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Patient safety strategies have traditionally involved the promotion of provider-oriented practices aimed at reducing known risks associated with surgery, infection, and continuity of care. With the knowledge that patient safety incidents can significantly impact patients, providers, and health care organizations, greater emphasis on patient involvement as a means to mitigate risks warrants further research. The primary objective of this research was to determine the relationship between perceptions of patient safety and the likelihood of patient involvement in both factual and challenging patient safety practices. This mixed methods study was conducted at two tertiary hospital sites located in Atlantic Canada between February 2011 and January 2012. The study design was the sequential explanatory model of mixed methods design, integrating both quantitative survey methods and qualitative focus group methods for both patient and provider participants. Survey data were analyzed using descriptive statistics and partial least squares (PLS) analysis. Focus group sessions were transcribed and analyzed using thematic analysis. The development and analysis of this research was guided by the Health Belief Model. Overall, patients were more willing to engage in factual patient safety practices (e.g., asking questions of their doctors) than challenging patient safety practices (e.g., asking a provider if they have washed their hands). The patient PLS analysis revealed relationships between patient perceptions of threat and self-efficacy and the performance of factual and challenging patient safety practices, explaining 46% and 42% of the variance, respectively. The provider PLS model found that perceptions of safety culture accounted for 34% of the variance in perceptions of threat and 42% of the variance in perceptions of barriers versus benefits. Thematic analysis resulted in the identification of four major themes for both patient and providers related to the phenomenon of patient involvement. Quantitative and qualitative results were complementary in nature. Perceptions of patient safety were shown to influence both patient and provider likelihood in engaging in selected patient safety practices. Greater understanding of the roles that perceptions play in patient involvement in their care may help to improve the safety and quality of care delivered.

Research into adverse events in home care is at a very early stage worldwide. Adverse event research in other health care sectors has demonstrated that patients can and do suffer harm, much of which is preventable, during the receipt of health care services. A stratified, random sample of patients who had received home care nursing service and were discharged in 2004/05 from three Ontario home care programs was studied to develop basic exploratory and descriptive evidence to advance the understanding of AEs in home care. The outcome is an estimate of the incidence of adverse events among patients, description of adverse event types and factors associated with adverse events, and the development of models predictive of home care patients with higher and lower potential for adverse events, and of the location of patients with adverse events. Positive critical indicators were identified in 66.5% of 430 cases. Sixty-one adverse events were identified in 55 (19.2%) of these 286 cases. When adjusted for sampling methodology, the adverse event rate was 13.2 per 100 patients (95%, CI 10.4% - 16.6%, SE 1.6%). Thirty-three percent of the adverse events were rated as having more than a 50% probability of preventability; 1.4% of all patients experienced an adverse event related death. Eight of the 45 factors significantly associated with adverse events formed a single factor model predictive of adverse events. Six two-factor interactions and the absence of one factor were also predictive of the occurrence of adverse events. Five of the 12 critical indicators significantly related to adverse events, as well as 7 critical indicator combinations formed models that reliably located about two-thirds of patients who had, and almost all patients who had not, experienced an adverse event. This study suggests that a significant number of home care patients experience adverse events, two-thirds of which are preventable. Use of adverse event sensitive factors as a screening tool for patients that may benefit from enhanced case management and clinical vigilance, and those unlikely to be placed at increased adverse event risk by maintaining current levels of vigilance, presents an opportunity to improve patient safety. Retrospective critical indicator models identifying home care patients who have experienced an adverse event can be used to estimate adverse event incidence rates and changes in rates over time.

Research into adverse events in home care is at a very early stage worldwide. Adverse event research in other health care sectors has demonstrated that patients can and do suffer harm, much of which is preventable, during the receipt of health care services. A stratified, random sample of patients who had received home care nursing service and were discharged in 2004/05 from three Ontario home care programs was studied to develop basic exploratory and descriptive evidence to advance the understanding of AEs in home care. The outcome is an estimate of the incidence of adverse events among patients, description of adverse event types and factors associated with adverse events, and the development of models predictive of home care patients with higher and lower potential for adverse events, and of the location of patients with adverse events. Positive critical indicators were identified in 66.5% of 430 cases. Sixty-one adverse events were identified in 55 (19.2%) of these 286 cases. When adjusted for sampling methodology, the adverse event rate was 13.2 per 100 patients (95%, CI 10.4% - 16.6%, SE 1.6%). Thirty-three percent of the adverse events were rated as having more than a 50% probability of preventability; 1.4% of all patients experienced an adverse event related death. Eight of the 45 factors significantly associated with adverse events formed a single factor model predictive of adverse events. Six two-factor interactions and the absence of one factor were also predictive of the occurrence of adverse events. Five of the 12 critical indicators significantly related to adverse events, as well as 7 critical indicator combinations formed models that reliably located about two-thirds of patients who had, and almost all patients who had not, experienced an adverse event. This study suggests that a significant number of home care patients experience adverse events, two-thirds of which are preventable. Use of adverse event sensitive factors as a screening tool for patients that may benefit from enhanced case management and clinical vigilance, and those unlikely to be placed at increased adverse event risk by maintaining current levels of vigilance, presents an opportunity to improve patient safety. Retrospective critical indicator models identifying home care patients who have experienced an adverse event can be used to estimate adverse event incidence rates and changes in rates over time.

Bakgrund: Modified Early Warning Score (MEWS) är ett bedömningsinstrument för utvärdering av patienters vitalparametrar. Verktygets funktion är att genom strukturerade observationer identifiera patienter med sviktande vitala funktioner, och således kunna vidta åtgärder innan patienten avlider eller kräver intensivvård. Nyttan av MEWS inom onkologisk heldygnsvård är än så länge dokumenterat i mycket liten utsträckning. En studie från 2012 indikerar att MEWS inte är ett effektivt verktyg för att förutse försämringar hos onkologiska patienter.   Syfte: Att undersöka om patienter inom onkologisk vård uppvisar MEWS 0-17 poäng veckan innan dödsfall. Vidare ämnar författarna vilka specifika parametrar inom MEWS som orsakade förhöjda totalpoäng, samt om några skillnader föreligger mellan män och kvinnor. Metod: Retrospektiv journalgranskningsstudie där dokumentation av MEWS-bedömningar granskades i 70 patientjournaler. Resultat: Undersökningsgruppen hade ett genomsnittligt MEWS på 2,99 under den sista levnadsveckan. Av de enskilda variablerna inom MEWS var andningsfrekvens den som oftast gav poäng ≥1. Det genomsnittliga värdet av MEWS steg från 3,13 poäng det sjunde sista till 8 poäng det sista levnadsdygnet, men på grund av den låga frekvensen av mätningar under det sista levnadsdygnet kan inga slutsatser dras från resultatet. Inga signifikanta skillnader mellan män och kvinnor har identifierats. Låg förekomst av registrerade MEWS hos avlidna onkologpatienter orsakade ett stort initialt bortfall.   Slutsats: Studien indikerar att MEWS används i liten utsträckning på onkologiska patienter innan dödsfall. Det är dock inte möjligt att med detta underlag uttala sig om huruvida MEWS är ett relevant verktyg inom den onkologiska vården, och vidare forskning måste därför göras. / Background: Modified Early Warning Score, MEWS, is a scoring system (0-17 points) for assessment of patients’ vital signs. The function of MEWS is to detect deteriating patients at an early stage, and being able to put in adequate treatment before their physical condition worsens. The benefits from using MEWS on oncology patients have so far been researched to small extent. A study from 2012 indicates that MEWS is not an effective tool for detecting deteriation in oncology patients.   Objective: To research if oncology patients have scores 0-17 on MEWS measurements the week before they are deceased. The writers also intend to research which certain parameters within MEWS caused higher overall scores, and lastly whether there are any differences in scores between men and women.   Methods: A retrospective review of medical records was performed on a total of 104 MEWS measurements belonging to 70 deceased patients. Results: The main results show an average MEWS of 2,99 points during the last week of the patients’ lives. Respiratory rate was the variable within MEWS to cause elevated scores (≥1) most often. The average MEWS increased from 3,13 points the seventh day before death to 8 points the last day before death, but due to the low frequency of measurements from the last day of the patients’ lives, it is not possible to make any assumptions based on these results. Furthermore, the initial loss of patients meeting the inclusion criteria was substantial due to low prevalence of registered MEWS.   Conclusion: The results indicate that MEWS is not used on oncology patients to a great extent. It is not, however, possible to determine whether MEWS is a relevant assessment tool in care of oncology patients, and further research is therefore needed.

Background: Several international studies have been published on the importance of exploring and describing the perceptions of professional nurses to improve patient safety and quality of care. There is also a growing body of literature that has established the associations of qualifications on patient safety and quality of care. However, no comparable research has been conducted in South Africa, and little is known about the influence of personal characteristics, such as qualifications of the professional nurse, on his/her perception of patient safety and quality of care. Objective: To investigate the perceptions of professional nurses regarding patient safety and quality of care as well as the relationship between the qualifications of professional nurses and these perceptions in medical and surgical units in public and private hospitals in South Africa. Design: Cross-sectional survey of nurses. Setting and participants: 1187 professional nurses (161 Baccalaureate degree and 956 diploma-prepared) working in medical and surgical units of 55 private hospitals and 7 public national referral hospitals in South Africa completed the survey. Measurements: Perceptions of patient safety, quality of care and occurrence of adverse events, qualifications, age, job satisfaction, emotional exhaustion, experience, personal accomplishment and depersonalization. Results: 54.1% (n = 87) of Baccalaureate professional nurses and 51.2% (n = 490) diploma nurses feel as if their mistakes are held against them. 37.9% (n = 61) of Baccalaureate professional nurses and 42.4% (n = 404) diploma nurses perceive important information to be lost during shift changes. 39.1% (n = 63) of Baccalaureate professional nurses and 38.6% (n = 369) diploma nurses feel that things “fall between the cracks” when transferring patients from one unit to another. 43.5% (n = 70) of Baccalaureate professional nurses and 48.7% (n = 465) diploma nurses feel that their hospital‟s managements are not approachable. Almost half of professional nurses (49% [n = 79] Baccalaureate and 44.4% [n = 418] diploma) do not have confidence in hospital management to resolve reported problems regarding patient care. 26.6% (n = 26.8) of Baccalaureate professional nurses and 25.5% (n = 237) of diploma professional nurses perceive the quality of care in their hospitals to have deteriorated. Both Baccalaureate and diploma professional nurses reported adverse events to occur a few times a year or less. Verbal abuse towards nurses is reported to occur once a month or less. Qualifications revealed no correlation with perceptions of patient safety and quality of care, though emotional exhaustion and depersonalization showed a small to medium negative correlation and personal accomplishment a small to medium positive correlation with these perceptions. Conclusions: Supportive leadership and development of an environment in which professional nurses can freely report adverse events and hindering factors with regard to quality of care might benefit patients in terms of safety and better quality care. / Thesis(M.Cur.)--North-West University, Potchefstroom Campus, 2012.

Background: Several international studies have been published on the importance of exploring and describing the perceptions of professional nurses to improve patient safety and quality of care. There is also a growing body of literature that has established the associations of qualifications on patient safety and quality of care. However, no comparable research has been conducted in South Africa, and little is known about the influence of personal characteristics, such as qualifications of the professional nurse, on his/her perception of patient safety and quality of care. Objective: To investigate the perceptions of professional nurses regarding patient safety and quality of care as well as the relationship between the qualifications of professional nurses and these perceptions in medical and surgical units in public and private hospitals in South Africa. Design: Cross-sectional survey of nurses. Setting and participants: 1187 professional nurses (161 Baccalaureate degree and 956 diploma-prepared) working in medical and surgical units of 55 private hospitals and 7 public national referral hospitals in South Africa completed the survey. Measurements: Perceptions of patient safety, quality of care and occurrence of adverse events, qualifications, age, job satisfaction, emotional exhaustion, experience, personal accomplishment and depersonalization. Results: 54.1% (n = 87) of Baccalaureate professional nurses and 51.2% (n = 490) diploma nurses feel as if their mistakes are held against them. 37.9% (n = 61) of Baccalaureate professional nurses and 42.4% (n = 404) diploma nurses perceive important information to be lost during shift changes. 39.1% (n = 63) of Baccalaureate professional nurses and 38.6% (n = 369) diploma nurses feel that things “fall between the cracks” when transferring patients from one unit to another. 43.5% (n = 70) of Baccalaureate professional nurses and 48.7% (n = 465) diploma nurses feel that their hospital‟s managements are not approachable. Almost half of professional nurses (49% [n = 79] Baccalaureate and 44.4% [n = 418] diploma) do not have confidence in hospital management to resolve reported problems regarding patient care. 26.6% (n = 26.8) of Baccalaureate professional nurses and 25.5% (n = 237) of diploma professional nurses perceive the quality of care in their hospitals to have deteriorated. Both Baccalaureate and diploma professional nurses reported adverse events to occur a few times a year or less. Verbal abuse towards nurses is reported to occur once a month or less. Qualifications revealed no correlation with perceptions of patient safety and quality of care, though emotional exhaustion and depersonalization showed a small to medium negative correlation and personal accomplishment a small to medium positive correlation with these perceptions. Conclusions: Supportive leadership and development of an environment in which professional nurses can freely report adverse events and hindering factors with regard to quality of care might benefit patients in terms of safety and better quality care. / Thesis(M.Cur.)--North-West University, Potchefstroom Campus, 2012.

Healthcare professionals are expected to know their role in patient safety. In a rural hospital, they may have different roles along with their professional role. Staff and services are fewer and the community is often part of the hospital. This can influence patient safety culture. Researchers and governing bodies have focused on developing processes to assist healthcare leaders developing their patient safety culture. Researchers and governing bodies have tended to focus on urban hospitals and then implement the same processes in rural hospitals. This strategy has not always been successful. The purpose of this study is to explore the roles and responsibilities in patient safety culture of health care professionals in rural hospitals. A systematic review, using the Joanna Briggs Institute (JBI) review process, was completed to discover how patient safety culture and rural hospitals are described and measured. Some common elements in the literature were unique characteristics of rural hospitals, leadership, error reporting and the use of patient safety culture surveys. Ethnographic methods were used to explore healthcare professional’s roles in patient safety culture in a rural hospital. Healthcare professionals describe their roles differently than described in the literature. A patient safety culture model was developed from the literature and refined with the study findings. The affinity model was developed based on the study findings from the small rural hospital and the literature. Everything they do is how rural hospital practitioners described their role in patient safety. / Thesis (Ph.D, Nursing) -- Queen's University, 2014-02-20 09:15:25.007

Previous research has established a consensus that in-hospital adverse events are ubiquitous, cause significant harm to patients, and have important financial consequences. However, information on the extent, consequences and costs of adverse events in Canada is limited. For example, there is, as yet, no published study that has investigated the costs of adverse events in a Canadian context. This dissertation aims to redress this situation by providing Ontario-based estimates of the impact of eleven nursing sensitive adverse events on cost, death, readmission, and ambulatory care use within 90 days after hospitalization. This dissertation also aims to contribute more broadly to the patient safety literature by quantifying the impact of diagnostic coding error in administrative data on estimates of the excess costs attributable to adverse events. Given the increasing importance of these estimates in Canada and elsewhere for hospital payment policy and for assessments of the business case for patient safety, this is an important gap in the literature. Each of the adverse events was associated with positive excess costs, ranging from $29,501 (metabolic derangement) to $66,412 (pressure ulcers). Extrapolation from the study hospitals yielded a provincial estimate of $481 million in annual excess costs attributable to the adverse events, which represents 2.8 percent of Ontario’s total hospital expenditures. Several of the adverse events were also associated with significant excess rates of death, readmission, and ambulatory care use. These results suggest that there are economic as well as ethical reasons to improve patient safety in Ontario hospitals. Estimates of adverse event costs were highly sensitive to coding error. The excess cost of adverse events is likely to be significantly underestimated if the error is ignored. This finding, coupled with the observation that the likelihood of error is ignored in most studies, suggests that previous assessments of the business case for patient safety may have been biased against the cost effectiveness of patient safety improvements. Furthermore, the observed extent of institutional level variation in adverse event coding indicates that administrative data are an inadequate basis for adverse event payment policies or for public reporting of adverse event rates.

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.