Journal of Patient Safety最新文献

Background: Hospital-acquired pressure injuries (HAPIs) are common adverse events with large burdens on patients and health systems. In 2020, during the initial waves of the COVID-19 pandemic, the incidence of admitted patients with HAPIs of stage II and above in our health system rose from 2.92% to 3.80%. In response to rising HAPI rates across our own hospital system, we established a quality aim to reduce HAPIs stage II and above by 50% over 3 years from the onset of the COVID-19 pandemic.

Methods: We designed a multidisciplinary quality improvement HAPI prevention program. Our initiative had 5 key aspects: fostering governance and accountability, providing education and training, changing clinical practice, monitoring data and evaluation, and modernizing environments and equipment.

Results: HAPI rate (outcome measure) declined from 3.8% at the onset of the COVID-19 pandemic to 1.6% (58% reduction, P<0.00001) postintervention. Braden Risk Assessment Tool use (process measure) improved from 88.2% to 92.2%. (P=0.00024). Rate of patient falls with injuries (balancing measure) decreased from 1.5 per 1000 patient days to 1.0 per 1000 patient days (P=0.0009).

Conclusions: Despite working during the COVID-19 pandemic where organizational resources were constrained and infection control practices were heightened, a multidisciplinary QI HAPI prevention program, informed by evidence-based practices and supported by access to real-time data, led to an ∼58% reduction in the HAPI rate.

Objective: To carry out a situational analysis of the medication practices in Brazilian hospitals through the Medication Safety Self-Assessment for Hospitals and the factors associated with better performance in the evaluation.

Methods: This is a multicenter cross-sectional study in which the results of the application of the Medication Safety Self-Assessment for Hospitals, between 2015 and 2020, in 30 Brazilian hospitals were described. In addition, whether the institutional profile was associated with higher self-assessment scores (better performance in the evaluation) was also evaluated.

Results: An average proportion of points obtained of 36.7±10.9% was identified (minimum=11.5%; maximum=59.7%), from a score ranging from 0 to 1826 points. The need to improve the use of devices for the preparation and administration of drug solutions, professional development, and patient education was highlighted. A positive association was identified between higher scores and the large or very large size of the hospitals (P=0.026) and having accreditation certification (P=0.007).

Conclusions: The study made it possible to identify the main weak points and opportunities for improvement of the medication system in the evaluated hospitals, bringing important reflection to national institutions.

Background: It is important for health care professionals to use evidence-based practice during  surgical procedures to ensure patient safety and prevent medical errors.

Aims: The aim of this study was to examine the relationship between surgical nurses' perceptions of their work environment's support for evidence-based practice and their attitudes toward medical errors.

Methods: The descriptive cross-sectional study was conducted between February and May 2023. A total of 105 nurses participated in the study. A personal information form, a medical errors attitude scale, and an evidence-based practice work environment scale were used to collect the data.

Results: It was determined that 92 (87.6%) of the participants used evidence-based practice. It was determined that the answers given by the nurses to the scales had very high reliability, and the mean score of the attitude scale in medical errors was 3.90 (Cronbach-α coefficient 0.770), and the mean score of the evidence-based practice work environment scale was 2.90 (Cronbach-α coefficient 0.840). In addition, according to the correlation, a positive, weak, and statistically significant correlation was found between the total scores of the attitude scale in medical errors and the evidence-based practice work environment scale (P<0.05).

Conclusion: As a result of the study, it was determined that nurses' attitudes toward preventing medical errors were positive and their perceptions of support for evidence-based practice work environments were high. In this direction, it can be said that the attitudes toward preventing medical errors of nurses whose working environment is supported by evidence-based practice can be positively affected and error tendencies in surgical clinics can be reduced.

Objectives: To examine the patient's perspective of the informed consent process, particularly with regards to reading the informed consent form, understanding and recall of the informed consent.

Methods: Between June and August 2022, 281 patients/proxies at King Fahad Medical City, Saudi Arabia, were surveyed within 7 days before having a medical procedure.

Results: In all, 66.2% of patients did not read the consent before signing. Around 76.2% of patients said they fully understood the information given, 14.9% only partially understood, and 8.9% stated that they had not understood. A total of 90.4% of patients were able to recall their diagnosis. About 27.4% were unable to state any benefit of the procedure. In all, 19.9% were unaware if there was an alternative to the procedure. Around 40.6% were unable to state any risks and only 58.4% could remember at least one risk.

Conclusions: A consent may be technically valid even when the patient has little understanding of the process; therefore, we must strive to ensure that we have ethically valid consent. From our findings, we conclude that informed consent has to be provided in an environment conducive to optimal patient understanding, for example, by ensuring that there is adequate time for explanation, preferably a day or 2 before the procedure. Informed consent should not be taken immediately before a (nonurgent) procedure. Secondly, due to the great variance in understanding between patients, it is vital for the physician to assess the patient's understanding of the consent process, this may be achieved using feedback methodology.

Background: PSI-90, a composite measure comprising ten indicators, reflects the quality of care during hospital stays. The Hospital-Acquired Condition Reduction Program (HACRP), a Centers for Medicare and Medical Services (CMS) program, assesses hospital performance based on quality measures, including PSI-90, with financial implications for poor performers.

Objectives: To evaluate PSI events, establish workflows for accurate documentation, and foster collaboration across clinical and administrative teams, with the ultimate objective of reducing PSI events.

Methods: Essential actions involved designating a PSI nurse reviewer and a quality physician advisor, securing the involvement of executive leadership, adopting computer-assisted coding technology, and promoting teamwork among Clinical Documentation Improvement (CDI), coding, and Health Information Management (HIM) teams.

Results: The collaborative efforts yielded a 45% reduction in PSI events, leading to estimated cost avoidance of $1.4 million, and exemption from HACRP penalties. Lessons learned encompassed the importance of executive leadership support, data-driven decision-making, and ongoing education.

Conclusion: This study shows the significance of collaboration, leadership support, and data utilization in PSI reduction efforts. Furthermore, it shows benefit of a surgical quality officer in advancing patient safety, aligning with ACS recommendations.

Objectives: Home assessment and modification are crucial to prevent fall and fall-related injuries, especially in vulnerable subjects. This study assessed the need for home modifications and investigated risk factors associated with home injuries in post-total knee arthroplasty (TKA) patients.

Methods: This study was conducted at the university hospital from July 2022 to July 2023. The patients who had undergone TKA without perioperative complications were recruited. The demographics, clinical data, home environmental factors, needs for home modification, and factors related to home unintentional injury were collected at 2 weeks postoperatively. The analysis was done by using descriptive statistics, and logistic regression.

Results: A total of 140 patients were included. The occurrence of falls within 2 weeks after TKA was 33.57%. The location of falls was the home entrance (29.09%), living room (23.64%), and bathroom (18.18%). About 38.5% of the patients explicitly needed home modifications. Falls were associated with inefficient grab bars [adjusted odds ratio=3.26, 95% CI=1.37-7.81, P=0.008] and lighting (adjusted odds ratio=12.83, 95% CI=1.36-121.34, P=0.026).

Conclusions: Falls among post-TKA patients were frequently occurred. Preoperative home assessment and home modifications should be done in order to minimize risks of falls, particularly in common locations.

Objectives: The objective of this study was to characterize the demographic, social, economic, and clinical factors of trauma surgery patients leaving against medical advice (AMA).

Methods: Data were retroactively obtained from a level-one trauma center in a medium-sized metropolitan area from January 2017 to December 2021. The sample population consisted of patients admitted or treated by the trauma surgical service.

Results: In the 5-year study period, 130 surgical patients left AMA and met the inclusion criteria for this study. The average patient was 38.8 years old. The majority were male (77.7%) and White (47.7%). It was found that 74.6% of patients had insurance, 23.6% were experiencing homelessness, and 6.2% required an interpreter. A large percentage of patients had a past medical history significant for depression (31.5%), anxiety disorders (25.4%), and substance use disorder (68.5%). Analysis of the hospital time course of this patient population indicated that patients were most often admitted to trauma surgery (70.0%) and most often required consults by neurosurgery (28.5%). Procedures were performed for 81.5% of patients and social services were consulted for 60.8% of patients. Only 50.8% of patients who left AMA were noted to receive discharge instructions. Nearly half (44.6%) of the patients returned to a hospital to receive additional care within 1 month of their initial AMA discharge date.

Conclusions: A concerning number of trauma surgery patients left without discharge instructions, possibly leading to a high rate of 30-day hospital readmission. Future studies are needed to examine and further characterize the relationship between discharge protocol and outcomes of patients leaving AMA.