National Patient Safety Initiatives Research Articles

Patient Safety and organizational Safety Culture in Surgery: A Need of an Hour in the developing countries

Every year, more than 200 million surgeries are performed around the world, and recent statistics show that adverse event rates for surgical pathologies remain unacceptably high, despite several national and global patient safety initiatives over the last decade. Patient safety is diverse and highly complicated in nature, with several critical components. Although concern for patient safety is fundamental in health care practice, its transition into knowledge is comparatively recent, and hence patient safety may be deemed a "new" field. Current surgical safety guidelines and checklists are generic and not adapted to specific patient concerns and risk factors in surgical subspecialties. All surgical practitioners and health care organizations must therefore become better aware of the fundamental context of patient safety, actively participate in endeavors to integrate patient safety measures in daily practice, and foster a patient safety culture. The purpose of this review article is to outline patient safety in surgical techniques that should be adopted and implemented.

The critical role of infection prevention overlooked in Ethiopia, only one-half of health-care workers had safe practice: A systematic review and meta-analysis.

Effective infection prevention and control measures, such as proper hand hygiene, the use of personal protective equipment, instrument processing, and safe injection practicein the healthcare facilitiesare essential elements of patient safety and lead to optimal patient outcomes. In Ethiopia, findings regarding infection prevention practices among healthcare workers have been highly variable and uncertain. This systematic review and meta-analysis estimates the pooled prevalence of safe infection prevention practices and summarizesthe associated factors among healthcare workers in Ethiopia. PubMed, Science Direct, Google Scholar, and the Cochran library were systematically searched. We included all observational studies reporting the prevalence of safe infection prevention practices among healthcare workers in Ethiopia. Two authors independently extracted all necessary data using a standardized data extraction format. Qualitative and quantitative analyseswere employed. The Cochran Q test statistics and I2 tests were used to assess the heterogeneity of the studies. A random-effects meta-analysis model was used to estimate the pooled prevalence of safe infection prevention practice. Of the 187 articles identified through our search, 10 studies fulfilled the inclusion criteria and were included in the meta-analysis. The pooled prevalence of safe infection prevention practice in Ethiopia was 52.2% (95%CI: 40.9-63.4). The highest prevalence of safe practice was observed in Addis Ababa (capital city) 66.2% (95%CI: 60.6-71.8), followed by Amhara region 54.6% (95%CI: 51.1-58.1), and then Oromia region 48.5% (95%CI: 24.2-72.8), and the least safe practices were reported from South Nation Nationalities and People (SNNP) and Tigray regions with a pooled prevalence of 39.4% (95%CI: 13.9-64.8). In our qualitative syntheses, the odds of safe infection prevention practice were higher among healthcare workers who had good knowledge and a positive attitude towards infection prevention. Also, healthcare workers working in facilities with continuous running water supply, having infection prevention guideline, and those received training were significantly associated withhigher odds of safe infection prevention practice. Infection prevention practices in Ethiopia was poor, with only half of the healthcare workers reporting safe practices. Further, the study found out that there were regional and professional variations in the prevalence of safe infection prevention practices. Therefore, the need to step-up efforts to intensify the current national infection prevention and patient safety initiative as key policy direction is strongly recommended, along with more attempts to increase healthcare worker's adherence towards infection prevention guidelines.

Patient Safety Culture Change over Time-Health Care Staffs’ Perceptions

Rationale and Aim: Patient safety is of great interest in health care organisations, worldwide. In Sweden, a national patient safety initiative was launched in 2011. The aim of this study was to examine and compare patient safety culture change over time from health care staffs’ perspective. A further aim was to examine factors that have had an effect on patient safety culture. Methods: Patient safety culture was assessed in 2009, 2011 and 2013 using the Swedish version of the Hospital Survey of Patient Safety Culture. Respondents in this study were registered nurses (n = 2149), enrolled nurses (n = 959), physicians (n = 355) and managers (n = 159) working in three health care divisions in a Swedish county council. Results: Patient safety culture decreased significantly over time for all but two dimensions. The dimension “Information to Patients/Relatives” was the only dimension to increase significantly over time. Health care staffs’ profession and health care division belonging had significant main effects on 14 and 8 dimensions, respectively. Managers and enrolled nurses scored patient safety culture significantly higher than registered nurses and physicians. Health care staff working in a mixed medical-surgical health care division scored significantly higher than those working in medical or surgical divisions did. Conclusions: Despite efforts for patient safety work in the county council, health care staffs’ perceptions of patient safety culture decreased over time. To improve hospital patient safety culture, managers and staff groups must meet and communicate with each other in order to create a common view of patient safety.

Incidence of adverse events in Sweden during 2013–2016: a cohort study describing the implementation of a national trigger tool

ObjectivesTo describe the implementation of a trigger tool in Sweden and present the national incidence of adverse events (AEs) over a 4-year period during which an ongoing national patient safety...

Quality improvement and accountability in the Danish health care system.

Denmark has unique opportunities for quality measurement and benchmarking since Denmark has well-developed health registries and unique patient identifier that allow all registries to include patient-level data and combine data into sophisticated quality performance monitoring. Over decades, Denmark has developed and implemented national quality and patient safety initiatives in the healthcare system in terms of national clinical guidelines, performance and outcome measurement integrated in clinical databases for important diseases and clinical conditions, measurement of patient experiences, reporting of adverse events, national handling of patient complaints, national accreditation and public disclosure of all data on the quality of care. Over the years, Denmark has worked up a progressive and transparent just culture in quality management; the different actors at the different levels of the healthcare system are mutually attentive and responsive in a coordinated effort for quality of the healthcare services. At national, regional, local and hospital level, it is mandatory to participate in the quality initiatives and to use data and results for quality management, quality improvement, transparency in health care and accountability. To further develop the Danish governance model, it is important to expand the model to the primary care sector. Furthermore, a national quality health programme 2015-18 recently launched by the government supports a new development in health care focusing upon delivering high-quality health care-high quality is defined by results of value to the patients.

Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers.

For health care systems in recent years, patient safety has increasingly become a priority issue. National and international strategies have been considered to attempt to overcome the most prominent hazards while patients are receiving health care. Thereby, clinical risk management (CRM) plays a dominant role in enabling the identification, analysis, and management of potential risks. CRM implementation into routine procedures within complex hospital organizations is challenging, as in the past, organizational change strategies using a top-down approach have often failed. Therefore, one of our main objectives was to educate a certain number of risk managers in facilitating CRM using a bottom-up approach. To achieve our primary purpose, five project strands were developed, and consequently followed, introducing CRM: corporate governance, risk management (RM) training, CRM process, information, and involvement. The core part of the CRM process involved the education of risk managers within each organizational unit. To account for the size of the existing organization, we assumed that a minimum of 1 % of the workforce had to be trained in RM to disseminate the continuous improvement of quality and safety. Following a roll-out plan, CRM was introduced in each unit and potential risks were identified. Alongside the changes in the corporate governance, a hospital-wide CRM process was introduced resulting in 158 trained risk managers correlating to 2.0 % of the total workforce. Currently, risk managers are present in every unit and have identified 360 operational risks. Among those, 176 risks were scored as strategic and clustered together into top risks. Effective meeting structures and opportunities to share information and knowledge were introduced. Thus far, 31 units have been externally audited in CRM. The CRM approach is unique with respect to its dimension; members of all health care professions were trained to be able to identify potential risks. A network of risk managers supported the centrally coordinated CRM process. There is a strong commitment among management, academia, clinicians, and administration to foster cooperation. The introduction of CRM led to a visible shift with regard to patient safety culture throughout the entire organization. Still, there is a long way to go to keep people engaged in CRM and work on national and international patient safety initiatives to continuously decrease potential hazards.

Integrating National Patient Safety Initiatives Into Prelicensure Clinical Learning

Integrating National Patient Safety Initiatives Into Prelicensure Clinical Learning

Empowering certified nurse's aides to improve quality of work life through a team communication program

The purpose of this pilot study was to explore the impact of a certified nurse's aide (CNA)-led interdisciplinary teamwork and communication intervention on perceived quality of work environment and six-month job intentions. CNAs are frequently excluded from team communication and decision-making, which often leads to job dissatisfaction with high levels of staff turnover. Using a mixed quantitative and qualitative approach with pre- post-program design, the intervention utilized the strategy of debriefing from the national patient safety initiative, TeamSTEPPS. Inherent in the program design, entitled Long Term Care (LTC) Team Talk, was the involvement of the CNAs in the development of the intervention as an empowering process on two wings of a transitional care unit in a long-term care facility in upstate NY. CNAs' perceptions of work environment quality were measured using a Quality of Work Life (QWL) instrument. Additionally, job turnover intent within six months was assessed. Results indicated improved scores on nearly all QWL subscales anticipated to be impacted, and enhanced perceived empowerment of the CNAs on each wing albeit through somewhat different experiential processes. The program is highly portable and can potentially be implemented in a variety of long-term care settings.

Challenges to and the future of medication safety in Saudi Arabia: A qualitative study

BackgroundMedication safety is a global concern among healthcare providers. However, the challenges to and the future of medication safety in Saudi Arabia have not been explored. ObjectivesWe explored the perspectives of healthcare practitioners on current issues about medication safety in hospitals and community settings in Saudi Arabia in order to identify challenges to improving it and explore the future of medication safety practice. MethodsA total of 65 physicians, pharmacists, academics and nurses attended a one-day meeting in March 2010, designed especially for the purpose of this study. The participants were divided into nine round-table discussion sessions. Three major themes were explored in these sessions, including: major factors contributing to medication safety problems, challenges to improving medication safety practice, and participants’ suggestions for improving medication safety. The round-table discussion sessions were videotaped and transcribed verbatim and analyzed by two independent researchers. ResultsThe round-table discussions revealed that major factors contributing to medication safety problems included unrestricted public access to medications from various hospitals and community pharmacies, communication gaps between healthcare institutions, limited use of important technologies such as computerized provider order entry, and the lack of medication safety programs in hospitals. Challenges to current medication safety practice identified by participants included underreporting of medication errors and adverse drug reactions, multilingualism and differing backgrounds of healthcare professionals, lack of communication between healthcare providers and patients, and high workloads. Suggestions for improving medication safety practices in Saudi Arabia included continuous education for healthcare professionals and competency assessment focusing on medication safety, development of a culture that encourages medication error and adverse drug reactions reporting, use of technology proven to decrease medication errors, and promotion and implementation of national patient safety initiatives. ConclusionsHealthcare professionals have identified major challenges and opportunities for medication safety in Saudi Arabia. Policy makers and practitioners should consider these factors when designing future programs aimed at improving the safe use of medications.

Back to School: TIGER and the VLE. Why Faculty Need to Access This Site

world of health care is becoming more dependent on health information technology (HIT) tools. Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 was designed to promote and expand the adoption of health information technologies. One component focused on ensuring that all health care entities adopt interoperable electronic health care records (EHRs), and criteria were established to ensure that all health care providers would become meaningful users of EHRs and other HIT tools. These meaningful use criteria are tied to national patient safety and quality initiatives and progress across three stages. At each stage, the hospital, clinic, or private physician office must demonstrate how criteria were met by generating and sending reports, exchanging data electronically, or by attestation. With each stage, additional criteria are required to maximize the use of EHRs for the provision of efficient, effective, safe, and quality care. criteria also focus on the engagement of patients and consumers in their health care. As meaningful use progresses through each stage, the goal is for more patients to have the ability to access and read their EHRs while also adding data they generate, such as daily glucose readings. In tandem with federal initiatives, the competencies expected for nursing students at all levels now include information management and informatics outcomes. QSEN initiative (Cronenwett, Sherwood, & Gelmon, 2009), the American Association of Colleges of Nursing Essentials (2008), and the National League for Nursing's outcomes and competencies framework (2010) emphasize the importance of the integration of informatics competencies. But do we have a cadre of nurse faculty who are knowledgeable about informatics who can begin to integrate content into the nursing curriculum to meet these outcome competencies? My sense, from talking with faculty across the United States, is that many schools of nursing are struggling. Many do not have resources to help faculty integrate informatics into the curriculum. In my view, informatics must be woven into the curriculum. Having a separate course will not foster the concept of informatics as an integral and essential component of the health care system and the entire health care experience. What options do schools of nursing have? One new option is now available from the TIGER (Technology Informatics Guiding Educational Reform) initiative. As many of you know, TIGER was a grassroots movement started in 2004 when the secretary of health and human services established the Office of the National Coordinator for Health Information Technology. first phase of TIGER culminated in an invitational summit in which leaders from specialty organizations came together to chart a short- and long-term vision of how we would prepare nurses to work in a consumer-centric information-technology-intensive health care environment. second phase focused on creating action plans. third phase of TIGER saw the creation of the TIGER Virtual Learning Environment (VLE), a web-based learning platform designed by an interprofessional health care team to provide access to knowledge about informatics and allow for interactions with the informatics community. As noted on the VLE webpage, The internet-based format provides convenience, flexibility, dynamic content and real-time accessibility to relevant information through webinars by industry experts, in-depth education sessions, demonstrations, smart rooms, simulations, white papers, and other communications. target audience is clinicians working in health care, faculty and students, administrators, and any health care professional who wants to learn and develop knowledge, skills, and awareness of technology and informatics. By increasing one's knowledge of HIT and informatics, a clinician can contribute to creating a safer, more effective, efficient, timely, patient-centered, and equitable health care system. …

Residual anaesthesia drugs – silent threat, visible solutions

We read Bowman et al.'s editorial 1 regarding retention of anaesthetic drugs in intravenous lines with great interest and commend the standards of care proposed. We have taken an interest in this topic ourselves due to a recent incident. A patient in our hospital underwent rapid sequence induction using an indwelling intravenous cannula sited on the ward and after induction, a new cannula was inserted for use during surgery. Several hours later, the original cannula and connector (total dead space 0.7 ml) was flushed before antibiotic administration on a surgical ward. The patient experienced a rapid loss of motor function, leading to respiratory arrest, presumably from accidental administration of retained suxamethonium. After approximately five minutes of bag-valve-mask ventilation, the patient recovered neuromuscular function and reported explicit awareness of events with no physical sequelae. Clinical psychology interviews were conducted and the patient's overriding concern was that measures be taken within our hospital to prevent a recurrence. In our review of this incident we have become aware of the need not only to flush all intravenous cannulae but also to remove any unnecessary cannulae after anaesthesia. This reduces the risk of both administration of retained drugs and cannula-associated infections. Before instigating a safety campaign, we conducted a local survey of practice using visible propofol as a surrogate for an unflushed cannula or connector. This was seen in 32% of cases. In 26% of cases, unnecessary connectors or cannulae remained in place after anaesthesia. Flushing of cannulae was not documented in the anaesthetic record or drug chart of any patient. We have addressed the problem with a local protocol, post-anaesthesia handover documentation and regular repeat audit. A range of safety posters – designed to be intentionally eye-catching – have been placed in areas where anaesthesia is administered or where anaesthetists gather (Fig. 1). These have been found to be particularly effective in maintaining awareness amongst anaesthetists and theatre staff. A subsequent re-survey has demonstrated that only 1.6% of patients had visible propofol in a cannula, no total intravenous anaesthesia connectors were left attached to lines and both written documentation and verbal handover to recovery staff have increased by 36%. Recovery nurses now routinely remove any unused cannulae. As described in Bowman et al.'s article, it is well recognised that the occurrence of critical incidents in general 2, and anaesthesia specifically, is underestimated due to under-reporting and misclassification 3. The danger posed by retained anaesthetic drugs in cannulae has long been recognised as a problem 4. Given this, and the potentially devastating sequelae, it would seem imprudent to view this issue as rare and not take firm action as an anaesthetic community. Analogous to the ‘Stop Before You Block’ campaign regarding wrong-site nerve blockade 5, the development of a highly visible national patient safety initiative to help prevent the accidental administration of anaesthetic drugs would improve patient safety.

Medication Discrepancies at Transitions in Pediatrics: A Review of the Literature

Medication reconciliation is an important process in reducing medication errors in many countries. Canada, the USA, and UK have incorporated medication reconciliation as a priority area for national patient safety initiatives and goals. The UK national guidance excludes the pediatric population. The aim of this review was to explore the occurrence of medication discrepancies in the pediatric population. The primary objective was to identify studies reporting the rate and clinical significance of the discrepancies and the secondary objective was to ascertain whether any specific interventions have been used for medication reconciliation in pediatric settings. The following electronic bibliographic databases were used to identify studies: PubMed, OVID EMBASE (1980 to 2012 week 1), ISI Web of Science, ISI Biosis, Cumulative Index to Nursing and Allied Health Literature, and OVID International Pharmaceutical Abstracts (1970 to January 2012). Primary studies were identified that observed medication discrepancies in children under 18years of age upon hospital admission, transfer and discharge, or had reported medication reconciliation interventions. Two independent reviewers screened titles and abstracts for relevant articles and extracted data using pre-defined data fields, including risk of bias assessment. Ten studies were identified with variances in reportage of stage and rate of discrepancies. Studies were heterogeneous in definitions, methods, and patient populations. Most studies related to admissions and reported consistently high rates of discrepancies ranging from 22 to 72.3% of patients (sample size ranging from 23 to 272). Seven of the studies were low-quality observational studies and three studies were 'grey literature' non-peer reviewed conference abstracts. Studies involving small numbers of patients have shown that medication discrepancies occur at all transitions of care in children. Further research is required to investigate and demonstrate how implementing medication reconciliation can reduce discrepancies and potential patient harm.

Danish hospital pharmacy: both a local matter and a national issue through close cooperation between the 10 hospital pharmacies and Amgros

In Denmark, the Ministry of Health is responsible for legislation on health care, including legislation on health provisions, personnel, hospitals and pharmacies. The Ministry also sets up overall guidelines and...

Reduction of Surgical Site Infections after Implementation of a Bundle of Care

BackgroundSurgical Site Infections (SSI) are relatively frequent complications after colorectal surgery and are associated with substantial morbidity and mortality.ObjectiveImplementing a bundle of care and measuring the effects on the SSI rate.DesignProspective quasi experimental cohort study.MethodsA prospective surveillance for SSI after colorectal surgery was performed in the Amphia Hospital, Breda, from January 1, 2008 until January 1, 2012. As part of a National patient safety initiative, a bundle of care consisting of 4 elements covering the surgical process was introduced in 2009. The elements of the bundle were perioperative antibiotic prophylaxis, hair removal before surgery, perioperative normothermia and discipline in the operating room. Bundle compliance was measured every 3 months in a random sample of surgical procedures.ResultsBundle compliance improved significantly from an average of 10% in 2009 to 60% in 2011. 1537 colorectal procedures were performed during the study period and 300 SSI (19.5%) occurred. SSI were associated with a prolonged length of stay (mean additional length of stay 18 days) and a significantly higher 6 months mortality (Adjusted OR: 2.71, 95% confidence interval 1.76–4.18). Logistic regression showed a significant decrease of the SSI rate that paralleled the introduction of the bundle. The adjusted Odds ratio of the SSI rate was 36% lower in 2011 compared to 2008.ConclusionThe implementation of the bundle was associated with improved compliance over time and a 36% reduction of the SSI rate after adjustment for confounders. This makes the bundle an important tool to improve patient safety.

“SCIP”ping antibiotic prophylaxis guidelines in trauma

The Surgical Care Improvement Project (SCIP) established surgical antibiotic prophylaxis guidelines as part of a national patient safety initiative aimed at reducing surgical complications such as surgical site infection (SSI). Although these antibiotic prophylaxis guidelines have become well established in surgical patients, they remain largely unstudied in patients with injury from trauma undergoing operative procedures. We sought to determine the role of these antibiotic prophylaxis guidelines in preventing SSI in patients undergoing trauma laparotomy. A retrospective review of all patients who underwent emergency trauma laparotomy at two Level I trauma centers (2007-2008) revealed 306 patients who survived more than 4 days after injury. Demographics and clinical risk SSI factors were analyzed, and patients were compared on the basis of adherence to the following SCIP guidelines: (1) prophylactic antibiotic given, (2) antibiotic received within 1 hour before incision, (3) correct antibiotic selection, and (4) discontinuation of antibiotic within 24 hours after surgery. The primary study end point was the development of SSI. The study sample varied by age (mean [SD], 32 [16] years) and injury mechanism (gunshot wound 44%, stab wound 27%, blunt trauma 30%). When patients with perioperative antibiotic management complying with the four SCIP antibiotic guidelines (n = 151) were compared with those who did not comply (n = 155), no difference between age, shock, small bowel or colon resection, damage control procedures, and skin closure was detected (p > 0.05). After controlling for injury severity score, hypotension, blood transfusion, enteric injury, operative duration, and other potential confounding variables in a multivariate analysis, complete adherence to these four SCIP antibiotic guidelines independently decreased the risk of SSI (odds ratio, 0.43; 95% confidence interval, 0.20-0.94; p = 0.035). Patients adhering to these guidelines less often developed SSI (17% vs. 33%, p = 0.001) and had shorter overall hospital duration of antibiotics (4 [6] vs. 9 [11] days, p < 0.001) and hospital length of stay (14 [13] vs. 19 [23] days, p = 0.016), although no difference in mortality was detected (p > 0.05). Our results suggest that SCIP antibiotic prophylaxis guidelines effectively reduce the risk of SSI in patients undergoing trauma laparotomy. Despite the emergent nature of operative procedures for trauma, efforts to adhere to these antibiotic guidelines should be maintained.

National patient safety initiatives: Moving beyond what is necessary

Ilan and Donchin have compared Israel and Canada's experiences in setting a national patient safety agenda. We broaden this comparison to include the U.S. experience, and suggest that there are three additional key steps which will be important in any national patient safety agenda, and which Israel in particular should consider. These are 1) using health information technology (HIT) to directly improve patient safety, 2) dissemination and broad use of checklists, and 3) measuring patient safety over time at the national level. Especially because of its already substantial commitment to HIT and well-developed HIT sector, Israel has a major opportunity to move forward rapidly in this area and to achieve broad impact on the safety front.This is a commentary on http://www.ijhpr.org/content/1/1/19/

Temporal Trends in Incidence of Hip Fractures in VA Community Living Centers (CLCs)

Introduction/Objective: We wanted to determine whether VA national patient safety initiatives (National Falls Toolkit and Hip Protector Toolkit Implementation) have impacted the incidence of hip fractures in VA community living centers (CLC) (aka nursing homes).

Utilizing quality improvement methods to prevent falls and injury from falls: Enhancing resident safety in long-term care

Introduction Internationally, the growing evidence related to preventable adverse events within healthcare settings has resulted in the creation of numerous patient safety and quality improvement initiatives. In Canada, Safer Healthcare Now!, a national patient safety initiative of the Canadian Patient Safety Institute, and the Registered Nurses’ Association of Ontario, the professional association representing registered nurses in Ontario, have partnered to combine quality improvement expertise with evidence-based practice expertise to accelerate improvement in the area of falls prevention and injury reduction. The synergistic relationship between Safer Healthcare Now! and the Registered Nurses’ Association of Ontario has resulted in the evolution of the Safer Healthcare Now! national Falls Prevention intervention. The ultimate goal of the Falls Prevention intervention is to improve care by translating “what we know” into “what we do,” by supporting quality improvement teams to make changes at the local level to enhance the patient experience. Method This article provides an overview of Safer Healthcare Now! as a national patient safety initiative, and highlights the results of a National Collaborative on Falls Prevention as a knowledge translation strategy utilized within the long-term care setting. A description of expanding supports for knowledge translation will also be provided.

How event reporting by US hospitals has changed from 2005 to 2009

ContextInformation is needed on the performance of hospitals' adverse-event reporting systems and the effects of national patient-safety initiatives, including the Patient Safety and Quality Improvement Act (PSQIA) of 2005. Results...

Perioperative Venous Thromboembolism and Antibiotic Prophylaxis in Obstetrics and Gynecology

Venous thromboembolism (VTE) and surgical site infection are common and potentially preventable postoperative complications. National patient safety and healthcare quality initiatives target perioperative VTE and infection as opportunities to improve patient care and reduce healthcare costs. Women undergoing gynecologic surgery and cesarean delivery are at risk for these complications. There is sufficient evidence to recommend that VTE and antibiotic prophylaxis be given to women undergoing certain major gynecologic surgery or cesarean delivery. Because there are always emerging issues as new studies become available, physicians should anticipate periodic changes to the guidelines. Adherence to the available practice guidelines and awareness of relevant performance measures will further efforts to reduce postoperative complications.