Patient Safety Practices Research Articles

Safety in Teletriage by Nurses and Physicians in the US and Israel - a Tale of 2 Systems

Abstract Background The safety of telemedicine in general and telephone triage (teletriage), in particular, have been a focus of concern since the 1970s. Inadequate telehealth systems may compromise patient safety. Objectives Our aim was to explore ways that developed teletriage systems produce safe outcomes by examining key system components and questioning long-held assumptions. Methods We examined safety by performing a narrative review of the literature using key terms concerning patient safety in teletriage. In addition, we conducted system analysis of 2 typical formal systems, physician led and nurse led, in Israel and the United States, respectively, and evaluated those systems’ respective approaches to safety. Additionally, we conducted in-depth interviews with representative physicians and 1 nurse using a qualitative approach. Results The review of literature indicated that research on various aspects of telehealth and teletriage safety is still sparse and of variable quality, producing conflicting and inconsistent results. The interviews with health care professionals demonstrated several challenges encountered during teletriage, mainly making diagnosis from a distance, treating unfamiliar patients, a stressful atmosphere, working alone, and technological difficulties. However, they reported using several measures that help them make accurate diagnoses and reasonable decisions, thus keeping patient safety, such as using their expertise and intuition, using structured protocols, and considering non-medical factors and patient preferences (Shared Decision-Making). Conclusions Remote encounters about acute, worrisome symptoms are time sensitive, requiring decision-making under conditions of uncertainty and urgency. Patient safety and safe professional practice are extremely important in the field of teletriage, which has a high potential for error. There is a need identifying safe systems to guide developers and clinicians about needed improvements. Key messages • Patient safety and safe professional practice are extremely important in the field of teletriage. • We need to guide developers and clinicians about needed improvements in teletriage systems.

Prevention in adults of transmission of infection with multidrug-resistant organisms: an updated systematic review from Making Healthcare Safer IV

BackgroundHealthcare-associated infections due to multidrug-resistant organisms (MDROs) remain a high priority patient safety topic, despite broad acceptance as standard-of-care safety practices to prevent central line-associated bloodstream infection, catheter-associated urinary tract...

Potential harms resulting from patient–clinician real-time clinical encounters using video-based telehealth: A making healthcare safer rapid evidence review

Objectives To review the evidence on harms associated with patient–clinician real-time encounters using video-based telehealth and determine the effectiveness of any related patient safety practices (PSPs), which are interventions, strategies, or approaches intended to prevent or mitigate unintended consequences of healthcare delivery and improve patient safety. Methods We searched PubMed, EMBASE, and Cochrane to identify eligible studies published from 2012 to 2022, supplemented by grey literature search. Outcomes of interest included adverse events and other specified harms (i.e., preventable hospitalizations, inappropriate treatment, missed or delayed diagnoses, duplication of services, privacy breaches). Findings Our search retrieved 7155 citations, of which 23 studies (including six randomized controlled trials [RCTs]) were eligible for review. Fourteen studies reported on adverse events or unintended effects of telehealth conducted in diverse settings. Adverse events such as death, reoperation, infection, or major complications were infrequent in both telehealth and usual care groups. Thirteen studies examined preventable hospitalizations or emergency department (ED) visits and reported mixed findings. Of the six RCTs, three showed no difference in risk of hospitalization or ED visits for telehealth compared to usual care and three showed reduced risk for patients receiving telehealth. We found no studies on the effectiveness of PSPs in reducing harms associated with real-time telehealth. Conclusions Telehealth was not inferior to usual care in terms of hospitalizations or ED visits. No studies evaluated a specific PSP. More research is needed to improve understanding of harms associated with real-time use of telehealth and how to prevent or mitigate those harms.

Patient safety initiatives and practices in Nigerian healthcare settings: A comprehensive analysis of current knowledge, challenges, and barriers

The imperative of patient safety in healthcare takes a central stage, more so in the context of Nigeria. This review aims to provide a comprehensive understanding of the patient safety landscape in Nigeria, drawing on 12 empirical studies. This study aims to elucidate the multifarious challenges and barriers health-care professionals encounter in Nigeria concerning patient safety. Concurrently, it delves into the prevailing patient safety culture and the factors shaping it. This study used secondary data to conduct a systematic review of existing literature; 12 studies, spanning from 2015 to 2022, were meticulously examined. These explorations cover a broad spectrum of patient safety aspects in Nigeria, focusing particularly on the insights of nurses and doctors. Through the use of thematic analysis, the studies’ synthesis illuminates a significant gap between the envisioned safety protocols and their on-ground realization. Exacerbating this challenge is the acute lack of resources, which invariably hampers the quality of care. In addition, barriers to effective communication and inadequate reporting mechanisms emerge as significant obstacles. The deficiencies in consistent training and education are also prominent, which stand as potential vulnerabilities in the system. The palpable need for heightened awareness, emphasis on recurrent training initiatives, and strict adherence to established safety guidelines are amplifying these concerns. It was, thus, concluded that the healthcare trajectory in Nigeria, as informed by this review, underscores a pressing need for systemic interventions to elevate patient safety standards. Such a transformative journey demands the concerted efforts of all stakeholders, fostering an environment that prioritizes patient safety and enhances the overall trust in Nigeria’s healthcare system.

Intensive and critical care nurses patient safety, care quality, professional self-efficacy, and missed nursing care: Structural equation model analysis.

Globally, nurses' patient safety, care quality, and missed nursing care are well documented. However, there is a paucity of studies on the mediating roles of care quality and professional self-efficacy, particularly among intensive and critical care unit (ICCU) nurses in developing countries like the Philippines. To test a model of the interrelationships of patient safety, care quality, professional self-efficacy, and missed nursing care among ICCU nurses. A cross-sectional, correlational design study was used. ICCU nurses (n = 335) were recruited via consecutive sampling from August to December 2023 and completed four validated self-report scales. Spearman Rho, structural equation modeling, mediation, and path analyses were utilized for data analysis. The emerging model demonstrated acceptable fit parameters. Patient safety positively influenced care quality (β = .34, p = .002) and professional self-efficacy (β = .18, p = .011), while negatively affecting missed nursing care (β = -.34, p = .003). Care quality positively and negatively influenced professional self-efficacy (β = .40, p = .003) and missed nursing care (β = -.13, p = .003), respectively. Professional self-efficacy indirectly impacted missed nursing care (β = -.32, p = .003). Care quality (β = -.10, p = .003) and professional self-efficacy (β = .13, p = .003) showed mediating effects between patient safety and missed nursing care. ICCU nurses' care quality and professional self-efficacy are essential mediating factors that can bolster patient safety practices, hence reducing missed nursing care. Therefore, healthcare organizations, nurse managers, and policymakers should cultivate care quality and self-efficacy by creating support programs and providing a positive practice environment. Nurses and nurse supervisors could directly observe missed nursing care in the ICCU to understand its underreported causes.

Linking patient safety, caring behaviours and professional self-efficacy with missed nursing care among Filipino emergency room nurses: A structural equation model study.

To investigate the interrelationships of patient safety, caring behaviours, professional self-efficacy and missed nursing care among emergency room nurses. Cross-sectional, correlational study. Filipino emergency room nurses (n = 345) participated via convenience sampling from September 2023 to January 2024. Four validated self-report scales were used to collect data and were analysed using Spearman rho, covariance-based structural equation modelling, mediation and path analyses. The emerging model of study variables displayed satisfactory fit indices. Patient safety directly influenced caring behaviours and professional self-efficacy, while negatively influencing missed nursing care. Caring behaviours directly and indirectly affected professional self-efficacy and missed nursing care, respectively. Professional self-efficacy negatively influences missed nursing care. Finally, caring behaviours and professional self-efficacy were significant mediators between the association of patient safety and missed nursing care. Caring behaviours and professional self-efficacy of emergency room nurses demonstrated mediating effects that can potentially improve patient safety practices thereby minimizing unfinished or missed nursing care. Nurses and healthcare organizations should commit to consistently maintain a workplace culture that fosters patient safety, caring behaviours and professional self-efficacy to minimize avoidable injuries and omitting nursing care tasks. STrengthening the Reporting of OBservational studies in Epidemiology (STROBE). No Patient or Public Contribution.

The Integration of Quality Improvement and Health Care Simulation: A Scoping Review.

Quality improvement (QI) and simulation employ complementary approaches to improve the care provided to patients. There is a significant opportunity to leverage these disciplines, yet little is known about how they are utilized in concert. The purpose of this study is to explore how QI and simulation have been used together in health care. This scoping review includes studies published between 2015 and 2021 in 4 databases: CINAHL, Embase, PubMed, and Scopus. The search yielded 921 unique articles.18 articles met the inclusion criteria and specifically described QI and simulation collaborative projects. Of the 18 articles, 28% focused on improvements in patient care, 17% on educational interventions, 17% on the identification of latent safety threats (LSTs) that could have an impact on clinical care, 11% on the creation of new processes, 11% on checklist creation, and 6% on both LST identification and educational intervention. The review revealed that 61% of the included studies demonstrated a concurrent integration of simulation and QI activities, while 33% used a sequential approach. There is a paucity of studies detailing the robust and synergistic use of QI and simulation. The findings of this review suggest a positive impact on patient safety when QI and simulation are used in tandem. The systematic integration of these disciplines and the use of established reporting guidelines can promote patient safety in practice and in the literature.

Māori nurse practitioners: The intersection of patient safety and culturally safe care from an Indigenous lens.

Dynamic and complex health systems require innovative and adaptive solutions to support patient safety and achieve equitable health outcomes for Indigenous populations. Understanding the ways by which Indigenous (and specifically Māori) nurse practitioners (NPs) practice patient safety is key to enhancing Indigenous health outcomes in predominantly westernized healthcare systems. To describe Māori NPs perspectives on patient safety when caring for Māori and understand how Māori NPs deliver safe health care. A group of five Māori NPs worked alongside a Māori nurse researcher to explore their perceptions of patient safety. Together, they held an online hui (focus group) in early 2024. Data were analysed collectively, informed by kaupapa Māori principles, using reflexive thematic analysis. Māori NP experiences, expressions and understandings of patient safety envelop cultural safety and have many facets that are specific to the needs of Māori populations. The three themes showed: (1) Te hanga a te mahi: the intersection of cultural and clinical expertise; (2) Mātauranga tuku iho: the knowledge from within, where safe practice was strongly informed by traditional knowledge and cultural practice; (3) Te Ao hurihuri: walking in two worlds, where Māori NPs navigated the westernized health system's policies and practices while acting autonomously to advocate for and deliver culturally safe care. The Māori NP lens on patient safety is vital for promoting culturally responsive and effective health care. By recognizing the unique needs of Māori patients and families and incorporating cultural perspectives into practice, Māori NPs contribute to a more comprehensive and inclusive approach to patient safety that goes beyond westernized principles and practices. No patient or public contribution.

PATIENT SAFETY GOALS, AFRICA: DEVELOPMENT OF A CONTEXT FITTING TOOL FOR PATIENT SAFETY AND CARE QUALITY ASSESSMENT IN AFRICA USING THE DECIDE(HUMAN FACTORS) MODEL.

Patient safety practice refers to processes or structures which when applied, reduce the probability of adverse events resulting from exposure to the healthcare system across a range of diseases and procedures. It aims at making health care safer for both clients and staff (Kohn, Corrigan, & Donaldson, 2000). It is “A framework of organized activities that createcultures, processes, procedures, behaviours, technologies and environments in health care that consistently and sustainably lower risks, reduce the occurrence of avoidable harm, make errors less likely and reduce the impact of harm when it does occur.” (WHO, 2021). Quality of care is “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (IOM, 1990 and ahrq.gov., 2016). Healthcare quality is a level or value provided by any healthcare resource, as determined by some measurement (Maxwell, 1984).As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. Other definitions of healthcare quality include: “the degree of conformity with accepted principles and practices (standards), the degree of satisfying the patient’s needs, and the degree of attainment of acceptable outcomes, while making appropriate use of resources.” The Joint Commission defines care quality as “the optimal achievement of therapeutic benefit and avoidance of risk and minimization of harm”. Care quality is also referred to as freedom from deficiencies and therefore less costly because deficiencies which often lead to customer dissatisfaction require additional costs to manage them. Quality care conforms to relevant requirements or standards - the needs and expectations of clients or patients.

SIMPLE procedures: Survey of Internal Medicine Providers' Limitations and Experiences with procedures and medical procedure services

AbstractBackgroundIn response to a decline in bedside procedures performed by hospitalists, some hospital medicine groups have created medical procedure services (MPSs) concentrating procedures under the expertise of trained hospitalist‐proceduralists.ObjectivesTo characterize the structure, breadth, and heterogeneity of academic medical center MPSs, as well as compare the procedural landscape for groups with and without an MPS.MethodsThe Survey of Internal Medicine Providers' Limitations and Experiences with Procedures and MPSs, is a cross‐sectional study, conducted in the United States and Canada through a web‐based survey administered from October 2022 to March 2023. We used convenience and snowball sampling to identify eligible study participants. The survey explored presence of MPS, procedure volumes, patient safety, and educational practices. For MPSs, we explored onboarding, staffing, skill maintenancy, funding, and barriers to growth.ResultsForty instututions (response rate 97.5%), represented by members of the Procedural Research and Innovation for Medical Educators (PRIME) consortum participated in the survey. MPSs were found in 75% of the surveyed institutions. Most MPSs (97%) involved trainees and were staffed by internists (100%) who often had additional clinical duties (70%). The majority (83%) of MPSs used checklists and procedural safety guidelines, but only 53% had a standardized process for tracking complications. There was significant variability in determining procedural competency and supervising trainees. Groups with an MPS reported higher procedure volume compared to those without.ConclusionsMPSs were highly prevalent among the participating instutitions, offered a broad array of bedside procedures, and often included trainees. There was a high variability in funding models, procedure volumes, patient safety practices, and skill maintenance requirements.

Teaching Strategies and Examples of Patient Safety Education in Nursing Students

The second National Patient Safety Comprehensive Plan was developed in 2023. In this, national-level patient safety education is designated as the fifth core task, with the establishment of an educational system for preliminary healthcare professionals included as a detailed task. The foundation for providing patient safety education to preliminary healthcare professionals has now been established. In 2011, the World Health Organization (WHO) published standard guidelines for patient safety education for healthcare professionals. This study introduces the WHO's 'Patient Safety Curriculum Guide: Multi-professional Edition' and shares the experiences and cases of patient safety education conducted for nursing students—that is, future nurses—according to these guidelines. The patient safety and nursing course was designed as an elective in the second semester of the third year. Before the class was conducted, only 6.9% of the students were familiar with the concept of patient safety. Of the 11 WHO topics, this course covers nine (excluding infection control and medicine safety) and is divided into seven modules. Three modules consist of lectures only, whereas the remaining modules involve practical training. To practice patient safety, it is essential for all healthcare professionals to acquire knowledge regarding patient safety during their undergraduate curriculum. This study aimed to provide foundational information regarding patient safety education for nursing and other healthcare students who have not yet undergone patient safety training.

THE IMPLEMENTATION OF PATIENT SAFETY GOALS IN THE INPATIENT DEPARTMENT: AN OVERVIEW

Patient safety is a system through which hospitals ensure that patient care is safe and free from undue injuries or potential harm. Implementing patient safety goals is essential to maintaining this safety. This is particularly important in the inpatient department of RSUD Kota Mataram, one of the largest hospitals in the province of NTB, which treats many patients. This study aims to provide an overview of the implementation of patient safety goals in the inpatient department of RSUD Kota Mataram in 2023. The sample for this study consisted of 40 nurses from the inpatient department with descriptive research. Data were collected using a questionnaire with 21 closed statements, and the sampling technique used was total sampling with descriptive analysis. The results show that the implementation of patient safety goals in RSUD Kota Mataram is rated as very good by 39 respondents (97.50%). The results highlight the excellent implementation of patient safety in RSUD Kota Mataram, with 97.50% of respondents implementing patient safety in accordance with standards. The head of the department and all the nurses at RSUD Kota Mataram are committed to continually supporting and improving patient safety practices to enhance patient satisfaction.

Patient Safety Culture in Pre-Post Partum and Perinatology Units

Introduction: Effective patient safety practices in pre-post partum and perinatology units are crucial for ensuring high-quality care for mothers and children. These practices are expected to reduce maternal and child mortality rates, which remain significant. Patient safety implementation in hospitals depends largely on the patient safety culture within each institution. Objective: This study aimed to assess the application of patient safety culture in pre-post partum and perinatology wards. Methods: The research employed a mixed-methods approach with a sequential explanatory design. Quantitative data were gathered using the AHRQ (Agency for Health Research and Quality) questionnaire. Meanwhile, the qualitative research used an instrumental case study approach insights were derived from in-depth interviews with 52 nurses working in these units. Results: Results show an overall positive response rate of 67.8% across the 12 dimensions of patient safety culture, indicating satisfactory levels. The dimension with the highest positive response rate is teamwork at 38%, while openness had the lowest at 6%. Challenges in patient safety program implementation include lack of safety culture surveys, inadequate incident reporting systems, high blaming culture, lack of support, delayed case reporting, and financial constraints. Reporting, analysis, and evaluation are predominantly limited to internal hospital processes. Conclusion: The obstacles encountered in implementing a patient safety culture are the behavior of healthcare workers and the lack of optimal support from management. The recommendations given are the formation of a Patient Safety Committee, education about safety culture for healthcare workers, Monitoring and evaluation of the patient safety program that has been implemented.

Factors associated with self-reported medical errors among undergraduate health science students in southern Ethiopia

IntroductionMedical errors are not uncommon, but they are seldom reported. Patient safety practices are among the key areas for service improvement. This study aimed to assess factors associated with self-reported medical errors among undergraduate health science students in southern Ethiopia.MethodsA facility-based cross-sectional study was conducted among health science students of Arba Minch University in 2018. The sample size was calculated using a single population proportion formula. A total of 287 medical students in their fourth year and above, nursing and midwifery students in their second year and above, and other health science students in their third year and above were included.ResultsThe majority (82.1, 95%CI: 77.63–86.67) of the study participants had a ‘good’ knowledge score on patient safety. Approximately 62.5% (95%CI: 56.8–68.2) of the participants had a ‘favorable’ patient safety attitude. Only 38.6% (95%CI: 32.8–44.3) of the study participants had ‘good’ patient safety practices. At adjusted analysis, the practical attachment unit, having ever managed a patient independently, having ever witnessed harm to patients by colleagues or other healthcare workers, and having ever witnessed harm to a close friend or family member were statistically significantly associated with self-reported medical errors. Participants who were doing their practical clinical attachment in the surgical and obstetric units were three times more likely to self-report medical errors as compared to those practicing in the pediatrics, internal medicine, and other units (AOR = 2.72, 95%CI: 1.16–6.39.97). Students who had never managed a patient independently were less likely to self-report medical error (AOR = 0.24, 95%CI: 0.08–0.72). The odds of self-reporting medical errors were less among among participants who had not ever witnessed harm to patients by colleagues or other healthcare workers (AOR = 0.12, 95%CI: 0.05–0.29) and participants who had not ever witnessed harm to a close friend or family member (AOR = 0.36, 95%CI: 0.16–0.80).ConclusionOne in five of the participants reported having harmed patients while practicing. Most of the students had good patient safety knowledge, while approximately two-thirds of the participants had a favorable attitude toward patient safety. Only 38.6% of the study participants had good patient safety practices. Having worked in surgical and obstetrics units, having managed a patient independently, and having witnessed harm to a patient were associated with self-reporting of medical errors.

Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study.

Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Patient safety — Are we speaking the same language?

BackgroundSince the radical years following the To Err is Human report, patient safety research has become settled on standardisation and audit cultures. Recent work suggests a change in direction. Current efforts exploring the intricate relationship between stability and change within organisations establish a more balanced patient safety perspective. Frontline staff insights are key to this new knowledge. AimThis study aims to explore the patient safety perceptions of registered nurses working directly with patients in acute care settings. MethodFacilitated reflexive workshops were conducted with nine wards from October to November 2022. Data analysis explored creative works and reflective notes of group discussions with frontline registered nurses using a critical lens. FindingsWe offer four analytical interpretations of how frontline registered nurses understand and experience patient safety. These are as follows: buzzwords, keep ME safe, listen to US, and this is MY role. These manifest the business of patient safety where nurses are, under siege, the silenced team member and experience tension between accountability and responsibility. DiscussionCritical questioning and reappraisal of patient safety practices require the vast knowledge of frontline staff to be fully utilised. ConclusionThis research reveals much of what is avoided in patient safety literature — the tension between what registered nurses understand, experience, and can deliver in patient safety practice. It challenges organisational leaders to enable and support frontline nurses in driving local change.

Rapid response systems, antibiotic stewardship and medication reconciliation: a scoping review on implementation factors, activities and outcomes

IntroductionMany patient safety practices are only partly established in routine clinical care, despite extensive quality improvement efforts. Implementation science can offer insights into how patient safety practices can be successfully...

Generational Exploration on Aesthetic Medicine Products: Influence of Social Media, Reviews, and Brand Identity-GEMS Bond Survey.

The study investigates the impact of social media reviews and brand identity on consumer preferences in the non-surgical aesthetics products across different generations. It highlights the evolving landscape of aesthetic medicine and surgery, driven by technological advancements and a cultural shift towards individual well-being. The research aims to explore the interplay between generational preferences, the influence of social media, and the role of brand identity in shaping consumer decisions. A cross-sectional study design was employed, with a sample size of > 5000 participants stratified across various generational cohorts. The study utilized an online questionnaire to capture both quantitative and qualitative insights into consumer behaviour, with statistical analysis performed to identify patterns and relationships. Analysis of 5850 responses revealed distinct generational preferences and behaviours. Social media engagement varied significantly across generations, with younger cohorts placing a higher emphasis on online reviews. The study also found that brand identity's influence is diminishing in decision-making processes, with consumers increasingly relying on peer reviews and social media content. The findings highlight a pivotal shift in the non-surgical aesthetics consumer market, emphasizing the growing importance of social media and peer reviews over traditional brand identities. Importantly, the study underscores the critical need for integrating patient safety and evidence-based practice within marketing strategies. As consumer preferences evolve towards valuing transparency and authenticity, non-surgical aesthetics providers must prioritize these elements, ensuring that their services are not only appealing but also grounded in safety and scientific validity. "This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ."

Perfusion Measures and Outcomes (PERForm) registry: First annual report.

The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology. This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (≥18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized. Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported. A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 hospitals. Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years. Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time. The use of conventional ultrafiltration decreased over the study period (2019 vs. 2022; 27.1% vs. 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs. 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs. 75.9%). Few robust clinical registries exist to collect data regarding the practice of CPB. Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.

PRIORITIZING PATIENT SAFETY BY HEALTHCARE PROFESSIONALS IN EMERGENCY AND URGENT CARE ENVIRONMENTS

Objective: Highlighting the importance of Patient Safety guidelines in Urgency and Emergency care settings in Brazil. Theoretical Framework: Awareness among healthcare professionals of the importance of following patient safety standards is an extremely relevant topic that has recently gained prominence. Thus, adverse events in hospital institutions, often caused by human errors, increasingly highlight the need to rethink the care models used. Method: An integrative literature review was conducted, along with data analysis, in the following stages: pre-analysis, material exploration, data treatment, and inference/interpretation of results. Results and Discussion: In line with the literature from various authors, the need for the implementation of actions aimed at ensuring safe and quality healthcare was evidenced. Implications of the Research: Providing insights into the optimization of patient safety protocols specific to emergency and emergency care settings, aiming to reduce medical errors and improve clinical outcomes. Originality/Value: The value of this research is evidenced by its innovative approach in analyzing patient safety practices in emergency and emergency care services. By investigating the specific challenges faced in these dynamic and high-pressure environments, this research highlights the importance of new perspectives on how to improve patient safety in critical situations.