted instrument can help produce specific information on primary health care and strengthen initiatives to improve patient safety in Brazil.

QSEN: Curriculum Integration and Bridging the Gap to Practice [Research Brief

Abstract The purpose of this project was to revise the curriculum at a diploma school of nursing to meet the call issued by QSEN. Course objectives were revised and principles of quality and safety were threaded throughout the curriculum with classroom, clinical, and simulation strategies. Students and faculty completed the Healthcare Professionals Patient Safety Assessment Curriculum Survey, and preceptors were surveyed regarding students' ability to meet QSEN competencies. No difference was found post-implementation, but statistically significant differences were found between students and faculty and between students at the start of the nursing program and one year later.

222. AST-VAC2: An Embryonic Stem Cell-Derived Dendritic Cell Cancer Immunotherapy

AST-VAC2 is a cancer immunotherapy product comprising embryonic stem cell-derived dendritic cells electroporated with an mRNA encoding a telomerase/lysosome-associated membrane protein 1 (LAMP hTERT) chimeric tumor antigen. Previous studies have shown that AST-VAC2 can elicit a telomerase-specific T-cell response from partially HLA-matched donor peripheral blood mononuclear cells. A related product (AST-VAC1), an autologous dendritic cell/LAMP hTERT cancer immunotherapy, has been tested in clinical trials on patients with prostate cancer or acute myeloid leukemia. The AST-VAC1 treatment was well tolerated and generated anti-telomerase immune responses. AST-VAC2 is being developed as an off-the-shelf allogeneic cancer vaccine for clinical testing in partially HLA matched patients with non-small cell lung carcinoma. The AST-VAC2 product is derived from the H1 human embryonic stem cell line. The stem cells are differentiated into mature dendritic cells in a multi-step process via embryoid bodies, prepared growth surfaces and specific growth factors. The differentiation process requires 34 days in culture. The cells are then electroporated with the LAMP hTERT mRNA and irradiated prior to cryopreservation. In preparation for clinical testing the manufacturing process has been scaled up from T-flasks to large surface area cell stacks. This has required a number of novel process modifications including large scale embryoid body filtration and flow-through electroporation. The final product will be rendered incapable of replication by gamma irradiation. The radiation dose required for halting replication while still preserving antigen presentation was determined using a combination colony formation/potency assay. It is anticipated that the proposed Phase 1/2a clinical trial will enroll approximately 30 patients and will include both a dose escalation and a broadening of inclusion criteria to permit an assessment of safety, toxicity and immunogenicity in patients with advanced disease. Asterias has recently partnered with Cancer Research United Kingdom (CRUK) and the University of Southampton for the GMP manufacturing and initial clinical testing of AST-VAC2 in the UK.

An approach to assessing patient safety in hospitals in low-income countries.

ObjectiveThe aim of the study was to assess non-technical aspects of patient safety practices using non-participant observation in different clinical areas.DesignQualitative study using non-participant observation and thematic analysis.SettingTwo eye care units in Uganda.ParticipantsStaff members in each hospital.Main outcome measuresA set of observations of patient safety practices by staff members in clinical areas that were then coded using thematic analysis.ResultsTwenty codes were developed that explained patient safety practices in the hospitals based on the observations. These were grouped into four themes: the team, the environment, patient-centred care and the process. The complexity of patient safety in each hospital was described using narrative reports to support the thematic analysis. Overall both hospitals demonstrated good patient safety practices however areas for improvement were staff-patient communication, the presence and use of protocols and a focus on consistent practice.ConclusionsThis is the first holistic assessment of patient safety practices in a low-income setting. The methods allowed the complexity of patient safety to be understood and explained with areas of concern highlighted. The next step will be to develop a useful and easy to use tool to measure patient safety practices in low-income settings.

A comparison of the methods used to support risk identification for patient safety in one UK NHS foundation trust

In healthcare, various methods are available to support risk identification in risk management process. However, there is no clear evidence on their contribution to risk identification. In this study, different methods used to support risk identification were therefore analysed to compare their contribution to overall risk identification. The study was conducted at Cambridge University Hospitals Foundation Trust, UK. Three main methods were selected to compare their support in risk identification: incident reports through their Risk Management Information System, risk registers through their Risk Registers system, and safety walkabouts through their internal patient safety assessment process. Where possible, simple comparison tests were run between the different methods of identifying risks as well as by the type of risks identified. It was found that each method has contributed to the risk identification by adding different sets of risk sources despite some overlaps. However, they produced discrete assessments from different aspects and none of them, on its own, could produce adequate results for effective risk identification. In any healthcare setting, having a system to put all risk information in one picture would help maximise the contribution of each method within the scope risk management process. Future studies may benefit from broader use of multiple and system-based risk identification approaches, and coding methods for more powerful analytical test.

Improving students' safety practice behaviors through a simulation-based learning experience.

This study evaluated 175 senior-level undergraduate nursing students' perceptions and comfort level regarding safety principles and practices before and after participating in a safety-focused clinical simulation-based experience during their nursing leadership course. The Healthcare Professionals Patient Safety Assessment (HPPSA) was used to measure students' perceptions and comfort level regarding patient safety practices. Respondents rated their level of agreement about statements related to errors and safety in health care, their comfort level in reporting and disclosing an error, and whether they had seen, disclosed, or reported an error. The t test for the HPPSA Part 2 was statistically significant (n = 153, t = 2.78, p = 0.006) with mean pretest and posttest scores of 16.95 (SD = 3.44) and 17.69 (SD = 3.25), respectively. The findings suggest simulation is a teaching strategy that may contribute to increasing undergraduate nursing students' comfort with reporting or investigating errors.

Abstract T MP100: Improving Timeliness of TPA Administration: Re-vamping Emergency Department Processes to Decrease Door to Needle Times

Introduction: Time to neuroimaging is one of the critical measures for fast thrombolysis in acute ischemic stroke (AIS). While many aim to give IV tPA under 60 minutes from hospital arrival (door-to-needle or DTN), every minute of delay decreases the chances of good outcomes. Following previous reports, we established a streamlined triage system (STS) for all out-of-hospital stroke alerts and report on the initial experience of this new system and its effect on DTN. Methods: We included all AIS with last known well (LKW) under 2 hours who were treated with IV tPA from 11/2012 to 06/2014 at our facilities. We excluded telestroke or patients who were transferred to us, implemented STS on November 01, 2013 and analyzed time to CT (start of the exam) and DTN for patients before (group 1) after (Group 2) that date, using the UCSD GetWithTheGuidelines® data set. STS includes rapid triage on the EMS stretcher in the ED to assess patient safety for immediate transfer by EMS to CT, without a detailed neurological assessment. Previously patients were roomed in the ED first and received a triage including a neurological exam. We assessed treatment times, ED arrival to CT (DTC) and DTN for each Group and assessed serious neurological and medical complications (episodes of increased intracranial pressure, cardiac or respiratory arrest) in radiology before and after STS. We used unpaired t-test for comparing means (continuous variables). Results: A total of 36 patients received IV tPA (Group 1: 22, Group 2: 14). Mean (±SD) times (minutes) for DTC was 15.9(7.3) versus 11.5(6.5) (NS), for DTN 62.6(17.7) versus 53.8(19.6) (NS). We saw no serious complication before or after STS. Conclusions: Our streamlined stroke triage is safe and we aim to continue our analysis to identify additional opportunities for shorten treatment times. Expanding STS to include all stroke patients may further shorten DTN.

Adaptación de la herramienta del cuestionario Medical Office Survey on Patient Safety Culture (MOSPSC)

ObjectiveTo adapt the Medical Office Survey on Patient Safety Culture (MOSPSC) Excel® tool for its use by Primary Care Teams of the Spanish National Public Health System. MethodsThe process of translation and adaptation of MOSPSC from the Agency for Healthcare and Research in Quality (AHRQ) was performed in five steps: Original version translation, Conceptual equivalence evaluation, Acceptability and viability assessment, Content validity and Questionnaire test and response analysis, and psychometric properties assessment. After confirming MOSPSC as a valid, reliable, consistent and useful tool for assessing patient safety culture in our setting, an Excel® worksheet was translated and adapted in the same way.It was decided to develop a tool to analyze the “Spanish survey” and to keep it linked to the “Original version” tool.The “Spanish survey” comparison data are those obtained in a 2011 nationwide Spanish survey, while the “Original version” comparison data are those provided by the AHRQ in 2012. ResultsThe translated and adapted tool and the analysis of the results from a 2011 nationwide Spanish survey are available on the website of the Ministry of Health, Social Services and Equality. It allows the questions which are decisive in the different dimensions to be determined, and it provides a comparison of the results with graphical representation. ConclusionsTranslation and adaptation of this tool enables a patient safety culture in Primary Care in Spain to be more effectively applied.