-
Journal of Psychiatric and Mental... Aug 2020WHAT IS KNOWN ON THE SUBJECT?: Aggressive behaviour is a major problem in clinical practice of mental health care and can result in the use of coercive measures....
WHAT IS KNOWN ON THE SUBJECT?: Aggressive behaviour is a major problem in clinical practice of mental health care and can result in the use of coercive measures. Coercive measures are dangerous for psychiatric patients and international mental healthcare works on the elimination of these interventions. There is no previous review that summarizes the attitude of nursing staff towards coercive measures and the influence of nursing staff characteristics on attitude towards and the use of coercive measures. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The attitude of nurses shifted from a therapeutic paradigm (coercive measures have positive effects on patients) to a safety paradigm (coercive measures are undesirable, but necessary for the wards' safety). Nurses express the need for less coercive interventions to prevent seclusion and restraint, but their perception of intrusiveness is influenced by how often they use specific coercive measures. The knowledge from scientific literature on the influence of nursing staff on coercive measures is highly inconclusive, although the feeling of safety of nurses might prove to be promising for further research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is need for increased attention specifically for the feeling of safety of nurses, to better equip nurses for their difficult work on acute mental health wards. ABSTRACT: Introduction The use of coercive measures generally has negative effects on patients. To help prevent its use, professionals need insight into what nurses believe about coercion and which staff determinants may influence its application. There is need for an integrated review on both attitude and influence of nurses on the use of coercion. Aim To summarize literature concerning attitude of nurses towards coercive measures and the influence of staff characteristics on the use of coercive measures. Method Systematic review. Results The attitude of nurses changed during the last two decades from a therapeutic to a safety paradigm. Nurses currently view coercive measures as undesirable, but necessary to deal with aggression. Nurses express the need for less intrusive interventions, although familiarity probably influences its perceived intrusiveness. Literature on the relation between staff characteristics and coercive measures is inconclusive. Discussion Nurses perceive coercive measures as unwanted but still necessary to maintain safety on psychiatric wards. Focussing on the determinants of perception of safety might be a promising direction for future research. Implications for practice Mental health care could improve the focus on the constructs of perceived safety and familiarity with alternative interventions to protect patients from unnecessary use of coercive interventions.
Topics: Attitude of Health Personnel; Coercion; Humans; Mental Disorders; Nursing Staff, Hospital; Patient Safety; Psychiatric Department, Hospital; Psychiatric Nursing; Restraint, Physical; Violence
PubMed: 31876970
DOI: 10.1111/jpm.12586 -
Otolaryngology--head and Neck Surgery :... Jun 2017Objective The breadth and depth of patient safety/quality improvement (PS/QI) research dedicated to otolaryngology-head and neck surgery (OHNS) education remains... (Review)
Review
Objective The breadth and depth of patient safety/quality improvement (PS/QI) research dedicated to otolaryngology-head and neck surgery (OHNS) education remains unknown. This systematic review aims to define this scope and to identify knowledge gaps as well as potential areas of future study to improved PS/QI education and training in OHNS. Data Sources A computerized Ovid/Medline database search was conducted (January 1, 1965, to May 15, 2015). Similar computerized searches were conducted using Cochrane Database, PubMed, and Google Scholar. Review Methods The study protocol was developed a priori using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Articles were classified by year, subspecialty, Institute of Medicine (IOM) Crossing the Chasm categories, and World Health Organization (WHO) subclass. Results Computerized searches yielded 8743 eligible articles, 267 (3.4%) of which met otolaryngology PS/QI inclusion criteria; 51 (19%) were dedicated to resident/fellow education and training. Simulation studies (39%) and performance/competency evaluation (23.5%) were the most common focus. Most projects involved general otolaryngology (47%), rhinology (18%), and otology (16%). Classification by the IOM included effective care (45%), safety/effective care (41%), and effective and efficient care (7.8%). Most research fell into the WHO category of "identifying solutions" (61%). Conclusion Nineteen percent of OHNS PS/QI articles are dedicated to education, the majority of which are simulation and focus on effective care. Knowledges gaps for future research include facial plastics PS/QI and the WHO category of "studies translating evidence into safer care."
Topics: Education, Medical; Humans; Otolaryngology; Patient Safety; Quality Improvement
PubMed: 28441509
DOI: 10.1177/0194599817701112 -
Journal of Nursing Management Oct 2022The purpose of this review was to evaluate the content, validity and reliability of patient-reported questionnaires on patient participation in patient safety. (Review)
Review
AIM
The purpose of this review was to evaluate the content, validity and reliability of patient-reported questionnaires on patient participation in patient safety.
BACKGROUND
Patient participation in patient safety is one of the key strategies that are increasingly regarded as a critical intervention to improve the quality of safety care.
EVALUATION
A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The content, reliability and validity of patient-reported questionnaires on patient participation in patient safety were assessed.
KEY ISSUES
Twenty-seven studies were included for data extraction and synthesis. The questionnaire contents most commonly used to describe patient participation in patient safety were 'attitudes and perceptions', 'experience', 'information and feedback' and 'willingness'. Internal consistency was evaluated for 17 questionnaires, and test-retest reliability was tested for four questionnaires. Content validity was assessed among all included questionnaires, and structural validity was evaluated for 12 questionnaires.
CONCLUSIONS
Future research targeting the different safety issues is still indispensable for developing patient-reported questionnaires with great psychometric quality in validity, reliability, feasibility and usability in patient participation in patient safety.
IMPLICATIONS FOR NURSING MANAGEMENT
Clinical nurses should consider the internal consistency, test-retest reliability, content validity and structural validity of the questionnaires that have been positively appraised for methodological quality before use.
Topics: Humans; Reproducibility of Results; Patient Safety; Patient Participation; Surveys and Questionnaires; Psychometrics
PubMed: 35593487
DOI: 10.1111/jonm.13690 -
Annals of Plastic Surgery Jul 2022Improving patient care and safety requires high-quality evidence. The objective of this study was to systematically review the existing evidence for patient safety (PS)...
BACKGROUND
Improving patient care and safety requires high-quality evidence. The objective of this study was to systematically review the existing evidence for patient safety (PS) and quality improvement initiatives in breast reconstruction.
METHODS
A systematic review of the published plastic surgery literature was undertaken using a computerized search and following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Publication descriptors, methodological details, and results were extracted. Articles were assessed for methodological quality and clinical heterogeneity. Descriptive statistics were completed, and a meta-analysis was considered.
RESULTS
Forty-six studies were included. Most studies were retrospective (52.2%) and from the third level of evidence (60.9%). Overall, the scientific quality was moderate, with randomized controlled trials generally being higher quality. Studies investigating approaches to reduce seroma (28.3% of included articles) suggested a potential benefit of quilting sutures. Studies focusing on infection (26.1%) demonstrated potential benefits to prophylactic antibiotics and drain use under 21 days. Enhanced recovery after surgery protocols (10.9%) overall did not compromise PS and was beneficial in reducing opioid use and length of stay. Interventions to increase flap survival (10.9%) demonstrated a potential benefit of nitroglycerin on mastectomy skin flaps.
CONCLUSIONS
Overall, studies were of moderate quality and investigated several worthwhile interventions. More validated, standardized outcome measures are required, and studies focusing on interventions to reduce thromboembolic events and bleeding risk could further improve PS.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Patient Safety; Quality Improvement; Retrospective Studies
PubMed: 35749815
DOI: 10.1097/SAP.0000000000003062 -
Journal of Biomedical Informatics Sep 2022Patient safety classifications/ontologies enable patient safety information systems to receive and analyze patient safety data to improve patient safety. Patient safety... (Review)
Review
INTRODUCTION
Patient safety classifications/ontologies enable patient safety information systems to receive and analyze patient safety data to improve patient safety. Patient safety classifications/ontologies have been developed and evaluated using a variety of methods. The purpose of this review was to discuss and analyze the methodologies for developing and evaluating patient safety classifications/ontologies.
METHODS
Studies that developed or evaluated patient safety classifications, terminologies, taxonomies, or ontologies were searched through Google Scholar, Google search engines, National Center for Biomedical Ontology (NCBO) BioPortal, Open Biological and Biomedical Ontology (OBO) Foundry and World Health Organization (WHO) websites and Scopus, Web of Science, PubMed, and Science Direct. We updated our search on 30 February 2021 and included all studies published until the end of 2020. Studies that developed or evaluated classifications only for patient safety and provided information on how they were developed or evaluated were included. Systems with covered patient safety terms (such as ICD-10) but are not specifically developed for patient safety were excluded. The quality and the risk of bias of studies were not assessed because all methodologies and criteria were intended to be covered. In addition, we analyzed the data through descriptive narrative synthesis and compared and classified the development and evaluation methods and evaluation criteria according to available development and evaluation approaches for biomedical ontologies.
RESULTS
We identified 84 articles that met all of the inclusion criteria, resulting in 70 classifications/ontologies, nine of which were for the general medical domain. The most papers were published in 2010 and 2011, with 8 and 7 papers, respectively. The United States (50) and Australia (23) have the most studies. The most commonly used methods for developing classifications/ontologies included the use of existing systems (for expanding or mapping) (44) and qualitative analysis of event reports (39). The most common evaluation methods were coding or classifying some safety report samples (25), quantitative analysis of incidents based on the developed classification (24), and consensus among physicians (16). The most commonly applied evaluation criteria were reliability (27), content and face validity (9), comprehensiveness (6), usability (5), linguistic clarity (5), and impact (4), respectively.
CONCLUSIONS
Because of the weaknesses and strengths of the development/evaluation methods, it is advised that more than one method for development or evaluation, as well as evaluation criteria, should be used. To organize the processes of developing classification/ontologies, well-established approaches such as Methontology are recommended. The most prevalent evaluation methods applied in this domain are well fitted to the biomedical ontology evaluation methods, but it is also advised to apply some evaluation approaches such as logic, rules, and Natural language processing (NLP) based in combination with other evaluation approaches. This research can assist domain researchers in developing or evaluating domain ontologies using more complete methodologies. There is also a lack of reporting consistency in the literature and same methods or criteria were reported with different terminologies.
Topics: Biological Ontologies; Humans; Logic; Natural Language Processing; Patient Safety; Reproducibility of Results
PubMed: 35878822
DOI: 10.1016/j.jbi.2022.104150 -
Journal of Biomedical Informatics Dec 2023Content coverage of patient safety ontology and classification systems should be evaluated to provide a guide for users to select appropriate ones for specific... (Review)
Review
BACKGROUND
Content coverage of patient safety ontology and classification systems should be evaluated to provide a guide for users to select appropriate ones for specific applications. In this review, we identified and compare content coverage of patient safety classifications and ontologies.
METHODS
We searched different databases and ontology/classification repositories to identify these classifications and ontologies. We included patient safety-related taxonomies, ontologies, classifications, and terminologies. We identified and extracted different concepts covered by these systems and mapped these concepts to international classification for patient safety (ICPS) and finally compared the content of these systems.
RESULTS
Finally, 89 papers (77 classifications or ontologies) were analyzed. Thirteen classifications have been developed to cover all medical domains. Among specific domain systems, most systems cover medication (16), surgery (8), medical devices (3), general practice (3), and primary care (3). The most common patient safety-related concepts covered in these systems include incident types (41), contributing factors/hazards (31), patient outcomes (29), degree of harm (25), and action (18). However, stage/phase (6), incident characteristics (5), detection (5), people involved (5), organizational outcomes (4), error type (4), and care setting (3) are some of the less covered concepts in these classifications/ontologies.
CONCLUSION
Among general systems, ICPS, World Health Organization's Adverse Reaction Terminology (WHO-ART), and Ontology of Adverse Events (OAE) cover most patient safety concepts and can be used as a gold standard for all medical domains. As a result, reporting systems could make use of these broad classifications, but the majority of their covered concepts are related to patient outcomes, with the exception of ICPS, which covers other patient safety concepts. However, the ICPS does not cover specialized domain concepts. For specific medical domains, MedDRA, NCC MERP, OPAE, ADRO, PPST, OCCME, TRTE, TSAHI, and PSIC-PC provide the broadest coverage of concepts. Many of the patient safety classifications and ontologies are not formally registered or available as formal classification/ontology in ontology repositories such as BioPortal. This study may be used as a guide for choosing appropriate classifications for various applications or expanding less developed patient safety classifications/ontologies. Furthermore, the same concepts are not represented by the same terms; therefore, the current study could be used to guide a harmonization process for existing or future patient safety classifications/ontologies.
Topics: Humans; Patient Safety; Biological Ontologies
PubMed: 37984548
DOI: 10.1016/j.jbi.2023.104549 -
Journal of Clinical Nursing Mar 2015This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. (Review)
Review
AIMS AND OBJECTIVES
This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives.
BACKGROUND
Ambiguities remain about how patients participate in routine measures designed to promote patient safety.
DESIGN
Systematic review using integrative methods.
METHODS
Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: "patient", "healthcare provider", "task", "work environment", "organisation & management".
RESULTS
We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives.
CONCLUSIONS
Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures.
RELEVANCE TO CLINICAL PRACTICE
Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety.
Topics: Humans; Patient Participation; Patient Safety
PubMed: 25178172
DOI: 10.1111/jocn.12664 -
Scandinavian Journal of Trauma,... Jul 2017This systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed... (Review)
Review
BACKGROUND
This systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process.
METHODS
We systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. We included all types of peer-reviewed designs on the five topics. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction.
RESULTS
We included 67 studies with low to moderate quality. Non-conveyance rates for general patient populations ranged from 3.7%-93.7%. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Within 24 h-48 h after non-conveyance, 2.5%-6.1% of the patients have EMS representations, and 4.6-19.0% present themselves at the ED. Mortality rates vary from 0.2%-3.5% after 24 h, up to 0.3%-6.1% after 72 h. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card).
CONCLUSIONS
Non-conveyance rates for general and specific patient populations vary. Patients in the non-conveyance population present themselves with a variety of initial complaints and conditions, common initial complaints or conditions are related to trauma and neurology. After non-conveyance, a proportion of patients re-enters the emergency healthcare system within 2 days. For ambulance professionals the non-conveyance decision-making process is complex and multifactorial. Competencies needed to perform non-conveyance are marginally described, and there is a limited amount of supportive tools is available for general and specific non-conveyance populations. This may compromise patient-safety.
Topics: Air Ambulances; Clinical Decision-Making; Humans; Patient Safety; Patient Selection
PubMed: 28716132
DOI: 10.1186/s13049-017-0409-6 -
Journal of Patient Safety Sep 2015In the past 13 years since the Institute of Medicine report, To Err is Human, was published, considerable attention was placed on the relationship between patient safety... (Review)
Review
CONTEXT
In the past 13 years since the Institute of Medicine report, To Err is Human, was published, considerable attention was placed on the relationship between patient safety culture and patient outcomes. Research to understand this relationship has been conducted; however, now, it is important to systematically review these studies to determine if there are tools, levels of measure and outcomes that have been shown to result in significant correlations.
OBJECTIVE
The purpose of this review is to evaluate the state of research connecting patient safety culture and patient outcomes to determine nurse-sensitive patient outcomes that have been significantly correlated to culture of safety and commonly used tools to measure culture of safety in the studies with significant correlations.
DATA SOURCES
Published English only research articles were considered for the review. Only studies that directly measured patient outcomes in relationship to patient safety culture in hospitals involving registered nurses as a participant were included.
RESULTS
Evidence of relationships between patient safety culture and patient outcomes exist at the hospital and nursing unit level of analysis; however, the number of studies finding statistically significant correlations particularly using nurse-sensitive outcomes is limited.
CONCLUSIONS
The findings from this review suggest that there are emerging trends indicating that the specific patient safety culture measurement tools, the level of analysis, and selection of outcome measures are important considerations in study design. More research is needed to determine interventions that improve patient safety culture and outcomes.
Topics: England; Humans; Organizational Culture; Patient Outcome Assessment; Patient Safety; Practice Patterns, Nurses'; Safety Management
PubMed: 24583952
DOI: 10.1097/PTS.0000000000000058 -
Brazilian Journal of Anesthesiology... 2022Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and... (Review)
Review
INTRODUCTION AND OBJECTIVE
Patient safety is a concept of great importance to managers, health professionals, and patients and their families, given patient safety promotes more effective care and reduces costs. Moreover, while analyzing the area of anesthesiology, one can realize the epidemiological changes, increased complexity and number of procedures, and the adoption of a new matrix of essential skills mandatory for residents of anesthesiology in Brazil. Thus, it is relevant to identify current patient safety competences among anesthesiology residents.
METHODS
A systematic review was elaborated using PubMed, SciELO, BVS, Cochrane Library, LILACS and CAPES databases with the descriptors "anesthesiology", "patient safety", "residency" and "competence".
RESULTS AND CONCLUSIONS
Thirteen articles published in the past 10 years were analyzed. The articles depicted competences grouped into three categories: knowledge (identification, prevention and management of adverse events; use of correct and up-to-date information; understanding of human factors; and continuous learning), skills (efficient communication; teamwork; leadership; decision-making; and self-confidence), and attitude (management of stress and fatigue; and infection control). All these skills can be developed and assessed through simulation and active learning methods, profiting from a multidisciplinary approach. Studies also reveal that residents perform poorly in certain patient safety domains due to lack of effective in-depth understanding, appreciation of the topic and ineffective teaching. As a result, greater investment in the topic is needed by teaching and health institutions and researchers.
Topics: Anesthesiology; Brazil; Clinical Competence; Humans; Internship and Residency; Patient Safety
PubMed: 35124107
DOI: 10.1016/j.bjane.2021.06.029