Journal of Patient Safety最新文献

Objectives: Understanding the protective factors of general internists' well-being helps maintain a resilient health care system. As human factors engineering (HFE) offers promising solutions to the challenges physicians face, it is essential to explore how internists understand the field.

Methods: A cross-sectional survey focusing on the well-being of general internal medicine physicians was mailed out to a random sample of 1,463 internal medicine physicians using the American Medical Association national database. This study focused on the HFE aspects of the survey.

Results: A total of 655 general internists responded to our survey (44.8% response rate). Out of 632 respondents, more than half (59.5%) believed that HFE has a role in enhancing their well-being as an internist, and roughly one-third (36.1%) were unsure. A qualitative analysis performed for the 176 open-ended responses revealed 15 unique categories, with most internists referencing their benefits for improving leadership quality, developing shared mental models among teams, and optimizing current processes.

Conclusions: Our findings indicate that most internists recognize the potential of HFE to positively impact their well-being, though a substantial portion remain uncertain about its applications and benefits. This highlights a need to conduct systems analyses to identify barriers and facilitators of internists' tasks to design tailored, systemic interventions, such as support from leadership in adaptation, support during patient rounds, and improvements to the EMR system. These systemic improvements in combination with spreading HFE knowledge have the potential to enhance internist well-being.

Objective: Falls are a significant patient safety concern in hospital settings, often resulting in unintended harm. This study aimed to investigate the prevalence and risk factors for falls in Korean hospitals with 200 or more beds, analyzing 13,034 incidents reported to the Korean Patient Safety Reporting and Learning System from 2017 to 2021.

Methods: The level of harm was classified into 3 categories: near-miss, adverse, and sentinel events. Hospital-related factors (hospital type, bed capacity, and location and time of fall incident) and patient-related factors (sex, age group, and admitting medical department) were included in the analysis. χ 2 tests were used to evaluate differences in fall severity, and binary logistic regression identified factors associated with harmful incidents.

Results: The study found that harmful falls were more likely to occur in nontertiary hospitals, particularly those with >500 beds, as well as in emergency departments. Furthermore, older female patients and those admitted to the internal medicine department are especially at risk.

Conclusions: Based on the results of this study, especially in nontertiary hospitals with >500 beds, comprehensive strategies for preventing falls, including the promotion of patient safety culture, are needed to reduce fall occurrence and its associated disabilities.

Objective: This study aimed to analyze the efficacy and safety of peripherally inserted central catheters (PICCs) inserted by the PICC nursing team in the neuro intensive care unit (ICU).

Methods: A retrospective analysis was conducted on 756 patients admitted to the neuro ICU of a clinical neurosciences center in Shanghai, China, between January 2019 and December 2022. All patients required elective central venous access and had a PICC inserted by the PICC nursing team. Data on patient demographics, catheter type, insertion approach, puncture site, tip position, insertion success rate, and complications were extracted from electronic medical records using Questionnaire Star software. The study compared outcomes before and after the implementation of a specialized training program for the PICC nursing team, which included theoretical and practical training on PICC insertion techniques, maintenance, and complications management.

Results: Following the implementation of the trained PICC nursing team, significant changes were observed in catheter type and insertion technique. The use of 3-way valve Solo catheters and power-injectable open-ended catheters increased, while the use of 3-way valve catheters decreased. In addition, the use of ultrasound-guided modified Seldinger technique (MST) increased significantly, with a corresponding decrease in conventional PICC insertion and MST without ultrasound guidance. Malpositioned tips occurred in 6.3% of cases. Notably, after the implementation of the trained team, complications significantly decreased ( P <0.05) and the first-attempt success rate significantly increased ( P <0.05) compared with the period before the training program.

Conclusions: In neuro ICU patients, the use of PICCs inserted by a well-trained, competent PICC nursing team demonstrated improved outcomes, including reduced complications, increased first-attempt success rates, and higher quality of care. These findings highlight the importance of specialized training for PICC nursing teams in neurointensive care management.

To rapidly advance patient safety research, in 2014 the US Agency for Healthcare Research and Quality launched a radically different research initiative by supporting patient safety learning laboratories (PSLLs) using systems perspectives and engineering approaches to advance patient safety. The 5-phase systems engineering methodology uses diverse methods and devotes particular attention to health care safety problem analysis, followed by design, development, implementation, and evaluation. PSLL projects have demonstrated decreases in mortality as well as increases in diagnostic accuracy, reduction in adverse drug events, decreased medication errors, improved early detection of adverse events, and reduction in the number of prenatal adverse events. PSLLs have developed guidance and resources to prevent as well as mitigate patient harm and improve the safety, efficiency, and effectiveness of health care delivery. By fusing approaches ranging from human-centered design to AI-driven analytics applied to health services research, PSLLs have produced influential, evidence-based, scalable interventions that strengthen health care delivery processes and improve outcomes for society, health care organizations, providers, and-most importantly-patients and their families.

Purpose: We combine the results of multiple studies to describe a systems engineering approach to a well-recognized patient safety problem. The goal of the Operating Room Systems-based Medication Administration error Reduction Team (OR-SMART) patient safety learning laboratory was to study the anesthesia medication work system to identify the characteristics of technologies and interventions that might feasibly reduce anesthesia medication errors.

Scope: The work was conducted at 2 large urban academic medical centers: Johns Hopkins and the Medical University of South Carolina. We sampled across many different types of anesthesia work, understanding the challenges of work-as-done, and applying systems safety principles and evaluation frameworks.

Methods: This was a mixed-methods study. Sources of data varied, with formal and informal interviews, formal and informal observations, video-based observations, hospital and national databases, and information from local incidents. Clinically embedded human factors professionals at both hospital sites facilitated informal sources of data. We explored the variable definitions of error; individual and organizational variability in decision-making; how syringes are used, stored, and moved within an operating room (OR); and used the Systems Engineering Initiative for Patient Safety framework to model medication processes. We were able to identify more than 100 possible interventions, and then prioritized a few for development and testing.

Results: We identified medication icon labels, a syringe holder hub, and workspace design guidelines as interventions for evaluation. Significant benefits of medication label icons were found in simulation and were highly utilized in practice. The syringe hub demonstrated high acceptability at one site but substantially less at another. A virtual reality-based evaluation of the OR design found that situational awareness, visual monitoring, and available workspace were subjectively improved.

Objectives: Nonlinear retrospective analytic techniques can allow for in-depth understanding of accidents and their causes, yet they are infrequently used in health care. The purpose of this study was to provide an example, using Causal Analysis based on Systems Theory (CAST) together with an inductive thematic analysis to understand the contextual factors contributing to one hospital's perioperative safety events.

Methods: We created a hierarchical control structure of the hospital's perioperative system with input from a multidisciplinary group. We then analyzed safety events that were self-reported during a COVID surge (April 2020) using CAST to understand their contributing factors. Next, we analyzed the contributing factors using inductive qualitative thematic coding to identify system-level safety risks. We mapped each system-level safety risk to a recommendation for future mitigation.

Results: We screened 122 safety reports and found 19 safety events that met inclusion criteria. The analysis revealed 245 contributing factors represented by 22 subthemes corresponding to 3 major themes: (1) vulnerable processes, being problems with workflows or communication channels; (2) personnel challenges including challenges with staff redeployment as well as cognitive and behavioural challenges; and (3) poorly designed or unavailable equipment. Each subtheme corresponded to a prevention strategy, such as creation of a central protocol hub.

Conclusions: Using a nonlinear accident analysis technique together with thematic analysis, we were able to identify system-wide contributing factors to safety events. These contributing factors led to recommendations for future pandemics or crises characterized by scarce resources, limited data, and a rapidly changing environment.

Objective: This systematic review aimed to identify tools for measuring the quality of medication safety-related processes in nursing homes.

Methods: We systematically searched Medline, Embase, and CINAHL databases to identify studies describing tools for measuring medication safety-related processes or systems supporting medication safety in nursing homes. Databases were searched from their inception to June 2022. For each tool, the individual items included in the tool were mapped to the 9 steps and 3 background processes of the medication management pathway and the methodological quality was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) Instrument.

Results: Four tools for assessing medication safety-related processes or systems in the nursing home setting were identified. The tools varied substantially in terms of development, content (number of key elements and items), focus and quality. Only one tool, the Canadian Medication Safety Self-Assessment for Long-Term Care (MSSA-LTC), addressed all 9 steps and 3 background processes of the medication management pathway and had a high overall quality rating as per the AIRE instrument.

Conclusions: While the Canadian MSSA-LTC tool had the widest focus and highest quality of the 4 tools identified, the choice of a tool by an individual nursing home or care organization will depend on the purpose of the assessment and processes of interest as well as the validity of the tool in the jurisdiction in which it is being used. Awareness of the differences and limitations of each tool in the relevant context should facilitate this endeavour.