No description available.

No description available.

Studies suggest that the majority of hospital errors go unreported. Equally disturbing is that data surrounding near miss events that could have harmed patients has been found to be even sparser. At the core of any medical error reporting effort is a desire to obtain data that can be used to reduce the frequency of errors, reveal the cause of errors, and empower those involved in the healthcare delivery system with the insight required to design methods to prevent the flaws that allow mistakes to occur. Aligned with the adage that “we can’t fix what we don’t know is broke”, the question is raised why does underreporting exist? The likelihood of reporting medical errors is explored as a manifestation of culture. Factors studied include communication and feedback, teamwork, fear of retribution, and leadership support (top management and supervisor). Data is presented using a nationally recognized instrument—the Agency for Healthcare Research and Quality (AHRQ) Culture of Safety survey. Findings from the research are mixed with little positive relationship between the model and number of events reported although each factor is found to be positively associated with an employee’s perceived frequency by which near miss and no harm events are reported. While advances in patient safety have materialized, the act of employees’ actually reporting events still pales in comparison to the number of errors that have likely occurred, regardless of efforts to advance culture. To explore influencers beyond those found in the AHRQ Culture of Safety survey, an overlapping model is presented. This includes studying various underlying factors, such as understanding what constitutes a reportable event, ease of reporting, and knowledge of the processes supporting data submission, along with attempting to better assess the impact of the direct supervisor and incentives in influencing behavior. Findings suggest that these additional factors do contribute, albeit modestly, to the act of reporting errors. When adding tenure and patient interaction to the model, a higher percentage of the variance is explained. In terms of perceived frequency of reporting near misses and no harm events, this model yields similar results to the first, explaining approximately 28% of the variance. The two factors most positively associated with perceived frequency of reporting near miss and no harm events are communication and feedback and infrastructure —suggesting that some unexplored relationship may exist between the overlapping models. / Business Administration/Interdisciplinary

Objectives: The objective of this thesis is to explore the association between delayed rapid response team activation and patient mortality and morbidity in adult in-patients. Methods: Study 1 presents a protocol for a systematic review of literature regarding the association of delayed activation of rapid response teams and patient outcomes. Study 2 contains the results of the conducted systematic review, performing a search of the literature to critically appraise, aggregate, and present a narrative synthesis of included studies. The final study examines the association between delayed rapid response team activation and hospital mortality, ICU transfer, and cardiopulmonary arrest risk in a retrospective observational cohort study conducted as part of the “Hospital without Code Blues” initiative at Hamilton Health Sciences. Results: Studies included in the systematic review report an association between delayed activation and patient mortality and ICU transfer odds. Results of study three find that these delays may not be associated with patient mortality, but are significantly associated with ICU transfer events and a composite outcome of patient in-hospital mortality, ICU transfer, and cardiopulmonary arrest. Overall, patients experiencing a delayed rapid response team activation were at greater odds of experiencing a negative event during their course of stay in hospital. Conclusions: This thesis presents findings that suggest delayed activation of rapid response teams is associated with an increase in patient mortality and ICU transfers. Increased durations of delay are associated with increased odds of experiencing the above events. / Thesis / Master of Science (MSc)

Bakgrund: Sjuksköterskan på en akutmottagning arbetar under ständig tidspress med en bristande arbetsmiljö. Genom en ökad förståelse för sjuksköterskors upplevelser avseende arbetsrelaterad stress, kan medvetenheten öka kring problematiken och eventuellt leda till potentiella framtida lösningar.  Syfte: Syftet med denna litteraturstudien var att undersöka samt belysa sjuksköterskors upplevelser av arbetsrelaterad stress på akutmottagningar. Metod: Denna litteraturstudie bestod av 10 vetenskapliga artiklar med kvalitativ ansats. Databassökningen genomfördes i Pubmed och Cinahl. Resultat: Studiens resultat baserades på 10 vetenskapliga studier och delades in i två kategorier och fem subkategorier. Organisatorisk arbetsmiljö, belyste arbetsbördor samt resursbrister som råder på akutmottagningar. Sjuksköterskorna upplevde en bristande arbetsmiljö i form av överbelastning som bidrog till stress i arbetet. I den andra kategorin, konsekvenser av stress, belystes konsekvenser av arbetsrelaterad stress på akutmottagningar som visade sig ha en negativ påverkan på sjuksköterskornas psykiska hälsa, privatliv samt patientsäkerheten . Sjuksköterskorna upplevde att stress till följd av resursbrist medförde en ökad risk för vårdskador. Slutsats: Den upplevda arbetsrelaterade stressen hos sjuksköterskor på Akutmottagningar har en negativ påverkan på sjuksköterskors hälsa, bidrar till en bristande omvårdnad, samt hotad patientsäkerhet. Förbättring av arbetsmiljön är av ytterst vikt för att uppnå en säkrare och effektivare vård samt för att främja sjuksköterskors hälsa.

Bakgrund: Ett av de mest kritiska momenten inom vården, där risken för hotadpatientsäkerhet är som störst, är vid överrapportering av kritiskt sjuka patienter. SBAR är enstandardiserad överrapporteringsmodell som rekommenderas att användas inom all hälso- ochsjukvård och anses stärka patientsäkerheten. Aktuell forskningen går dock isär om SBAR ären bra överrapporteringsmodell. Den fungerar bra vid övningar men sämre i praktiken. Akutatidskritiska situationer anses ha en tydlig påverkan på användandet av SBAR. Komplexiteten idessa situationer anses inte tillräckligt utforskad och det behövs mer forskning om vad sompåverkar ambulanssjuksköterskors användande av SBAR. Syfte: Syftet är att beskriva vad som påverkar användandet av SBAR vid överrapportering avkritiskt sjuka patienter till vårdpersonal på akutrummet. Metod: Kvalitativ deltagande observationsstudie med efterföljande intervju med induktivansats. 20 stycken observationer utfördes på ett akutrum med intervjuer som utfördes direktefteråt. Den insamlade datan analyserades manifest med Graneheim och Lundmans (2004)kvalitativa innehållsanalys. Resultat: I intervjuernas resultat framkom två kategorier: Inre och Yttre faktorer och iobservationernas resultat framkom en kategori: Yttre faktorer. Inre faktorer beskriverambulanspersonalens egna påverkan på SBAR där förberedelser och justeringar av SBARhade störst påverkan. Yttre faktorer beskriver hur vårdpersonalens mottagande av rapport påakutrummet och arbetsmiljön påverkade ambulanspersonalens användande av SBAR. Slutsats: Resultatet visar på inre och yttre faktorer som både underlättar och försvårarambulanspersonalens överrapporteringar. Denna förståelse kan leda till förbättrat användandeav SBAR och därför en ökad patientsäkerhet. / Bakground: A critical moment where the risk to patient safety is high is during handover ofcritically ill patients. SBAR is recommended for use across all healthcare settings and isbelieved to increase patient safety. However, current research diverges on whether SBAR is agood model. It performs well in exercises but not as good in practice. Acute time-criticalsituations are considered to influence the use of SBAR. The complexity of these situations isdeemed insufficiently explored and further research about factors influencing ambulancenurses use of SBAR is needed. Aim: The aim of this study is to describe the factors influencing the use of SBAR duringhandover of critically ill patients to healthcare personnel in the emergency room. Method: Qualitative participatory observational study followed by interviews using aninductive approach. Twenty observations were conducted in an emergency room followed byinterviews. The collected data was analyzed manifest and by using Graneheim and Lundmans(2004) qualitative content analysis method. Results: The interviews revealed two categories: Internal factors and external factors. Theobservations revealed one category: External factors. Internal factors describes theambulance personnel´s own influence on SBAR, where preparations and adjustments toSBAR had the greatest impact. External factors describes how the reception of the patienthandover and the work environment affected the ambulance personnel´s use of SBAR. Conclusion: The result indicates that internal and external factors both facilitates and hinderambulance personnel´s handovers. This understanding can lead to improved use of SBAR andthus increase patient safety.

Bakgrund: Dagsljuset är en stor del av vår vardag, då det ger oss ljus och energi. Forskning visar att för lite tillgång till dagsljus kan påverka individen negativt. Studien har för avsikt att undersöka om det kan påverka operationssjuksköterskorna och patientsäkerheten.Syfte: Operationssjuksköterskors upplevelser av tillgång till dagsljus under arbetstid och hur det kan påverka patientsäkerheten.Metod: Kvalitativa semistrukturerade intervjuer användes, där sex intervjuer hölls, som kunde generera svar gentemot syftet. Intervjuerna analyserades genom en kvalitativ manifest innehållsanalys.Resultat: Operationssjuksköterskorna upplevde att tillgången till dagsljus var minimal och att det gjorde dem tröttare. De upplevde inte att det påverkade patientsäkerheten negativt, då de samlade krafter och såg till att god kvalitet av patientsäkerheten hölls. Detta dock på bekostnad av operationssjuksköterskornas psykiska och fysiska hälsa. Slutsats: Operationssjuksköterskorna upplevde att tillgången till dagsljus på arbetsplatsen var mycket begränsad. Trots begränsad åtkomst av dagsljus upplevde operationssjuksköterskorna inte att det påverkade patientsäkerheten negativt. Däremot påverkade det operationssjuksköterskornas välmående och deras energi efter arbetspassen. / Background: Daylight is a big part of our everyday lives because it gives us light and energy. Decreased exposure to this light source has been proven to impact individuals negatively. This study wants to examine whether lowered exposure impacts scrub nurses and patient safety.Aim: The aim is to describe scrub nurses’ experiences with access to daylight during working hours and how it might affect patient safety.Method: This study used qualitative semi-structured interviews, where six interviews were conducted that could answer the aim. The interviews were analyzed through qualitative manifest content analysis.Result: The scrub nurses experienced that the exposure to daylight was minimal, which made them more fatigued. They did not experience that it impacted patient safety negatively because they gathered their strength and made sure that the quality of patient safety was good. The scrub nurses' thought it was at the cost of their health.Conclusion: Scrub nurses experienced that the access to daylight at the workplace was very limited. Even though access to daylight was limited, the scrub nurses did not experience it negatively impacting patient safety. Though, it affected the scrub nurses’ well-being and their energy after their shift was over.

Improving the safety of medicines management when people leave hospital is an international priority. There is evidence that poor co-ordination of medicines between providers can cause preventable harm to patients, yet there is insufficient evidence of the structure and function of the medicines management system that patients experience. This research used a mixed-methods social network analysis to determine the structure, content and function of that system as experienced by patients. Patients’ networks comprised a range of loosely connected healthcare professionals in different organisations and informal, personal contacts. Networks performed multiple functions, including health condition management, and orienting patients concerning their medicines. Some patients experienced safety incidents as a function of their networks. Staff discharging patients from hospital were also observed. Contributory factors that were found to risk the safety of patients’ discharge with medicines included active failures, individual factors and local working conditions. System defences involving staff and patients were also observed. The study identified how patients often co-ordinated a system that lacked personalisation and there is a need to provide more consistent support for patients’ self-management of medicines after they leave hospital. This could be achieved through interventions that include patients’ informal contacts in supporting their medicines use, enhancing their resilience to preventable harm, and developing and testing the role of a ‘medicines key worker’ in safely managing the transfer of care. The role of GP practices in co-ordinating the involvement of multiple professionals in patient polypharmacy needs to be further explored. / University of Bradford studentship

Improving the quality and safety of maternity services is an international top agenda item. This thesis describes the progress towards the development of a multidimensional approach to measure the quality and safety of care in ten maternity units in Oman based on three of the five dimensional Patient Safety Measurement and Monitoring Framework (PSMMF) which include measuring "past harm" and "anticipation and preparedness”. The three monitoring approaches used in this research are: (1) measuring the patient safety culture (2) measuring patient satisfaction (3) and monitoring caesarean section rates. The specific objectives of the research are to (1) measure patient safety culture level, (2) examine the association between nurse’s nationality and patient safety culture, (3) validate an Arabic language survey to measure maternal satisfaction about the childbearing experience, (4) measure patient satisfaction about the childbearing experience, and (5) to examine caesarean section rates across maternity units using statistical process control charts. This thesis started with four systematic reviews that focused on (1) the use of patient safety culture for monitoring maternity units (2) the available interventions to improve patient safety culture (3) Arabic surveys available for measuring maternal satisfaction and (4) the use of statistical process control charts for monitoring performance indicators. The overall conclusion from these reviews that these approaches are being increasingly used in maternity, found feasible and useful, and there are areas that need attention for future work. Five field studies were conducted to address the research aim and objectives. Patient safety culture was measured by a cross-sectional survey of all staff in the ten maternity units. It was found that safety culture in Oman is below the target level and that there is wide variation in the safety scores across hospitals and across different categories of staff. Non-Omani nurses have a more positive perception of patient safety culture than Omani nurses in all domains except in respect of stress recognition and this difference need further investigation and needs to be considered by designers of interventions to enhance patient safety culture. Using two existing validated English surveys, an Arabic survey was developed, validated, and used to measure maternal satisfaction with childbirth services. It was found that the new survey has good psychometric properties and that in all the ten hospitals, mothers were satisfied with the care provided during child delivery but satisfaction score varied across hospitals and groups of participants. Caesarean section rate in the last 17 years was examined using statistical process control charts to understand the variation across the ten hospitals. It was found that caesarean section rate is above the rate recommended by the World Health Organisation. Special cause variations were detected that warrant further investigation. In conclusion, the field studies demonstrated that it is feasible to use the three approaches to monitor quality and safety in maternity units. However, further work is required to use these data to enhance the quality and safety of care. Additionally, future work is needed to cover the other three dimensions of the PSMMF. / Ministry of Health in Oman,

Yes / Multiple changes are made to older patients' medicines during hospital admission, which can sometimes cause confusion and anxiety. This results in problems with post-discharge medicines management, for example medicines taken incorrectly, which can lead to harm, hospital readmission and reduced quality of life. To explore the experiences of older patients and their family carers as they enacted post-discharge medicines management. Semi-structured interviews took place in participants' homes, approximately two weeks after hospital discharge. Data analysis used the Framework method. Recruitment took place during admission to one of two large teaching hospitals in North England. Twenty-seven participants aged 75 plus who lived with long-term conditions and polypharmacy, and nine family carers, were interviewed. Three core themes emerged: impact of the transition, safety strategies and medicines management role. Conversations between participants and health-care professionals about medicines changes often lacked detail, which disrupted some participants' knowledge and medicines management capabilities. Participants used multiple strategies to support post-discharge medicines management, such as creating administration checklists, seeking advice or supporting primary care through prompts to ensure medicines were supplied on time. The level to which they engaged with these activities varied. Participants experienced gaps in their post-discharge medicines management, which they had to bridge through implementing their own strategies or by enlisting support from others. Areas for improvement were identified, mainly through better communication about medicines changes and wider involvement of patients and family carers in their medicines-related care during the hospital-to-home transition. / This work was supported by the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC). This independent research is funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0317-20010).