Patient Safety Procedures Research Articles

A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals.

The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals. The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals. We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation. Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12.9% from the first assessment (mean ± SEM = 64 ± 4.4) to the second assessment (77 ± 4.0, P = 0.022). The PRS score domains also showed improvements in coordination of pediatric patient care (median improvement, 50%), quality improvement activities (median improvement, 79%), patient safety initiatives (mean improvement, 7%), policies and procedures (mean improvement, 17%), and availability of pediatric equipment (mean improvement, 7%). Participation in a simulation-based quality improvement collaborative was associated with improvements in pediatric readiness.

Implementing an Antibiotic Stewardship Information System to Improve Hospital Infection Control: A Co-Design Process.

HAITooL information system design and implementation was based on Design Science Research Methodology, ensuring full participation, in close collaboration, of researchers and a multidisciplinary team of healthcare professionals. HAITooL enables effective monitoring of antibiotic resistance, antibiotic use and provides an antibiotic prescription decision-supporting system by clinicians, strengthening the patient safety procedures. The design, development and implementation process reveals benefits in organizational and behavior change with significant success. Leadership commitment multidisciplinary team and mainly informaticians engagement was crucial to the implementation process. Participants' motivation and the final product delivery and evolution depends on that.

State of the art thoracic ultrasound: intervention and therapeutics

The use of thoracic ultrasound outside the radiology department and in everyday clinical practice is becoming increasingly common, having been incorporated into standards of care for many specialties. For the...

Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab.

Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown.We analyzed electronic health record (EHR) data from 2 health systems, a university center and a safety net health system, including diagnosis grouper codes, problem lists, medications, laboratory results, procedures codes, clinical encounter notes, and scanned documents. We identified all patients who received rituximab between 6/1/2012 and 1/1/2016. We calculated the proportion of rituximab users with inadequate screening for HBV according to the Centers for Disease Control guidelines for detecting latent HBV infection before their first rituximab infusion during the study period. We also assessed the proportion of patients with positive hepatitis B screening tests who were prescribed antiviral prophylaxis. Finally, we characterized safety failures and adverse events.We included 926 patients from the university and 132 patients from the safety net health system. Sixty-one percent of patients from the university had adequate screening for HBV compared with 90% from the safety net. Among patients at risk for reactivation based on results of HBV testing, 66% and 92% received antiviral prophylaxis at the university and safety net, respectively.We found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients. Interventions should be developed to improve patient safety procedures in this high-risk patient population.

Physicians’ and nurses’ perceptions of patient safety risks in the emergency department

The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians’ perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians’ experiences with regard to patient safety risks. MethodSemi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis. ResultsThe experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures. ConclusionThe results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high.

Bilateral effects of hospital patient-safety procedures on nurses' job satisfaction.

The aim of this study was to examine how hospital patient-safety procedures affect the job satisfaction of hospital nurses. Additionally, we investigated the association between perceived autonomy and hospital patient-safety procedures and job satisfaction. Recently, measures for patient safety have been recognized as an essential requirement in hospitals. Hospital patient-safety procedures may enhance the job satisfaction of nurses by improving the quality of their work. However, such procedures may also decrease their job satisfaction by imposing excessive stress on nurses because they cannot make mistakes. The participants included 537 nurses at 10 private hospitals in Japan (The surveys were collected from March to July 2012). Factors related to hospital patient-safety procedures were demonstrated using factor analysis, and the associations between these factors and nurses' self-perceived autonomy and job satisfaction were examined using structural equationmodelling. Five factors regarding hospital patient-safety procedures were extracted. Additionally, structural equationmodelling revealed statistically significant associations between these factors and the nurses' self-perceived autonomy and job satisfaction. The findings showed that nurses' perceived autonomy of the workplace enhanced their job satisfaction and that their perceptions of hospital patient-safety procedures promoted their job satisfaction. However, some styles of chief nurses' leadership regarding patient safety restrict nurses' independent and autonomous decision-making and actions, resulting in a lowering of job satisfaction. This study demonstrated that hospital patient-safety procedures have ambiguous effects on nurses' job satisfaction. In particular, chief nurses' leadership relating to patient safety can have a positive or negative effect on nurses' job satisfaction. The findings indicated that hospital managers should demonstrate positive attitudes to improve patient safety for nurses' job satisfaction. In addition, policymakers in the hospitals should consider that chief nurses' leadership styles may reduce autonomy and suppress nurses' job satisfaction.

SU‐F‐T‐250: What Does It Take to Correctly Assess the High Failure Modes of an Advanced Radiotherapy Procedure Such as Stereotactic Body Radiation Therapy?

Purpose:Assess the correct implementation of risk‐based methodology of TG 100 to optimize quality management and patient safety procedures for Stereotactic Body Radiation Therapy.Methods:A detailed process map of SBRT treatment procedure was generated by a team of three physicists with varying clinical experience at our institution to assess the potential high‐risk failure modes. The probabilities of occurrence (O), severity (S) and detectability (D) for potential failure mode in each step of the process map were assigned by these individuals independently on the scale from1 to 10. The risk priority numbers (RPN) were computed and analyzed. The highest 30 potential modes from each physicist's analysis were then compared.Results:The RPN values assessed by the three physicists ranged from 30 to 300. The magnitudes of the RPN values from each physicist were different, and there was no concordance in the highest RPN values recorded by three physicists independently. The 10 highest RPN values belonged to sub steps of CT simulation, contouring and delivery in the SBRT process map. For these 10 highest RPN values, at least two physicists, irrespective of their length of experience had concordance but no general conclusions emerged.Conclusion:This study clearly shows that the risk‐based assessment of a clinical process map requires great deal of preparation, group discussions, and participation by all stakeholders. One group albeit physicists cannot effectively implement risk‐based methodology proposed by TG100. It should be a team effort in which the physicists can certainly play the leading role. This also corroborates TG100 recommendation that risk‐based assessment of clinical processes is a multidisciplinary team effort.

Patient Safety Applications for Improving Health Care Quality

Patient safety is the fundamental thing that needs to be taken care of by medical staff when giving healthcare to patient especially in the Emergency Installation. PKU Muhammadiyah Public Hospital at Bantul has implemented Patient safety well in providing services for patients. Expected to be a reference for other hospitals to implement Patient safety as well as efforts to improve the quality of health services, but do not close the possibility there were still some deficiencies that could be made a suggestion for the PKU Muhammadiyah Bantul Hospital. There for researchers interested to review more detail how application of Patient safetyin Emergency Installation PKU Muhammadiyah Bantul Public Hospital in 2014. This research was qualitative observational study, using research subjects: The Head of the medical service, 1 Officer of Emergency Installation, the head of disaster management, 1 medical doctor, 1 nurse, and 4 patients that were taken with inclusion criteria: getting inpatient class III Hospitals in Yogyakarta, have inpatient more than 1 day.<strong> </strong>All the input items on the application of patient safety which include facilities, equipment, drugs, procedures, and activities of officers at Emergency Installation at PKU Muhammadiyah Bantul Hospital, as well as the application process is in compliance with the Guidelines of Observation Guidelines Patient Safety 2008 Survey and Guidelines for Accreditation of Hospital Emergency Services Specific Guidelines (revised edition 2007), ACT No. 44 Hospital in 2009, and patient safety procedures 2008. Patient perceived output includes five dimensions of quality (Tangible, Reliable, Responsiveness, Assurance and Empathy) all have the same perception of good and satisfying. Application on standard input, process and output is suit with Observation Guidelines for Patient Safety 2008 Survey and Guidelines for Accreditation of Hospital Emergency Services Specific Guidelines (revised edition 2007), ACT No. 44 Hospital in 2009, and patient safety procedures 2008.

Patient Safety Applications for Improving Health Care Quality

Patient safety is the fundamental thing that needs to be taken care of by medical staff when giving healthcare to patient especially in the Emergency Installation. PKU Muhammadiyah Public Hospital at Bantul has implemented Patient safety well in providing services for patients. Expected to be a reference for other hospitals to implement Patient safety as well as efforts to improve the quality of health services, but do not close the possibility there were still some deficiencies that could be made a suggestion for the PKU Muhammadiyah Bantul Hospital. There for researchers interested to review more detail how application of Patient safetyin Emergency Installation PKU Muhammadiyah Bantul Public Hospital in 2014. This research was qualitative observational study, using research subjects: The Head of the medical service, 1 Officer of Emergency Installation, the head of disaster management, 1 medical doctor, 1 nurse, and 4 patients that were taken with inclusion criteria: getting inpatient class III Hospitals in Yogyakarta, have inpatient more than 1 day.<strong> </strong>All the input items on the application of patient safety which include facilities, equipment, drugs, procedures, and activities of officers at Emergency Installation at PKU Muhammadiyah Bantul Hospital, as well as the application process is in compliance with the Guidelines of Observation Guidelines Patient Safety 2008 Survey and Guidelines for Accreditation of Hospital Emergency Services Specific Guidelines (revised edition 2007), ACT No. 44 Hospital in 2009, and patient safety procedures 2008. Patient perceived output includes five dimensions of quality (Tangible, Reliable, Responsiveness, Assurance and Empathy) all have the same perception of good and satisfying. Application on standard input, process and output is suit with Observation Guidelines for Patient Safety 2008 Survey and Guidelines for Accreditation of Hospital Emergency Services Specific Guidelines (revised edition 2007), ACT No. 44 Hospital in 2009, and patient safety procedures 2008.

Overall State of Pediatric Readiness in U.S. Improved Over the Past 10 Years, but Gaps Remain

Overall pediatric readiness has improved over the last 10 years, but many U.S. EDs lack equipment and pediatric specific training for healthcare providers. OVER THE LAST two decades, U.S. researchers have focused on improving pediatric readiness for children in emergency care settings. Last month researchers from the National Pediatric Readiness Project updated a 2006 report assessing the pediatric readiness of U.S. emergency departments (ED) (Gausche-Hill et al., 2015). The study is important because it provides the most up-to-date and comprehensive evaluation of pediatric readiness of U.S. EDs. The current report found that overall pediatric readiness had improved over the last 10 years, but that many U.S. EDs continue to lack pediatric equipment and pediatric-specific training for healthcare workers. To assess pediatric readiness the researchers used a weighted 55 question Web-based survey based on the guidelines for care of children in EDs issued by the American Academy of Pediatrics, American College of Emergency Physicians, and the Emergency Nurses Association (2009). Previous reports had showed relatively poor, uneven compliance with the guidelines. The investigators assessed pediatric readiness, including physician/nurse training, quality of improvement activities, patient safety initiatives, policies and procedures, availability of equipment and disaster planning. Of the 4,137 assessments completed (83% response rate) in 2013, there was a median score of 69 on the 100-point weighted pediatric readiness score (WPRS) scale, an increase from a median of 55 in 2003. The researchers found a correlation between the WPRS scores and the annual volume of pediatric patients. Hospitals with less than 1,800 pediatric patients a year had a

Savile review urges NHS to tighten its patient safety procedures.

Recommendations include more security policies, checking of volunteers and safeguarding strategies, finds Nick Triggle

Medical aesthetic procedures should not be auctioned off alongside fashion shows

Over recent years there has been widespread concern about patient safety and non-surgical cosmetic procedures, often triggered by reports of injectables being administered in public or at trade shows. Last month, Helena Collier unknowingly attended a ‘beauty’ day for ‘ladies who lunch’ and was nowhere near prepared for what she was about to witness. In this month's column, she shares her experience

SU-E-E-02: Introduction to a Comprehensive MR Safety Course for Medical Students

Purpose: The purpose is to introduce an educational MR safety module with a concise multiple choice exam for instructing medical students about basic MR and patient related safety. The MR safety course can be implemented as a traditional didactic lecture, interactive, or self administered online. The goal of the course is to make sure that medical students get a basic understanding of MR principles and safety considerations. It prepares the medical students for optimal ordering of MR studies while emphasizing patient screening and safety. A standardized multiple choice exam, accessible through the internet and the program ExamWeb (Exam Web, LLC; Newport Beach, CA) at the end of the course documents the proficiency of the medical students. The course can be used universally by all medical school programs and will help to ensure consistent quality of teaching materials and MR safety standards. Methods: 1.) Course description and examples of implementation2.) Importance of MR safety for physicians3.) MR principles and magnetic fields a) Static magnetic fields (B0) b) Radiofrequency field (B1) c) Gradient fields (Gx, Gy, Gz)4.) Effects of magnetic fields in an MR suite a) Attractive forces on ferromagnetic objects b) Projectile effects c) Thermal effects d) Peripheral nerve stimulation5.) Types of MR systems6.) Fringe fields and 5 Gauss line7.) MR screening procedures a) Implanted devices (e.g. pacemakers, hearing aids, surgical implants) b) Pregnancy c) MR contrast agent reactions and renal insufficiency8.) Emergency procedures in an MR suite Results: This presentation will provide a comprehensive overview on the implementation of an MR safety course for medical students. Conclusion: Education in MR safety for medical students will enable these future physicians to optimize requests for MR studies by increasing their u=derstanding of patient screening and safety procedures.

The cross‐level impact of patient safety climate on nursing innovation: a cross‐sectional questionnaire survey

To explore the cross-level effects of the four dimensions of patient safety climate on nursing innovation. Across the globe, nursing innovation is highly encouraged by nursing experts to improve nursing outcome. Nursing innovation, in turn, is affected by organisational climate, and a critical aspect of organisational climate is patient safety. This is a cross-sectional study. We employed a questionnaire survey to collect data and selected nurses from Taiwan hospitals as samples. A total of 808 valid questionnaires in 172 teams of four hospitals were collected. Patient safety climate was aggregated by individual-level data; thus, we examined r(wg) , ICC 1 and ICC 2. Hierarchical linear modelling was used to analyse the data. Of these three dimensions of nursing innovation, the level of knowledge creation was perceived by the nurses as the highest. In terms of patient safety climate, managerial practices regarding patient safety scored the highest, followed by patient safety procedures, patient safety information flow and patient safety priority. Only patient safety information flow yielded a significant positive influence on knowledge creation, innovation behaviour or innovation diffusion. Hospital nurses do achieve better performance in knowledge creation. Patient safety information flow has positive and cross-level impact on nursing innovation; therefore, the method to increase safety information flow is the key focus of nursing innovation management. Through the improvements made in patient safety climate, hospital managers could promote the development of nursing innovation. Patient safety information flow is positively associated with nursing innovation. Patient safety information could be integrated in nursing training in all levels. Rules and procedures regarding patient safety should be drafted in simple and clear terms. A procedure to review and revise the rules and procedures will also be helpful in improving patient safety information flow.

Implementation of intraoperative radiation therapy (IORT) for breast cancer treatment: An emphasis on radiation and patient safety and quality using a Provonost checklist approach.

e11537 Background: IORT is being evaluated as a novel approach to radiation delivery as part of breast conserving surgery. To improve the quality, patient safety and radiation safety issues with this technology we utilized a checklist approach to streamline treatment delivery. Methods: IORT is delivered as a single-dose Intraoperative radiation treatment. The treatment requires a high level of radiation and surgical expertise. We developed a model of implementation that would improve quality, and radiation safety for patient and staff and reduce the possibility of radiation errors associated with treatment delivery. To achieve this goal, we developed a pre op and Intraoperative “Provonost checklist” approach. We streamlined implementation by developing lists using an “Lean thinking method”. 1) Initial meeting with senior management for OR, Nursing and Physicians, with brainstorming to create checklists, timelines and identify IORT quality and safety issues 2) Communicated IORT quality and safety plan to all involved staff. In-services presentations were designed for the nursing, surgical and anesthesia staff as well as well-designed quizzes 3) Safety checklist for nursing, physics, OR staff and separate “time out” for the Intraoperative radiation portion of the procedure. 4) Two end-to-end dry runs prior to the procedures were performed, modifying the list(s) when necessary. This was found to be a necessary step toward the final goal. 5) Evaluated results of the test run, encouraged feedback 6) stabilized the results and by using evaluations to improve efficiency with IORT procedure. Results: IORT was able to be incorporated as part of our cancer center and operating room practice smoothly and successfully, with all radiation and patient safety procedures followed by staff. Conclusions: We performed a thorough and rigorous implementation program, dedicated to potential quality and radiation safety issues in every aspect of implementing IORT. This allowed for decreased OR time, minimal radiation exposure, to staff and reduced anesthesia time during our implementation of this IORT treatment to our Cancer Center.

An Overview of Patient Safety and Accreditation: A Literature Review Study

Patient safety is one of the most important points to consider in healthcare. As such, various programs are entered by healthcare institutions to monitor their services including patient safety procedures. One of these programs is accreditation. Accreditation is an internationally recognized evaluation process used to assess, promote and guarantee efficient and effective quality of patient care and patient safety. This study will provide valuable information regarding the impact and limitations of the accreditation process found by other researchers as well as the experience of King Abdul-Aziz University Hospital in Saudi Arabia. The 28 out of 81 (34.57%) patient safely indicators significantly improved during accreditation process at King Abdulaziz University Hospital. Survey results show that the overall average of relative improvement percent is 34.43%. Both results are similar to other findings. The accreditation process as experienced by King Abdulaziz University Hospital has significantly improved 1/3 of patient safety indicators and perception of nursing staffs is correlated with statistical findings. Those findings are supported by international literature. © Medwell Journals, 2011.

Effects of Perceived Patient Safety Culture on Safety Nursing Activities in the General Hospital Nurse's

Purpose: This descriptive correlation study was done to identify how perception of patient safety culture of general hospital nurses affects safety during nursing activities. Data from this study should provide information on management of patient safety as well as improvement in patient safety. Method: Participants in this study were 357 clinical nurses working in a general hospital in M city which had two medical evaluations. A survey was conducted to gather the data. Results: The score for perception of patient safety culture of the general hospital nurses was 3.42, out of a possible 5 points, and the score for safety care activities was 3.90. There was a statistically significant positive relationship between the nurses' perception of patient safety culture and their safety care activities, Perception of patient safety culture, Supervisor/manager, communication and procedures, and frequency of accident reporting were factors that impacted significantly on safety nursing activity. Conclusion: The results of the study indicate that patient safety cultural perception significantly affects the safety of nursing activities and thus systematic educational strategies to increase perception should be provided to increase the level of patient safety culture. Also, other specific methods that increase the level of patient safety culture should be considered.

Patient safety during anaesthesia: incorporation of the WHO safe surgery guidelines into clinical practice

WHO makes clear recommendations on how to improve patient safety during surgical procedures by using the WHO Surgical Safety Checklist. We will review the scientific basis of these recommendations and the practical problems encountered during introduction. Perioperative severe complications and death are a major health issue in both developed and developing countries. Nearly half of these complications can be avoided. The systematic use of checklists and structured preprocedural and postprocedural briefings like a time-out procedure reduces perioperative morbidity and mortality. A broader use of checklists to cover the whole surgical pathway gives additional benefit, further reducing perioperative morbidity and mortality.Introducing patient safety procedures can be met with some resistance from healthcare workers and is helped by an organization-wide safety policy and a systematic approach. There is sufficient scientific evidence to make the use of checklists and structured perioperative briefings and debriefings mandatory for the broad spectrum of operative procedures.

Surgery in Safe Hands

Surgery in Safe Hands

The Pathophysiology of Venous Thromboembolism: Implications With Compression Garments

The highest risk of venous thromboembolism lies with abdominoplasty and liposuction and deaths increase when combined with other procedures. The objective of this study was to evaluate physiologic changes in the deep venous system with compression-garments and asses whether there is a correlation between these procedures, rectus plication, and garments. Part 1 of this article is a retrospective review of all office surgical incidents that resulted in an abdominoplasty and/or liposuction death in the state of Florida over the past 8 years. Part 2 is a clinical study, evaluating the effect compression garments have on the pathophysiology of venous thromboembolism. Duplex ultrasounds were performed with and without garments to evaluate venous changes. Literature was reviewed related to intraabdominal pressure and high-tension abdominal closures and surgeons were polled about their use of rectus plication and garments/binders. In 8 years, 13 patients died related to abdominoplasty, liposuction, or the combination of the 2. In 100% of subjects, ultrasounds showed a decrease in venous flow, proximal vessel dilation, and loss of normal biphasic flow within the popliteal vein. Multiple publications have reported an increased morbidity and mortality related to liposuction and abdominoplasty procedures. The most frequent cause of death with these types of procedures was thromboembolism, and we discuss possible reasons for this increased rate. The exact cause of deep venous thrombosis in these procedures remains unknown, but postoperative garments may affect the physiology of venous flow, and may be involved in the formation of deep venous thrombosis and should be considered along with other patient safety procedures.