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Applied Clinical Informatics Aug 2017Electronic patient safety event reporting (e-reporting) is an effective mechanism to learn from errors and enhance patient safety. Unfortunately, the value of... (Review)
Review
OBJECTIVES
Electronic patient safety event reporting (e-reporting) is an effective mechanism to learn from errors and enhance patient safety. Unfortunately, the value of e-reporting system (a software or web server based platform) in patient safety research is greatly overshadowed by low quality reporting. This paper aims at revealing the current status of system features, detecting potential gaps in system design, and accordingly proposing suggestions for future design and implementation of the system.
METHODS
Three literature databases were searched for publications that contain informative descriptions of e-reporting systems. In addition, both online publicly accessible reporting forms and systems were investigated.
RESULTS
48 systems were identified and reviewed. 11 system design features and their frequencies of occurrence (Top 5: widgets (41), anonymity or confidentiality (29), hierarchy (20), validator (17), review notification (15)) were identified and summarized into a system hierarchical model.
CONCLUSIONS
The model indicated the current e-reporting systems are at an immature stage in their development, and discussed their future development direction toward efficient and effective systems to improve patient safety.
Topics: Humans; Medical Errors; Medical Informatics; Patient Safety
PubMed: 28853766
DOI: 10.4338/ACI-2016-02-R-0023 -
Journal of Preventive Medicine and... Mar 2017We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient... (Review)
Review
OBJECTIVES
We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI).
METHODS
We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them.
RESULTS
There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI.
CONCLUSIONS
The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.
Topics: Databases, Factual; Humans; Medical Errors; Patient Safety; Physicians
PubMed: 28372351
DOI: 10.3961/jpmph.16.105 -
International Journal For Quality in... Aug 2015To establish current knowledge of patient safety and quality of care in developing countries in Southeast Asia, current interventions and the knowledge gaps. (Review)
Review
OBJECTIVE
To establish current knowledge of patient safety and quality of care in developing countries in Southeast Asia, current interventions and the knowledge gaps.
STUDY DESIGN
Systematic review and narrative synthesis.
DATA SOURCES
Key words, synonyms and subject headings were used to search seven electronic databases in addition to manual searching of relevant journals.
DATA SYNTHESIS
Titles and abstracts of publications between 1990 and 2014 were screened by two reviewers and checked by a third. Full text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted and synthesized.
RESULTS
Four inter-related safety and quality concerns were evident from 33 publications: (i) the risk of patient infection in healthcare delivery, (ii) medications errors/use, (iii) the quality and provision of maternal and perinatal care and (iv) the quality of healthcare provision overall.
CONCLUSIONS
Large-scale prevalence studies are needed to identify the full range of safety and quality problems in developing countries in Southeast Asia. Sharing lessons learnt from extensive quality and safety work conducted in industrialized nations may contribute to significant improvements. Yet the applicability of interventions utilized in developed countries to the political and social context in this region must be considered. Strategies to facilitate the collection of robust safety and quality data in the context of limited resources and the local context in each country are needed.
Topics: Asia, Southeastern; Cross Infection; Developing Countries; Humans; Maternal Health Services; Medication Errors; Patient Safety; Perinatal Care; Quality of Health Care
PubMed: 26071280
DOI: 10.1093/intqhc/mzv041 -
Journal of Advanced Nursing Jan 2020To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach.
AIMS
To obtain a comprehensive insight of the impact of patient and family engagement on patient safety and identify issues in implementing this approach.
BACKGROUND
Patient and family engagement is increasingly emerging as a potential approach for improving patient safety.
DESIGN
Mixed method multilevel synthesis.
DATA SOURCES
PubMed, CINAHL, Embase, and Cochrance Library (January 2009-April 2018).
REVIEW METHODS
The review was conducted according to the principles recommended by the Cochrane Handbook for Systematic Review and in accordance with the PRISMA guidelines.
RESULTS
Forty-two relevant studies were identified. Common intervention groups included 'direct care' and 'organization' levels with 'consultation' and 'involvement' approaches, while the 'health system' level and 'partnership and shared leadership' approaches were rarely implemented. Findings revealed positive effects of the interventions on patient safety. Most study participants expressed their willingness to engage in or support patient and family engagement. However, existing gaps and barriers in implementing patient and family engagement were identified.
CONCLUSION
Future research should further focus on issuing consensus guidelines for implementing patient and family engagement in patient safety, extending the research scope for all aspects of patient and family engagement and patient safety and identifying priority areas for action that is suitable for each health facility.
IMPACT
Policymakers should issue guidelines for implementing patient and family engagement in healthcare systems which would enable healthcare providers to implement patient and family engagement and improve patient safety appropriately and effectively.
Topics: Family; Female; Humans; Male; Patient Safety; Patients
PubMed: 31588602
DOI: 10.1111/jan.14227 -
American Journal of Medical Quality :... 2017Safety measure development has focused on inpatient care despite outpatient visits far outnumbering inpatient admissions. Some measures are clearly identified as... (Review)
Review
Safety measure development has focused on inpatient care despite outpatient visits far outnumbering inpatient admissions. Some measures are clearly identified as outpatient safety measures when published, yet outcomes from quality improvement studies also may be useful measures. The authors conducted a systematic review of the literature to identify published articles detailing safety measures applicable to adult primary care. A total of 21 articles were identified, providing specifications for 182 safety measures. Each measure was classified into one of 6 outpatient safety dimensions: medication management, sentinel events, care coordination, procedures and treatment, laboratory testing and monitoring, and facility structures/resources. Compared to the multitude of available inpatient safety measures, the number of existing adult primary care measures is low. The measures identified by this systematic review may yield further insight into the breadth of safety events causing harm in primary care, while also identifying areas of patient safety in primary care that may be understudied.
Topics: Humans; Medical Errors; Outcome and Process Assessment, Health Care; Patient Safety; Primary Health Care; Quality Indicators, Health Care; Safety Management
PubMed: 27117638
DOI: 10.1177/1062860616644328 -
International Journal For Equity in... Aug 2018Patient safety is a quality indicator for primary care and it should be based on individual needs, and not differ among different social groups. Nevertheless, the... (Review)
Review
BACKGROUND
Patient safety is a quality indicator for primary care and it should be based on individual needs, and not differ among different social groups. Nevertheless, the attention on social disparities in patient safety has been mainly directed towards the hospital care, often overlooking the primary care setting. Therefore, this paper aims to synthesise social disparities in patient safety in the primary care setting.
METHODS
The Databases PubMed and Web of Science were searched for relevant studies published between January 1st 2006 and January 31st 2017. Papers investigating racial, gender and socioeconomic disparities in regards to administrative errors, diagnostic errors, medication errors and transition of care errors in primary care were included. No distinction in terms of participants' age was made.
RESULTS
Women and black patients are more likely to experience patient safety events in primary care, although it depends on the type of disease, treatment, and healthcare service. The available literature largely describes gender and ethnic disparities in the different patient safety domains whilst income and educational level are studied to a lesser extent.
CONCLUSIONS
The results of this systematic review suggest that vulnerable social groups are likely to experience adverse patient safety events in primary care. Enhancing family doctors' awareness of these inequities is a necessary first step to tackle them and improve patient safety for all patients. Future research should focus on social disparities in patient safety using socioeconomic indicators, such as income and education.
Topics: Ethnicity; Female; Healthcare Disparities; Humans; Male; Patient Safety; Primary Health Care; Racial Groups; Sex Factors; Socioeconomic Factors; Young Adult
PubMed: 30086754
DOI: 10.1186/s12939-018-0828-7 -
BMJ Open Quality Apr 2023The implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although...
BACKGROUND
The implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although substantial efforts have sought to improve these systems, there is a need to more comprehensively understand critical success factors. This study aims to summarise the barriers and facilitators perceived by hospital staff and physicians to influence the reporting, analysis, learning and feedback within PSLS in hospitals.
METHODS
We performed a systematic review and meta-synthesis by searching MEDLINE (Ovid), EMBASE (Ovid), CINAHL, Scopus and Web of Science. We included English-language manuscripts of qualitative studies evaluating effectiveness of the PSLS and excluded studies evaluating specific individual adverse events, such as systems for tracking only medication side effects, for example. We followed the Joanna Briggs Institute methodology for qualitative systematic reviews.
RESULTS
We extracted data from 22 studies, after screening 2475 for inclusion/exclusion criteria. The included studies focused on reporting aspects of the PSLS, however, there were important barriers and facilitators across the analysis, learning and feedback phases. We identified the following barriers for effective use of PSLS: inadequate organisational support with shortage of resources, lack of training, weak safety culture, lack of accountability, defective policies, blame and a punitive environment, complex system, lack of experience and lack of feedback. We identified the following enabling factors: continuous training, a balance between accountability and responsibility, leaders as role models, anonymous reporting, user-friendly systems, well-structured analysis teams, tangible improvement.
CONCLUSION
Multiple barriers and facilitators to uptake of PSLS exist. These factors should be considered by decision makers seeking to enhance the impact of PSLS.
ETHICS AND DISSEMINATION
No formal ethical approval or consent were required as no primary data were collected.
Topics: Humans; Patient Safety; Learning
PubMed: 37012003
DOI: 10.1136/bmjoq-2022-002134 -
Emergency Medicine Journal : EMJ Jun 2019Patient experience is positively associated with both clinical effectiveness and patient safety and should be a priority for emergency care providers. While both... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patient experience is positively associated with both clinical effectiveness and patient safety and should be a priority for emergency care providers. While both quantitative and qualitative approaches can be used to evaluate patient experience in the emergency department (ED), the latter is well aligned to develop a detailed understanding of features influencing the lived experience of ED patients. This study aimed to systematically review the literature of qualitative studies to identify determinants of adult patient experience in the ED.
METHODS
A Preferred Reporting Items for Systematic review and Meta-Analysis compliant systematic review was conducted using PubMed, CINAHL, EMBASE, BNI and bibliography searches to identify qualitative studies exploring patient experiences in ED published in English between 1997 and 2018. Quality assessment was conducted using the Critical Appraisal Skills Programme checklist. Descriptive text and quotations relating to patient experience were extracted from included studies and a meta-synthesis conducted using thematic analysis.
RESULTS
A total of 625 records were screened from which 40 studies underwent full review and 22 were included. Results were coded by two researchers (BG and JML). Meta-synthesis identified 198 discrete units of analysis which were clustered around five analytical themes. These were based on the perceived 'needs' of patients visiting the ED and were defined as communication, emotional, competent care, physical/environmental and waiting needs. Findings were translated into a conceptual model for optimising patient experience in the ED.
CONCLUSION
This meta-synthesis provides a framework for understanding the determinants of patient experience in the ED. The resulting conceptual model and recommendations may have the potential to directly inform practice and improve the patient experience.
Topics: Delivery of Health Care; Emergency Service, Hospital; Humans; Life Change Events; Patient Safety; Patients; Physician-Patient Relations; Qualitative Research; Quality of Health Care
PubMed: 31003992
DOI: 10.1136/emermed-2018-208156 -
Journal of Patient Safety Mar 2022The aim of this systematic review was to synthesize, summarize, and evaluate the quality of extant quantitative and qualitative literature related to patient safety in...
OBJECTIVES
The aim of this systematic review was to synthesize, summarize, and evaluate the quality of extant quantitative and qualitative literature related to patient safety in pharmacy education. This systematic review included literature that targeted the content, delivery, and outcomes of patient safety in addition to literature that explored the perspectives of pharmacy students and faculty on how patient safety is integrated within their curricula.
METHODS
A systematic review was conducted. Four electronic databases were searched for articles published between 2000 and 2019: PubMed, MEDLINE, EMBASE, and ScienceDirect. Selection was based on prespecified criteria and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two independent reviewers selected articles, extracted data, and assessed articles' qualities using the Crowe Critical Appraisal Tool. Discrepancies were resolved by consensus or by consulting a third reviewer. Descriptive synthesis of data was performed.
RESULTS
Twenty-five eligible articles were included. The majority of studies originated from United States (n = 15). Educational content involved principles of patient safety, and identification, disclosure, and management of medication errors. There was a lack of standardization on how patient safety is incorporated into the pharmacy curricula. Eleven articles (64%) were interprofessional in nature, delivered as a patient safety course (n = 6), through simulation (n = 3), as seminars (n = 1), or as part of student experiential learning (n = 1). Of the 7 articles discussing delivery of patient safety through courses or modules, 4 (57%) were offered as elective courses. Students' perceptions and attitudes significantly improved after all patient safety interventions, reflecting the importance of addressing patient safety in education to ensure optimum future practice.
CONCLUSIONS
This systematic review demonstrated how patient safety education was incorporated into pharmacy programs in terms of the content and methods of delivery. It was promising to see patient safety content being delivered interprofessionally and in experiential education. Students and faculty regarded implementing patient safety in education as an essential act to meet future work demands. Longitudinal studies to assess the long-term impact of incorporating patient safety on student behaviors upon graduation and health outcomes are needed.
Topics: Clinical Competence; Curriculum; Humans; Patient Safety; Pharmacies; Pharmacy
PubMed: 35188928
DOI: 10.1097/PTS.0000000000000818 -
Drugs & Aging Oct 2013Inappropriate medication use is common in the elderly and the risks associated with their use are well known. The term deprescribing has been utilised to describe the... (Review)
Review
BACKGROUND
Inappropriate medication use is common in the elderly and the risks associated with their use are well known. The term deprescribing has been utilised to describe the complex process that is required for the safe and effective cessation of inappropriate medications. Given the primacy of the consumer in health care, their views must be central in the development of any deprescribing process.
OBJECTIVES
The aim of this study was to identify barriers and enablers that may influence a patient's decision to cease a medication.
DATA SOURCES
A systematic search of MEDLINE, International Pharmaceutical Abstracts, EMBASE, CINAHL, Informit and Scopus was conducted and augmented with a manual search. Numerous search terms relating to withdrawal of medications and consumers' beliefs were utilised.
STUDY ELIGIBILITY CRITERIA
Articles were included if the barriers or enablers were directly patient/carer reported and related to long-term medication(s) that they were currently taking or had recently ceased.
STUDY APPRAISAL AND SYNTHESIS METHODS
Determination of relevance and data extraction was performed independently by two reviewers. Content analysis with coding was utilised for synthesis of results.
RESULTS
Twenty-one articles met the criteria and were included in the review. Three themes, disagreement/agreement with 'appropriateness' of cessation, absence/presence of a 'process' for cessation, and negative/positive 'influences' to cease medication, were identified as both potential barriers and enablers, with 'fear' of cessation and 'dislike' of medications as a fourth barrier and enabler, respectively. The most common barrier/enabler identified was 'appropriateness' of cessation, with 15 studies identifying this as a barrier and 18 as an enabler.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
The decision to stop a medication by an individual is influenced by multiple competing barriers and enablers. Knowledge of these will aid in the development of a deprescribing process, particularly in approaching the topic of cessation with the patient and what process should be utilised. However, further research is required to determine if the proposed patient-centred deprescribing process will result in improved patient outcomes.
Topics: Decision Making; Humans; Inappropriate Prescribing; Patient Safety; Withholding Treatment
PubMed: 23912674
DOI: 10.1007/s40266-013-0106-8