Delivery Of Safe Patient Care Research Articles

Job satisfaction and intent to stay in neonatal nursing in England and Wales: a study protocol

BackgroundNursing shortages are an ongoing concern for neonatal units, with many struggling to meet recommended nurse to patient ratios. Workforce data underlines the high proportion of neonatal nurses nearing retirement and a reduced number of nurses joining the profession. In order to recommend strategies to increase recruitment and retention to neonatal nursing, we need to understand the current challenges nurses are facing within the profession. The aim of this study is to investigate current job satisfaction, burnout, and intent to stay in neonatal nursing in England and Wales.MethodsThis study has two parts: (1) a systematic review exploring job satisfaction, burnout and intent to stay in neonatal nursing, and any previous interventions undertaken to enhance nurse retention, (2) an online survey of neonatal nurses in England and Wales exploring job satisfaction, burnout and intent to stay in neonatal nursing. We will measure job satisfaction using the McCloskey Mueller Satisfaction Scale (MMSS), burnout using the Copenhagen Burnout Inventory (CBI) and the Nurse Retention Index (NRI) will be used to measure intent to stay. All nurses working in neonatal units in England and Wales will be eligible to participate in the nursing survey.DiscussionRetention of neonatal nurses is a significant issue affecting neonatal units across England and Wales, which can impact the delivery of safe patient care. Exploring job satisfaction and intent to stay will enable the understanding of challenges being faced and how best to support neonatal nurses. Identifying localised initiatives for the geographical areas most at risk of nurses leaving would help to improve nurse retention.

Department of Hospital Administration, AIIMS, New Delhi, India

Background: Nurses form the backbone of the health care system, and their role is vital in health care delivery in terms of promotion, prevention, treatment, care and rehabilitation. Nurse managers play a key role in the coordination of patient care and ensure quality nursing care. Apart from this, they also perform staff management, document administrative activities and supervise hospital substore activities. Efficient and effective nursing administration is essential for smooth hospital functioning and delivery of safe patient care. Methods: Study design: Observational. The estimation of time utilization by administrative nurses in different tasks was carried out in two phases. In the first phase, a questionnaire was developed for the self-reporting of various activities that were carried out by various administrative nurses. In the second phase, an activity sampling with a total of 316 hours of observations and 15,344 nursing activities was recorded across the hospital to estimate the actual time distribution and time utilization of administrative nurses. Results: Administrative nurses spent a major portion of their time in store management (28%), staff management (23%), and documentation (21%) but much less time for patient care supervision and teaching activities, i.e., 4-8% of the total time available in a day. Conclusion: The activity sampling study identified that administrative nurses spent most of their time in three major activities: store management, staff management and documentation. It may be emphasized to deliver more attention in patient care supervision and teaching.

Medico-legal issues related to emergency physicians' documentation in Canadian emergency departments.

Physician documentation plays a central role in the delivery of safe patient care. It describes a physician's clinical decision-making and supports essential communication between healthcare providers within the patient's circle of care. Good documentation can potentially also decrease a physician's medico-legal risk. This study provides examples of documentation issues attributed to physicians practicing emergency medicine as identified by peer experts in civil legal actions, regulatory authority complaints (College) and hospital complaints (collectively, medico-legal cases) in Canada. We conducted a descriptive study and content analysis of medico-legal cases involving emergency department physicians from a national repository at the Canadian Medical Protective Association. Cases with peer expert criticism of an emergency physician's documentation, which were closed between 2016 and 2020, and occurred in an emergency department were included in our analysis. Of the 1628 cases involving emergency medicine, our inclusion criteria identified that absent or insufficiently detailed documentation was present in 24% of cases (391/1,628). A detailed review of 20% of the cases (79/391), selected randomly, found that documentation issues were most often associated with the assessment and investigation stage of care. This pertained to documenting details of the clinical examination, relevant medical history, diagnosis, and differential diagnosis. For physicians practicing emergency medicine, criticism of documentation was frequently observed in medico-legal cases. Based on the findings of this study and the expert criticism related to documentation, emergency medicine physicians may consider reflecting upon their documentation of the care provided to determine if their documentation provides a clear and accurate chronicle of the care and the rationale for their clinical decisions.

Remote evaluation of NAVIFY Oncology Hub using clinical simulation.

e13622 Background: Clinical workflow is critical for the efficient and safe delivery of patient care. NAVIFY Oncology Hub is a clinical workflow solution that provides clinicians with a comprehensive view of a patient’s clinical journey and aims to enable effective and efficient care decisions in oncology care. This study explored the use of remote clinical simulation to assess the usability, efficiency, and cognitive burden associated with using NAVIFY Oncology Hub. Methods: Twenty seven (27) board-certified oncologists were recruited to participate in remote evaluation sessions conducted via teleconference. Participants were instructed to review and synthesize clinical information from 10 synthetic breast cancer cases using NAVIFY Oncology Hub (case order was randomized). After completing the exercise, participants answered a survey which included the system usability scale (SUS), Likert-scale questions designed for participants to self-report the efficiency of completing each task, and the NASA Task Load index (to assess cognitive burden). The survey and a short interview was also used to gather structured feedback on the solution, patient cases, and study methods. Results: NAVIFY Oncology Hub scored an “excellent” 82 on the system usability scale (SUS). Most participants (67%) indicated that they would be likely to use the solution in their clinical practice, with approximately half (48%) reporting they would recommend it to a colleague. The majority of participants (96%) said they were “a lot more efficient” or “somewhat more efficient” when using NAVIFY Oncology Hub to review patient information. The majority of participants (78%) felt it would be “significantly better” or “somewhat better” than their existing solution at facilitating patient discussion and coordinating care. On the NASA Task Load Index survey, the majority of participants (63%) required low or very low levels of mental demand, temporal demand, and effort to successfully complete tasks using NAVIFY Oncology Hub. The majority of participants (91%) felt the synthetic patient cases were either ‘very similar’ or ‘somewhat similar’ to cases seen in routine clinical practice, and that the tasks completed during the sessions were ‘very similar’ or ‘somewhat similar’ to their clinical practice. Conclusions: This novel clinical simulation study shows early evidence that NAVIFY Oncology Hub has high usability, potential to increase overall efficiency and reduce cognitive burden on oncologists compared to contemporary EHR systems. Clinical trial information: NCT05478135 .

Patient safety knowledge, attitude and practice among undergraduate health science students in South West Ethiopia.

Patient safety is minimizing the risk of unnecessary damage associated with healthcare to a minimum. It has been linked as a global precedence area where substantial knowledge gaps exist. Knowledge, attitude, and practice of the healthcare providers toward patient safety have a great influence on the delivery of safe patient care. Regardless of this, the issue has not been adequately addressed in Ethiopia. The main aim of this study was to assess the knowledge, attitude, practice, and factors associated with patient safety practice among undergraduate health science students at Jimma University Institute of Health. An institution-based cross-sectional study design was conducted from May to November 2021. Data were collected from 678 undergraduate health science students using a pretested, structured and self-administered questionnaire. EPI data 3.1 was used for data entry, and SPSS version 25 was used for analysis. A binary logistic regression model was utilized to identify factors associated with outcome variables. An adjusted odds ratio with a 95% confidence interval and P < 0.05 were computed to determine the level of significance. Of the total students, only 293 (43.2%) and 308 (45.4%) had good knowledge and positive attitudes toward patient safety, respectively. Moreover, only 135 (19.9%) of the students had good practices regarding patient safety. Year of study [AOR = 3.75, 95% CI: (2.3, 9.3)], duration on practical attachment [AOR = 2.6, 95% CI: (1.2, 5.9)], and knowledge about patient safety [AOR = 2.9, 95% CI: (1.9, 3.4)] were associated with better patient safety practices. In the current study the practice of patient safety among health science students was low and less than half of the students had good knowledge and favorable attitudes toward patient safety. Patient safety practices were influenced by the length of the clinical attachment, the study year, and the knowledge of patient safety. This calls for patient safety courses to be included in training curricula of undergraduate health sciences students.

WE8.8 Analgesia prescribing in a Surgical Assessment Unit

Abstract Aim Efficient analgesia administration is paramount to delivering good patient care and is an important factor in the safe assessment of patients. The aim of this audit was to assess analgesia prescribing and administration in the local Surgical Assessment Unit (SAU) and compare it with the standard of care set out by the Royal College of Emergency Medicine guidelines. Methods A retrospective audit was performed. Paper and electronic notes, including electronic prescribing data via HEPMA and pain scores were analysed for all patients referred with abdominal pain to SAU by GP's between the 21st of October and the 30th of October 2021. Data was compared with the RCEM best practice guidelines. Results A total of 33 patients were included. 39% of patients had a documented first pain score within 15 minutes of arrival, with a median time of 20 minutes. Of all patients presenting with moderate to severe pain, none received analgesia within 20 minutes. Earliest analgesia administration for this group was 1 hour 42 minutes. Overall median time to first analgesia prescription was 2 hours and 4 minutes and median time to administration was 4 hours and 8 minutes. Conclusion Since the COVID pandemic, NHS hospital staff- and bed shortages have put increased pressure on the delivery of safe patient care. This audit has found significant delays in both prescribing and administering analgesia for patients presenting to SAU. An electronic prescribing protocol was developed to increase efficiency in prescribing and another audit will be conducted to assess impact.

Webinar and survey on quality management principles within the Australian and New Zealand ACPSEM Workforce.

Healthcare relies upon the accurate and safe delivery of patient care. This is only achievable when systems are developed to ensure high quality, robust outcomes, for instance quality management systems. The concept of quality management can take on a different meaning depending on the context in which it is found. To add complication, the amount of education required for quality management will vary depending on one's exposure to the implementation of quality systems. In part to address these issues, the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM) Queensland Branch held a quality management webinar for members and non-members across Australia and New Zealand. The purpose of the webinar was to educate and facilitate discussion regarding the application of quality management principles for the ACPSEM profession. In conjunction, a pre- and post-webinar survey was conducted to gain an insight into existing knowledge and attitudes within the professions governed by the ACPSEM and students undertaking related studies. This paper authored by the webinar speakers reintroduces the quality management principles that were discussed in webinar, exemplifies the importance of quality management skills within the ACPSEM professions and presents the results of the surveys, promoting the need for more educational resources on quality management tools.

Commissioning Clinical Spaces During a Pandemic: Merging Methodologies of Human Factors and Simulation.

The objective of this case study is to demonstrate the value of applying tabletop and simulation techniques to highlight high-risk, high-impact outcomes and organizational recommendations in the commissioning of a new clinical spaces. Generalizability of lessons learned from this case study aim to support other health organizations in commissioning of clinical spaces during communicable disease outbreaks. COVID-19 challenged our healthcare system, requiring teams to prepare in a short span of time. Bridging expertise of human factor and simulation teams provided a novel, interdisciplinary, and timely approach to evaluate and commission spaces. Human factors and simulation teams were enlisted to conduct an evaluation of a new space prior to readiness for delivery of safe patient care. An adapted tabletop evaluation and subsequent systems integration simulation was conducted. The goal of the tabletop exercise was to identify and define processes and risks to tested in the physical space using simulation. Applying both human factors science and systems simulation proactively identified the highest risk, highest impact outcomes, validated existing processes and allowed for refining of potential solutions and recommendations of the new space. A strong working relationship between teams fostered an opportunity to share information, debrief, evaluate, and adapt methods while applying timely changes based on emergent findings. These combined methodologies are important tools that can be learned and applied to healthcare commissioning of new clinical spaces in the identification of high-risk, high-impact outcomes affecting staff and organizational preparedness and safety.

Assessing Clinical Skills of Nursing Students: A Triangulation Study to Explore Faculty Experiences and Feedback in Objective Structured Clinical Examination (OSCE)

Background and aim: Developing clinical skills and its assessment is one of the most important components in nursing education which prepares the student for the reality of practice. Objective structured clinical examination (OSCE) is extensively used and widely accepted by nurse educators across the globe to assess the competency skills of nursing students. The present study aimed at identifying the attitude and perceptions of faculty, and exploring their feedback and experience in conducting OSCE as an assessment tool. Methods: A triangulation research approach was used with convenience sampling. Data collection was carried out using questionnaires and semi-structured interviews. Participants were ten faculty members who were involved in conducting OSCE for students. Results and conclusion: Most of the faculty felt that OSCE reflected the skills of delivery of safe patient care, and the structure reflected mastery of knowledge and skills, which are related to course objectives. OSCE was regarded by the faculty as a consistent, reliable, valid, and objective measure to assess students’ performance and to improve students’ confidence in clinical skills. Concerns were raised about a high level of stress in students, the time required for the proper performance of tasks, OSCE scenarios lacking real-life situations in assessment, and the need for repeated practice and intensive mock training sessions. The applicability of OSCE in terms of limitations in human and material resources with a large number of students would necessitate rethinking in developing other assessment strategies to improve the overall process. Key words: Clinical examination, nursing education, nursing competencies, clinical skills assessment, clinical evaluation

Nurse managers' learning facilitation practices: A philosophical hermeneutic study.

To understand how nurse managers facilitate learning in clinical workplaces. Meeting staff learning needs in the complex workplaces of contemporary health care is paramount to the delivery of safe patient care. Hospitals employ a range of strategies to address these needs. However, nurse managers' contribution to staff learning at the unit level is underexplored in contemporary literature. A Gadamerian philosophical hermeneutic framework guided data collection and analysis. Thirteen nurse managers from two Australian hospitals each participated in two interviews and a period of observation. Nurse managers' learning facilitation practices were enacted with staff individually, within teams, and through artefacts, and were shaped by their identities, perspectives on staff learning, knowledge of staff performance, and motivations. Power was revealed as a uniquely enacted driver of their learning facilitation practices. This paper illuminates an aspect of nurse managers' practice that has been poorly acknowledged in contemporary nursing literature. Nurse managers' learning facilitation practices were found to be complex, fluid, and embedded in their everyday work routines. Given current concerns about safety and quality in health care, this research opens up possibilities for definition and enrichment of nurse managers' practice as facilitators of learning.

Development and web deployment of an automated neuroradiology MRI protocoling tool with natural language processing

BackgroundA systematic approach to MRI protocol assignment is essential for the efficient delivery of safe patient care. Advances in natural language processing (NLP) allow for the development of accurate automated protocol assignment. We aim to develop, evaluate, and deploy an NLP model that automates protocol assignment, given the clinician indication text.MethodsWe collected 7139 spine MRI protocols (routine or contrast) and 990 head MRI protocols (routine brain, contrast brain, or other) from a single institution. Protocols were split into training (n = 4997 for spine MRI; n = 839 for head MRI), validation (n = 1071 for spine MRI, fivefold cross-validation used for head MRI), and test (n = 1071 for spine MRI; n = 151 for head MRI) sets. fastText and XGBoost were used to develop 2 NLP models to classify spine and head MRI protocols, respectively. A Flask-based web app was developed to be deployed via Heroku.ResultsThe spine MRI model had an accuracy of 83.38% and a receiver operator characteristic area under the curve (ROC-AUC) of 0.8873. The head MRI model had an accuracy of 85.43% with a routine brain protocol ROC-AUC of 0.9463 and contrast brain protocol ROC-AUC of 0.9284. Cancer, infectious, and inflammatory related keywords were associated with contrast administration. Structural anatomic abnormalities and stroke/altered mental status were indicative of routine spine and brain MRI, respectively. Error analysis revealed increasing the sample size may improve performance for head MRI protocols. A web version of the model is provided for demonstration and deployment.ConclusionWe developed and web-deployed two NLP models that accurately predict spine and head MRI protocol assignment, which could improve radiology workflow efficiency.

An introduction to urgent care for the GP trainee

Working in urgent care requires the ability to manage medical, surgical, social and mental health presentations. It is essential to understand the organisational aspects of how such care is provided. Communication and consultation skills need to be adapted to different clinical contexts. Self-management of safety, time, and stress are important capabilities. One of the requirements of GP training is to demonstrate capabilities in urgent care, including delivery of safe patient care, demonstration of effective communication skills, maintaining continuity for patients and coordinating care across services. In this article we aim to give GP trainees an overview of the urgent care service in Scotland and to give advice on best practice.

Massive blood loss protocol 'Code Red' at Papworth Hospital: A closed loop audit.

AimTo investigate if the massive blood loss protocol ‘Code Red’ at a specialist cardiothoracic hospital was activated according to local and national guidelines by a closed loop audit.MethodsElectronic and paper patient care systems were searched in 2015 and 2018 to access records for the ‘Code Red’ activations. Activation of the massive blood loss protocol was compared against the national standards set by The British Committee for Standards in Haematology. The percentage of cases meeting each of the ten standards in the specialist cardiac unit’s Protocol for the Management of Massive Blood Loss in Adults (adapted from the national standards) were evaluated.Results‘Code Red’ protocol was activated on 18 occasions in 2015 and nine occasions in 2018, representing just 0.83 and 0.26% of emergency surgeries, respectively. Between 2015 and 2018, there was a 6% increase of ‘Code Red’ cases being appropriately activated, a 26% increase in the prompt notification of the haematology department upon activation, alongside a 30% increase in the timely delivery of blood products, and a 25% decrease in the average amount of blood transferred prior to ‘Code Red’ activation.ConclusionThere has been an improvement in the standards of care and management of massive blood loss this specialist cardiac centre despite the target timeframe being reduced from 30 to 15min between 2015 and 2018. Preparation for and anticipation of massive blood loss has likely decreased the number of incidences requiring ‘Code Red’ activation, permitting delivery of safe patient care.

Occupational burnout in nurses: a concept analysis†

Abstract Objective This paper aims to clarify the concept of occupational burnout (OB) as well as develop appropriate methods to relieve or prevent OB in the nursing profession. Methods Walker and Avant’s eight-step approach of concept analysis was applied. Results OB was defined as a chronic form of work-related stress. Accurately, it was characterized by emotional exhaustion, depersonalization/cynicism, and reduced personal accomplishment/inefficacy. Antecedents of burnout included (a) demographic characteristics; (b) chronic exposure to work-related stressors; (c) quantitative and qualitative job demands; (d) lack of job resources; and (e) personality traits. Consequences involved (a) individual’s unfavorable quality of life; (b) negative impact on the organization; and (c) poor services quality. Although the Maslach Burnout Inventory (MBI) is perceived as an ideal tool to measure burnout and hence, it is used worldwide, whether this instrument fits to measure this concept for nurses has still not yet been verified and thus further research is needed. Conclusions By proposing a comprehensive definition of the concept, this analysis contributes to recognition of the process of OB of nurses. All nurses are vulnerable to OB. Hence, burnout in nursing needs to be recognized as a critical factor in the delivery of safe patient care. It proposes that the prevention of OB would be achieved through team communication training, mindfulness group, education, etc.

Combining Cognitive Rehearsal, Simulation, and Evidence-Based Scripting to Address Incivility.

Nurses have a professional and ethical obligation to foster civility and healthy work environments to protect patient safety. Evidence-based teaching strategies are needed to prepare nursing students to address acts of incivility that threaten patient safety. Incivility in health care must be effectively addressed because the delivery of safe patient care may depend on these vital skills. Cognitive rehearsal (CR) is an evidence-based technique where learners practice addressing workplace incivility in a nonthreatening environment with a skilled facilitator. The author describes the unique combination of CR, simulation, evidence-based scripting, deliberate practice, and debriefing to prepare nursing students to address uncivil encounters. Learners who participated in CR identified benefits using this approach. Combining CR with simulation, evidence-based scripting, repeated dosing through deliberate practice, and skillful debriefing is an effective method to provide nursing students with the skills needed to address incivility, thereby increasing the likelihood of protecting patient safety.

Development of an e-learning programme to improve knowledge of interprofessional education.

Evidence has highlighted the importance of interprofessional education in relation to the promotion of collaborative team working and the ultimate reduction in communication errors between health professionals. The establishment of interprofessional education in undergraduate healthcare programmes prepares students for interprofessional collaboration, which is vital to the delivery of safe patient care. Using a logic model approach an interprofessional education e-learning programme was developed and made available to healthcare students to undertake during their clinical practice experiences. This article describes how a logic model process was used to develop and implement this interprofessional education e-learning programme for use by undergraduate healthcare students.

Formative peer assessment in healthcare education programmes: protocol for a scoping review

IntroductionIn formative peer assessment, the students give and receive feedback from each other and expand their knowledge in a social context of interaction and collaboration. The ability to collaborate and...

Understanding better how emergency doctors work. Analysis of distribution of time and activities of emergency doctors: a systematic review and critical appraisal of time and motion studies

BackgroundOptimising the efficiency and productivity of senior doctors is critical to ED function and delivery of safe patient care. Time and motion studies (TMS) can allow quantification of how these...

Fire in operating theatres: DaSH-ing to the rescue.

Operating theatres are dynamic environments that require multi professional team interactions. Effective team working is essential for efficient delivery of safe patient care. A fire in the operating theatre is a rare but potentially life threatening event for both patients and staff. A rapid and cohesive response from theatre and allied staff including porters, fire safety officer etc is paramount. We delivered a training session that utilised in situ simulation (simulation in workplace). After conducting needs analysis, learning objectives were agreed. After thorough planning, the date and location of the training session were identified. Contingency plans were put in place to ensure that patient care was not compromised at any point. To ensure success, checklists for faculty were devised and adhered to. A medium fidelity manikin with live monitoring was used. The first part of the scenario involved management of a surgical emergency by theatre staff. The second part involved management of a fire in the operating theatre while an emergency procedure was being undertaken. To achieve maximum learning potential, debriefing was provided immediately after each part of the scenario. A fire safety officer was present as a content expert. Latent errors (hidden errors in the workplace, staff knowledge etc) were identified. Malfunctioning of theatre floor windows and staff unawareness about the location of an evacuation site were some of the identified latent errors. Thorough feedback to address these issues was provided to the participants on the day. A detailed report of the training session was given to the relevant departments. This resulted in the equipment faults being rectified. The training session was a very positive experience and helped not only in improving participants' knowledge, behaviour and confidence but also it made system and environment better equipped.

Barriers for Hospital-Based Nurse Practitioners Utilizing Clinical Decision Support Systems: A Systematic Review.

There is a national focus on the adoption of healthcare technology to improve the delivery of safe, efficient, and high-quality patient care. Nurse practitioners fulfill an emerging strategic role in the hospital setting. A comprehensive literature review focused on the question: What are the barriers for nurse practitioners utilizing clinical decision support in the hospital setting? Nine studies conducted from 2011 to 2017 were the basis for this review, which identified 13 barriers for nurse practitioners utilizing clinical decision support in the hospital. Having the right information, including up-to-date evidence-based practice guidelines, accurate clinical pathways, and current clinical algorithms, was the most common barrier. Providing reliable clinical decision support is crucial as nurse practitioners become more dependent on hospital technology systems in the delivery of safe patient care. Eliminating barriers to the use of clinical decision support is important for informaticists and nurse practitioners because both groups concentrate on acceptance of decision support systems in the hospital to meet the goal of safe and high-quality patient care.