Risk Of Patient Safety Incidents Research Articles

Using Multiple Strategies to Reduce the Incidence of Delirium in Older Adult Patients Receiving Surgery

Older adult patients receiving surgery experience a relatively high rate of developing acute delirium due to factors related to the environment, surgery and anesthesia, pain, and indwelling line, which puts these patients at higher risk of patient safety incidents. The incidence of delirium among older patients receiving surgery in our ward was 12.3%. Moreover, in our ward, delirium-attributed self-extraction accounted for 84.2% of the "tubing events" reported via the Taiwan Patient-safety Reporting System and delirium-attributed falls accounted for 33.3% of the "fall events". Thus, delirium in this patient population had a serious effect on patient safety and increased medical expenses. Reduce the incidence of delirium in older adult patients receiving surgery from 12.3% to 6.6%. Strategies used included providing delirium care education and training to improve the delivery of delirium preventive treatments and the care implementation rate by care teams; formulating a surgical delirium high-risk factor assessment scale for the early screening of high-risk patients; adopting the "RADAR" delirium identification method for the rapid identification of cognition changes; establishing delirium prevention and treatment care guidelines for quality-of-care improvement; introducing bedside exercise equipment to increase patient mobility; and designating a dedicated delirium ward for these patients to provide high-quality delirium care services. The incidence rate of delirium in older adult patients receiving surgery was reduced to 6.5%. In addition, the implementation rate of delirium prevention treatment was increased to 98% in physicians and 100% in nurses. This project resulted in significantly improved outcomes and was expanded to the other surgical wards. The innovative concept of incorporating a designated delirium ward for older patients receiving surgery into other wards may be referenced in future ward planning and strategies for improving the quality of medical care.

Costs and consequences of using average demand to plan baseline nurse staffing levels: a computer simulation study

BackgroundPlanning numbers of nursing staff allocated to each hospital ward (the ‘staffing establishment’) is challenging because both demand for and supply of staff vary. Having low numbers of registered nurses...

Gambaran Pendekatan Model Copa pada Perawat Pelaksana di Rumah Sakit Abdul Manap Kota Jambi

The safety of hospital patients is the hospital system to make patient care safer. Safe from the possibility of the risk of Patient Safety Incidents (IKP). One that can override the Model COPA patient safety is requesting more competent, safe practices, verified by examination performance. This study used a descriptive correlation design with cross sectional approach. The goal is to obtain COPA analysis model approach and the determinant factors of nurses with patient safety. The population is all nurses in inpatient hospital Abdul Manap city of Jambi. The number of samples in this study were 50 nurses using total sampling technique. In the bivariate analysis, obtained variables skills assessment and intervention, communication, critical thinking, human caring and relations of social, management, leadership, teaching and integration of science, gender, type of education, length of work, married status, employment status, accreditation campus, GPA, there is a significant association with patient safety with p-value <0.005. Meanwhile, to test each dependent variable and independent variables used chi square test. Multivariate analysis using logistic regression. For that to hospitals in hiring the necessary consideration in terms of the skill factor, for workforce training nurses for patient safety and hospital complements the SPO and equipment less.

Assessing the Patient Safety Culture in Dentistry.

Medical errors are among the leading causes of death within the United States. Studies have shown that patients can be harmed while receiving care, sometimes resulting in permanent injury or, in extreme cases, death. To reduce the risk of patient safety incidents, it is imperative that a robust culture of safety be established. The primary objective of this study was to evaluate the patient safety culture among providers at 4 US dental institutions, comparing the results with their medical counterparts in 2016. This cross-sectional study uses the Medical Office Survey on Patient Safety Culture that was modified for dentistry and administered at 4 US dental institutions during the 2016 calendar year. All dental team members were invited to complete electronic or paper-based versions of the questionnaire. Among 1,615 invited participants, 656 providers responded (rate, 40.6%). Medical institutions outperformed the dental institutions on 9 of the 10 safety culture dimensions, 6 of the 6 overall quality items, and 8 of the 9 patient safety and quality issues. The surveyed dental institutions reported the strongest average percentage positive scores in organizational learning (85%) and teamwork (79%). These findings suggest that the patient safety culture progressed over time. However, there is still heterogeneity within safety culture among academic dental, private (nonacademic), and medical clinics. Patient safety is the first dimension of quality improvement. Administering the Medical Office Survey on Patient Safety Culture within dental clinics represents a key measure to understand where improvements can be made with respect to patient care safety.

Physician Well-being.

1. Paria M. Wilson, MD, MEd* 2. Maneesh Batra, MD, MPH† 3. Kathi J. Kemper, MD, MPH‡ 4. John D. Mahan, MD‡,§ 5. Betty B. Staples, MD¶ 6. Janet R. Serwint, MD** 1. *Division of Emergency Medicine, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA 2. †Department of Pediatrics, Division of Neonatology, Seattle Children’s Hospital and the University of Washington, Seattle, WA 3. ‡The Ohio State University, Columbus, OH 4. §Department of Pediatrics, Division of Nephrology, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH 5. ¶Department of Pediatrics, Duke University Medical Center, Durham, NC 6. **Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD * Abbreviations: EHR: : electronic health record OR: : odds ratio SMART: : Stress Management and Resiliency Training > Every once in a while in Pediatrics in Review , Editors-in-Chief Bob Haggerty and Larry Nazarian would advise readers to care for themselves. They offered commentaries on such subjects as how to transition to retirement or part-time practice, taking time to reflect on the joy of pediatrics, and stepping out of the office to partake in community events. In the spirit of Dr Haggerty’s and Dr Nazarian’s hope that readers take care of themselves, Pediatrics in Review offers the following review. > > —JZ Clinicians and trainee physicians should be aware of the components of wellness and how to foster them in their daily practice. Interventions have been aimed at the individual and organizational levels. After …

A content analysis of documentation on communication disability in hospital progress notes: diagnosis, function, and patient safety

Objective: To examine the content, quantity, and quality of multidisciplinary team documentation of ‘communication’ in hospital progress notes of patients with communication disability, and to explore the relationship of this documentation to patient safety. Design: Retrospective chart review involving a descriptive analysis and a qualitative content analysis of the progress notes. Setting: Acute medical and rehabilitation wards in two regional hospitals in one health district in Australia. Participants: Eight patients with communication disability who had experienced documented patient safety incidents in hospital. Methods: In total, 906 progress note entries about communication during 38 hospital admissions were extracted from eight patient’s charts; written by staff in 11 different health disciplines. Data were analysed descriptively according to quantity, and qualitatively according to the content. Results: Four content categories of meaning in progress note entries relating to communication were (1) use of communication diagnostic and impairment terms; (2) notes on the patient’s communicative function; (3) reports of the topic or content of the patient’s communication attempts; and (4) references to third parties communicating for the patient. Communication-related information was often brief, unclear, and/or inaccurate. Descriptions of communicative function and recommended strategies for successful communication were often lacking. Conclusion: The suboptimal documentation of patient communication in progress notes may contribute to the higher risk of patient safety incidents for hospital patients with communication disability. Increased accuracy in documenting communication disability and function in progress notes might assist staff in communicating with these patients and improve the quality and safety of their care.

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction

Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified. To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction. MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched. Quantitative observational studies. Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed. The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs. Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007). This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.

Aislamiento del paciente crítico: ¿riesgo o protección?

IntroductionIsolation precautions are an effective measure to prevent the spread of multi-resistant microorganisms (MMR). However, its implementation is complex and can increase some risks to the patient. The aim of this study is to determine whether the implementation of isolation precautions increase the risk of patient safety incidents (PSI) in critically ill patients. Material and methodsA retrospective observational study was conducted involving patients admitted to the ICU of a University Hospital, and that required isolation for more than 48h. Period of study: two years (from 2013/03/01 to 2015/03/31). Data source was the electronic medical record. The tools for evaluation were the Modular Review Form questionnaires (MRF1 and MRF2). An analysis was made of PSI and adverse events (AEs) during periods with and without isolation precautions, including the PSI type, severity, and preventability. ResultsThe study included a total of 76 patients, 74 of whom had at least one PSI. A total of 798 PSI were detected (511 during isolation period), 599 were a No harm incident (NHI) and 199 were adverse AEs. The most frequent PSIs were associated with medication (316) and patient health care (279). Most of them were moderately or highly preventable. The incidence of PSI during periods with and without isolation was 27.3 (SD 33.8) and 29 (39.6) per 100 patient-days, respectively. ConclusionsPSIs in ICU are frequent, and the most of them are preventable. The adoption of isolation precautions does not constitute a risk factor for PSI. Improving patient safety culture is essential for an adequate prevention strategy.

Safety of People with Intellectual Disabilities in Hospital. What Can the Hospital Pharmacist Do to Improve Quality of Care?

People with intellectual disabilities are vulnerable in healthcare environments. They experience health and healthcare inequalities, and when admitted to general hospitals are at a greater risk of patient safety incidents. This is well known in specialist services, but less recognized within primary or secondary healthcare. The most significant barriers to safer and better healthcare appear to include ‘invisibility’ of people with intellectual disabilities within health-care systems, widespread lack of staff understanding of intellectual disability, the vulnerabilities of people with intellectual disabilities, and the reasonable adjustment they may need in order to access health-care services. They may be ‘invisible’ to pharmacists in general hospitals. This article aims to raise awareness among those pharmacists and others providing care and support to people with intellectual disabilities in hospital in relation to how pharmacists can contribute to safety. Medication is the main therapeutic intervention in this population. Research is needed to determine the role of pharmacists in improving health outcomes and reducing health inequalities in this vulnerable population group when they are admitted to general hospitals.

P1-366 A prospective mixed methods cohort study to assess ethnic inequities in patient safety in Dutch hospital care

IntroductionUSA studies showed an increased risk of patient safety incidents in hospital care among ethnic minorities, but in Europe ethnic disparities in patient safety have never been analysed. The present...

NPSA infusion device toolkit: a cost‐saving way to improve patient safety

The National Patient Safety Agency (NPSA) has been established to reduce the risk of patient safety incidents and promote learning across the National Health Service that will improve patient safety and help organisations to learn from the experience of others. One of the first projects has been to look at the way that infusion devices are purchased, stored and used within hospitals. This work has resulted in a number of recommendations centred on simplifying the range of devices available, using a centralised system to maximise use of the equipment and ensuring that staff are properly trained. The work has also involved manufacturers in the hope that future developments in equipment design will result in more user‐friendly devices that will reduce the risk of misuse and any consequent harm to patients. NPSA has just issued its first Safer Practice Notice to Trusts to highlight the issues around infusion devices and offer NHS organisations a toolkit to help them improve patient safety and make significant cost savings.