Journal of Patient Safety最新文献

Background: Physical restraint is commonly applied in the clinical settings despite numerous studies presenting its paucity of efficacy and safety. Despite the various tangible and intangible factors associated with moral and safety issues, nurses must make decisions on restraint use in ethical dilemmas. Health care providers often find it challenging to make appropriate decisions regarding the use of physical restraint in demanding clinical environments without a standard and objective assessment tool.

Objectives: The objectives aimed to identify effective instrument to justify the decision-making regarding the use of physical restraint in general adult ward settings.

Methods: A literature search was conducted on several electronic databases, including Medline, PubMed, CINAHL Complete, Embase, and Cochrane Library, using subject MeSH headings and relevant keywords to identify any relevant studies pertaining to the research question. Only articles written in English from January 2014 to March 2024 were considered. The search was filtered by screening for articles with the full-text availability, cohort studies that are not considered an experimental studies, systematic reviews, or meta-analysis. The reference lists of literatures were also searched to identify any further relevant studies.

Results: Eight studies were included in this review, consisting of 6 cohort studies, 1 stepped-wedge randomized controlled trial, and 1 systematic review. The quality of the studies ranged from low to moderate, with the risk of bias being moderate to high. The interventions retrieved from the included studies can be categorized as restraint decision instruments, restraint preventive interventions and restraint preventive strategies. All included studies reported a significantly improved rate of restrained patients in the intervention group comparing to the control group. The rate of restrained patient days decreased significantly in the intervention group. There was no significant difference in the rate and number of accidental catheter removal, fall incident, and length of stay.

Conclusions: Implementing the evidence-based instrument can help improve patient outcomes, reduce inappropriate use of physical restraint, and provide a structured decision-making process for health care staff. An evidence-based assessment instrument is developed to assess patients who are necessary to be given physical restraint, and further stringent research is necessary to evaluate the effect of such instrument. Training on least restrictive techniques and effective strategies is crucial for nurses to ensure adherence of nurses and appropriate care for patients.

Objectives: A framework of high-reliability principles was used to identify, investigate, and mitigate infusion pump safety concerns at a large, multisite health care system. We developed a systematic approach to address challenges associated with overinfusions, underinfusions, and the inability to clear upstream occlusion alarms. We identified 112,875 upstream occlusion events for 389,604 infusion starts (failure rate, 29%) within 6 months.

Methods: Five high-reliability principles were applied to infusion pump management. Preoccupation with failure emphasized reporting safety concerns and performing appropriate clinical and bench tests. Deference to expertise prompted the development of a multidisciplinary team with internal and external partners. Sensitivity to operations prompted assessment of human factors design, with simulations and analysis of medication-specific factors (e.g., viscosity; infusion rates). Reluctance to simplify prompted assessment of tubing characteristics (e.g., concentricity; wall thickness) with micro-computed tomography and process development for removing faulty equipment. Practice of resilience ensured ongoing engagement and commitment to a culture of safety and patient advocacy.

Results: The multidisciplinary oversight team prompted a national recall, removal of malfunctioning pumps, and development of system-wide training and mitigation protocols. Despite ongoing pump challenges, our team optimized internal patient safety systems and processes. The cause of these malfunctions remains under investigation, but serious patient harm has been prevented.

Conclusions: Key strategies for enhancing patient safety were continuous vigilance, interdisciplinary collaboration, and embracing complexity in a large health care organization. Future directions involve deeply integrating these high-reliability principles across all aspects of health care delivery to continue improving safety and quality outcomes.

Objectives: Care for black patients in the United States is concentrated in relatively few hospitals-known as black serving hospitals (BSHs). BSHs have high rates of safety events. Yet, it is unknown what aspects of patient safety culture are associated with employee assessments of patient safety or reporting safety events, and whether these patterns differ for hospitals predominantly serving black patients.

Methods: We identified hospitals as BSH if their proportion of admitted black patients exceeded the national average (12.1%). We linked BSH status to the 2021-2022 Hospital Survey on Patient Safety Culture 2.0 (HSOPS) data, identifying 128 BSHs and 243 non-BSHs (with 107,224 and 138,028 HSOPS respondents, respectively). We examined the associations of 10 aspects of patient safety culture with 2 summary measures: employee's overall rating of patient safety and whether employees reported safety events. We fit respondent-level models, overall and stratified by BSH status, controlling for respondent characteristics. We used weights accounting for hospital HSOPS observations and to make results nationally representative. t tests were obtained from a model fully interacted with BSH status to test whether the associations for BSHs and non-BSHs were different.

Results: Positive patient safety ratings were most associated with staffing/work pace, communication openness, management support of safety, and organizational learning-continuous improvement. Reporting any event was most positively associated with response to error and most negatively associated with management support. Patterns were similar for BSHs and non-BSHs, except for 4 associations: stronger positive association of organizational learning-continuous improvement with positive patient safety ratings in BSHs. Stronger negative association of staffing/work pace and communication openness with reporting any event in BSHs. Stronger positive association of communication openness with reporting any events in non-BSHs.

Conclusions: Key aspects of creating hospital workplace cultures that engage in identifying events and learning from them to support patient safety differed in BSHs and non-BSHs, warranting further investigation. This knowledge may help mitigate differences in patient safety across hospitals.

Objectives: In recent years, health care resilience has garnered increased attention, particularly since COVID-19. Resilience in health care is commonly framed across four interconnected levels: individual, team, organisational, and systemic. While individual-level resilience is relatively well explored, conceptualisations at other levels remain poorly defined.

Methods: To address this gap, we conducted a scoping review exploring conceptualisations of health care resilience outside of the individual-level using systematic searches of MEDLINE, EMBASE, PsycINFO, and Google Scholar.

Results: From 3734 initial records, 58 met our criteria. Of these, 7 (12.1%) articles did not explicitly define resilience. System-level resilience was the most explored (n=38, 65.5%), followed by organisational (n=12, 20.7%), and cross-level studies (n=8, 13.8%), with no studies exclusively focusing on team-level resilience. Conceptualisations of resilience revealed 5 themes: the goal of resilience; what systems are resilient to; resilience characteristics; its classification as ability, capacity, or capability; and the temporal dimension of resilience. Notably, no distinct patterns emerged specific to a conceptual level, suggesting resilience can be conceptualised across team, organisation, and system levels.

Conclusions: Our findings underscore significant diversity in resilience definitions, indicating an evolving health care resilience paradigm. On the basis of these insights, we propose the following definition, applicable across all levels: health care resilience is the ability to anticipate, absorb, adapt or transform in response to everyday pressures, threats and opportunities to maintain efficient, high quality, and safe performance. A shared understanding of health care resilience would promote the critical imperative for research to bolster health care recovery post-COVID-19 and to prepare for future disruptive events.

Objectives: Congested hospitals are increasingly common. Electronic health (eHealth) and artificial intelligence (AI)-based tools may improve in-hospital patient flow, however their implementation into practice varies. This study aims to identify and synthesize evidence on implementing eHealth and AI-based tools to manage in-hospital patient flow.

Methods: Structured language and keywords related to patient flow and eHealth or AI-based tools were searched in five databases. Studies were eligible if they reported barriers or facilitators (determinants) to implementing eHealth and/or AI-based tools, and/or key metrics for patient flow. Study characteristics, tool characteristics, study population, setting, and outcome measures were abstracted. Information related to determinants of implementation were categorized using the Theoretical Domains Framework and interventions were mapped to the Expert Recommendations for Implementing Change Taxonomy.

Results: Twenty-five studies were included; 40% were quasiexperimental studies and most (n=19) were conducted in the United States. Four categories of tools were identified with imbedding eHealth or AI-based tools into an existing electronic medical or health record being the most common. Barriers to tool implementation were commonly linked to the environmental context and resources (n=5), while facilitators were linked to social influence (n=4).

Conclusions: This scoping review classified the reported barriers and facilitators to implementing eHealth and AI-based tools to improve in-hospital patient flow. Future research on in-hospital patient flow should adopt the identified measures when reporting tool effectiveness. To improve implementation efforts, more consistent reporting of determinants of tool implementation is needed.

Objectives: To explore the range of experiences and opinions of people participating in morbidity and mortality (M&M) meetings at a public health service, and the perceived effects of a structured approach to the meetings on clinician engagement and patient safety culture.

Methods: Semistructured interviews and focus groups were conducted with 13 participants from a large public health service (14,000 staff) in Australia. A semistructured interview guide was used to explore the experiences and opinions of committee chairs and M&M meeting members. Thematic analysis was used to identify key themes from transcripts.

Results: Five themes were identified: (1) purpose, (2) attendance, (3) formality, (4) case selection and review, and (5) leadership and culture. Within these 5 themes, clear differences emerged in experiences between chairs and members and between individual participants. Factors associated with variation in experiences and opinions of participants included the nature and extent of their individual, previous, and current involvement in M&Ms and with the state of development of their local M&M meeting's purpose, leadership, and governance.

Conclusions: A high level of maturity is required for M&M meetings to meet the diverse and competing needs of clinicians and health services. Structural elements such as a meeting agenda and register of recommended actions may assist junior staff and/or staff who do not attend regularly. Reflective and respectful leaders can foster psychological safety for members. Organisations can support their staff with the administration and communications for M&M meetings and help to share the learnings across departments and hospitals through clinical governance systems.

Introduction: To ensure effective care in rare events such as neonatal resuscitation, high levels of system safety and error management are essential. It is thus imperative to mitigate avoidable errors and latent safety threats (LSTs). This study examined the use of safety reports (SR) from 3-day interdisciplinary, high-fidelity neonatal in situ simulation trainings (SIMs) to classify LSTs and assess their recurrence or resolution across successive SIMs.

Methods: We retrospectively screened the SR of 9 Austrian hospitals for LSTs and grouped the identified LSTs into 3 main categories: (1) equipment, environment, and ergonomics (EEE); (2) knowledge, skills and training (KST); and (3) systems, pathways, and resources (SPR). The LSTs from consecutive SR were compared for each hospital.

Results: A large number of LSTs were identified: 271 in 9 initial reports (SR1) and 129 in the 9 follow-ups (SR2). Comparing SR2 with SR1, fewer LSTs were reported in all 3 categories in all 9 hospitals (ranging from -37% to -79%). We detected fewer than half of the number of LSTs in SR2 for EEE (-62%). LSTs in KST were almost halved in SR2 (-45%), and marginally changed in SPR (-10%). A third SR (SR3) obtained in 4 hospitals indicated a further reduction in overall LSTs (-21% to -60%).

Conclusion: This study shows that SIMs effectively reduce LSTs in neonatal care, with SR highlighting significant improvements, particularly in equipment-related issues. SIMs prove to be a valuable tool for enhancing safety and driving continuous improvement in neonatal care settings.

Objectives: To evaluate the longitudinal patterns of the burden of adverse effects of medical treatment (AEMT) in children and adolescents in China from 1990 to 2021.

Methods: Data used in this study were obtained from public data sets of the Global Burden of Disease 2021. AEMT was defined as harm resulting from procedures, treatments, or other contacts with the health care system. The case number, crude rates, and age-standardised rates (ASR) of incidence, deaths, and disability-adjusted life-years (DALYs), grouped by age and sex, were the primary outcomes for evaluating the burden of AEMT in Chinese children and adolescents (<20 y). The Age-Period-Cohort (A-P-C) model was used to analyze the changes in AEMT incidence rate by distinguishing the contributions of age, period, and cohort effects.

Results: In China, the case number and ASR of incidence, deaths, and DALYs in children and adolescents showed significant decreasing trends from 1990 to 2021. In 2021, there were 85,649 incident cases, 369 deaths, and 31,833 DALYs. Age subgroup analysis demonstrated a substantial reduction in the burden of AEMT across 9 age groups. The A-P-C analysis indicated the highest incidence rate of AEMT in children under 5 years of age, and there were predominantly favorable trends in period and birth cohort effects.

Conclusion: Although the burden of AEMT in children and adolescents in China has decreased significantly from 1990 to 2021, patient safety for children under 5 years of age still needs attention, especially for neonates.