The overall aim of the thesis was to investigate whether patient safety can be improved for patients with hip fracture by nutritional intervention and by pharmacological treatment with cranberry concentrate. Another aim was to describe the patients’ experience of involvement in their care. The thesis includes results from four studies that include both quantitative and qualitative design. Studies I and II were intervention studies with a quasi-experimental design, with intervention and comparison groups. Study III was a randomised, double-blind, placebo-controlled trial with intervention and control groups. Study IV took a qualitative approach. Study I showed that when patients with hip fracture received nutritional supplementation according to nutritional guidelines, from admission until five days postoperatively, fewer patients developed pressure ulcers. Study II showed that it is possible to objectively evaluate a short-term nutritional intervention through the nutritional biochemical marker IGF-1, as it was affected by a five-day high-energy regimen. The randomised controlled trial, Study III, showed that a short-term treatment from admission until five days postoperatively with cranberry as capsules does not seem to be useful in preventing positive urine cultures in female patients with hip fracture and a urinary catheter. Finally, Study IV showed that patients with hip fracture reported experiencing very little involvement in their nursing care, to the extent that fundamental aspects of nursing care went unfulfilled. Patients did not feel valued by the nurses and unbearable pain that affected rehabilitation was reported. Positive interactions with nurses, however, did encourage patients to be more active. It is possible for every nurse to improve patient safety at bedside when caring for patients with hip fracture. Simply by increasing caloric/energy intake, it is possible to prevent pressure ulcers. It is also important to involve patients in nursing care, since the patients have experienced low or almost no involvement in care. Nurses need to see each patient as a whole person with different wishes and needs. However, certain prerequisites have to be in place to give nurses the opportunity to increase patient safety at bedside for patients with hip fracture.

The purpose of this dissertation is to effectively understand, measure, and model the impact of Access to Care (AC) on Patient Safety (PS) through the creation of a model that evaluates their interdependence. Through the use of statistical tools and through the combination of variables that define patient access to health care and patient safety, a Patient Access and Safety (PACSA) index is developed. The calculated Patient Access and Safety index provides information to both providers and patients about the impact of access and safety on treatment outcomes. The input variables used to support this research are Patient Access Factors (PAF) (Age, Insurance Type, Visit Type, List Price, and Days To an Appointment) and Patient Safety Factors (PSF) (Severity of Diagnosis, Race, and Gender). In this model, 7,535 observations were used from a single organization based in South Florida, in order to develop the index. The PACSA index offers a tool that helps providers, healthcare staff and patients evaluate patient safety as it is impacted by access to healthcare through the calculated index. This index produces an equation that examines the relationship between access to care and patient safety using the following relationship: PACSA=∑_(i=0)〖(.645〖PSF〗_i- .645〖PAF〗_i )+0.399〗An extensive literature review identifies the connection between AC and PS and the relationships governing these two concepts. Although large organizations like the World Health Organization (WHO), Agency for Healthcare Research and Quality (AHRQ), and Institute of Healthcare Improvement (IHI) have studied these concepts independently, there has not been a study that used a factor or index to describe the relationship. As the healthcare delivery system becomes more complex, and consumers demand better treatment outcomes, there is a growing need to analyze these concepts jointly. This study focuses on diabetic retinopathy (DR). This is a condition experienced by chronic Diabetic patients, and it is one of the major causes of blindness (National Eye Institute, 2009). The increase in the occurrence of Diabetes worldwide has heightened the disease and inspired clinical research. In 2002, it was estimated that the disease stemming from Diabetes, namely DR, accounted for about 5% of world blindness, representing almost 5 million blind people. If left untreated or undetected, about 2% of people become blind, and about 10% develop severe visual impairment. By the year 2030, a possible 36 million people will have acute visual impairments and 7.2 million people will possibly be blind worldwide. In the United States, there are 18 million people with Diabetes, and 30% have Diabetic Retinopathy (5.3 million Americans over the age of 18) (ATA Report 2004; AHRQ, 2004; WHO, 2004). Although this study focused on DR, the model has been designed with the ability to be applied to other diseases and conditions. The goal of creating the PACSA index is to help healthcare workers understand when to schedule patients within the context of access and safety. Current appointment schedules, which are the tools used by healthcare workers, use a “New patient vs. Follow up patient” design. The PACSA challenges the current scheduling schema. No longer will patients be categorized into “New vs. Follow Up” visits. Instead, they will be evaluated for access to care requirements and patient safety needs from the initial point of entry into the health system. The recommendation is to start designing schedules based on PACSA (low PACSA, medium PACSA, and high PACSA). In this new paradigm, the low PACSA would describe patients that have low disease complexity, low number of risk factors, and can wait a little longer for their appointment without having complications of disease from lack of treatment. On the contrary, the high PACSA would include a subset of patients that have high disease complexity, high number of risk factors, and require immediate appointment and medical continuity of care to have the best treatments and outcomes. The PACSA index can serve as a visual guide for decisions regarding access and patient safety requirements. Two key components of quality within healthcare include access to care and patient safety. To create “congruent system integration” (Maier-Speredelozzi, 2007), there must exist synchronization of all healthcare delivery operations. The Patient Access and Safety Index (PACSA) provides a framework for integrating these two components. This research and the indices developed can offer benefits to health care organizations, patients, physicians, and government entities by providing a versatile tool to help improve access to health care and patient safety.

SAMMANFATTNING     Bakgrund: Patienter på kirurgavdelningar är komplexa såtillvida att de förutom den kirurgiska åkomman kan ha olika medicinska diagnoser vilket ofta komplicerar både vården, behandlingen samt medför svårigheter i att upptäcka ett försämrat tillstånd. För att kunna bedöma patientens tillstånd och få en uppfattning om hur denne mår måste objektiva och lätt mätbara parametrar användas. Modified Early Warning Score (MEWS) är ett poängsystem som mäter några av patientens vitala funktioner och baseras på sex mätbara/bedömningsbara  funktioner: andningsfrekvens, puls, systoliskt blodtryck, kroppstemperatur, vakenhet och urinmängd. Poängsumman varierar mellan 0 och 17, där 0 är normalt.   Syfte: Att kartlägga fördelningen av poäng enligt MEWS hos akuta patienter med kirurgiska åkommor på två kirurgavdelningar på ett universitetssjukhus i Sverige samt undersöka vilka åtgärder som vidtagits vid respektive poäng enligt MEWS.   Metod: Retrospektiv journalgranskningsstudie  där dokumentation av mätningar med MEWS för 94 patienter granskades.   Resultat: Totalt återfanns 229 poäng enligt MEWS varav 76 var från mätningar vid ankomst till avdelning och resterande  153 från mätningar under fortsatt vårdtid. Antalet MEWS-mätningar per patient varierade mellan  1 och 31. Nitton åtgärder som ingår i sjuksköterskans profession kopplade till en poäng enligt MEWS återfanns. De mest förekommande åtgärderna var att ge smärtstillande läkemedel på generell ordination samt att utföra upprepade kontroller av patientens vitala funktioner. Tjugotvå medicinska åtgärder kopplade till en poäng enligt MEWS återfanns. De mest  förekommande medicinska åtgärderna var att ordinera provtagning eller odling samt att ordinera  extra dropp. Inte i något fall ledde en poäng enligt MEWS till att någon patient flyttade till en högre vårdnivå.   Slutsats: Det fanns mätningar enligt MEWS för 85 % av patienterna där medianpoängen var 1 av maximala 17. Medianpoängen när åtgärd som ingår i sjuksköterskans profession eller medicinska åtgärder vidtogs var 4. De vanligaste åtgärderna var att ge smärtstillande läkemedel på generell ordination, göra upprepade kontroller, ordinera provtagning,  odling eller extra dropp. / ABSTRACT     Background: Patients with surgical conditions are complex, since many patients have various medical diagnoses besides their surgical condition. Apart from complicating care and treatment, this makes it difficult to detect deterioration in the patient's condition. In order to assess the patient's condition, objective and easily measurable parameters are preferably used. A scoring system, the Modified Ear­ ly Waming Score, MEWS, was developed in the early 1990s and based on some ofthe patient's vital functions: respiratory rate, heart rate, systolic blood pressure, body temperature, alertness/awareness and urine output. The result varies between 0 and 17, with 0 demonstrating normal vital functions.   Objective: To describe the distribution of MEWS scores for emergency patients with surgical condi­ tions in two surgical wards at a university hospital in Sweden, and to examine what actions had been taken based on the MEWS scores.   Methods: A retrospective review was performed on MEWS measurements and medical records for 94 patients.   Results: In total, 229 MEWS measurements had been performed, ofwhich 76 were taken on arrival at the ward, and the remaining 153 <luring the continued hospitalization. The number ofMEWS measurements per patient ranged from 1 to 31. Nineteen actions, based on MEWS scores, related the nursing professions were found, with the administration of painkillers and repeated checks ofthe pa­ tient's vital functions, being the two most common. Twenty-two medical procedures, based on MEWS scores, were identified, where sampling for bacterial cultures or prescribing extra intravenous fluid were the most frequent. No patient was transferred toa higher level of care because of their MEWS score.   Conclusion: MEWS measurements were performed in 85% of the patients and the median result was 1 of maximum 17. Different actions, related the nursing or medical profession, were taken at a me­ dian result of 4. No patient was transferred toa higher level of care. The most common actions were administration of painkillers, repeated checks ofthe patient's vital functions, sampling for bacterial cultures and prescribing extra intravenous fluid

The provision of equitable access to health care, particularly acute care remains a challenge. This challenge is often met through the provision of outreach critical care services. These services may take the form of Medical Emergency Teams responding to hospital in-patients who become acutely ill outside a hospital critical care environment (eg a general medical ward) or medically staffed retrieval services that respond to patients who become acutely ill in an out of hospital environment for which critical care resources are not immediately available and are delivered to the patient by a responding retrieval team. In both circumstances the intention is early recognition of the acutely ill patient, a timely response by a team with the desired critical care skills, where appropriate deliver the patient to a Critical Care environment (eg an Intensive Care Unit) for ongoing management and by doing so prevent potential adverse patient events. Retrieval services are becoming increasingly important as centralisation of specialty and acute medical services is increasing. These processes involve many complex interactions, with the potential for adverse patient events. Thus it is important to better understand the nature, frequency of occurrence and patient outcomes associated with out of hospital patient transportation, particularly with critically ill patients requiring admission to an Intensive Care Unit. This body of work, across a number of studies, showed that patients whose ICU source of admission was another hospital had a severity of illness that was higher than for other ICU admissions, had a greater than expected mortality and a mortality and hospital length of stay that exceeded that of similar patients, matched for demographics and casemix who had not undergone a interhospital transfer. These findings varied according to the diagnostic category (being stronger for trauma, respiratory illness, sepsis and intra cranial haemorrhage) and varied across geographical regions. These studies also showed that there was regional variation in the proportion of patients admitted to an ICU from another hospital, the proportion of such patients was increasing (particularly for sepsis) as well as patterns of variation based upon day of the week (highest occurrence Friday and Saturday) and moth of the year (mostly July to October). They also revealed that there is a negative correlation between the proportion of patients admitted to an ICU from another hospital with the proportion of elective and post operative admissions to the ICU. This information is important in regards to planning for the provision of acute care and emergency services resources. The interhospital transfer of critically ill patients has been previously documented to be associated with significant adverse patient events. However our understanding of these events in terms of contributing factors, preventability, potential for harm and minimizing factors has not been well documented. This body of work also showed that medical treatment may be altered based solely on the fact that a patient is undergoing retrieval. An example of this is the finding that such patients have a significantly greater likelihood of endotracheal intubation and mechanical ventilation that similar patients matched for demographics, severity of illness and diagnosis who have not undergone retrieval. Retrieval however can provide significant patient benefit, and this body of work illustrates that through the description of a number of unique and challenging cases and the retrieval specific factors that were associated with a good outcome for each of those cases. This information points to the importance of identifying quality in retrieval practice. This body of work outlines the original development of an incident monitoring tool for retrieval, based upon existing examples of use of the incident monitoring methodology within other medical and non medical domains. Following a retrospective review and analysis of comments from retrieval patient records and consultation a tool for Retrieval Incident Monitoring was developed. An investigation of the use of Retrieval Incident Monitoring across a number of retrieval organisations and pre hospital activities, including during deployment at a major public event (2000 Sydney Olympics) was undertaken. The findings of this study showed that the majority of incidents during retrieval are preventable (91%) and that most incidents were related to problems with equipment, then patient care, and transport operations, interpersonal communication, planning or preparation, retrieval staffing and tasking. Incidents were most likely to occur during patient transport to the receiving facility, at patient origin, during patient loading and at the retrieval service base. Contributing factors were almost equally spread between those that were system and human based. Patient harm was documented in 59% as well as a death. The importance of good crew skills/teamwork was highlighted as a minimising factor to incident occurrence. Subsequently this knowledge, experience and data was used to develop and validity a Retrieval and Ambulance Healthcare Incident Type within the generic and widely used Advanced Incident Management System (AIMS). Finally the occurrence of retrieval can be used as a quality measure for the wider health system. Ideally, because of the findings from this body of work of an associated greater than expected mortality and hospital stay of patients undergoing retrieval, particularly for certain diagnostic categories, then a measure of the occurrence of retrieval could be used as a quality indicator of health service provision across a region. As the need for retrieval will never be negated, outcomes associated with retrieval can be measured and benchmarked across a number of regions In summary, in its entirety, this work has added and tested new knowledge and methods as well as value added to existing knowledge for critical care delivery in the out of hospital environment, in particularly to medical retrieval of critically ill patients admitted to an Intensive Care Unit within Australia and New Zealand. It has developed and validated the efficacy of a new quality tool for retrieval and retrieval based quality measures. It has also pointed towards new areas of future investigation particularly in relation to factors that may favourably or adversely impact upon retrieval outcomes and outcomes of patients undergoing retrieval. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346925 / Thesis (M.D.) - University of Adelaide, School of Medicine, 2008.

ABSTRACT Objectives: To develop and validate in an Australian setting, an instrument to effectively measure patient safety culture; to survey health care workers (HCWs) in a large public healthcare system to establish baseline patient safety culture; and, using the Theory of Planned Behaviour (TPB), to use behavioural modelling to identify the factors that predict and influence Patient Safety Behavioural Intent (PSBI) Eg. Reporting clinical incidents and speaking up when a colleague makes an error. Design: Cross sectional survey analysed with multiple logistic regression (MLR). Setting: Metropolitan, regional and rural public hospitals in Queensland, Australia. Participants: 5294 clinical and managerial staff. Main outcome measures: 1) Behavioural models for high-level Patient Safety Behavioural Intent (PSBI) for senior and junior doctors, senior and junior nurses, and allied health professionals. 2) Odds ratios to compare levels of PSBI between professional groups. Results: 1) The factors that influence high-level PSBI for each professional group give rise to unique predictive models. Two factors stand out as influencing high-level PSBI for all HCWs (R2 0.21). These are: i) Preventive Action Beliefs (Adjusted Odds Ratio (AOR) 2.38) (HCWs??? belief that engaging in the target behaviour(s) will lead to improved patient safety) and ii) Professional Peer Behaviour (AOR 1.79) (HCWs??? perceptions of the safety behaviour(s) of one???s professional peers). 2) There was a six-fold difference in the level of target behaviour (PSBI) across the clinical groups with few (29.6%) junior doctors having a high-level of PSBI. When compared with the junior doctors, the senior doctors were nearly 1.5 times more likely (Odds Ratio (OR) 1.46, 95% Confidence Interval (CI) 1.01-2.13), allied health staff 2.7 times more likely (OR 2.71, 95%CI 1.91-3.73), junior nurses 3.9 times more likely (OR 3.86, 95%CI 2.83-5.26), and senior nurses 6.0 times more likely (OR 6.01, 95%CI 4.78-9.16) to have high-level PSBI. Conclusions: This is the first published study to develop behavioural models of factors that influence HCWs??? intention to engage in behaviours known to be associated with improved patient safety. The findings of this study will greatly assist in the future design and implementation of targeted and cost-effective patient safety improvement initiatives.

Bakgrund: Vårdskador är ett vanligt förekommande problem inom slutenvården. En vårdskada är en skada som hade kunnat undvikas. I Sverige drabbas årligen ungefär var tionde patient av en vårdskada vilket medför stora merkostnader både på individ- och samhällsnivå. I varje landsting finns en Patientnämnd vars syfte bland annat är att ta emot patienter och anhörigas synpunkter och klagomål på vården samt förmedla dessa vidare till berörd verksamhet. Syfte: studien granskade vilka vårdskador som anmäldes till Patientnämnden under hösten 2014 i ett landsting i Mellansverige samt vilka åtgärder som vidtogs från vårdgivarens sida efter kontakt från Patientnämnden. Metod: En empirisk studie med kvantitativ design, data erhölls från avslutade ärenden hos Patientnämnden. Resultat: 34,2 % av anmälda ärenden rörde vårdskador. Vanligast var att ärendet gällde en kvinna (69 %) och att patienten själv anmälde till Patientnämnden (71 %). Försenad och/eller felaktig behandling och/eller diagnos var de vanligaste anmälda vårdskadorna i denna studie. I 47,4 % fall vidtogs åtgärder från vårdgivarens sida. Slutsats: I 41 av 75 ärenden kontaktades inte berörd verksamhet för yttrande. Detta då Patientnämnden ej kunde gå vidare med ärendet eftersom skriftliga synpunkter uteblev från anmälande part. Anledningen till detta kan vara värd att studera vidare. Kanske behöver Patientnämnden utveckla ett alternativt anmälningssystem för att underlätta processen för att inte tappa denna grupp som kan behöva mer stöd för att fullfölja sin anmälan. Då även dessa synpunkter är viktiga för fortsatt arbete med kvalitetssäkring och en öka patientsäkerheten inom slutenvården. / Background: Adverse events are a common problem in inpatient care. An adverse event is an injury that could have been avoided. In Sweden every tenth patient are affected every year of injuries form health care which results in big costs both at an individual and a society level. Every county has a Patient Advisory Board whose purpose is to receive patients and relatives' opinions and complaints of the health care and to communicate these to the concerned care unit. Objective: The study examined reported adverse events to the Patient Advisory Board in the fall of 2014 in a county in central Sweden and the measures that were taken from the caregiver's side after being contacted by the Patient Advisory Board. Method: An empirical study using quantitative design, data were obtained from closed cases of this board. Results: 34.2 % of the studied cases concerned nursing injuries. Most commonly the case involved a woman (69 %), and in 71 % of reviewed cases the patients themselves contacted the Patient Advisory Board. Delayed and/or improper treatment and/or diagnosis were the most commonly reported adverse events in this study. In 34 cases, measures were taken from a health care provider. Conclusion: In 41 of the 75 cases the caregiver was not contacted because the Patients Advisory Board could not proceed since written comments regarding the case was not obtained from notifying party. In the future further studies may be needed to find strategies for helping those who have trouble reporting discontent in healthcare.

Bakgrund: Stress är ett vanligt förekommande i dagens samhälle, inte minst för sjuksköterskor då den ökade arbetsbelastningen gör att tid för återhämtning och reflektion får allt mindre utrymme. Stressen medför såväl fysiska som psykiska besvär, vilket påverkar sjuksköterskan både yrkesmässigt och privat. Syfte: Syftet med studien är att belysa vilka faktorer i sjuksköterskans arbete som orsakar stress. Metod: En litteraturstudie som baseras på totalt tio vetenskapliga artiklar, varav tre kvalitativa och sju kvantitativa. Resultatartiklarna valdes ut efter en systematisk litteratursökning i databaserna CINAHL och Academic Search Premier. Resultat: I resultatet visas olika faktorer som orsakar stress i sjuksköterskans arbete och dessa struktureras upp i två huvudteman; (1)Bristande socialt stöd och (2)Arbetsbelastning och krav. Till huvudtema (1) tillkommer ett undertema; Relation och kommunikation med kollegor och chefer. Till huvudtema (2) tillkommer tre underteman; (1)Omorganiseringar, tidsbrist och för lite resurser, (2)Ålder och erfarenhet samt (3)Bristande kontroll och delaktighet. Diskussion: Det sociala stödet är av stor betydelse i sjuksköterskans arbete då känslan av att vara en enhet ökar arbetsglädjen samt gör att stressen blir lättare att hantera. För att öka upplevelsen av meningsfullhet i sitt arbete är det även viktigt för sjuksköterskor att känna att de är delaktiga i olika beslut på arbetsplatsen, men många sjuksköterskor menar att det är svårt att få sin röst hörd. Den omfattande yrkesrollen kan göra att känslan av begriplighet försämras men samtidigt kan oförutsägbarheten vara stimulerande. På grund av de olika stressfaktorerna kan det vara svårt att helt följa de kompetenser som krävs av sjuksköterskan. / Background: Stress is a common occurrence in today's society, especially for nurses when the increased workload decreases the space for recovery and reflection. Stress causes both physical and psychological disorders, which affect nurses both professionally and privately. Aim: The aim of this study is to elucidate the factors in the nurse's work that causes stress. Methods: A literature review based on a total of ten scientific articles, three of which qualitative and seven quantitative. Results articles were selected by a systematic literature search in the databases CINAHL and Academic Search Premier. Results: The result shows various factors that cause stress to the nursing profession and these are structured into two main themes: (1)Lack of social support and (2)Workload and requirements. Main theme (1) has one sub-theme: Relationships and communication with colleagues and managers. Main theme (2) has three sub-themes: (1)Organisational Change, lack of time and lack of resources, (2)Age and experience, and (3)Lack of control and participation. Discussion: Social support is of great importance to the nursing profession as the feeling of being a team increases job satisfaction and makes the stress easier to handle. To enhance the experience of meaningfulness in their work, it is important for nurses to feel that they are involved in various decisions in the workplace, but many nurses believe that it is difficult to get their voices heard. The extensive professional role can deteriorate the sense of comprehensibility, but the unpredictability can at the same time be stimulating. Because of the different stress factors it can be difficult to fully comply with the competencies needed by the nurse.

Bakgrund: Årligen drabbas cirka 100 000 patienter i Sverige av vårdskador på grund av otillräcklig dokumentation. Bristande kommunikation mellan vårdpersonal är en av huvudfaktorerna för vårdskador. Med anledning av detta syftar denna litteraturöversikt till att belysa sjuksköterskans erfarenheter och attityder gentemot omvårdnadsdokumentation. Syfte: Syftet var att belysa sjuksköterskans erfarenheter av omvårdnadsdokumentation. Metod: En litteraturöversikt med kvalitativa artiklar och induktiv ansats. Resultat: Tidskrävande och svårhanterligt datasystem med bristfällig utbildning av de nya systemen samt stora krav från samhället gjorde det svårt att dokumentera. Trots att sjuksköterskorna ansåg att det var tidskrävande förstod de vikten av en fullständig dokumentation och patientsäkerheten den ger. Sjuksköterskorna ansåg däremot att bristen på stöd från organisationen försvårade deras möjligheter till en fullständig dokumentation. Slutsats: Mer forskning fokuserad på väsentligheten av ökat stöd vid utbildning när det gäller införandet av ett nytt system eller lära sig det elektroniska dokumentationssystemet från grunden behövs. Att tillåta sjuksköterskor att få mer individanpassad hjälp när det gäller vidareutbildningen, skulle kunna ha en positiv inverka mot en mer professionell och regelrätt dokumentation. / Background: Each year approximately 100,000 patients in Sweden suffer from healthcare injuries due to the insufficiency of documentation. Lack of communication between healthcare staff is one of the main factors for healthcare injuries. In view of this, this literature review aims at highlighting the nurse's experiences and attitudes towards nursing documentation. Aim: The aim was to highlight nurses' experiences of nursing documentation. Method: A literature review with qualitative articles and inductive approach. Results: Time consuming and difficult to manage computer systems with inadequate training of the new systems and large demand from the community made it difficult to document. Although the nurses felt that it was time-consuming, they understood the importance of a complete documentation because of the patient safety it provides. Nurses on the other hand, consider that the lack of support from the organization made it difficult for them to complete documentation. Conclusion: More research focusing on the essentials of increased supports when implementation of a new system or learn the electronic health system from scratch is needed. To allow nurses to receive more personalized assistance with regard to further education, could have a positive impact on a more professionally and accurate documentation.

Abstract The goals: The goal of the present thesis is to describe the principles of safe identification of patients by a nurse and the application of the medicines with higher risk rate. Another goal is to define procedures for prevention of a confusion of an intervention, a location or a patient at the operation theatre and to characterize the hand hygiene procedures in healthcare. The next goal was to describe a programme of prevention and reduction of falls and decubiti in hospitalized patients. The last goal focuses on the oral and telephonic prescription of medicines, on the reporting of patient examination results, and on the procedure of patient handover. Eight research questions were set in relation to these goals. Methodology: A qualitative research method based on in-depth interviews was chosen to reach the goals of the thesis. The intentional choice method was chosen for the selection of the communication partners. The research was performed in three selected hospitals of the South Bohemia Region. 20 communication partners participated in the anonymous questioning. The in-depth interviews were performed with a head nurse, with a quality manager, with perioperative nurses, with nurses from a neurology department and an after-care department. Scientific contributions of the thesis: The research deals with the current safety problems of hospitalized patients. The scientific results of the research are intended for both, specialist and the general public. The research study could serve to hospital managements as a stimulus for the improvement of the safety in the healthcare provision system. The achieved findings and conclusions: Hospitalization always brings some risk to a patient. From the point of view of the minimizing of adverse events and damage to a patient healthcare staff need to identify a patient safely, to apply risky medicines in safe manners, to prevent adverse events in operations, to adhere to the hand hygiene and the barrier nursing techniques. The healthcare staff also have to proceed correctly in the oral or telephonic prescription of medicines, in reporting of patient examination results, and in the patient handover procedures. It is in also the interest of the healthcare staff to minimize the risk of falls and to prevent the occurrence of decubiti in hospitalized patients.

Bakgrund: Intrahospitala transporter innebär att lämna tryggheten på intensivvårdsavdelningen och möta farorna i sjukhusets korridorer. Syfte: Denna studie har syftat till att öka förståelsen för patientsäkerhetsarbete i samband med intrahospitala transporter genom att belysa effekten av en checklista i ett före-efter förhållande utifrån tre perspektiv, kommunikation mellan professionerna, patientsäkerhet och arbetsflöde. Metod: Intervjuer utfördes på en intensivvårdsavdelning på ett universitetssjukhus i Mellansverige. Intervjuerna analyserades sedan med kvalitativ innehållsanalys i enlighet med Elo och Kyngäs (2008). De nio informanterna inkluderades från samtliga professioner som använder checklistan. Resultat: Patientsäkerheten har stärkts av att checklistan förbättrar förutsättningarna till dialog mellan intensivvårdsläkare och intensivvårdssjuksköterska kring patientens tillstånd inför transport. Den har även ökat riskmedvetenheten vid intrahospitala transporter. Slutsats: Studien visar att checklistan fungerat tydliggörande i ansvars- och rollfördelning vid transporter. Brist på resurser utgör det största hindret till att efterleva checklistans höga ambitioner. / Background: The process of intrahospital transports is one of leaving the safety of the intensive care unit and venturing out into the relative danger zone of the hospital corridors. Aim: This study aims to increase the understanding of patient safety and the effects of the use of a checklist from three different perspectives; communication between professions, patient safety and workflow. Method: Interviews were conducted in an intensive care unit situated in a university hospital in the middle of Sweden. The Elo and Kyngäs (2008) method of qualitative content analysis was used to analyse the interviews. The nine participants were from three different professions of the workforce in the ward were included. Results: Patient safety increased using the checklists by improving the possibilities for communication between doctors and nurses about the patient’s condition before transportation. The checklist also increased hazard awareness during intrahospital transports. Conclusion: The study shows that the checklist improves cooperation and division of responsibility during transport. The lack of resources is the main obstacle hindering full implementation of the checklist.