Patient Safety Practices Research Articles

Barriers and Facilitators to Implementing the National Patient Safety Implementation Framework in Public Health Facilities in Tamil Nadu: A Qualitative Study.

In 2017, the National Patient Safety Implementation Framework (NPSIF) was introduced in India to ensure patient safety at different levels of the health care delivery system by 2025. Evaluating the implementation status, feasibility, and challenges and obtaining suggestions for improvement are key to the successful and sustainable implementation of any national health framework. Hence, we explored the facilitators and challenges in implementing the NPSIF and sought suggestions to address the challenges. We adopted a descriptive qualitative approach to inquire about NPSIF implementation. Health care workers were selected using maximum variability sampling from 18 secondary- and tertiary-level public health care facilities in Tamil Nadu, India. From August to October 2021, we conducted a total of 80 key informant interviews and in-depth interviews with the relevant officers in-charge and HCWs of varied cadres. Facilitating factors reported were facilities obtaining/working toward quality certification; availability of standard protocols and checklists; and government rewards for the best-performing hospitals, doctors, and staff. Major implementation challenges reported were staff shortages; lack of infrastructure, facilities, and equipment; lack of awareness about patient safety, noncompliance to standard guidelines, and lack of patient cooperation. Recommendations suggested to overcome these challenges included providing educational materials to patients, offering regular continuing medical education and training, improving record maintenance, having a dedicated staff/team and surveillance system setup for patient safety and dedicated staff for data entry, filling existing staff vacancies, and using a carryover option for funding. Based on the current situation of patient safety practices in public health facilities in Tamil Nadu, it will be difficult to achieve full-scale implementation of the NPSIF by 2025. However, as a first step, a core patient safety committee can be formed at the state level to develop a Gantt chart for implementation based on the priorities over the next 2 years.

The Implementation Science of Financial Intelligence in Evidence-Based Medicine Using Select Criteria Mechanism as Treatment Process towards Healthcare Corporate Governance

Purpose: Implementation science is the broader aspect of corporate social responsibility (CSR) translating healthcare education to clinical research and practice for public health and patient safety encompassing the hierarchy of evidence-based medicine (EBM), hence, serving as an integrative method of combing CSR towards healthcare corporate governance. This paper aims to model EBM under principles of valid contract formation as compliance to CSR theories of promoting positive health outcomes of patient safety leading to financial success and lessening the risks of mortality cases.
 Methodology: The elements of valid contract formation and sources of errors are the systematic plan for behavioral guidance of EBM practice. These determinants are crucial in refining the clinical judgment of medical experts together with other healthcare professionals in support with high-ranking databases of research publication, resulting to a greater impact of positive health outcomes of patient safety under “judicious” application of CSR. These principles of contract law are integrated for “measuring” the EBM’s financial success towards healthcare corporate governance.
 Findings: EBM is a scientific approach to handle medical cases and reports towards patient safety under clinical judgment of medical expert and healthcare team in corroboration with reliable sources of databases for medical research and review for reducing death rates in healthcare setting. SELECT Criteria Mechanism elucidated EBM as implementation science integrating CSR for behavioral compliance to healthcare corporate governance. First, the modeling of CSR as method to comply with EBM delineates the elements formed for valid contract formation in producing an “ethical” standard as responsibility for optimal patient safety as bargained promise under acceptance of the clinical team. Second, the illustration of the healthcare corporate governance in EBM practice as theory “measures” the reduction of healthcare expenditures from the exhibited means of diminishing mortality cases. Therefore, implementation science serves as an initiation for remediation process of reducing risks of death cases. 
 Recommendation: Implementation science is very important in EBM practice in treating ways of lessening the probability of mortality cases under “ethical” or “judicious” patient safety guidelines as corporate social responsibility. Hence, it is recommended to develop systems for behavioral guidance in a more organized plan of targeting death reduction cases towards financial intelligence as fulfillment in implementation science.

Healthcare practitioners’ attitudes toward patient safety in hospital settings in Jeddah, Kingdom of Saudi Arabia

PurposePatient safety focuses on minimizing risks that might occur to patients during provision of healthcare. The purpose of this study was to explore healthcare practitioners’ attitudes towards patient safety inside different hospital settings in Jeddah, Kingdom of Saudi Arabia.Design/methodology/approachA descriptive, cross-sectional study was conducted on a sample of healthcare practitioners in main hospitals in Jeddah. Two main hospitals (one governmental and one private) were selected from each region of Jeddah (east, west, north and south), with a total number of eight out of thirty hospitals. Data were collected through the Attitudes to Patient Safety Questionnaire III that was distributed online. The questionnaire used a 5-point scale. Descriptive statistics were used. Comparisons were made by independent t-test and ANOVA. The statistical significance level was set at p < 0.05.FindingsThe study included 341 healthcare practitioners of different sexes and specialties in eight major governmental and private hospitals in Jeddah. “Working hours as error cause” subscale had the highest mean score (4.03 ± 0.89), while “Professional incompetence as error cause” had the lowest mean score (3.49 ± 0.97). The total questionnaire had a moderate average score (3.74 ± 0.63). Weak correlations between the average score of the questionnaire and sex, occupation and workplace were found (−0.119, −0.018 and −0.088, respectively).Practical implicationsHospitals need to develop targeted interventions, including continuing professional development programs, to enhance patient safety culture and practices. Moreover, patient safety training is required at the undergraduate education level, which necessitates health professions education institutions to give more attention to patient safety education in their curricula.Originality/valueThe study contributed to the existing literature on patient safety culture in hospital settings in Jeddah, Saudi Arabia. The insights generated by the study can inform targeted interventions to enhance patient safety culture in hospitals and improve patient outcomes.

Accreditation Surveyor and Patient Safety: Learning from World Patient Safety Day 2023 (Literature Review)

This article serves as a commemoration for World Patient Safety Day (WPSD) 2023, observed every 17th of September. Unlike previous years, this year’s theme is "Engaging Patients for Patient Safety" with the slogan "Elevate the voice of patients!". All parties are encouraged to actively participate and collaborate in involving patients and their families in their care. This involvement encompasses primary and secondary care facilities, whether in-patient or outpatient settings, community health clinics or hospitals. The role of surveyors has been further enhanced to evaluate and proactively ensure the participation of patients and their families in their care. Numerous studies have shown that the roles of surveyors, be it in guidance or accreditation, are crucial in ensuring this engagement occurs and that improvements in patient safety and quality are achieved. Accreditation surveyors play a vital role in supporting and developing patient safety practices that actively involve patients. They assist health facilities in understanding and adhering to required patient safety standards while facilitating collaboration between patients, families, and care teams. The role of surveyors in ensuring patient safety becomes increasingly relevant and essential in the pursuit of safer and higher-quality healthcare services.

Crisis management for Patient Safety Officers: lessons learned from the Covid-19 pandemic

BackgroundThere is no consensus for the role definition for Patient Safety Officers (PSOs) in healthcare during pandemics or other crises as opposed to their routine activities. This study aimed to examine the contribution of personality traits and systemic factors on the performance of PSOs during the pandemic, and to compare these variables during the first and third waves of the Covid-19 pandemic in Israel.MethodsThis cross-sectional study invited 117 PSOs to complete a questionnaire addressing their role during the Covid-19 pandemic. The questionnaire included items concerning: Personal and socio-demographic characteristics; Uncertainty; Personal initiative; Burnout; Professional functioning; Patient Safety and Risk Management policies and practices; Organizational functioning; and Personal Involvement in risk management activities. Qualitative data was collected by two open-ended questions.ResultsA total of 78 PSOs (67%) completed the questionnaire. The results revealed that many PSOs reduced their involvement in risk management processes or even left their position temporarily in order to return to their primary specialization as clinicians. Only 51.3% and 57.7% reported practicing risk management in the first and third waves, respectively. The three main factors that kept PSOs functioning were managerial support, mobilization of their team, and the belief in the importance of their position.ConclusionsA crisis generates uncertainty, a plethora of frequent and urgent tasks, and the need to adapt policy to changing circumstances and to the increased risks. The risk manager must be a member of the crisis management team and participate in every important discussion in order to represent essential staff and patient safety issues and ensure that these are fully addressed already in the early stages of planning.

Stop the NHS patient safety policymaking and practice merry-go-round and act.

Stop the NHS patient safety policymaking and practice merry-go-round and act.

Nurses’ knowledge and self-assessment of their clinical experiences of intraosseous access: A multicentre cross-sectional study

BackgroundIntraosseous access is an effective and safe option when difficult vascular access occurs. The knowledge, competence, and clinical experience of nurses are collectively essential for the successful implementation of this approach in clinical practice. Education and clinical learning are the main pillars supporting this new practice to ensure patient safety. The aim of this study was to identify the nurses’ knowledge and clinical experience of intraosseous access and the factors associated with the adoption of this procedure. MethodsA cross-sectional study was carried out from October to December 2020. A convenience sample of 432 nurses from four Italian hospitals were involved. A structured questionnaire was used to assess the nurses’ knowledge of the intraosseous access guidelines and their clinical experience. ResultsMost participants were female (71.5%) with more than 10 years of experience (63.7%) working in an emergency (38.9%) and medical (37.7%) setting. Most of the participants demonstrated their knowledge of the use of a device e.g., it is used if vascular access is not rapidly achieved in a child (83.1%) and the boluses of liquids required in the intraosseous procedure (72.7%). A few participants reported having placed intraosseous access (3.5%). A higher level of educational preparation and working in emergency and paediatric settings were associated with increased knowledge. ConclusionsOur findings highlighted a sub-optimal level of knowledge of the IO procedure, little experience of this practice in clinical contexts, also associated with a lack of adequate protocols and devices available to nurses. Nurses need to develop their knowledge and practice the skill clinically to embed this practice. University and nurse educators should emphasise the relevance of this practice in nursing education and training, so as to improve the nursing care practice and level of patient safety.

Medication Competence: A Concept Analysis

Concept analysis means clarifying the meaning of concepts for diverse reasons. Concepts are the fundamental building blocks of theory construction. Hence, it is crucial to have solid and reliable notions. Therefore, concept analysis is a good starting point for learning how to think logically in relation to terms, definitions, and uses in theory development. Hence, the purpose of the paper is to perform a detailed concept analysis on medication competence in the context of nursing. Also, to develop a precise description of the concept for use in research and to enhance its usage and communication in healthcare. For this paper, the Walker and Avant concept analysis approach was used to create a thorough knowledge of the phenomenon of nurse medication competency. The literature review was performed from different electronic databases such as Google Scholar, PubMed, PubMed Central and PakMediNet. For the literature search, keywords were used: medication competence, medication management, medication skills, medication safety, nurses, and student nurses. Results: defining attributes were found: knowledge, skills, and attitude. Antecedents for medication competence are proper training, work experience, motivation, critical thinking, pharmacovigilant, proper dose formulation, and self-confidence. Consequences for medication competence were highlighted as the accuracy of medication calculation skills, prevention of medication errors, and improved patient outcomes by maintaining patient safety practices. Additionally, nurses can use medication competence to build interprofessional collaboration, communication, leadership, and delegation skills. Additionally, it is believed that this analysis would provide insight to the nurses and other healthcare personnel as a strong foundation for clinical practice research, and theory development.

Anticoagulation-Associated Adverse Drug Events in Hospitalized Patients Across Two Time Periods

PurposeAnticoagulants often cause adverse drug events (ADEs), comprised of medication errors and adverse drug reactions, in patients. Our study objective was to determine the clinical characteristics, types, severity, cause, and outcomes of anticoagulation-associated ADEs from 2015-2020 (a contemporary period following implementation of an electronic health record, infusion device technology, and anticoagulant dosing nomograms) and to compare them with those of a historical period (2004-2009). MethodsWe reviewed all anticoagulant-associated ADEs reported as part of our hospital-wide safety system. Reviewers classified type, severity, root cause, and outcomes for each ADE according to standard definitions. Reviewers also assessed events for patient harm. Patients were followed up to 30 days after the event. ResultsDespite implementation of enhanced patient safety technology and procedure, ADEs increased in the contemporary period. In the contemporary period, we found 925 patients who had 984 anticoagulation-associated ADEs, including 811 isolated medication errors (82.4%); 13 isolated adverse drug reactions (1.4%); and 160 combined medication errors, adverse drug reactions, or both (16.2%). Unfractionated heparin was the most frequent ADE-related anticoagulant (77.7%, contemporary period vs 58.3%, historical period). The most frequent anticoagulation-associated medication error in the contemporary period was wrong rate or frequency of administration (26.1%, n = 253), with the most frequent root cause being prescribing errors (21.3%, n = 207). The type, root cause, and harm from ADEs were similar between periods. ConclusionsWe found that anticoagulation-associated ADEs occurred despite advances in patient safety technologies and practices. Events were common, suggesting marginal improvements in anticoagulant safety over time and ample opportunities for improvement.

Potentially avoidable mortality after endoscopic retrograde cholangiopancreatography in Australia: an 8-year qualitative analysis.

Endoscopic retrograde cholangiopancreatography (ERCP) is a commonly performed procedure worldwide. The aim of this study was to examine cases of mortality after ERCP to identify clinical incidents that are potentially preventable, to improve patient safety. The Australian and New Zealand Audit of Surgical Mortality provides an independent and externally peer-reviewed audit of surgical mortality pertaining to potentially avoidable issues. A retrospective review of prospectively collected data within this database was performed for the 8-year audit period from 1 January 2009 to 31 December 2016. Clinical incidents were identified by assessors through first- or second-line review, and thematically coded into periprocedural stages. These themes were then qualitatively analysed. There were 58 potentially avoidable deaths following ERCP, with 85 clinical incidents. Preprocedural incidents were most common (n = 37), followed by postprocedural (n = 32) and then intraprocedural (n = 8). Communication issues occurred across the periprocedural period (n = 8). Preprocedural incidents included delay to procedure, inadequate resuscitative management, decision to perform procedure and inadequate assessment. Intraprocedural incidents comprised technical factors and inadequate support. Postprocedural incidents involved inappropriate treatment, delay in definitive surgical treatment or in recognizing complications, inappropriate second-line intervention and inadequate assessment. Communication incidents comprised inadequate documentation, failure to escalate care and poor inter-clinician communication. Causes of mortality following ERCP are wide-ranging, and reviewing clinical incidents associated with potentially avoidable mortality can serve to inform and educate practitioners. In collating a subset of cases in which procedure-related mortality was deemed avoidable, a series of cautionary tales about ERCP is presented that may provide cues to practitioners on improving patient safety and inform future surgical practice.

Barriers Preventing the Reporting of Incidents and Near Misses Among Healthcare Professionals

Reporting of incidents and near misses among healthcare professionals can help target improvement efforts and system changes to reduce the likelihood of patient injury. This study explored barriers that hinder healthcare professionals’ disclosure of incidents and near misses in hospital settings in Saudi Arabia. Cross-sectional data were collected using a qualitative semi-structured interview with 30 participants, including surgeons, physicians, nurses, allied health professionals, pharmacists, and healthcare quality staff during January and February 2020. Barriers reported by the participants were classified across six themes: fear, lack of knowledge, lack of leadership support, workload, reporting system, and lack of motivation. Health leaders must ensure that the reporting process is planned, designed, and implemented in a nonpunitive manner. When selecting middle-level managers, their knowledge regarding quality of care and patient safety practices should be assessed. The findings of this study add to existing knowledge regarding the barriers preventing the reporting of incidents and near misses among healthcare professionals.

ENHANCING PATIENT SAFETYA PRESCRIPTION AUDIT IN A TERTIARY CARE HOSPITAL

Prescription audits are an important aspect of patient safety practice. Medication errors are a common occurrence and need constant monitoring and audit for ensuring right medicine to right patient ,at right time with right dose and right administration and documentation. Medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm in process of prescribing, order communication, product labelling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use Objective- To audit the IPD prescriptions of the different wards and critical care areas for quality improvement in medication management A retrospective random sampling of 506 IPD les of June 2022 -July 2022 including Methodology- sample from wards and .ICU were included and team of trained auditors audited them according to a predened checklist . The ndings were subject to analysis and reports generated The 23 point checklist based audit nding Results- s revealed good compliance in documentation of the various audit points. Improvement was needed in capital letters use and writing of date and time along with authentication details .More detailed audits and in depth analysis is needed for further improvement The Conclusionaudit showed good compliance in documentation. There is need for focus audits for high risk drugs and doses of high alert medicines along side this audit

‘They didn’t do anything wrong! What will I talk about?’

Simulation educators are often unsure of how to conduct a debriefing when learner performance meets or exceeds the expected standard and no significant errors have occurred. Similar to patient safety practices in clinical settings, simulation educators frequently focus on debriefing errors. Indeed, much debriefing training focuses on developing skills needed to conduct the “difficult conversations” that involve giving feedback on errors that occurred. Many simulation educators have not been taught an approach to debriefing positive performance. This manuscript provides such an approach. The approach applies the principles of Cognitive Task Analysis, a technique used in human factors research, to debriefing positive performance. The steps of knowledge elicitation, knowledge representation, and data analysis and synthesis can guide debriefers as they help learners discuss their positive performance, with the goal that the same positive practices will be repeated in future clinical practice.

How can we reduce medication errors in veterinary practice?

Errors happen – we are all human. While we can instil a no‐blame culture and learn from errors, there are systems we can adopt to reduce the chance of an error occurring as much as possible. This article discusses some of the common errors that can happen with veterinary medication, and explores small changes that teams can make to improve patient safety in practice.

Hubungan Kompetensi Keselamatan Pasien dengan Perilaku Keselamatan Pada Perawat di RSU X Tangerang

In health care settings, patient safety is a major concern. The emergence of diseases, the aggressiveness of germs, and environmental changes force nurses to improve their patient protection skills. The phenomena at RSU X suggests dangerous behavior in carrying out work when debriefing and monitoring about impacted person protection have been completed robotically. This suggests that nurses' safety behavior is still insufficient. The purpose of this study is to determine the connection between nurses' skill in patient protection and their safe behavior in RSU X. This study's design employs a cross-sectional approach to corroborate data. The examination was carried out at RSU X in Tangerang Banten. 184 nurses participated in this study as respondents. With a p value of 0.0001, the results suggested a strong relationship between skill level and patient protective behavior. It can be said that nurses at RSU X have a relationship between their competency level and patient safety practices.

Implementation of Supervision About Patient Safety with an Inguinal Hernia Diagnosed in an Inpatient Room: A Case Study

Introduction: Patient safety has become a global issue that is currently being discussed in all countries. Concerns about patient safety have increased significantly over the last decade. The implementation of supervision is very important in order to improve the implementation of patient safety goals. The purpose of this research is to analyze the implementation of supervision regarding patient safety in patients with a diagnosis of Inguinal Hernia in the Inpatient Room. Method: Used a survey method with a supervision questionnaire for patient safety and a supervision effectiveness questionnaire for patient safety. Results: The results showed that supervision of patient safety in patients with a diagnosis of Inguinal Hernia has been carried out in the Hospital Inpatient Room. Implementation of this supervision is effective to do in order to increase the motivation of nurses in implementing patient safety goals. But the implementation of supervision about patient safety is still not optimally implemented because there are several obstacles such as the patient safety program has not become a priority agenda, there is no driving force, it is carried out under forced conditions such as only because of demands from superiors, there are obstacles due to a lack of understanding of the implementation of patient safety programs, there is no sense of awareness in towards patient safety culture, and non-optimal incident reporting. Conclusion: These results can be a reference for hospitals about the attitude of nurses in monitoring patient safety and should improve existing nursing training by allowing nurses to continue their education to a higher level, by holding regular training on patient safety practices.

Preliminary Program Guide: Sunday, May 21, 2023

Preliminary Program Guide: Sunday, May 21, 2023

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.

Patient Safety Policies and Practices among Selected Middle East Countries: Are We Walking on the Right Path?

Background: The Ministry of Health (MOH) is the foremost authority for public health services in the Middle East through a network of primary, secondary and tertiary healthcare centres. In 2017, the healthcare policy was updated for patient safety by the MOH. Human errors have always been a prime topic of debate in complex systems, especially healthcare, due to the adverse consequences leading to cultural blame; this adversely affects the patient safety policy and quality care and also leads to financial strain. As a result, patients continue to suffer harm and substandard care, and This can be avoidable through proper healthcare information and awareness among the organizations. Methodology: This review article has been written after evaluating 15 articles published in peer-reviewed journals globally. PubMed, Scopus, Springer, Research Gate, and Embase are some of the databases utilized for the literature research. The article also includes various studies that focus on patient safety culture. Results: A thorough review has been conducted, including measures taken by countries in the Middle East to enhance patient safety policy. Studies conducted across these countries provide an evidence-based understanding of the patient safety culture. Conclusion: There is a compelling need to promote patient safety culture to improve healthcare quality in the Middle East; this includes policies and measures adopted by various healthcare organizations, healthcare professionals, and those involved in medical education.

Patient safety knowledge, attitude and practice among undergraduate health science students in South West Ethiopia.

Patient safety is minimizing the risk of unnecessary damage associated with healthcare to a minimum. It has been linked as a global precedence area where substantial knowledge gaps exist. Knowledge, attitude, and practice of the healthcare providers toward patient safety have a great influence on the delivery of safe patient care. Regardless of this, the issue has not been adequately addressed in Ethiopia. The main aim of this study was to assess the knowledge, attitude, practice, and factors associated with patient safety practice among undergraduate health science students at Jimma University Institute of Health. An institution-based cross-sectional study design was conducted from May to November 2021. Data were collected from 678 undergraduate health science students using a pretested, structured and self-administered questionnaire. EPI data 3.1 was used for data entry, and SPSS version 25 was used for analysis. A binary logistic regression model was utilized to identify factors associated with outcome variables. An adjusted odds ratio with a 95% confidence interval and P < 0.05 were computed to determine the level of significance. Of the total students, only 293 (43.2%) and 308 (45.4%) had good knowledge and positive attitudes toward patient safety, respectively. Moreover, only 135 (19.9%) of the students had good practices regarding patient safety. Year of study [AOR = 3.75, 95% CI: (2.3, 9.3)], duration on practical attachment [AOR = 2.6, 95% CI: (1.2, 5.9)], and knowledge about patient safety [AOR = 2.9, 95% CI: (1.9, 3.4)] were associated with better patient safety practices. In the current study the practice of patient safety among health science students was low and less than half of the students had good knowledge and favorable attitudes toward patient safety. Patient safety practices were influenced by the length of the clinical attachment, the study year, and the knowledge of patient safety. This calls for patient safety courses to be included in training curricula of undergraduate health sciences students.