Journal of Patient Safety最新文献

Objectives: We aimed to assess possible changes in medication safety over a mandatory pre-/post- COVID-19 clinic slowdown in a high-risk population of patients with diabetes seen at a safety net clinic.

Methods: Retrospective chart review of all patient encounters 1 year before and after the slowdown. The study cohort were all patients with poorly controlled diabetes established pre-COVID-19 who were prescribed 4+ chronic medications. Each clinic note was abstracted for reports of any medication-related problems. The primary outcomes were measures of health care system utilization and potential adverse drug events (ADEs).

Results: Out of 762 patients with diabetes, 59 were poorly controlled and formed the high-risk study cohort: age 53.0±11 years, 69% female, 17% White, 29% Hispanic, and 43% African American. There were similar numbers of patient encounters pre-/post-slowdown (7.68 clinic visits vs. 4.2 clinic visits plus 3.19 telehealth visits), cancellations (2.54 vs. 2.97), and no-shows (2.17 vs. 1.98). There was no change in the number of prescribed medications pre-/post-slowdown (12.1 vs. 11.7), but more potential adverse medication events (6/380 (1.6%) vs. 17/429 (4.0%), P=0.04). Of all abstracted medication-related problems, the majority were in diabetic medications 57/78 (73.1%), and of those, most involved insulin 43/57 (75.4%). Eleven preventable ADEs over the 2-year period were observed, all involved insulin, and were often affected by patient work system challenges such as self-administration and timing.

Conclusions: There was a small increase in potential adverse medication events among a cohort of high-risk patients during the COVID-19 pandemic. The most common ADE was hypoglycemia associated with insulin.

Objectives: Interpersonal conflict between physicians and their coworkers hinders health care organizations today on an unprecedented scale. Most research on physician conflict has been restricted to 2 occupational groups, nurses and administrators. Yet as health care delivery becomes more complex and interdependent, physician interpersonal conflict impacts all occupational groups. Thus, we seek to provide health care managers with specific guidance about how they might eliminate negative effects of physician-related interpersonal conflict for each occupation.

Methods: We examined antecedents and outcomes of physician conflict across 4 occupational groups (office clerical and support staff, professional and technical, nursing, and managerial) in a survey of 1451 US health care employees. Using Multigroup Structural Equations Modeling (MSEM) analysis we estimated each relationship in our model across the 4 occupational groups.

Results: We found that workload, perceived HR climate and patient-related incentives predicted physician conflict, and that physician conflict related to burnout, intention to turn over and psychological safety. Most notably, these antecedents and outcomes varied meaningfully across occupational groups.

Conclusions: These observed differential effects in our results suggest that managers should carefully consider the needs of different occupational groups separately when designing and implementing interventions to prevent and ameliorate physician conflict. In short, the antecedents and outcomes of physician conflict are different for office/clerical, nurses, professional/technical employees, and management groups and therefore require different solutions. In short, it behooves health care organizations to avoid a one size fits all approach to improving workplace relationships.

Objectives: A strong safety culture encourages staff to identify and report safety events and near misses through an incident reporting system. The objectives were to: (1) assess the effectiveness of real-time reporting of safety events for timely identification of trends and improvement opportunities in a rapidly changing environment and (2) determine temporal changes in safety event categories throughout the 4 COVID-19 pandemic waves in Southern California.

Methods: This retrospective study involved all safety incidents reported in patients over age 18 related to the care of COVID-19 through the hospital's incident reporting system, CS-Safe from March 17, 2020 to February 25, 2022.

Results: There were 5843 suspected and confirmed COVID-19 cases across the 4 waves. The reported events primarily were associated with patients between the ages of 65 and 84 years, with the majority (62.7%) male, white (65.4%), and non-Hispanic (73.5%). Most events reported were related to clinical care issues (41.6%). A difference in the rates of safety incidents was observed across the waves. The highest rate of medication management-related safety incidents was in wave 2 (0.25 incidents/1000 d) and the highest rate of incidents occurred in critical care in wave 3 (1.20 incidents/1000 d).

Conclusions: The alignment of COVID-19-related safety incidents across the 4 waves with the occurrences during this time demonstrates the value of real-time reporting in identifying trends and opportunities for improvement in a rapidly changing environment. Hence, real-time assessment of events can be valuable in concurrently addressing demands during unprecedented situations.

Objectives: Patient experiences are focal points in the discourse around medical errors and patient safety, with social media offering new avenues to explore them. This study aimed to understand patient and family perspectives through a mixed-method analysis of posts made to a public Facebook group focused on patient safety.

Methods: A total of 200 posts posted between November 21, 2022 and June 23, 2023 were manually extracted and double-coded by 2 independent human coders using a systematically developed codebook. Frequencies were calculated and χ2 tests were performed to analyze associations between codes. A grounded theory approach was used to qualitatively analyze key themes in the posts.

Results: Of the 141 posts deemed relevant to patient safety, the majority (85%) included links to external news sources or information, rather than direct accounts of personal experiences. The most frequently discussed error types were surgical errors (28%) and infections (17%). The most frequent content codes were policy and regulatory issues (35%) and patient empowerment and advocacy (33%). Posts containing links had significantly more discussions about empowerment and advocacy, infections in vulnerable populations, and policy and advocacy compared with those without links. Overarching qualitative themes included the personal impact of medical errors, systemic challenges, the importance of empowerment through education, and the role of community support.

Conclusions: This study underscores the importance of online communities in influencing patient safety discourse. Findings support the utility of using social media data for patient safety research and provide unique insights into patient concerns and advocacy efforts.

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: Hypomagnesemia early diagnosis and consequently early, timely magnesium supplementation is of utmost benefit, but it often goes underdiagnosed. The objective was to show and monitor an intervention to identify hypomagnesemia in patients with arrhythmia.

Methods: A cross-sectional study was designed in the laboratory. In primary care patients, the Laboratory Information System would automatically add a serum magnesium test when sample availability is present in any request when a diagnosis of arrhythmia is made. We counted the number of detected patients with hypomagnesemia (serum magnesium <1.7 mg/dL, <0.7 mmol/L), and calculated the cost in reagent of each identified case.

Results: In 430 patients with arrhythmia, serum magnesium was measured, and 41 (9.5%) had hypomagnesemia results. One patient showed severe hypomagnesemia values (<1.2 mg/dL and <0.49 mmol/L). Patients with a deficit were significantly ( P <0.01) older than the total group of patients with normal magnesium values (66.3±13.2 versus 61.6±12.5). Each case represented a cost of 3.15€ in reagent.

Conclusions: The automated computer-based intervention to identify patients with hypomagnesemia was useful and affordable, given the cost per detected case.

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.