Patient Safety Activities Research Articles

Keterlibatan Pasien dalam Aktivitas Meningkatkan Patient Safety

This review aims to examine patient engagement in care activities to improve patient safety. The research method uses an integrative literature review. A systematic search was carried out in the databases PubMed, ProQuest, Science Direct, Medline, Cochrane Library and Winley Online Library. The keywords used in the search are: (Patient participation OR Patient involvement OR Patient engagement) AND (Health care OR Care) AND (Patient safety). Articles must come from international databases, be published within the last 5 years and focus on patient engagement, care and patient safety with full text. Articles will be excluded if they do not focus on objectives, are more than 5 years old and if they have been reviewed. As a result of research, nine articles identified in this review that the patient's role in care can improve patient safety and the nurse's role in encouraging patients to participate in care can contribute to improving patient safety. In conclusion, patient involvement in patient safety activities can improve the safety of patients in hospitals.
 
 Keywords: Patient Safety, Patient Involvement, Care

Evaluating the utility and challenges associated with "anonymous" patients in the electronic medical record

Abstract Electronic medical records (EMRs) allow for the creation of "test" patients that can be used for training new users, testing changes before they go "live", simulating the placement of orders, or for a range of similar applications. Test patients are commonly utilized in EMR validation, support, or “playground” environments that might use a copy of the production EMR database but do not connect to the official medical record to prevent billing errors or patient harm. However, there are a variety of cases where it is useful to have test or anonymous patients within the EMR production environment as well. One example of this is infectious disease testing for employee blood-borne pathogen exposure (e.g., needlestick injury) that may need to be stored in a de-identified or restricted manner to comply with workplace privacy regulations. There are also instances, generally in emergency situations, where a medical record is created for a patient about whom little identifying information is known. In this example, these so-called "anonymous" patients are assigned random or arbitrarily pre-determined birthdates (e.g., 1/1/1900) and on occasion have no sex assigned in their chart. This poses a variety of challenges from a laboratory standpoint as it can be difficult to provide accurate normal ranges for laboratory results that are age and/or gender specific. Additionally, this has on occasion resulted in an inability to identify appropriate blood products as these recommendations are similarly based on age and gender. Another layer of complexity comes as additional information regarding the patient is made available, and health care information services merges data from a previously anonymous account to a specific patient record. Such mergers can result in cancellation of pending orders, errors in reporting laboratory results, or other complications depending on the specific process utilized. Surprisingly, there is little to no literature regarding the use cases for these “test” and “anonymous” patients or the challenges associated with their existence in the EMR. To explore this topic, we identified three classes of patients in our institutional EMR: true virtual “test” patients, “anonymous” patients that were subsequently identified, and “anonymous” patients that were never identified. Basic characteristics of these patients (sex and date of birth) and available laboratory results were compiled. Along with this, we present a series of instructional cases adapted from actual patient safety events at our institution involving anonymous patient records. These illustrative cases highlight the utility of these “test” and “anonymous” patients, as well as the challenges these pose on an institutional and individual level. Lastly, we provide recommendations on how best to manage similar scenarios that may arise.

Nursing students' handling patient safety incidents during clinical practice: A retrospective qualitative study

BackgroundNursing students may encounter patient safety incidents during clinical practice. Understanding the challenges and concerns of nursing students in handling with patient safety incident could contribute to informing nursing education and clinical practice training. ObjectivesThe aim of this study was to investigate how nursing students handle patient safety incidents during clinical practice. DesignA retrospective descriptive qualitative study. SettingNursing school in Slovenia. ParticipantsA snowball sampling technique was used to recruit nursing students (n = 15). MethodsData were collected via guided self-reflection diaries in 2021. Collected data were analysed using thematic analysis. ResultsWe have generated the main theme of nursing students' handling patient safety incidents during clinical practice. The four primary thematic subthemes were: (1) emotional responses; (2) patient safety incident occurrence and actions taken; (3) contributing factors; and (4) consequences. ConclusionsOur study highlights nursing students' handling of patient safety incidents during clinical practice, revealing a spectrum of emotional responses, immediate actions, contributing factors, consequences, and the importance of fostering a non-blaming culture through reporting and effective communication.

GAMBARAN BUDAYA KESELAMATAN PASIEN PADA PERAWAT DI RUMAH SAKIT X. BEKASI TAHUN 2022

The implementation of a culture of patient safety is crucial in hospitals so that patients do not experience unwanted or unexpected hazards during hospitalization. Hospital X. Bekasi has a quality unit, but incident reporting at Hospital X. Bekasi is not going well. This illustrates the implementation of a patient safety culture that is not running well. This study aims to look at the culture of patient safety among nurses in RSX. The year 2022 is seen in the 12 dimensions of the culture of patient safety, according to the Association for Health Care and Research Quality (AHRQ). This research uses a cross-sectional design. The population in this study is the nurse who directly serves the patient. A large sample in this study of 90 nurses was taken with total sampling techniques. The instrument used in this study is the Hospital Survey on Patient Safety Culture (HSOPSC), which has 12 dimensions. The results showed average positive responses from 12 dimensions of patient safety culture (62.5%), Higher Expectations and Action in Promoting Patient Safety (53.3%), Learning for Organizational Continuous Improvement (64.8%), Unit Collaboration (57.5%), Open Communication (61.1), Feedback and Communication on Errors (63.2%), Non-Positive Response (79.6%), Staffing (69.4%), Management Support Dimension for Patient Security (92.2%), Inter-Units Cooperation (64.4%), Overall Perception of Patients Safety (50.2%), Incident Reporting Frequency (50.7%) and Incident Reports Frequencies (50.7%). Hospital X. Bekasi is expected to continue and maintain patient safety programs, evaluate the number of existing staff, improve incident reporting motivation, and conduct comprehensive and periodic patient safety culture measurements.

Developing surgical and anesthesia resident patient safety competencies through systems-based event analysis. Guide to curricular development and evaluation of longer-term resident perceptions

Previous studies have demonstrated that residents participating in patient safety event investigations become more engaged in future patient safety activities. Currently, there is a gap in resident participation in patient safety event analyses. The objective was to develop and implement a sustainable, faculty-led curriculum for resident participation in patient safety event investigations and to evaluate resident perceptions of the training at least one year following completion of the training. One hundred sixty-five residents from three specialties participated in a formal RCA2 training curriculum from 2013 to 2019. In November 2019, the same residents were asked to complete a survey which examined their perception of the training including the tools and techniques such as event mapping, cause-and-effect diagramming, and developing action plans for solving problems and unsafe conditions. The survey response rate was 36 % (60/165). Sixty-three percent (38/60) of the residents responding to the survey believed that RCA2 training should be provided to all residents. Former residents rated the RCA2 training tools and skills favorably, 3.6 median score (3.5–3.7, 95 % C.I.). Forty-eight percent of responding residents (29/60) believed that the previous RCA2 training improved the way they identify and solve problems. The curriculum and faculty development program provides an effective intervention to address the current, identified gaps in patient safety in graduate medical education.

A systematic narrative review of coroners’ Prevention of Future Deaths reports (PFDs): A tool for patient safety in hospitals

Patient harm due to unsafe healthcare is widespread, potentially devastating, and often preventable. Hoping to eliminate avoidable harms, the World Health Organization (WHO) published the Global Patient Safety Action Plan in July 2021. The UK's National Health Service relies on several measures, including ‘never events’, ‘serious incidents’, ‘patient safety events’ and coroners’ Prevention of Future Deaths reports (PFDs) to monitor healthcare quality and safety. We conducted a systematic narrative review of PubMed and medRxiv on 19 February 2023 to explore the strengths and limitations of coroners’ PFDs and whether they could be a safety tool to help meet the WHO's Global Patient Safety Action Plan. We identified 17 studies that investigated a range of PFDs, including preventable deaths involving medicines and an assessment during the COVID-19 pandemic. We found that PFDs offered important information that could support hospitals to improve patient safety and prevent deaths. However, inconsistent reporting, low response rates to PFDs, and difficulty in accessing, analysing and monitoring PFDs limited their use and adoption as a patient safety tool for hospitals. To fulfil the potential of PFDs, a national system is required that develops guidelines, sanctions failed responses and embeds technology to encourage the prevention of future deaths.

The Effect of Patient Safety Experience on Patient Satisfaction of Patients Using Outpatient Health Services in Hospitals/Clinics

Objectives: The aim of this study is to identify outpatients’ experiences of patient safety, patient satisfaction levels, and examine the factors influencing on patients’ satisfaction. Methods: Data from the Survey on the Experience with Healthcare Service in 2021 were used for this secondary analysis. Data from 6,027 patients aged over 20 who experienced outpatient health services in hospitals or clinics were analyzed. Logistic regression analysis was carried out to explore as influential factors which are patient characteristics, health-related characteristics, and their experiences of patient safety. Results: Generally, the level of patient satisfaction was high as 90.6% of participants were satisfied with the received outpatient care. High patient satisfaction was related to gender (females), job (housewives), education level (below secondary education level) and perceived health status (good status). Besides, those who experience being educated the side effects related to the medications or no checking the safety facilities of medical institutions were more likely to satisfy with the outpatient care. Conclusions: It is revealed that demographic and health-related characteristics, and patient safety experiences affected patients’ satisfaction with outpatient health services. To improve overall patients’ satisfaction with outpatient care, it is needed to enhance nonclinical patient safety activities such as explaining medication related side effects for patients.

The Effect of Professional Autonomy and Nursing Work Environment on Nurses’ Patient Safety Activities: A Perspective on Magnet Hospitals

Aim. This study aimed to identify the effects of nurses’ professional autonomy and work environment on patient safety in general hospitals. By understanding this relationship, we sought to identify practical measures to improve patient safety in the healthcare context. Background. Professional autonomy and nursing work environments have positive effects on job performance, job satisfaction, and patient outcomes. Methods. Data were collected from 200 nurses working in general hospitals, using a cross-sectional survey design. The survey was conducted in 2021 using self-report questionnaires that included the Nursing Work Environment Scale and items on professional autonomy and patient safety activities. Results. The total professional autonomy score was 162.06 (range: 60–240). The mean scores of nursing work environment and nurses’ patient safety activities were 2.55 out of 4 and 4.22 out of 5, respectively. Multiple regression analysis revealed that professional autonomy (β = 0.234 and p = 0.001 ) and nursing work environment (β = 0.138 and p < 0.05 ) were identified as variables that had significant effects on patient safety activities. Among the independent variables, professional autonomy had the greatest influence on patient safety. Conclusion. The findings confirm the need to improve and find ways to enhance nurses’ professional autonomy and nursing work environment. Implications for Nursing Management. The findings confirm the need to improve and find ways to enhance nurses’ professional autonomy and the nursing work environment. Based on these findings, medical institutions and nursing managers should continue to make efforts to improve the nursing work environment to enhance patient safety, especially system improvements, expand nurse autonomy within medical institutions, strengthen hospital management support to evaluate its effectiveness, and further improve government-level policies and systems.

Psychometric Validation of the Korean Version of the Family-Centered Care Questionnaire-Revised.

Background and Purpose: Family-centered care (FCC) is a philosophy of care that applies to all areas of pediatric nursing and is a key component of the care model for patient safety and management activities in the medical environment of hospitalized children. The aim of this study was to translate and evaluate the psychometric properties of the Korean version of the Family-Centered Care Questionnaire-Revised (FCCQ-R). Methods: A total of 239 questionnaires were completed by pediatric nurses at 4 consenting general hospitals. Results: Fourteen items were removed from the original questionnaire through exploratory factor analysis and nine subscales were reduced to five. The factor loadings of the 30 items on the 5 subscales ranged from 0.50-0.80. The model of the Korean version of the questionnaire was validated by an exploratory and confirmatory factor analysis. Reliability analysis for internal consistency showed an acceptable to high Cronbach's α of 0.96 in total and the subscales ranged from 0.59-0.92. Conclusions: This study verified the validity and reliability of the tool to measure the perception of FCC. Future research will need to correlate FCC with more relevant measures, such as the nurse-parent partnership measure tool, to confirm predictive and concurrent validity. The Korean version of the FCCQ-R of 30 questions on 5 subscales is a valid and reliable measurement of Korean nurses' perceptions of FCC.

A realist synthesis of interprofessional patient safety activities and healthcare student attitudes towards patient safety

ABSTRACT Interprofessional education (IPE) has been used for instilling a positive safety culture within healthcare, yet what interventions work to change healthcare student attitudes and how improved patient safety outcomes are best achieved with this intervention, is unclear and challenging to evaluate. A realist synthesis was undertaken to ascertain how, why, and in what circumstances IPE activities result in a positive change to student attitudes to patient safety. Database searches of CINAHL, MEDLINE, Scopus, and Eric were undertaken in April 2022 to identify relevant studies. Synthesis with a realist framework of analysis, coupled with the development of a program theory was conducted to identify interactions among contexts, intervention, mechanisms, and outcomes (CIMO). Twenty-three articles eligible for inclusion articulated environments in which varied contexts, interventions, and mechanisms were activated to influence student attitudes to patient safety. Findings from this realist synthesis informs awareness into the methods of delivering and evaluating IPE activities and offers new perspectives for educators in planning and evaluating future IPE from a collaborative and positive safety culture perspective.

Evaluation of health care professionals' knowledge, attitudes, practices and barriers to pharmacovigilance and adverse drug reaction reporting: A cross-sectional multicentral study.

Healthcare professionals' involvement and reporting of adverse drug reactions are essential for the success of a pharmacovigilance program. The aim of this study was to assess healthcare professionals (medical doctors, pharmacists, nurses, dentists, midwives, and paramedics) current knowledge, attitude, practices, and barriers regarding pharmacovigilance and adverse drug reactions reporting in multicentral healthcare settings. A cross-sectional face-to-face survey was conducted among currently working healthcare professionals in various hospitals in ten districts of Adana province, Türkiye from March to October 2022. A self-administered, pretested questionnaire (Cronbach's alpha = 0.894 for knowledge, attitudes and practices variables) was used for data collection. The questionnaire's final draft included five sections (sociodemographic/general information, knowledge, attitude, practices, and barriers) with 58 questions. The collected data was analyzed in SPSS (version 25) using descriptive statistics, the chi-square test, and logistic regression. Of the total 435 distributed questionnaires, 412 completed the entire questionnaire, yielding a 94% response rate. The majority of healthcare professionals (60.4%; n = 249) had never received pharmacovigilance training. Among healthcare professionals 51.9% (n = 214), 71.1% (n = 293) and 92.5% (n = 381) had poor knowledge, positive attitudes and poor practices, respectively. Only 32.5% of healthcare professionals kept the record of an adverse drug reaction and only 13.1% reported adverse drug reactions. The profession (medical doctors, pharmacists, nurses, dentists, midwives, and paramedics) of healthcare professionals and a lack of training were predictors of poor adverse drug reaction reporting (p < 0.05). A statistically significant difference in healthcare professionals and knowledge, attitude and practices scores was also observed (p < 0.05). The main barriers which were supposed to discourage adverse drug reactions reporting by the healthcare professionals were higher workload (63.8%) followed by thinking that a single adverse drug reaction report makes no impact (63.6%) and lack of a professional atmosphere (51.9%). In the current study, most healthcare professionals had poor knowledge and practice, but they had a positive attitude toward pharmacovigilance and adverse drug reactions reporting. Barriers to under-reporting of adverse drug reactions were also highlighted. Periodic training programs, educational interventions, systematic follow-up of healthcare professionals by local healthcare authorities, interprofessional links between all healthcare professionals, and the implementation of mandatory reporting policies are critical for improving healthcare professionals knowledge, practices, patient safety and pharmacovigilance activities.

Analysis of Reported Suicide Safety Events Among Veterans Who Received Treatment Through Department of Veterans Affairs-Contracted Community Care.

Veteran patients have access to a broad range of health care services in the Veterans' Health Administration (VHA). There are concerns, however, that all Veteran patients may not have access to timely care. The Maintaining Internal Systems and Strengthening Integrated Outside Networks Act was passed in 2018 to ensure that eligible Veterans can receive timely, high-quality care. The Maintaining Internal Systems and Strengthening Integrated Outside Networks Act makes use of Department of Veterans Affairs (VA)-contracted care to achieve its goal. There are concerns, however, that these transitions of care may, in fact, place Veterans at a higher risk of poor health outcomes. This is a particular concern with regard to suicide prevention. No study has investigated suicide-related safety events in Veteran patients who receive care in VA-contracted community care settings. A retrospective analysis of root-cause analysis (RCA) reports and patient safety reports of suicide-related safety events that involved VA-contracted community care was conducted. Events that were reported to the VHA National Center for Patient Safety between January 1, 2018, and June 30, 2022, were included. A coding book was developed to abstract relevant variables from each report, for example, report type and facility and patient characteristics. Root causes reported in RCAs were also coded, and the factors that contributed to the events were described in the patient safety reports. Two reviewers independently coded 10 cases, and we then calculated a kappa. Because the kappa was greater than 80% (i.e. 89.2%), one reviewer coded the remaining cases. Among 139 potentially eligible reports, 88 reports were identified that met the study inclusion criteria. Of these 88 reports, 62.5% were patient safety reports and 37.5% were RCA reports. There were 129 root causes of suicide-related safety events involving VA-contracted community care. Most root causes were because of health care-related processes. Reports cited concerns around challenges with communication and deficiencies in mental health treatment. A few reports also described concerns that community care providers were not available to engage in patient safety activities. Patient safety reports voiced similar concerns but also pointed to specific issues with the safety of the environment, for example, access to methods of strangulation in community care treatment settings in an emergency room or a rehabilitation unit. It is important to strengthen the systems of care across VHA- and VA-contracted community care settings to reduce the risk of suicide in Veteran patients. This includes developing standardized methods to improve the safety of the clinical environment as well as implementing robust methods to facilitate communication between VHA and community care providers. In addition, Veteran patients may benefit from quality and safety activities that capitalize on the collective knowledge of VHA- and VA-contracted community care organizations.

Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation

BackgroundThe World Health Organization’s Global Patient Safety Action Plan 2021–2030 call for attention to patient and family involvement to reduce preventable patient harm. Existing evidence indicates that patients’ involvement in their own safety has positive effects on reducing hospitalisation time and readmissions. One intervention reported in the literature is the use of checklists designed for patients’ completion. Studies on such checklists are small scale, but they are linked to reduction in length of hospital stay and readmissions. We have previously developed and validated a two-part surgical patient safety checklist (PASC). This study aims to investigate the feasibility of the PASC usage and implementation prior to its use in a large-scale clinical trial.MethodsThis is a prospective cross-sectional feasibility study, set up as part of the design of a larger stepped-wedge cluster randomised controlled trial (SW-CRCT). Descriptive statistics were used to investigate patient demographics, reasons for not completing the PASC and percentage of PASC item usage. Qualitative patient interviews were used to identify barriers and drivers for implementation. Interview was analysed through content analysis.ResultsOut of 428 recruited patients, 50.2% (215/428) used both parts of PASC. A total of 24.1% (103/428) of the patients did not use it at all due to surgical or COVID-19-related cancellations. A total of 19.9% (85/428) did not consent to participate, 5.1% (22/428) lost the checklist and 0.7% (3/428) of the patients died during the study. A total of 86.5% (186/215) patients used ≥ 80% of the checklist items. Barriers and drivers for PASC implementation were grouped into the following categories: Time frame for completing the checklist, patient safety checklist design, impetus to communicate with healthcare professionals and support throughout the surgical pathway.ConclusionsElective surgical patients were willing and able to use PASC. The study further revealed a set of barriers and drivers to the implementation. A large-scale definitive clinical-implementation hybrid trial is being launched to ascertain the clinical effectiveness and scalability of PASC in improving surgical patient safety.Trial registrationClinicaltrials.gov: NCT03105713. Registered 10.04.2017

Development and implementation of a centralized surveillance infection prevention program in a multi-facility health system: A quality improvement project.

To develop, implement, and evaluate the effectiveness of a unique centralized surveillance infection prevention (CSIP) program. Observational quality improvement project. An integrated academic healthcare system. The CSIP program comprises senior infection preventionists who are responsible for healthcare-associated infection (HAI) surveillance and reporting, allowing local infection preventionists (LIPs) a greater portion of their time to non-surveillance patient safety activities. Four CSIP team members accrued HAI responsibilities at 8 facilities. We evaluated the effectiveness of the CSIP program using 4 measures: recovery of LIP time, efficiency of surveillance activities by LIPs and CSIP staff, surveys characterizing LIP perception of their effectiveness in HAI reduction, and nursing leaders' perception of LIP effectiveness. The amount of time spent by LIP teams on HAI surveillance was highly variable, while CSIP time commitment and efficiency was steady. Post-CSIP implementation, 76.9% of LIPs agreed that they spend adequate time on inpatient units, compared to 15.4% pre-CSIP; LIPs also reported more time to allot to non-surveillance activities. Nursing leaders reported greater satisfaction with LIP involvement with HAI reduction practices. CSIP programs are a little-reported strategy to ease burden on LIPs with reallocation of HAI surveillance. The analyses presented here will aid health systems in anticipating the benefit of CSIP programs.

Patient Understanding of Patient Safety: Based on Results from Focus Group Discussion

Purpose: To examine the degree of recognition regarding the concept of patient safety, as perceived by the patient, using a focus group discussion.Methods: A focus group discussion was conducted with a patient group comprising seven patients.Results: When the participants heard the term “patient safety” they seemed to understand it to be related to the hospital environment or satisfaction with the overall hospitalization experience. The participants emphasized communication between the medical staff and the patients in relation to the explanation of treatments, as well as the provision of information regarding prevention, experience, and the treatment of incidents with patient safety. They agreed on the need for indicators reported by patients. However, they emphasized that additional items and a questionnaire method that considers the patients' point of view are needed.Conclusion: It is necessary to establish and implement various strategies that can raise the awareness of patient safety using patient safety indicators and increase participation in patient safety activities.

Nationales Gesundheitsziel Patientensicherheit

Improving patient safety is key to better health and nursing care. The Association for the Continuous Development of the National Health Target Process, health-targets.de (gesundheitsziele.de), has defined two focus areas, each with six goals, to jointly initiate significant progress in patient safety in Germany and achieve the health target of the same name. It is based on the "Global Patient Safety Action Plan 2021-2030" of the World Health Organization (WHO) and contributes to its implementation on anational level.The national health target addresses all players in healthcare and highlights the role of patients. Strengthening patient safety culture and expanding patient safety competence are at the center of the target process.For patient safety culture, asystemic approach is crucial. Individual-related factors as well as structural and process-oriented variables are looked at. Acooperation that focusses on the wellbeing of patients is essential.Patient safety competence spotlights knowledge on security related aspects in healthcare. At the same time, it focuses on the ability of all those involved to influence care in apositive way-thereby being open to the capabilities of patients.

Combination Relationship between Features of Person-Centered Care and Patient Safety Activities of Nurses Working in Small-Medium-Sized Hospitals: A Cross-Sectional Study.

Perceived safety culture and nursing work environment are considered important prerequisites for a patient safety activity. Patient safety is also associated with person-centered care; however, few studies apply the person-centered care framework which includes staff attributes and care environment. This study aimed to examine the canonical correlations of person-centered care factors, including professional self-concept, patient safety culture, nursing work environment, and patient safety activities of nurses working in small-medium-sized hospitals. A cross-sectional survey was used. Participants included 171 nurses from seven small-medium-sized hospitals in Busan metropolitan city, in Korea. Data were analyzed using descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's correlation coefficients, and canonical correlations. Two significant canonical variates were found. First, better professional self-concept, a positive patient safety culture, and better nursing work environment were associated with better patient safety care activities. Second, a negative patient safety culture and healthy nursing work environment were associated with a lack of communication between medical staff. Person-centered framework factors such as staff attributes and care environment were positively associated with patient safety activities. Based on the results, nurses in small-medium-sized hospitals should be highly aware of their professional self-concept. Moreover, nurses should be equipped with psychological safety and a healthy work environment to enhance patient safety activities.

Influencing Factors for the Patient Safety Activities of Nursing Assistants

Influencing Factors for the Patient Safety Activities of Nursing Assistants

Status of patient safety in selected Ghanaian hospitals: a national cross-sectional study

BackgroundSafety is one of the dimensions of healthcare quality and is core to achieving universal health coverage and healthcare delivery worldwide. In Ghana, the status of patient safety in the...

Introducing Patient Safety Activities in Canada: Focused on Medication Incidents and Preventions

Su-Jin Kim, MS, Jiyun Yang, BS, Sun-Young Jung, PhD, Jae Young Lim, PhD, Haejin Yoon, MS, Hyekyung Park, PhD and Mose Lee, PhD. Journal of Pharmacoepidemiology and Risk Management 2022;14:114-24. https://doi.org/10.56142/jperm.22.0011