Safe Patient Care Research Articles

Proactive Risk Management using Healthcare Failure Mode Effect Analysis Tool to Improve Medication Management Process

Proactive risk management program is essential to maintain the quality and safety of patient care, treatment, and services within a healthcare system. According to the Joint Commission, hospitals need to adopt a proactive approach for risk management and develop risk mitigation strategies to reduce or eliminate the potentially harmful impact of possible risk. There are multiple tools that can be used for proactive analysis. Leaders of Evercare hospital Dhaka selected Healthcare FMEA tool to identify the potential failure modes in the current medication management process as it is one of the complex and high processes in healthcare settings. A multidisciplinary Healthcare FMEA team was formed comprising physician, nurse, pharmacist, quality, IT personnel and senior managements of EHD to conduct Healthcare FMEA. After completing Healthcare FMEA, twenty failure modes(n-20) and fifty-nine potential causes(n-59) of failure modes were detected in existing medication management process of EHD. The hazardous score was Two hundred & seventeen (n-217). There were Twelve major failures modes with higher hazardous score. Healthcare FMEA team members decided to eliminate major failures and actions were taken to control these failures. The main objective of this study is to maintain the medication error of EHD within the target (2/1000 patient days) by implementing required strategies and redesigning existing medication management process. The limitation of this study was it is a time-consuming process, it only helps to identify the possibilities of fail; it does not eliminate them, additional efforts are required to develop corrective action. Pulse Vol.15, 2023 P: 28-33

Escalating competition in NHS: implications for healthcare quality and workforce sustainability.

The UK's National Health Service (NHS) faces escalating competition ratios for specialty training positions, with application rates dramatically outpacing the growth in available posts. This trend contributes to systemic bottlenecks and challenges traditional career progression pathways within medicine. In this evolving landscape, the once-certain career progression within medicine is now increasingly uncertain. This commentary explores the complex dynamics of increased medical school admissions against stagnant specialty training placements and the broader strategic implications for workforce planning within the NHS. It critically evaluates the implications of current funding policies, which seem to prioritise an expansion of nondoctor healthcare roles over the development of specialist training, raising concerns about the long-term patient care quality and safety. Key recommendations include a reassessment of medical education expansion, a review of funding allocation, increased support for specialty training, and government accountability for healthcare workforce planning. The urgent need for strategic policy reform is underscored to ensure that NHS can sustain a high-quality, specialist-led healthcare provision in the face of rising competition and workforce pressures.

Diagnosis and management of infertility: NICE-adapted guidelines from the Italian Society of Human Reproduction

In Italy the fertility rate is very low, and an increasing number of patients are infertile and require treatments. The Italian Law concerning the safety of patient care, and the professional liability of health professionals, indicates that health professionals must comply with the recommendations set out in the guidelines developed by public and private bodies and institutions, as well as scientific societies and technical-scientific associations of the health professions, except for specific cases. Unfortunately, no guideline for the diagnosis and the management of infertility is currently available in Italy. In 2019, the Italian Society of Human Reproduction pointed out the need to produce Italian guidelines and subsequently approved the establishment of a multidisciplinary and multiprofessional working group (MMWG) to develop such a guideline. The MMWG was representative of 5 scientific societies, one national federation of professional orders, 3 citizens' and patients' associations, 5 professions (including lawyer, biologist, doctor, midwife, and psychologist), and 3 medical specialties (including medical genetics, obstetrics and gynecology, and urology). The MMWG chose to adapt a high-quality guideline to the Italian context instead of developing one from scratch. Using the Italian version of the Appraisal of Guidelines for Research and Evaluation II scoring system, the National Institute of Clinical Excellence guidelines were selected and adapted to the Italian context. The document was improved upon by incorporating comments and suggestions where needed. This study presents the process of adaptation and discusses the pros and cons of the often-neglected choice of adapting rather than developing new guidelines.

Role of Magnet®-recognized hospital nurse managers in implementing evidence-based practice: A mixed-method study.

Healthcare systems recognize evidence-based practice (EBP) as the prestigious standard for providing safe and high-quality patient care, nursing excellence, and Magnet Recognition. Despite the well-documented benefits, implementation of EBP is inconsistent and remains elusive in the US and throughout the world and many patients still fail to receive evidence-based care. The literature revealed a huge gap between nursing science and practice but provided evidence that nurse managers (NMs) had a pivotal leadership role in implementing EBP. To gain a deeper understanding of Magnet-recognized hospital nurse managers' (MRHNMs) leadership roles, the influencing factors, and their experience in implementing EBP to enhance EBP initiatives and sustain Magnet recognition. This mixed-method study guided by Goodall's (Australasian Psychiatry, 2016. 24, 231) theory of expert leadership used a sequential explanatory method with a quantitative-driven design based on a national correlational survey augmented by a qualitative descriptive component using semi-structured interviews. The findings of the study demonstrated that MRHNMs had a 54.6% effective leadership role in implementing EBP and produced numerous themes indicating that MRHNMs did implement EBP with struggle. MRHNMs in this study viewed EBP as a healthcare priority and leadership of NMs is necessary to promote EBP. However, lack of knowledge, difficulties with the EBP process, time constraints, and staffing issues negatively impacted EBP. Postgraduate degree, formal EBP education, critical care units as workplace, collaboration with doctorally prepared nurses, and Magnet culture enhanced EBP among MRHNMs. EBP is essential for Magnet recognition and is a hallmark of nursing excellence, however, is a complex and challenging process. The leadership of NMs is necessary to shape evidence-based care, and NMs require EBP preparation during leadership training, necessary resources, and time to complete the EBP process. EBP cannot become a reality without leaders being engaged, supportive, and persistent.

Factors that influence locum practice in public and faith-based hospitals in Malawi.

Locum practice is a non-standard form of employment used to address the shortage of healthcare workers in hospitals. In Malawi, the locum practice is used to improvre the availability of healthcare workers and promote continuity of care. Despite this, little attention has been paid to the effective and efficient use of locum practice. To explore the factors influencing locum practices in public and faith-based hospitals in Malawi. Six public and faith-based hospitals in Malawi. An exploratory descriptive design was used in the qualitative strand of this larger mixed-methods study. Data were collected through in-depth interviews with hospital managers (n = 15) and focus group discussions (FGD) with nurses, medical officers, and clinical officers (n = 29). All the interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data. Locum practice was characterised by challenges related to healthcare workers working beyond the prescribed hours, a lack of orientation for locu staff, inconsistent locum rates, and delayed payments. The consequences of these challenges are compromised quality and safety of patient care. Locum practice is associated with numerous challenges in both public and faith-based hospitals in resource-limited settings. This could be attributed to the lack of regulation, supervision and monitoring of locum practice. The findings suggest the need for the development and adherence to guidelines and policies for managing locum practice. Further studies could explore measures to retain permanent staff as a way of reducing the demand for locum staff.

Investigating the Integration of Anatomical Variabilities into Medical Education as a Potential Strategy for Mitigating Surgical Errors

Introduction: Surgical errors burden health-care systems globally, with anatomical variations being a significant contributor. This review examined the role of these variations and offers valuable insights for medical practitioners, educators, and policymakers to develop strategies to address and mitigate challenges posed by these variations. Materials and Methods: They keywords were generated from the title and online databases were searched with the help of a search string of keywords and Boolean operators. Results: A total of 13 articles were included in the present review. Thematic data analysis identified seven key themes highlighting the significance of anatomical variations in medical education. These include incorporating variations, determining optimal introduction and contact levels, identifying significant variations, teaching methods, visualization techniques, and challenges in integrating them. This systematic review has shown that earlier literature underscores the importance of anatomical variations in the context of medical education. However, there is evidence that students and trainees lack the necessary skills to effectively understand the concepts of anatomical variability and their application in the clinical setting. The final theme discusses potential solutions to enhance students’ understanding of human anatomy. Conclusion: Medical education aims to produce qualified physicians who provide competent and safe patient care. However, students and trainees often lack the skills to understand anatomical variations, leading to misdiagnoses and health-care malpractice. Active medical education professionals should ensure familiarization with anatomical variations to clear misconceptions about the human body, provide valuable knowledge about patient uniqueness, and spark interest in physicians.

Nurse managers’ early intervention in nurses’ professional conduct: A document analysis

Nurses’ professional conduct and work-related well-being are crucial for providing high-quality, safe patient care. Previous knowledge about nurse managers’ early interventions in nurses’ professional conduct is scarce. The aim of this study was to describe how nurse managers intervene in registered nurses’ professional conduct, based on the documents of early intervention and support. A retrospective, cross-sectional document analysis with inductive content analysis was conducted on 43 documents of an early intervention and support program for registered nurses in one Finnish hospital between 2019 and 2021. The manuscript and reporting of the findings were guided by the Standards for Reporting Qualitative Research checklist. The concerns about nurses’ work-related well-being and their working initiated the early intervention process. Nurse managers’ early interventions included supportive and strength-based approaches. These involved appreciating the nurses’ own awareness of their ability to work and supported the process, as did a collaboration with occupation health and other support services. More knowledge is needed about the influence of early intervention programs and nurses' and managers' awareness of different methods.

Patient safety culture and satisfaction in Ghana: a facility-based cross-sectional study

BackgroundGlobally, one of the measures of high performing healthcare facilities is the compliance of patient safety culture, which encompasses the ability of health institutions to avoid or drastically reduce patient...

Preoperativna procena rizika u pedijatrijskoj anesteziji

In general pediatric surgical population, the incidence of perioperative 30-day mortality is low. A child's physical status at the time of elective surgery and the presence of comorbidities can notably impact the perioperative risk. In order to provide quality care, preoperative evaluation should be undertaken in a timely and thorough manner. In preoperative period, it is highly important to be able to identify the patients who are at a higher risk, with the premise that early identification of these patients will allow for additional care to be provided, thereby minimizing possible complications. The main objectives of adequate preoperative assessment are to evaluate patients' readiness for the procedure, optimize patients' health status before surgery, reduce surgical morbidity, and help patients regain their usual functions postoperatively. Routine prescription of additional tests in children should be replaced by selective and rational prescriptions, based on the patients' history and performed clinical evaluation. Surgical and anesthetic complications can have adverse effects on patients' health, and they have also been proven to be associated with increased inpatient and postoperative costs. Each member of the surgical team plays a vital role in the safe care of pediatric patients. Well known risk factors for critical events in the perioperative period in pediatric population are as follows: ASA physical status, age, emergency surgery, and the existence of an underlying disease. This review highlights potential risks encountered in children and directs preoperative assessment towards selecting essential tests based on identified individual risk factors.

Interprofessional Education to Impact Professional Nursing Clinical Practice

Since the Joint Commission issued its roadmap for hospitals in 2010 outlining the need for interprofessional collaboration for safety, quality, and effectiveness in patient care, institutions have sought to improve the healthcare environment. While communication and teamwork have improved in recent years, the Joint Commission and the World Health Organization have continued to stress the importance of the key components of interprofessional collaboration: an understanding of other disciplines’ values/ethics and roles/responsibilities and the ability to communicate work as a team. Researchers have concluded the importance of introducing interprofessional education in pre-licensure settings to impact future healthcare professionals’ ability to collaborate with other disciplines in the workplace. Several nursing schools have implemented strategies for interprofessional education and are looking for new, innovative ways to simulate interprofessional collaboration for future practice.

Pediatric resident use, perceptions, and desires for improvement of a clinical secure messaging application

BackgroundHospitals are transitioning away from traditional pagers to secure text messaging (STM) applications. STM is perceived to improve efficiency and accessibility. There is limited research on user's impressions of how STM impacts patient safety, provider wellness, and quality of patient care. ObjectivesTo understand the use and perceptions of a clinical STM by pediatric residents at a free-standing quaternary care children's hospital. MethodsA survey was conducted of pediatric residents regarding their experience with Diagnotes®. Demographic data were obtained along with use patterns, ability to perform tasks, and perceptions of intended purpose. Further questions evaluated agreement with communication strategies and satisfaction with features. Three open-ended questions asked about experience where STM impacted (1) patient care coordination and (2) patient safety. A final question asked for any additional STM feedback. ResultsOf 169 surveys, there were 112 respondents (66.3 % response rate). Respondents unanimously endorsed daily STM use on their personal mobile devices with good knowledge of basic features. Respondents were overall satisfied with Diagnotes® (73.9 %) including the ability to communicate efficiently (84.8 %) and effectively (79.5 %). Yet only 32.1 % were satisfied with Diagnotes® training. Only 59.5 % believed Diagnotes® was appropriate for urgent patient care needs and only 43.2 % believed its purpose was to inform the team of patient emergencies. Key qualitative themes included improved coordination of patient care tasks through STM, but there were concerns raised around sending and receiving messages, the additional cognitive burden placed by STM, and differences in culture of use that created conflict. ConclusionsDiagnotes® is viewed positively including use for effective coordination of patient care and familiarity of functions of Diagnotes®. Barriers included unclear interprofessional expectations for use. Future research should incorporate a broad range of healthcare professionals' perceptions and co-creation of STM best practice guidelines for use, including around urgent or emergent patient care issues.

Evaluation of Patient safety skills among nursing students

Objective: To evaluate the patient safety skills among nursing students in various academic settings. Methodology: In this cross-sectional study, data were gathered from 320 university nursing students from September 2023 until February 2024 through Health Professional Education in Patient Safety Survey. Results: There was a relation between patient safety awareness and GPA scores of the students (p=0.024). Clinical safety issues and understanding human & environmental factors were the highest safety domains (3.92±0.67), (3.91±0.52). There was a statistically significant difference between the classroom and clinical setting in risk management domain (p=0.033). Conclusion: For safe and effective patient care, nursing students should acquire the necessary competencies to navigate complex clinical environments and contribute to positive patient outcomes.

Fostering Proficiency in Essential Skills among Emergency Medicine Residents through Simulation-Based Education

Introduction: Simulation-based education has become a crucial element within emergency medicine (EM) residency programs. Medical education places great emphasis on competency-based assessments, and high-fidelity simulation has emerged as an effective methodology to support these assessments. Objective: The Accreditation Council for Graduate Medical Education (ACGME) defines a set of core competencies that healthcare professionals must acquire to ensure the delivery of safe and effective patient care. In our study, we sought to investigate the impact of simulation-based education on the enhancement of ACGME core competencies among emergency medicine residents. Method: We conducted a prospective observational study at our institute, involving all current EM residents. Each month, we conducted a high-fidelity immersive simulation session, featuring three separate scenarios for both first year (R1) and second year (R2) residents. From August 2020 to April 2023, a total of 36 simulation sessions were conducted, encompassing 108 scenarios. To assess performance in clinical and non-technical skills, the expert faculty used our custom-designed objective structured assessment tool, the Emergency Medicine Simulation Assessment Tool (EMSAT). This tool evaluated performance across 15 sub-tasks (9 (60%) clinical and 6 (40%) non-technical skills). Each sub-task was mapped to the ACGME core competency; Patient Care (PC), Medical Knowledge (MK), Practice Based Learning (PBL), Systems Based Practice (SBP), Interpersonal and Communication Skills (ICS), and Professionalism (P). The achieved scores for each competency were converted into percentages for analysis. The data was divided into two groups. The first 18 sessions (54 scenarios) formed phase-I, while the last 18 sessions (54 scenarios) constituted phase-II. A two-tailed paired T-test was utilized to compare the two phases. Our primary outcome measure focused on the improvement observed across all six ACGME core competencies. Results: The paired T-test results revealed a significant and substantial difference in all six core competencies between phase-I and phase-II. The mean scores demonstrated a significant improvement between two phases i.e., PC (M=55.1, M=84.4), MK (M=57.2, M=83.6), PBL (M=60.5, M=88.4), SBP (M=62.2, M=89.7), ICS (M=61.8, M=89.7), and P (M=64, M=89.9). Conclusion: The implementation of high-fidelity immersive simulations in the training of emergency medicine residents yielded remarkable advancements across all six ACGME core competencies.

Optimizing Healthcare Organization Performance via Comparative Studies: Global Trends, Challenges and Future Research Directions in Health Economics

Health economics research and evaluation has demonstrated its key role in shaping global health. Patient care quality and safety measures coupled with the balance of equity of care and cost efficiency are essential to help countries to achieve high quality and productivity in their performance. Furthermore, data science coupled with artificial intelligence plays a pivotal role in conducting rigorous comparative studies guided by sound theoretical perspectives in selecting appropriate data and predictive models. With the assistance of quantum computing technology, it is promising that new insight could be gained from longitudinal study design and analysis of both micro- and macro-predictor variables of efficiency and effectiveness to optimize health organization performance.

Knowledge, Attitudes, and Awareness of Food and Drug Interactions (FDI) Among Nurses on General Medical Wards: A Cross-Sectional Study.

Food and nutritional supplements can interact with medication and cause drug interaction. Registered nurses play an essential role in patients' safety related to drug interaction. Explore nurses' knowledge, attitudes, and awareness regarding food-drug interactions (FDIs). A cross-sectional survey was conducted among nurses working in the general medical wards at Hamad General Hospital (HGH) in Qatar. The survey questionnaire comprised 50 multiple-choice questions, encompassing three key sections: (a) demographic details, (b) assessment of FDIs knowledge, and (c) exploration of beliefs, attitudes, and practices concerning FDIs. A total of 227 surveys were collected. Nurses' average score for FDI knowledge across all responses was 20 out of 34 (IQR 16-25). Notably, there were no statistically significant differences in average scores based on respondents' demographic subgroups. While nurses displayed a high level of knowledge (over 90%) regarding the timing of food and drug intake for proton pump inhibitors, nonsteroidal anti-inflammatory drugs, and thyroid hormones, they exhibited limited awareness of the possible FDIs related to carvedilol and furosemide. Approximately half of the participating nurses (56.4%) rated their FDI knowledge as satisfactory. However, only 42.3% claimed to be always educating patients about FDIs in their daily practice. Two-thirds (67.4%) of respondents believed educating patients about FDIs should primarily fall under the responsibility of pharmacists. This study highlights the nurses' knowledge, attitudes, and beliefs of FDIs. Prompt intervention is required to enhance the nurse's awareness and knowledge in this domain which may impact patient care and drug safety.

Enhancing radiation safety and efficiency in nuclear medicine through automated drug dispensing systems: A feasibility study with staff acceptance analysis

Nuclear medicine, a vital component of modern healthcare, harnesses the power of radioactive isotopes to enable precise diagnoses and treatments. However, the handling of radioactive materials poses inherent risks. This study introduces an automated drug dispensing system (ADDS) within a nuclear medicine department to enhance safety and efficiency. The research comprehensively evaluates ADDS implementation’s financial and operational feasibility, considering staff perceptions and acceptance. Findings reveal that RESCUEDOSE, an ADDS solution, offers a cost-effective, safety-enhancing option with rapid investment returns. Staff members exhibit favorable acceptance, contingent on adequate training. This study contributes to the broader trend of automation in healthcare, emphasizing its potential to elevate patient care and radiation safety.

Potential drug-drug interactions between discharge medication from the emergency department and home medication in tertiary hospital

Objective: This retrospective analysis aimed to comprehensively examine the age distribution, gender prevalence, comorbidity patterns, and potential drug-drug interactions among discharged emergency department (ED) patients. By elucidating these factors, the study would contribute valuable insights for improving patient care and medication safety. Methods: The study used retrospective data collection and analyzed cross-sectional data of patients discharged from the ED at King Abdullah Medical City from January to February 2023. Results: The results showed that the majority of discharged patients were between the ages of 36 and 50 years (56.4%) and had a balanced gender distribution. The most common department of discharge was cardiology (42.1%). The analysis also revealed that 68.5% of patients had 3 to 6 comorbidities. The study found significant associations between discharge status and potential drug-drug interactions (DDIs), with patients discharged against medical advice having a higher incidence of potential DDIs (p = 0.037). Conclusion: The study highlighted the importance of training emergency physicians to use hospital systems to identify and prevent potential DDIs. The prevalence of DDIs between prescribed ED medication and home medication was found to be high. The study suggested that discharge status and DDI severity are significant factors influencing the frequency of potential DDIs.

Factors associated with care omission and patient safety climate.

To identify the factors associated with the omission of nursing care and patient safety climate. A cross-sectional study developed at a university hospital in the Brazilian Center-West, between September and December 2022. The MISSCARE-Brazil and the Safety Attitudes Questionnaire were applied to a convenience sample of 164 nursing professionals. The most omitted care was walking three times a day or as prescribed (66.5%). The overall score of the Safety Attitudes Questionnaire was 63,8 (SD: 12,6). The level of satisfaction (p<0.018) and the perception of professional adequacy (p<0.018) were associated with the omission of nursing care and the patient safety climate. The study showed a high prevalence of omission of care and unfavorable perception of the patient safety climate, mainly associated with professional adequacy for work performance.

Missed nursing care and associated factors among nurses working in public hospitals of Wolaita Zone, 2023: Mixed-method study design

BackgroundMissed nursing care encompasses any aspect of care that is either partially or entirely omitted, delayed, or inadequately carried out. This acknowledged concealed issue poses a serious risk to patients, potentially leading to adverse consequences. So, identifying magnitude of missed nursing care is important to enhancement of nursing care quality and patient safety. The main focus of the study was to assess the extent of missed nursing care and examine into the factors that contribute to it. MethodFrom June 10 to July 10, 2023, a mixed study design was implemented among nurses working in public hospitals of Wolaita Zone. Participants were randomly selected using computer-generated random numbers from each working unit and purposive sampling was used for in-depth interview. The results are presented in frequencies, means, and medians. A binary logistic regression model was utilized to evaluate the effects of independent variables on the outcome variables and content thematic analysis were done using the four-step approach of thematic analysis. ResultThe level of missed nursing care was 54.9%. It was significantly associated with availability of resource, nursing teamwork, and job satisfaction. In qualitative analysis, Nurse related factor, Institution related factor, and patient related factors were emerged from the thematic analysis. ConclusionThe prevalence of missed nursing care was notably high, Nurses are encouraged to engage in effective communication and collaborate closely with fellow nurses and healthcare professionals to reduce instances of missed care.

Effectiveness of Jigsaw Learning Strategy on Administration of Pediatric Medications among 3rd Year BSc Nursing Students Posted in Pediatric Wards at Selected Hospital, Mysuru

Background: Patient safety and quality care are issues of major concern worldwide and are significant challenges facing healthcare systems, clinical practice and Nursing education. Administering medications to children is a unique challenge requiring specialized knowledge and skills. Each child’s age, background and level of physical and psychosocial development must be considered. Children are at increased risk of medication errors. This is due to a combination of factors including the need for calculation to be performed at all stages of the process. Reducing medication errors and increasing patient safety has recently become a really critical issue in nursing. Improving medication administration skills of nursing students takes an important place in nursing education systems too. Objectives: To evaluate the effectiveness of Jigsaw Learning strategy on knowledge regarding administration of pediatric medications among 3rd year BSc Nursing students posted in pediatric wards at selected hospital, Mysuru, Karnataka. Methodology: A pre-experimental design and evaluative approach was used in the study. The data was collected from 50 subjects through simple random sampling technique. Data was collected using structured questionnaire. Results: Findings of the study concluded that majority 31 (62%) of the subjects had moderately adequate knowledge and 19 (38%) of the subjects had inadequate knowledge regarding administration of pediatric medications in the pre-test. Where as in post-test, majority 45 (90%) of them had adequate knowledge and 5 (10%) of them had moderately adequate knowledge. Hence the study concluded that, the Jigsaw learning strategy was effective in enhancing knowledge regarding medication administration among 3rd year BSc Nursing students. Therefore, the study reinforces the need to organize health campaigns and teaching programs which sensitize the 3rd year BSc Nursing students to enhance the knowledge regarding administration of pediatric medications among 3rd year BSc Nursing students. Conclusion: Findings of the study show that there was a significant difference in pre-test and post-test level of knowledge of 3rd year BSc Nursing students posted in pediatric wards. Hence it is concluded that the Jigsaw Learning strategy is effective in improving the level of knowledge of 3rd year BSc Nursing students posted in pediatric wards. There was no significant association between level of knowledge of 3rd year BSc Nursing students posted in pediatric wards and selected demographic variables such as Age, gender, type of family, source of information and religion.