通过对老年痴呆照顾者的培训减少患者安全隐患的效果分析

目的 了解老年痴呆照顾者对安全知识的需求,实施相应的知识培训,以减少患者的安全隐患,提高家庭生活质量。 方法 根据要求制定安全培训课程,针对患者、家属及主要照顾者实施个性化、人性化的安全培训干预, 通过小组化的健康教育和护理指导,以培训前后患者发生不安全事件的多少,照顾者对安全知识的掌握得分、需求得分、焦虑抑郁评分等结果对比,评价培训干预效果。 结果 培训干预后照顾者焦虑抑郁情绪明显改善(P<0.05),相关知识掌握得分明显提高(P<0.05),患者发生不安全事件较明显减少,对护理满意度也较培训前明显提高(P<0.05)。 结论 安全培训是老年痴呆照顾者的迫切需求,通过培训不仅能降低老年痴呆患者的安全的隐患还能拉近医患关系,提高护理服务满意度。     

Discharge planning for palliative care patients: a qualitative analysis

For patients hospitalized with life-threatening illnesses and their families, palliative care consultants can provide critical support by providing information about prognosis, ensuring that symptoms are managed, helping to clarify goals of care, and addressing psychosocial and spiritual concerns. However, once patients leave the hospital, many hospital-based palliative care teams (PCTs) cannot continue to play active roles in patient care. Gaps in discharge planning not only decrease quality of life for patients, but also translate into lack of support for caregivers. The palliative care population would be expected to benefit from a customized approach to hospital discharge. The aim of this study was to identify the range of health care experiences of family caregivers and patients who received palliative care consultations after they left the hospital, and to understand how PCTs might best prepare patients and caregivers for the post-hospital experience.     

Patient Participation: Current Knowledge and Applicability to Patient Safety

Patient participation is increasingly recognized as a key component in the redesign of health care processes and is advocated as a means to improve patient safety. The concept has been successfully applied to various areas of patient care, such as decision making and the management of chronic diseases. We review the origins of patient participation, discuss the published evidence on its efficacy, and summarize the factors influencing its implementation. Patient-related factors, such as acceptance of the new patient role, lack of medical knowledge, lack of confidence, comorbidity, and various sociodemographic parameters, all affect willingness to participate in the health care process. Among health care workers, the acceptance and promotion of patient participation are influenced by other issues, including the desire to maintain control, lack of time, personal beliefs, type of illness, and training in patient-caregiver relationships. Social status, specialty, ethnic origin, and the stakes involved also influence patient and health care worker acceptance. The London Declaration, endorsed by the World Health Organization World Alliance for Patient Safety, calls for a greater role for patients to improve the safety of health care worldwide. Patient participation in hand hygiene promotion among staff to prevent health care—associated infection is discussed as an illustrative example. A conceptual model including key factors that influence participation and invite patients to contribute to error prevention is proposed. Further research is essential to establish key determinants for the success of patient participation in reducing medical errors and in improving patient safety.Patient participation is a complex concept and arises from the widespread consumer movement of the 1960s that affirmed the consumer''s right to safety, the right to be informed, the right to choose, and the right to be heard.¹ During the past few years, patient participation has been increasingly recognized as a key component in the redesign of health care processes and successfully applied to some aspects of patient care, notably the decision-making process and the treatment of chronic illness. Recently, increasing patient participation has been recommended to improve patient safety. The World Health Organization (WHO) World Alliance for Patient Safety is actively highlighting the role that patients and their families could play in the improvement of health care.² However, this field of patient participation has not been widely researched thus far.We review the underlying principles and the efficacy of patient participation in decision making and self-treatment of chronic illness, as well as the potential obstacles to implementation. Building on these principles, we develop a conceptual framework for patient participation. Finally, we suggest that patient participation could be useful to improve quality of care and prevent medical errors and propose an agenda for research.     

Safety Culture and Care: A Program to Prevent Surgical Errors

Surgical errors are under scrutiny in health care as part of ensuring a culture of safety in which patients receive quality care. Hospitals use safety measures to compare their performance against industry benchmarks. To understand patient safety issues, health care providers must have processes in place to analyze and evaluate the quality of the care they provide. At one facility, efforts made to improve its quality and safety led to the development of a robust safety program with resources devoted to enhancing the culture of safety in the Perioperative Services department. Improvement initiatives included changing processes for safety reporting and performance improvement plans, adding resources and nurse roles, and creating communication strategies around adverse safety events and how to improve care. One key outcome included a 54% increase in the percentage of personnel who indicated in a survey that they would speak up if they saw something negatively affecting patient care.     

Interventions related to patient safety.

Patient safety is a growing priority in today's increasingly complex, highly technologic, and business-oriented health care system. This increasing emphasis is being fueled by issues such as cost containment, risk management, quality assurance, health care consumer activism, and legal accountability for practice. In such an environment, it is important that nursing be able to quantify and communicate what it does to promote and maintain patient safety. A standardized language of patient safety interventions provides nursing with the tool to do this. It provides a common language to use when dealing with patient safety issues in the practice, education, research, and administrative arenas. It also allows nurses to package and market the "product" of nursing care to health care consumers, other health care professionals, hospital administrators, and politicians, all of whom share an interest in ensuring that patient safety is maintained and promoted in the most comprehensive yet cost-efficient manner possible.     

Making the case for a clinical information system: the chief information officer view

Adequate decision support for clinicians and other caregivers requires accessible and reliable patient information. Powerful societal and economic forces are moving us toward an integrated, patient-centered health care information system that will allow caregivers to exchange up-to-date patient health information quickly and easily. These forces include patient safety, potential health care cost savings, empowerment of consumers (and their subsequent demands for quality), new federal policies, and growing regional health care initiatives. Underspending on health care information technologies has gone on for many years; and the creation and implementation of a comprehensive clinical information system will entail many difficulties, particularly in regard to patients' privacy and control of their information, standardization of electronic health records, cost of adopting information technology, unbalanced financial incentives, and the varying levels of preparation across caregivers. There will also be potential effects on the physician-patient relationship. Ultimately, an integrated system will require a concerted transformation of the health care industry that is akin to what the banking industry has accomplished with electronic automation. Critical care units provide a good starting point for how information system technologies can be used and electronic patient information collected, although the robust systems designed for intensive care units are not always used to their potential.     

患者的安全共同的责任

患者安全是护理质量中基本和重要的部分。然而，国际卫生保健系统是易于出现过失的，并且对患者的安全性护理是有害的，是基本系统缺陷所造成的。大量的利益相关者（社会大众、患者、护士、护理教育者、管理者和研究者、医师、政府和立法机关、职业协会和委任机构）对促进患者安全出院及无伤害发生是负有责任的。本文讨论了护理缺陷中相关者对患者安全的职责与特殊功能及继续接受和促进安全护理。     

Patient safety: a shared responsibility

Patient safety is an essential and vital component of quality nursing care. However, the nation's health care system is prone to errors, and can be detrimental to safe patient care, as a result of basic systems flaws. A variety of stakeholders (society in general; patients; individual nurses; nursing educators, administrators, and researchers; physicians; governments and legislative bodies; professional associations; and accrediting agencies) are responsible for ensuring that patient care is safely delivered and that no harm occurs to patients. The responsibility of these stakeholders in addressing patient safety in the context of a nursing shortage is discussed, along with specific actions they have taken, and can continue to take, to promote safe care.     

Transitioning the older adult in the ambulatory care setting

Transitions between care settings are periods of vulnerability for patients. This is especially true for older adults, for whom comorbidities and functional impairments can increase the complexity of care and the need for multiple caregivers can compromise safety. Poor care transitions can result in costly hospital admissions. For this reason, leading health care organizations have initiated programs to improve the quality of transitions; however, to date, the ambulatory surgical setting has not been a focus of these initiatives. The ambulatory setting serves an increasingly complex patient population and provides the majority of elective surgeries, and adapting some of the transition tools that have been tested in other settings will benefit health care providers and patients in the ambulatory setting. Identifying periods of transition and risk, implementing electronic health records across all phases of patient care, and using evidence-based tools at each transitional stage can optimize the quality and safety of patient care.     

Efficacy of clinical laboratory: Therapeutic TAT,safety, and medical errors

Health care services rely on continued technological advances and management of the operational systems for optimum reduction of medical errors. Significant gains in health care outcomes as indicated by recorded increases in life expectancies have been achieved due to the availability and application of technological advances for medical services. The inadequacies in the application of these systems for maximum benefit of the health care systems have however been the subject of recent publications dealing with patient safety and medical errors [1], [2], [3], [4]. Estimates by the Institute of Medicine (IOM) indicate that approximately 44,000–98,000 deaths occur each year as a consequence of inadequate safety and failure to prevent errors in the health care system. This puts medical errors in the top four leading causes of deaths per the IOM report. Other studies in the USA states of Colorado, Utah, and New York suggest that medical errors occur in 2–4% of hospitalizations. The paper by Raab et al. denoted a 6.7% discrepancy between original report and secondary case review, and 5% of the discrepancies have modest to significant effect on patient care [Raab SS, Grzybicki DM, Zarbo RJ, Meier FA, Geyer SJ, Jensen C. Anatomic pathology databases and patient safety. Arch Pathol Lab Med 2005;129:459–66]. This presentation focuses on the health care safety and medical errors relative to clinical laboratory. The impact of laboratory operations with resultant delays in test turn around times (TAT) and other laboratory errors on the health care services are presented. The role of governmental (US Department of Health and Human Services) and non-governmental regulatory agencies (CAP, AACC, IFCC, CLSI, etc) in mitigating these clinical laboratory errors is discussed. The use of payment system as a mechanism for improving the quality of laboratory services is also presented to illustrate the checks and balance systems aimed at reduction of medical errors. The presentation will conclude with the recommendation that majority of the clinical laboratory delays in turn around time and other errors can be prevented with appropriate analytical systems and operational processes under the overall guidance of the right regulatory agencies.     

“I see myself as part of the team” – family caregivers’ contribution to safety in advanced home care

Background

The use of medical technology and the various contributing and interdepending human factors in home care have implications for patient safety. Although family caregivers are often involved in the provision of advanced home care, there is little research on their contribution to safety. The study aims to explore family caregivers in Home Mechanical Ventilation (HMV) safety experiences and how safety is perceived by them in this context. Furthermore, it seeks to understand how family caregivers contribute to the patients’ and their own safety in HMV and what kind of support they expect from their health care team.

Methods

An explorative, qualitative study was applied using elements from grounded theory methodology. Data were collected through individual interviews with 15 family caregivers to patients receiving HMV in two regions in Germany. The audiotaped interviews were then subject to thematic analysis.

Results

The findings shows that family caregivers contribute to safety in HMV by trying to foster mutual information sharing about the patient and his/her situation, coordinating informally health care services and undertaking compensation of shortcomings in HMV.

Conclusion

Consequently, family caregivers take on considerable responsibility for patient safety in advanced home care by being actively and constantly committed to safety work.Nurses working in this setting should be clinically and technically skilled and focus on building partnership relations with family caregivers. This especially encompasses negotiation about their role in care and patient safety. Support and education should be offered if needed. Only skilled nurses, who can provide safe care and who can handle critical situations should be appointed to HMV. They should also serve as professional care coordinators and provide educational interventions to strengthen family caregivers’ competence.

     

High reliability and implications for nursing leaders

Aim  To review high reliability theory and discuss its implications for the nursing leader.
Background  A high reliability organization (HRO) is considered that which has measurable near perfect performance for quality and safety.
Evaluation  The author has reviewed the literature, discussed research findings that contribute to improving reliability in health care organizations, and makes five recommendations for how nursing leaders can create high reliability organizations.
Key issues  Health care is not a safe industry and unintended patient harm occurs at epidemic levels. Health care can learn from high reliability theory and practice developed in other high-risk industries.
Conclusions  Viewed by HRO standards, unintended patient injury in health care is excessively high and quality is distressingly low. HRO theory and practice can be successfully applied in health care using advanced interdisciplinary teamwork training and deliberate process design techniques.
Implications for nursing management  Nursing has a primary leadership function for ensuring patient safety and achieving high quality in health care organizations. Learning HRO theory and methods for achieving high reliability is a foremost opportunity for nursing leaders.     

Caregiving at the end of life: Perceptions of health care quality and quality of life among patients and caregivers

This study explored the association between perceptions of health care quality and quality of life in patients with advanced metastatic cancer and their informal caregivers (n=39). Patients' and caregivers' perceptions of health care quality, mental health, health-related quality of life, symptoms, and burden were measured. The key findings included the following: 1) patients' mental health and depression scores correlated with those of caregivers, suggesting that the mental health of patients and their caregivers are associated; 2) patients and caregivers shared similar perceptions regarding health care quality; 3) the presence of depression in caregivers correlated with caregivers being less satisfied with the health care being given to their patients (this correlation did not exist for patients, a finding that may be due in part to the protective buffering effect that caregivers provide their patients as illness progresses); and 4) a modified Primary Care Assessment Survey, originally designed for primary care patients, was a useful measure of health care assessment for both patients and caregivers. These data suggest that patients with advanced disease and their caregivers share similar perceptions and evolve as a "unit of care," and caregivers, as unique and important members of the patient's health care team, are also in need of care. When depressed, caregivers may unilaterally lose trust by becoming less satisfied with the quality of health care being provided to their patients.     

The role of internationally educated nurses in a quality,safe workforce

Migration and globalization of the nursing workforce affect source countries and destination countries. Policies and regulations governing the movement of nurses from one country to another safeguard the public by ensuring educational comparability and competence. The global movement of nurses and other health care workers calls for quality and safety competencies that meet standards such as those defined by the Institute of Medicine. This article examines nurse migration and employment of internationally educated nurses (IENs) in the context of supporting and maintaining safe, quality patient care environments. Migration to the United States is featured as an exemplar to consider the following key factors: the impact of nurse migration on the nursing workforce; issues in determining educational comparability of nursing programs between countries; quality and safety concerns in transitioning IENs into the workforce; and strategies for helping IENs transition as safe, qualified members of the nursing workforce in the destination country.     

Safety of Care by Caregivers of Cancer Patients

ObjectivesTo describe common areas of threats to patient safety and quality of care when caregivers provide care. Recommendations for caregivers to enable them to provide safe care are included.Data SourcesResearch-based articles and reports.ConclusionThe literature is limited in discussion on home safety issues for caregivers. Non cancer-specific literature provides some direction for recommendations for nurses to guide caregivers.Implications for Nursing PracticeThe home environment is an unregulated and uncontrolled site, and the safety risks families take are unknown. Professionals should assess the caregiver's knowledge and ability when providing caregiving guidance to ensure the patient is receiving safe and quality care. Nurses need to stress the importance of providing safe quality care and provide education and community resources.     

Preoperative assessment of the surgical patient

Nurses play an important role in the preassessment of surgical patients. With the rise in free-standing surgical clinics and the move of many surgical procedures to office-based surgical clinics, quality patient care could be compromised. Preassessment of surgical patients in office-based and hospital clinics ensures quality patient care from the moment patients enter the office to when they are discharged from care. The process of preoperative evaluation is essential in assessing the medical condition of patients, evaluating their overall health status, determining risk factors, and educating them. Surgical preassessment benefits patients, physicians, and nurses by not only improving surgical outcomes and patient satisfaction but also ensuring patient safety. Nurses employed in office-based surgical suites require specialized knowledge and clinical skills to offer continued, well-informed care to their patients.     

Unlicensed persons in patient care settings. Administrative, policy, and ethical issues

The current nursing shortage is a supply-and-demand problem. Factors contributing to the shortage include increased hospital use of RNs; decreased nursing school enrollment; increased demand for RNs outside of hospitals in skilled nursing facilities, health maintenance organizations, and home health care programs; noncompetitive salaries; and lack of autonomy. The nursing shortage has triggered the development and implementation of programs to prepare non-nurse bedside technicians to work in partnership with RNs. The functions of these unlicensed persons range from housekeeping, stocking, and clerical responsibilities to several technical treatments that once fell within the role responsibilities of registered or practical nurses. The partnerships between unlicensed persons and RNs in patient care settings have given rise to several administrative, policy, and ethical issues for nurse leaders. An ethical analysis, based on the application of ethical principles and moral dilemmas found in "The Parable of the Sadhu," offers some guidelines to nursing leaders in the administrative and policy decisions inherent in the development and retention of licensed persons in patient care settings. Some conclusions drawn from the ethically based questions are: The acquisition and retention of RNs and other licensed caregivers should take precedence over the development of programs for non-nurse bedside technicians. RNs in partnership with unlicensed persons in patient care settings must know what they can legitimately delegate. The RN has personal responsibility for ensuring optimal standards of nursing practice in the delegation of duties. The partnership between professional nurses and unlicensed persons must be a participative effort, not a manipulative or coercive one. In putting the organizational principle of subsidiarity into practice, decision makers will be able to maintain respect for human dignity and the uniqueness of patients and caregivers as well. The development and retention of unlicensed persons in patient care settings depends on a well-developed personal ethic that needs to be congruent with the mission, philosophy, and codes of ethics of national and local health care organizations.