Background: Lay press investigations have been published that describe pharmacist errors and the workplace environment in the community pharmacy setting. However, recent studies that explore pharmacists' perceptions of patient safety in the workplace are limited. Objectives: 1) To describe pharmacists' perceptions of workplace patient safety; 2) To compare pharmacists' perceptions of workplace patient safety across practice setting type, pharmacist roles, average hours worked per shift, and average hours worked per week. Methods: Actively licensed Tennessee pharmacists were recruited from January 1 and June 30, 2019 to complete a 13-item survey of workplace patient safety perceptions ( =1391). Descriptive statistics were calculated, and nonparametric statistical tests employed to compare differences in perceptions across practice setting type, pharmacist roles, and hours worked per shift and per week. Results: Statistically significant differences in workplace patient safety perceptions were noted across practice setting type (p values <.001) and pharmacist roles (p values <.001). The extent to which pharmacists agreed/strongly agreed that their employer provides a work environment that allows for safe patient care ranged from 29.7% of chain community pharmacists to 85% of compounding pharmacists. Fifty-two percent of staff pharmacists, 56.5% of relief pharmacists, and 58.5% of managers/pharmacists in charge agreed or strongly agreed that their employer provides a work environment that allows for safe patient care, whereas 89.3% of regional managers/directors/vice-presidents and 72.5% of clinical/specialty pharmacists indicated the same. Average hours per shift was inversely correlated with perceptions of workplace patient safety (p values <.001). Conclusion: Tennessee pharmacists' perceptions of workplace patient safety varied widely across practice setting type and pharmacist roles. Perceptions of safety were notably lower in the chain community pharmacy setting. Additional research is warranted to better understand the relationship between pharmacist perceptions and quantifiable patient safety metrics, particularly in the chain community pharmacy setting.

The aim of this thesis is to examine the contributory factors in drug errors and their reporting so as to design an enhanced reporting scheme to improve the quality of reporting in an acute hospital trust. The related research questions are: 1. What are the contributory factors in drug errors? 2. How effective is the reporting of drug errors? 3. Can an enhanced reporting scheme, predicated on the analysis of local documentary and interview data, identify the contributory factors in drug errors and improve the quality of their reporting in an acute hospital trust? The study aim and research questions reflect a growing consensus, articulated by Boaden and Walshe (2006), that patient safety research should focus on understanding the causes of adverse events and developing interventions to improve safety. Although there are concerns about the value of incident reporting (Wald & Shojania 2003, Armitage & Chapman 2007), it would appear that error reporting systems remain a high priority in advancing patient safety (Kohn et al 2000, Department of Health 2000a, National Patient Safety Agency 2004, WHO & World Alliance for Patient Safety 2004), and consequently it is the area chosen for intervention in this study. Enhancement of the existing scheme is based on a greater understanding of drug errors, their causation, and their reporting.

The need for a positive safety culture in healthcare is essential. It not only advances the prevention and reduction of possible medical errors and threats to patient safety, but also enhances the overall quality of healthcare services provided, especially in respect of medication safety. While the evolution and surge in hospital pharmacies has bolstered treatment possibilities, the risk of harm to patients has also increased as errors in the provision of medication by pharmacists create a threat to patient safety. The increasing need to deploy a protective measure to enhance patient safety culture in the healthcare is imperative suggesting the necessity for the inclusion of new knowledge through the process of organizational learning. Safety culture and organizational learning are complex constructs which may be measured, to some extent, by validated instruments. The current study seeks to assess the reliability and validity of a translated Arabic version of the learning organization survey short-form (LOS-27), and the pharmacy survey on patient safety culture (PSOPSC) through the evaluation of pharmacy staff’s knowledge about organizational learning and patient safety culture in public and private hospital pharmacies of Kuwait. The aim is to explore the relationship between organizational learning and patient safety culture in hospital pharmacy settings through the LOS-27 and PSPOSC instruments. In addition, the relationship between the different dimensions of organizational learning and pharmacy patient safety culture is explored. The results highlighted the adequacy of the Arabic translation of the LOS-27 and PSOPSC questionnaires as they depicted the reliability and validity consistent with the original surveys results. It was also found that in the context of Kuwaiti pharmacies, organizational learning was positively related to performance of the staff in creating a positive patient safety culture. Several dimensions of the organizational learning showed association with various elements of patient safety culture in pharmacy settings, specifically: training, management that reinforces learning, and a supportive learning environment had the strongest effects on the pharmacy patient safety culture dimensions. The contribution of this thesis is in three areas. First, it is the first research that links organizational learning with patient safety culture in a hospital pharmacy setting (theoretical contribution). Second, the research is useful for research scholars as it combines the two questionnaires, LOS-27 and PSOPSC, on the same participants using a single form to explore the relationship between organizational learning and patient safety culture in a hospital pharmacy setting and their dimensions (method contribution). Third, this research contributed to the currently limited literature that examines patient safety culture and organizational learning by considering the context of Kuwait (Contextual Contribution).

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No / Introduction Patients represent an important and as yet untapped source of information about the factors that contribute to the safety of their care. The aim of the current study is to test the reliability and validity of the Patient Measure of Safety (PMOS), a brief patient-completed questionnaire that allows hospitals to proactively identify areas of safety concern and vulnerability, and to intervene before incidents occur. Methods 297 patients from 11 hospital wards completed the PMOS questionnaire during their stay; 25 completed a second 1 week later. The Agency for Healthcare Research and Quality (AHRQ) safety culture survey was completed by 190 staff on 10 of these wards. Factor structure, internal reliability, test-retest reliability, discriminant validity and convergent validity were assessed. Results Factor analyses revealed 8 key domains of safety (eg, communication and team work, access to resources, staff roles and responsibilities) explaining 58% variance of the original questionnaire. Cronbach’s α (range 0.66–0.89) and test-retest reliability (r=0.75) were good. The PMOS positive index significantly correlated with staff reported ‘perceptions of patient safety’ (r=0.79) and ‘patient safety grade’ (r=−0.81) outcomes from the AHRQ (demonstrating convergent validity). A multivariate analysis of variance (MAMOVA) revealed that three PMOS factors and one retained single item discriminated significantly across the 11 wards. Discussion The PMOS is the first patient questionnaire used to assess factors contributing to safety in hospital settings from a patient perspective. It has demonstrated acceptable reliability and validity. Such information is useful to help hospitals/units proactively improve the safety of their care.

Yes / Objective To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Main outcome measures Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). Results The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Conclusions Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction. / Dr McIntosh is a member of the the RN4CAST Consortium.

Yes / Evidence suggests that patients can meaningfully feed back to healthcare providers about the safety of their care. The PRASE (Patient Reporting and Action for a Safe Environment) intervention provides a way to systematically collect feedback from patients to support service improvement. The intervention is being implemented in acute care settings with patient feedback collected by hospital volunteers for the first time. To undertake a formative evaluation which explores the feasibility and acceptability of the PRASE intervention delivered in collaboration with hospital volunteers from the perspectives of key stakeholders. Design: A qualitative evaluation design was adopted across two acute NHS Trusts in the UK between July 2014 and November 2015. We conducted five focus groups with hospital volunteers (n = 15), voluntary services and patient experience staff (n = 3) and semistructured interviews with ward staff (n = 5). Data were interpreted using framework analysis. Results: All stakeholders were positive about the PRASE intervention as a way to support service improvement, and the benefits of involving volunteers. Volunteers felt adequate training and support would be essential for retention. Staff concentrated on the infrastructure needed for implementation and raised concerns around sustainability. Findings were fed back to the implementation team to support revisions to the intervention moving into the subsequent summative evaluation phase. Conclusion: Although there are concerns regarding sustainability in practice, the PRASE intervention delivered in collaboration with hospital volunteers is a promising approach to collect patient feedback for service improvement. / The Health Foundation (Closing the Gap in Patient Safety Programme).

Yes / Although the risks associated with iodinated contrast administration are acknowledged to be very low, screening of kidney function prior to administration is still standard practice in many hospitals. This study has evaluated the feasibility of implementing a screening form in conjunction with point of care (PoC) creatinine testing as a method to manage the risks of post contrast acute kidney injury (PC-AKI) within the CT imaging pathway. Method: Over an eight-week period 300 adult outpatients attending a UK CT department for contrast-enhanced scans were approached. Participants completed a screening questionnaire for co-morbidities linked to kidney dysfunction and consented to have a PoC and laboratory creatinine tests. Comparison was made against with previous baseline blood tests obtained within the preceding 3 months, as required by the study site. Participants were also invited to attend for follow up PoC and laboratory bloods tests at 48–72 h. Results: 14 patients (4.7%) had a scan-day eGFR below 45mL/min/1.73m2, all identified through screening. The majority of patients (n=281/300; 93.7%) fell in the same risk category based on previous and scan-day blood results. Six PoC test failures were recorded on the scan day. The constant error between the Abbott i-STAT PoC scan-day measurements and the laboratory scan-day measurements was -3.71 (95% CI: -6.41 to -0.50). Five patients had an elevated creatinine (≥25% from baseline) post contrast administration, but no instances of PC-AKI (≥50% from baseline) were identified. Conclusion: PoC creatinine testing is a practical method of ensuring renal function and is feasible in the radiology environment. / National Cancer Diagnostics Capacity Fund, NHS England. Andrew Lewington, Bethany Shinkins and Michael Messenger are currently supported by the NIHR MIC- Leeds In Vitro Diagnostics Co-operative (was previously NIHR Leeds Diagnostic Evidence Co-operative)