scholarly journals 0173 Spring Forward, Fall Back: Increased Patient Safety-Related Adverse Events Following the Spring Time Change

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A69-A69
Author(s):  
B Kolla ◽  
B J Coombes ◽  
T I Morgenthaler ◽  
M P Mansukhani
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Human Error ◽  
Negative Binomial ◽  
Random Effect ◽  
Time Change ◽  
Healthcare Organizations ◽  
Human Errors ◽  
Fall Time ◽  
Increased Risk

Abstract Introduction “Spring forward,” the start of daylight savings time (DST) reduces sleep opportunity by an hour. The resulting sleep deprivation in healthcare workers can increase the potential for medical errors. We examined the change in patient safety-related adverse events (AEs) following the time change in both spring and fall. Methods Self-reported AEs that occurred 7 days prior to and following the spring and fall time changes for years 2010–2017 in a large healthcare organization were ascertained. AEs likely resulting from human errors were identified. The change in the number of AEs (all AEs or restricted to those resulting from human error) following the spring and fall time change were modeled using negative binomial mixed models using a random effect to correct for non-independent observations in consecutive. Results Over the 8 year period, there were more AEs (all and human) in the 7 days following the change in time both in spring (All: 2812 V. 2699; Human: 1902 V. 1625) and fall (All: 3207 V. 3007; Human: 2189 V. 2087). However, the only statistically significant increase was for the estimated 18% increase in human errors following time change in spring (95% CI: 6% to 34%; p = 0.004). The 18% AE increase in spring was also significantly greater than the 5% increase in AE in fall (p = 0.018). Conclusion There is a significant increase in human error related AEs following the “spring forward” clock change which can jeopardize patient safety. Based on safety considerations, DST might best be eliminated; alternatively, policy makers and healthcare organizations should evaluate measures to mitigate the increased risk during this period. Support NA

610 Self-Reported Sleep and Circadian Characteristics Predict Future Substance Use: A Longitudinal Analysis from the NCANDA Study

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A240-A240
Author(s):  
Brant Hasler ◽  
Jessica Graves ◽  
Meredith Wallace ◽  
Stephanie Claudatos ◽  
Fiona Baker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
Sleep Duration ◽  
Daytime Sleepiness ◽  
Parental Education ◽  
Negative Binomial ◽  
Longitudinal Design ◽  
Random Effect ◽  
Cannabis Use ◽  
Increased Risk

Abstract Introduction Growing evidence indicates that sleep characteristics predict later substance use and related problems during adolescence and young adulthood. However, most prior studies have assessed a limited range of sleep characteristics, studied only a narrow age span, and included relatively few follow-up assessments. Here, we used multiple years of data from the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study, which spans the adolescent period with an accelerated longitudinal design, to examine whether multiple sleep characteristics in any year predict substance use the following year. Methods The sample included 831 participants (423 females; age 12–21 years at baseline) from NCANDA. Sleep variables included the previous year’s circadian preference, sleep quality, daytime sleepiness, timing of midsleep (weekday and weekend), and sleep duration (weekday and weekend). Each sleep variable’s association with the subsequent year’s substance use (cannabis use or alcohol binge severity) across years 1–5 was tested separately using generalized linear mixed models (zero-inflated Negative Binomial for cannabis; ordinal for binge severity) with age, sex, race, visit, parental education, previous year’s substance use (yes/no) as covariates and subject as a random effect. Results With regard to cannabis use, greater eveningness and shorter weekday sleep duration predicted an increased risk for additional days of cannabis use the following year, while greater eveningness and later weekend midsleep predicted a greater likelihood of any cannabis use the following year. With regard to alcohol binge severity, greater eveningness, greater daytime sleepiness, and shorter sleep duration (weekday and weekend) all predicted an increased risk for more severe alcohol bingeing the following year. Post-hoc stratified analyses indicated that some of these associations may differ between high school-age and college-age participants. Conclusion Our findings extend prior work, indicating that eveningness and later sleep timing, as well as shorter sleep duration, especially on weekdays, are risk factors for future cannabis use and alcohol misuse. These results underscore a need for greater attention to sleep characteristics as potential risk factors for substance use in adolescents and young adults and may inform future areas of intervention. Support (if any) Grants from NIH: R01AA025626 (Hasler) and U01AA021690 (Clark) and UO1 AA021696 (Baker & Colrain)

scholarly journals 32 Quantifying the Prevalence of Frailty in Drug Trials and the Relationship with Serious Adverse Events

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i7-i11
Author(s):  
P Hanlon ◽  
E Butterly ◽  
J Lewsey ◽  
S Siebert ◽  
F S Mair ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Adverse Events ◽  
Disease Severity ◽  
Negative Binomial ◽  
Frailty Index ◽  
Chronic Obstructive ◽  
Drug Trials ◽  
Phase 3 ◽  
Serious Adverse Events ◽  
Increased Risk

Abstract Introduction Frailty is common in clinical practice, but trials rarely report on participant frailty. Consequently, clinicians and guideline-developers assume frailty is largely absent from trials and have questioned the relevance of trial findings to frail people. Therefore, we examined frailty in phase 3/4 industry-sponsored clinical trials of pharmacological interventions for three exemplar conditions: type 2 diabetes mellitus (T2DM), rheumatoid arthritis (RA), and chronic obstructive pulmonary disease (COPD). Methods We constructed a 40-item frailty index (FI) in 19 clinical trials (7 T2DM, 8 RA, 4 COPD, mean age 42–65 years) using individual-level participant data. Participants with a FI >0.24 were considered “frail”. Baseline disease severity was assessed using HbA1c for T2DM, Disease Activity Score-28 (DAS28) for RA, and % predicted FEV1 for COPD. Using generalised gamma regression, we modelled FI on age, sex and disease severity. In negative binomial regression we modelled serious adverse event rates on FI, and combined results for each index condition in a random-effects meta-analysis. Results All trials included frail participants: prevalence 7–21% in T2DM trials, 33–73% in RA trials, and 15–22% in COPD trials. Increased disease severity and female sex were associated with higher FI in all trials. Frailty was associated with age in T2DM and RA trials, but not in COPD. Across all trials, and after adjusting for age, sex, and disease severity, higher FI predicted increased risk of serious adverse events; the pooled incidence rate ratios (per 0.1-point increase in FI scale) were 1.46 (95% CI 1.21–1.75), 1.45 (1.13–1.87) and 1.99 (1.43–2.76) for T2DM, RA and COPD, respectively. Conclusion Frailty is identifiable and prevalent among middle aged and older participants in phase 3/4 drug trials and has clinically important safety implications. Trial data may be harnessed to better understand chronic disease management in people living with frailty.

scholarly journals Identifying frailty in trials: an analysis of individual participant data from trials of novel pharmacological interventions

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Peter Hanlon ◽  
Elaine Butterly ◽  
Jim Lewsey ◽  
Stefan Siebert ◽  
Frances S. Mair ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Adverse Events ◽  
Disease Severity ◽  
Negative Binomial ◽  
Frailty Index ◽  
Chronic Obstructive ◽  
Pharmacological Interventions ◽  
Phase 3 ◽  
Serious Adverse Events ◽  
Increased Risk

Abstract Background Frailty is common in clinical practice, but trials rarely report on participant frailty. Consequently, clinicians and guideline-developers assume frailty is largely absent from trials and have questioned the relevance of trial findings to frail people. Therefore, we examined frailty in phase 3/4 industry-sponsored clinical trials of pharmacological interventions for three exemplar conditions: type 2 diabetes mellitus (T2DM), rheumatoid arthritis (RA), and chronic obstructive pulmonary disease (COPD). Methods We constructed a 40-item frailty index (FI) in 19 clinical trials (7 T2DM, 8 RA, 4 COPD, mean age 42–65 years) using individual-level participant data. Participants with a FI > 0.24 were considered ‘frail’. Baseline disease severity was assessed using HbA1c for T2DM, Disease Activity Score-28 (DAS28) for RA, and % predicted FEV1 for COPD. Using generalised gamma regression, we modelled FI on age, sex, and disease severity. In negative binomial regression, we modelled serious adverse event rates on FI and combined results for each index condition in a random-effects meta-analysis. Results All trials included frail participants: prevalence 7–21% in T2DM trials, 33–73% in RA trials, and 15–22% in COPD trials. The 99th centile of the FI ranged between 0.35 and 0.45. Female sex was associated with higher FI in all trials. Increased disease severity was associated with higher FI in RA and COPD, but not T2DM. Frailty was associated with age in T2DM and RA trials, but not in COPD. Across all trials, and after adjusting for age, sex, and disease severity, higher FI predicted increased risk of serious adverse events; the pooled incidence rate ratios (per 0.1-point increase in FI scale) were 1.46 (95% CI 1.21–1.75), 1.45 (1.13–1.87), and 1.99 (1.43–2.76) for T2DM, RA, and COPD, respectively. Conclusion The upper limit of frailty in trials is lower than has been described in the general population. However, mild to moderate frailty was common, suggesting trial data may be harnessed to inform disease management in people living with frailty. Participants with higher FI experienced more serious adverse events, suggesting screening for frailty in trial participants would enable identification of those that merit closer monitoring. Frailty is identifiable and prevalent among middle-aged and older participants in phase 3/4 drug trials and has clinically important safety implications.

scholarly journals Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit

CJEM ◽  
2011 ◽  
Vol 13 (01) ◽  
pp. 13-18 ◽  
Author(s):  
Blair L. Bigham ◽  
Ellen Bull ◽  
Merideth Morrison ◽  
Rob Burgess ◽  
Janet Maher ◽  
...  
Keyword(s):  
Patient Safety ◽  
Adverse Events ◽  
Emergency Medical Services ◽  
Clinical Decision Making ◽  
Qualitative Interviews ◽  
Primary Objective ◽  
Medical Services ◽  
Executive Summary ◽  
Emergency Medical ◽  
Increased Risk

ABSTRACT Emergency medical services (EMS) personnel care for patients in challenging and dynamic environments that may contribute to an increased risk for adverse events. However, little is known about the risks to patient safety in the EMS setting. To address this knowledge gap, we conducted a systematic review of the literature, including nonrandomized, noncontrolled studies, conducted qualitative interviews of key informants, and, with the assistance of a pan-Canadian advisory board, hosted a 1-day summit of 52 experts in the field of EMS patient safety. The intent of the summit was to review available research, discuss the issues affecting prehospital patient safety, and discuss interventions that might improve the safety of the EMS industry. The primary objective was to define the strategic goals for improving patient safety in EMS. Participants represented all geographic regions of Canada and included administrators, educators, physicians, researchers, and patient safety experts. Data were collected through electronic voting and qualitative analysis of the discussions. The group reached consensus on nine recommendations to increase awareness, reduce adverse events, and suggest research and educational directions in EMS patient safety: increasing awareness of patient safety principles, improving adverse event reporting through creating nonpunitive reporting systems, supporting paramedic clinical decision making through improved research and education, policy changes, using flexible algorithms, adopting patient safety strategies from other disciplines, increasing funding for research in patient safety, salary support for paramedic researchers, and access to graduate training in prehospital research.

scholarly journals Activity levels influence frequency of premature atrial contractions

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L S B Johnson ◽  
N Napiorkowski ◽  
A Grotek ◽  
M Dziubinski ◽  
J S Healey ◽  
...  
Keyword(s):  
Individual Differences ◽  
Daily Activity ◽  
Negative Binomial ◽  
Random Effect ◽  
Negative Binomial Regression ◽  
Negative Binomial Regression Model ◽  
Activity Levels ◽  
Funding Sources ◽  
Increased Risk ◽  
Swedish Society

Abstract Background Frequent premature atrial contractions (PACs) are associated with substantially increased risk of atrial fibrillation (AF) and stroke, but PAC count varies substantially day-to-day. With the emergence of potential therapies for primary prevention of AF reliable estimation of PAC frequency is increasingly relevant, as is an understanding of PAC determinants. Purpose To determine the effect of daily activity and heart rate on an individuals' daily PAC count. Methods We included a random sample of patients 18–85 years without AF who recorded an ambulatory ECG for 7–31 days in the U.S.A during 2019 using a full-disclosure mobile cardiac telemetry device, and who had ≥500PACs on at least one recording day. PACs were algorithmically detected and manually verified. PAC count and activity was sampled for each individual and each recording day during daytime (06–22h). The effect of activity on daily PAC count was assessed in a negative binomial regression model including age, sex and with a random effect for individual, to account for confounding due to inter-individual differences. Results The study population consisted of 2,094 patients, of which 48% were men (Fig 1). Mean time spent in activity was 32% (standard deviation (SD 10%) for men and women 31% (SD 10%) for women (Fig 2). The median PAC count was 592 (inter-quartile range 1280). Beyond age, sex and intra-individual differences PAC frequency was determined by activity levels, (intercept 629 PACs; incidence rate ratio per 10 minute increase in activity 1.03, p<0.0001). A 1-hour increase in daily activity was associated with a 20% increase in daily PACs count. Conclusions Physical activity is associated with increased PACs counts, implying both that a reliable diagnosis of PAC frequency needs to be conducted during a person's habitual level of activity and that PAC frequency is modifiable. In-hospital assessments of PACs while patients are mainly inactive may underestimate PAC frequency. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): the Swedish Society For Medical Researchthe Swedish Heart and Lung Foundation Age and sex distribution Activity levels by sex

scholarly journals PENGARUH PENGETAHUAN PASIEN DAN KELUARGA TENTANG PATIENT SAFETY TERHADAP PENCEGAHAN TERJADINYA BAHAYA DAN ADVERSE EVENTS

2020 ◽  
Author(s):  
Ria Oktaviany
Keyword(s):  
Patient Safety ◽  
Literature Review ◽  
Adverse Events ◽  
Human Error

Keselamatan pasien merupakan hal yang utama dan penting untuk dicapai dalam setiap fasilitas kesehatan. Latar Belakang : Rumah sakit sebagai tempat perawatan seseorang untuk mencapai kesembuhan tak lepas dari risiko bahaya. Setiap tindakan medis yang tujuannya untuk kesembuhan klien dapat berubah menjadi bahaya bagi klien jika tidak tepat dalam pelaksanaannya. Metode : Metode yang dipakai unuk mengetahui pengaruh pengetahuan pasien dan keluarga tentang patient safety terhadap pencegahan bahaya dan adverse events adalah dengan metode kepustakaan. Hasil : Berdasarkan hasil literature review terdapat hubungan antara pengetahuan klien dan keluarga tejtang patient safety dengan pencegahan bahaya dan adverse events yang terjadi di rumah sakit. Hal ini dapat disimpulkan karena bila pasien dan keluarga paham betul tentang patient safety di rumah sakit, tentu pasien dan keluarga dapat menekan angka bahaya dan adverse events yang berpotensi terjadi di rumah sakit. Pembahasan : Keselamatan pasien merupakan tindakan dimana pelayanan dan asuhan keperawatan tidak berpotensi terhadap kecelakaan dan menimbulkan bahaya kepada klien. Upaya dan cara pencegahan bahaya ini dilakukan agar klien merasa aman dan memperoleh kesembuhan tanpa adanya bahaya akibat human error. Penutup : Pengetahuan klien dan keluarga tentang patient safety mampu membantu tenaga kesehatan dalam memberikan pelayanan dan asuhannya apakah tepat sasaran atau tidak.

scholarly journals Inpatient patient safety events in vulnerable populations: a retrospective cohort study

2020 ◽  
pp. bmjqs-2020-011920 ◽  
Author(s):  
Lucy B Schulson ◽  
Victor Novack ◽  
Patricia H Folcarelli ◽  
Jennifer P Stevens ◽  
Bruce E Landon
Keyword(s):  
Patient Safety ◽  
Cohort Study ◽  
Vulnerable Populations ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Negative Binomial ◽  
Academic Medical Centre ◽  
Increased Risk ◽  
Safety Event ◽  
Race Ethnicity

BackgroundWidespread attention to structural racism has heightened interest in disparities in the quality of care delivered to racial/ethnic minorities and other vulnerable populations. These groups may also be at increased risk of patient safety events.ObjectiveTo examine differences in inpatient patient safety events for vulnerable populations defined by race/ethnicity, insurance status and limited English proficiency (LEP).DesignRetrospective cohort study.SettingSingle tertiary care academic medical centre.ParticipantsInpatient admissions of those aged ≥18 years from 1 October 2014 to 31 December 2018.MeasurementsPrimary exposures of interest were self-identified race/ethnicity, Medicaid insurance/uninsured and LEP. The primary outcome of interest was the total number of patient safety events, defined as any event identified by a modified version of the Institute for Healthcare Improvement global trigger tool that automatically identifies patient safety events (‘automated’) from the electronic record or by the hospital-wide voluntary provider reporting system (‘voluntary’). Negative binomial models were used to adjust for demographic and clinical factors. We also stratified results by automated and voluntary.ResultsWe studied 141 877 hospitalisations, of which 13.6% had any patient safety event. In adjusted analyses, Asian race/ethnicity was associated with a lower event rate (incident rate ratio (IRR) 0.89, 95% CI 0.83 to 0.96); LEP patients had a lower risk of any patient safety event and voluntary events (IRR 0.91, 95% CI 0.87 to 0.96; IRR 0.89, 95% CI 0.85 to 0.94). Asian and Latino race/ethnicity were also associated with a lower rate of voluntary events but no difference in risk of automated events. Black race was associated with an increased risk of automated events (IRR 1.11, 95% CI 1.03 to 1.20).LimitationsThis is a single centre study.ConclusionsA commonly used method for monitoring patient safety problems, namely voluntary incident reporting, may underdetect safety events in vulnerable populations.

scholarly journals Assessment of Knowledge About Patient Safety Concepts Among Medical and Pharmacy Students

2021 ◽  
Author(s):  
Areeg Abumostafa ◽  
Fadwa Abu Mostafa ◽  
Khaled Al-Kattan ◽  
Rana Alkateb ◽  
Aljohara Alayesh ◽  
...  
Keyword(s):  
Patient Safety ◽  
Human Error ◽  
Cross Sectional Study ◽  
Pharmacy Students ◽  
Research Centre ◽  
Safety Education ◽  
Cross Sectional ◽  
Human Errors ◽  
School Year ◽  
Causes Of Errors

ABSTRACT Introduction Patient safety is a central principle of healthcare professional practice that requires a significant consideration within the teaching curricula; however, there is a lack of special courses that focus on patient safety concepts in an integrated way in many countries. This study aims to assess the knowledge of medical and pharmacy students regarding patient safety concepts. Methods A cross-sectional study was conducted at Alfaisal University during the 2018-2019 school year. A survey consisting of 15 questions was designed with the help of the quality and patient safety department at King Faisal Specialist Hospital and Research Centre, Riyadh (KFSHRC). The survey was validated and then electronically distributed to all students enrolled in the College of Medicine and College of Pharmacy. Results A total of 304 (22%) of 1368 students completed the survey. The survey revealed that 51% of students had an acceptable understanding of the types of human error; however, 53% of students had little knowledge about the factors that lead to these errors and 61% did not know how to report an error. Many students (41%) reported being directly involved in an unsafe situation that may cause patient harm, such as a healthcare-related error, adverse event, or inconsistent care. Most students (90%) agreed that hiding errors to avoid further implications is unethical and reporting errors is the responsibility of every healthcare provider. Conclusion Most Alfaisal University students understand the significance of patient safety education and understand the types of human errors, yet the causes of errors and the protocols for reporting them were not well understood by most students.

scholarly journals Patient Safety and the Significance of Human Factors Engineering Modality: A Review

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Bashkin Osnat
Keyword(s):  
Patient Safety ◽  
Human Factors ◽  
Human Error ◽  
Human Factors Engineering ◽  
Human Beings ◽  
Medical Systems ◽  
Human Errors ◽  
Proactive Approach ◽  
Depth Analysis ◽  
The Many

The issue of patient safety and medical human error has been arousing growing concern around the world. Attempts to reduce the rate of human error present a great challenge, and there is an increased understanding that the issue of patient safety in healthcare systems is a complex one that requires in-depth analysis and understanding. Despite the many programs and interventions designed to reduce the rate of human medical errors, various publications that expose the extent of this phenomenon point to a high percentage of human errors that causes injury, and to the difficulties in improving patient safety. The understanding that the focus must be on prevention and the growing need for practical solutions have led to the involvement of disciplines such as human-factors engineering in an attempt to understand the root causes of safety problems and find ways to prevent them. Human-factors engineering is a proactive approach that may contribute to the planning of safe medical systems by taking into account the diverse needs, capabilities, and limitations of the human beings involved in these systems. This article reviews the benefits and challenges in applying the principles of human-factors engineering to promote patient safety, as well as the implications for policy in the field

scholarly journals Non-conveyance of older adult patients and association with subsequent clinical and adverse events after initial assessment by ambulance clinicians: a cohort analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jakob Lederman ◽  
Veronica Lindström ◽  
Carina Elmqvist ◽  
Caroline Löfvenmark ◽  
Gunnar Ljunggren ◽  
...  
Keyword(s):  
Older Adults ◽  
Patient Safety ◽  
Adverse Events ◽  
Older Adult ◽  
Emergency Department Visits ◽  
Adult Patients ◽  
Ambulance Service ◽  
Oxygen Saturation Level ◽  
Presenting Symptoms ◽  
Increased Risk

Abstract Background Older adults (age ≥ 65 years) represent a significant proportion of all patients who are not transported to hospital after assessment by ambulance clinicians (non-conveyed patients). This study aimed to fill the knowledge gap in the understanding of the prevalence of older adult non-conveyed patients and investigate their characteristics and risk factors for subsequent and adverse events with those of younger non-conveyed patients comparatively. Methods This population-based retrospective cohort study included all adult non-conveyed patients who availed the ambulance service of Region Stockholm, Sweden in 2015; they were age-stratified into two groups: 18–64 and ≥ 65 years. Inter-group differences in short-term outcomes (i.e. emergency department visits, hospitalisations, and mortality within 7 days following non-conveyance) were assessed using multivariate regression analyses. Results Older adult patients comprised 48% of the 17,809 non-conveyed patients. Dispatch priority levels were generally lower among older non-conveyed patients than among younger patients. Non-conveyance among older patients occurred more often during daytime, and they were more frequently assessed by ambulance clinicians with nonspecific presenting symptoms. Approximately one in five older adults was hospitalised within 7 days following non-conveyance. Patients presenting with infectious symptoms had the highest mortality risk following non-conveyance. Oxygen saturation level < 95% or systolic blood pressure > 160 mmHg had significantly higher associations with hospitalisation within 7 days following non-conveyance in older adult patients. Conclusions Older adult patients have an increased risk for adverse events following non-conveyance. In combination with a complex and variating presentation of symptoms and vital signs proved difficult for dispatch operators and ambulance clinicians to identify and assess, the identified risks raise questions on the patient safety of older adult non-conveyed patients. The results indicate a system failure that need to be managed within the ambulance service organisation to achieve higher levels of patient safety for older non-conveyed patients.

Sign in / Sign up

Export Citation Format

Share Document