Yes / This paper presents a mixed-methods study protocol that will be used to evaluate a recent implementation of a real-time, centralised hospital command centre in the UK. The command centre represents a complex intervention within a complex adaptive system. It could support better operational decision-making and facilitate identification and mitigation of threats to patient safety. There is, however, limited research on the impact of such complex health information technology on patient safety, reliability and operational efficiency of healthcare delivery and this study aims to help address that gap. We will conduct a longitudinal mixed-method evaluation that will be informed by public-and-patient involvement and engagement. Interviews and ethnographic observations will inform iterations with quantitative analysis that will sensitise further qualitative work. Quantitative work will take an iterative approach to identify relevant outcome measures from both the literature and pragmatically from datasets of routinely collected electronic health records. This protocol has been approved by the University of Leeds Engineering and Physical Sciences Research Ethics Committee (#MEEC 20-016) and the National Health Service Health Research Authority (IRAS No.: 285933). Our results will be communicated through peer-reviewed publications in international journals and conferences. We will provide ongoing feedback as part of our engagement work with local trust stakeholders. / National Institute for Health Research Health Service and Delivery Research Programme (NIHR129483)

No / Falls are the most common safety incident reported by acute hospitals. NICE recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute NHS hospitals in England. Design: Realist review and multi-site case study. (1) Systematic searches to identify stakeholders’ theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (N=50), patient and carer interviews (N=31), and record review (N=60). Setting: Three Trusts, one orthopaedic and one older person ward in each. Results: Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored: (1) Leadership: Wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared Responsibility: A key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: Assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient Participation: Nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations: Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions: (1) Leadership: There should be a clear distinction between senior nurses’ roles and falls link practitioners in relation to falls prevention; (2) Shared Responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) Facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) Patient Participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work: (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) Mixed method and economic evaluations of patient supervision; (3) Evaluation of engagement support workers, volunteers, and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. / This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in the Health and Social Care Delivery Research Journal.

Yes / Digital health twins (DHTs) have been evolving with their diverse applications in medicine, specifically in older care settings, with the increasing demands of older adults. DHTs have already contributed to improving the quality of dementia and trauma care, cardiac treatment, and health care services for older individuals. Despite its many benefits, the optimum implementation of DHTs has faced several challenges associated with ethical issues, quality of care, management and leadership, and design considerations in older care settings. Since the need for such care is continuously rising and there is evident potential for DHTs to meet those needs, this review aims to map key concepts to address the gaps in the research knowledge to improve DHT implementation. The review aims to compile and synthesize the best available evidence regarding the problems encountered by older adults and care providers associated with the application of DHTs. The synthesis will collate the evidence of the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in older care settings. The review will follow the Joanna Briggs Institute (JBI) methodology. The published studies will be searched through CINAHL, MEDLINE, JBI, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. Studies published in English from 2002 will be considered. This review will include studies of older individuals (aged 65 years or older) undergoing care delivery associated with DHTs and their respective care providers. The concept will include the application of the technology, and the context will involve studies based on the older care setting. A broad scope of evidence, including quantitative, qualitative, text and opinion studies, will be considered. A total of 2 independent reviewers will screen the titles and s and then review the full text. Data will be extracted from the included studies using a data extraction tool developed for this study. The results will be presented in a PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews) flow diagram. A draft charting table will be developed as a data extraction tool. The results will be presented as a "map" of the data in a logical, diagrammatic, or tabular form in a descriptive format. The evidence synthesis is expected to uncover the shreds of evidence required to address the ethical and care quality-related challenges associated with applying DHTs. A synthesis of various strategies used to overcome identified challenges will provide more prospects for adopting them elsewhere and create a resource allocation model for older individuals. DERR1-10.2196/51153. / A publishing grant has been received from Linnaeus University as part of the University Library’s research support.

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2015-07-16T17:52:38Z No. of bitstreams: 1 Natasha Dejigov Monteiro da Silva.pdf: 2789563 bytes, checksum: 4802430c85976463fb4fa4d5130e4bc1 (MD5) / Made available in DSpace on 2015-07-16T17:52:38Z (GMT). No. of bitstreams: 1 Natasha Dejigov Monteiro da Silva.pdf: 2789563 bytes, checksum: 4802430c85976463fb4fa4d5130e4bc1 (MD5) Previous issue date: 2014-12-04 / Considering patient safety one of the critical points that reflect the performance of a hospital organization, this study aimed to identify how patient safety is included in the organizational culture of hospital organizations in São Paulo, different in their administrative nature: public hospitals of direct administration, public hospitals operated by management contract, and private hospitals. The methodological strategy used was the multiple-case study, applying a self-assessment questionnaire from the Emergency Care Research Institute (ECRI), translated for the Portuguese language. The questionnaire was applied both to leaders who work directly with patient care and administrative leaders that ensure assistance is not prevented or interrupted, and thus indirectly reflect on patient safety. Qualitative and quantitative questions were graded using a Likert scale and consolidated according to seven dimensions, namely: expectations and safety promotion, support and investment from hospital management, security environment, openness to communication and non-punitive response, organizational learning, teamwork, and feedback (information and communication feedback about errors). Data analysis was performed using the statistical programSTATATM 12.1, whose response sample was subjected to linear regression for analysis of variance (ANOVA), having an F test of joint statistical significance as decision rule , in which the p-value is zero. The analysis of mean values of the groups in the studied organizations, as perceived by the respondents, showed a gradation among organizations, with higher values concentrating in private institutions. However, when assessing the specifics among the dimensions of safety culture used for the data analysis, it was found that, as perceived by the participants of the study, the most significant dimensions are Security Environment and Organizational Learning, with an explanatory power of 80%. In addition, also as perceived by the agents, the correlation between the above-mentioned dimensions is stronger in direct administration organizations, followed by the institutions under governmental autonomous administration. / Considerando que a segurança do paciente é um dos pontos críticos que refletem no desempenho de uma organização hospitalar, o presente estudo teve como objetivo identificar como a segurança do paciente se insere na cultura organizacional de organizações hospitalares do município de São Paulo, de diferentes naturezas administrativas: hospitais públicos de administração direta, hospitais públicos administrados por contrato de gestão e hospitais privados. A estratégia metodológica utilizada foi o estudo de casos múltiplos, com aplicação do questionário de autoavaliação do Emergency Care Research Institute (ECRI), traduzido para a língua portuguesa. Procedeu-se a aplicação do instrumento com as lideranças que atuam diretamente com a assistência aos pacientes e com as lideranças administrativas que garantem que a assistência não seja inviabilizada ou interrompida, e, assim, refletem indiretamente na segurança dos pacientes. As questões, qualitativas e quantitativas, utilizaram uma escala de Likert para sua gradação e foram consolidadas segundo sete dimensões, a saber: expectativas e ações de promoção da segurança, apoio e investimento da gestão hospitalar, ambiente de segurança, abertura para comunicações e respostas não punitivas, aprendizado organizacional, trabalho em equipe e feedback (retorno da informação e comunicação a respeito de erros). Para análise dos dados utilizou-se o programa de estatística STATATM 12.1, cuja amostra de resposta foi submetida a regressão linear para análise de variância (ANOVA), considerando como base decisória um teste F, de relevância estatística conjunta, em que p-valor é igual a zero. A análise das médias de respostas obtidas nos grupos das organizações estudadas, segundo a percepção dos respondentes, evidenciou uma gradação entre as organizações com maiores valores se concentrando nas de natureza privada. Entretanto, ao serem avaliadas as especificidades entre as dimensões da cultura de segurança utilizadas para a análise dos dados, verificou-se que, segundo a percepção dos participantes do estudo, as dimensões significativas foram a do Ambiente de Segurança e Aprendizado Organizacional, com um poder explicativo de 80%. Além disso, também segundo a percepção dos agentes, a correlação entre as dimensões citadas acima foi mais forte nas organizações de administração direta, seguida pelas instituições sob administração autárquica.

Le Comité de Retour d’Expérience (CREX) est un dispositif de gestion de la sécurité des patients en équipe, engageant les professionnels de santé dans la pratique collective de l’analyse des causes racines des événements indésirables associés aux soins. Ce dispositif, développé en France en 2005, est désormais implanté dans la majorité des établissements de santé français. Curieusement, après 10 ans de développement dans des milliers d’équipes médicales, aucun travail scientifique publié ne s’était penché sur leur fonctionnement et leurs effets sur la sécurité des patients. Mon travail de thèse a permis d’évaluer le fonctionnement des CREX, ainsi que leur association aux dimensions de la culture de sécurité des professionnels de santé. Nous avons montré que les CREX sont appropriés pour fonctionner dans les diverses spécialités d’un établissement de santé. De plus, ce dispositif permet aux soignants de réaliser des analyses des causes racines, et de décider collectivement d’actions visant à corriger les défaillances profondes des organisations. Afin d’étudier les relations entre la participation à un CREX et les dimensions de la culture de sécurité des soignants, nous avons effectué une enquête auprès de 3888 professionnels de santé, en utilisant le questionnaire Hospital Survey On Patient Safety Culture (HSOPS), dont nous avons précisé les propriétés métrologiques (psychométrie, variabilité des méthodes d’agrégation des scores, méthodes d’imputation des données manquantes). Nous avons mis en évidence des relations favorables entre la participation à un CREX et la culture de sécurité des soignants. Les CREX permettent de favoriser le travail en équipe, la multidisciplinarité, ainsi que de modifier la culture de l’erreur. Malgré ses limites, notre travail contribue à mieux connaitre les CREX et leur place dans les dispositifs de gestion de la sécurité des patients. Cette thèse plaide pour le développement d’une recherche centrée sur l’implication des professionnels de santé dans la gestion de la sécurité des patients. / The Experience Feedback Committee (EFC) is a tool designed to involve medical teams in patient safety management, through root cause analysis of adverse events within the team. This program was created in 2005, and was implemented in the vast majority of French hospitals. Despite its wide implementation in thousands of French medical teams, the EFC still lacks scientific evaluation. To our knowledge, the EFC framework and the association between EFC and patient safety culture have never been assessed. In this context, our work aimed to determine whether patient safety culture, as measured by the Hospital Survey On Patient Safety Culture (HSOPS), differed regarding care provider involvement in EFC activities. Using the original data from a cross-sectional survey of 3,888 employees at a single university hospital in France, we analyzed the differences in HSOPS dimension scores according involvement in EFC activities. We also specified the metrological properties of the transcultural adaptation of the HSOPS into French (psychometrics properties, variability of scoring strategies and missing data imputation methods). Our findings suggest that EFC participation may improve patient safety culture, teamwork and non-blame oriented processes. Despite several limitations, our study contributes to a better understanding of EFC and its position amongst patient safety systems. This thesis advocates research developments centered on health care givers involvement in patient safety management.

Introduktion: Operationssjuksköterskan ansvarar för patientens omvårdnad under den perioperativa processen och den ska bedrivas utifrån personcentrerad omvårdnad (PCO). I den högteknologiska miljön fungerar operationssjuksköterskan som en länk mellan tekniken och patienten. Endast ett fåtal studier belyser operationssjuksköterskans perioperativa omvårdnad och behovet av ett omvårdnadsinriktat arbete inom operationssjukvården kan ifrågasättas. Syfte: Studiens syfte var att beskriva operationssjuksköterskors upplevelser av vad som utmärker perioperativ omvårdnad. Metod: Studien var en kvalitativ intervjustudie med induktiv ansats. Datainsamlingen gjordes genom reflexiva intervjuer av tio operationssjuksköterskor från två operationskliniker. Intervjuerna baserades på en upplevd situation av perioperativ omvårdnad. Dataanalysen genomfördes utifrån innehållsanalys. Resultat: Operationssjuksköterskornas upplevelser av perioperativ omvårdnad kan sammanfattas i en huvudkategori: Patientsäker omvårdnad. Tre generiska kategorier framkom: Bevara patientens värdighet, Samordna och kontrollera patientens vård samt Skydda patientens kropp. Operationssjuksköterskorna beskrev hur de arbetade utifrån patientens individuella behov samt hade operationsmetodiska och medicintekniska kunskaper vilket förhindrade vårdskador hos patienten. Konklusion: Den perioperativa omvårdnaden utmärks av att operationssjuksköterskorna genom sina specifika kunskaper samordnar och kontrollerar patientens vård, skyddar patientens kropp och medverkar till en bevarad värdighet hos patienten vilket bidrar till en patientsäker vård. Enligt riktlinjer ska den perioperativa omvårdnaden vara personcentrerad vilken den delvis är men ytterligare evidens kring PCO perioperativt skulle vara betydelsefullt. / Introduction: The operating theatre nurse (OTN) is responsible for the patient’s care during the perioperative process and it should be conducted on the basis of person-centered care (PCC). In the high-tech environment the OTN work as a link between technology and the patient. Only a few studies illustrate the OTN’s perioperative care and the need for a care-oriented work in the operating room is questionable. Aim: The aim of the study was to describe OTNs' experiences of the characteristics of perioperative nursing. Method: The study was a qualitative interview study with an inductive approach. The data was collected through reflexive interviews of ten OTNs’ from two surgical clinics. The interviews were based on a perceived situation of perioperative care. Data analysis was carried out with content analysis. Result: The OTNs' experiences of perioperative care can be summarized in one key category: Patient safe care. Three generic categories emerged: Preserving the patient's dignity, Coordination and control of the patient’s care and Protect the patient's body. The OTNs’ described how they worked according to individual patient needs and had specific operating and technical knowledge which prevented the emergence of health damage to the patient. Conclusion: The perioperative nursing characterized by the OTNs’ through their specific knowledge coordinates and controls the patient's care, protect the patient's body and contributes to the preservation of the patient’s dignity, which contributes to a patient safe care. According to the guidelines, the perioperative care should be person-centered which it partly is but further evidence regarding perioperative PCC would be significant.

No description available.

Background Patient safety is an undisputable part of healthcare. The use of clinical practice guidelines, usually based on evidence-based practice/best practice, promotes patient safety and high quality care, reduces unnecessary patient suffering, and healthcare costs. Analysing results from venous blood specimen collection is one of the most commonly used services within healthcare, and a substantial number of decisions on diagnosis, treatment, and treatment evaluation are based on the results. Hence, the accuracy of these tests are vitally important. Earlier research has demonstrated that healthcare staff report suboptimal adherence to venous blood specimen collection guidelines together with the need for improved practices. Blood sample collection is carried out by several professionals, among them registered nurses and, as a consequence, nursing students too. University nursing students learn and practice venous blood specimen collection in one of their first semesters. After initial skill training at clinical skill laboratories, they continue to perform the task during clinical placements in various clinical settings. Few or no studies have been performed on nursing students, hence it seemed important to assess guideline adherence to venous blood specimen collection among university students as well as to further explore adherence to guidelines among healthcare staff. Therefore, the overall aim for this thesis was to explore adherence to, and factors influencing venous blood specimen collection guidelines practice among university nursing students and healthcare staff. Methods The thesis includes four studies. Study I-III had a quantitative, cross-sectional design, study IV had a qualitative approach. Study I included 164 healthcare staff from 25 primary healthcare centres. Study II included 101 nursing students in their 5th and 6th semesters, and study III included 305 nursing students in their 2nd, 4th, and 6th semesters. To assess adherence to venous blood specimen collection guidelines, data were collected using the Venous Blood Specimen Questionnaire, completed with background variables (I, II, III) and additional scales (III). Descriptive statistics, multilevel and multiple logistic regression analyses were used to analyse the data. In study IV, data were collected through five focus group interviews among 6th semester nursing students (n=26). Data were analysed using qualitative content analysis. Results Workplace affiliation was found to explain variances in reported adherence between different primary healthcare centres. Associations between reported venous blood specimen collection practices and individual as well as workplace factors were revealed. Nursing students were found to increasingly deviate from guideline adherence during their education. Also among students, several associations between guideline adherence and other iv factors were revealed. Reported research use at clinical practice was associated with higher levels of adherence, as were higher capability beliefs regarding both evidence-based practice and academic ability. Analyses from focus group interviews summarised students’ reflections on deviations from VBSC guidelines in the overall theme ‘Striving to blend in and simultaneously follow guidelines’. Conclusion Both healthcare staff at primary healthcare centres and nursing students demonstrate decreasing levels of guideline adherence with time. Factors influencing adherence are both individual as well as contextual. This indicate that both students and staff are subjected to socialisation processes that influences levels of adherence. In order to enhance venous blood specimen collection practices and thereby patient safety, actions must be taken - both in healthcare clinical contexts and by educators. The use of models in practical skill training, and in the ambition to bridge the theory-practice gap may be the path to success. It is reasonable to assume that collaboration between, on the one hand, education representatives and on the other, supervising RNs in clinical settings, will be fruitful. Finally, by empowering students their self-efficacy may be strengthened, and hence their ability to maintain guideline adherence.

Background: Insertion of a peripheral intravenous catheter (PVC) is a common procedure performed by nurses. The practical skill is a complex act, which not only requires theoretical and practical knowledge, but also nursing care adjusted to each patient's history and needs. Aim: The aim was to explore the procedure of inserting a peripheral intravenous catheter at a local hospital in Tanzania with focus on nursing care and patient safety. Method: The study was performed as a non-participating observational study and was preceded by a pilot study performed in Sweden. Eight observations were made, which were analysed with a qualitative content analysis. Result: The categories “Execution” and “Respecting patients” with associated sub-categories constituted the results. “Execution” describes how the procedure is performed, while “Respecting patients,” explains the performed nursing care during the practical skill. Conclusion: The Model of Practical Skill Performance was used for interpreting and discussing the result. The model clarified that some components were not fulfilled and the performance can therefore not be considered as well proceeded. One can discuss whether it depends on lack of knowledge, resources and/or culture. Keywords: Peripheral intravenous catheter, nursing care, patient safety, Tanzania, low-income country. / Bakgrund: Insättning av perifer venkateter (PVK) är en vanligt förekommande uppgift för sjuksköterskor. Denna praktiska färdighet kan anses vara komplex, då den inte bara kräver teoretisk och praktisk kunskap, utan också omvårdnad anpassad efter varje patients behov och tidigare erfarenheter. Syfte: Syftet var att undersöka tillvägagångssättet vid insättning av perifer venkateter på ett lokalt sjukhus i Tanzania, med fokus på omvårdnad och patientsäkerhet. Metod: Studien utfördes som en icke-deltagande observationsstudie och föregicks av en pilotstudie utförd i Sverige. Åtta observationer genomfördes som sedan analyserades med kvalitativ innehållsanalys. Resultat: Kategorierna “Utförande” och “Respektera patienter” med tillhörande underkategorier utgjorde resultatet. ”Utförande” beskriver tillvägagångssättet vid insättnig av PVK, samt förberedelser och slutförande. “Respektera patienter” beskriver den givna omvårdnaden under det det praktiska utförandet. Konklusion: Modellen för praktisk färdighetsutövande användes för att tolka och diskutera resultatet. Modellen klargjorde att några komponenter inte uppfylldes och utförandet kan därmed inte anses som väl utfört. Det kan diskuteras om detta beror på bristande kunskap, resurser och/eller kultur. Nyckelord: Perifer venkateter, omvårdnad, patientsäkerhet, Tanzania, låginkomstland.

The objective of this thesis is to explore how a systems approach can be used to provide an insight into patient safety in NHS hospitals in England. Healthcare delivers considerable benefits yet there remains a relatively high rate of harm and death for patients through adverse events occurring during the process of treatment. The extant patient safety literature acknowledges the influence of organisational or system factors on patient safety. However, the literature is weak in explaining how system factors affect patient safety. To provide an insight into the interactions within healthcare systems, this research explores the characteristics of NHS hospitals, regarded as complex socio-technical systems, using concepts from resilience, systems, accident and social theory. A theoretical Safe Working Envelope (SWE) model (Rasmussen, 1997) is developed and contextualised for use in the NHS. The case study field work was carried out in two NHS hospitals during consecutive winter months at times of high demand for inpatient services. A third case study uses secondary data about patient safety failures in the Mid Staffordshire NHS Foundation Trust. The original SWE model has three failure boundaries. The model is developed by introducing an additional boundary to take account of Government targets. Social theory and system dynamics are used to include the dialectic feedback of social actors and the dynamics of workload. The model depicts the competing pressures, constraints and the workload associated with the need to meet the financial, target, staff workload and patient safety requirements. Three interacting construct sets are explored. These are the constraints within which the system operates, the pressures from the context, and the system dynamics of demand, capacity and decision making. Insights into system behaviours of the hospitals are derived from examining the construct set interactions. The proposition is made that there are five system behaviour archetypes which create the conditions that influence patient safety. The archetypes are derived from the system dynamics and in particular the relationship between reinforcing and balancing feedback loops. The five archetypes are safe practice, drift, tip, collapse and transition towards failure. As hospitals become overcrowded the complexity increases and the reinforcing feedback loops dominate the system and potentially increase the risk to patients. An element of risk arises from staff normalising to the drift in standards of care.