Objectives: The concept of clinical champions has been widely promoted, yet empirically underdeveloped in health services literature. The objectives of this study are to investigate the role of the clinical champion and how it contributes to effective patient safety change. Methods: Case study design was used to examine the role of champions in the implementation of rapid response teams in two hospitals. Central themes were derived through qualitative analysis of semi-structured interviews with key informants. Results: Analysis revealed a typology of champions: clinical, managerial, and executive. Champions engaged in five core activities: disseminating knowledge, advocating, building relationships, navigating boundaries, and facilitating consensus. Individuals became champions by informal emergence or by formal appointment combined with informal emergence. Conclusions: This study furthered understanding of patient safety champions by revealing types, activities, and modes of emergence. Findings will allow health care professionals to use an evidence-based approach to identifying and supporting champions.

The purpose of this research was to compare the design of Dose Error Reduction Software (DERS) between smart pumps to determine which features affect the ability of nurses to safely and efficiently program intravenous medications. A high-fidelity usability experiment was conducted. Twenty-four Registered Nurses completed a series of infusion tasks, in a simulated clinical environment, using three smart pumps (Cardinal Alaris System, BBraun Infusomat, and Hospira Symbiq). Results found significant differences in nursing performance across the smart pumps. Nurses were more likely to override clinically inappropriate soft limit alerts when using BBraun Infusomat, than when using Hospira Symbiq or Cardinal Alaris System. Furthermore, when asked to program an infusion over a specific duration, nurses were found to make significantly more parameter entry errors when using Hospira Symbiq than when using Cardinal Alaris System. Results from this study will help set DERS design principles, and assist hospitals during their procurement processes.

Objectives: The concept of clinical champions has been widely promoted, yet empirically underdeveloped in health services literature. The objectives of this study are to investigate the role of the clinical champion and how it contributes to effective patient safety change. Methods: Case study design was used to examine the role of champions in the implementation of rapid response teams in two hospitals. Central themes were derived through qualitative analysis of semi-structured interviews with key informants. Results: Analysis revealed a typology of champions: clinical, managerial, and executive. Champions engaged in five core activities: disseminating knowledge, advocating, building relationships, navigating boundaries, and facilitating consensus. Individuals became champions by informal emergence or by formal appointment combined with informal emergence. Conclusions: This study furthered understanding of patient safety champions by revealing types, activities, and modes of emergence. Findings will allow health care professionals to use an evidence-based approach to identifying and supporting champions.

Bakgrund: En strukturerad överrapportering inom sjukvården är viktig för att minska vårdskador. Sjuksköterskan har en betydande roll i det interprofessionella teamet gällande att öka patientsäkerheten. Situation, Bakgrund, Aktuellt, Rekommendation (SBAR) är ett rapporteringsverktyg som implementerades i Sverige 2010 och används på sjukhus, främst inom akutsjukvården.  Syfte: Undersöka hur SBAR följs vid muntlig överrapportering mellan ambulanspersonal och mottagande sjuksköterska på akutmottagning. Syftet var också att undersöka om, när och vilka störande faktorer som förekom i samband med överrapportering. Metod: Metoden var kvantitativ med empirisk ansats. Materialet inhämtades genom 53 observationer på en akutmottagning på ett medelstort sjukhus i Sverige. Data samlades in via två olika observationsprotokoll vid överrapportering, ett gällande SBARs ordning och ett gällande störande faktorer. Resultatet bearbetades med SPSS statistics. Resultat: Resultatet beskrivs i två kategorier, kategori 1 SBAR som belyser följsamhet till SBAR och kategori 2 störande faktorer som belyser förekomst av störande faktorer. Resultatet visade att följsamheten till SBAR missades i stor utsträckning och att störande faktorer var frekvent förekommande. Slutsats: SBAR togs fram på grund av brister vid överrapportering men ändå missas betydelsefull information som ligger till grund för patientsäkerheten. Detta innebär att SBAR – akut situation kan ifrågasättas gällande lämplighet vid muntlig överrapportering mellan ambulanspersonal och mottagande sjuksköterska på akutmottagning. / Background: A structured bedside handover in healthcare is important for reduce care damage. Nurses have a considerable role in the interprofessional team current to increase patient safety. Situation, Background, Assessment, Recommendation (SBAR) is an instrument for bedside handovers and implemented in Sweden 2010. It is used in hospitals, mainly within emergency Care. Purpose:  Examine how to study the following of SBAR at the bedside handover between ambulance and nurse in the emergency care. Another purpose was to examine if, when and which disturbing factors had an impact in the bedside handover. Method:  The method was quantitative with empirical assaulted.  The material was collected through 53 observations in emergency care on a medium sized hospital in Sweden. The data were collected by two different observation-protocols during bedside handover, one aiming at SBAR and the other disturbing factors. The result was processed in SPSS statistics. Result The result is described in two categories, Category 1 SBAR, which illustrates compliance with SBAR and Category 2, which illustrates the occurrence of disturbing factors. The result showed that compliance with SBAR was largely missed and that interfering factors were frequent. Conclusion: SBAR where produced as a result of shortcomings during bedside handovers, despite that important information according to the patient safety is lost. This means that the SBAR card for emergency can be questioned when it comes to suitability for bedside handover between ambulance and emergency care.

abstract: For more than twenty years, clinical researchers have been publishing data regarding incidence and risk of adverse events (AEs) incurred during hospitalizations. Hospitals have standard operating policies and procedures (SOPP) to protect patients from AE. The AE specifics (rates, SOPP failures, timing and risk factors) during heart failure (HF) hospitalizations are unknown. There were 1,722 patients discharged with a primary diagnosis of HF from an academic hospital between January 2005 and December 2007. Three hundred eighty-one patients experienced 566 AEs, classified into four categories: medication (43.9%), infection (18.9%), patient care (26.3%), or procedural (10.9%). Three distinct analyses were performed: 1) patient's perspective of SOPP reliability including cumulative distribution and hazard functions of time to AEs; 2) Cox proportional hazards model to determine independent patient-specific risk factors for AEs; and 3) hospital administration's perspective of SOPP reliability through three years of the study including cumulative distribution and hazard functions of time between AEs and moving range statistical process control (SPC) charts for days between failures of each type. This is the first study, to our knowledge, to consider reliability of SOPP from both the patient's and hospital administration's perspective. AE rates in hospitalized patients are similar to other recently published reports and did not improve during the study period. Operations research methodologies will be necessary to improve reliability of care delivered to hospitalized patients. / Dissertation/Thesis / M.S. Industrial Engineering 2012

The published literature indicates that large information system implementations are often expensive failures with costs to human safety largely because of missing or corrupt information. This has generated the overall research question of “What do Key Informants think about Information Quality in Acute Care?” This dissertation research examined information quality using a Grounded Theory analytic method for coding and analyzing semi structured interview responses from ten clinical (nurses, physicians, pharmacist) and ten non-clinical (IT support) interviewees in several public sector health organizations across Canada. The semi structured interview questions focused on five key areas: information quality, acute care setting, information systems, risk (as a function of poor information quality) and patient safety. A key finding from the interview data is that information is missing and unstable within the two key health care information systems: the paper chart, the main repository of narrative unstructured data, and the electronic health record system, of structured data. The interviewees mentioned pressure to information standardization such as fixed patient identity information anchoring patient data in the rest of the patient record. However, there is resistance to standardizing other information because the users, nurses and physicians, resist fettering in order to be able to tell the patient’s story in narrative unstructured data form. A descriptive socio-technical model, the Systems Engineering Initiative for Patient Safety (SEIPS) Model that organizes elements for analysis under the headings of person, task, technology and tools, organization, external environment and patient outcomes, was considered for further discussion in the context of the study. The SEIPS Model analysis also helps to identify gaps in the Model including what missing and uncertain information might mean. Key points from this discussion include how the information system maps to the real world, the patient, and to the user’s perception of the real world. This mapping can never be totally accurate and complete so gaps exist. The discussion of information and information flow lead to enhancements of the SEIPS Model, placing information and information quality in its rightful place as a “glue” for the acute care system. This is an important contribution to knowledge that can lead to future research so there can be a better fit between the real world, information, information systems and people to provide safer care. / Graduate

Alguns medicamentos são notórios por possuírem risco aumentado de causar danos significativos ou fatais em decorrência de falhas durante o uso, sendo identificados como medicamentos potencialmente perigosos. Conhecimento e informação são aliados na prevenção de tais falhas, contudo, o conhecimento apresentado pelos profissionais de saúde para evitá-las é incerto. Nesse contexto, almejando obter um panorama do conhecimento inerente aos profissionais enfermeiros e formular mecanismos para uma intervenção futura, pesquisadores de nacionalidade chinesa elaboraram e validaram o Questionário de Medicamentos Potencialmente Perigosos, destinado a mensurar o conhecimento pertinente à prática envolvendo estes medicamentos. Dessa forma, o objetivo deste trabalho foi traduzir para a língua portuguesa brasileira e adaptar culturalmente o Questionário de Medicamentos Potencialmente Perigosos, verificando sua aplicabilidade no contexto brasileiro. Tratou-se de uma pesquisa metodológica, cujo rigoroso processo de tradução e adaptação transcultural compreendeu as seguintes etapas: tradução do chinês para o português brasileiro por dois tradutores independentes; síntese das traduções; retrotradução para a língua de origem; avaliação por um comitê de cinco juízes, que verificaram as equivalências semântica, idiomática, conceitual e cultural dos itens, e propuseram alterações; e pré-teste, cuja função foi julgar a clareza e a pertinência do conteúdo dos itens e proceder à versão final do questionário, sendo realizado em uma amostra composta por 30 enfermeiros que exerciam suas atividades em tempo integral ou parcial em um hospital de ensino do interior do Estado de São Paulo. No processo de tradução houve pequenas variações entre as traduções independentes que foram solucionadas após argumentação e consenso entre os tradutores. Na etapa referente à avaliação pelo comitê de juízes, os especialistas consideraram que a versão traduzida para o português apresentou equivalência semântica, idiomática, cultural e conceitual, mas alguns itens necessitaram de ajustes para se tornarem culturalmente cabíveis. No pré-teste a população-alvo foi interrogada quanto à clareza da redação e pertinência dos itens. Na primeira parte do questionário (Administração dos Medicamentos), os percentuais médios relativos à clareza da redação e pertinência dos itens foram de 93,3% e 89,6%, respectivamente. No tocante à segunda parte do questionário (Procedimentos Clínicos), o percentual médio referente à clareza da redação foi de 93,3%, enquanto que, em média, 85,3% dos sujeitos concordaram com a pertinência dos itens. Desse modo, com base nos aspectos metodológicos adotados neste estudo, o resultado apresentado pelo processo de tradução e adaptação transcultural do instrumento investigado foi considerado satisfatório, havendo equivalência entre a versão original e a versão traduzida do questionário, a qual se apresenta facilmente compreensível e adequadamente adaptada para o contexto brasileiro. Além disso, assume-se que o estudo propiciou um embasamento indispensável para o prosseguimento do processo de validação do questionário investigado / Some medications are notorious for having an increased risk of causing significant harm or death due faults during their use, being identified as high-alert medications. Knowledge and information are allies in preventing such failures, however the knowledge presented by healthcare professionals to prevent them is uncertain. In this context, aiming to obtain an overview of the inherent knowledge to nurses and formulate mechanisms for a future intervention, researchers of Chinese nationality have developed and validated the Questionnaire of High-Alert Medications designed to measure the pertinent knowledge to the practice involving these medications. Thus, the aim of this study was to translate to Brazilian Portuguese and culturally adapt the Questionnaire of High-Alert Medications checking its applicability in the Brazilian context. It was a methodological study, in which the rigorous process of translation and cross-cultural adaptation included the following stages: translation from Chinese to Brazilian Portuguese by two independent translators; synthesis of translations; back translation into the source language; evaluation by a committee of five judges that verified the semantic, idiomatic, cultural and conceptual equivalence of the items, and have suggested changes; and pre-test, whose function was to judge the clarity and relevance of the content of the items and proceed to the final version of the questionnaire, which was conducted in a sample composed by 30 nurses who performed their activities in full or part time in a teaching hospital in the State of São Paulo. In the translation process there were minor variations between the independent translations that were resolved after argumentation and consensus among translators. In the stage related to the evaluation by the committee of judges, the experts considered that the translated version to Portuguese showed semantic, idiomatic, cultural and conceptual equivalence, but some items needed adjustments in order to become culturally appropriate. In the pre-test the target population was questioned about the clarity of writing and relevance of the items. In the first part of the questionnaire (Drug Administration) the average percentages for the clarity of writing and relevance of the items were 93.3% and 89.6%, respectively. In relation to the second part of the questionnaire (Clinical Procedures) the average percentage related to the clarity of writing was 93.3%, whereas, on average, 85.3% of the subjects agreed with the relevance of the items. Therefore, based on the methodological aspects adopted in this study, the result presented by the translation and cross-cultural adaptation process of the instrument was satisfactory and there was equivalence between the original and the translated version of the questionnaire, which presents itself easily understandable and properly adapted to the Brazilian context. In addition, it is assumed that the study provided an indispensable resource for the continuation of the validation process of the questionnaire investigated

The delivery process of the intravenous (IV) medication, one of the activities of greater responsibility of the nursing team, has a high incidence in child care in urgent and emergency situation. This process is considered highly complex and when not planned, controlled and monitored through indicators is exposed to unpredictable results affecting the quality of care. The objective was to evaluate the nursing practice in drug administration in child trough IV. Exploratory, descriptive, observational, quantitative study. It was developed in the urgency and emergency department in a pediatric referral hospital of the municipal sphere of Fortaleza. The study population consisted of 69 nurses whom participated in the drug administration via IV process that was in work schedules during the study period in the investigated unit. The sample of professionals was composed by 36 licensed practice nurses and 2 nurses. For the number of observations, it was considered the calculation for finite population with a total of 327 observations of intravenous medication delivery process. Interviews were carried out for data collection with the nursing staff and systematic observation of drug delivery process in children via IV. For data collection interviews were performed with the nursing staff and systematic observation by IV drug delivery process in children, considering seven stages, namely: medical prescription reading, hand hygiene, preparation of material and medication , guidance on the procedure, puncture technique and administration of the drug. Such steps have the total 47 shares. The data was stored in a database produced on the Windows Excel 2010 and analyzed according to the literature. The study was approved by the Ethics Committee under CAAE protocol 34651314.7.0000.5054. It was found that in 15% of the observations nursing professionals did not understand the prescription due to illegible handwriting professional. In 78.0% of the time there was no hand hygiene. It was found that all professionals used personal protective equipment (cap and mask), but none used gloves. Among the 327 observations included: peripheral intravenous device most commonly used was the scalp 21 (63.3%); selection of dorsal hand veins arc (83.9%); success on the first attempt of venipuncture (82.6%); explains the procedure for child and /or guardian (5.5%); calms the child (82.6%); performs antisepsis of the skin at the site to be punctured with a swab with 70% alcohol (100%); awaits antiseptic evaporation to then continue the procedure (45.6%); proper disposal of the materials used during the procedure (89.3%); checks the prescription immediately after drug administration (86.8%). It was found unsatisfactory performance in 23 actions by IV drug administration process. Therefore, we suggest the development of training for nursing professionals about medication delivery process. / O processo de administraÃÃo de medicamento por via intravenosa (IV), uma das atividades mais importante da equipe de Enfermagem, possui alta incidÃncia na assistÃncia à crianÃa em situaÃÃo de urgÃncia e emergÃncia. Tal processo à considerado de alta complexidade e, quando nÃo planejado, controlado e monitorado por meio de indicadores, fica exposto à imprevisibilidade de seus resultados, interferindo na qualidade da assistÃncia. Objetivou-se avaliar a prÃtica de enfermagem no processo de administraÃÃo de medicamento por via IV na crianÃa. Trata-se de um estudo exploratÃrio, descritivo, observacional, de natureza quantitativa, desenvolvido no setor de urgÃncia e emergÃncia de um hospital pediÃtrico de referÃncia da esfera municipal de Fortaleza-CE. A populaÃÃo do estudo foi constituÃda por 69 profissionais de enfermagem que participaram do processo de administraÃÃo de medicamento pela via IV e que estavam nas escalas de trabalho durante o perÃodo do estudo na unidade investigada. A amostra dos profissionais foi composta por 36 tÃcnicos de enfermagem e 2 enfermeiros. Para o nÃmero de observaÃÃes, considerou-se o cÃlculo para populaÃÃo finita, com um total de 327 observaÃÃes do processo de administraÃÃo de medicamento por via IV. Para a coleta de dados realizou-se entrevista com a equipe de enfermagem e observaÃÃo sistemÃtica do processo de administraÃÃo de medicamento por via IV na crianÃa, considerando sete etapas, quais sejam: leitura da prescriÃÃo mÃdica, higienizaÃÃo das mÃos, preparo do material e medicaÃÃo, orientaÃÃo acerca do procedimento, tÃcnica de punÃÃo e administraÃÃo do medicamento. Tais etapas possuem ao total 47 aÃÃes. Os dados foram armazenados em um banco de dados produzidos no Excel do Windows 2010, analisados estatisticamente e de acordo com a literatura pertinente. O estudo foi aprovado pelo Comità de Ãtica sob parecer N0 805.953. Constatou-se que em 15% das observaÃÃes o profissional de enfermagem nÃo compreendeu a prescriÃÃo mÃdica devido à letra ilegÃvel do profissional. Em 78,0% das observaÃÃes nÃo houve a higienizaÃÃo das mÃos. Identificou-se que todos os profissionais utilizaram equipamento de proteÃÃo individual (gorro e mÃscara), entretanto nenhum utilizou luvas. Dentre as 327 observaÃÃes destacaram-se como dispositivo intravenoso perifÃrico mais utilizado o scalp n 21 (63,3%); escolha das veias do arco dorsal da mÃo (83,9%); Ãxito na primeira tentativa da punÃÃo venosa (82,6%); orientaÃÃo sobre o procedimento para crianÃa e/ou responsÃvel (5,5%); acalma a crianÃa (82,6%); realizaÃÃo de antissepsia da pele no local a ser puncionado com algodÃo embebido com Ãlcool a 70% (100%); aguarda a evaporaÃÃo do antissÃptico para em seguida dar prosseguimento ao procedimento (45,6%); descarte adequado dos materiais utilizados durante o procedimento (89,3%); checou a prescriÃÃo imediatamente apÃs a administraÃÃo do medicamento (86,8%). Concluiu-se desempenho insatisfatÃrio em 23 aÃÃes do processo de administraÃÃo de medicamento por via IV. Portanto, sugere-se o desenvolvimento de capacitaÃÃo para os profissionais de enfermagem acerca do processo de administraÃÃo de medicamento.

Submitted by Irene Nascimento (irene.kessia@ufpe.br) on 2017-04-26T17:42:32Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) PRONTA Dissertação Vanessa.pdf: 1042935 bytes, checksum: 5bdc65647d310e8d46e28a299e4d3513 (MD5) / Made available in DSpace on 2017-04-26T17:42:32Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) PRONTA Dissertação Vanessa.pdf: 1042935 bytes, checksum: 5bdc65647d310e8d46e28a299e4d3513 (MD5) Previous issue date: 2016-03-01 / A segurança do paciente é: “a redução, ao mínimo aceitável, do risco de dano desnecessário associado à assistência à saúde”. A Organização Mundial da Saúde estima que danos à saúde ocorram em dezenas de milhares de pessoas todos os anos no mundo. Sabe-se que as causas que levam à ocorrência de um Eventos Adversos são multifatoriais, podendo ser identificados dois grandes grupos de fatores: humanos e organizacionais. No segundo, pode-se incluir as questões de infra-estrutura, adequação e preparo das instalações para a execução das ações de segurança por profissionais e pacientes (fatores humanos). Esse trabalho objetiva analisar a viabilidade financeira de implantação das 6 metas internacionais do Programa Nacional de Segurança do Paciente em um serviço hospitalar do município de João Pessoa/Paraíba/ Brasil. Trata-se de um estudo de caso, com projeção de custos por um período de 3 anos e aplicação do VPL (Valor Presente Líquido) como método de análise de viabilidade. Obteve-se um custo total de aquisição de insumos materiais de R$ 931.296,44. O custo por paciente internado foi de R$ 51,73 e por atendimento/mês foi de R$ 3,87. O VPL obtido foi um valor positivo de R$ 3.668.554,53, o que demonstra que a proposta de implantação pode ser aceita e é viável para execução. A análise de viabilidade financeira pode subsidiar a gestão pública para a tomada de decisão na alocação de recursos para a execução de estratégias em segurança do paciente. Outros estudos como os de custo-efetividade não necessários para achados mais precisos de resultados. / Patient safety is: "minimizing the risk of unnecessary harm associated with health care". The World Health Organization estimates that damage to health occurs in tens of thousands of people every year in the world. It is known that the causes that lead to the occurrence of Adverse Events are multifactorial, and two major groups of factors can be identified: human and organizational. In the second, it is possible to include the questions of infrastructure, adequacy and preparation of facilities for the execution of safety actions by professionals and patients (human factors). This study aims to analyze the financial feasibility of implementing the 6 international goals of the National Patient Safety Program in a hospital service in the city of João Pessoa / Paraíba / Brazil. This is a case study, with projection of costs over a period of 3 years and application of NPV (Net Present Value) as a method of feasibility analysis. A total cost for the acquisition of material inputs of R $ 931,296.44 was obtained. The cost per patient was R $ 51.73 and per service / month was R $ 3.87. The NPV obtained was a positive value of R $ 3,668,554.53, which shows that the proposed implementation can be accepted and is feasible for execution. The financial feasibility analysis can subsidize public management for decision making in the allocation of resources for the execution of patient safety strategies. Other studies such as cost-effectiveness are not necessary for more accurate results.

The purchase of medical devices involves engaging various stakeholders as well as balancing clinical, technical and financial requirements. Failure to consider these requirements can lead to wider consequences in the delivery of care. This study first builds a general knowledge base of current purchasing practice in a sample of NHS Trusts, which confirms the direction and guidance given by policy documents and literature as to the extent of the challenges faced by purchasing stakeholders. This then leads to an analysis to identify inefficiencies in the purchasing process, and how such practice can lead to risks in the delivery of care. These risks range from injury to individuals, impacts to the healthcare delivery service, and financial and litigation risks. Finally, a framework that highlights these potential risks in the life-cycle of medical devices in hospitals is presented. Key policy guidance has encouraged both researchers and implementers of healthcare services to approach patient safety from a systems perspective, acknowledging that medical device errors are not only directly related to device design, but to the design of the healthcare delivery service system in which the device operates. Little evidence exists of successfully applying systems approaches specifically to medical device purchasing practice. Medical device purchasing, because of its implications to patient safety on the one hand, and the uniqueness of the healthcare context, requires a unique approach. By demonstrating the influence of purchasing practice to service delivery and patient care, the thesis made is that taking a holistic systems approach is one method to improve device purchasing practice, and hence influence better care.