Improve Patient Safety Research Articles

Perceptions of cognitive workload measurement using multimodal sensors in surgery

BackgroundThe study of cognitive load management in surgery has led to identification of objective cognitive workload (CWL) correlates offering the potential to improve patient safety, enhance surgeon performance and their long-term well-being. Sensors have been used in isolation within surgery to measure physiological changes of the surgeon to infer CWL. More recently however, the use of multimodal sensors (MMS) has been explored to improve the reliability of CWL measurement. Despite the emergence of this technology, the behavioural intention of future users of MMS is not well understood. The aim of this study is to explore the perceptions of CWL measurement using MMS in surgery and secondly, to develop a model of acceptance amongst a cohort of future users.MethodsA cross-sectional survey of medical students in the United Kingdom was undertaken by means of an online questionnaire based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model, using performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC) and behavioural intention (BI) as latent constructs. A purposive sampling method was undertaken over a period of nine months. Results were analysed using structural equation modelling.ResultsThere were 232 responses with 138 fully completed responses used for final data analysis. Weighted averages of all item responses demonstrated positive responses to all questionnaire statements. Students strongly agreed to ‘Technology used to measure my mental workload would be useful to me’ (42.8%), ‘I would use the system if it was comfortable to wear’ (53.6%) and ‘I would like to know that the technology is reliable before using it’ (68.8%). Pathway co-efficients were 0.444 for PE → BI (p = < 0.001), 0.221 for EE → BI (p = < 0.001), 0.096 for SI → BI (p = 0.186) and 0.142 for FC → BI (p = 0.094).ConclusionThis study demonstrates an overall positive perception of CWL measurement using MMS. Although social influences and facilitating conditions demonstrate a positive influence on the behavioural intention of students, performance and effort expectancy are significant constructs to consider, namely the comfort and reliability of multimodal sensors. Findings from this study can be used to guide future development of emerging MMS systems that can be used to reduce human error, improve training and patient safety.

Patient safety incident reporting software: A cross-sectional survey of nurses and other users' perspectives.

To investigate nurses' and other users' perceptions and knowledge regarding patient safety incident reporting software and incident reporting. A cross-sectional online survey. The survey, 'The Users' Perceptions of Patient Safety Incident Reporting Software', was developed and used for data collection January-February 2024. We aimed to invite all potential users of reporting software in two wellbeing service counties in Finland to participate in the survey. Potential users (reporters/handlers/others) were nurses, other health professionals and employees. Satisfaction was classified as dissatisfied, neutral, or satisfied. The association between overall satisfaction and demographics was tested using cross-tabulation and a Chi-square test. The completion rate was 54% (n = 755). Some respondents (n = 25) had never used reporting software, most often due to no perceived need to report, although their average work experience was 15 years. Of other respondents (n = 730), mostly nurses (n = 432), under half agreed that the software was quick to use and easy to navigate. The biggest dissatisfaction was with the report processing features. Over a fifth did not trust that reporting was anonymous. Training and frequency of using the software were associated with overall satisfaction. Reporting software has not reached its full potential and needs development. Report handling is essential for shared learning; however, the processing features require the most improvements. Users' perceptions must be considered when developing reporting software and processes. Incident reporting software usability is central to reporting, but nurses' and other users' perceptions of software are poorly understood. This survey shows weaknesses in reporting software and emphasizes the importance of training. The survey can contribute to paying more attention to organizing training, getting users to participate in software development, and deepening knowledge of issues in reporting software. Making the needed improvements could improve patient safety. The STROBE Checklist (Supplement-S1). No Patient or Public Contribution.

Assessment of Patient Safety Culture Amongst Pharmacy Staff of Selected Healthcare Facilities in Delta North, Nigeria

The strategy for improving patient safety in hospitals heavily relies on safety culture. The study aimed to evaluate patient safety cultures amongst pharmacy staffs of selected health facilities in Delta North, Delya State, Nigeria. Data on patient safety amongst 70 pharmacy personnel in two major secondary and 5 general health facilities across Delta North senatorial district, Delta State, were collected using the Hospital Survey on Patient Safety Culture (HSOPSC) tool. Information on communication openness, the frequency of documenting different types of mistakes, as well as the overall patient safety culture rating, was collected. Composite scores were analyzed using SPSS version 22. Measurement data were presented as mean ± standard deviation (SD) and compared using a student t-test. The results were considered significant at p&amp;lt;0.05. The mean scores of all the various composite item responses were calculated and grouped into positive and negative responses with a mean score of ≥4 and &amp;lt;4, respectively. The safety cultures of physical space and environment, staff training and skills, and communication openness had a good composite score of 4.0 – 4.1. The safety culture of procedures for communicating prescriptions across shifts was poorly rated, with composite scores of 3.8. The safety culture of patient counselling had the highest composite score of 4.3. The safety composites for documenting various shades of mistakes had a mean score of 3.5. Overall, 68.1% of the healthcare facilities were rated excellent, although there were some loopholes (documenting mistakes and poor communication across shifts) in the safety composite scores requiring areas for improvement.

2304 Models of care and the role of clinical pharmacists in UK primary care for older people: findings from a scoping review

Abstract Introduction Pharmacists have traditionally worked in primary care, in the community, and with GPs. However, the role of the clinical pharmacist in primary care is evolving and there are plans to employ more clinical pharmacists in the NHS. With an ageing UK population, there is an increase in the number of people living with multiple long-term conditions, accompanied by polypharmacy, posing numerous challenges to healthcare systems. This review investigates the evidence about the varied roles and services delivered by clinical pharmacists in primary care, capturing the perspectives of health and care professionals, older adults, and their carers. Method Our scoping review followed the framework for scoping reviews in accordance with the Joanna Briggs Institute (JBI) methodology. A broad search was conducted in 2023 in CINAHL, Cochrane, Medline, SCOPUS, and Web of Science. We included articles that explored the landscape of clinical pharmacy services for older people in the UK, focusing on roles and services delivered, perceptions, and experiences. Results A total of 23 articles was included. These shed light on the multifaceted responsibilities of clinical pharmacists for older people. Stakeholder perspectives, including healthcare professionals and care home staff, emphasise the positive outcomes of clinical pharmacist involvement, from reducing other practitioners’ workloads to improving patient safety. However, communication gaps among the primary care team and those living with dementia, concerns about competence, and the need for clear role definitions of clinical pharmacists emerge as challenges. Conclusions and implications The review enhances our understanding of the clinical pharmacist service in the UK and identifies gaps in research evidence, emphasising the need for empirical studies on the experiences of older people with cognitive impairment and those from minority ethnic backgrounds. The findings can be used for policymaking, workforce planning, and healthcare provision to improve the services for older people in the UK.

Strengthening the Chain: A Continuing Medical Education Program for Test Results Follow-up.

The Canadian Medical Protective Association (CMPA)'s Commitment to Change in Test-Results Follow-Up (CTC-TRFU) program aims to provide physicians with resources to enhance their test results follow-up systems for improved patient safety. Framed around the Transtheoretical Model, the program involves a 6-month multimodal educational intervention involving individual and group coaching sessions, action planning, and reflection surveys. This study evaluates the CTC-TRFU program's impact by analyzing survey responses and course documents, focusing on three main outcomes: physicians' perceived barriers and challenges, changes in their confidence and commitment, and implemented practice changes with perceived impact on patient safety. Participants were Canadian physicians who enrolled through the CMPA's open-access registration, with a particular emphasis on those facing challenges in test result follow-up. One hundred two physicians have enrolled in the program. Of these physicians, 34 (33.3%) have successfully completed the program and 28 (27.5%) are actively enrolled. Among the 34 physicians who successfully completed the program, an overwhelming majority of 97.1% (n = 33) expressed their belief that the improvements made to their test follow-up system significantly enhance patient safety within their practice. We observed a significant increase in confidence in the robustness of the physician's follow-up system from program registration to completion (P < .001). Physicians reported catching specific missed test results (55.9%, n = 19), including various laboratory reports and diagnostic imaging like abnormal mammograms or missing MRI/CT results. Physicians who participated in the CTC-TRFU program reported meaningful practice changes, which we believe underscores the value of comprehensive, longitudinal continuing patient safety CPD initiatives. These findings indicate the potential for future studies to explore the long-term impact of similar programs and their scalability.

Simulation-based ultrasound-guided regional anesthesia education: a national survey of Canadian anesthesiology residency training programs.

Simulation-based education in ultrasound-guided regional anesthesia (UGRA) improves knowledge, skills, and patient outcomes. Nevertheless, it is not known how simulation-based UGRA education is used across Canada. We aimed to characterize the current use of simulation-based UGRA education in Canadian anesthesiology residency training programs. We developed and distributed a structured national survey to simulation leads of all 17 Canadian anesthesiology residency training programs. The survey inquired about program demographics, simulation modalities, facilitators and barriers to simulation use, use for assessment, and beliefs around simulation-based UGRA education. We gathered data from August to November 2023 and summarized our findings descriptively. Fifteen programs (88%) responded to our survey. Eight programs (53%) used UGRA simulation for technical training and nine programs (60%) for nontechnical training. The most common simulators used were live model scanning (13 programs, 87%) and gel phantom models (7 programs, 47%). Five programs (33%) mandated simulation-based UGRA in their curriculum. We found that deliberate practice and improved patient safety were most valued in simulation training while lack of funding and faculty availability were the most common barriers to implementation. Most respondents agreed that formative simulation-based education would improve trainee skills and called for greater standardization. Nevertheless, there were mixed responses regarding summative UGRA simulation and the need for simulation proficiency before clinical practice. Our findings show significant variations in simulation implementation and views on UGRA simulation-based education among Canadian anesthesiology residency training programs. Future studies should explore avenues to overcome barriers and improve knowledge translation in UGRA.

The transition of patient care: Exploring the outcomes of prehospital to hospital patient handover practices and healthcare provider education

IntroductionInadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices. MethodsA multi-method study design was used – a document analysis of HCP programme outcomes and a two-section questionnaire. The questionnaire was sent to HCPs to determine the impact of patient handover practices on current healthcare systems and their opinion on whether the training on handovers is sufficient. ResultsHCPs indicated little educational interaction regarding patient handover. Most participants felt handover education relied predominantly on informal training. With their existing knowledge, many HCPs revealed that they were comfortable in handing over a patient. Little interprofessional confidence regarding patient handover information indicates minimal interprofessional collaboration toward standardised approaches for patient handover. ConclusionThis study indicates a lack of standardised handover procedures, which leads to HCP self-interpretations. There is low trust between HCPs regarding information received. The study highlights the need for standardised handover training in healthcare curricula to improve patient safety and interprofessional collaboration.

Cumulative Analysis of Device-associated Hospital-acquired Infection Quality Indicators in a Teaching Hospital in Telangana

Background and Aims: In the realm of healthcare, device-associated hospital-acquired infections (DA-HAIs) pose significant challenges. These infections occur due to invasive medical devices and can lead to serious complications for patients. This study intends to assess the trends in device-associated infections over time in order to improve patient safety and quality through measurements and improvements in device-associated infections. Methods: The Department of Microbiology conducted a routine surveillance using a specific infection surveillance proforma for various healthcare-associated infections, including ventilator-associated events (VAEs), central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). The data were examined at the end of each month, and the infection rate was determined using CDC guidelines. Results: The overall rate of HAI was found to be 1.69 HAI cases per 1,000 patient days. The cumulative DAI rates for the years 2021 and 2022 were CAUTI 6.14/1,000 urinary catheter days, CLABSI 4.5/1,000 central line catheter days and VAE 16.3/1,000 ventilator days. Discussion: It was observed that the CAUTI and CLABSI rates in our institution were comparable to or slightly higher than the national standard benchmark and INICC report and were significantly higher compared to the CDC/NHSN benchmark. The VAE rate was comparable to INICC report but was significantly higher compared to the NSB and the CDC/NHSN reports. Conclusion: Individual hospitals should make efforts to generate and evaluate their DAI trends and overall HAI rates and implement and improve their infection control programme to collectively achieve the target in our country in bringing down HAIs.

Uncovering the Knowledge Landscape of Food-Drug Interactions Among Medical Professionals

Background: Drug-food interactions (DFIs) can alter drug pharmacokinetics and pharmacodynamics, impacting patient outcomes. Health care professionals (HCPs) play a critical role in managing these interactions. Specific Background: Despite their significance, the awareness of DFIs among Iraqi medical professionals is inadequately documented. Knowledge Gap: There is a lack of comprehensive studies evaluating the knowledge of DFIs among medical professionals in Iraq, which is crucial for improving patient care and therapeutic efficacy. Aims: This study aimed to evaluate the knowledge of food-drug interactions among Iraqi medical professionals, including medical students, newly graduated doctors, and junior doctors. Methods: A cross-sectional study was conducted using a self-administered questionnaire with 20 questions evaluating knowledge on common DFIs. Results: The study revealed a concerning lack of knowledge about DFIs among participants, with junior doctors scoring an average of 7.1 out of 15, newly graduated doctors 6.38, and sixth-grade medical students 5.27. Only 13% felt knowledgeable about DFIs, while 31.7% acknowledged their insufficient understanding. Notably, knowledge on interactions such as tyramine-rich foods with antidepressants and grapefruit juice with statins was limited. Novelty: This study provides the first comprehensive assessment of DFI knowledge among Iraqi medical professionals, highlighting significant gaps and educational needs. Implications: The findings underscore the necessity for enhanced educational programs targeting DFIs in medical curricula, ensuring HCPs are equipped to counsel patients effectively, thereby improving patient safety and therapeutic outcomes. These results emphasize the importance of targeted educational interventions to bridge the knowledge gap, ultimately contributing to better health outcomes and informed patient care in Iraq. Highlights: Knowledge Gaps: Iraqi medical professionals lack understanding of common food-drug interactions. Education Needed: Enhanced training on interactions is essential in medical curricula. Patient Safety: Improving knowledge will lead to better patient outcomes. Keywords: Food–Drug Interactions, Knowledge, Drug Interaction, Medical Students

LEGAL LIABILITY OF A PHYSICIAN FOR PROVIDING INADEQUATE MEDICAL CARE TO A PATIENT: ANALYSIS OF APPROACHES BASED ON THE EXAMPLES OF KAZAKHSTAN AND THE UNITED STATES

Background: This research focuses on the determination of liability for medical professionals causing harm to patients, using the criminal legislation of the Republic of Kazakhstan as a foundation. Criminal liability for medical offences is stipulated in Chapter 12 of the Criminal Code. By identifying the mandatory characteristics or elements of a medical criminal offence according to the criminal legislation of Kazakhstan, parallels are drawn with the types of culpability provided for in developed countries worldwide. The authors reviewed scholarly works examining the effectiveness of handling cases involving harm to patients and decisions regarding the satisfaction or dismissal of the patient's claims in Kazakhstan. Attention has been given to empirical data collected within the territory of the Republic of Kazakhstan. The results of sociological research conducted by the authors over a period of 3 months among healthcare professionals from different regions of the country have been utilised. Special attention has been devoted to international experiences in implementing measures to improve patient safety, reducing citizen complaints regarding the quality of healthcare services, and enhancing the legal protection of medical personnel. The research selects provisions from scholarly works that reduce the risk of harm to patients and thereby contribute to reducing medical crime levels. Methods: In this research, the authors employed a number of methods of scientific research to achieve their goals and solve their tasks, in particular legal analysis, comparative legal analysis, survey, questionnaire, and interviewing. Legal analysis of the Criminal Legislation of the Republic of Kazakhstan, including Chapter 12 of the Criminal Code, was conducted to identify the specifics of criminal liability for medical offences, exemplified by Article 317. This analysis highlighted the nuances of criminal liability for medical offences in Kazakhstan. Comparative legal analysis made it possible to compare the responsibilities of doctors in the USA and Kazakhstan. Attention was drawn to the similarity of the concepts of guilt in the form of negligence, with a specific emphasis on the American approach, which offers valuable insights for Kazakhstan. These aspects could be adapted to improve Kazakhstan's legal system. The specific cases of harm to patients considered by the courts of the Republic of Kazakhstan were studied, and court decisions concerning the satisfaction of patients' claims and their rejection were analysed, which allowed the authors to identify the main arguments and trends in judicial practice. Surveys and questionnaires were conducted among medical workers from various regions of Kazakhstan to gather empirical data on their perceptions of duties and responsibilities. Additionally, in-depth interviews were also conducted with experts in the field of medicine and law, as well as patients, and representatives of health authorities, providing high-quality data on the problems and challenges faced by medical workers. Statistical data collected during sociological research were processed and analysed. This included data on citizen complaints about the quality of medical care, cases of harm to patients and other relevant statistical indicators. The study of the problem at various levels revealed the level of patient safety and legal protection of medical personnel. Results and Conclusion: Creating conditions for medicine and ensuring effective social and professional medical insurance are some factors that provide opportunities for medical practice as a whole and the healthcare system. These facts also facilitate a proper legal assessment of a doctor's performance

Improving Patient Safety and Care Quality Through a "Speaking-Up" Climate: The Mediating Role of Situation Monitoring.

In healthcare settings, a climate that encourages speaking up among staff is believed to enhance patient safety and quality of care. However, the specific mechanisms of this relationship remain underexplored. Particularly, there is a need to understand how components of teamwork, such as situation monitoring, can be linked to the impact of a speaking-up climate on relevant outcomes. This study aimed to investigate the direct and indirect effects of a speaking-up climate on patient safety and quality of care using situation monitoring as a potential mediator. This cross-sectional study used survey data from 380 staff nurses who provided direct patient care at three Korean hospitals. Structural equation modeling was utilized to test a hypothesized mediation model using Mplus 7.0. Our data analysis confirmed the partial mediation model. As hypothesized, a speaking-up climate directly improved patient safety (β = 0.384, p < 0.001) and quality of care (β = 0.393, p < 0.001). Also, we found that indirect effects of a speaking-up climate on patient safety (β = 0.224, p < 0.001) and quality of care (β = 0.186, p = 0.005) through situation monitoring were significant. These results indicate that situation monitoring was found to significantly mediate the relationship between a speaking-up climate, patient safety, and quality of care. Our study demonstrates that the positive impact of a speaking-up climate extends beyond improving nurses' speaking up. Further, fostering a speaking-up climate can significantly improve patient safety and quality of care, and situation monitoring has a critical role in this relationship. These findings contribute to understanding how encouraging a speaking-up climate could benefit patient safety and care quality in healthcare organizations.

Assessment of risk factors for adverse events in analgosedation for pediatric endoscopy: A 10-year retrospective analysis.

Data regarding the occurrence of complications specifically during pediatric anesthesia for endoscopic procedures is limited. By evaluating such data, factors could be identified to assure proper staffing and preparation to minimize adverse events and improve patient safety during flexible endoscopy. This retrospective cohort study included children undergoing anesthesia for gastroscopy, colonoscopy, bronchoscopy, or combined endoscopic procedures over 10-year period. The primary study aim was to evaluate the incidence of complications and identify risk factors for adverse events. Overall, 2064 endoscopic procedures including 1356 gastroscopies (65.7%), 93 colonoscopies (4.5%), 235 bronchoscopies (11.4%), and 380 combined procedures (18.4%) were performed. Of the 1613 patients, 151 (7.3%) patients exhibited an adverse event, with respiratory complications being the most common (65 [3.1%]). Combination of gastrointestinal endoscopies did not lead to an increased adverse event rate (gastroscopy: 5.5%, colonoscopy: 3.2%). Diagnostic endoscopy as compared to interventional had a lower rate. If bronchoscopy was performed, the rate was similar to that of bronchoscopy alone (19.5% vs. 20.4%). Age < 5.8 years or body weight less than 20 kg, bronchoscopy, American Society of Anesthesiologists status ≥ 2 or pre-existing anesthesia-relevant diseases, and urgency of the procedure were independent risk factors for adverse events. For each risk factor, the risk for events increased 2.1-fold [1.8-2.4]. This study identifies multiple factors that increase the rate of adverse events associated anesthesia-based endoscopy. Combined gastrointestinal procedures did not increase the risk for adverse events while combination of bronchoscopy to gastrointestinal endoscopy showed a similar risk as bronchoscopy alone.

Preventing pediatric accidental decannulation events: A quality improvement initiative

ObjectiveTo describe a quality improvement (QI) method to decrease pediatric accidental decannulation (AD) in the early postoperative period for children under age 3. MethodsA retrospective chart review was conducted on children under age 3 who underwent tracheostomy at Duke University Health System from August 1, 2013 to May 1, 2023 (n = 104). A root cause analysis was used to assess factors associated with AD following pediatric tracheostomy. Based on the factors identified by the research team, retrospective data was collected before (8/1/13 - 1/31/22) and after (2/1/22 - 5/1/23) a single practice change was implemented: using twill neck ties, rather than foam neck ties, to secure newly-placed tracheostomy tubes. Twill ties were applied intraoperatively as a visual cue to signal a recent tracheostomy for the interdisciplinary care team. The primary outcome in the pre-intervention and post-intervention period was measured as 30-day incidence of AD per 10 tracheostomy cases. ResultsPrior to the intervention, a total of 11 ADs occurred in 9 patients across 93 pediatric tracheostomies (1.18 AD per 10 cases). Afterward, 0 ADs occurred across 11 pediatric tracheostomies (0 AD per 10 cases). ConclusionThis data suggests that the twill tie intervention may prevent AD and the associated morbidity. With the twill tie initiative, we describe 11 ADs and associated risk factors and present a QI intervention that may help prevent AD and improve patient safety in the early postoperative period.

Improving Emergency Skills: Training Program at Medono Health Center, Pekalongan City

First aid is crucial and essential for providing emergency assistance. Early treatment of injured individuals at home can significantly reduce morbidity and mortality rates. Community health center staff, as primary service providers to the community, must be proficient in first aid since emergencies can happen anytime and anywhere. This study assessed the effectiveness of Cardiopulmonary Resuscitation (CPR) training at the Medono Community Health Center in enhancing the knowledge and skills of healthcare workers. Initially, 76.2% of participants had inadequate knowledge about CPR, but after training, 86% showed a substantial improvement in knowledge. Furthermore, the training reduced errors in using the Bag Valve Mask (BVM) and performing chest compressions. Mistakes in ventilation decreased after proper instruction, and errors in compression positioning dropped from 57.8% to nearly zero. These findings highlight the critical role of CPR training in enhancing the preparedness and competence of healthcare workers in emergencies. The Medono Health Center is dedicated to regularly conducting CPR training to ensure the continuous improvement of healthcare quality and patient safety.

Enhancing Healthcare Accountability for Administrators: Fostering Transparency for Patient Safety and Quality Enhancement.

Transparency in healthcare organizations is essential for creating a culture of patient-centered care where patients are respected, informed, and actively engaged in their health and well-being. Organizational transparency is a crucial element in healthcare, enhancing patient safety and quality improvement. Transparency involves open communication about healthcare organizations' performance, outcomes, and processes, leading to improved accountability, trust, and patient engagement. Transparent organizations prioritize patient-centered care, involving patients in decision-making and fostering shared mental models between healthcare providers and patients. Psychological safety is vital for organizational transparency. Patient safety reporting systems play a key role in transparency, allowing anonymous reporting of safety concerns and incidents. These systems facilitate early risk identification, continuous improvement, and compliance with regulatory requirements. Transparency in reporting encourages a culture of openness, learning from near misses, and addressing systemic issues and human errors. It aligns with ethical principles, potentially mitigating legal challenges. This review synthesizes key themes, including the importance of patient-centered care, the role of psychological safety in fostering transparency, and the effectiveness of patient safety reporting systems.

Organizational and infrastructural risk factors for health care–associated Clostridioides difficile infections or methicillin-resistant Staphylococcus aureus in hospitals

This study explores the infrastructural and organizational risk factors for healthcare-associated (HCA) Clostridioides difficile infections (CDIs) and methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. This is a retrospective observational study involving all eligible inpatient units from 12 hospitals in British Columbia, Canada, from April 1, 2020 to September 16, 2021. The outcomes were the average HCA CDI or MRSA rates. Covariates included, but were not limited to, infection control factors (eg, hand hygiene rate), infrastructural factors (eg, unit age), and organizational factors (eg, hallway bed utilization). Multivariable regression was performed to identify statistically significant risk factors. Older units were associated with higher HCA CDI rates (adjusted relative risk [aRR]: 0.012; 95%confidence interval (CI) [0.004, 0.020]). Higher HCA MRSA rates were associated with decreased hand hygiene rate (aRR: -0.035; 95%CI [-0.063, -0.008]), higher MRSA bioburden (aRR: 9.008; 95%CI [5.586, 12.429]), increased utilization of hallway beds (aRR: 0.680; 95%CI [0.094, 1.267]), increased nursing overtime rate (aRR: 5.018; 95%CI [1.210, 8.826]), and not keeping the clean supply room door closed (aRR: -0.283; 95%CI [-0.536, -0.03]). The study confirmed the multifaceted nature of infection prevention and emphasized the importance of interdepartmental collaboration to improve patient safety.

Leveraging the full expertise of radiographers for improved healthcare delivery.

The role of radiographers in healthcare has evolved significantly from operating imaging equipment to being essential in patient care and diagnosis. In Australia, radiographers play a crucial role in image interpretation, identifying and communicating significant findings to enhance patient outcomes. Preliminary image evaluation (PIE) allows radiographers to interpret images and ensure significant findings are noted, particularly in urgent situations, complementing diagnoses when radiologist reports are unavailable. Despite their potential, many radiographers lack empowerment, leading to delays and adverse patient outcomes. This underutilisation stems from a lack of support and systemic barriers. Radiographers, with their extensive expertise in imaging, are vital for ensuring patient safety and care quality. Policy changes are needed to integrate PIE into standard workflows, allowing radiographers to fully utilise their skills. Recognising and leveraging their expertise will enhance patient care, foster collaboration, and ensure radiographers contribute fully to the healthcare team, ultimately improving patient safety and care quality.

Pediatric Tele-Critical Care: Initial Experience with a Continuous Surveillance Model Aiming to Prevent Cardiac Arrest in Children with Critical Heart Disease.

Introduction: Despite advances in treatment of children with critical heart disease, cardiac arrest (CA) remains a common occurrence. We provided virtual support to bedside teams (BTs) from a tele-critical care (TCC) unit in a pediatric cardiac intensive care unit (CICU) and focused on early detection of concerning trends (CT) and avoidance of CA. Virtual surveillance workflows included a review of remote monitoring, video feed from patient room cameras, medical records, and artificial intelligence tools. We present our initial experience with a focus on critical communications (CCs) to BTs. Methods: A retrospective, descriptive review of TCC activities was conducted from January 2019 to December 2022, involving electronic databases and electronic medical records of patients in the CICU, including related CCs to BTs, responses from BTs, and related CA. Results: We conducted 18,171 TCC activities, including 2,678 non-CCs and 248 CCs. Over time, there was a significant increase in the proportion of CCs related with CT (p = 0.002), respiratory concerns (<0.001), and abnormalities in cardiac rhythm (p = 0.04). Among a sample of 244 CCs, subsequent interventions by BTs resulted in adjustment of medical treatment (127), respiratory support (68), surgery or intervention (19), cardiac rhythm control (17), imaging study (14), early resuscitation (9), and others (10). Conclusions: CCs from a TCC unit in a pediatric CICU changed over time with an increased focus on CT and resulted in early interventions, potentially contributing to avoiding CA. This model of care in pediatric cardiac critical care has the potential to improve patient safety.

Reduction in preventable time-critical dose omissions: impact of electronic medication management systems on in-patients

Background: The omission of time-critical medication doses may result in poor patient outcomes. There are few publications about the influence of electronic medication management (EMM) systems, including automated dispensing cabinets (ADC), on timely medication administration. The study aimed to evaluate the influence of EMM systems, including ADCs, on timely medication administration 6 and 30 months after EMM implementation, focussing on preventable time-critical medication dose omissions and documented reasons for not administering a dose. Methods: Data on doses of regular inpatient medications not administered were obtained from electronic medication records (EMR) over 1 week in March 2019 and 4 weeks in March 2021. An omission was a dose not administered before the next due dose. Time-critical medications were defined using the health service’s guidelines. Reasons for doses not being administered were obtained from nursing documentation in the EMR collated from digital health reports. Reasons for time-critical medication doses not given were defined as ‘valid’ or ‘preventable’. Results: In 2019 and 2021, 620 and 2524 patients with 44,756 and 146,940 scheduled medication doses were reviewed. Of these, 4385 (9.8%) and 19,610 (13.4%) doses were not administered. In 2019 and 2021, there were 593 (1.3%) and 1811 (1.2%), p < 0.0001, time-critical doses not administered. Preventable time-critical dose omissions decreased from 0.20% in 2019 to 0.15% (p = 0.015) in 2021. Wards with ADCs had a significantly lower rate of time-critical dose omissions compared to those without ADCs (1.1% vs 1.3%, p = 0.014). Conclusion: With the introduction of an EMM system, there was a decrease in the rate of time-critical medications not administered, including a reduced rate of preventable omissions over the 24-month period. Regular assessment of time-critical medication administration will help target patient safety improvements.

Nursing students' perceptions of interaction in a multiplayer virtual reality simulation: A qualitative descriptive study.

To describe nursing students' perceptions of interaction in a multiplayer virtual reality (MPVR) simulation. A qualitative descriptive study. Second-semester nursing students (n = 24) participated in pairs in MPVR simulations and semi-structured interviews. Data were analysed deductively and inductively. Four types of interaction in a MPVR simulation were identified: interaction between the students, interaction between the student and the virtual environment (VE), interaction between the student and the virtual patient (VP), and interaction between the student and the simulation facilitator. Interaction consisted of verbal and nonverbal interaction, as well as object manipulation and movement in the VE. The reasons for interaction were to coordinate the care, to assess the VP, and to implement VPs' care. MPVR simulation offered nursing students an opportunity to practice nurse-to-nurse interaction and interaction related to nurses' collaboration, which are essential skills in nursing practice. Students were also able to interact with the VP, which can promote students' nurse-patient interaction skills. Therefore, MPVR simulations can be utilized as a platform to enhance interaction skills of future healthcare professionals, which could improve patient safety. None.