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Showing results for tags 'Research'.
Found 951 results
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Content ArticleJones et al. hypothesised that antimicrobial stewardship (AMS) could be enhanced through positive feedback for the behaviors of healthcare professionals. This project aimed to reduce antimicrobial consumption in a Pediatric Intensive Care Unit (PICU) by >5%, with secondary aims to reduce broad-spectrum antimicrobial consumption, and processes related to AMS.
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Content ArticleThe purpose of this study from Kleven et al. was to provide a national estimate of the number of healthcare-associated infections (HAI) and deaths in United States hospitals.
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Content Article
Double checking: a second look (16 November 2015)
Patient Safety Learning posted an article in Process improvement
Double checking is a standard practice intended to improve patient safety. It is used in different areas of health care, such as medication administration, radiotherapy and blood transfusion. Some studies have found double checking to be a useful practice, which has been endorsed by agencies and individuals. The confidence in double checking exists in spite of the lack of evidence substantiating its effectiveness. In this study, Hewitt et al. asks: ‘How do front line practitioners conceptualise double checking? What are the weaknesses of double checking? What alternate views of double checking could render it a more robust process?’ The authors conclude that double checking deserves more questioning, as there are limitations to the process. Practitioners could view double checking through alternate lenses, and thus help strengthen this ubiquitous practice that is rarely challenged. -
Content ArticlePreventing surgical site infections requires knowledge of the sources of wound contamination. One possible source of wound contamination is bacteria aerosolised in diathermy plume (ie, surgical smoke). This study from Leonard Schultz used an experimental model of porcine tissue embedded with Serratia marcescens to determine the extent of viable bacteria present in surgical plume. The results showed that only blended current electrosurgery, not laser plume or coagulation electrosurgery, contains viable bacteria. Further, the study revealed that placing a suction device near the electrosurgical site reduced the number of aerosolised viable bacteria. Therefore, evacuating the electrosurgical plume may help reduce contamination of the surgical wound. Nurses may wish to advocate for the use of air suction devices as one way to protect patients from surgical site infections.
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Content ArticleSurgical site infections continue to represent a costly complication of spine surgery. Studies show that surgical smoke can contain infectious agents, and smoke evacuation systems have demonstrated effective removal of these particles from the operative field. Kreuger et al. reviewed the literature on surgical smoke and to study the effect of a smoke evacuation system on the rate of surgical site infections (SSIs) after spine surgery.
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Content ArticleThe aim of this study from Martinez et al. was to develop and test the psychometric properties of two new survey scales aiming to measure the extent to which the clinical environment supports speaking up about (a) patient safety concerns and (b) unprofessional behaviour.
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Safety climate survey – are we getting better? (12 June 2019)
Patient Safety Learning posted an article in Culture
Organisations working towards a culture of safety need a reliable measure to monitor the success of their initiatives. A Safety Climate Survey was carried out during September 2017 in the Paediatric ward at Daisy Hill Hospital, as part of the S.A.F.E. (Safety Awareness for Everyone) initiative. -
Content ArticleThe aim of this project from Hollis et al. was to improve engagement with the incident reporting process and to encourage staff to raise issues and create a proactive culture of quality improvement. This project demonstrates that a relatively simple intervention can have effect significant positive cultural change in an organisation over a small period of time. By giving frontline staff a mechanism to record issues it is possible to develop a positive culture of grass roots change. Incident reporting can act as a vehicle not only to improve patient safety but more broadly to generate ongoing ideas for quality improvement within an organisation.
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Content ArticleBureaucratic organisational culture is less favourable to quality improvement, whereas organisations with group (teamwork) culture are better aligned for quality improvement. In this study, Speroff et al. determine whether an organisational group culture shows better alignment with patient safety climate.
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Content ArticleBuilding on cultural dimensions of underperforming group homes, Bigby and Beadle-Brown analyses culture in better performing services. In depth qualitative case studies were conducted in three better group homes using participant observation and interviews. The culture in these homes, reflected in patterns of staff practice and talk, as well as artefacts differed from that found in underperforming services. Formal power holders were undisputed leaders, their values aligned with those of other staff and the organization, responsibility for practice quality was shared enabling teamwork, staff perceived their purpose as “making the life each person wants it to be,” working practices were person centered, and new ideas and outsiders were embraced. The culture was charactersed as coherent, respectful, “enabling” for residents, and “motivating” for staff. Though it is unclear whether good group homes have a similar culture to better ones the insights from this study provide knowledge to guide service development and evaluation.
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Content ArticleThis article from Peden et al. reviews of some of the key topics and challenges in quality, safety, and the measurement and improvement of outcomes in anaesthesia. Topics covered include medication safety, changes in approaches to patient safety, payment reform, longer term measurement of outcomes, large-scale improvement programmes, the ageing population, and burnout. The article begins with a section on the success of the specialty of anaesthesia in improving the quality, safety, and outcomes for our patients, and ends with a look to future developments, including greater use of technology and patient engagement.
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Content ArticleA culture of teamwork and learning from mistakes are universally acknowledged as essential factors to improve patient safety. Both are part of the Comprehensive Unit-based Safety Program (CUSP), which improved safety in intensive care units but had not been evaluated in other inpatient settings.
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Content ArticleIn 2008, the UK National Patient Safety Agency (NPSA) made recommendations for safe arterial line management. Following a patient safety incident in their intensive care unit (ICU), Leslie et al. surveyed current practice in arterial line management and determined whether these recommendations had been adopted. They contacted all 241 adult ICUs in the UK; 228 (94.6%) completed the survey. Some NPSA recommendations have been widely implemented – use of sodium chloride 0.9% as flush fluid, two‐person checking of fluids before use – and their practice was consistent. Others have been incompletely implemented and many areas of practice (prescription of fluids, two‐person checking at shift changes, use of opaque pressure bags, arterial sampling technique) were highly variable. More importantly, the use of the wrong fluid as an arterial flush was reported by 30% of respondents for ICU practice, and a further 30% for practice elsewhere in the hospital. This survey provides evidence of continuing risk to patients.
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Content Article
The architecture of safety: hospital design (2007)
Patient Safety Learning posted an article in Design for safety
This paper reviews recent research literature reporting the effects of hospital design on patient safety. -
Content ArticlePatient safety has been considered the heart of healthcare quality. This study from Najjar et al. in Safety in Health aimed to explore relationships between patient safety culture and adverse event rates at unit levels in Palestinian hospitals, and provide insight on initiatives to improve patient safety. The study confirms the idea that a more positive patient safety culture is associated with lower adverse events in hospitals at the departmental levels in Palestine. Further analysis should include a more representative sample to examine the causal relationship between patient safety culture and adverse events incidents.
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Content ArticleImplementation science has a core aim – to get evidence into practice. Early in the evidence-based medicine movement, this task was construed in linear terms, wherein the knowledge pipeline moved from evidence created in the laboratory through to clinical trials and, finally, via new tests, drugs, equipment, or procedures, into clinical practice. We now know that this straight-line thinking was naïve at best, and little more than an idealisation, with multiple fractures appearing in the pipeline.
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Content ArticleEffective teamwork is critical to successful outcomes in pediatric cardiac surgery. Unfortunately, lapses in professional performance and conduct by those who treat paediatric cardiac patients pose threats to quality and safety. One hallmark of a profession is self regulation. Therefore, healthcare leaders need specific means for identifying and addressing those lapses and indicators of unsafe systems or individuals. This article from Pichert et al. describes an initial “near miss” event involving a paediatric cardiac surgeon. While fictional, the case represents a composite of events involving several paediatric cardiac surgeons who practice at different medical centers throughout the US.
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Content ArticleVideo recording technologies offer a powerful way to document what happens in clinical areas. Cameras, and to a lesser extent, microphones, can be found in a growing number of modern operating rooms in the USA, UK and other parts of the world. While they could be used to create a detailed record of what happens in and around the operating table, this is still rarely being done; the vast majority of operations are still only documented in written operation notes. In this paper, Bezemer et al. discuss using microanalysis of videos from the operating room.
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Content ArticleThe biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Borrell-Carrió et al. discuss the principles behind the biopsychosocial model and its application.
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Content ArticleFew empirical studies have directly examined the relationship between staff experiences of providing healthcare and patient experience. Present concerns over the care of older people in UK acute hospitals – and the reported attitudes of staff in such settings – highlight an important area of study. Maben et al. examine the links between staff experience of work and patient experience of care in a ‘Medicine for Older People’ (MfOP) service in England.
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Content ArticleRisk management has a number of accident causation models that have been used for a number of years. Dr Nancy Leveson has developed a new model of accidents using a systems approach. The new model is called Systems Theoretic Accident Modeling and Processes (STAMP). It incorporates three basic components: constraints, hierarchical levels of control, and process loops. In this model, accidents are examined in terms of why the controls that were in place did not prevent or detect the hazard(s) and why these controls were not adequate to enforcing the system safety constraints. Altabbakh et al. present STAMP accident analysis and its usefulness in evaluating system safety is compared to more traditional risk models. STAMP is applied to a case study in the oil and gas industry to demonstrate both practicality and validity of the model. The model successfully identified both direct and indirect violations against existing safety constraints that resulted in the accident at each level of the organisation.
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Content ArticleWe need less research, better research, and research done for the right reasons says D G Altman in this BMJ editorial.
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Content Article
Less research is needed (25 June 2012)
Patient Safety Learning posted an article in Research, data and insight
Guest blogger for PLOS Blogs 'Speaking of Medicine', Trish Greenhalgh, suggests its time for less research and more thinking. -
Content ArticleTraditionally, clinicians present complications at surgical morbidity and mortality (M&M) conferences, and the AHRQ Patient Safety Indicators (PSIs) use inpatient administrative data to identify certain adverse outcomes. Although both methods are used to identify adverse events and inform quality improvement efforts, these two methods might not overlap. This is a retrospective observational study from Anderson et al. of all hospitalisations at a single academic department of surgery (including subspecialties) in 2016 involving a PSI-defined event identified by surgery faculty and residents for review by departmental M&M conference or administrative data. The authors analysed the degree to which these two processes captured PSI-defined events and reasons for exclusion by each process. The study found that surgical M&M and the PSIs are complementary approaches to identifying complications. Both case-finding processes should be used to inform quality improvement efforts.
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Content ArticlePreventable adverse events are an ongoing challenge in healthcare. International studies demonstrate that 3%–17% of admissions are associated with an adverse event (defined as an injury caused by healthcare management resulting in prolonged hospitalisation, disability on discharge or death). Approximately half of the adverse events are preventable. Little is known about adverse events in the Irish healthcare system.Therefore, recommendations on improving patient safety at a national level are being made on limited information. The aim of the Irish National Adverse Events Study (INAES) from Rafter et al. was to quantify the frequency and nature of adverse events in acute hospitals in the Republic of Ireland for the first time using an internationally recognised retrospective patient chart review methodology.
