Global journal on quality and safety in healthcare最新文献

Introduction: This study aimed to examine the reporting rate and the factors associated with serious outcomes of patient safety incidents at public hospitals in Malaysia.

Methods: All patient safety incidents reported in the e-Incident-Reporting System from January to December 2019 were included in the study. A descriptive study was used to describe the characteristics of incidents, and logistic models were used to identify factors associated with low reporting rates and severe harm or death outcomes of incidents.

Results: There were 9431 patient safety incidents reported in the system in 2019. The mean reporting rate was 2.1/1000 patient bed-days or 1.5% of hospital admissions. The major category of incidents was drug-related incidents (32.4%). No-harm incidents contributed to 56.1% of all the incidents, while 1.1% resulted in death. More hospitals in the eastern (odds ratio [OR], 12.1) and southern regions (OR, 6.1) had low reporting rates compared to the central region. Incidents with severe harm or death outcomes were associated with more males (OR, 1.4) than females and with the emergency department (OR, 10.6), internal medicine (OR, 5.7), obstetrics and gynecology (OR, 2.4), and surgical department (OR, 5.0) more than the pharmacy department. Compared to drug-related incidents, operation-related (OR, 3.0), procedure-related (OR, 3.5), and therapeutic-related (OR, 4.8) incidents had significantly more severe harm or death outcomes, and patient falls (OR, 0.4) had less severe harm or death outcomes.

Conclusion: The mean reporting rate was 2.1/1000 patient bed-days or 1.5% of hospital admissions. More hospitals in the eastern and southern regions had low reporting rates. Certain categories of incidents had significantly more severe outcomes.

The objective of this article is to describe a simplified process for building and assessing the quality of healthcare-related research questions. This process consisted of three stages. The first stage aimed to select and explore a field of science. This field would be the area for which to identify outputs, such as units of analysis, variables, and objectives. The second stage aimed to write structured research questions, taking into account the outputs of the first stage. In general, the structure of research questions starts with interrogative adverbs (e.g., what and when), auxiliary verbs (e.g., is there and are there), or other auxiliaries (e.g., do, does, and did); followed by nouns nominalized from verbs of research objectives, such as association, correlation, influence, causation, prediction, application; research variables (e.g., risk factors, efficiency, effectiveness, and safety); and units of analysis (e.g., patients with hypertension and general hospitals). The third stage aimed to assess the quality and feasibility of the research questions against a set of criteria such as relevance, originality, generalizability, measurability, communicability, availability of resources, and ethical issues. By following the proposed simplified process, novice researchers may learn how to write structured research questions of sound scientific value.

Introduction: Safe medication administration is a vital process that ensures patients' safety and quality of life. However, reports of medication errors and their solutions are lacking. The aim of this study was to examine the correlation between medication administration safety practices and perceived barriers among nurses in northern Nigeria.

Methods: A descriptive approach to research and cross-sectional design was applied to this study. The study population included nurse employees of the Zamfara State Government in northern Nigeria. Simple random sampling and systematic sampling were used in selecting the respondents of the study. Descriptive analysis and the Spearman rank-order correlation were used in data analysis.

Results: Fewer than 50% of the respondents were found to agree or strongly agree that they identify allergic patients before administering medication. Most of the respondents had agreed or strongly agreed with the following as barriers to medication administration safety practices: lack of appropriate coordination between physicians and nurses, and lack of favorable policies and facilities. There was a very weak positive correlation between medication safety practices and barriers to medication safety practices, and the correlation was statistically significant (r_s = 0.180, P = 0.009).

Conclusion: There was a high level of desirable medication administration safety practices that the respondents followed. Nonidentification of a patient's allergic status and inadequate information on the effects of medications were among the identified medication administration practice gaps. There should be policies guiding medication administration in all hospitals in Zamfara, Nigeria.

Introduction: Face masks prevent acute respiratory infections. Healthcare workers are prone to infections owing to their direct and constant exposure to infected patients. This pioneering study in Bangalore city, analyzed the awareness and attitude of healthcare staff toward using a face mask.

Methods: This observational study was conducted among 290 subjects (mean age, 33.89 ± 7.88 years; male:female ratio, 1:2.67). The study included all the healthcare workers from various departments. Data on basic demographic characteristics, attitude, awareness, and observations on the use of face mask were collected.

Results: A large proportion of the sample were from the nursing department (n = 161, 55.51%). Most of the healthcare workers believed that making wearing a mask mandatory in public was very effective (80%) and 79% believed that wearing a mask could prevent the spread of coronavirus. Most of the healthcare workers said they would wear masks even when not mandatory. Most of them used an N95 mask or an N95 mask along with a surgical mask. Almost all were conscious of wearing the mask above the nose, covering the mouth and chin (289, 99.65%). A significantly higher number of doctors (medical postgraduates) (17, 45.95%, p = 0.01) used two masks when compared with others. Significantly fewer doctors (4, 10.81%) and other healthcare staff (8, 22.22%) reused masks (p = 0.002). Most of them used the mask only once, and those who reused it, cleaned it on alternate days (< 0.001). Sun-drying or air-drying, preceded by washing with detergent or soap, were the cleaning methods used, and most used paper or plastic bags to store the masks when not in use. Most of them did not use hand sanitizer before wearing the mask but followed all other precautions and measures to prevent infection.

Conclusions: Most of the healthcare workers believed the use of masks could prevent virus transmission. A significantly higher number of doctors used two masks when compared with other healthcare staff. Significantly fewer doctors and other healthcare staff reused masks when compared with nurses and technicians.

Introduction: The objective of the study was to achieve continuous improvement in Central Sterile Supply Department (CSSD) management through performance measurements using user satisfaction surveys and interventions.

Methods: A brainstorming session was conducted with the multidisciplinary process improvement team in 2012 on the reasons for dissatisfaction with CSSD services. A baseline survey questionnaire was prepared to assess levels of dissatisfaction for key indicators and to establish target benchmarks for improvement. Charge nurses in the wards were chosen as respondents. The report was presented by the Quality Management Cell (QMC) to the steering committee in the presence of the CSSD managers. Solutions and support were offered to the team for improvement. Similar surveys were conducted in 2014, 2016, 2017, 2018, and 2019 to understand the impact of the changes implemented.

Results: The overall satisfaction of the respondents with the CSSD services increased from 54% in 2012 to 89% in 2019, which is statistically significant (95% Cl: -0.56 to -0.25) with p-value < 0.001.

Conclusion: This exercise helped to build a strong team and create a culture of openness in the CSSD. Improvement measures were data driven and other departments like Radiology and Laundry were motivated to embrace the idea of understanding their user perceptions. This study demonstrates the effectiveness of internal user satisfaction surveys as a valuable tool for continuous quality improvement. This exercise proved beyond doubt that regular monitoring improves quality of services.

Introduction: The aim of this study was to evaluate the change in the healthcare providers' perceptions regarding the World Health Organization Surgical Safety Checklist (WHO SSC) and patient safety in the operating room (OR) at a tertiary hospital in Riyadh, Saudi Arabia.

Methods: This cross-sectional study was conducted at King Abdulaziz Medical City. Data were collected from two years (2011 and 2019) for comparison. The co-investigators distributed a self-administered Likert scale questionnaire in the various operating areas (35 ORs).

Results: The total sample was 461. Number of participants enrolled from both years was 235 (51%) and 226 (49%), respectively. The results indicated a statistically significant difference in the attitude of the participants regarding all aspects of patient safety in the OR when the two periods were compared (p < 0.001). Similarly, healthcare providers' perceptions regarding the importance of the WHO SSC increased from 50% (2011) excellent to 68% excellent (2019) (p < 0.001).

Conclusions: Currently, more healthcare providers recognize the importance of the WHO SSC, and more have a positive attitude toward teamwork, communication, and feeling free to speak out when surgical safety is compromised. All of these cultural changes have positive impact on the overall safety of the OR; however, there are still aspects requiring improvement to provide a safer OR and surgery. Educational interventions regarding the importance of communication and teamwork would improve the safety of surgical care in the OR.

Hospital at Home (HaH) is a sustainable, innovative, and next-generation model of healthcare. From the healthcare management point of view, this model provides cost benefits and quality improvement, and from the physicians' point of view, it helps in providing patient-centered medical care and keeps patients away from hospital admission and its complications. The HaH model was first introduced at John Hopkins in the United States in 1995, which showed very promising results in context to the length of stay, readmission rates, patient satisfaction, and hospital-acquired infections. The HaH model of care provides acute critical care to patients at home and reduces unnecessary hospitalization and related complications. The identified patients for this model of care are elderly patients with chronic conditions and multiple comorbidities. The emergence of technology in today's world and the impact of coronavirus disease 2019 (COVID-19) have increased the demand for the HaH model of care. Although there are many benefits and advantages, the HaH model of care has significant barriers and limitations, such as reimbursement for payment, physician and patient resistance, patient safety, and lack of quantifying research data to support the use of this model. Specific training for the physician, nursing, and other members of the HaH multidisciplinary team is necessary for HaH treatment protocols, along with patient and family caregiver education for those who elect the HaH model of care. HaH is the future of comprehensive healthcare services and helps in achieving the triple aim of access to healthcare, improved quality of care, and reduced cost for healthcare.