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.     

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.     

A teamwork model to promote patient safety in critical care

To create a safe health care system, providers must understand teamwork as a complementary relationship of interdependence. Continuing efforts to adopt the aviation model will enable health care providers to examine the role of human performance factors related to fatigue, leadership, and communication among all providers. The aviation model provides a basis for designing teamwork programs to reduce error and introduces human factor principles and key skills to be learned. Health care providers need explicit instruction in communication and teamwork rather than learning by trial and error, which can instill unintended values, attitudes, and behaviors. The growing research base continues to examine the problem of health care safety and to test the most effective team training approaches. What is the most effective pattern and timing of communication among providers? What system level changes are needed in the critical care area to improve communication through teamwork and thus create a safer health care system? What are potential points of error in the daily operation that could be alleviated through effective teamwork? Continuing to test the model will ultimately change patient safety.     

Safety in the pediatric ICU: the key to quality outcomes

Patient safety is a major concern in the pediatric ICU. The acuity has never been higher, patient needs are extremely complex, and the margin for error is small. The concentration on safety needs to revolve around designing safe systems and processes. This article discusses communication, patient identification, catheter-related bloodstream infections, unplanned extubations, restraints and medication administration. The health care system of the future must be transparent, making safety information to insurers, patients and health care providers easily available.     

Patient safety culture in Norwegian primary care: A study in out-of-hours casualty clinics and GP practices

Objective. This study aimed to investigate patient safety attitudes amongst health care providers in Norwegian primary care by using the Safety Attitudes Questionnaire, in both out-of-hours (OOH) casualty clinics and GP practices. The questionnaire identifies five major patient safety factors: Teamwork climate, Safety climate, Job satisfaction, Perceptions of management, and Working conditions. Design. Cross-sectional study. Statistical analysis included multiple linear regression and independent samples t-tests. Setting. Seven OOH casualty clinics and 17 GP practices in Norway. Subjects. In October and November 2012, 510 primary health care providers working in OOH casualty clinics and GP practices (316 doctors and 194 nurses) were invited to participate anonymously. Main outcome measures. To study whether patterns in patient safety attitudes were related to professional background, gender, age, and clinical setting. Results. The overall response rate was 52%; 72% of the nurses and 39% of the doctors answered the questionnaire. In the OOH clinics, nurses scored significantly higher than doctors on Safety climate and Job satisfaction. Older health care providers scored significantly higher than younger on Safety climate and Working conditions. In GP practices, male health professionals scored significantly higher than female on Teamwork climate, Safety climate, Perceptions of management and Working conditions. Health care providers in GP practices had significant higher mean scores on the factors Safety climate and Working conditions, compared with those working in the OOH clinics. Conclusion. Our study showed that nurses scored higher than doctors, older health professionals scored higher than younger, male GPs scored higher than female GPs, and health professionals in GP practices scored higher than those in OOH clinics – on several patient safety factors.Key Words: Adverse events, general practice, medical errors, Norway, out-of-hours, patient safety culture, primary care, Safety Attitudes QuestionnairePatient safety culture is how leader and staff interaction, attitudes, routines, and practices in a group setting may protect patients from adverse events.

• In out-of-hours clinics, nurses scored higher than doctors, and older health professionals scored higher than younger on patient safety factors.
• Male professionals in GP practices scored significantly higher than female on four of the patient safety factors.
• Health care providers in GP practices had higher patient safety factor scores than those working in out-of-hours clinics.

     

Health information technology: transforming chronic disease management and care transitions

Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety.     

BITTEN at the Bedside: An Application Guide for Nurse Practitioners

Patients with complex medical conditions may have a medical history that includes multiple negative/traumatic experiences with the health care system over the course of their diagnosis and treatment. The BITTEN (Betrayal history by health-related institutions; Indicator for health care engagement; Trauma symptoms related to health care; Trust in health care providers; Expectation of patient; Needs of patient) model posits that health care providers can recognize and respond in a way that encourages resisting patient retraumatization. We present a hypothetical case study applying the BITTEN model as a patient-centered framework to include in a standard visit. Increased awareness of the patient’s risk for institutional betrayal, trauma, and overall negative past health care experiences can help the NP better understand the patient’s current and future health care needs and expectations.     

护理安全管理新思路

病人安全与医疗护理差错日益受到人们关注。从护理角度出发,保障和促进病人安全,需要加强护理安全管理,随着对病人安全的深入研究和探讨,护理管理者对护理安全理念的认识也应更新,重点从接受人皆会犯错的事实、明确差错多来自系统问题、借助安全管理成果和信息技术、创建“安全文化”以及建立自愿报告系统5个方面阐述了护理安全管理的一些新思路。     

Logrolling: establishing consistent practice

Logrolling is a common patient care procedure performed by many health care workers. The purpose of logrolling is to maintain alignment of the spine while turning and moving the patient who has had spinal surgery or suspected or documented spinal injury. Achieving consistency in logrolling practice across patient care settings is particularly challenging, but necessary for patient safety and satisfaction. A multidisciplinary group of health care providers developed regional policies and procedures for logrolling, logrolling with cervical spine (C-spine) precautions, and collar care. The process used for establishing best practice, staff education, and implementation is described.     

Consider the Dose

Health care providers have a responsibility to their patients to ensure strict adherence to the international guiding principle “as low as reasonably achievable” for radiation safety. Nurses can pledge their support for this concept and lead through education on radiation safety. We can become radiation cognizant and educate health care professionals on the doses patients receive during computed tomography examinations. This will aid health care providers in deciding the risks and benefits of these exams.     

Designing a Patient Safety Undergraduate Medical Curriculum: The Telluride Interdisciplinary Roundtable Experience

Purpose: Patient safety has emerged as a global concern in the provision of quality health care, and yet, to date, few medical schools have created and/or implemented patient safety curricula. The purpose of this article is to introduce readers to one model of a patient safety undergraduate medical curriculum, as designed by a group of experts attending an annual interdisciplinary roundtable assembled for this purpose. Summary: The Annual Telluride Interdisciplinary Roundtable met in 2005 and 2006 to design what it considered to be a comprehensive patient safety curriculum for medical students. Invited members included stakeholders from a variety of fields, including health care providers, senior health care administration, students, residents, patient advocacy leaders, and curriculum development/assessment experts. The group developed a list of general curricular principles, followed by 11 specific elements felt to be essential to an effective patient safety curriculum for undergraduate medical education students. It also identified a number of challenges to implementing such a curriculum. Conclusions: A patient safety curriculum, developed by a group of experts for an undergraduate medical education population, was successfully developed over a two-year period of time. Future meetings of the Telluride Roundtable group have centered on evaluation and refinement of these curricular elements as pilots occur in a number of medical schools, and new curricular ideas continue to be developed. Continued interprofessional dialogue and collaborative research will enable the development and implementation of a standardized longitudinal patient safety student curriculum.     

Start-up of a simulation center in an acute care hospital

High-fidelity simulation facilitates the professional development and interprofessional collaboration of health care providers across multiple disciplines and specialties, thus reducing medical errors, improving patient safety, and changing the way that health care professionals feel about and manage the low-occurrence, high-risk scenarios that inevitably occur in the clinical setting. Less complex forms of simulation have long been used to teach clinical competencies and critical thinking, standardize care, and improve interdisciplinary communication. Because high-fidelity simulation can provide an edge in continuing health care education, innovative organizations increasingly use high-fidelity simulation. Often, simulation centers are built from the ground up by health care personnel who have minimal experience with high-fidelity simulation or other forms of advanced technology. This article describes the start-up of a simulation center for interprofessional continuing education in the acute care setting.     

Meaningful Use of Electronic Health Records

The concerns on patient safety and quality improvement in health care are increasing. There is growing use of technology in health care, particularly use of the electronic health record (EHR). As this occurs, the health care system is transforming. The federal government has become involved in EHR implementation, encouraging improved health care. The Centers for Medicare & Medicaid Services are implementing the Meaningful Use (MU) Incentive Program for Medicare- and Medicaid-eligible providers. As EHR implementation and MU Programs grow, it is important for the nurse practitioner (NP) to be aware of the MU Program. As NPs become engaged in using EHRs, MU will have an impact on changing health care systems and implications related to clinical practice and improved outcomes.     

Kernicterus: A “never-event” in healthy term and near-term newborns

Kernicterus is a tragic and unacceptable outcome for jaundice in an otherwise healthy newborn. But as health care practices and attitudes have changed over the years, reemergence of kernicterus has been evident in the medical literature and in the community. Current practice management for jaundice is prone to misunderstanding and oversights. Not all health care providers are involved in the process and there was a loss of concern about potential bilirubin toxicity. To ensure patient safety, address the root causes of kernicterus, and enhance the human factor performance, a system-based approach to hyperbilirubinemia to prevent kernicterus is described.     

AORN guidance statement: safe on-call practices in perioperative practice settings. Association of periOperative Registered Nurses

Call staffing and the associated long work hours can be challenging for both perioperative staff members and the health care organization. A change in culture is needed to recognize exhaustion as an unacceptable risk to patients and perioperative personnel safety. Perioperative health care providers have a personal responsibility to arrive at work fully rested. Health care organizations have a responsibility to create work and call schedules that consider the effect of long work hours on patient safety as well as perioperative staff members' welfare. The development of standardized safe work hours and call practices should reflect current recommendations emerging from authoritative sources, legislation, and empirical data. Prolonged work periods without adequate rest may contribute to diminished performance by perioperative personnel, placing both patients and workers at risk. This guidance statement may assist managers and clinicians in developing policies and procedures for safe call practices.     

Second victim phenomenon: Is ‘just culture’ a reality? An integrative review

BackgroundDespite rigorous and multiple attempts to establish a culture of patient safety and a goal to decrease incidence of patient deaths in the health care, estimations of preventable mortality due to medical errors varied widely from 44,000 to 250,000 in hospital settings. This magnitude of medical errors establishes patient safety as being at the forefront of public concerns, healthcare practice and research. In addition to the potential negative impact on patients and the healthcare system, medical errors evoke intense psychological responses in health care providers' responses that threaten their personal and professional selves, and their ability to deliver high quality patient care. Studies show half of all hospital providers will suffer from second victim phenomena at least once in their careers. Health care institutions have begun a paradigm shift from blame to fairness, referred to as ‘just culture’. ‘Just culture’ better ensures that a balanced, responsible approach for both providers who err and healthcare organizations in which they practice, and shifts the focus to designing improved systems in the workplace.ObjectivesThe aim of this review was to identify: how medical errors affect health care professionals, as second victims; and how health care organizations can make ‘just culture’ a reality.DesignAn integrative review was performed using a methodical three-step search on the concept of second victims' perceptions and responses, as well as ‘just culture’ of health care institutions.ResultsA total of 42 research studies were identified involving health care professionals: 10 qualitative studies; eight mixed-method studies; and 24 quantitative studies. Second victims' perceptions of the current ‘just culture’ included: 1) fear of repercussions of reporting medical errors as a barrier; 2) supportive safety leadership is central to reducing fear of error reporting; 3) improved education on adverse event reporting, developing positive feedback when adverse events are reported, and the development of non-punitive error guidelines for health care professionals are needed; and 4) the need for development of standard operating procedures for health care facility peer-support teams.ConclusionsSecond victims' perceptions of organizational and peer support are a part of ‘just culture’. Enhanced support for second victims may improve the quality of health care, strengthen the emotional support of the health care professionals, and build relationships between health care institutions and staff. Although some programs are in place in health care institutions to support ‘just culture’ and second victims, more comprehensive programs are needed.     

Changing competencies in health care professions: Will your nurses be ready?

In 1999, the Institute of Medicine (IOM) report “To Err is Human: Building a Safer Health System” brought the issues of medical error and patient safety to the forefront of national concern.¹ In this report, the now popularized statistic that “at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented” stimulated health care providers and purchasers into action. Problems arising from decentralized and fragmented delivery systems, inadequate safety reporting methods, and the absence of a blameless culture of learning in health care all were cited as contributing factors to preventable medical errors with resultant patient harm.     

The Health and Social Care Act 2008

Several inquiry reports have shown that there is still a need to further improve health and social care and strengthen public confidence in these services. The reports have particularly emphasized the need for stricter regulation of health and adult social care providers and the need to use statutory powers to ensure compliance with quality and safety standards.This article outlines how the provisions of the Health and Social Care Act 2008 aim to address this need to further regulate quality and safety standards in health and social care.