no / Background Estimates show that as many as one in 10 patients are harmed while receiving hospital care. Previous strategies to improve safety have focused on developing incident reporting systems and changing systems of care and professional behaviour, with little involvement of patients. The need to engage with patients about the quality and safety of their care has never been more evident with recent high profile reviews of poor hospital care all emphasising the need to develop and support better systems for capturing and responding to the patient perspective on their care. Over the past 3 years, our research team have developed, tested and refined the PRASE (Patient Reporting and Action for a Safe Environment) intervention, which gains patient feedback about quality and safety on hospital wards. Methods/design A multi-centre, cluster, wait list design, randomised controlled trial with an embedded qualitative process evaluation. The aim is to assess the efficacy of the PRASE intervention, in achieving patient safety improvements over a 12-month period. The trial will take place across 32 hospital wards in three NHS Hospital Trusts in the North of England. The PRASE intervention comprises two tools: (1) a 44-item questionnaire which asks patients about safety concerns and issues; and (2) a proforma for patients to report (a) any specific patient safety incidents they have been involved in or witnessed and (b) any positive experiences. These two tools then provide data which are fed back to wards in a structured feedback report. Using this report, ward staff are asked to hold action planning meetings (APMs) in order to action plan, then implement their plans in line with the issues raised by patients in order to improve patient safety and the patient experience. The trial will be subjected to a rigorous qualitative process evaluation which will enable interpretation of the trial results. Methods: fieldworker diaries, ethnographic observation of APMs, structured interviews with APM lead and collection of key data about intervention wards. Intervention fidelity will be assessed primarily by adherence to the intervention via scoring based on an adapted framework. Discussion This study will be one of the largest patient safety trials ever conducted, involving 32 hospital wards. The results will further understanding about how patient feedback on the safety of care can be used to improve safety at a ward level. Incorporating the ‘patient voice’ is critical if patient feedback is to be situated as an integral part of patient safety improvements.

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Les Soins Primaires constituent le premier niveau de contact des patients avec le système de santé, assurant une réponse à 90% des patients dans 90 % des cas. Les évènements indésirables associés aux soins (EIAS) y sont fréquents, réduisant la qualité et la sécurité des soins. Ce travail traite de la sécurité du patient en ville. Dans une première partie, il explore la terminologie et l'épidémiologie relatives aux EIAS en ville (à travers les études ECOGEN et ESPRIT). Dans une deuxième partie, la notion de culture de sécurité est abordée, ainsi que son évaluation auprès de professionnels ou d'étudiants en médecine ; un travail de revue de la littérature internationale et la traduction d'un outil sont présentés. Dans une troisième partie, 3 exemples d'éléments de gestion des risques déployés en soins primaires sont présentés : la mise en œuvre des revues de morbi-mortalité en ambulatoire, celle d'un système de déclaration d'EIAS auprès de médecins généralistes et enfin une grille d'analyse systémique dédiée à l'ambulatoire (CADYA) / Primary care is for patients the first level of contact with the healthcare system, providing answers in 90% of the health-related issues. Patient safety incidents (PSI) are common, reducing quality and safety of care. This work deals with patient safety in primary care. In a first part, this work considers the terminology and epidemiology related to PSI in primary care (through ECOGEN and ESPRIT studies). In a second part, the concept of patient safety culture is discussed, as well as its assessment with professionals or medical students. An international literature review and the translation of a survey for medical students are exposed. In a third part, three examples of risk management elements deployed in primary care are introduced: morbidity and mortality reviews, a PSI reporting system for general practitioners, and a tool for root cause analysis dedicated to primary care (CADYA)

The overall aim of the present thesis was to study aspects of patient safety in critically ill patients with special focus on airway management, respiratory complications and nursing procedures. Study I describes a method called pharyngeal oxygen administration during intubation in an experimental acute lung injury model. The study showed that pharyngeal oxygenation prevented or considerably increased the time to life-threatening hypoxemia at shunt fractions by at least up to 25% and that this technique could be implemented in airway algorithms for the intubation of hypoxemic patients. In study II, we investigated short-term disconnection of the expiratory circuit from the ventilator during filter exchange in critically ill patients. We demonstrated that when using pressure modes in the ventilator, there was no indication of any significant deterioration in the patient's lung function. A bench test suggests that this result is explained by auto-triggering with high inspiratory flows during the filter exchange, maintaining the airway pressure. Study III was a clinical observational study of critically ill patients in which adverse events were studied in connection with routine nursing procedures. We found that adverse events were common, not well documented, and potentially harmful, indicating that it is important to weigh the risks and benefits of routine nursing when caring for unstable, critically ill patients. In study IV, we conducted a retrospective database study in patients with pelvis fractures treated in the intensive care unit. We found that the incidence of respiratory failure was high, that the procedure involved in surgical stabilization affected the respiratory status in patients with lung contusion, and that the mortality was low and probably not influenced by the respiratory condition. In conclusion, the results obtained in the present thesis have increase our knowledge in important areas in the most severely ill patients and have underlined the need for improvements in the field of patient safety.

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Introduction: Building a safety net, leadership and containing quality, are some of many responsibilities that comes with the profession nursing. To maintain health care of highest quality knowledge about patient safety is important. Patient safety means prevent medical errors that may cause the patient physical or psychological damage or in worst case scenario, death. Aim: To describe Vietnamese nurses’ conceptions of patient safety. Method: The study had a qualitative design. Data were collected from interviewing nurses at Hué University Hospital with open-ended questions. The collected data has been transcribed and condensed to categories through content analysis to find key sentences which explained Vietnamese nurses’ conception of patient safety. Result: Data analysis regarding Vietnamese nurse´s conception of patient safety resulted in seven categories which affect patient safety in Hue University Hospital, Equipment effecting the patient safety, Knowledge to provide safer care, Procedures used to increase patient safety, Infections in relation to poor patient safety, Nurses´ conception of communication, Documentation effecting patient safety and Inadequate number of nurses. Conclusion: This study shows that lack of good hygiene, insufficient equipment and the great number of patients are the most common factors to affect the patient safety in a negative way in Vietnam. The study shows that the nurses are well aware of what factors affecting the patient safety as well as how to improve patient safety.

Objective: High Risk Reminder (HRR) system is the lately mobile application technology developed by Taipei Medical University of Medical Informatics Research Institute. The objective of HRR is to provide high risk patient test results such as lab, radiology, pathology to physician immediately by mobile short message and internet e-mail. The mobile short message is to provide abstract information to physician such as patient name, inpatient bed ward number, the abcdrmal test result. The physician can receive the latest patient’s abcdrmal test information at any place, time. Therefore, the physician can take intervention treatment as soon as possible for patient treatment. Moreover, the physician wants to know more detail the high risk patient’s information can open the e-mail to review the patient’s profile in order to provide treatment plan. The purpose of using the mobile and internet technology is to improve patient safety. The WF Teaching Hospital has using the HRR system to serve its patient and physician for 6 months. There are more than 600 mobile short messages and e-mail communication for physicians. To reach the patient safety goals is the critical mission of WF Hospital. Therefore, the evaluation of HRR patient safety contribution needs to analyze.。This study is introducing HRR system functions and evaluating HRR’s contribution.。This research is based on the empirical study. We investigate the HRR’s impaction to assist high risk patient severe test result information communication for physician to assist patient’s treatment for physician and hospital. Meanwhile, the two mobile short message and e-mail communication media which one is more effective for physician is analyzed also. Design: This study measures dimensions of information quality, system quality, use, user satisfaction, individual impact and organizational impact based on the D&M IS Success Model. Multivariate techniques were used to evaluate the relationships of the Model. Measurements: The dimensionality of each scale and degree of association of each item with the attribute of interest were determined by principal components factor analysis with orthogonal varimax rotation. The reliability of each resultant scale was computed using Cronbach’s alpha coefficient. Construct validity was examined through factor analysis and by correlation analyses. Multiple regression techniques were used to evaluate the relationship between the set of six dimensions and comparison of PHS and e-mail. Results: Physicians have using the HRR systems are the surveyors composed of this survey samples. There are 56 questionnaires had been distributed the physicians. Seven questionnaires are invalid due to rarely using the HRR system. The valid questionnaires are 85%。Of the respondents, 93% were male; 73% were undergraduate; 90% were primary physicians.。 From the research finding , the two communication medias of short message, and e-mail are positive relationships for effective and efficiency communication for physicians to assist high risk patient severe test result information delivery. The research two constructs of PHS and e-mails’ indicators are positive for improving better communication; The information quality for user’s effectiveness, satisfaction relationship impacts for users and organization. Comparison effective communication between PHS and e-mail media, the research finding is PHS is more powerful than e-mail to deliver information for physician. From regression analysis, each □ value of PHS is higher than e-mail. The individual using PHS and e-mail is positive to effect the hospital to diffuse of HRR system. Conclusion: The survey of user’s satisfaction of using the HRR system is reached over 70%. However, 60 % of physicians indicates the HRRS provides efficiency and effectiveness each high risk patient’s information causing the information overload. This is the drawback of the implementation HRR system. How to decrease the information overload pressure needs to solve in the near future to improve HRR system. Furthermore, utilization mobile technology to provide two channel communication for physician to access the patient‘s database treatment, test, medication information to integrate all required information to develop the well treatment plan to improve patient safety and reduce patient risk.

SAMMANFATTNING BAKGRUND: För att hälso- och sjukvården ska kunna hålla en hög kvalitet och fortsätta att utvecklas är det viktigt att uppmärksamma när patienter anser sig felbehandlade av vården. Vårdgivaren är skyldig att granska och utreda händelser och klagomål rörande vårdskador (SFS 2010:659), och patientnämnden har som samhällsinstans en central roll att på landstingsnivå granska patientärenden och utgöra en opartisk bro mellan patient och hälso- och sjukvård. Det är viktigt att belysa förekomsten och typen av anmälningsärenden för att kunna bedriva kontinuerligt förbättringsarbete. SYFTE: Syftet med denna studie är att kvantitativt beskriva de anmälningar rörande vårdskador som inkommit till patientnämnden i ett landsting i Mellansverige under 2015. METOD: Denna studie är en empirisk retrospektiv studie med kvantitativ ansats. Ärendena inhämtades från patientnämnden. Totalt 893 ärenden inkom till patientnämnden år 2015 och samtliga ärenden granskades. Därefter inkluderades 229 ärenden som kategoriserades med hjälp av en modifierad granskningsmall. RESULTAT: De vanligaste förekommande anledningarna till anmälan om vårdskada är misstanke eller upplevelse av felbehandling respektive feldiagnos (54 %). Kirurgi- och onkologidivsionen är den division varifrån flest ärenden kommer (41 %). Majoriteten (74 %) av ärendena anmäls av patienten själv. Kvinnor står för fler anmälningar till patientnämnden än män (65 % vs 35 %).  I 41 % av de granskade fallen har berörd divison fastställt att vårdskada inträffat. SLUTSATS: Totalt 229 ärenden bedömdes som vårdskador. Det behövs vidare forskning för att bekräfta studiens resultat. Nyckelord: patientsäkerhet, vårdskador, patienträttigheter / ABSTRACT BACKGROUND: It´s important to acknowledge when patients consider themselves mistreated, in order to strive for better and safer health care. The caregiver is obliged to investigate events and complaints resulting in patient injuries (SFS 2010:659). Patientnämnden is an organizational unit within the county and it has a central role in reviewing patient complaint cases, being an impartial bridge between the patient and the health care. OBJECTIVE: The aim of this study is to describe the complaints regarding patient injuries from a county in mid Sweden 2015. METHODS: An empirical retrospective study with a quantative approach was conducted. The data was collected from patientnämnden. A total of 893 complaints were received by patientnämnden during the year 2015. All of the complaints were reviewed. Two hundred twenty-nine complaints were included and categorized with a modified examination instrument. RESULTS: The most common reason for complaints regarding patient injuries are mistreatment and misdiagnosis (54 %). Most of the complaints come from the surgery and oncology division (41 %). The majority (74 %) of the complaints is reported by the patient, and it´s more common for women compared to men to file complaints to patientnämnden (65 % vs 35 %). In 41 % of the cases, a medical injury was confirmed by the caregiver in some way. CONCLUSION: A total of 229 complaints was categorized as patient injuries. More research are needed to confirm the result of this study. Keywords: patient safety, patient harm, patient rights

Bakgrund: Brist på vårdplatser innebär att en patient får vårdas på en vårdplats som inte uppfyller kraven på utformning, utrustning och säkerhet eller att kunskapen hos sjuksköterskor inte stämmer överens med vårdbehovet (Socialstyrelsen 2016, s. 93). Syfte: Att undersöka om patientsäkerheten påverkas vid platsbrist och överbeläggning. Metod: Examensarbetet är en litteraturstudie där 11 artiklar granskats och analyserats samt presenteras i resultatet. Resultat: Överbeläggningar och utlokaliseringar leder till ökade vårdskador och orsakar ett lidande för patienten. Brister i sjukvårdsmiljön visade sig genom att utrustning eller läkemedel inte var tillgängliga, vilket ledde till ytterligare fördröjning av behandling för patienten och till en förlängd sjukhusvistelse. En annan effekt var ökad risk att smittas av vårdrelaterade infektioner.

A nurse’s contribution to patient safety in regards to early detection of issues in the clinical setting is undisputed (Redman, 2008). If these patient situations require a response that is beyond the scope of nursing practice, in most instances nurses are not sanctioned to intervene without physician consultation (Gaba, 2000). The evidence in the nursing literature does suggest that some nurses exercise professional discretion and are, at times, making the decision to initiate interventions independently (Benner, Hooper-Kyriakidis, & Stannard, 1999; Hutchinson, 1990; Tiffany, Cruise, & Cruise, 1988). The focus of this inquiry was to examine the determinants of a nurse’s discretionary decision to respond to situations that place patients at risk for safety events but requires a response that is beyond the scope of nursing practice. This study utilized a cross-sectional correlation design. Data for this study were obtained using a survey questionnaire. The nurses were asked to respond to questions measuring each concept of the research model based on Thompson’s (1967) conceptual model of determinants of discretionary behavior (education, experience, situational awareness, proactive behavior, and perceptions of transformational leadership). In addition, the nurses were asked to read three clinical vignettes and answer questions regarding the decisions they would make if faced with the situation in the clinical setting. The overall fit of the research model for this study was significant at the 95% confidence level when two of the independent variables (proactive personality and nursing education) were retained, and the three independent variables were excluded (nursing experience, situational awareness, and perceptions of transformational leadership). The predictive power of the final model was low indicating that the two retained independent variables explained only a small amount of the model variance. Eighty percent (n = 84) of the respondents did indicate that they would make a discretionary decision that extends beyond the scope of nursing practice when the patient was at risk for a safety event. This study demonstrates that nurses do engage in this behavior, but fails to identify the majority of the variables that influence this behavior.