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BMC Nursing Feb 2023Work stress is one of the leading causes of physical and mental problems among nurses and can affect patient safety. Nurses experiencing stress are more prone to make...
BACKGROUND
Work stress is one of the leading causes of physical and mental problems among nurses and can affect patient safety. Nurses experiencing stress are more prone to make errors, which has consequences for the safety culture. This study aimed to describe the findings of studies that examined the relationship between job stress and patient safety culture among nurses.
METHODS
A systematic review of published English-language articles from 2017 to 2021 was obtained through an electronic search of three large online databases (i.e., CINAHL through EBSCOhost, Medline through PubMed, and Embase). We used the Statement of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to guide the undertaking of this review. In addition, data extraction and quality assessment were performed for the final seven quantitative articles.
RESULTS
This review showed a significant relationship between job-related stress in its different factors, patient safety culture, and patient safety. Three studies of the seven reviewed articles examined the relationship. The rest of the studies examined the relationship indirectly, discussing factors that impacted job stress and how they affected patient safety culture. However, differences in working conditions and study characteristics affected the results of these studies and the significance of this relationship.
CONCLUSIONS
This review suggests that nursing managers and administrators should consider actions to minimize nursing job stress to the minimum levels and improve their work environment to provide the best possible patient care. Future studies are needed to develop interventions to reduce workplace stress and improve nurses' safety. Furthermore, nurses' managers and educators should train nurses on resilience and how to work in trauma-informed care.
PubMed: 36782195
DOI: 10.1186/s12912-023-01198-9 -
Research in Social & Administrative... Jul 2023Unlicensed medicines are used across the UK to treat an individual's clinical needs when there are no appropriate licensed alternatives. Patients, carers and parents... (Review)
Review
BACKGROUND
Unlicensed medicines are used across the UK to treat an individual's clinical needs when there are no appropriate licensed alternatives. Patients, carers and parents have reported facing challenges with unlicensed medicines at the points of transfer of care between settings, a key time when medication errors may occur. There is little known about the patient journey as a whole, or the factors affecting patient care when receiving an unlicensed medicine.
OBJECTIVE
A systematic review of UK literature to better understand factors that affect the entire patient journey from the decision to initiate treatment with an unlicensed medicine to the point at which treatment is supplied through a community pharmacy or ends.
METHODS
Scopus, OVID EMCARE, EMBASE, OVID Medline ALL, CINAHL, Web of Science and Joanna Briggs Institute were searched from 1968 (introduction of the Medicines Act) until November 2020, using the PRISMA guidelines. Narrative synthesis of UK studies was employed to analyse descriptive and qualitative data on any reported findings that would impact the patient journey or care related to the use of unlicensed medicines, and any described barriers or enablers.
RESULTS
Forty-five studies met criteria for final inclusion, with high levels of heterogeneity in terms of designs and methods. Specific challenges that were seen to impact the continuity of care across care settings, patient safety and provision of patient-centred care included diversity of clinical needs and impact of patient population age; healthcare professional awareness and acceptability of the use of unlicensed medicines; the hierarchical structure of the NHS; inconsistent doses and formulations with varying bioequivalence; patient/parent/carer/public awareness of unlicensed medicines use and perceived acceptability.
CONCLUSIONS
This review identified a clear need for consistent information to be provided to healthcare professional and patients alike to support the safe and effective use of unlicensed medicines across care settings.
Topics: Humans; Patient Care; Health Personnel; Caregivers; Medicine; Medication Errors
PubMed: 37121796
DOI: 10.1016/j.sapharm.2023.04.120 -
Respiratory Care Feb 2021Although studies have confirmed the safety and feasibility of early active mobilization, its implementation status is still unsatisfactory. The most important obstacle... (Review)
Review
BACKGROUND
Although studies have confirmed the safety and feasibility of early active mobilization, its implementation status is still unsatisfactory. The most important obstacle is ensuring patient safety. Comprehensively assessing the physical condition of patients considered for mobilization is the basis of safety. However, appropriate guidance is lacking. We performed a systematic review to extract and summarize current safety assessment criteria for the early active mobilization of mechanically ventilated patients in the ICU.
METHODS
A systematic literature search was conducted using English and Chinese databases according to the PRISMA checklist and guidelines to identify relevant original studies that evaluated safety assessment variables and specific parameters.
RESULTS
A total of 24 medium- and high-quality articles involving a total of 4,842 subjects were included in the analysis. Among these studies, there were 15 randomized controlled trials involving 1,777 subjects (888 in the control groups, 889 in the interventional groups) and 9 cohort studies involving 3,065 subjects (1,240 in the control groups, 1,825 in the exposure groups). There were 5 safety assessment criteria, including cardiovascular, respiratory, neurological, musculoskeletal, and other. Within these were 17 different variables and 48 specific parameters.
CONCLUSIONS
The safety assessment criteria should focus on cardiac reserve, respiratory reserve, consciousness, and muscle strength. It is especially important to note whether the parameters are stable because parameter stability can be more representative of a patient's condition than absolute values. We provide a flow diagram for clinical safety assessments; however, some limitations exist, and this assessment requires further validation and optimization.
Topics: Early Ambulation; Humans; Intensive Care Units; Muscle Strength; Patient Safety; Respiration, Artificial
PubMed: 32900917
DOI: 10.4187/respcare.07888 -
Orthopaedics & Traumatology, Surgery &... Jun 2023Planned overlapping surgery can improve efficiency, reduce costs and help manage long waiting lists; yet, this practice has been questioned due to patient safety... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Planned overlapping surgery can improve efficiency, reduce costs and help manage long waiting lists; yet, this practice has been questioned due to patient safety concerns. A systematic review and meta-analysis were performed to answer the question: (1) are there any differences in the risk of postoperative adverse outcomes; and (2) are there any differences in length of stay or length of surgery, in elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed either as non-overlapping surgery (NOS) or overlapping surgery (OS).
PATIENTS AND METHODS
A systematic search of literature in the databases of MEDLINE, PubMed, Embase and Cochrane from dates of inception was performed. All studies published in English were included. Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-I) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were utilised. Relative risk (RR) was used for dichotomous outcomes, while mean difference (MD) was used for continuous variables, with 95% confidence intervals. Alpha was set at 0.05.
RESULTS
A total of nine studies with 120,625 patients were included for analyses. There were no statistically significant differences for overall rates of postoperative complications, dislocations, fractures, infections, readmissions or revision surgery nor with length of stay or length of surgery (p>0.05). Patient characteristics between groups were similar (p>0.05).
DISCUSSION
There were no differences in postoperative adverse outcomes for elective orthopaedic THA and TKA performed as NOS when compared to OS. Operating schedules for OS in elective lower limb arthroplasty appear to be safe, given appropriate patient selection processes and may be a useful method to improve hospital efficiency. Informed consent and preoperative patient education should remain paramount.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Arthroplasty, Replacement, Knee; Postoperative Complications; Arthroplasty, Replacement, Hip; Reoperation; Preoperative Care; Length of Stay
PubMed: 35472455
DOI: 10.1016/j.otsr.2022.103299 -
TheScientificWorldJournal 2021Medical errors are the third leading cause of death in the United States. Reporting of all medical errors is important to better understand the problem and to implement...
BACKGROUND
Medical errors are the third leading cause of death in the United States. Reporting of all medical errors is important to better understand the problem and to implement solutions based on root causes. Underreporting of medical errors is a common and a challenging obstacle in the fight for patient safety. The goal of this study is to review common barriers to reporting medical errors.
METHODS
We systematically reviewed the literature by searching the MEDLINE and SCOPUS databases for studies on barriers to reporting medical errors. The preferred reporting items for systematic reviews and meta-analyses guideline was followed in selecting eligible studies.
RESULTS
Thirty studies were included in the final review, 8 of which were from the United States. The majority of the studies used self-administered questionnaires (75%) to collect data. Nurses were the most studied providers (87%), followed by physicians (27%). Fear of consequences is the most reported barrier (63%), followed by lack of feedback (27%) and work climate/culture (27%). Barriers to reporting were highly variable between different centers.
Topics: Medical Errors; Patient Safety; Risk Management; Surveys and Questionnaires; United States
PubMed: 34220366
DOI: 10.1155/2021/6494889 -
Revista Brasileira de Enfermagem 2023Map, in the scientific literature, the actions taken to promote the safety of patients with covid-19 in the hospital context. (Review)
Review
OBJECTIVE
Map, in the scientific literature, the actions taken to promote the safety of patients with covid-19 in the hospital context.
METHODS
This is a scoping review according to the Joanna Briggs Institute, using the Checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. In April 2022, searches were performed on nine data sources. The results were summarized in a table and analyzed descriptively.
RESULTS
Fifteen studies were selected to compose the final sample. Most articles refer to cohort studies, followed by clinical trials. As for the areas of activity, there was a predominance of surgical centers, followed by adult and pediatric Intensive Care Units.
CONCLUSIONS
With this review, it was possible to map measures such as contingency plans and reorganization of beds, rooms, and operating rooms, in addition to the isolation and distancing practiced by patients and professionals.
Topics: Adult; Child; Humans; Patient Safety; COVID-19; Hospital Units; Operating Rooms; Beds; Research Design
PubMed: 37820105
DOI: 10.1590/0034-7167-2022-0557 -
Revista Brasileira de Enfermagem 2022to describe scientific evidence on the involvement of companions in patient safety, from their own perspective and health professionals' perspective in neonatal and...
OBJECTIVES
to describe scientific evidence on the involvement of companions in patient safety, from their own perspective and health professionals' perspective in neonatal and pediatric units.
METHODS
scoping review carried out according to The Joanna Briggs Institute's recommendations, in eight databases, following the Preferred Reporting Items checklist for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist, between 2011 and 2021.
RESULTS
the 13 studies included highlighted the importance of companions' involvement in patient safety and the prevention of adverse events. However, they pointed out failures in communication and weakness in the training of professionals, which were obstacles to their involvement. The strengthening of health education, multidisciplinary rounds and educational technologies were highlighted as strategies to expand the involvement of companions.
FINAL CONSIDERATIONS
this study directs elements for health professionals and managers to rethink the companions' role in patient safety and development of collective strategies.
Topics: Child; Communication; Friends; Health Personnel; Humans; Infant, Newborn; Patient Safety
PubMed: 35137890
DOI: 10.1590/0034-7167-2021-0504 -
International Emergency Nursing May 2021Emergency handover of critical patients is used to describe the moment of union between prehospital and hospital health team. However, the literature shows several... (Review)
Review
BACKGROUND
Emergency handover of critical patients is used to describe the moment of union between prehospital and hospital health team. However, the literature shows several definitions leading to great heterogeneity.
PURPOSE
To study the emergency handover of critical patients between two critical-emergency care wards performed by emergency nurses worldwide and to identify the features of these processes.
METHODS
We conducted an integrative review in eleven databases published from 2010 to 2019. Quality criteria and PRISMA checklist were applied. The protocol is registered with PROSPERO (CRD42020182335).
RESULTS
A total of 22 studies included and the following factors were identified: variability vs standardization, identification, professionals' behavior, localization, environmental factors, patient participation, clinical records, education/training, responsability, and communication.
CONCLUSIONS
The actual emergency handover occurs under conditions quite contrary to those recommended by experts so that it is neither safe nor effective, leading a serious problem for patient safety and quality care.
Topics: Communication; Emergency Medical Services; Emergency Service, Hospital; Humans; Patient Handoff; Patient Safety
PubMed: 33887611
DOI: 10.1016/j.ienj.2021.100997 -
Health Expectations : An International... Dec 2023We conducted a systematic review of qualitative evidence to improve understanding of the processes and outcomes of redress and reconciliation following a life-changing... (Review)
Review
INTRODUCTION
We conducted a systematic review of qualitative evidence to improve understanding of the processes and outcomes of redress and reconciliation following a life-changing event from the perspectives of individuals experiencing the event and their families.
METHODS
We searched six bibliographic databases for primary qualitative evidence exploring the views of individuals who have experienced a life-changing event, and/or their family or carers, of redress or reconciliation processes. This was supplemented with targeted database searches, forward and backward citation chasing and searches of Google Scholar and relevant websites. Title and abstract and full-text screening were undertaken independently by two reviewers. Data extraction and quality appraisal were conducted by one reviewer and checked by a second. We used a best-fit framework synthesis approach, drawing upon procedural and restorative justice concepts.
FINDINGS
Fifty-three studies (61 papers) were eligible for inclusion. Forty-one studies (47 papers) were included in the synthesis, from which we identified four themes. Three themes 'Transparency', 'Person-centered' and 'Trustworthy' represent the procedural elements required to support a fair and objective process. The fourth, 'Restorative justice' encapsulates how a fair process feels to those who have experienced a life-changing event. This theme highlights the importance of an empathic relationship between the different parties involved in the redress-reconciliation process and the significance of being able to engage in meaningful action.
CONCLUSION
Our findings highlight the procedural aspects and context of redress-reconciliation processes required to ensure that the process and outcomes are experienced as fair. These criteria may be applied to the processes used to investigate both recent and historical patient safety events.
PUBLIC CONTRIBUTION
One member of the public affiliated with the Exeter Policy Research Programme Evidence Review Facility helped develop the review protocol. Two people with experience of medically life-changing events provided insight which corroborated our findings and identified important limitations of the evidence included in this review.
Topics: Humans; Caregivers; Qualitative Research; Patients; Empathy; Emotions
PubMed: 37452516
DOI: 10.1111/hex.13820 -
Pharmacy (Basel, Switzerland) Jul 2019Prescription medicines aim to relieve patients' suffering but they can be associated with adverse side effects or adverse drug reactions (ADRs). ADRs are an important... (Review)
Review
Prescription medicines aim to relieve patients' suffering but they can be associated with adverse side effects or adverse drug reactions (ADRs). ADRs are an important cause of hospital admissions and a financial burden on healthcare systems across the globe. There is little integrative and collective knowledge on ADR reporting and monitoring in the Norwegian healthcare system. Accordingly, this systematic review aims to investigate the current trends in ADR reporting, monitoring, and handling in the Norwegian healthcare system and describe related interventions. Appropriate keywords, with regard to ADRs in both English and Norwegian languages, were used to retrieve articles published from 2010 to 2019. Six articles met the inclusion criteria. The findings offer a comprehensive picture of ADR reporting and monitoring in the Norwegian healthcare system. Psychotropic medicines were most commonly implicated by patients, while professionals most commonly reported ADRs associated with anticoagulants. The current ADR systems were compiled with the involvement of both patients and healthcare providers to record all types of drugs and ADRs of various severities, and aimed at improving ADR tracking. However, there is a need to improve current initiatives in terms of feedback and quality, and more studies are needed to explore how ADR profiles, and the associated vigilance, can improve the safety of medicines management in Norway.
PubMed: 31349705
DOI: 10.3390/pharmacy7030102