Canadian Patient Safety Institute Research Articles

Faculty-Wide Peer-Support Program During the COVID-19 Pandemic: Design and Preliminary Results.

Physicians experience higher rates of burnout relative to the general population. Concerns of confidentiality, stigma, and professional identities as health care providers act as barriers to seeking and receiving appropriate support. In the context of the COVID-19 pandemic, factors that contribute to burnout and barriers to seeking support have been amplified, elevating the overall risks of mental distress and burnout for physicians. This paper aimed to describe the rapid development and implementation of a peer support program within a health care organization located in London, Ontario, Canada. A peer support program leveraging existing infrastructures within the health care organization was developed and launched in April 2020. The "Peers for Peers" program drew from the work of Shapiro and Galowitz in identifying key components within hospital settings that contributed to burnout. The program design was derived from a combination of the peer support frameworks from the Airline Pilot Assistance Program and the Canadian Patient Safety Institute. Data gathered over 2 waves of peer leadership training and program evaluations highlighted a diversity of topics covered through the peer support program. Further, enrollment continued to increase in size and scope over the 2 waves of program deployments into 2023. Findings suggest that the peer support program is acceptable to physicians and can be easily and feasibly implemented within a health care organization. The structured program development and implementation can be adopted by other organizations in support of emerging needs and challenges.

Perceptions of Patient Safety Competence Using the Modified Version of the Health Professional Education in Patient Safety Survey (H-PEPSS) Instrument Among Dental Students in Riyadh, Saudi Arabia.

AimTo investigate dental students’ self-reported confidence in learning about various domains of patient safety during their clinical training years.MethodsThe Health Professional Education in Patient Safety Survey (H-PEPSS) was distributed to the fourth- and fifth-year undergraduate students, interns and postgraduate dental students. The survey explores how the seven domains of the Canadian Patient Safety Institute Safety Competencies Framework and wider cases of patient safety issues are presented in dental education, as well as participants’ self-reported comfortability regarding revealing about patient safety issues. A comparison of the patient safety domains scores were assessed through learning scenarios (classroom and clinical), gender, level of study and type of institution.ResultsOut of 409 participants, 359 undergraduate dental students and 131 postgraduate dental students responded to the survey. Irrespective of the groups, all dental students were most confident regarding their learning aspects about skills pertaining to clinical safety and effective communication and least confident in learning related to managing safety risks. All the patient safety factors irrespective of the scenario, scored above 75% and thus interpreted as good competence. Statistically significant differences were reported among the genders in the classroom scenario for learning about communicating effectively with the patients regarding patient safety issues (p < 0.05). Male dental students, undergraduates and those in the private institution were significantly less confident about recognizing and reporting to immediate risks in the clinical scenario compared to their respective counterparts (p < 0.05).ConclusionBased on the results, the dental students are quite confident with regard to the learning aspects of clinical patient safety, nevertheless, their confidence in learning certain patient safety aspects warrants further improvement. This implies a need to address the impact of regular interventions, extra motivation and repeated mentoring in both the classroom and clinical scenarios on improving dental students’ confidence about patient safety.

Developing the first pan-Canadian survey on patient engagement in patient safety

BackgroundPatient safety is a worldwide problem, and the patient contribution to mitigate the risk of patient harm is now recognized as a cornerstone to its solution. In order to understand the nature of integrating patients into patient safety and healthcare organizations and to monitor their integration, a Canadian survey tool has been co-constructed by patients, researchers and the Canadian Patient Safety Institute (CPSI). This questionnaire has been adapted from the French version of the patient engagement (PE) in patient safety (PS) questionnaire created for the province of Quebec, Canada.MethodologyThe pan-Canadian PE in PS survey tool was developed in a five-step process: (1) a literature review and revision of the initial tool developed in the province of Quebec; (2) translation of the French questionnaire into an English version tool; (3) creation of a Canadian expert advisory group; (4) adaptation of the English version tool based on feedback from the expert advisory group (assessment and development of the construct’s dimensions, wording assessment and adaptation for pan-Canadian use, technical testing of the online platform for the survey); and (5) pilot testing and pre-validation of the tool before pan-Canadian use.Results and conclusionEight pan-Canadian PE in PS surveys were completed from five Canadian provinces by the expert advisory group and six surveys were completed during the pilot project by participants from different provinces in Canada. This survey tool comprises 5 sections: (1) demographic identification of the participants (Q1 to Q5); (2) general questions (Q6 to Q17); (3) the patient engagement process (experience level of participants and organizational incentives for PE in general) (Q18 to Q33); (4) PE in PS processes, such as current activities, strategies, structures, resources and factors (Q34 to Q67); and (5) the context and impact of PE in PS initiatives in Canadian healthcare organizations (CHOs) (Q68 to Q75), including outcome identification, improvement mechanisms and strategies, evaluation mechanisms, and indicators.

Economic Analysis of the Prevention and Control of Nosocomial Infections: Research Protocol.

Background: Nosocomial infections (NIs) are among the main preventable healthcare adverse events. Like all countries, Canada and its provinces are affected by NIs. In 2004, Ministry of Health and Social Services (MSSS) of Quebec instituted a mandatory surveillance NI program for the prevention and control (NIPC) in the hospitals of the province. One target of the MSSS 2015–2020 action plan is to assess the implementation, costs, effects, and return on investment of NIPC measures. This project goes in the same way and is one of the first major studies in Canada to evaluate the efficiency of the NIPC measures. Three objectives will be pursued: evaluate the cost of implementing clinical best practices (CBPs) for infection control; evaluate the economic burden attributable to NIs; and examine the cost-effectiveness of the NIPC by comparing the costs of CBPs against those of NIs.Methods: This project is based on an infection control intervention framework that includes four CBPs: hand hygiene; hygiene and sanitation; screening; and additional precautions. Four medical and surgical units in two hospitals (nonUniversity, University) in the province of Quebec will be studied. The project has four components. Component 1 will construct and content validate an observation grid for measuring the costs of CBPs. Component 2 will estimate CBP costs via 2-week prospective observations of health workers, conducted every 2 months over a 1-year period. Component 3 will evaluate, through a matched case-control study, the economic burden of the four most monitored NIs in Quebec (C-difficile, MRSA, VRE, and CPGNB). Archival patient data will be collected retrospectively. Component 4 will determine the optimal breakeven point for CBPs associated with NIPC.Discussion: This project will produce evidence of the economic analysis of NIPC and give health stakeholders an overview of NIPC cost-effectiveness. It will meet the objectives of the Canadian Patient Safety Institute and the MSSS action plan to analyze the efficiency of NIPC preventive measures. To our knowledge, this is the first such exercise in Quebec and Canada. It will provide governments with a decision support tool through a major empirical study that could be replicated nationally to capture the financial benefits of NIPC.

An evidence-based tool (PE for PS) for healthcare managers to assess patient engagement for patient safety in healthcare organizations

In 1999, the Institute of Medicine had already warned that medical errors caused between 44,000 and 98,000 avoidable deaths per year in the United States. A similar situation was subsequently in 2000, documented in Canadian hospitals. According to a Canadian Patient Safety Institute report (2016), incidents in both acute and home care settings resulted in additional costs of $2.75 billion each year. Research suggests that Patient Engagement (PE) for Patient Safety (PS) can help address this issue. However, the use of PE in various strategies to promote PS has yet to be fully integrated across healthcare systems in OECD countries. The aim of this study was to develop a tool for managers to assess PE strategies implemented at a health system level to enhance PS. Developing the tool involved 3 phases: (1) creating a framework; (2) building a first version of the tool; (3) validating the tool by an expert committee of PS and PE managers. The final tool consists of 81 questions, divided into four sections: (1) describing the healthcare organization (n=14); (2) gathering general information on PE strategies (n=15); (3) assessing different PE strategies for PS (n=49); and (4) describing the respondent’s involvement in PS committees (n=3). The tool is currently being used (by healthcare professionals working in Risk Management (RM) or PS, or, by task groups that include patients) in a research study in Canada and France, to assist healthcare managers in monitoring the evolution of PE for PS at a system level.

Combining enhanced recovery and short-stay protocols for hip and knee joint replacements: the ideal solution

SummaryPressure to reduce health care costs, limited hospital bed availability as well as improvements in surgical techniques and perioperative care motivated many health care centres to implement short-stay protocols for patients undergoing hip or knee arthroplasty. To improve patient outcomes and maintain care safety, we strongly believe the best way to implement a successful outpatient program would be to embrace the principles of Enhanced Recovery After Surgery (ERAS), and to improve patient recovery to a level such that the patient could leave the hospital sooner. Enhanced Recovery Canada and the Canadian Patient Safety Institute support the development of ERAS pathways for orthopedic procedures. The goal is to provide patients, health care providers and leaders with helpful tools and resources to effectively implement and sustain ERAS protocols. Reducing the rate of adverse events while reducing the length of hospital stays to less than 24 hours is a winning situation for everyone.

\u201cWe\u2019ve got the home care data, what do we do with it?\u201d: understanding data use in decision making and quality improvement

BackgroundIn the past decade the provision of home care services in Canada has doubled; with this increase there has been a growing interest in improving quality and safety. National-level data are captured in the Home Care Reporting System (HCRS), using the interRAI-HC tools. Data in the HCRS provide decision-makers and administrators with actionable evidence to inform quality and safety improvement initiatives. The objective of this study was to determine how providers and administrators were using these data, and if there were any opportunities to enhance their use.MethodsWe collaborated with the Canadian Patient Safety Institute to conduct this qualitative study. To understand data use in home care, we recruited participants in management and/or data analysis roles from home care organizations across Canada. We conducted three individual interviews and three focus group interviews with a total of eleven participants from five Canadian provinces. Individual and focus group interviews were audio recorded, transcribed, and analysed using a combination of emergent coding and thematic analysis.ResultsSeveral participants provided powerful examples of how interRAI data have been used to guide patient safety and quality improvement initiatives; however, all participants recognized challenges in using these data. Leveraging interRAI data in the complex home care environment is limited by several factors: the general “newness” of these data in many jurisdictions; the sheer volume of data; limited capacity and resources to interpret and analyse the data; and connectivity issues in rural areas. Participants recognized and appreciated the training that has been provided, and made several recommendations for additional training.ConclusionsMandated clinical datasets, such as the suite of interRAI tools, have the potential to improve quality and inform decision-making. However, in order to utilize these data, home care agencies require additional education, personnel and supports. Additional training and resources for these organizations could improve the use of available data by home care agencies, as well as outcomes for individuals receiving home care services.

Empowering Patients to Start a Conversation: 5 Questions to Ask about Your Medications.

This quality improvement initiative to help prevent known medication-related failures during transitions of care was co-led by Patients for Patient Safety Canada, the Institute for Safe Medication Practices Canada, the Canadian Patient Safety Institute, the Canadian Pharmacists Association, and the Canadian Society for Hospital Pharmacists. Initially, the intervention was to develop, test, evaluate and disseminate a medication safety "checklist" for patients and healthcare providers. Through small tests of change, the checklist was redesigned as the "5 Questions to Ask about Your Medications." Collective results demonstrate a shared commitment among more than 200 organizations to empower patients with questions to ask about their medications.

Homecare Safety Virtual Quality Improvement Collaboratives.

With Canada's aging population, innovations in technology and changes in patient preferences regarding where they receive care, there is a growing reliance on homecare services. Professionals in the homecare sector want to provide the best care possible for their clients, whereas homecare organizations look to foster a greater patient safety culture. The Canadian Patient Safety Institute and the Canadian Home Care Association conducted two learning collaboratives aimed at increasing quality improvement capability in homecare settings. Teams from across the country have increased their capacity and capability to engage patients and families, mitigate and prevent harm from homecare safety incidents such as falls and specifically address issues such as improving interprofessional collaboration, teamwork and communication.

Patient Safety Never Events: Cross-Canada Checkup.

In September 2015, Health Quality Ontario (HQO) and the Canadian Patient Safety Institute (CPSI), with an action team that brought together quality councils and committees along with patient and family representatives, garnered consensus and published the report Never Events for Hospital Care in Canada (HQO and CPSI 2015). The report is a call to action for healthcare leaders to prevent the occurrence of never events. Many sites have already been collecting data and focusing efforts on reducing never events. We need to take this action further, to collaborate between sites and provinces and territories so that we can learn from one another and prevent patient harm. This is an opportune time to centre our efforts so that never events no longer occur in our hospitals.

National Patient Safety Consortium: Learning from Large-Scale Collaboration

From 2014 to 2018, the Canadian Patient Safety Institute brought together key partners and established the National Patient Safety Consortium to drive a shared action plan for safer healthcare. With ongoing consensus development on key priorities, an unprecedented level of collaboration and shared leadership with diverse stakeholders and patients and families as full partners, the Consortium and its Integrated Patient Safety Action Plan built a culture of engagement and improvement across Canada.

Development of a clinical pathway for enhanced recovery in colorectal surgery: a Canadian collaboration

Enhanced Recovery After Surgery (ERAS) is a model of care that was introduced in the late 1990s by a group of surgeons in Europe. The model consists of a number of evidence-based principles that support better outcomes for surgical patients, including improved patient experience, reduced length of stay in hospital, decreased complication rates and fewer hospital readmissions. A number of Canadian surgical care teams have already adopted ERAS principles and have reported positive outcomes. Arising from the Canadian Patient Safety Institute’s Integrated Patient Safety Action Plan for Surgical Care Safety, and with support from numerous partner organizations from across the country, Enhanced Recovery Canada is leading the drive to improve surgical safety across the country and help disseminate these ERAS principles. We discuss the development of a multidisciplinary clinical pathway for elective colorectal surgery to help guide Canadian clinicians.

Evaluation of a Novel Audit Tool for Medication Reconciliation at Hospital Discharge

Discharge medication reconciliation (MedRec) is designed to reduce medication errors and inform patients and key postdischarge providers, but it has been difficult to implement routinely in Canadian hospitals. To evaluate and optimize a new discharge MedRec quality audit tool and to use it at 3 urban teaching hospitals. The discharge MedRec quality audit tool, developed by the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada, was assessed and modified to improve comprehensiveness, clarity, and quality. The modified tool was then used to evaluate the quality of the discharge MedRec process for adult patients discharged to home from the general internal medicine service at 3 academic hospitals. Postdischarge telephone interviews were conducted with consenting patients, their community pharmacists, and their family doctors. The audit tool required modification to include aspects of admission MedRec, high-risk medication discrepancies, and direct communication of discharge MedRec to key follow-up providers. Thirty-five patients (mean age 67.7 years, standard deviation [SD] 18.0 years; 17 [49%] women), with a mean of 8.8 (SD 4.5) prescribed medications at discharge, participated in the discharge MedRec evaluation. Documentation of any discharge MedRec was found for only 1 patient (3%), and no discharge MedRec was carried out by pharmacists. Postdischarge follow-up interviews elicited major gaps in communication with community pharmacists and with family physicians, which could lead to serious medication errors. The modified audit tool was useful for identifying gaps in the quality of discharge MedRec.

Moving Beyond the Quality and Safety Quagmire: Collective Wisdom from Nurse Leaders.

As part of the special focus on nursing leadership and quality improvement, I had the privilege of interviewing Chris Power (CP) chief executive officer of Canadian Patient Safety Institute (CPSI); Michael Villeneuve (MV) chief executive officer of the Canadian Nurses Association (CNA) and Judith Shamian (JS) past president International Council of Nurses (ICN) and former CNA president around their perspectives of our current context and their collective wisdom on key actions for nurse leaders to undertake to advance the quality and safety agenda in Canada and globally.

New Tools for Measuring and Improving Patient Safety in Canadian Hospitals.

The Canadian Institute for Health Information (CIHI) and the Canadian Patient Safety Institute (CPSI) have collaborated on a new measure of patient safety, along with a resource of evidence-informed practices. This measure captures four broad categories of harm in acute care hospitals, consisting of 31 clinical groups selected by clinicians. Analysis showed that harm was experienced in 1 of 18 hospital stays in Canada in 2014ߝ2015 and that no single category accounted for the majority of harmful events. Although CIHI and CPSI continue to work with hospitals and experts to further refine the methodology, the measure and associated Improvement Resource are useful new tools for monitoring and identifying harm, and have the potential to improve patient safety.

Professional training and research: which resources?

The National Plan of Prevention (PNP 2014-2018) [1], which is the key document for the Italian Public Health, underlines the need to realize for all people an empowerment level able to increase or maintain the health control. At international level, the Ljubljana Charter [2] contains the sanitarian systems commitment to rearrange, in the aim to improve continually the quality, with reference to, in particular, the rate cost /efficacy of the system. The manual for medical practitioners and pediatricians (Ministry of Heath, 2010) [3] acknowledges the seven fields of skills for operators, as defined by the Canadian Patient Safety Institute, the CPSI. Continuous training for health professionals started as a national program in Italy in 2002; some years later (2007) administrative control had been transferred from the Ministry of Health to the National Agency for Health Services, Agenas. At distance training and online updating are now becoming very common, close to traditional kinds of events for training, always in respect of the Evidence Based Medicine (EBM). We can identify, in the continuous sanitarian training system, different roles and various kinds of providers. Relevant organisations include the National Committee for Training, in the Ministry of Health, the Warranty Committee, and the National Observatory about Quality of Training. Regarding research in the field of health, we can consider it as the architrave of the National Health Service; the Report on Health Status in Italy 2012-13 [4] defines some essential aspects of it, such as the improvement of criteria of selection of the projects, to simplify bureaucratic procedures, evaluation and the rapid spread of the results. The National Committee for Sanitarian Research defines the program and initiatives, monitors and evaluates the results. Research institutes involved in Italy must accept different challenges, according with the Singapore Declaration [5], which defined some criteria about loyalty and professional honesty. The European Union invested 80M Euro in research with Horizon 2020, in the aim of destroying barriers and realising, all over the world, a common environment concerning knowledge, research and innovation. A recent piece of research related to the food habits in the age of complementary feeding is Nutrintake 6/36 [6], the first Italian study which confirms some excesses and deficiencies in the diet. It suggests the opportunity of the definition of specific nutritional guidelines.

Pharmacy awareness: a continuous process.

JCPH – Vol. 68, no 2 – mars–avril 2015 182 of Pharmacy Regulatory Authorities, the Canadian Pharmacists Association, the Canadian Association of Pharmacy in Oncology, the Association des pharmaciens des etablissements de sante du Quebec, the Canadian Patient Safety Institute, the Institute for Safe Medication Practices Canada, and the Canadian Association of Pharmacy Technicians. CSHP’s advocacy efforts at both the National and Branch levels are necessary and appropriate, but advocacy at the grassroots level is crucial. At the front line, dealing with the daily workload and patient care demands, individual practitioners often find it difficult to see how they personally can be advocates for change and for the profession. I would invite you to consider the possibility that each and every interaction that a pharmacist has with either a health care professional or a patient is a moment of advocacy, not just for the profession, but also for the patient. What a powerful combination.

Clinician's Commentary on Mori et al.(1).

Mori and colleagues' well-done systematic review of simulation learning in physical therapy entry-to-practice curricula raises some interesting issues. As the authors note, simulation learning has been around for several decades, in many different forms. Although Mori and colleagues defined simulation quite broadly, as “the range of learning experiences (e.g., role playing) in which the learner had the opportunity to interact with the simulated clinical scenario,” they still found only 23 articles to include in their review. Their extensive search initially found 800 abstracts, however, which probably reflects the fact that this field is still establishing itself and there is no agreed-upon definition of simulation learning, especially as it relates to entry-to-practice curricula. Depending on the definitions used, simulation learning can include standardized patients (low fidelity) and virtual reality (intermediate fidelity), as well as the high-fidelity simulations with computerized mannequins used for such purposes as practising surgical skills and CPR training, which are shown in the media when any new simulation centre is opened. Patient safety, although not specifically mentioned in this article, has been one of the main drivers of patient simulation, and especially of high-fidelity simulation. Close to a decade ago, the Canadian Patient Safety Institute took the lead in this area, in response to data emerging across the country that showed an increasing number of adverse events in hospitals.2,3 Patient simulation was seen as both a safer and a more ethical way to learn than practising invasive techniques on real patients, and using simulation is also a way to teach patient safety competencies.4 Mori and colleagues divided the studies they reviewed into four key areas, based on the different learning objectives of the simulation activities.

Undergraduate baccalaureate nursing students’ self-reported confidence in learning about patient safety in the classroom and clinical settings: An annual cross-sectional study (2010–2013)

BackgroundGiven the increasing incidence of adverse events and medication errors in healthcare settings, a greater emphasis is being placed on the integration of patient safety competencies into health professional education. Nurses play an important role in preventing and minimizing harm in the healthcare setting. Although patient safety concepts are generally incorporated within many undergraduate nursing programs, the level of students’ confidence in learning about patient safety remains unclear. ObjectivesSelf-reported patient safety competence has been operationalized as confidence in learning about various dimensions of patient safety. The present study explores nursing students’ self-reported confidence in learning about patient safety during their undergraduate baccalaureate nursing program. DesignCross-sectional study with a nested cohort component conducted annually from 2010 to 2013. Setting and participantsParticipants were recruited from one Canadian university with a four-year baccalaureate of nursing science program. All students enrolled in the program were eligible to participate. MethodsThe Health Professional Education in Patient Safety Survey was administered annually. The Health Professional Education in Patient Safety Survey captures how the six dimensions of the Canadian Patient Safety Institute Safety Competencies Framework and broader patient safety issues are addressed in health professional education, as well as respondents’ self-reported comfort in speaking up about patient safety issues. ResultsIn general, nursing students were relatively confident in what they were learning about the clinical dimensions of patient safety, but they were less confident about the sociocultural aspects of patient safety. Confidence in what they were learning in the clinical setting about working in teams, managing adverse events and responding to adverse events declined in upper years. The majority of students did not feel comfortable speaking up about patient safety issues. The nested cohort analysis confirmed these findings. In particular, confidence in acquiring basic clinical skills, learning about adverse events, and managing safety risks improved between Year 1 and Year 2, and confidence in managing safety risks declined in upper years. ConclusionsThese findings suggest nursing students are confident in what they are learning about clinical aspects of patient safety, however, their confidence in learning about sociocultural aspects declines as they are increasingly exposed to the clinical environment. This suggests a need to address the impact of the practice environment on nursing students’ confidence in what they are learning about patient safety.

Development and testing of an objective structured clinical exam (OSCE) to assess socio-cultural dimensions of patient safety competency

BackgroundPatient safety (PS) receives limited attention in health professional curricula. We developed and pilot tested four Objective Structured Clinical Examination (OSCE) stations intended to reflect socio-cultural dimensions in the Canadian...