Patient Safety Framework Research Articles

A nationwide mixed-methods study of gaps and barriers to implementation of antimicrobial stewardship programmes in hospitals in Indonesia

There is an urgent need to understand the implementation barriers of antimicrobial stewardship programs (ASP) in low- and middle-income countries. We conducted a mixed-methods study in public and private hospitals across all provinces in Indonesia (March-December 2023). We used a self-assessment questionnaire with a scoring system, and multilevel ordinal regression to assess associations with hospital and district-level characteristics. Focus group discussions (FGD) with hospital stakeholders examined barriers and enablers. We applied a patient safety framework to integrate results. 575 (19%) of 3026 hospitals completed the self-assessment, of whom 516 (89.7%) had a formal ASP (median 4 [IQR1-5] years), and 14 participated in FGD. The median overall ASP development score was 48.4% (35.9-62.5%), classifying 41 (8.0%) hospitals as inadequate (0-25%), 237 (45.9%) as basic (26-50%), 179 (34.7%) as intermediate (51-75%) and 59 (11.4%) as advanced (76-100%). Scores were highest for hospital leadership support (83.4% [66.7-100%]), followed by ASP team and infectious disease training (66.7% [55.6-77.8%]); education (50% [0.0-75.0%]); ASP interventions (43.8% [18.7-68.7%]); hospital infrastructure (42.9% [14.3-71.4%]); and monitoring, reporting and feedback (40.9% [27.3-54.5%]). A higher ASP development score was associated with higher hospital tiered level, longer ASP duration, and higher district-level public health development index and per capita domestic expenditure, but not with hospital ownership or geographic region. FGDs highlighted barriers related to hospital leadership support, staff technical and behavioral skills, cross-disciplinary collaboration, fear of loss of prescriber autonomy, microbiology and IT support, and hospital accreditation. Identified implementation barriers can inform actions for context-specific, sustainable improvement of ASPs.

Building a Learning Management Framework for Patient Safety: Lessons From a Large Multistate System

Background Embracing a learning, transparent, and improvement culture is crucial for healthcare organizations to effectively learn from human errors and deliver safer, higher-quality patient care. However, the application of organizational learning in healthcare has been relatively narrow, necessitating the establishment of learning systems across healthcare organizations. This paper presents a novel learning management framework in a multistate health system, which is also a patient safety organization (PSO), facilitating a transition into a high reliability organization. We also provide initial results, uniquely contributing to the limited literature on healthcare learning management networks for patient safety. Methods We explore solutions for widespread learning from safety events in a large multistate U.S. healthcare system. We discuss the challenges of culture, technology, measurement systems, and barriers to learning from errors. We present our key driver diagram, critical details of implementing a learning network, and our initial findings, including the positive impact of the good catch program and the culture of safety survey. These initiatives have led to improved communication about errors and a growing willingness to learn from them, demonstrating the effectiveness of our learning management network. We also discuss the importance of data in organizational learning. Results From 2021 to 2023, the overall event reporting rate, which includes all severity levels of harm, increased by 22.41%, from 165.15 to 202.16 events per 10,000 patient days (p-value<0.0001). The reporting rate for near-miss events also rose by 20.50%, from 138.09 to 166.41 events per 10,000 patient days (p-value<0.0001). We attribute these improvements to enhanced data sharing and a culture of transparency the learning management network fosters. The “Communication about error” element in the culture of safety survey, with over 55,000 respondents, improved from 69.5% in 2020 to 70.6% in 2022 (p-value<0.0001), indicating better communication and a growing willingness to learn from errors. Feedback from over 1,000 PSO safe table participants highlighted a respectful and supportive atmosphere, acknowledging areas for improvement without blame. Conclusion In conclusion, we emphasize the comprehensive approach to patient safety, utilizing diverse strategies and evidence-backed methods to spread learning and data sources and reinforcing the commitment to “healing without harm.” Looking ahead, we aim to instill essential learning mindsets, create psychologically safe workplaces, and promote high reliability and safety behaviors. We remain optimistic that the maturation of the learning management network will ultimately contribute to a decrease in harm rates, aligning with our ongoing commitment to patient safety and continuous enhancement. Our future research will focus on further refining and expanding the learning management framework to significantly impact patient safety in healthcare organizations.

Challenges to Integrating Portable Magnetic Resonance Imaging Systems in Emergency Medical Service Ambulances for Stroke Care

This qualitative study explores the barriers to incorporating portable MRI devices in ambulances, enabling effective patient triage and potentially reducing time to thrombolytic treatment for stroke. Using a digital twin of the patient handling process, semi-structured interviews were conducted with 11 paramedics and 7 neurologists from an emergency medical services system and a tertiary stroke care center. Thematic analysis of interview transcripts, guided by the Systems Engineering Initiative for Patient Safety framework, revealed key barriers: the need for specialized MRI operation skills, complex patient handling procedures, limited space, and the necessity for training and policy development. The study proposes solutions to address these challenges, aiming to facilitate the implementation of ambulance-based MRI systems for expedited stroke care. The findings contribute to understanding the factors influencing the adoption of advanced imaging technology in pre-hospital settings, ultimately improving patient outcomes by minimizing delays in stroke treatment.

Mixed methods evaluation of a specialty-specific system to promote physician engagement in safety and quality reporting in a large academic health system

BackgroundIncident reporting systems (IRS) can improve care quality and patient safety, yet their impact is limited by clinician engagement. Our objective was to assess barriers to reporting in a hospital-wide...

A Qualitative Analysis of Barriers to Evidence-Based Care in the Prehospital Management of Patients with Suspected Acute Coronary Syndrome

Objectives Prehospital electrocardiogram (ECG) and administration of aspirin are evidence-based strategies for patients with acute coronary syndrome (ACS). However, emergency medical services (EMS) compliance in patients with suspected ACS varies widely. We sought to understand the barriers to prehospital ECG acquisition and aspirin administration for patients with suspected ACS. Methods In this qualitative study, we interviewed EMS clinicians at three geographically diverse United States (U.S.)-based EMS agencies. We interviewed practicing clinicians and quality and operations leaders at these agencies. Based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, interviews were recorded, transcribed, and analyzed using a grounded qualitative approach with open coding. The Systems Engineering Initiative for Patient Safety (SEIPS) framework and a constant comparison technique were used to identify and refine themes. Results Twenty-five paramedics and 20 additional agency personnel participated. Median age was 41 (IQR: 34–51) years and 13 (29%) were female. Themes were organized using SEIPS and longitudinally through four phases of an EMS call. During the pre-arrival phase, staffing challenges, training quality, and dispatch may anchor EMS clinicians on a diagnosis. During the diagnosis and treatment phase, safety and communication barriers may take priority over care delivery. Additionally, EMS clinicians must allocate assets (e.g. whether to send an advanced life support unit) and financial resources; veteran EMS clinicians identified their experience whereas newer clinicians cited their recent education when making these decisions. Also, diagnostic uncertainty due to increasing patient complexity and atypical presentations contributed to diagnostic errors. During the response and transport phase, the scope of practice limits the use and interpretation of the ECG, with clinicians reporting that liberal use of ECG led to more rapid decision-making. Finally, in the after phase, personnel reported the “psychologically taxing” nature of the job contributing to biases, bad habits, and burnout. Performance feedback was desired for personal development, though currently perceived as infrequent and punitive. Conclusions Multiple, interrelated themes underscored the complexities of delivering evidence-based care to prehospital patients with ACS. Education in ECG interpretation, resource allocation, bias, and enhancing feedback may serve as strategies to address the identified barriers.

Presenteeism Among Healthcare Professionals (HCP) During the COVID-19 Pandemic: Survey of Perceived Barriers

Background: Presenteeism when ill in healthcare personnel (HCP) can contribute to the spread of respiratory illness among HCP and patients. However, during the COVID-19 pandemic and now, there are substantial challenges preventing HCP from staying home when ill. We examined these challenges using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. Method: As part of a larger anonymous electronic survey between 3/11/2022 and 4/12/2022 at an academic tertiary referral center, in inpatient and ambulatory settings where respondents were asked to describe factors impacting presenteeism when ill, we analyzed free-text responses using the SEIPS categories of tasks, tools/technology, person, organization, and physical environment. Result: 522 comments were received in response to the open-ended survey question asking individuals to describe any factors that would assist them in remaining home and/or help them get tested for COVID-19 when they have symptoms of a respiratory illness; 21 were excluded due to absent or incomplete response. Of the remaining responses (N = 501, Figure 1), 82% were associated with a single SEIPS component such as organization (N = 409), while other responses discussed factors that involved two SEIPS components, in no particular order (N = 92). A majority of the responses (N = 324, 55%) reported organizational barriers, frequently citing a strict sick call-in policy as well as a lack of protected time-off for COVID-19 testing or related absences. The next two most commonly identified components were physical environment (N= 88, 15%) and tasks (N = 72, 12%), mentioning barriers such as far distances to testing centers and prolonged waiting periods for testing Results: The person and tools/technology components were less commonly identified, with a frequency of 9% each. Conclusion: A number of systems level factors were identified that may impact the ability of HCP to stay home when ill. Interventions to help overcome HCP perceived barriers to staying home when experiencing respiratory symptoms should focus on the policies and practices within an organization. Communication from leadership should support staying home with respiratory symptoms by creating plans for coverage and back up consistently across all employee types in direct care.

Barriers to integrating portable Magnetic Resonance Imaging systems in emergency medical service ambulances for stroke care

This study examines the barriers to integrating portable Magnetic Resonance Imaging (MRI) systems into ambulance services to enable effective triaging of patients to the appropriate hospitals for timely stroke care and potentially reduce door-to-needle time for thrombolytic administration. The study employs a qualitative methodology using a digital twin of the patient handling process developed and demonstrated through semi-structured interviews with 18 participants, including 11 paramedics from an Emergency Medical Services system and seven neurologists from a tertiary stroke care centre. The interview transcripts were thematically analysed to determine the barriers based on the Systems Engineering Initiative for Patient Safety framework. Key barriers include the need for MRI operation skills, procedural complexities in patient handling, space constraints, and the need for training and policy development. Potential solutions are suggested to mitigate these barriers. The findings can facilitate implementing MRI systems in ambulances to expedite stroke treatment.

Exploring the challenges and risks of dead body handling faced by healthcare professionals during the coronavirus pandemic: Cross sectional survey study

The coronavirus pandemic shocked the already overwhelmed global healthcare system, challenging its preparedness to deal with mass fatalities. Our research examines the safety issues faced by healthcare workers when handling dead (deceased) bodies, highlighting the need for better strategies in the event of mass fatalities. Healthcare providers involved in dead body handling during the COVID-19 pandemic in the U.S. were eligible to participate in our study. Using a web-based survey, we analyzed responses of 206 participants across 43 U.S. states. We used the Systems Engineering Initiative for Patient Safety (SEIPS) framework to deduce themes from participants’ open-ended responses. The study showed how routine tasks become extraordinarily challenging during pandemic due to increased workload, emotional stress, and resource constraints. Tasks such as lifting and transferring bodies, underscored physical and emotional toll on workers. The mental strain induced by mass fatalities and the complexities of communicating with families and peers were also prominent, adding to the overall burden on healthcare workers. The participants emphasized the importance of specialized training, policy refinements, and improvements in its implementation. In conclusion, our study contributes to understanding the complexities of dead body handling during a pandemic. It underscores the need for emergency response planning and systemic changes in healthcare policies and practices to ensure the safety and well-being of healthcare workers engaged in these critical tasks.

Patient Training and Patient Safety in Home Hemodialysis.

The success of a home hemodialysis program depends largely on a patient safety framework and the risk tolerance of a home dialysis program. Dialysis treatments require operators to perform dozens of steps repeatedly and reliably in a complex procedure. For home hemodialysis, those operators are patients themselves or their care partners, so attention to safety and risk mitigation is front of mind. While newer, smaller, and more user-friendly dialysis machines designed explicitly for home use are slowly entering the marketplace, teaching patients to perform their own treatments in an unsupervised setting hundreds of times remains a foundational programmatic obligation regardless of machine. Just how safe is home hemodialysis? How does patient training affect this safety? There is a surprising lack of literature surrounding these questions. No consensus exists among home hemodialysis programs regarding optimized training schedules or methods, with each program adopting its own approach on the basis of local experience. Furthermore, there are little available data on the safety of home hemodialysis as compared with conventional in-center hemodialysis. This review will outline considerations for training patients on home hemodialysis, discuss the safety of home hemodialysis with an emphasis on the risk of serious and life-threatening adverse effects, and address the methods by which adverse events are monitored and prevented.

Application of a Human Factors and Systems Engineering Approach to Explore Care Transitions of Sepsis Survivors From Hospital to Home Health Care.

This study aims to describe the transition-in-care work process for sepsis survivors going from hospitals to home health care (HHC) and identify facilitators and barriers to enable practice change and safe care transitions using a human factors and systems engineering approach. Despite high readmission risk for sepsis survivors, the transition-in-care work process from hospitals to HHC has not been described. We analyzed semi-structured needs assessment interviews with 24 stakeholders involved in transitioning sepsis survivors from two hospitals and one affiliated HHC agency participating in the parent implementation science study, I-TRANSFER. The qualitative data analysis was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to describe the work process and identify work system elements. We identified 31 tasks characterized as decision making, patient education, communication, information, documentation, and scheduling tasks. Technological and organizational facilitators lacked in HHC compared to the hospitals. Person and organization elements in HHC had the most barriers but few facilitators. Additionally, we identified specific task barriers that could hinder sepsis information transfer from hospitals to HHC. This study explored the complex transition-in-care work processes for sepsis survivors going from hospitals to HHC. We identified barriers, facilitators, and critical areas for improvement to enable implementation and ensure safe care transitions. A key finding was the sepsis information transfer deficit, highlighting a critical issue for future study. We recommend using the SEIPS framework to explore complex healthcare work processes before the implementation of evidence-based interventions.

CancelRx case study: implications for clinic and community pharmacy work systems

BackgroundMedication prescribing and discontinuation processes are complex and involve the patient, numerous health care professionals, organizations, health information technology (IT). CancelRx is a health IT that automatically communicates medication discontinuations from the clinic electronic health record to the community pharmacy dispensing platform, theoretically improving communication. CancelRx was implemented across a Midwest academic health system in October 2017. The health system also operates 15 outpatient community pharmacies.ObjectiveThe goal of this qualitative study was to describe how both the clinic and community pharmacy work systems change and interact over time regarding medication discontinuations, before and after CancelRx implantation.ApproachMedical Assistants (n = 9), Community Pharmacists (n = 12), and Pharmacy Administrators (n = 3), employed by the health system were interviewed across 3-time periods between 2017 and 2018— 3-months prior to CancelRx implementation, 3-months after CancelRx implementation, and 9-months after CancelRx implementation. Interviews were audio recorded, transcribed, and conducted a hybrid analysis with deductive content analysis following the Systems Engineering Initiative for Patient Safety (SEIPS) framework and inductive analysis to capture additional codes and themes.Key resultsCancelRx changed the medication discontinuation process at both clinics and community pharmacies. In the clinics, the workflows and medication discontinuation tasks changed over time while MA roles and clinic staff communication practices remained variable. In the pharmacy, CancelRx automated and streamlined how medication discontinuation messages were received and processed, but also increased workload for the pharmacists and introduced new errors.ConclusionsThis study utilizes a systems approach to assess disparate systems within a patient network. Future studies may consider health IT implications for systems that are not in the same health system as well as assessing the role of implementation decisions on health IT use and dissemination.

A69Sustain and Spread: A Standardized Solution for High Quality Simulation

The past three years during Covid19 have brought significant changes to our simulation service, including a change of specialist extended faculty. As we began to resume our standard service, and new faculty members joined the team, it became apparent that we had been heavily reliant on individual faculty memory and had lost some organizational memory. This impacted the efficiency and quality of the service, as well as the experience for the new staff members. Therefore, we decided to evaluate all our courses to identify opportunities that would improve the overall service and help integrate new faculty. We initially used a scoping exercise based on the System Engineering Initiative in Patient Safety (SEIPS) framework [1] to evaluate all our courses looking at course design, scenario design, evaluation tools and course delivery to highlight themes for service improvement. Potential service improvement ideas were prioritized taking into consideration the Hierarchy of Intervention Effectiveness to ensure improvements were mixed across the person and system-focused levels [2]. The SEIPS scoping exercise highlighted inconsistency in course design, delivery and evaluation. As a team we set about designing a standardized approach that could be applied to both established and new courses, aiming to enable course resilience and retain valuable knowledge and documentation. We have designed and embedded standardization in all aspects of course design, delivery and evaluation: SEIPS based scenario design proforma Course introduction with a human factors workshop Incivility workshop Technical teaching aid for debriefing Human factors teaching tools Pre- and post-course evaluation Anonymized feedback from faculty was used to assess the impact of the standardized course design. This standardized approach has supported existing and new faculty to develop and run high quality courses; created a shared understanding of teaching content and delivery, and has had a positive impact on the consistency of course quality. By scoping and exploring our service we illuminated gaps within our organizational memory and were able to strengthen these by designing a series of innovative documents, proformas, teaching aides and evaluation. This standardized approach helps to enable consistent high quality, support new faculty, whilst still allowing for flexibility and adaptations when delivering courses. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Using a Systems Engineering Approach to Study Processing Errors in Cytology Testing at a Cancer Clinic

Cancer patients are a high-risk population and often undergo strenuous testing. One type of testing is cytology testing, which is less invasive and simpler to attain than a traditional biopsy. However, there can be errors in the cytology testing process that can lead to a loss of results, thus a delay in treatment or retesting. The purpose of this work is to utilize a systems engineering approach to understand cytology testing ordering process and identify where errors may occur. The Systems Engineering Initiative for Patient Safety (SEIPS) framework was utilized to make visual process maps with the use of SEIPS 101 tooling methods. The use of SEIPS 101 tools showed the relationships between the components of a work system. Handoff points, where information is at risk of being lost, were identified. Future work can look at the implementation of solutions to gather data on the quality improvement measures.

Analysis of Patient Safety Culture at Semen Padang Hospital Indonesia

Background: Hospitals have a role and function to provide integrated health services for patients as consumers of health services. When providing services to patients, hospitals must pay attention to quality and safety. This study aimed to find out the patient safety culture that has been built at Semen Padang Hospital in 2022.
 Methods: This study uses an approach mixed methods research with a design sequential explanatory, namely research that uses a combination of quantitative and qualitative methods simultaneously (quantitative-qualitative). The subjects of this study were employees of Semen Padang Hospital, with as many as 81 respondents for quantitative data and 11 respondents for qualitative data. Measurement of patient safety culture using the MaPSaF instrument (Manchester patient safety framework) in the form of filling out the MaPSCAT questionnaire (Manchester patient safety culture assessment tool). This questionnaire consists of 10 dimensions with a total of 24 questions and is equipped with in-depth interview data.
 Results: Data collection was carried out using the MaPSCAT instrument on 10 dimensions of patient safety culture, 6 dominant dimensions were at the proactive level, namely the dimension of overall commitment to continuous improvement (1st dimension), the dimension of system error and individual responsibility (3rd dimension), the dimension of incident evaluation and best practices (5th dimension), effective learning and change (6th dimension), communication about patient safety issues (7th dimension) and staff education and training dimension (9th dimension).
 Conclusion: The safety culture at Semen Padang Hospital is generally at a proactive level. This indicates that the hospital places priority on improving patient safety and is carried out on an ongoing basis. A system that is integrated and comprehensive has a wide scale, involved stakeholders, and an evidence-based approach.

ASSESSMENT OF THE ATTITUDE OF INTENSIVE CARE UNITS NURSES OF THE DIMENSIONS OF A SAFETY CULTURE

To assess intensive care unit nurse’s attitude towards patient safety dimensions.
 Methods. The study was conducted at two hospitals, from 2022 April till June in Intensive Care Units. 156 nurses participated in the study. The questionnaire was made by authors according to the „Manchester Patient Safety Framework. Acute” literature.
 Results. Nurses with a university education agreed more often than those with a non-university education that their department takes a responsible approach to patient safety issues (respectively, n=52; 96.3% and n=93; 95.9%), p=0.05, that departments have a correct understanding of why it is necessary to report adverse patient safety events (respectively, n=51; 80.0% and n=80; 51.0%), p=0.04.
 Non-university-educated nurses indicated more often than university-educated nurses that their department constantly assesses risks related to patient safety and looks for ways to improve quality (respectively, n=92; 93.9% n=43; 79.6%), p=0.02 that adverse patient safety events are not seen as an opportunity to blame the nurse or other staff (respectively, n=62; 64.6% and n=25; 46.3%,), p=0.04. Nurses with a non-university education more often agreed that there is no prevailing culture of blame in the department (respectively, n=65; 67.7% n=25; 46.3%), p=0.02, more often report potential adverse events (respectively, n =26; 48.1% and n=58, 61.1%), p=0.01, than nurses with university education.
 Conclusions. Critical care and intensive care nurses pay sufficient attention to patient safety, system error and individual responsibility, and adverse event recording and best practice dimensions. However, in the opinion of university-educated nurses, risks related to patient safety are still not sufficiently assessed in the workplace and ways to improve quality are sought, there is a lack of safety culture.

What do healthcare staff think about the quality and safety of care provided to children and young people with an intellectual disability? A qualitative study using the framework method of analysis

ObjectiveTo elicit patient safety issues pertaining to children and young people with intellectual disability in hospital from healthcare staff perspectives. This follows a previous paper of parent interviews of patient...

Patient, Caregiver, and Clinician Experience with a Technologically Enabled Pillbox: A Qualitative Study

Abstract Objectives As part of a study to assess whether a technologically enabled pillbox prescribed to patients at hospital discharge can improve medication safety, we sought to assess participant experiences with the intervention. Methods We conducted a series of semi-structured phone interviews with patients, patient caregivers, and inpatient and outpatient clinicians who participated in the Smart Pillbox Transition Study. We developed an interview guide using the Systems Engineering Initiative for Patient Safety (SEIPS) framework, which included the a priori domains of (1) barriers to implementation, (2) facilitators of the intervention, and (3) general feedback regarding experience with the intervention. Within these domains, we employed SEIPS-informed themes of environment and organization, logistics and tasks, personnel and patients, and technology and tools. Interviews were conducted between May 2018 and January 2019. We used content analysis to interpret findings. Results We interviewed 6 patients, 2 caregivers, and 5 inpatient and 2 outpatient clinicians. Patient-endorsed barriers in the theme of technology and tools included signal issues, inappropriate alarms, and portability. Barriers in the theme of logistics and tasks included coordination with pharmacists in the event of a prescription change. Barriers mentioned by clinicians included patients who were poor fits for the intervention (theme: personnel and patients) and competing demands at discharge (theme: logistics and tasks). Facilitators that were frequently mentioned by patients and caregivers in the theme of technology and tools included useful alarms and ease of use. Clinicians stated that communication with pharmacy and study staff helped facilitate the intervention (theme: personnel and patients). Conclusion We identified several key barriers and facilitators from patients, caregivers, and clinicians to successful implementation of this intervention. Reconciling these sometimes contrasting viewpoints will be crucial if the Smart Pillbox or similar health information technology interventions are to be adopted as tools to improve medication safety during care transitions.

Frontline perspectives of C. difficile infection prevention practice implementation within veterans affairs health care facilities: A qualitative study

In 2012, the Veteran's Affairs (VA) Multidrug-Resistant Organism (MDRO) Program Office launched a national Clostridioides difficile Infection (CDI) Prevention Initiative to address CDI as the most common cause of healthcare associated infections, mandating use of a VA CDI Bundle of prevention practices in inpatient facilities. We draw upon frontline worker perspectives to explore work system barriers and facilitators to the sustained implementation of the VA CDI Bundle using the Systems Engineering Initiative for Patient Safety (SEIPS) framework. We interviewed 29 key stakeholders at 4 participating sites between October 2019-July 2021. Participants included infection prevention and control (IPC) leaders, nurses, physicians, and environmental management staff. Interviews were analyzed to identify themes and perceptions of facilitators and barriers to CDI prevention. IPC leadership was most likely to know of the specific VA CDI Bundle components. Other participants demonstrated general knowledge of CDI prevention practices, with role-based variation in the depth of awareness of specific practices. Facilitators included leadership support, mandated CDI training and prevention practices, and readily available training from multiple sources. Barriers included limits to communication about facility or unit-level CDI rates, ambiguous communications about CDI prevention practice updates and VA mandates, and role-hierarchies that may limit team members' clinical contributions. Recommendations include improving centrally-mandated clarity about and standardization of CDI prevention policies, including testing. Regular IPC training updates for all clinical stakeholders are also recommended. A work system analysis using SEIPS identified barriers and facilitators to CDI prevention practices that could be addressed both nationally at the system level and locally at the facility level, specifically in the areas of communication and coordination.

A qualitative study of barriers and facilitators to pediatric early warning score (PEWS) implementation in a resource-limited setting.

Globally, pediatric hospitals have implemented Pediatric Early Warning Scores (PEWS) to standardize escalation of care and improve detection of clinical deterioration in pediatric patients. This study aims to utilize qualitative methodology to understand barriers and facilitators of PEWS implementation at Philippine Children's Medical Center (PCMC), a tertiary care hospital in Manila, Philippines. Semi-structured interviews querying current processes for clinical monitoring, Pediatric Intensive Care Unit (PICU) transfer, and clinician attitudes towards PEWS implementation were audio recorded. In-person hospital observations served to triangulate interview findings. The Systems Engineering Initiative for Patient Safety (SEIPS) framework guided content coding of interviews to characterize work systems, processes, and outcomes related to patient monitoring and care escalation. Thematic coding was performed using Dedoose software. This model allowed identification of barriers and facilitators to PEWS implementation. Barriers within PCMC workflow included: limited bed capacity, delay in referral, patient overflow, limited monitoring equipment, and high patient to staff ratio. Facilitators of PEWS implementation included support for PEWS adaptation and existence of systems for vital sign monitoring. Observations by study personnel confirmed validity of themes. Utilizing qualitative methodology to understand barriers and facilitators to PEWS in specific contexts can guide implementation at resource-limited hospitals.

Evaluation of National Patient Safety Implementation Framework in Selected Public Healthcare Facilities of Tamil Nadu: An Operational Research.

The Ministry of Health and Family Welfare has introduced the "National Patient Safety Implementation Framework" to ensure the patient safety at different levels of healthcare delivery system. However, there is limited effort made in evaluating the implementation status of this framework. Hence, we have performed the process evaluation of National Patient Safety Implementation Framework across the public healthcare facilities in Tamil Nadu. This was a facility-level survey conducted by research assistants who visited 18 public health facilities across 6 districts of Tamil Nadu, India, for the purpose of documenting the presence of structural support systems and strategies to promote patient safety. We developed a tool for data collection based on the framework. It comprised a total of 100 indicators under the following domains and subdomains: structural support, systems for reporting, workforce, infection prevention and control, biomedical waste management, sterile supplies, blood safety, injection safety, surgical safety, antimicrobial safety, and COVID-19 safety. Only one facility (subdistrict hospital) belonged to the high-performing category with a score of 79.5 on the implementation of patient safety practices. About 11 facilities (4 medical colleges and 7 Government Hospitals) belonging to medium-performing category. The best-performing medical college had a score of 61.5 for patient safety practices. Six facilities (2 medical colleges, 4 Government Hospitals) belonged to low-performing category in terms of patient safety. The least-performing facilities (both subdistrict hospitals) had scores of 29.5 and 26 for patient safety practices, respectively. Because of COVID-19, there was a positive effect on biomedical waste management and infectious disease safety across all facilities. Most performed poor in the domain with structural systems to support quality and efficiency of healthcare and patient safety. The study concludes that based on the current situation of patient safety practices in public health facilities, it will be difficult to perform full-fledged implementation of patient safety framework by the year 2025.