Safer Health Care System Research Articles

Assessing the Level of Knowledge Regarding Medication Errors among Nurses in Karachi, Pakistan

One of the key elements influencing hospital service quality and decreasing patient safety in healthcare systems is medical error. In the healthcare industry, medication errors are a frequent source of harm and fatalities. Objective: To assess the level of knowledge among nurses regarding medication errors. Methods: This cross-sectional study was conducted in a tertiary care hospital in Karachi among 120 nurses from January 2024 to March 2024. Participants were selected through a convenient sampling technique. The sample size was calculated by open EPI softer by taking into consideration a 95% confidence level and a 5% margin of error. The data were entered and analyzed by Statistical Package Social Sciences software version 26. Results: According to the study results, 14 (12%) of the participants had a low level of knowledge, and 37 (31%), had a moderate level of knowledge. while 69 (57%) had a high level of knowledge regarding medication errors. Conclusion: This study concluded that most of the nurses had a high level of knowledge regarding medication errors.

A crucial step towards a safer healthcare system: Embracing the WHO surgery checklist in Pakistan.

Mistakes happen. We all make mistakes that makes us human. But when a surgeon makes mistake, it costs lives. Being surgeon, a little negligence might make catastrophic incidents happen. An unintentionally retained needle in the abdominal cavity or surgery of a normal limb instead of faulty gall bladder can have serious consequences not only for the patient and the patient-physician relation but also for the healthcare system. Such negligence events have become common in Pakistan. In Faisalabad, it was reported that a patient with gall stones was mixed up with a patient of limb surgery having the same name that led to inappropriate surgical procedures performed on both.[1] In Abbottabad, an incident was reported where the patient had to undergo an arm surgery but an eye surgery was performed in a private hospital. [2] Everyone blamed the surgeon and the health care system but no one dared to dig into the cause. Why are such childish mistakes happening? And if happened once how is this being repeated? How could a surgeon, a practically learned man make such non-sense? The answer to all these questions lies in the WHO Surgical Safety Checklist. “Safe Surgery Save Lives” was initiated by the World Health Organization (WHO) in 2007 in order to alleviate the number of such unwanted events encountered in the surgical procedures. For the purpose of improving patient safety with least of the resource utilization, WHO came on board with safety checklist in 2008.[3] The WHO 19-item checklist is based on advocating safety checks and a good communication among surgery team members during perioperative periods. It also contains a time-out procedure. In Pakistan, in spite of the great effectiveness, the time-out is either not practiced or is done by some junior, and not by the operating surgeon at the preoperative time. A time-out is a short interval before incision during which it is confirmed that the patient on the surgery bed is the correct one, the procedure to be performed on it is exact and at the required part of body either marked or unmarked.[4] The surgeon should be present at the time-out and all members should guarantee the correct patient, procedure and site. Patient participation in the time-out process is also advised. Majority of the patients show great compliance and satisfaction for participating in the time-out procedure. ---Continue

Incorporation of Trauma-Informed Care Into Entrustable Professional Activities for Medical Student Assessment.

Trauma-informed care (TIC) provides a medical framework for addressing and mitigating the negative consequences of trauma. In response to student and faculty advocacy, medical schools are developing trauma-informed curricular content. However, medical education literature does not present a comprehensive assessment rubric to evaluate medical students' acquisition of trauma-informed clinical skills. A committee of medical students, trainees, and faculty developed a longitudinal TIC curricular theme at Harvard Medical School (HMS). Guided by the National Collaborative on Trauma-Informed Health Care Education and Research competencies, the committee created a set of medical student TIC competencies from July to December 2019. From November 2021 to November 2022, 3 committee subgroups generated new TIC descriptors for each HMS entrustable professional activity (EPA), then circulated these to other subgroups, external experts, and stakeholders for review and feedback. From April to June 2023, the committee iteratively reviewed the materials until reaching consensus for content and pedagogy. The committee integrated TIC content into HMS's existing EPAs expected of students, provided anchoring descriptions of each level, and achieved consensus using a process of iterative review with TIC content experts. The committee identified 10 TIC competencies and revised all 13 general HMS EPAs to include specific items based on these competencies. The committee incorporated at least 1 trauma-informed competency into each HMS EPA. This novel set of HMS EPAs provides a framework for assessment of TIC clinical skills. Faculty will be trained to correctly and reliably incorporate TIC competencies into patient care and to use the TIC-inclusive EPAs for student assessment, ensuring that TIC is standard medical practice at HMS. This work may facilitate the adoption of trauma-inclusive EPAs by other institutions to educate the next generation of physicians to practice TIC and thus promote a more accessible, safe, and equitable health care system.

Integration of Ethereum Blockchain with Cloud Computing for Secure Healthcare Data Management System

Effective management of health data is critical in this age of digital change. In order to solve the issues with safe healthcare data systems, this paper suggests a brand-new Hybrid Healthcare Data Management System (HDMS) that seamlessly combines blockchain and cloud computing technology. The solution guarantees the safe storage and effective administration of health data by utilizing the scalability and flexibility of cloud computing. The Ethereum blockchain, which offers immutability through smart contracts for data integrity assurance, is used to improve security. Important components of the suggested approach include Blockchain Anchoring, which uses distinct hash references on Ethereum to ensure data integrity, Google Cloud Integration for scalable storage and immediate data access, and compliance with Health Level 7 (HL7) formatting criteria for medical data storage. Robust privacy safeguards include cutting-edge methods like decentralized identifiers (DIDs) and homomorphic encryption, which guarantee secure computations on encrypted data and trustworthy identification for allowed access. IPFS file storage is used by the system to improve security by providing redundancy and resilience. By utilizing blockchain's immutability and cloud storage's distributed architecture, HDMS demonstrates resilience against disturbances. Results of the proposed method is implemented in Python Software. The Homomorphic approach that has been suggested continuously beats Optimized Blowfish Algorithm (OBA) in terms of encryption and decryption times. The improvement in encryption is between 3000ms (10 kb) and 1350ms (40 kb). The enhancement demonstrates improved efficiency across data sizes, ranging from 4000ms (10 kb) to 3350ms (40 kb) in decryption. The goal of HDMS is to create a future in which patient outcomes are enhanced by the appropriate handling, storage, analysis, and use of medical data.

Balancing pediatric device utility and harm: navigating the challenges for safer healthcare.

This article discusses the challenges in balancing the utility and harm associated with pediatric medical devices. Takashima et al. explored the prevalence and complications of invasive devices across three Australian pediatric tertiary hospitals and reported a high prevalence of complications, particularly with vascular access devices. We also highlight the need to pay attention to the use of these devices, particularly intravenous catheters, and the importance of a culture of patient safety in healthcare systems. We emphasize the need for a nuanced approach that carefully weighs the benefits against potential risks and encourages collaboration among stakeholders to establish robust regulatory frameworks and prioritize the safety and well-being of pediatric patients. Finally, we conclude by advocating the involvement of parents and families in gathering information about hospital safety incidents and fostering a culture of safety that supports reporting, flexibility, and learning. IMPACT: Reporting adverse events and their consequences is essential in the strategy to prevent them, allowing comparison with national or international standards, and identifying indicators to optimize and harbor the possibility of determining improvement measures that pursue a multifactorial approach and are cost-effective. Our comment advocates limiting the prevalence of medical invasive devices and their consequences by reviewing their epidemiology. Although advancements in medical technology have undoubtedly improved the diagnostic and therapeutic possibilities, the delicate balance between device utility and potential harm necessitates careful consideration.

The Attitudes of Emergency Department Nurses towards Patient Safety in Alqassim Region, Saudi Arabia: A Questionnairebased Cross-sectional Study

Introduction: Patient safety is a crucial aspect of healthcare delivery, and nurses play a critical role in ensuring that patients receive safe and high-quality care. As healthcare systems continue to evolve, it is essential to understand the attitudes and perceptions of nurses towards patient safety. Aim: To explore emergency department nurses’ attitudes toward patient safety in the Alqassim region, Saudi Arabia. Materials and Methods: This was a cross-sectional study involving 420 emergency department nurses from the hospitals of the Alqassim region, Saudi Arabia. The World Health Organisation (WHO) patient safety questionnaire, specifically tailored for nurses, was employed. Data analysis was conducted using Statistical Package for Social Sciences (SPSS) version 25.0. Results: Total of 139 nurses out 420 completed the research. Most participants were males aged between 22 and 30 years, married, and held a Bachelor of Science in Nursing (BSN) degree. The overall average score for patient safety reached a moderate level, with a mean of 118.66±23.33. The component on workplace safety had the highest average score of 32.33±7.40, while the section on personal attitudes towards patient safety had the lowest average score of 15.02±3.72. Conclusion: Nurses exhibited moderate attitudes towards various aspects of patient safety, including error and patient safety, healthcare system safety, and personal attitudes towards patient safety. Enhancing patient safety measures is crucial for fostering a resilient safety culture in the healthcare sector.

Biosafety in Nursing Practice

Biosecurity is essential in healthcare to protect patients, staff and the community from infectious diseases. In this context, nursing is crucial, as professionals are on the front line implementing safe practices to prevent infections. Hospital complexity and new diseases, such as COVID-19, have emphasized the need to strengthen biosecurity strategies. Nurses must be trained and actively involved in biosafety education. This paper discusses the intersection between biosafety and nursing, exploring fundamental principles and providing a comprehensive view of how they complement each other to create a safe and resilient healthcare system capable of responding to current and emerging biological threats.

An Approach Based on Machine Learning for the Cybersecurity of Blockchain-Based Smart Internet of Medical Things (IoMT) Networks

This paper presents a hybrid blockchain architecture for Internet of Medical Things (IoMT) systems, aiming to enhance their security and performance. The proposed approach combines artificial intelligence (AI) models with blockchain technology to create a safe and efficient healthcare system. The study focuses on addressing the challenges related to data storage, data management, real-time medical applications, and system precision in IoMT. Through experimental evaluations, the effectiveness of the proposed techniques in terms of communication overhead, transaction performance, and privacy preservation is demonstrated. The results highlight the potential of leveraging AI and blockchain to improve the overall functionality of IoMT systems.

Cancer Patients’ Experience of a Patient-Safe Pathway Is Associated with Health Literacy and Support from Relatives: A Cross-Sectional Survey

Introduction. The aim was to assess the impact of cancer patients’ health literacy (HL) on their experience of patient safety. Furthermore, we investigated whether support from relatives affected cancer patients’ experiences of patient safety. Methods. A cross-sectional study was conducted using questionnaire data from the Danish National Cancer Patient Survey 2017 among Danish cancer patients (n = 5,389) and sociodemographic characteristic data from national registries. Results. A low level of HL is associated with increased patient safety errors among cancer patients regarding patient-reported adverse events and an experience of inadequate information. Results also showed increased odds of patient safety risks among patients with no support from relatives. Conclusion. Having a low level of HL or no support from relatives has a negative impact on patient safety. Focusing on improvements related to cancer patients’ HL and supportive network may increase patients experiencing a high quality and safe health care system and reduce inequalities and inequity in the cancer pathway.

A pilot of a veteran suicide prevention learning collaborative among community organizations: Initial results and outcomes.

Veteran suicide remains an ongoing public health concern in need of fresh, community-based initiatives. The Department of Veterans Affairs (VA) has built an enterprise-wide integrated behavioral health system that has pioneered numerous suicide prevention methods. However, most Veterans receive healthcare outside the VA, from organizations that may not be equipped to address Veteran suicide risk. One solution is implementing a VA/community suicide prevention learning collaborative to support organizations in implementing suicide prevention best practices for Veterans. Although learning collaboratives have a history of supporting improved patient safety in healthcare systems, to our knowledge, none have focused on Veteran suicide prevention. The current quality improvement project sought to pilot a VA/community suicide prevention learning collaborative in the broader Denver and Colorado Springs areas with 13 organizations that served, interacted with, or employed Veterans. The collaborative had a large footprint in the region, with organizations interacting with over 24,000 community members and over 5000 Veterans. Organizations implemented 92 Veteran suicide prevention program components within a 16-month period. Overall, the learning collaborative made significant strides in Veteran suicide prevention. Findings suggest that this method facilitates rapid implementation of Veteran suicide prevention practices and may be promising for accelerating uptake within communities.

The Role of Blockchain in Medical Data Sharing

As medical technology advances, there is an increasing need for healthcare providers all over the world to securely share a growing volume of data. Blockchain is a powerful technology that allows multiple parties to securely access and share data. Given the enormous challenge that healthcare systems face in digitizing and sharing health records, it is not unexpected that many are attempting to improve healthcare processes by utilizing blockchain technology. By systematically examining articles published from 2017 to 2022, this review addresses the existing gap by methodically discussing the state, research trends, and challenges of blockchain in medical data exchange. The number of articles on this issue has increased, reflecting the growing importance and interest in blockchain research for medical data exchange. Recent blockchain-based medical data sharing advances include safe healthcare management systems, health data architectures, smart contract frameworks, and encryption approaches. The evaluation examines medical data encryption, blockchain networks, and how the Internet of Things (IoT) improves hospital workflows. The findings show that blockchain can improve patient care and healthcare services by securely sharing data.

“You just want to feel safe when you go to a healthcare professional:” Intimate partner violence and patient safety

Since the early 1990s, researchers and policymakers in the United States have addressed the concept of patient safety in healthcare systems. Traditionally, scholars have conceptualized patient safety as health care that is free from medical error and harm. However, sociologists have called for a more complex understanding of patient safety that includes relational aspects of safety. Although marginalized groups face unique threats to safety, intimate partner violence (IPV) survivors have been largely overlooked within the literature on patient safety. This study addresses that gap. Using the case of IPV, I find that survivors construct healthcare spaces as ideologically safe, but their experiences do not reflect this. Survivors' narratives reveal that patient safety is complex, multi-faceted, and relational. I argue that experiences of safety, or lack thereof, are situated within larger systems of organizational power, relational power hierarchies, and systems of inequalities. These findings have implications when considering how to improve IPV survivors’ safety in healthcare settings.

Preserving the sanctity of the physician peer review system

A just, equitable, and credible peer review process is the cornerstone of a high quality and safe Health Care System. The importance of an unbiased and protected Peer Review System is codified in the Health Care Quality Improvement Act of 1986

Preserving the Credibility of the Physician Peer Review System

A just, equitable, and credible peer review process is the cornerstone of a high quality and safe Health Care System. The importance of an unbiased and protected Peer Review System is codified in the Health Care Quality Improvement Act of 1986, HCQIA. However, the peer review process may go wrong when in the new landscape of healthcare which is dominated by large hospital organizations and the big business of medicine, the peer review system may be misused for reasons other than to ensure compliance to the highest standards of professionalism in the interest of the public and the profession. In those instances, due to the immunity protection, which is afforded by HCQIA, contrived allegations of incompetence or disruptive behavior may be used to retaliate against physicians. Most physicians are not familiar with these complex issues which can affect their careers. It is time for a comprehensive discourse among physicians and healthcare attorneys with the singular goal of preserving the legitimacy of Peer Review.

Patients Experience with Telemedicine during COVID-19 Pandemic in a Tertiary Cancer Center in Qatar

Background: The Coronavirus-19 is an ongoing global pandemic that to date, has resulted in over 5 million deaths with more than 240 million cases worldwide. COVID-19 has caused a major burden on public health; however, it simultaneously shed the light on pre-existing gaps within current health care systems worldwide. Health care systems were burdened through both inpatient as well as outpatient settings, with a notable decline in outpatient clinic follow ups. Fortunately, many innovated solutions were being created to tackle the may barriers, one being telehealth. Telemedicine is the provision of medical information exchanged via electronic communication. This is done through a growing variety of services, such as audio or video calls, emails, and other forms of telecommunication. It is a promising means that can provide care to a selected group of patients, particularly cancer patients who are at a higher risk in comparison to the general population. It provides a safe and alternative route to combat patient care while minimizing their risk of exposure. In this study we provide insight to patients experience with telemedicine through this pandemic. Methods: We conducted a cross-sectional study on 279 (RR:85%) patients in tertiary cancer care center National Center for Cancer Care and Research (NCCCR) in Qatar. Our inclusion criteria included patients following regularly by telemedicine in outpatient clinics during COVID 19, patients aged 18 years and above, ability to complete the questionnaire over the phone and with no language barriers. We excluded patients who did not respond to the phone call after 5 attempts (at different times on different days), patients who were abroad, patients who did not consent to answer the questionnaire and patients who had expired. Data was collected through phone calls whereby a standard introductory script followed by a survey questionnaire was read by the physician to patients. We focused on patients' experience with telemedicine services amid the pandemic. This was done by using 7 questions that were scaled from 1 through 6, using a six-point Likert scoring system. It was divided into two main categories; category 1 comprised of patients' demographics and category 2 comprised of 7 questions on their feedback and satisfaction scale. Results: Over a period of 6 weeks, 297 patients were contacted over the phone to answer the survey questionnaire (Table 1). The cohort of patients included 46.1% with solid tumor malignancy, 38.4% with benign hematological conditions and 15.5% with hematological malignancies. More than 80% of patients somewhat to strongly agreed that telemedicine met their care needs, improved their confidence in their health care system, and were generally satisfied with the quality of care provided. It was evident that the level of communication through telemedicine was not compromised over the phone as 89% of patients somewhat to strongly agreed they could freely talk; 90% understood their physicians' recommendations and more than half of the patients (89%) felt they could freely communicate their concerns. Although 88% of participants were somewhat to strongly satisfied with their telemedicine experience; if given the choice most would prefer in person consultations over teleconsultations (68% vs. 32%, respectively). Having said that, 90% would still be willing to take part in future teleconsultations. Conclusions: Telemedicine is a revolutionary system that has pioneered a new era for delivering patient care. Integration of telemedicine-based care into our standard practices in the future, could potentially provide a safe health care system in addition to being time and cost-effective for health sectors and patients alike. Our study indicates an overall positive experience among patients towards the use of telemedicine. Although our data did show that patients preferred in-person visitations majority were not opposed to future teleconsultations. Cancer care providers may explore the reasoning as well as solutions for this with future studies. We as health care professionals should look to implementing patient as well as physician education so that we may expand the telehealth approach in the future. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

An attack Resistant Privacy-Preserving Access Control Scheme for Outsourced E-pharma Data in Cloud

Key Aggregate Cryptosystem was used to construct a safe and scalable healthcare data exchange system in the cloud (KAC). KAC offered single-key encryption and decryption rights delegation for any group of ciphertexts utilizing an aggregated secret key. However, leakage of delegation keys and a specified bound on number of maximal ciphertext classes were major issues with KAC.The Scalable and Strengthened -KAC (SSKAC) approach was created to decide the number of ciphertext classes using an elliptic curve dynamically while simultaneously boosting the security level of KAC by utilising double encryption. Access control is crucial because the majority of healthcare data is extremely sensitive and should only be accessed by those who are permitted. As a result, SSKAC includes attribute-based access control with anonymous authentication to give access control on health data with anonymous authentication. However, the access policy may expose end-user privacy to an attacker. To tackle this problem,we used the cuckoo filter to disguise the right of entry policy tosafeguard the privacy information of the owner. The inference assault affects medical records. One of the strategies for ensuring data confidentiality from unforeseen data access is inference control. The Individual data privacy is secured through the use of two inference control methods; The Query Set Size Prevention and K-Anonymity.

A High-reliability Organization Mindset.

In 2020, the US Department of Veterans Affairs Connecticut Healthcare System began its journey to becoming a high-reliability organization as part of Veterans Affairs efforts to become an enterprise-wide high-reliability organization through the Veterans Health Administration. The initiative was launched to create safe enterprise-wide health care systems and environments with robust continuous process improvements as a method for providing patients with safer and higher quality care. In this article, the authors describe a continuous process improvement initiative aimed at implementing system-wide initiatives along the journey to becoming a high-reliability organization. The initiatives are described from the perspectives of individuals representing staff from the frontline to executive leadership. The authors believe that the processes, strategies, and example initiatives described can be readily adopted and implemented in other health care organizations along the journey to high reliability.

“The world is so white”: improving cultural safety in healthcare systems for Australian Indigenous people with rheumatic heart disease

ObjectiveTo examine the views of senior health system knowledge holders, including Aboriginal experts, regarding the spaces where elimination strategies for rheumatic heart disease take place: Aboriginal and Torres Strait Islander ways of knowing, being and doing; and biomedical healthcare models. We aimed to support the implementation of the RHD Endgame Strategy by providing some of the ‘how’. MethodsIn‐depth interviews were undertaken with 23 participants. The design of the interview questions and analysis of the data used strengths‐based approaches as directed by Aboriginal researchers. ResultsGiven the dominance of the biomedical worldview, and the complex trajectory of RHD, there is significant tension in the intersection of worldviews. Tensions that limit productive dialogue are juxtaposed with suggestions on how to reduce tension through reflexivity, power shifting and endorsing Aboriginal leadership and governance. Evidence supported cultural safety for RHD care, prevention and elimination as the key action. ConclusionsRecommendations include addressing power imbalances between dominant and minority populations throughout the health system; reform that both supports and is supported by Non‐Indigenous and Aboriginal and Torres Strait Islander leadership. Implications for public healthIncreased understanding of and support for Indigenous leadership and cultural safety will enable implementation of the new RHD strategy.

Healthcare Workers' Resilience Toolkit for Disaster Management and Climate Change Adaptation.

Climate change has been recognised as a multiplier of risk factors affecting public health. Disruptions caused by natural disasters and other climate-driven impacts are placing increasing demands on healthcare systems. These, in turn, impact the wellness and performance of healthcare workers (HCWs) and hinder the accessibility, functionality and safety of healthcare systems. This study explored factors influencing HCWs’ disaster management capabilities with the aim of improving their resilience and adaptive capacity in the face of climate change. In-depth, semi-structured interviews were conducted with thirteen HCWs who dealt with disasters within two hospitals in Queensland, Australia. Analysis of the results identified two significant themes, HCWs’ disaster education and HCWs’ wellness and needs. The latter comprised five subthemes: HCWs’ fear and vulnerability, doubts and uncertainty, competing priorities, resilience and adaptation, and needs assessment. This study developed an ‘HCWs Resilience Toolkit’, which encourages mindfulness amongst leaders, managers and policymakers about supporting four priority HCWs’ needs: ‘Wellness’, ‘Education’, ‘Resources’ and ‘Communication’. The authors focused on the ‘Education’ component to detail recommended training for each of the pre-disaster, mid-disaster and post-disaster phases. The authors conclude the significance of the toolkit, which provides a timely contribution to the healthcare sector amidst ongoing adversity.

COVID-19 Biomedical Waste Management Practices among Medical Professionals in a Tertiary Hospital

Context: The Coronavirus Disease 2019 (COVID-19) pandemic that began in 2019 has affected more than 232 million people around the world with over 4.7 million deaths as on September 30, 2021. Amidst the crisis, there has been increased generation of biomedical-waste (BMW). In April 2021, a 62% rise was observed compared to 123 metric tonnes of waste generated in February 2021. The hospital waste mismanagement has diverse ramifications as it affects the patients, healthcare workers (HCWs), public, environment, and economy. Proper BMW management aims to reduce generation, ensures efficient collection, handling and safe disposal so that it controls infection and improves safety. Aims: The present study was conducted to assess the knowledge among medical professionals regarding BMW segregation, transport, and treatment. Settings, Design, Methods, and Materials: A google formed based survey was done to assess the knowledge regarding management of COVID-19 BMW among HCWs (MBBS students, residents, and consultants) associated with tertiary care hospitals of North India. Results: The knowledge score was : for segregation − 27.4%, 59.6%, and 49.8%; transport from site of generation to site of disposal − 63.6%, 89.1%, and 95.2%; disposal − 29%, 71.9%, and 68.2%; overall score − 41.4%, 67.9%, and 61.3% among the students, residents, and consultants respectively. We found that participants with greater years of experience (residents and consultants) had better knowledge as compared to that of the students (P = 0.032). Conclusion: We found a mean score of 56.9% which is more than that of few low- and middle-income countries but less than that of European countries. The chances of infection directly correlate with lower knowledge score. Appropriate evidence-based, judicious use of PPE as per the settings and guidelines should be followed. Training aspects, periodic evaluation, and assessment should be strengthened, both for practising medical professionals and for students, to ensure a safe and sustainable healthcare system.