患者为患者安全伦敦宣言

我们,患者为患者安全,希望实现一个无因医疗过失而受害的世界,我们作为合作伙伴,保护人们不受卫生保健中本可避免的伤害。风险与不确定性始终相伴。因此,我们走到一起进行对话,与医护人员一起参加卫生保健。我们将通力合作,倡导在发展中国家和发达国家消除卫生保健工作中发生的伤害。     

创建安全文化保证患者安全

探讨医疗安全与患者安全现状,分析医疗差错发生的原因,提出医疗风险无处不在,保障患者就医安全应从加强医疗安全做起,患者安全成功的关键在于文化建设,积极的安全文化接受差错出现的必然性,主动地寻找系统内潜在的危机,患者安全文化是医疗安全的思想基础、行动依据和内在动力;医疗机构应重视患者安全,增加人、财、物的投入,优化资源配置及诊疗流程,增进患者安全。     

《患者十大安全目标》在ICU的应用

据世界卫生组织（WH0）2007年5月8日关于病人安全的十个事实中报道：在发达国家每10名病人中即有1名病人在接受治疗时受到伤害,而发展中国家病人住院感染的发生率比发达国家要高出20倍。因此,医疗护理安全越来越受到业内外人士的高度重视。2008年我国出台了《2008患者十大安全目标》,目的是保证为病人提供安全的医疗护理服务,安全护理是指护理人员在进行护理工作中要严格遵循护理制度和操作规程,准确无误地执行医嘱,实施护理计划,确保病人在治疗和康复中获得身心安全。     

护理安全管理在住院精神病患者吸烟中的应用

护理安全管理是精神科护士工作的灵魂，任何不安全因素都可能导致护理缺陷的发生，甚至威胁患者的生命。所以，一切工作都不能忘记安全，现报道如下。     

患者安全教育护理现状

患者安全是当今世界卫生组织高度重视的课题,也是衡量医疗护理质量的重要指标.根据美国伊利诺州护理协会提出的预防发生的方法,其中最重要的就是对护理人员要落实患者安全知识的职前训练和在职教育[1].国外在患者安全运动的起始阶段就已经重视并开展了患者安全教育,而我国在此方面的文献报道较少[2],对护理人员的培训缺乏此方面的内容.另外,我国现有护理教育课程体系和临床实践课程中,患者安全知识并未得到充分体现[3],如何在护理人员中有效地开展患者安全教育工作,仍是我们继续探索的问题.本文就护理人员患者安全知识教育相关知识的国内外研究现状进行综述,以期为我国的相关工作及研究提供借鉴.     

中德患者安全目标与护理安全的比较

护理安全已成为衡量护理服务的重要质量指标,护理管理应从保障患者安全的高度,重视和加强护理安全管理。本文从影响护理安全的几个重要因素出发,分析比较了中德两国之间在患者安全目标与护理安全之间的差异,以提供国内护理管理者思考和借鉴。     

从“核对患者住院号”谈患者安全

患者安全是在医疗过程中对于引起的不良结果或损害所采取的避免、预防与改善措施，包括技术安全、管理安全和心理安全三个方面。近年来，患者安全的问题正伴随着医院的发展、医学的进步、医疗设施设备的更新和医药的升级换代，正在以新的媒介、更大量地涌向医院。关注患者安全，共创医患关系双赢局面，已成为现代医疗服务模式所追求的目标。医疗安全是医疗质量的首要特征，医疗安全管理是医院管理的核心内容。     

健康教育对糖尿病患者的血糖影响

糖尿病为慢性终生性疾病．其危害在于高血糖所带来的各种并发症，尤其心、脑、肾的并发症是危害患健康并影响寿命的重要因素，糖尿病治疗除加强医疗护理外，健康教育是重要环节。通过健康教育提高患对疾病相关知识的认识水平，掌握科学的自我管理自我护理的办法，有利于疾病控制达标。作对46例住院糖尿病患进行有针对性的健康教育，效果良好，现报告如下。     

16个省市患者参与患者安全实践及管理现状研究

目的 通过问卷调查的方法,分析全国16个省市102所医院患者参与患者安全实践及管理的现状和存在问题,为护理管理者制定管理举措提供决策依据。方法 选取全国16个省和直辖市的102所医院,在回顾大量国内外相关文献的基础上自制问卷进行网络调查。调查内容包含医疗机构的一般情况、患者参与患者安全的管理现状及护理实践情况。结果 我国各地区、各级各类医院在促进患者参与患者安全实施方面核心管理举措存在差异,西部地区在制度建设及教育培训方面与其他地区存在显著差异(P<0.01);在组织体系、制度建设、教育培训3个方面呈现的趋势为三级医院优于二级及以下医院,综合医院优于专科医院(P<0.05)。患者参与患者安全的护理实践主要集中在参与安全核查、手术安全、药物使用、安全事件预防及改进、照护决策及沟通等重点护理环节。结论 我国患者参与患者安全的相关工作虽然已广泛开展,各医院患者的参与程度不同,目前尚未形成相关的工作规范及标准化管理策略,需进行深入的研究及探索。     

患者安全相关问题的国外研究现状

安全是患者的基本需要之一,促进患者安全是医疗护理的基本要求,是医疗护理质量监控和管理的核心目标。近年来,患者的安全问题成为卫生保健体系和社会大众关注的热点问题。本文将患者安全的国外研究现状综述如下。     

患者安全:现状与对策

本文概述了患者安全运动的起源、国内外患者安全运动开展至今20年的现状与问题,并从医改、医保、制度、文化、教育与培训、患者参与患者安全6个角度阐述了患者安全的对策,以促进我国患者安全工作健康发展。     

Patient safety education and baccalaureate nursing students' patient safety competency: A cross‐sectional study

This cross‐sectional study examines baccalaureate nursing programs in South Korea to determine how and to what extent patient safety education was delivered, and to assess nursing students' patient safety competency. The Quality and Safety Education for Nurses (QSEN) student evaluation survey and a Patient Safety Competency Self‐Evaluation tool were used. We distributed 234 surveys to senior students in four nursing schools; 206 (88%) students responded to the survey. The majority of students (81.6%) reported that they had received patient safety education during coursework. Patient safety education was delivered primarily by lecture rather than during laboratory or simulation sessions. The degree of coverage of QSEN competency and the students' self‐reported competency in total and attitude scores showed statistical differences among nursing schools. Students' attitude score was significantly higher than skill and knowledge. Our results confirm the need to revise the nursing curriculum and to use various teaching methods to deliver patient safety education more comprehensively and effectively. Furthermore, there is a need to develop an integrated approach to ensuring students' balanced competency.     

Effect of patient safety education interventions on patient safety culture of health care professionals: Systematic review and meta-analysis

AimTo synthesize and evaluate the cumulative effect of patient safety education intervention for health care professional staff in the hospital setting on their patient safety culture.BackgroundPatient security Culture is an important factor in ensuring patient safety and it is recommended as one of the pillars of preventive strategies in the healthcare system.DesignSystematic review and meta-analysis were prospectively registered with PROSPERO.MethodsThis review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed, EMBASE, Ovid, CINAHL, Cochran Library, Web of Science and randomized control trial registration databases from January 1999 to February 2021. Studies on patient safety culture intervention were included. We assessed research quality using the jadad scale for RCTs and the Methodological Index for Non-Randomized StudiesResultsSixteen studies with a total of 3438 participants in the intervention group and 3121 in the control group were included in the final analysis. The random-effect meta-analysis shows significant heterogeneity among studies that assessed patient safety culture as a mean percentage of positive responses or as a mean score of 1–5 scale. (I² = 91% and 77%, respectively). Also, there was a significant difference between experimental and control group in the overall pooled effect of patient safety culture in the studies that used the mean percentage of positive response [Mean Difference = 5.24, 95% confidence interval (1.32, 9.16, Z = 2.62; P = 0.009] or the mean score [Mean Difference = 0.08, 95% confidence interval (0.01, 0.15), Z = 2.26; P = 0.02]. The difference was no longer significant in the mean score studies after excluding the studies with low-quality scores. Subgroup analysis showed no change in the pooled effect of the studies with quasi-experimental [Mean Difference = 7.84, 95% confidence interval (2.35, 13.33); Z = 2.80; p = 0.005) or before-after design [MD= 0.11, 95% confidence interval (0.07, 0.14); Z = 5.74; p = 0.000]. However, the patient safety education intervention remained effective after one year of follow-up.ConclusionsOur review Provides empirical evidence on current efforts in patient safety education to improve a healthcare professional-patient safety culture. The Patient safety education program could improve the patient safety culture of health care professionals.     

The ethics and practical importance of defining, distinguishing and disclosing nursing errors: a discussion paper

Nurses globally are required and expected to report nursing errors. As is clearly demonstrated in the international literature, fulfilling this requirement is not, however, without risks. In this discussion paper, the notion of 'nursing error', the practical and moral importance of defining, distinguishing and disclosing nursing errors and how a distinct definition of 'nursing error' fits with the new 'system approach' to human-error management in health care are critiqued. Drawing on international literature and two key case exemplars from the USA and Australia, arguments are advanced to support the view that although it is 'right' for nurses to report nursing errors, it will be very difficult for them to do so unless a non-punitive approach to nursing-error management is adopted.     

Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey

Objective: To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness.

Design: Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience.

Results: Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N?=?470) and triage nurses (N?=?189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors.

Conclusions: Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents’ profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture.

• Key Points

• Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that:

• ??healthcare providers in Dutch GP cooperatives perceive patient safety culture positively;

• ??triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals – on several patient safety culture factors; and

• ??within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.

     

Patient safety in intensive care: results from the multinational Sentinel Events Evaluation (SEE) study

Objective To assess on a multinational level the prevalence and corresponding factors of selected unintended events that compromise patient safety (sentinel events) in intensive care units (ICUs).Design An observational, 24-h cross-sectional study of incidents in five representative categories.Setting 205 ICUs worldwideMeasurements Events were reported by intensive care unit staff members with the use of a structured questionnaire. Both ICU- and patient-related factors were assessed.Results In 1,913 adult patients a total of 584 events affecting 391 patients were reported. During 24 h multiple errors related to medication occurred in 136 patients; unplanned dislodgement or inappropriate disconnection of lines, catheters, and drains in 158; equipment failure in 112; loss, obstruction or leakage of artificial airway in 47; and inappropriate turn-off of alarms in 17. Per 100 patient days, 38.8 (95% confidence interval 34.7–42.9) events were observed. In a multiple logistic regression with ICU as a random component, the following were associated with elevated odds for experiencing a sentinel event: any organ failure (odds ratio 1.13, 95% confidence interval 1.00–1.28), a higher intensity in level of care (odds ratio 1.62, 95% confidence interval 1.18–2.22), and time of exposure (odds ratio 1.06, 95% confidence interval 1.04–1.08).Conclusions Sentinel events related to medication, indwelling lines, airway, and equipment failure in ICUs occur with considerable frequency. Although patient safety is recognised as a serious issue in many ICUs, there is an urgent need for development and implementation of strategies for prevention and early detection of errors.Electronic supplementary material The electronic reference of this article is . The online full-text version of this article includes electronic supplementary material. This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured full-text article. To cite or link to this article you can use the above reference.On behalf of the Research Group on Quality Improvement of the European Society of Intensive Care Medicine (ESICM) and the SEE study investigatorsThis article is discussed in the editorial available at:     

A baseline assessment of patient safety culture and its associated factors from the perspective of critical care nurses: Results from 10 hospitals

IntroductionCritical care nurses are considered the key to patient safety improvement and play a vital role in enhancing quality of care in intensive care units (ICUs) where adverse events are frequent and have severe consequences. Moreover, there is recognition of the importance of the assessment and the development of patient safety culture (PSC) as a strategic focus for the improvement of patient safety and healthcare quality, notably in critical care settings.ObjectivesThis study aimed to assess critical care nurses' perception of PSC and to determine its associated factors.MethodsThis cross-sectional study was conducted among nurses working in the ICUs of the Tunisian centre (six Tunisian governorates). The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture questionnaire, comprising 10 dimensions and a total of 50 items.ResultsA total of 249 nurses from 18 ICUs participated in the study, with a participation rate of 87.36%. The dimensions scores ranged between 17.2% for the dimension “frequency of events reported” and 50.1% for the dimension “teamwork within units”. Multivariable logistic regression indicated that respondents who worked in private hospitals were five times more likely to have a developed PSC (adjusted odds ratio [AOR]: 5.34; 95% confidence interval [CI], [2.28, 12.51]; p < 10^–3). Similarly, participants who worked in a certified hospital were two times more likely to have a more developed PSC than respondents who work in noncertified hospitals (AOR: 2.51; 95% CI, [.92–6.82]; p = 0.041). In addition, an increased nurse-per-patient ratio (i.e., reduced workload) increased PSC (AOR: 1.10; 95% CI, [1.02–1.12]; p = 0.018).ConclusionThis study has shown that the state of critical care nurses' PSC is critically low and these baseline results can help to form a plan of actions for improvements.     

Patient trust and patient safety for low-priority patients: A randomized controlled trial pilot study in the prehospital chain of care

BackgroundPatients who call for an ambulance but only have primary care needs do not always get appropriate care. The starting point in this study is that such patients should be assigned to as basic of care as possible, while maintaining high levels of patient trust and patient safety.AimTo evaluate patient trust and patient safety among low-priority ambulance patients referred to care at either the Community Health Centre (CHC) or the Emergency Department (ED).MethodsThis randomized controlled trial pilot study compared the level of patient trust and patient safety among low-priority ambulance patients who were randomized into two groups: CHC (n = 105) or ED (n = 83).ResultsThere was a high level of trust in the care received, regardless of whether the patient received care at CHC or ED. Overall 31% fulfilled one or more of the given criteria for potentially jeopardizing patient safety.ConclusionPatient selection for the trial indicated a potential limit in patient safety. There was a high level of trust in the care received regardless of whether the patient received care. The accuracy of patient selection for the new care model needs to be further improved with the intention to enhance patient safety even further.