Patient Safety Topics Research Articles

Patient safety in undergraduate radiography curricula: A European perspective

PurposeTo establish an understanding of patient safety within radiography education across Europe by surveying higher education institutions registered as affiliate members of the European Federation of Radiographer Societies (EFRS). MethodAn online survey was developed to ascertain data on: programme type, patient safety definitions, relevant safety topics, specific areas taught, teaching and assessment methods, levels of teaching and curriculum drivers. Responses were identifiable in terms of educational institution and country. All 54 affiliated educational institutions were invited to participate. Descriptive and thematic analyses are reported. ResultsA response rate of 61.1% (n = 33) was achieved from educational institutions representing 19 countries. Patient safety topics appear to be extremely well covered across curricula, however, topics including radiation protection and optimisation were not reported as being taught at an ‘advanced level’ by five and twelve respondents, respectively. Respondents identified the clinical department as the location of most patient safety-related teaching. ConclusionsPatient safety topics are deeply embedded within radiography curricula across Europe. Variations exist in terms of individual safety topics including, teaching and assessment methods, and the depth in which subjects are taught. Results from this study provide a baseline for assessing developments in curricula and can also serve as a benchmark for comparisons.

SEGURANÇA DO PACIENTE NA ATENÇÃO PRIMÁRIA À SAÚDE: REVISÃO INTEGRATIVA

Revisão integrativa que objetivou analisar produções científicas sobre a Segurança do paciente na Atenção Primária à Saúde. Realizada de janeiro a março de 2016, em periódicos nacionais, internacionais e nas bases de dados em ciências da saúde da Biblioteca Virtual em Saúde. Selecionaram-se dez artigos que respondiam à questão norteadora: de que forma é evidenciada na literatura a temática Segurança do Paciente na Atenção Primária à Saúde? Observou-se que as publicações datavam de 2008 em diante, com temática variando entre investigação da cultura de segurança, relação da segurança do paciente com a prevenção de eventos adversos e avaliação de incidentes, e tradução de instrumento para avaliação da segurança do paciente. O conteúdo evidenciado pela análise permitiu concluir sobre a importância de discutir sobre segurança de modo a contribuir na melhoria da qualidade da assistência à saúde, assim como a necessidade de novos estudos, haja vista relevância do tema e pouca produção científica na área.

The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education--A Position Statement of the Committee for Patient Safety and Error Management of the German Association for Medical Education.

Background: Since the report “To err is human” was published by the Institute of Medicine in the year 2000, topics regarding patient safety and error management are in the focal point of interest of science and politics. Despite international attention, a structured and comprehensive medical education regarding these topics remains to be missing.Goals: The Learning Objective Catalogue for Patient Safety described below the Committee for Patient Safety and Error Management of the German Association for Medical Education (GMA) has aimed to establish a common foundation for the structured implementation of patient safety curricula at the medical faculties in German-speaking countries. Methods: The development the Learning Objective Catalogue resulted via the participation of 13 faculties in two committee meetings, two multi-day workshops, and additional judgments of external specialists.Results: The Committee of Patient Safety and Error Management of GMA developed the present Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education, structured in three chapters: Basics, Recognize Causes as Foundation for Proactive Behavior, and Approaches for Solutions. The learning objectives within the chapters are organized on three levels with a hierarchical organization of the topics. Overall, the Learning Objective Catalogue consists of 38 learning objectives. All learning objectives are referenced with the National Competency-based Catalogue of Learning Objectives for Undergraduate Medical Education.Discussion: The Learning Objective Catalogue for Patient Safety in Undergraduate Medical Education is a product that was developed through collaboration of members from 13 medical faculties. In the German-speaking countries, the Learning Objective Catalogue should advance discussion regarding the topics of patient safety and error management and help develop subsequent educational structures. The Learning Objective Catalogue for Patient Safety can serve as a common ground for an intensified, constructive, subject-specific discussion about these topics at the medical faculties, and guide the implementation of hopefully multiple patient safety curricula in undergraduate medical education.

Evaluating the effectiveness of a peer-led education intervention to improve the patient safety attitudes of junior pharmacy students: a cross-sectional study using a latent growth curve modelling approach

ObjectiveDespite the recognition that educating healthcare students in patient safety is essential, changing already full curricula can be challenging. Furthermore, institutions may lack the capacity and capability to deliver patient...

Field Test of the World Health Organization Multi-Professional Patient Safety Curriculum Guide.

IntroductionAlthough the importance of training in patient safety has been acknowledged for over a decade, it remains under-utilized and under-valued in most countries. WHO developed the Multi-professional Patient Safety Curriculum Guide to provide schools with the requirements and tools for incorporating patient safety in education. It was field tested with 12 participating schools across the six WHO regions, to assess its effectiveness for teaching patient safety to undergraduate and graduate students in a global variety of settings.MethodsThe evaluation used a combined prospective/retrospective design to generate formative information on the experiences of working with the Guide and summative information on the impacts of the Guide. Using stakeholder interviews and student surveys, data were gathered from each participating school at three times: the start of the field test (baseline), soon after each school started teaching, and soon after each school finished teaching.ResultsStakeholders interviewed were strongly positive about the Guide, noting that it emphasized universally important patient safety topics, was culturally appropriate for their countries, and gave credibility and created a focus on patient safety at their schools. Student perceptions and attitudes regarding patient safety improved substantially during the field test, and their knowledge of the topics they were taught doubled, from 10.7% to 20.8% of correct answers on the student survey.DiscussionThis evaluation documented the effectiveness of the Curriculum Guide, for both ease of use by schools and its impacts on improving the patient safety knowledge of healthcare students. WHO should be well positioned to refine the contents of the Guide and move forward in encouraging broader use of the Guide globally for teaching patient safety.

Clinics in Plastic Surgery: Outpatient Plastic Surgery

Geoffrey R. Keyes and Robert Singer, eds. Clinics in Plastic Surgery: Outpatient Plastic Surgery . New York, NY: Elsevier, 2013. ISBN-10: 1455776068, $129.00. ![Graphic][1] Outpatient Plastic Surgery is a valuable recent addition to the well-established “Clinics in Plastic Surgery” series. With a multidisciplinary pool of 31 authors and 15 chapters, Outpatient Plastic Surgery addresses several categories of topics pertinent to risk reduction, patient safety, and decision-making in the ambulatory surgery setting. Specific patient safety topics are directly addressed, such as deep venous thrombosis prophylaxis, the prevention of surgical site infection, perioperative nausea and vomiting, and hypothermia. Beyond such expected patient safety foci, however, Outpatient Plastic Surgery addresses other topics critical to patient safety, but infrequently addressed. While these topics may not appear at first as intuitively interesting, nonetheless they are just as critical to safe patient care: outpatient facility standards, evidence-based medicine and data sharing, quality assurance, peer review, the use of surgical checklists, and the role of accreditation. Without foundations such as these, the best-intended clinical management may be for naught. The inclusion of such non-traditional topics seems a natural result of the origin of Outpatient Plastic Surgery , authored by … Corresponding Author: Felmont F. Eaves III, MD, FACS, 3200 Downwood Circle, Suite 640, Atlanta, GA 30327. E-mail: felmont.farrell.eaves{at}emory.edu [1]: /embed/inline-graphic-1.gif

Gaming to Enhance Students’ Patient-Safety Skills: Evaluation of Air Medic Sky One

Aim: To evaluate the effects of a patient safety game, aimed to reduce preventable adverse events in health care through educational game-playing, on satisfaction, knowledge and self-efficacy. Methods: Our institute developed a patient safety serious game called Air Medic Sky One (AMS-1), including expeditions, short lectures and biofeedback modules with a device that enables students to control the game with breath, heart rate and skin conduction, using stress reduction excercises. Final year medical students wer asked to participate. Before and after playing AMS-1, participants completed a knowledge test on patient safety topics; self-efficacy was measured with a 100 mm visual analogue scale. A post-intervention evaluation questionnaire measured satisfaction with the game. Outcomes of both knowledge tests and self efficacy questions were compared using the Student’s t- tests. Results: All 27 participants agreed that AMS-1 provides an entertaining and instructive experience; most found it time consuming (4 to 6 hours). Knowledge of patient safety issues increased significantly after playing the game. Self-efficacy measures showed a mean increase of 28.6% across different aspects of patient safety. Conclusions: AMS-1 appears to be an instructive tool that deserves further, controlled investigation in its effect on actual patient safety behavior in the clinical environment.

Patients’ Role in Their Own Safety—A Systematic Review of Patient Involvement in Safety

It is necessary to evaluate progress in the area of patient safety. However, although there has been an increase in number of quality and safety related studies have increased, the topics of patient involvement and patient safety are not automatically linked. The aim of this systematic review was to identify and evaluate the evidence contributed by studies of patient involvement in the provision of safe care. Inclusion criteria were studies undertaken to promote involvement in safety, covering patients’ attitudes, unsafe and safe care, risk reduction and handover practices during discharge from hospital to primary care. The results revealed three themes: satisfaction with and need for knowledge about healthcare and the health system, sharing responsibility and accountability for safety and the need to overcome language barriers to prevent harm and error. In conclusion, there is an increased focus on the role of the patient in the provision of safe care. Existing evidence is related to medication rather than patients’ capability and willingness to be involved. It is recommended that patient participation in the provision of safe care should be explored in relation to phenomena such as trust, responsibility, shared decision-making and powerlessness. It is also important to investigate the patient’s role with respect to patient rights.

ABR Core Examination Preparation: Results of a Survey of Fourth-Year Radiology Residents Who Took the 2013 Examination

A survey was administered to fourth-year radiology residents after receiving their results from the first American Board of Radiology (ABR) Core examination in 2013. The purpose was to gather information regarding resources and study strategies to share with program directors and future resident classes. An online survey was distributed to examinees nationwide. The survey included free-response and multiple choice questions that covered examination results, perceived value of enumerated study resources, case-based and didactic teaching conferences, board reviews, study materials for noninterpretive skills, multidisciplinary conference attendance, and free-form comments. Two hundred sixty-six of 1186 residents who took the Core examination responded to the survey. Some resources demonstrated a significant difference in perceived value between residents who passed the examination and residents who failed, including internal board reviews (1.10, P<.01), daily didactic conferences (1.51, P<.01), and daily case conferences (1.43, P<.01). Residents who passed reported that conferences and review sessions at their institutions were modified with multiple choice questions, audience response, and integration of clinical physics and patient safety topics compared to residents who failed. Radiology residents and residency programs have adapted their preparations for the ABR Core examination in a variety of ways. Certain practices and study tools, including daily conferences and internal board reviews, had greater perceived value by residents who passed the examination than by residents who failed. This survey provides insights that can be used to assess and modify current preparation strategies for the ABR Core examination.

Tailoring Morning Reports to an Internal Medicine Residency in Qatar.

Morning report, a case-based conference that allows learners and teachers to interact and discuss patient care, is a standard educational feature of internal residency programs, as well as some other specialties. Our intervention was aimed at enhancing the format for morning report in our internal medicine residency program in Doha, Qatar. In July 2011, we performed a needs assessment of the 115 residents in our internal medicine residency program, using a questionnaire. Resident input was analyzed and prioritized using the percentage of residents who agreed with a given recommendation for improving morning report. We translated the input into interventions that enhanced the format and content, and improved environmental factors surrounding morning report. We resurveyed residents using the questionnaire that was used for the needs assessment. Key changes to the format for morning report included improving organization, adding variety to the content, enhancing case selection and the quality of presentations, and introducing patient safety and quality improvement topics into discussions. This led to a morning report format that is resident-driven, and resident-led, and that produces resident-focused learning and quality improvement activities. Our revised morning report format is a dynamic tool, and we will continue to tailor and modify it on an ongoing basis in response to participant feedback. We recommend a process of assessing and reassessing morning report for other programs that want to enhance resident interest and participation in clinical and safety-focused discussions.

Educating future leaders in patient safety.

Education of health care professionals has given little attention to patient safety, resulting in limited understanding of the nature of risk in health care and the importance of strengthening systems. The World Health Organization developed the Patient Safety Curriculum Guide: Multiprofessional Edition to accelerate the incorporation of patient safety teaching into higher educational curricula. The World Health Organization Curriculum Guide uses a health system-focused, team-dependent approach, which impacts all health care professionals and students learning in an integrated way about how to operate within a culture of safety. The guide is pertinent in the context of global educational reforms and growing recognition of the need to introduce patient safety into health care professionals’ curricula. The guide helps to advance patient safety education worldwide in five ways. First, it addresses the variety of opportunities and contexts in which health care educators teach, and provides practical recommendations to learning. Second, it recommends shared learning by students of different professions, thus enhancing student capacity to work together effectively in multidisciplinary teams. Third, it provides guidance on a range of teaching methods and pedagogical activities to ensure that students understand that patient safety is a practical science teaching them to act in evidence-based ways to reduce patient risk. Fourth, it encourages supportive teaching and learning, emphasizing the need to establishing teaching environments in which students feel comfortable to learn and practice patient safety. Finally, it helps educators incorporate patient safety topics across all areas of clinical practice.

German undergraduate medical students’ attitudes and needs regarding medical errors and patient safety – A national survey in Germany

Introduction: Errors in medicine and patient safety are topics with growing scientific and public attention. In undergraduate medical education, these issues are little investigated so far. The aim of this study was to collect data regarding attitudes and needs of medical students.Methods: In a sample of 269 German medical students, data were collected using an anonymous online questionnaire. It consisted of three parts: (1) international validated questionnaire, (2) questions about the German medical education system and (3) demographic data. Data were analysed quantitatively and qualitatively.Results: One-hundred sixty-seven data sets were analysed (completion rate 62%). Twenty-five percent of the respondents stated that they already had committed a medical error. Almost half of the participants reported that they had been assigned tasks they had not been qualified for (47%), or where medical errors could have happened easily (50%). Final year students showed less confidence in error disclosure compared to younger students (p < 0.001). The majority of respondents (64%) wished for more education on the issues.Discussion: With regard to future curricular developments, a consideration of attitudes and needs of medical students regarding the topics of medical errors and patient safety seems necessary. A goal-directed undergraduate education can promote an open culture and can lead to safety and satisfaction for both patients and medical professionals.

A Pilot Study on Developing a Patient Safety Curriculum Using the Consensus Workshop Method

Patient safety is achieved through systematic improvement based on the knowledge and willingness of medical professionals. A systematic longitudinal curriculum for patient safety is essential to prepare medical students and professionals. The purpose of this article is to introduce our experience with a ‘workshop for developing a patient safety curriculum’ and to compare the results with previous studies. The workshop comprising 15 medical professors and patient safety experts met for 2 days. The Consensus Workshop method was applied, collecting opinions from all of the members and reaching consensus through the following stages: context, brainstorm, cluster, name, and resolve. The patient safety curriculum was developed by this method, covering patient safety topics and issues, and teaching and assessment methods. A total of 7 topics were extracted, ‘activities for patient safety, concepts of patient safety, leadership and teamwork, error disclosure, self-management, patient education, policies.’ Issues, teaching methods, and assessment methods were developed for each topic. The patient safety curriculum developed from the workshop was similar to previous curricula developed by other institutions and medical schools. The Consensus Workshop method proved to be an effective approach to developing a patient safety curriculum.

Examining patient safety education in pre-registration nursing curriculum: Qualitative study

Background: Patient safety education has become an important tool to shape the future safety behaviour of health care professionals. The World Health Organisation has recently advocated eleven patient safety themes that need to be addressed in any health care educational curriculum. It is not known at this stage how far pre-registration adult nursing curriculum addresses these patient safety themes. Aims: To examine the views of nursing students and faculty members on patient safety education in a pre-registration adult nursing curriculum in relation to the WHO’ patient safety themes. Method: Qualitative method, utilising 20 semi-structured interviews with pre-registration adult nursing students and faculty members (10 students and 10 faculty members). The data were analysed thematically. Findings: Three main themes emerged from the participants’ views: ‘Not explicitly linked to patient safety’, ‘Mismatch between theory and practice’ and ‘The role of the mentor in practice’. The power imbalance between the students and staff in clinical placement appeared to have rendered many students reluctant to challenge unsafe practice. Conclusion: Patient safety education needs to be more visibly taught in nursing education. The nursing curriculum’ content, teaching and delivery methods may need to be reconsidered to better address the relevant WHO’ patient safety themes, but also to accommodate the unique context of each nursing educational system.

Top 10 Patient-Safety Strategies Update

Patient-safety experts in North America and the U.K. systematically reviewed the growing evidence base for 158 patient-safety topics, including 41

Patient neglect in healthcare institutions: a systematic review and conceptual model.

BackgroundPatient neglect is an issue of increasing public concern in Europe and North America, yet remains poorly understood. This is the first systematic review on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error.MethodThe Pubmed, Science Direct, and Medline databases were searched in order to identify research studies investigating patient neglect. Ten articles and four government reports met the inclusion criteria of reporting primary data on the occurrence or causes of patient neglect. Qualitative and quantitative data extraction investigated (1) the definition of patient neglect, (2) the forms of behaviour associated with neglect, (3) the reported frequency of neglect, and (4) the causes of neglect.ResultsPatient neglect is found to have two aspects. First, procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care. Second, caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The perceived frequency of neglectful behaviour varies by observer. Patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The causes of patient neglect frequently relate to organisational factors (e.g. high workloads that constrain the behaviours of healthcare staff, burnout), and the relationship between carers and patients.ConclusionA social psychology-based conceptual model is developed to explain the occurrence and nature of patient neglect. This model will facilitate investigations of i) differences between patients and healthcare staff in how they perceive neglect, ii) the association with patient neglect and health outcomes, iii) the relative importance of system and organisational factors in causing neglect, and iv) the design of interventions and health policy to reduce patient neglect.

Patient Safety Strategies: A Call for Physician Leadership

In the supplement on patient safety that accompanies this issue, an expert panel has rated the strength of evidence for each safety strategy and recommended 10 patient safety strategies that should...

Reflective learning in a patient safety course for final-year medical students

Background: Patient safety has become an important topic over the last decade and has also been increasingly implemented in the undergraduate curriculum. However, the best timing and method of teaching still remains to be decided.Aims: To develop and evaluate a patient safety course for final-year students. The course is based on reflective learning and personal experiences to improve the transfer of theory into practice.Methods: We performed a mixed method evaluation study of the course. An evaluation questionnaire and the number of completed incident report cards were analyzed using descriptive statistics. Focus groups, organized two and four weeks after the course, were analyzed using template analysis; the Theory of Planned Behaviour (TPB) was used to interpret the results.Results: Students found the course overall instructive and reacted positively towards many elements of the course. Focus group analysis showed that an increase in knowledge about patient safety topics resulted in a change of attitudes towards these subjects and in an increase in awareness of patient safety. This influenced students’ behavioral intention and their behavior.Conclusions: A course based on students’ personal experiences enables them to transfer theory on patient safety issues into their own practice and has an effect on their awareness, attitudes and behavior. This could have a large impact on their future role as resident.

Clinical leadership: individual advancement, political authority, and a lack of direction?

> ‘No amount of competencies, skills, authority, or inspiration will make leadership good if it leads us off a cliff. A moral compass is essential …’ ‘Doctors and leadership: oil and water?’ asked Richard Smith, before he became editor of the BMJ . ‘Doctors have problems with leadership, both leading and being led,’ he pointed out, quoting Leadership Professor Warren Bennis: ‘leading doctors is like herding cats.’1 Only a few years ago, the question of whether doctors should be doing more to lead the NHS was still open to debate.2 Questions are no longer asked about whether doctors can or should do leadership. Since Ara Darzi's 2008 NHS Review emphasised the importance of ‘leading change in the NHS’ and ‘fostering leadership for quality’3 leadership has appeared with increasing prominence in medicine's clinical and political rhetoric. Competency frameworks and an industry of medical education have been constructed to support a standardised model of leadership. The Health and Social Care Act and discussions surrounding it have further influenced the concept and promotion of clinical leadership. However, questions persist about what leadership actually means in medicine.4,5 This essay suggests that the morality of leadership and the direction of progress have been overlooked. Clinical leadership once described the role of clinicians implementing hands-on change and improvement in clinical practice (for instance, implementation of hospital information projects,6 management of stroke,7 and interventions for specific patients8). A 2005 BMJ editorial on the theme of patient safety, for example, asserted that ‘basic errors in clinical care’ arise from the insufficient contribution of experienced staff, insubstantial support of junior doctors, and ‘inadequate time devoted to team-building’: clinical leadership was advocated as the solution to these problems.9 The theme was elaborated by correspondents who emphasised the value of teaching leadership …

Patient safety teaching in Australian medical schools: a national survey

Objective To measure perceptions of Australian medical students and staff about whether key Learning Topics included in the National Patient Safety Education Framework (NPSEF) are being taught and what challenges to patient safety teaching are thought to be operating. Methods A cross-sectional survey of medical deans, educators and students was conducted in 2010. Twenty of twenty-one Australian medical schools participated. Using a five-point Likert scale, respondents rated whether patient safety topics were taught in their medical school and challenges to including patient safety in the curriculum. Results There were 2413 eligible responses: deans (or nominees) ( n = 14); medical educators ( n = 98); and medical students ( n = 2301). There was most agreement that teaching occurred about communicating effectively (8% neutral or disagreed) and least agreement that there was teaching about adverse events and near misses (35% neutral or disagreed). Deans, educators and students responded positively about available champions and expertise and negatively to the curriculum being too full to include patient safety. There were consistent differences between the responses of the stakeholder groups ( P &lt; 0.0005 in a non-parametric test). Deans were more positive than educators, who were more positive than students. Conclusions Strong variability between perceptions of Learning Areas reveals opportunities for improvement in teaching about patient safety, especially in the area of recognizing and addressing adverse events and risks. Consistent differences across stakeholder groups reveal disparities in the perceptions of the teachers and their students. The results indicate targets for improving patient safety learning and closing the feedback loop between students and staff.