Patient Safety Practices Research Articles

Patient safety content and delivery in pre-registration nursing curricula: A national cross-sectional survey study

BackgroundPatient safety is a core principle of health professional practice and as such requires significant attention within undergraduate curricula. However, patient safety practice is complex requiring a broad range of skills and behaviours including the application of sound clinical knowledge within a range of health care contexts and cultures. There is very little research that explores how this is taught within Australian nursing curricula. ObjectivesTo examine how Australian nursing curricula address patient safety; identify where and how patient safety learning occurs; and describe who is responsible for facilitating this learning. DesignA cross-sectional study. SettingEighteen universities across seven Australian States and Territories. ParticipantsThe sample consisted of 18 nursing course coordinators or those responsible for the inclusion of patient safety content within a Bachelor of Nursing course at Australian universities. MethodsAn online survey was conducted to evaluate the patient safety content included and teaching methods used in Australian pre-registration nursing curricula. ResultsApproaches to teaching patient safety vary considerably between universities where patient safety tended to be integrated within undergraduate nursing course subjects rather than explicitly taught in separate, stand-alone subjects. Three-quarters of the surveyed staff believed patient safety was currently being adequately covered in their undergraduate nursing curricula. ConclusionAlthough there is consensus in relation to the importance of patient safety across universities, and similarity in views about what knowledge, skills and attitudes should be taught, there were differences in: the amount of time allocated, who was responsible for the teaching and learning, and in which setting the learning occurred and was assessed. There was little indication of the existence of a systematic approach to learning patient safety, with most participants reporting emphasis on learning applied to infection control and medication safety.

Safety I to Safety II: A Paradigm Shift or More Work as Imagined? Comment on "False Dawns and New Horizons in Patient Safety Research and Practice".

In their editorial, Mannion and Braithwaite contend that the approach to solving the problem of unsafe care, Safety I, is flawed and requires a shift in thinking to what they are calling Safety II. We have reservations as to whether by itself the shift from Safety I to Safety II is sufficient. Perhaps our failure to improve outcomes in the field of patient safety and quality lies less in our approach – Safety I vs. Safety II – and more in the lack of an agreed upon, commonly understood set of core competencies (knowledge, skills, and attitudes) needed in its workforce. The authors explore in this commentary the need to establish core competencies as part of the pathway to professionalism for the discipline of patient safety and quality.

The Rise of Patient Safety-II: Should We Give Up Hope on Safety-I and Extracting Value From Patient Safety Incidents? Comment on "False Dawns and New Horizons in Patient Safety Research and Practice".

Who could disagree with the seemingly common-sense reasoning that: "We must learn from the things that go wrong."? Despite major investments to improve patient safety, relatively few evaluations demonstrate convincing reductions in risk, harm, serious error or death. This disappointing trajectory of improvement from learning from errors or Safety-I as it is sometimes known has led some researchers to argue that there is more to be gained by learning from the majority of healthcare episodes: the things that go right. Based on this premise, socalled Safety-II has emerged as a new paradigm. In this commentary, we consider the ongoing value of Safety-I based approaches and explore whether now is the time to abandon learning from "the bad" and re-energise data collection and analysis by focusing on "the good."

Baseline assessment of patient safety culture in public hospitals in Kuwait

Conducting patient safety culture assessments can provide hospitals with information on how structures and processes within their system can impact patient outcomes. This study used the Hospital Survey on Patient Safety Culture (HSOPSC) to conduct an assessment of patient safety culture in public hospitals in Kuwait and benchmark against regional and international studies that utilized the same tool. This objective of this study is to examine the association between the predictors and outcomes of patient safety culture. This cross sectional study adopted a customized version of HSOPSC developed by the Agency for Healthcare Research and Quality. The survey targeted selected public hospital staff with at least one year of experience. Data was analyzed using SPSS 24 at a significance level of 0.05. Univariate analysis was utilized to obtain an overview of respondent demographics. The association between patient safety grade and the number of events reported and the remaining patient safety culture composites was analyzed using ANOVA f-test. Four regression models were constructed, two adopted Generalized Estimating Equations and the others were linear models. Results were benchmarked against similar initiatives in Lebanon, Saudi Arabia and USA. A total of 12,092 employees from 16 public hospitals in Kuwait completed the survey. The overall response rate was 60.5% (20,003 distributed surveys). Areas of strength were Teamwork within Units, Organizational Learning—Continuous Improvement, Management Support for Patient Safety, Supervisor/Manager Expectations & Actions Promoting Patient Safety, and Feedback and Communication about Error. Regression findings highlighted significant association between patient safety outcomes and composites. Benchmarking analysis revealed that Kuwaiti hospitals are performing at or better than benchmark on several composites compared to regional and international findings. This is the first major study addressing patient safety culture in public hospitals in Kuwait. Despite having some areas for improvement, public hospitals in Kuwait were found to have multiple areas of strength. Improving patient safety culture is critical if hospitals want to improve quality and safety of medical services. Study findings can guide and inform country level strategies to further improve the systems governing patient safety practices.

Embracing Action: Passing the Torch, Reviewing the Year.

Embracing Action: Passing the Torch, Reviewing the Year.

A Safety-II Perspective on Organisational Learning in Healthcare Organisations Comment on "False Dawns and New Horizons in Patient Safety Research and Practice".

In their recent editorial Mannion and Braithwaite provide an insightful critique of traditional patient safety improvement efforts, and offer a powerful alternative vision based on Safety-II thinking that has the potential to radically transform the way we approach patient safety. In this commentary, I explore how the Safety-II perspective points to new directions for organisational learning in healthcare organisations. Current approaches to organisational learning adopted by healthcare organisations have had limited success in improving patient safety. I argue that these approaches learn about the wrong things, and in the wrong way. I conclude that organisational learning in healthcare organisations should provide deeper understanding of the adaptations healthcare workers make in their everyday clinical work, and that learning and improvement approaches should be more democratic by promoting participation and ownership among a broader range of stakeholders as well as patients.

It Ain't What You Do (But the Way That You Do It): Will Safety II Transform the Way We Do Patient Safety? Comment on "False Dawns and New Horizons in Patient Safety Research and Practice".

Mannion and Braithwaite outline a new paradigm for studying and improving patient safety – Safety II. In this response, I argue that Safety I should not be dismissed simply because the safety management strategies that are developed and enacted in the name of Safety I are not always true to the original philosophy of ‘systems thinking.’

Circulando hacia la seguridad del paciente: realidad y deseo

ObjectiveTo evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign iconicity to promote their implementation. MethodThe study was developed in two stages: 1) review of safe practices recommended by different organizations and 2) a survey to assess the perceptions for the need and implementation of them and the usefulness of signs to improve their implementation. The sample consisted of professionals from Spain and Latin America working in healthcare settings and in the academic field related to patient safety. Results365 questionnaires were collected. All safe practices included were considered necessary (mean and lower limit of confidence interval over 3 out of 5 points). However, in six of the patient safety practices evaluated the implementation was considered insufficient: illegible handwriting, medication reconciliation, standardization of communication systems, early warning systems, procedures performed or equipment used only by trained people, and compliance with patient preferences at the end of life. Improve compliance of with hand hygiene and barrier precautions to prevent infections, ensure the correct identification of patients and the use of checklists are the four practices in which more than 75% of respondents found a high degree of consensus on the usefulness of traffic sings to broaden their use. ConclusionThe differences between perceived need and actual implementation in some safe practices indicate areas for improvement in patient safety. With this aim, the common language and the iconicity of traffic signs could constitute a simple instrument to improve compliance with safe practices for patient safety.

Perception Towards Patient Safety Practice and Associated Factors among Health Care Providers of Jimma Zone Public Hospitals

Perception Towards Patient Safety Practice and Associated Factors among Health Care Providers of Jimma Zone Public Hospitals

Independent dentists’ knowledge on patient safety and reporting of adverse events. Medellín, Colombia, 2017

Introduction: In Colombia, the Comprehensive Health Services Qualifying System (Sistema Único de Habilitación de Servicios de Salud) has been revised several times. It is currently governed by Resolution 2003 of 2014, which includes dentists as independent professionals who must abide by its content. This regulation considers healthcare quality in relation to patient safety as a key aspect for professional practice. The goal of the present study was to determine the associations between dentists’ sociodemographic characteristics, their knowledge on patient safety, and the reporting of adverse events with the patient safety perception by independent providers of the dental services in the city of Medellín. Methods: This is a descriptive, cross-sectional, analytical study in 215 independent dentists from Medellín; an empirical analytical approach was used for data collection, conducting univariate, bivariate, and multivariate statistical analysis. Results: of the population of dentists studied, 52.1% were female and 50% were 41 years or younger. The variables with statistically significant association regarding dentists’ perception on patient safety were: pursuing patient safety studies after graduation, having full qualifying standards, and have performed more than one corrective action of adverse events over the past year. Conclusions: Independent dentists generally lack knowledge on adverse events management and patient safety practices. Universities and monitoring and control bodies can promote theoretical and practical activities to improve these aspects and thus the safety of dental patients.

Patient safety and infection control in operation theatre: A prospective observational study in a tertiary care hospital of India

Introduction: This study aimed to observe the various patient care processes pertaining to patient safety including infection control. Materials and Methods: A descriptive, prospective, observational, qualitative study was conducted in operation theatre (OT) complex of a tertiary care teaching hospital of North India from January to December 2016. Eleven operating rooms utilised for performing routine surgeries were included in the study. Non-participant observations were made by the single trained observer, and in-depth unstructured discussions were also held with the key stakeholders. One OT each for a full day per week was observed. Simple random sampling without replacement using chit system was used for selecting the OT and day of the week for data collection. Results: There are documented infection control guidelines which are being utilised for infection control. There is no patient safety committee, no guidelines on patient safety and no mechanism has been established for reporting of the patient safety incidents. Implementation of surgical safety checklist was inadequate and only nursing personnel filled it. There is a comprehensive training programme available for infection control among nursing staff only but not on patient safety. Only one adverse event was observed during the study period, in addition to four near misses. Conclusion: Culture of patient safety needs to be established, especially in critical areas such as OT. Mechanism needs to be developed for capturing data pertaining to patient safety and patient safety practices, especially implementation of surgical safety checklist need intense and sustained efforts.

Primary Health Care Physicians' Knowledge, Attitude and Practice towards Evidence-Based Medicine in Tabuk City, KSA

Background: Evidence-based medicine (EBM) is an essential component of modern medical practice and crucial for patient safety and high-quality health care services. Objectives: This study was conducted to assess the knowledge, attitude and practice towards evidence-based medicine and the barriers against its application in daily medical practice. Subjects and Methods: This is a cross-sectional survey using a self-administered validated questionnaire among 68 primary health care physicians in Tabuk city, Kingdom of Saudi Arabia during the period from December 2016 to June 2017. Validated questionnaire was used to collect data from the respondents. The Statistical Package for Social Sciences (SPSS) was used for data analysis. P-value of <0.05 was considered as significant. Result: There are 62.2% male participants, the age of the majority were from 30 to 50 years (73.5%) and (72.1%) did not have board qualification, the primary literature review and summaries were the popular methods for EBM. The knowledge and attitude were suboptimal; some did not even access Medline. The unavailability of time and internet access were the most frequent barriers reported. Only a minority received formal EBM training. Conclusion: The knowledge and attitude regarding EBM were suboptimal among the primary health care physicians, the time factors, unavailability of the internet and the lack of letters, access to journals, and guidelines were the principal barriers to EBM incorporation in the clinical practice.

Good practices for patient safety in the operating room: nurses' recommendations.

To describe nurses' recommendations for good patient safety practices in the operating room. Quantitative, descriptive and exploratory research developed from an online survey of 220 operating room nurses from different regions of Brazil. The data processing for textual analysis was performed by the software IRAMUTEQ. There were eight recommendations: (1) Involvement of the multiprofessional team and the managers of the institution; (2) Establishment of a patient safety culture; (3) Use of the safe surgery checklist; (4) Improvement of interpersonal communication; (5) Expansion of nurses' performance; (6) Adequate availability of physical, material and human resources; (7) Individual search for professional updating; and (8) Development of continuing education actions. These recommendations can be used as care management strategies by nurses for patient safety in the operating room.

How Is Patient Safety Understood by Healthcare Professionals? The Case of Bhutan.

ObjectiveThe aim of the study was to explore how the term patient safety is understood by healthcare professionals (nurses, educators, doctors, ward managers, senior managers, and health assistants), all of whom are responsible for promoting the patient safety agenda in the Bhutanese healthcare system.MethodsThe study was conducted as a naturalistic inquiry using qualitative exploratory descriptive inquiry. A purposeful sample of 94 healthcare professionals and managers was recruited from three different hospitals, a training institute, and the Ministry of Health. Data were collected via in-depth individual interviews. All data were subsequently analyzed using thematic analysis strategies.ResultsData analysis revealed variation in the understanding of patient safety among healthcare professionals. Although most participants understood patient safety as fundamentally concerning “doing no harm” or “reducing the risk of harm or injuries” to patients, some understood patient safety as simply having sturdy infrastructure/buildings with sufficient space to manage public health emergencies such as earthquakes, floods, and epidemics. Some confused patient safety with quality of care and patient rights.ConclusionsInadequate understanding of the term patient safety has potential to hinder improvement of patient safety processes and practices in the Bhutanese healthcare system. To improve patient safety in Bhutan’s healthcare system, patient safety training and education need to be provided to all categories of healthcare professionals.

The nexus of nursing leadership and a culture of safer patient care

To explore the connection between +6 nursing leadership and enhanced patient safety. Critical reports from the Institute of Medicine in 1999 and Francis QC report of 2013 indicate that healthcare organisations, inclusive of nursing leadership, were remiss or inconsistent in fostering a culture of safety. The factors required to foster organisational safety culture include supportive leadership, effective communication, an orientation programme and ongoing training, appropriate staffing, open communication regarding errors, compliance to policy and procedure, and environmental safety and security. As nurses have the highest patient interaction, and leadership is discernible at all levels of nursing, nurse leaders are the nexus to influencing organisational culture towards safer practices. The position of this article was to explore the need to form a nexus between safety culture and leadership for the provision of safe care. Safety is crucial in health care for patient safety and patient outcomes. A culture of safety has been exposed as a major influence on patient safety practices, heavily influenced by leadership behaviours. The relationship between leadership and safety plays a pivotal role in creating positive safety outcomes for patient care. A safe culture is one nurtured by effective leadership. Patient safety is the responsibility of all healthcare workers, from the highest executive to the bedside nurse, thus effective leadership throughout all levels is essential in engaging staff to provide high quality care for the best possible patient outcomes.

Association Between Ophthalmologist Age and Unsolicited Patient Complaints

Understanding the distribution of patient complaints by physician age may provide insight into common patient concerns characteristic of early, middle, and late stages of careers in ophthalmology. Most previous studies of patient dissatisfaction have not addressed the association with physician age or controlled for other characteristics (eg, practice setting, subspecialty) that may contribute to the likelihood of patient complaints, unsafe care, and lawsuits. To assess the association between ophthalmologist age and the likelihood of generating unsolicited patient complaints (UPCs) among a cohort of ophthalmologists. Retrospective cohort study with variable duration of follow-up. The study assessed time to first complaint between 2002 and 2015 in 1342 attending ophthalmologists or neuro-ophthalmologists who had graduated from medical school before 2010 and were affiliated with an organization that participates in Vanderbilt University Medical Center's Patient Advocacy Reporting System. Participants were stratified into 5 age bands and were followed up from the time of their employment to receipt of their first complaint. Trained coders categorized UPCs into 34 specific types under 6 major categories. Time to first recorded complaint. Multivariable Cox proportional hazards model was used to measure the association between time to first complaint and ophthalmologist age after adjustment for predetermined covariates. The median physician age was 47 years, with 9% who were 71 years or older. The cohort was 74% male, 90% held MD degrees, and 73% practiced in academic medical centers. The mean follow-up period was 9.8 years. Ophthalmologists older than 70 years had the lowest complaint rate (0.71 per 1000 follow-up days vs 1.41, 1.84, 2.02, and 1.88 in descending order of age band). By 2000 days of follow-up (or within 5.5 years), the youngest group had an estimated UPC risk of 0.523. By 4000 days (>10 years), participants in the older than 70 years age band had an estimated risk of UPC of only 0.364. The 2 youngest age bands were associated with a statistically significant shorter time to first complaint. Compared with those aged 71 years or older, the risk of incurring a UPC for those aged 41 to 50 years was 1.73-fold higher (hazard ratio [HR], 1.73; 95% CI, 1.21-2.46; P = .002). Similarly, participants aged 31 to 40 years had a 2.36 times higher risk of incurring a UPC (HR, 2.36; 95% CI, 1.64-3.40; P < .001). This study suggests that older ophthalmologists are less likely to receive UPCs than younger ones. Although limitations in the study design could affect the interpretation of these conclusions, the findings may have practical implications for patient safety, clinical education, and clinical practice management.

Patient safety ward round checklist via an electronic app: implications for harm prevention.

Patient safety is a value at the core of modern healthcare. Though awareness in the medical community is growing, implementing systematic approaches similar to those used in other high reliability industries is proving difficult. The aim of this research was twofold, to establish a baseline for patient safety practices on routine ward rounds and to test the feasibility of implementing an electronic patient safety checklist application. Two research teams were formed; one auditing a medical team to establish a procedural baseline of "usual care" practice and an intervention team concurrently was enforcing the implementation of the checklist. The checklist was comprised of eight standard clinical practice items. The program was conducted over a 2-week period and 1month later, a retrospective analysis of patient charts was conducted using a global trigger tool to determine variance between the experimental groups. Finally, feedback from the physician participants was considered. The results demonstrated a statistically significant difference on five variables of a total of 16. The auditing team observed low adherence to patient identification (0.0%), hand decontamination (5.5%), and presence of nurse on ward rounds (6.8%). Physician feedback was generally positive. The baseline audit demonstrated significant practice bias on daily ward rounds which tended to omit several key-proven patient safety practices such as prompting hand decontamination and obtaining up to date reports from nursing staff. Results of the intervention arm demonstrate the feasibility of using the Checklist App on daily ward rounds.

Towards promoting patient safety practices: Baseline assessment of patient safety culture in three private hospitals

ABSTRACT The study aimed to: assess patient safety culture in three private hospitals, define strengths and weaknesses in patient safety culture, and examine the socio-demographic determinants of patient safety culture. A cross-sectional study was conducted among 1193 healthcare providers and administrators with 68.4% response rate. A locally customized hospital version of the Patient Safety Culture Survey (HSOPSC) developed by the Agency for Healthcare Research and Quality (AHRQ) was used. The mean score of overall perception of safety and frequency of event reporting were 3.4/5.0 and 4.0/5.0, respectively. ‘Excellent’ and ‘very good’ overall grade on patient safety was reported by 28.9 and 55.3% of participants, respectively. About half of participants reported no events in the last 12 months, while 31.4% reported 1–2 events. The strength areas were teamwork within units, organizational learning, and continuous improvement composite dimensions. However, the areas that required improvement were supervisor expectations, actions promoting patient safety, and hospital handoffs and transitions. Higher level of education, nursing career, training on patient safety, having direct communication with patients and working in small hospitals were the determinants of better patient safety culture practice. Hospital managers and policy makers ought to heighten the performance and practices within a non-punitive reporting atmosphere.

Review: Statutory regulation of invasive complementary therapies, such as hijama and acupuncture, is the only effective way of ensuring both patient safety and good practice.

The development of statutory regulation of healthcare professionals first emerged in the 15th century in the UK. However, it was not until the 20th century that statutory regulation of complementary therapies emerged with the Osteopath and Chiropractors Acts. However, during that period, acupuncture failed to gain statutory regulation but was rather subject to the equivalent of trading standards. This review explores the background to this failure and the present need for statutory regulation. It draws comparisons with the need for regulation of hijama, another invasive therapy, for which there is at present no regulation. The benefits of the negative licensing model developed in Australia are considered.

Family bedside orientations: An innovative peer support model to enhance a culture of family-centred care at the Stollery Children's Hospital.

This paper presents family bedside orientations, an innovative bedside peer support model for families of paediatric patients piloted in one unit at the Stollery Children's Hospital in Edmonton, Alberta. The model invites family members of former patients back to the hospital as volunteer peer mentors responsible for meeting one-on-one with current inpatient families to provide a listening presence, discuss patient safety practices and encourage families to participate in their child's care. Using qualitative and quantitative data collection methods, the model was evaluated over 1 year (December 2014 to December 2015). Data sources included peer mentor field notes (from 163 visits) detailing the number of family bedside orientations completed by peer mentors and how they interacted with families, as well as post-visit family (n=35) surveys, Hospital-Child Inpatient Experience Survey data, peer mentor (n=6) questionnaires, focus groups with unit staff (n=10) and interviews with members of the project leadership team (n=5). Our findings indicated that family bedside orientations became an established practice in the pilot unit and positively impacted family care experiences. We attribute these successes to championing and support from unit staff and our multidisciplinary project leadership team. We discuss how our team addressed family privacy and confidentiality while introducing peer mentors in the unit. We also highlight strategies used to integrate peer mentors as part of the staff team and enhance peer support culture in the pilot unit. Practical considerations for implementing this model in other paediatric environments are provided.