Patient involvement in blood transfusion safety: patients' and healthcare professionals' perspective

Background : Blood transfusion is one of the major areas where serious clinical consequences, even death, related to patient misidentification can occur. In the UK, healthcare professional compliance with pre‐transfusion checking procedures which help to prevent misidentification errors is poor. Involving patients at a number of stages in the transfusion pathway could help prevent the occurrence of these incidents. Objectives : To investigate patients' willingness to be involved and healthcare professionals' willingness to support patient involvement in pre‐transfusion checking behaviours. Measures : A cross‐sectional design was employed assessing willingness to participate in pre‐transfusion checking behaviours (patient survey) and willingness to support patient involvement (healthcare professional survey) on a scale of 1–7. Participants : One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 male) and 123 healthcare professionals (doctors, nurses and midwives) involved in giving blood transfusions to patients. Results : Mean scores for patients' willingness to participate in safety‐relevant transfusion behaviours and healthcare professionals' willingness to support patient involvement ranged from 4·96–6·27 to 4·53–6·66, respectively. Both groups perceived it most acceptable for patients to help prevent errors or omissions relating to their hospital identification wristband. Neither prior experience of receiving a blood transfusion nor professional role of healthcare staff had an effect on attitudes towards patient participation. Conclusion : Overall, both patients and healthcare professionals view patient involvement in transfusion‐related behaviours quite favourably and appear in agreement regarding the behaviours patients should adopt an active role in. Further work is needed to determine the effectiveness of this approach to improve transfusion safety.     

A vignette study to examine health care professionals' attitudes towards patient involvement in error prevention

Background Various authorities recommend the participation of patients in promoting patient safety, but little is known about health care professionals' (HCPs') attitudes towards patients' involvement in safety‐related behaviours. Objective To investigate how HCPs evaluate patients' behaviours and HCP responses to patient involvement in the behaviour, relative to different aspects of the patient, the involved HCP and the potential error. Design Cross‐sectional fractional factorial survey with seven factors embedded in two error scenarios (missed hand hygiene, medication error). Each survey included two randomized vignettes that described the potential error, a patient's reaction to that error and the HCP response to the patient. Setting Twelve hospitals in Switzerland. Participants A total of 1141 HCPs (response rate 45%). Measurements Approval of patients' behaviour, HCP response to the patient, anticipated effects on the patient–HCP relationship, HCPs' support for being asked the question, affective response to the vignettes. Outcomes were measured on 7‐point scales. Results Approval of patients' safety‐related interventions was generally high and largely affected by patients' behaviour and correct identification of error. Anticipated effects on the patient–HCP relationship were much less positive, little correlated with approval of patients' behaviour and were mainly determined by the HCP response to intervening patients. HCPs expressed more favourable attitudes towards patients intervening about a medication error than about hand sanitation. Conclusions This study provides the first insights into predictors of HCPs' attitudes towards patient engagement in safety. Future research is however required to assess the generalizability of the findings into practice before training can be designed to address critical issues.     

The medical student as a patient: attitudes towards involvement in the quality and safety of health care

Background In recent years, factors that affect patients' willingness and ability to participate in safety‐relevant behaviours have been investigated. However, how trained healthcare professionals or medical students would feel participating in safety‐relevant behaviours as a patient in hospital remains largely unexplored. Objectives To investigate medical students' willingness to participate in behaviours related to the quality and safety of their health care. Design A cross‐sectional exploratory study using a survey that addressed willingness to participate in different behaviours recommended by current patient safety initiatives. Three types of interactional behaviours (asking factual or challenging questions, notifying doctors or nurses of errors/problems) and three non‐interactional behaviours (choosing a hospital based on the safety record, bringing medicines and a list of allergies into hospital, and reporting an error to a national reporting system) were assessed. Participants One hundred and seventy‐nine medical students from an inner city London teaching hospital participated in the study. Findings Students' willingness to participate was affected (P < 0.05) by the action required by the patient and (for interactional behaviours) whether the patient was engaging in the specific action with a doctor or nurse. Students were least willing to ask ‘challenging’ questions to doctors and nurses and to report errors to a national reporting system. Doctors' and nurses' encouragement appeared to increase self‐reported willingness to participate in behaviours where baseline willingness was low. Conclusion Similar to research on lay patient populations; medical students do not view involvement in safety‐related behaviours equally. Interventions should be tailored at encouraging students to participate in behaviours they are less inclined to take on an active role in. Future research is required to examine students' motivations for participation in this important but heavily under‐researched area.     

Consent to transfusion: patients' and healthcare professionals' attitudes towards the provision of blood transfusion information

Background: Patients should be informed about the risks and benefits of blood transfusion and their consent should be documented. However, this is not routinely practised in the UK, and there have been few studies to investigate patients' and healthcare professionals' attitudes towards this process. Objectives: To investigate patients' and healthcare professionals' attitudes towards the information patients are provided with about transfusion and obtaining consent for transfusion. Measures: A cross‐sectional qualitative survey design was employed. Attitudes towards transfusion‐related information and consenting to transfusion were assessed using a patient survey and healthcare professional survey. Participants: One hundred and ten patients who had received a transfusion aged between 18 and 93 (60 males and 50 females) and 123 healthcare professionals (doctors, nurses and midwives) involved in administering transfusions. Results: Sixty‐one patients recalled consenting transfusion. The majority said they were just told they needed a transfusion (N = 67) and only 1 patient said a full discussion about the risks and the benefits of the transfusion took place. However, although 82 patients said they were satisfied with the information, 22 patients reported they would have liked to have been given more details. The majority of healthcare professionals (N = 83) felt that patients were often not given sufficient information about transfusion. Conclusion: Greater efforts should be made to provide information to patients about the risks and benefits of blood transfusions. Future research should explore the most effective ways of delivering this information to patients in an appropriate and timely manner.     

急诊科护士对患者参与患者安全认知现状调查分析

目的了解急诊科护士对患者参与患者安全的认知状况及存在的阻碍因素,为制订具体有效干预策略提供依据。方法采用护理人员对患者参与患者安全认知现状调查表于2016年9月对陕西省34所医院的735名急诊护士进行调查。结果急诊护士对患者参与患者安全的整体认知得分为(3.74±0.48)分,在具体参与内容上,护士感知的患者现实参与方面,决策性参与(3.90±0.68)分高于照护性参与(3.89±0.70)分,并高于诉求性参与(3.55±0.93);而在护士对患者参与的支持和鼓励方面,照护性参与条目均分均高于决策性参与,并高于诉求性参与,患者参与患者安全存在的障碍因素,急诊科护士认为媒体有失公正的报道和患者疾病相关的认知水平占主要因素。结论急诊科护士认为患者参与患者安全的利大于弊,建议未来应呼吁媒体客观报道,加强护患沟通,提升患者参与患者安全的能力及意愿,引导患者理性参与,充分发挥患者在保障患者安全方面的能动作用。     

Healthcare professionals' knowledge,attitudes and skills regarding patient safety: a systematic literature review

The purpose of this literature review was to determine the extent of existing knowledge about healthcare professionals' knowledge, attitudes and skills related to patient safety. A systematic review was performed using two electronic databases: MEDLINE (Ovid) and CINAHL (EBSCO) for the period 2000–2012. The inclusion criteria were peer‐reviewed articles or empirical studies, published in English. The focus groups of the study were physicians, head nurses, nurses and nurse assistants. Altogether, 18 studies met the criteria and were included. Inductive content analysis was carried out to analyse and categorise the data. The investigated themes regarding healthcare professionals' knowledge of patient safety were their existing knowledge level, knowledge deficits and knowledge improvement. Results considered the target groups' overall attitudes to patient safety, attitudes to event reporting and safety attitude improvement. The investigations into healthcare professionals' skills included mathematical skills and those related to achieving patient safety. From this review, it is concluded that further research should be conducted into the investigation of healthcare professionals' knowledge and skills in patient safety.     

Concepts related to Chinese patients' perceptions of health,illness and person: issues of conceptual clarity

Since most health professionals who care for Chinese patients are trained using Western medical educational systems, they are often unaware of the complex Chinese culture that influences their patients' responses to care. Discrepancies often exist between health professionals' and Chinese patients' perceptions of health and evaluations of the quality of care.In order to provide culturally sensitive care for this population, the complex Chinese traditional philosophies, such as the theory of yin and yang and the five phases, as well as the philosophies related to the concept of personhood including Confucianism, Taoism and Buddhism are examined first. This is because these theories and philosophies not only influence Chinese patients' values and beliefs, but also determine their perceptions of health, illness and nursing care. The discussion of implications for surgical cardiovascular nursing practice for this particular population are followed.     

Effects of an educational patient safety campaign on patients' safety behaviours and adverse events

Rationale, aims and objectives The study aims to investigate the effects of a patient safety advisory on patients' risk perceptions, perceived behavioural control, performance of safety behaviours and experience of adverse incidents. Method Quasi‐experimental intervention study with non‐equivalent group comparison was used. Patients admitted to the surgical department of a Swiss large non‐university hospital were included. Patients in the intervention group received a safety advisory at their first clinical encounter. Outcomes were assessed using a questionnaire at discharge. Odds ratios for control versus intervention group were calculated. Regression analysis was used to model the effects of the intervention and safety behaviours on the experience of safety incidents. Results Two hundred eighteen patients in the control and 202 in the intervention group completed the survey (75 and 77% response rates, respectively). Patients in the intervention group were less likely to feel poorly informed about medical errors (OR = 0.55, P = 0.043). There were 73.1% in the intervention and 84.3% in the control group who underestimated the risk for infection (OR = 0.51, CI 0.31–0.84, P = 0.009). Perceived behavioural control was lower in the control group (mean_Con = 3.2, mean_Int = 3.5, P = 0.010). Performance of safety‐related behaviours was unaffected by the intervention. Patients in the intervention group were less likely to experience any safety‐related incident or unsafe situation (OR for intervention group = 0.57, CI 0.38–0.87, P = 0.009). There were no differences in concerns for errors during hospitalization. There were 96% of patients (intervention) who would recommend other patients to read the advisory. Conclusions The results suggest that the safety advisory decreases experiences of adverse events and unsafe situations. It renders awareness and perceived behavioural control without increasing concerns for safety and can thus serve as a useful instrument for communication about safety between health care workers and patients.     

Attitudes of mental health professionals towards service user involvement

Patient‐centred care and user involvement in healthcare services are much emphasised globally. This study was the first step in a multicentre research project in Finland to improve service users' and carers' opportunities to be more involved in mental health services. The aim of the study was to assess attitudes of professionals towards service user involvement. The data were collected via an online questionnaire from 1069 mental health professionals in four hospital districts. Altogether, 351 professionals responded. Data were analysed using appropriate statistical methods. According to the results, attitudes of healthcare professionals were more positive towards service users' involvement in their own treatment than in other levels of services. There were also differences in gender, age groups, working places and experiences in the attitudes of professionals concerning service users' involvement in their own treatment. These should be taken into account in the future when planning education for mental health professionals. In spite of governmental guidance on service user involvement and the growing body of knowledge of the benefits associated with it, change in attitudes towards user involvement is slow. Special attention should be paid to the attitudes of professionals working in inpatient care and of those with less working experience.     

Hospital patients' reports of medical errors and undesirable events in their health care

Objective To investigate hospital patients' reports of undesirable events in their health care. Design Cross‐sectional mixed methods design. Participants A total of 80 medical and surgical patients (mean age 58, 56 male). Intervention Patients were interviewed post‐discharge using a survey to assess patient reports of errors or problems in their care. Patients' medical records and notes were also reviewed. Main outcome measures Frequency of health care process problems, medical complications and interpersonal problems, and patient willingness to report an undesirable event in their care. Results In total, 258 undesirable events were reported (rate of 3.2 per person), including 136 interpersonal problems, 90 medical complications and 32 health care process problems. Patients identified a number of events that were reported in the medical records (30 out of 36). In addition, patients reported events that were not recorded in the medical records. Patients were more willing (P < 0.05) to report undesirable events to a researcher (as in the present case) than to a local or national reporting system. Conclusion Patients appear able to report undesirable events that occur in their health care management over and above those that are recorded in their medical records. However, patients appear more willing to report these incidents for the purpose of a study rather than to an established incident reporting system. Interventions aimed at educating and encouraging patients about incident reporting systems need to be developed in order to enhance this important contribution patients could make to improving patient safety.     

Research Article: Perceptions of Japanese patients and their family about medical treatment decisions

Internationally, nurses and physicians are increasingly expected to undertake roles in communication and patient advocacy, including in Japan, where the reigning principle underlying medical ethics is in transition from paternalism to respect for patient autonomy. The study reports the results of a survey in two Japanese teaching hospitals that clarified the perspectives of 128 patients and 41 family members regarding their current and desired involvement in health decision‐making. The commonest process that was desired by patients and their family was for patients to make decisions after consultation with both the physician and their family. The decision‐making preferences for competent patients varied among the participants, who believed that families have a crucial role to play in health‐care decision‐making, even when patients are competent to make their own decisions. The findings will inform health professionals about contemporary Japanese health‐care decision‐making and the ethical issues involved in this process, as well as assist the future development of a culturally relevant model to support patients' preferences for ethical decision‐making.     

Cancer patients' perceptions of quality‐of‐care attributes—Associations with age,perceived health status,gender and education

Aims and objectives

The aim of this study was to explore the associations between patients' gender, education, health status in relation to assessments of patient‐centred quality and individuality in care and trust in nurses for those <65 (working age) and ≥65 years (older people).

Background

Patients' assessments of the quality of care they receive are essential for the development of the provision of patient care and services. Previous studies have revealed age of the patient is associated with their assessment of care quality attributes.

Design

The study employed a cross‐sectional, multicultural comparative survey design.

Methods

The data were collected using questionnaires among hospitalised cancer patients (N = 876, n = 599, 68%) in four European countries: Greece, Cyprus, Sweden and Finland. The data were divided into two subgroups based on age (cut point 65 years) and were analysed statistically.

Results

Cancer patients' age, gender and level of education were not related to their assessments of care quality attributes: person‐centred care quality, individuality in care and trust in nurses. Subgroup analysis of the older adults and those of working age showed clear associations with patients' assessments of quality‐of‐care attributes and perceived health status. The lower the perceived health status, the lower the assessment of care quality attributes.

Discussion

The results suggest that the cancer itself is the strongest determinant of the care delivered, rather than any patient characteristics, such as age, education or gender. Perceived health status, in association with cancer patient assessments of care quality attributes, may be useful in the development of patient‐centred, individualised care strategies alongside a stronger focus on people instead of cancer‐care‐related processes and duties.

Conclusions

Health status was the only factor associated with cancer patients' assessments of care quality attributes. Cancer itself may be the strongest determinant of the care quality perceptions, rather than any patient characteristics.

Relevance to clinical practice

The findings of this study have implications for cancer care professionals in terms of patient assessment and care planning. The measures may be useful in assessing quality of cancer nursing care.     

Doctors' perceptions of laboratory monitoring in office practice

Background Laboratory monitoring has been increasingly recognized as an important area for improving patient safety in ambulatory care. Little is known about doctors' attitudes towards laboratory monitoring and potential ways to improve it. Methods Six focus groups and one individual interview with 20 primary care doctors and nine specialists from three Massachusetts communities. Results Participants viewed laboratory monitoring as a critical, time‐consuming task integral to their practice of medicine. Most believed they commit few laboratory monitoring errors and were surprised at the error rates reported in the literature. They listed various barriers to monitoring, including not knowing which doctor was responsible for ensuring the completion of laboratory monitoring, uncertainty regarding the necessity of monitoring, lack of alerts/reminders and patient non‐adherence with recommended monitoring. The primary facilitator of monitoring was ordering laboratory tests while the patient is in the office. Primary care doctors felt more strongly than specialists that computerized alerts could improve laboratory monitoring. Participants wanted to individualize alerts for their practices and warned that alerts must not interrupt work flow or require too many clicks. Conclusions Doctors in community practice recognized the potential of computerized alerts to enhance their monitoring protocols for some medications. They viewed patient non‐adherence as a barrier to optimal monitoring. Interventions to improve laboratory monitoring should address doctor workflow issues, in addition to patients' awareness of the importance of fulfilling recommended therapeutic monitoring to prevent adverse drug events.     

Improving forensic mental health care for Aboriginal Australians: Challenges and opportunities

Mental illnesses constitute a major burden of disease in Aboriginal Australians and Torres Strait Islanders (hereafter Aboriginal Australians), who are also overrepresented in the prison system. A legacy of colonization compounds such prevalence, and is further exacerbated by the persistence of racial discrimination and insensitivity across many sectors, including health. This research completed in a Western Australian forensic mental health setting identifies non‐Aboriginal health professionals' support needs to deliver high‐quality, culturally‐safe care to Aboriginal patients. Data were collected from health professionals using an online survey and 10 semistructured interviews. Survey and interview results found that ongoing education was needed for staff to provide culturally‐safe care, where Aboriginal knowledge, beliefs, and values were respected. The findings also support previous research linking Aboriginal health providers to improved health outcomes for Aboriginal patients. In a colonized country, such as Australia, education programmes that critically reflect on power relations privileging white Anglo‐Australian cultural dominance and subjugating Aboriginal knowledge, beliefs, and values are important to identify factors promoting or compromising the care of Aboriginal patients and developing a deeper understanding of ‘cultural safety’ and its clinical application. Organizational commitment is needed to translate the findings to support non‐Aboriginal health professionals deliver high‐quality care to Aboriginal patients that is respectful of cultural differences.     

A new perspective on blame culture: an experimental study

Objectives Recently, a range of different institutions worldwide has identified the ‘culture of blame’ and the fear of being punished as the principal reasons for the lack of medical error reporting and, consequently, of their reiteration and of the poor quality of patient care. Despite much theoretical debate, there currently exist no experimental studies that directly investigate the presence and pervasiveness of the blame and punishment culture in health care contexts. In order to document empirical evidence for this culture in medicine and nursing, we conducted an experimental study asking physicians and nurses to express their fear of blame or punishment in the context of having made an error that would cause: (i) no; (ii) mild; (iii) severe consequences; or (iv) the death of the patient. Methods Two hundred and forty‐nine health care providers (38 physicians, 11 medical students, 127 nurses and 73 nursing students) were included in the study. Two main data emerged: first, in general, the fear of being blamed is higher than the fear of being punished. Second, while the fear of being blamed is equally distributed among all participants, the fear of being punished varies according to the experience of subjects (it is higher in nursing students than in seniors nurses) and to their professional role (student and senior nurses are more susceptible to it than medical students and senior physicians). Conclusion Given the relevance of these factors in medical error reporting and the evidence that they are so deep‐seated not only in senior professionals, but also in students, we argue that an educational approach, together with an organization‐based intervention, is desirable to shape cultural attitudes of health care providers in the direction of a ‘safety culture’.