Delivery Of Safe Patient Care Research Articles

Quality patient care: challenges and opportunities.

There are several interlocking elements integral to the delivery of safe patient care, including clinical governance, efficient communication, teamwork, risk assessment, inter-professional education and effective leadership. Each element can be challenging to understand, develop, or act on, but it is essential that nurses use these as opportunities to ensure their specialty or service delivers safe and high-quality care. This article discusses each of these elements and its relationship to quality patient care, with specific reference to the role of children's nurses.

The role of radiology in diagnostic error: a medical malpractice claims review.

Just as radiologic studies allow us to see past the surface to the vulnerable and broken parts of the human body, medical malpractice claims help us see past the surface of medical errors to the deeper vulnerabilities and potentially broken aspects of our healthcare delivery system. And just as the insights we gain through radiologic studies provide focus for a treatment plan for healing, so too can the analysis of malpractice claims provide insights to improve the delivery of safe patient care. We review 1325 coded claims where Radiology was the primary service provider to better understand the problems leading to patient harm, and the opportunities most likely to improve diagnostic care in the future.

Development and Evaluation of a Systems Thinking Education Strategy for Baccalaureate Nursing Curriculum: A Pilot Study.

Nurse educators are charged to develop and evaluate curricula on systems thinking to prepare future nurses to provide safe nursing care. The goal of this pilot study was to design and evaluate a four-hour educational strategy that prepares future professional nurses to use systems thinking approaches in the delivery of safe patient care. This study exposed prelicensure baccalaureate nursing students to systems thinking principles, which included didactic and experiential activities. A descriptive design was used to determine the effect of an on-campus educational strategy. A paired samples t-test revealed statistical significance from pretest to posttest.

What do clinicians understand about deaths reportable to the Coroner?

SettingThe study setting is a tertiary referral hospital of over 980 beds, in Victoria, Australia. The hospital is a long established major academic public health service providing healthcare, health professional education and health research. The hospital has 103,756 in-patient admissions, 190,756 outpatient attendances and over 82,000 presentations to the Emergency Department annually. Participants22 clinicians completed an in-depth, audio-recorded interview: 12 medical and 10 nursing staff, with a variety of clinical experience. Intervention(s)Each audio recorded interview was transcribed verbatim for thematic analysis. The semi structured questions were designed to explore the clinician's understanding of deaths that meet the criteria to be reported to Coroners Court of Victoria (CCOV), and why such reporting was required. There was also the opportunity to identify any barriers or enablers to the reporting process, whether internal or external to the organisation. ResultsTwo main themes emerged from the interviews: 1. lack of awareness of which deaths are reportable to the coroner and 2. the need for educational support. Several subthemes were also identified such as accountability, the need for feedback and blame. DiscussionThe understanding of clinicians as to which deaths meet the reportable criteria in healthcare is quite variable and this indicates that there might be a level of under reporting. Apart from the potential of not meeting legal obligations, there may also be the loss of a valuable opportunity for lessons to inform clinical practice and enhance the delivery of safe patient care.

A framework for transition to specialty practice programmes.

To develop a framework for emergency nursing transition to specialty practice programmes. Transition to Specialty Practice programmes were introduced to fill workforce shortages and facilitate the transition of nurses to specialty nursing practice. These programmes are recognized as an essential preparation for emergency nurses. Emergency nursing Transition to Specialty Practice programmes have developed in an ad hoc manner and as a result, programme characteristics vary. Variability in programme characteristics may result in inconsistent preparation of emergency nurses. Donabedian's Structure-Process-Outcome model was used to integrate results of an Australian study of emergency nursing Transition to Specialty Practice programmes with key education, nursing practice and safety and quality standards to develop the Transition to Specialty Practice (Emergency Nursing) Framework. An explanatory sequential design was used. Data were collected from 118 emergency departments over 10months in 2013 using surveys. Thirteen interviews were also conducted. Comparisons were made using Mann-Whitney U, Kruskal-Wallis and Chi-square tests. Qualitative data were analysed using content analysis. Transition to Specialty Practice programmes were offered in 80 (72·1%) emergency departments surveyed, to improve safe delivery of patient care. Better professional development outcomes were achieved in emergency departments which employed participants in small groups (Median=4 participants) and offered programmes of 6months duration. Written assessments were significantly associated with articulation to postgraduate study (Chi-square Fisher's exact P=<0·001). The Transition to Specialty Practice (Emergency Nursing) Framework has been developed based on best available evidence to enable a standardized approach to the preparation of novice emergency nurses.

Improving the quality of oncology fellows' clinical documentation.

124 Background: Proper documentation in oncology is a vital skill for fellows to learn. It not only allows for delivery of safe patient care by providing a mean for communication within providers, but it is also essential for coding and reimbursements, audits, research, quality/healthgrade scores and provides the the main body of medico-legal defense. From an educational perspective, it takes into account all 6 competences of medical education and hence is an integral part of fellowship training. The objective of this quality improvement project is to improve our fellows' documentation by ensuring they communicate timely and effectively a comprehensive care plan. Methods: We identified 10 random charts of patients who are actively being treated with systemic therapy by 4 of our senior fellows. The initial and a random follow up notes were reviewed and 34 areas thought to be of importance, specifically in oncology, were identified and logged. Verbal and written feedbacks were provided regarding their performances and areas of improvement, after which charts were re-evaluated in 6 months. Results: See table below. Conclusions: We successfully improved the fellows' documentation skills through this project, creating a better practice module. [Table: see text]

Emotional Strain: A Concept Analysis for Nursing

Emotional strain is referenced in the literature in the context of job demands and caregiving, but is seldom defined as a distinct concept. This concept is examined using Walker and Avant’s method of analysis. Defining attributes, antecedents, and consequences of emotional strain are proposed. This analysis adopts a definition of emotional strain that encourages communication and enhances concept understanding. Emotional strain in nursing needs to be recognized as a key factor in the delivery of safe patient care. The definition contributes to the development of nursing knowledge and enhances efforts to serve nurses and students affected by emotional strain.

A structured framework improves clinical patient assessment and nontechnical skills of early career emergency nurses: a pre-post study using full immersion simulation.

The aim of this study was to evaluate the effect of the new evidence-informed nursing assessment framework HIRAID (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) on the quality of patient assessment and fundamental nontechnical skills including communication, decision making, task management and situational awareness. Assessment is a core component of nursing practice and underpins clinical decisions and the safe delivery of patient care. Yet there is no universal or validated system used to teach emergency nurses how to comprehensively assess and care for patients. A pre-post design was used. The performance of thirty eight emergency nurses from five Australian hospitals was evaluated before and after undertaking education in the application of the HIRAID assessment framework. Video recordings of participant performance in immersive simulations of common presentations to the emergency department were evaluated, as well as participant documentation during the simulations. Paired parametric and nonparametric tests were used to compare changes from pre to postintervention. From pre to postintervention, participant performance increases were observed in the percentage of patient history elements collected, critical indicators of urgency collected and reported to medical officers, and patient reassessments performed. Participants also demonstrated improvement in each of the four nontechnical skills categories: communication, decision making, task management and situational awareness. The HIRAID assessment framework improves clinical patient assessments performed by emergency nurses and has the potential to enhance patient care. HIRAID should be considered for integration into clinical practice to provide nurses with a systematic approach to patient assessment and potentially improve the delivery of safe patient care.

R.A.P.I.D. (Root Aggregated Prioritized Information Display): A single screen display for efficient digital triaging of medical reports

ObjectiveThe timely acknowledgement of critical patient clinical reports is vital for the delivery of safe patient care. With current EHR systems, critical reports reside on different screens. This leads to treatment delays and inefficient work flows. As a remedy, the R.A.P.I.D. (Root Aggregated Prioritized Information Display) system represents all data on a single screen, and its simple and intuitive “button” array structure allows triaged sign-off/sign-out of critical and non-critical reports. Materials and methodsWith 100 hematology and chemistry reports from each of two EHR systems Meditech (Westwood, MA) and Orchard Labs, Inc. (Carmel, IN), we generated files of the reports in their individual standard display formats (enhanced Meditech-EM and enhanced Orchard-EO). We also displayed the same 200 reports in the R.A.P.I.D. format. We then conducted a randomized trial to compare the time and accuracy of acknowledgement of critical and non-critical results. ResultsThe sign-off times for reviewing the results for physician and non-physician providers, respectively, in seconds (with 95% confidence intervals) were for EM 1.78 (1.40–2.26) and 1.99 (1.72–2.30), for EO 2.69 (2.12–3.42) and 2.78 (2.40–3.21), and for R.A.P.I.D. 0.83 (0.70–0.98) and 1.58 (1.43–1.76). Non-physician providers reassigned system-defined non-critical results as critical with a frequency of 15.2% for EM, 18.4% for EO, and 7.83% for R.A.P.I.D., and critical results as non-critical with a frequency of 14.7%, 5.6%, and 5.8% respectively. DiscussionThe new display system was superior to two standard EHR systems that were significantly enhanced by first collecting the reports from their usual distributed locations and then by creating for each of the two standard EHRs a single file of reports for acknowledgement. ConclusionsFrom a single screen display of all reports, the new display system enables timely acknowledgement of critical reports for patient safety and non-critical report triage for improved provider work flows.

A reflection on the experiences of implementing gynaecology robotic surgery.

When the decision is made to introduce a new technological innovation, it is only the very start of a complex journey. New technology can often be met with mixed emotions from the perioperative team such as excitement and apprehension. If the correct implementation process is not established at the beginning, perioperative teams can fear change instead of embracing it; this could also potentially have a negative effect on the desired result, which is the delivery of safe patient care.

Use of mobile devices in community health care: barriers and solutions to implementation.

Mobile devices allow clinicians to access electronic clinical systems away from traditional base locations. They have contributed to increased productivity and efficiency, and clinical staff also cite benefits to patient care. A selection of NHS trusts have participated in a national pilot to explore the benefits and drawbacks of this technology. Clinical engagement with frontline staff is essential to ensure the staff feel valued, listened to, and fully involved to ensure any change to existing practice is successful. Moreover, the training needs of the workforce require careful consideration. The provision of information technology (IT) support services is fundamental to ensure that staff receive the necessary assistance with any functionality issues they may experience with mobile devices to minimise the effect on clinical practice. Variability in internet connectivity may present as a challenge to clinical staff, and the benefits of complimentary offline working solutions should be considered. Barriers to the successful use of mobile devices should be reported as this may have a negative clinical effect on the safe delivery of patient care. Clinical staff need to be mindful of their obligations in relation to information governance, and should appreciate that the same consideration needs to be given to both paper and electronic records.

Learning from positively deviant wards to improve patient safety: an observational study protocol

IntroductionPositive deviance is an asset-based approach to improvement which has recently been adopted to improve quality and safety within healthcare. The approach assumes that solutions to problems already exist within...

Guiding Healthcare Technology Implementation

Healthcare technology is used to improve delivery of safe patient care by providing tools for early diagnosis, ongoing monitoring, and treatment of patients. This technology includes bedside physiologic monitors, pulse oximetry devices, electrocardiogram machines, bedside telemetry, infusion pumps, ventilators, and electronic health records. Healthcare costs are a challenge for society, and hospitals are pushed to lower costs by discharging patients sooner. Healthcare technology is being used to facilitate these early discharges. There is little understanding of how healthcare facilities purchase, implement, and adopt technology. There are two areas of theories and models currently used when investigating technology: technology adoption and implementation science. Technology adoption focuses mainly on how the end users adopt technology, whereas implementation science describes methods, interventions, and variables that promote the use of evidence-based practice. These two approaches are not well informed by each other. In addition, amplifying the knowledge gap is the limited conceptualization of healthcare technology implementation frameworks. To bridge this gap, an all-encompassing model is needed. To understand the key technology implementation factors utilized by leading healthcare facilities, the prevailing technology adoption and implementation science theories and models were reviewed. From this review, an integrated technology implementation model will be set forth.

Whiteboards and discharge traffic lights: visual management in acute care.

Flinders Medical Centre was experiencing issues with timely discharge and knowing the potential discharges and in-patient bed capacity for the next day. This case study describes the application of 'visual management' theory to discharge processes. The solutions developed were 'patient journey boards' and 'discharge traffic lights'. The implementation of these visual management systems has enabled the hospital to improve its discharge processes.

Are We All Talking about the Same Thing? Heterogeneity and Nomenclature in Description of Natural Health Products

The use of Natural Health Products (NHPs) in pediatrics is becoming increasingly common. NHPs are often referred to by a variety of different names, which may lead to paren- tal/patient confusion when asked to disclose their use. The aim of this paper is to determine what terminology is cited throughout the literature to describe NHPs. This review reveals that there is significant heterogeneity in the literature used to describe NHPs. Nurses need to be aware of the diverse terminology used to describe or define NHPs, so that further delineation can be attempted while assessing for their use among their patients. Clear communication is pertinent to the delivery of safe patient care, so that all medicinal products can be accounted for, regardless if they are classified as natural or otherwise.

Resident physicians' clinical training and error rate: the roles of autonomy, consultation, and familiarity with the literature.

Resident physicians' clinical training poses unique challenges for the delivery of safe patient care. Residents face special risks of involvement in medical errors since they have tremendous responsibility for patient care, yet they are novice practitioners in the process of learning and mastering their profession. The present study explores the relationships between residents' error rates and three clinical training methods (1) progressive independence or level of autonomy, (2) consulting the physician on call, and (3) familiarity with up-to-date medical literature, and whether these relationships vary among the specialties of surgery and internal medicine and between novice and experienced residents. 142 Residents in 22 medical departments from two hospitals participated in the study. Results of hierarchical linear model analysis indicated that lower levels of autonomy, higher levels of consultation with the physician on call, and higher levels of familiarity with up-to-date medical literature were associated with lower levels of resident's error rates. The associations varied between internal and surgery specializations and novice and experienced residents. In conclusion, the study results suggested that the implicit curriculum that residents should be afforded autonomy and progressive independence with nominal supervision in accordance with their relevant skills and experience must be applied cautiously depending on specialization and experience. In addition, it is necessary to create a supportive and judgment free climate within the department that may reduce a resident's hesitation to consult the attending physician.

Safe patient care - safety culture and risk management in otorhinolaryngology.

Safety culture is positioned at the heart of an organization’s vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture (“top-down process”). A type marker for organizational culture and thus a predictor for an organization’s maturity in respect to safety is information flow and in particular an organization’s general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed “informed culture”. An informed culture is free of blame and open for information provided by incidents. “Incident reporting systems” are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organization’s safe surgery checklist” is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality.Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate stimulation based team trainings into their curriculum.

Patientenversorgung - aber sicher.

Safety culture is positioned at the heart of an organisation's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organizations maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organisation's "safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality.Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate simulation based team trainings into their curriculum.

A concept analysis of situational awareness in nursing

This article reports an analysis of the concept of situational awareness in nursing. Situational awareness is a fundamental and well-understood concept used to maintain operational safety in high reliability organizations; however, it has not been studied in nursing. Nurses play a critical role in providing vigilance in health care and what they do or fail to do is directly related to patient outcomes. Multiple databases, including PubMed, CINAHL, JSTOR, and Google Scholar, were searched with the term, 'situational awareness'. The primary search, used to identify all uses of the concept, did not employ date criteria. A secondary search for articles measuring situational awareness as an independent or dependent variable was completed using 2009-2011 articles. Concept Analysis. The concept of situational awareness was examined using Walker and Avant's eight step method of analysis. Three defining attributes of situational awareness include perception, comprehension, and projection. Situational awareness is defined as the perception of the elements in the environment in a volume of time and space, the comprehension of their meaning and the projection of their status in the near future. Although situational awareness is related to other terms in nursing, there is increasing recognition that the concept, which is likely a consolidation of the related terms, has an impact on healthcare professionals. Failures in perception, comprehension, and/or projection can significantly reduce the accuracy and appropriateness of patient care decisions. Therefore, as a precursor to decision making, poor or inadequate levels of situational awareness present serious threats to patient safety. Situational awareness needs to be examined in a theoretical context, studied systematically and openly recognized as a key factor in the delivery of safe patient care.

Clinical human factors: the need to speak up to improve patient safety

This article aims to inspire nurses to recognise how human factors affect individual and team performance. Use of a case study and learning derived from a subsequent independent inquiry exposes the dynamics that can affect teamwork and inhibit effective communication with devastating consequences. The contribution of situational awareness and the importance of nurses speaking up when they have concerns are demonstrated as vital components in the delivery of safe patient care.