Patient Involvement In Safety Research Articles

Consumers' perspectives on their involvement in recognizing and responding to patient deterioration-Developing a model for consumer reporting.

BackgroundAdverse events occur in health care. Detection and reporting of deterioration therefore have a critical role to play. Patient and family member (consumer) involvement in patient safety has gained powerful support amongst global policymakers. Few studies, with none taking a rigorous qualitative approach, have drawn upon consumers’ experiences to establish their preferences in consumer reporting of patient deterioration programmes.ObjectiveTo explore consumers’ experiences of previous reporting of patient deterioration; their preferred educational strategies on this role and recommended pathways in a consumer reporting of patient deterioration model.Design, setting and participantsAn interpretive, qualitative research design was utilized. Nine focus group interviews were undertaken across Adelaide, capital city of South Australia. Interviews were audio‐taped, transcribed and analysed thematically. Twenty‐six adults described, then reflected, on previous experiences of reporting patient deterioration.ResultsOverarching themes incorporated consumers’ experiences and patient/family education. Three themes emerged in relation to consumers’ experiences: feelings, thoughts and actions. Five themes arose on educating consumers: content, timing, format, information providers and information recipients. The consumers’ deep reflections on their past reporting experiences led to the development of a new model for consumer reporting of patient deterioration.ConclusionsConsumers’ views on ways to improve consumer reporting of patient deterioration processes emerged. These improvements include structured educational programmes for staff advocating open health‐care professional/consumer communication, educational materials developed and tested with English‐speaking and culturally and linguistically diverse consumers and a model with three consumer reporting pathways.

A 5-facet framework to describe patient engagement in patient safety.

BackgroundHealth care remains unacceptably error prone. Recently, efforts to address this problem have included the patient and their family as partners with providers in harm prevention. Policymakers and clinicians have created patient safety strategies to encourage patient engagement, yet they have typically not included patient perspectives in their development or been comprehensively evaluated. We do not have a good understanding of “if” and “how” patients want involvement in patient safety during clinical interactions.ObjectiveThe objective of this study was to gain insight into patients’ perspectives about their knowledge, comfort level and behaviours in promoting their safety while receiving health care in hospital.MethodsThe study design was a descriptive, exploratory qualitative approach to inductively examine how adult patients in a community hospital describe health‐care safety and see their role in preventing error.ResultsThe findings, which included participation of 30 patients and four family members, indicate that although there are shared themes that influence a patient's engagement in safety, beliefs about involvement and actions taken are varied. Five conceptual themes emerged from their narratives: Personal Capacity, Experiential Knowledge, Personal Character, Relationships and Meaning of Safety.DiscussionThese results will be used to develop and test a pragmatic, accessible tool to enable providers a way to collaborate with patients for determining their personal level and type of safety involvement.ConclusionThe most ethical and responsible approach to health‐care safety is to consider every potential way for improvement. This study provides fundamental insights into the complexity of patient engagement in safety.

Sustained Impact of a Pediatric Resident-Led Patient Safety Council.

The aim of the study was to evaluate the impact of a resident-led patient safety council. This study measured change in resident perceptions and knowledge of safety issues for 3 years, as well as behavioral choices to participate in patient safety activities during and after residency. Pediatric residents formed a resident-led safety council to engage their peers in patient safety activities. Surveys were distributed annually from 2013 to 2015 to measure residents' perception and knowledge surrounding patient safety. The number of patient safety reports submitted by residents was tracked for the same period. In addition, recent graduates were surveyed to assess the influence of the council on postresidency involvement in patient safety. Resident perception of the institutional culture of safety improved and knowledge of basic patient safety concepts increased. The number of resident-submitted safety reports increased from 6.2 to 15.2 reports per month in the 2013 and 2015 academic years, respectively. Surveys of recent graduates suggest that involvement with the safety council during residency fostered future engagement in patient safety. This resident-led council models successful involvement of trainees in system-based patient safety. Such involvement can help shape the safety culture within a training program and encourages continued participation in patient safety after residency completion.

Mindful organizing in patients' contributions to primary care medication safety.

BackgroundThere is a need to ensure that the risks associated with medication usage in primary health care are controlled. To maintain an understanding of the risks, health‐care organizations may engage in a process known as “mindful organizing.” While this is typically conceived of as involving organizational members, it may in the health‐care context also include patients. Our study aimed to examine ways in which patients might contribute to mindful organizing with respect to primary care medication safety.MethodQualitative focus groups and interviews were carried out with 126 members of the public in North West England and the East Midlands. Participants were taking medicines for a long‐term health condition, were taking several medicines, had previously encountered problems with their medication or were caring for another person in any of these categories. Participants described their experiences of dealing with medication‐related concerns. The transcripts were analysed using a thematic method.ResultsWe identified 4 themes to explain patient behaviour associated with mindful organizing: knowledge about clinical or system issues; artefacts that facilitate control of medication risks; communication with health‐care professionals; and the relationship between patients and the health‐care system (in particular, mutual trust).ConclusionsMindful organizing is potentially useful for framing patient involvement in safety, although there are some conceptual and practical issues to be addressed before it can be fully exploited in this setting. We have identified factors that influence (and are strengthened by) patients’ engagement in mindful organizing, and as such would be a useful focus of efforts to support patient involvement.

A Descriptive Analysis of Patient Safety at Universitas Gadjah Mada Academic Hospital Yogyakarta : A Case Study Using IHI Global Trigger Tool for Measuring Adverse Events

Background: Management of medical treatment is a very complex multi-disciplinary process with many stages. During patient care at Universitas Gadjah Mada Academic Hospital (UGM Academic Hospital) incidents involving patient safety either go unreported or are accidentally found. According to some public health research only about 10-20% of incidents were reported. The purpose of this research aimed to provide data to the management about the level of patient safety and make recommendations to improve service quality, especially to reduce injury and increase patient safety.Methods: Our study was conducted by doing a review of patient medical records of hospitalized adults (n = 60) treated in September 2015 to detect trigger and adverse events using the IHI Global Trigger Tool for Measuring Adverse Events. Group Cares was designed to reflect the adverse events that occurred anywhere in UGM Academic Hopitaltal so that all samples should be reviewed by both modules. All three remaining modules were used if necessary depending on the unit where patients were treated. Technical analysis used in this research was descriptive statistics.Results: The study found 69 incidents / triggers that occurred in 27 patients (n = 60) consisting of 47 incidents in the treatment group, 16 incidents in the surgery group, one incident in intensive care, and 5 incidents at the Emergency Department. Based on the level of injury, the incidents which happened demanded extended day care, requiring more intervention and assistance of disability. No cases of death were reported due to the incidents.Conclusions: The incidence found in all categories according to the modules with the highest incidence was the incidence of treatment and the smallest was in intensive care. Most incidents resulted in extending the duration of treatment and require more intervention. No fatal cases were reported to have resulted in the studied sample.

Patient-Reported Dental Safety Events: A South African Perspective.

In recent years, there has been an increase in research studies highlighting patients' experiences of adverse events (AEs) as well as the role of patients in promoting safety. The primary goal of the study was to assess the prevalence of dental AEs (DAEs) among dental patients in South Africa and its associated factors. The integration of the patient perspective into dental patient safety research will enhance our collective understanding of DAEs. We conducted a cross-sectional study of adult patients at a large dental academic institution in South Africa from May to June 2015, evaluating their previous experiences of DAEs at any dental clinic in South Africa. Descriptive statistics and bivariate and multivariate analyses were performed to identify the factors associated with an increased likelihood of experiencing a DAE. A total of 440 questionnaires were returned during the 6-week study period (response rate = 97.8%). Overall, 45.5% of participants reported experiencing one or more DAEs. Two hundred participants reported a total of 717 DAEs giving us a lifetime prevalence of 1.6 DAEs per respondent. Our results suggest that respondents who were younger (18-24 y), from high-income families (>R150,000 or US $9200), dissatisfied with their last dental visit and oral health had an increased likelihood of reporting a previous experience of a DAE. This study provides an insight into the nature of information that can be gleaned from dental patients regarding safety and helps lay the foundation for patient involvement in patient safety reporting.

Patient Involvement in Patient Safety: A Qualitative Study of Nursing Staff and Patient Perceptions.

The risk associated with receiving health care has called for an increased focus on the role of patients in helping to improve safety. Recent research has highlighted that patient involvement in patient safety practices may be influenced by patient perceptions of patient safety practices and the perceptions of their health care providers. The objective of this research was to describe patient involvement in patient safety practices by exploring patient and nursing staff perceptions of safety. Qualitative focus groups were conducted with a convenience sample of nursing staff and patients who had previously completed a patient safety survey in 2 tertiary hospital sites in Eastern Canada. Six focus groups (June 2011 to January 2012) were conducted and analyzed using inductive thematic analysis. Four themes were identified: (1) wanting control, (2) feeling connected, (3) encountering roadblocks, and (4) sharing responsibility for safety. Both patient and nursing staff participants highlighted the importance of building a personal connection as a precursor to ensuring that patients are involved in their care and safety. However, perceptions of provider stress and nursing staff workload often reduced the ability of the nursing staff and patient participants to connect with one another and promote involvement. Current strategies aimed at increasing patient awareness of patient safety may not be enough. The findings suggest that providing the context for interaction to occur between nursing staff and patients as well as targeted interventions aimed at increasing patient control may be needed to ensure patient involvement in patient safety.

Patient Safety and Quality Improvement Education in Otolaryngology Residency: Preliminary Look at a Module-Based Approach.

Since publication of the Institute of Medicine’s report To Err Is Human in 1999, patient safety and health care quality have become hot topics in the parlance of modern medical care. The Accreditation Council for Graduate Medical Education now requires integration of these topics into resident education, with evidence of trainee involvement in Patient Safety and Quality Improvement (PSQI) projects. Research in other disciplines indicates that interactive, experiential learning leads to the highest quality PSQI education. Otolaryngology as a field has been slow to adopt these changes into its residency curricula due to competing educational demands and lack of faculty expertise. The author reports preliminary experience with integration of an online module-based curriculum that addresses both of these issues.

The Role of Safety Culture in Influencing Provider Perceptions of Patient Safety

To determine how provider perceptions of safety culture influence their involvement in patient safety practices. Health-care providers were surveyed in 2 tertiary hospitals located in Atlantic Canada, composed of 4 units in total. The partial least squares (PLS) approach to structural equation modeling was used to analyze the data. Latent variables provider PLS model encompassed the hypothesized relationships between provider characteristics, safety culture, perceptions of patient safety practices, and actual performance of patient safety practices, using the Health Belief Model (HBM) as a guide. Data analysis was conducted using SmartPLS. A total of 113 health-care providers completed a survey out of an eligible 318, representing a response rate of 35.5%. The final PLS model showed acceptable internal consistency with all four latent variables having a composite reliability score above the recommended 0.70 cutoff value (safety culture = 0.86, threat = 0.76, expectations = 0.83, PS practices = 0.75). Discriminant validity was established, and all path coefficients were found to be significant at the α = 0.05 level using nonparametric bootstrapping. The survey results show that safety culture accounted for 34% of the variance in perceptions of threat and 42% of the variance in expectations. This research supports the role that safety culture plays in the promotion and maintenance of patient safety activities for health-care providers. As such, it is recommended that the introduction of new patient safety strategies follow a thorough exploration of an organization's safety culture.

Hospitalized patients′ attitude to participate in patient′ssafety

Objective To investigate hospitalized patients′ attitude to participate in patient′s safety, to explore its influencing factors, and to provide scientific suggestions to encourage patients′ involvement in medical safety. Methods A convenience sample containing 140 patients from a level three class A hospital and 108 patients from a level two class A hospital in Shanghai were investigated using Questionnaire of Perceived Effectiveness and the likelihood of Petients′ Participation in Medical Safety , which was designed by Hibbard JH and had been cross-culturally Chinesized in this research. Results Total score and average score of patients′ willingness for involvement in patient safety were 0-66 (full score 66) and (58.60±8.71). Relative factor is patients′ satisfaction of the safe surroundings provided by hospital (r=0.149, P<0.05). Total score and average score of patients′perceived effectiveness of involvement in patient safety was 20-66(full score 66), and (59.53±7.98). Relative factor was patients′ satisfaction of the safe surroundings provided by hospital (r=0.174, P<0.05). Patients′ willingness for involvement was positively correlated withperceived effectiveness (r=0.781, P<0.01). Conclusions Most of the patients are motivated in patient′s safety, yet they have different attitudes to various participant modes. Medical staff should enhance patient-safety education so as to make patients become real cooperator in medical activities. Key words: Patient′s safety; Patients′ participation; Attitudes; Investigation

Blood transfusion: patient identification and empowerment.

Positive patient identification is pivotal to several steps of the transfusion process; it is integral to ensuring that the correct blood is given to the correct patient. If patient misidentification occurs, this has potentially fatal consequences for patients. Historically patient involvement in healthcare has focused on clinical decision making, where the patient, having been provided with medical information, is encouraged to become involved in the decisions related to their individualised treatment. This article explores the aspects of patient contribution to patient safety relating to positive patient identification in transfusion. When involving patients in their care, however, clinicians must recognise the diversity of patients and the capacity of the patient to be involved. It must not be assumed that all patients will be willing or indeed able to participate. Additionally, clinicians' attitudes to patient involvement in patient safety can determine whether cultural change is successful.

Health care professionals' attitude of patients involvement in patient safety and its influencing factors

Objective To investigate health care professionals' attitude of patient involvement in patient safety and analyze its influencing factors. Methods A convenience sample of 946 health care professionals recruited from twelve hospitals in Shanghai was employed for a cross-sectional survey. Results The general attitudes of patient involvement in patient safety scored 3.86±0.56, the perception of the content of patient involvement scored 3.97±0.54, the average score of caring involvement (4.12±0.59) was larger than the average score of decisive involvement (3.88±0.58), the average score of complaining involvement was the least (3.39±0.81), the difference had statistical significance (F=583.797,P <0.01). The regression analysis showed that identity, professional title, hospital grade influenced health care professionals' general attitude of patient involvement in patient safety and that identity, hospital grade influenced health care professionals' attitude of the content of patient involvement. Conclusions In health care professionals' opinion, patient involvement in patient safety has both advantages and disadvantages. They preferred to caring involvement, followed by decisive involvement, then complaining involvement. So, hospital managers should view patient involvement in patient safety discriminately and construct rational involvement model of patients willing, medical support, promote interaction and harmony build. Key words: Health care professionals; Patient involvement; Patient safety; Attitude

Involving patients in patient safety programmes: A scoping review and consensus procedure by the LINNEAUS collaboration on patient safety in primary care

ABSTRACTBackground: Patient involvement has only recently received attention as a potentially useful approach to patient safety in primary care.Objective: To summarize work conducted on a scoping review of interventions focussing on patient involvement for patient safety; to develop consensus-based recommendations in this area.Methods: Scoping review of the literature 2006–2011 about methods and effects of involving patients in patient safety in primary care identified evidence for previous experiences of patient involvement in patient safety. This information was fed back to an expert panel for the development of recommendations for healthcare professionals and policy makers.Results: The scoping review identified only weak evidence in support of the effectiveness of patient involvement. Identified barriers included a number of patient factors but also the healthcare workers’ attitudes, abilities and lack of training. The expert panel recommended the integration of patient safety in the educational curricula for healthcare professionals, and expected a commitment from professionals to act as first movers by inviting and encouraging the patients to take an active role. The panel proposed a checklist to be used by primary care clinicians at the point of care for promoting patient involvement.Conclusion: There is only weak evidence on the effectiveness of patient involvement in patient safety. The recommendations of the panel can inform future policy and practice on patient involvement in safety in primary care.

Patients and Public Involvement in Patient Safety and Treatment Process in Hospitals Affiliated to Kashan University of Medical Sciences, Iran, 2013.

Background:In the recent decades, healthcare providers had a perspective of benevolent paternalism. Nowadays, the patients’ role has changed and they have a significant obligation to participate in their caring decisions.Objectives:The current study aimed to investigate the involvement of patients and public in the patient safety and treatment process in hospitals affiliated to Kashan University of Medical Sciences, Kashan, Iran, 2013.Patients and Methods:A cross-sectional study was conducted in the hospitals affiliated to Kashan University of Medical Sciences in 2013. Subjects included all of the 18 chief managers, 10% of nurses in each hospital, and 375 patients. Data collection instruments included a questionnaire and a checklist designed according to the research objectives. Data analysis was performed using the SPSS ver. 13. Descriptive statistics, percentage and frequencies, were calculated for all variables and analyzed by Chi-square test.Results:In the treatment process, 81 patients (21.61%), 50 nurses (80.6%) and 15 chief managers (83.3%) had awareness about Patient Bill of Rights. In patient Safety, 19.73% of the patients stated that hospitals received their feedbacks. Management activities were weak in evaluation. All of the six hospitals (100%) had a defined process to perform satisfaction surveys’ quality improvement and patient authentication policy.Conclusions:Patient and public participation in Kashan hospitals are not adhered well. As the patient has an important role in improving the quality of services, more use of mass media especially local newspapers, hospital websites, and training programs are suggested to inform both the patients and public on their rights and roles in improving the healthcare services.

Patients’ Role in Their Own Safety—A Systematic Review of Patient Involvement in Safety

It is necessary to evaluate progress in the area of patient safety. However, although there has been an increase in number of quality and safety related studies have increased, the topics of patient involvement and patient safety are not automatically linked. The aim of this systematic review was to identify and evaluate the evidence contributed by studies of patient involvement in the provision of safe care. Inclusion criteria were studies undertaken to promote involvement in safety, covering patients’ attitudes, unsafe and safe care, risk reduction and handover practices during discharge from hospital to primary care. The results revealed three themes: satisfaction with and need for knowledge about healthcare and the health system, sharing responsibility and accountability for safety and the need to overcome language barriers to prevent harm and error. In conclusion, there is an increased focus on the role of the patient in the provision of safe care. Existing evidence is related to medication rather than patients’ capability and willingness to be involved. It is recommended that patient participation in the provision of safe care should be explored in relation to phenomena such as trust, responsibility, shared decision-making and powerlessness. It is also important to investigate the patient’s role with respect to patient rights.

Using the Health Belief Model to explain patient involvement in patient safety.

With the knowledge that patient safety incidents can significantly impact patients, providers and health-care organizations, greater emphasis on patient involvement as a means to mitigate risks warrants further research. To understand whether patient perceptions of patient safety play a role in patient involvement in factual and challenging patient safety practices and whether the constructs of the Health Belief Model (HBM) help to explain such perceptions. Partial least squares (PLS) analysis of survey data. Four inpatient units located in two tertiary hospitals in Atlantic Canada. Patients discharged from participating units between November 2010 and January 2011. None. A total of 217 of the 587 patient surveys were returned for a final response rate of 37.0%. The PLS analysis revealed relationships between patient perceptions of threat and self-efficacy and the performance of factual and challenging patient safety practices, explaining 46 and 42% of the variance, respectively. The results from this study provide evidence for the constructs and relationships set forth by the HBM. Perceptions of patient safety were shown to influence patient likelihood for engaging in selected patient safety practices. While perceptions of barriers and benefits and threats were found to be a contributing factor to patient involvement in patient safety practices, self-efficacy plays an important role as a mediating factor. Overall, the use of the HBM within patient safety provides for increased understanding of how such perceptions can be influenced to improve patient engagement in promoting safer health care.

Patient participation in patient safety and nursing input - a systematic review.

This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Systematic review using integrative methods. Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: "patient", "healthcare provider", "task", "work environment", "organisation & management". We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety.

Predictors of healthcare professionals' attitudes towards family involvement in safety-relevant behaviours: a cross-sectional factorial survey study.

ObjectivesTo investigate predictors of healthcare professionals’ (HCPs) attitudes towards family involvement in safety-relevant behaviours.DesignA cross-sectional fractional factorial survey that assessed HCPs’ attitudes towards family involvement in two error scenarios relating to hand hygiene and medication safety. Each survey comprised two randomised vignettes that described the potential error, how the family member communicated with the HCP about the error and how the HCP responded to the family member’s question.Setting5 teaching hospitals in London, the Midlands and York. HCPs were approached on a range of medical and surgical wards.Participants160 HCPs (73 doctors; 87 nurses) aged between 21 and 65 years (mean 37) 102 were female.Outcome measuresHCP approval of family member’s behaviour; HCP reaction to the family member; anticipated effects on the family member–HCP relationship; HCP support for being questioned about hand hygiene/medication; affective rating responses.ResultsHCPs supported family member's intervening (88%) but only 41% agreed this would have positive effects on the family member/HCP relationship. Across vignettes and error scenarios the strongest predictors of attitudes were how the HCP (in the scenario) responded to the family member and whether an error actually occurred. Doctors (vs nurses) provided systematically more positive affective ratings to the vignettes.ConclusionsImportant predictors of HCPs’ attitudes towards family members’ involvement in patient safety have been highlighted. In particular, a discouraging response from HCP’s decreased support for family members being involved and had strong perceived negative effects on the family member/HCP relationship.

Patients' and carers' perceptions of safety in rural general practice.

To explore patients' and carers' experiences of rural general practice to identify their perceptions of safety of care. Four focus group interviews were conducted with 26 rural patients and carers in south-west Victoria between September and December 2012. Frequent users of general practice were recruited from local allied health self-management programs and a mothers' group. Focus groups were audio recorded, transcripts were independently analysed and interpreted using narrative methodologies. Participants who had experienced some level of harm were able to comment more extensively on safety aspects of care. Several key themes related to safety were identified from the analysis of all participant narratives. An assumed sense of safety in general practice was predominant, and was influenced by participants' level of risk awareness and trust in their general practitioner. Additional unique themes included feelings of vulnerability, desire for an explanation and apology, a forgiving view of mistakes, and preference for GP interpersonal skills over competence. This study revealed new insights into the factors that influence patients' and carers' perspectives of safety, and demonstrated the value of incorporating the patient voice into safety research. An assumed sense of safety due to a default position of trust, coupled with limited risk perception, directly contests the current literature on patient involvement in safety. Further exploration is required to determine how patients and carers can effectively engage in and assist with improving safety in general practice.

ESPR uroradiology task force and ESUR Paediatric Work Group—Imaging recommendations in paediatric uroradiology, part VI: childhood renal biopsy and imaging of neonatal and infant genital tract

The European Society of Paediatric Radiology Uroradiology Task Force and the ESUR Paediatric Work Group jointly publish guidelines for paediatric urogenital imaging. Two yet unaddressed topics involving patient safety and imaging load are addressed in this paper: renal biopsy in childhood and imaging of the neonatal genital tract, particularly in girls. Based on our thorough review of literature and variable practice in multiple centers, procedural recommendations are proposed on how to perform renal biopsy in children and how to approach the genital tract in (female) neonates. These are statements by consensus due to lack of sufficient evidence-based data. The procedural recommendation on renal biopsy in childhood aims at improving patient safety and reducing the number of unsuccessful passes and/or biopsy-related complications. The recommendation for an imaging algorithm in the assessment of the neonatal genital tract focuses on the potential of ultrasonography to reduce the need for more invasive or radiating imaging, however, with additional fluoroscopy or MRI to be used in selected cases. Adherence to these recommendations will allow comparable data and evidence to be generated for future adaptation of imaging strategies in paediatric uroradiology.