scholarly journals How can patient-held lists of medication enhance patient safety? A mixed-methods study with a focus on user experience

2020 ◽  
Vol 29 (9) ◽  
pp. 764-773 ◽  
Author(s):  
Sara Garfield ◽  
Dominic Furniss ◽  
Fran Husson ◽  
Mike Etkind ◽  
Marney Williams ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Distributed Cognition ◽  
Healthcare Professionals ◽  
Healthcare Settings ◽  
Medicines Reconciliation ◽  
Wide Range ◽  
Semistructured Interviews ◽  
Enhance Patient Safety ◽  
Key Barrier

BackgroundPatients often carry medication lists to mitigate information loss across healthcare settings. We aimed to identify mechanisms by which these lists could be used to support safety, key supporting features, and barriers and facilitators to their use.MethodsWe used a mixed-methods design comprising two focus groups with patients and carers, 16 semistructured interviews with healthcare professionals, 60 semistructured interviews with people carrying medication lists, a quantitative features analysis of tools available for patients to record their medicines and usability testing of four tools. Findings were triangulated using thematic analysis. Distributed cognition for teamwork models were used as sensitising concepts.ResultsWe identified a wide range of mechanisms through which carrying medication lists can improve medication safety. These included improving the accuracy of medicines reconciliation, allowing identification of potential drug interactions, facilitating communication about medicines, acting as an aide-mémoire to patients during appointments, allowing patients to check their medicines for errors and reminding patients to take and reorder their medicines. Different tools for recording medicines met different needs. Of 103 tools examined, none met the core needs of all users. A key barrier to use was lack of awareness by patients and carers that healthcare information systems can be fragmented, a key facilitator was encouragement from healthcare professionals.ConclusionOur findings suggest that patients and healthcare professionals perceive patient-held medication lists to have a wide variety of benefits. Interventions are needed to raise awareness of the potential role of these lists in enhancing patient safety. Such interventions should empower patients and carers to identify a method that suits them best from a range of options and avoid a ‘one size fits all’ approach.

Critical Values in Anatomic Pathology

2006 ◽  
Vol 130 (5) ◽  
pp. 638-640 ◽  
Author(s):  
Jan F. Silverman ◽  
Telma C. Pereira
Keyword(s):  
Patient Safety ◽  
Improve Patient Safety ◽  
Clinical Pathology ◽  
Critical Values ◽  
Surgical Pathology ◽  
Anatomic Pathology ◽  
Wide Range ◽  
Enhance Patient Safety ◽  
Pathology Reports ◽  
Improve Patient

Abstract Similar to critical values (CVs) in clinical pathology, occasional diagnoses in surgical pathology and cytology could require immediate notification of the physician to rapidly initiate treatment. However, there are no established CV guidelines in anatomic pathology. A retrospective review of surgical pathology reports was recently conducted to study the incidence of CVs in surgical pathology and to survey the perceptions of pathologists and clinicians about CVs in surgical pathology, with a similar analysis of CVs performed in cytology. The results indicated that CVs in surgical pathology and cytology are uncommon but not rare and that there is a wide range of opinion among pathologists and between pathologists and clinicians about the need for an immediate telephone call and about the degree of urgency. It was obvious from the study that there is a lack of consensus in identifying what constitutes surgical pathology and cytology CV cases. Since the Institute of Medicine's report on medical errors, there has been an increasing number of initiatives to improve patient safety. Having guidelines for anatomic pathology CVs could enhance patient safety, in contrast to the current practice in which CV cases are managed based on common sense and on personal experience. Therefore, a discussion involving the pathology community might prove useful in an attempt to establish anatomic pathology CV guidelines that could represent a practice improvement.

Primary care physician’s (PCP) perceived value of patient-reported outcomes (PROs) in clinical practice: a mixed methods study

2021 ◽  
pp. bmjqs-2020-012206
Author(s):  
Danny Mou ◽  
Daniel M Horn ◽  
Marilyn Heng ◽  
Manuel Castillo-Angeles ◽  
Keren Ladin ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Mixed Methods ◽  
Clinical Setting ◽  
Patient Reported Outcomes ◽  
Mixed Methods Study ◽  
Clinic Efficiency ◽  
Wide Range ◽  
Patient Reported ◽  
Semistructured Interviews

BackgroundPatient-reported outcomes (PROs) can promote patient engagement, shared-decision making and improve the overall experience of care. However, PRO integration in the primary care clinical setting is limited. Exploring the perspectives of primary care physicians (PCPs) on PROs is key to understanding how they are being used in the clinical setting. We sought to elucidate this clinical perspective at one of the largest US health systems that has integrated a wide range of PROs into routine primary care.MethodsMixed methods study with both anonymous online surveys and in-person qualitative semistructured interviews conducted with PCPs to understand their clinical perspectives on the applications of the existing PROs. PCPs from the 19 affiliated clinics were prompted to complete the survey. Interviewed PCPs were selected via a combination of random and purposive selection from the PCP directory.ResultsOf 172 PCPs, 117 (68%) completed the online survey and 28 completed semistructured interviews. Most PCPs (77%) reviewed PRO responses with their patients. PCPs endorsed that PROs improve clinic efficiency and clinical management. However, PCPs have heterogeneous perspectives on the relevance of PROs in clinical practice, likely due to variations in clinic practice. For specific PRO instruments, PCPs reported anxiety and depression screening PROs to be most helpful. PCPs felt that PROs assisted with completing screening questions that are required by regulatory bodies. Barriers to using PROs include poor user-interface for both clinicians and patients and inadequate training.ConclusionsMost PCPs regularly use PRO data though there are mixed opinions about their clinical relevance. An adaptable, user-friendly PRO system has the potential to have meaningful clinical applications in primary care.

scholarly journals Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e020235 ◽  
Author(s):  
Maria R Dahm ◽  
Andrew Georgiou ◽  
Johanna I Westbrook ◽  
David Greenfield ◽  
Andrea R Horvath ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Local Health ◽  
Safety Risks ◽  
Semistructured Interviews ◽  
Result Management ◽  
Governance Processes ◽  
The Impact ◽  
Test Result

IntroductionThe failure to follow-up pathology and medical imaging test results poses patient-safety risks which threaten the effectiveness, quality and safety of patient care. The objective of this project is to: (1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility and accountability; (2) harness health information technology (IT) to inform and monitor test-result management; (3) enhance the contribution of consumers to the establishment of safe and effective test-result management systems.Methods and analysisThis convergent mixed-methods project triangulates three multistage studies at seven adult hospitals and one paediatric hospital in Australia.Study 1 adopts qualitative research approaches including semistructured interviews, focus groups and ethnographic observations to gain a better understanding of test-result communication and management practices in hospitals, and to identify patient-safety risks which require quality-improvement interventions.Study 2 analyses linked sets of routinely collected healthcare data to examine critical test-result thresholds and test-result notification processes. A controlled before-and-after study across three emergency departments will measure the impact of interventions (including the use of IT) developed to improve the safety and quality of test-result communication and management processes.Study 3 adopts a consumer-driven approach, including semistructured interviews, and the convening of consumer-reference groups and community forums. The qualitative data will identify mechanisms to enhance the role of consumers in test-management governance processes, and inform the direction of the research and the interpretation of findings.Ethics and disseminationEthical approval has been granted by the South Eastern Sydney Local Health District Human Research Ethics Committee and Macquarie University. Findings will be disseminated in academic, industry and consumer journals, newsletters and conferences.

Error Reduction, Patient Safety and Institutional Ethics Committees

2004 ◽  
Vol 32 (2) ◽  
pp. 358-364 ◽  
Author(s):  
Mark E. Meaney
Keyword(s):  
Patient Safety ◽  
Medical Error ◽  
Healthcare Professionals ◽  
Healthcare Delivery ◽  
Ethics Committees ◽  
Error Reduction ◽  
Culture Of Safety ◽  
Institutional Ethics ◽  
Enhance Patient Safety ◽  
Integral Role

Institutional ethics committees remain largely absent from the literature on error reduction and patient safety. This paper attempts to fill the gap. Healthcare professionals are on the front lines in the defense against medical error, but the changes that are needed to reduce medical errors and enhance patient safety are cultural and systemic in nature. As noted in the Hastings Centers recent report, Promoting Patient Safety, the occurrence of medical error involves a complex web of multiple factors. Human misstep is certainly one such factor, but not the only one. In this paper, I build on the Hasting Centers report on patient safety (HCR) in arguing that institutional ethics committees ought to play an integral role in the transformation of a culture of blame to a culture of safety in healthcare delivery.

A Proactive Risk Assessment Methodology to Enhance Patient Safety: Reducing Wrong Site Surgery as a Preventable Medical Error

2020 ◽  
Vol 64 (1) ◽  
pp. 664-668
Author(s):  
Maryam Tabibzadeh ◽  
Gelareh Jahangiri
Keyword(s):  
Risk Assessment ◽  
Patient Safety ◽  
Integrated System ◽  
Wrong Site Surgery ◽  
Healthcare Settings ◽  
Enhance Patient Safety ◽  
Sentinel Events ◽  
Area Of Concern ◽  
Risk Assessment Methodology ◽  
Wrong Site

Patient safety has been a major area of concern over the last decades in the healthcare industry. The number of preventable medical errors in hospitals has been noticeably high. These errors are more likely to occur in intensive care units including Operating Rooms (ORs). Wrong site surgery is one of the critical sentinel events that occur in healthcare settings. This paper fills an important gap by proposing an integrated, system-oriented methodology for proactive risk assessment of operations in ORs, to specifically analyze the wrong site surgery issue, through the identification and monitoring of appropriate Leading Safety Indicators (LSIs) to evaluate the safety of those operations and generate warning/predicting signals for potential failures. These LSIs are identified across the layers of an introduced framework, which is built on the foundation of the Human-Organization-Technology (HOT) model originally developed by Meshkati (1992). This multi-layered framework captures the contributing causes of wrong site surgery.

scholarly journals Barriers and facilitators of medicines reconciliation at transitions of care in Ireland – a qualitative study

2020 ◽  
Author(s):  
Patrick Redmond ◽  
Khalid Munir ◽  
Oludare Alabi ◽  
Tamasine Grimes ◽  
Barbara Clyne ◽  
...  
Keyword(s):  
Medication Error ◽  
Healthcare Professionals ◽  
Community Pharmacists ◽  
Information And Communications Technology ◽  
Barriers And Facilitators ◽  
Transitions Of Care ◽  
Multidisciplinary Teams ◽  
Structured Interviews ◽  
Medicines Reconciliation ◽  
Wide Range

Abstract Background: Medication error at transitions of care is common. The implementation of medicines reconciliation processes to improve this issue has been recommended by many regulatory and safety organisations. The aim of this study was to gain insight from healthcare professionals on the barriers and facilitators to the medicines reconciliation implementation process.Methods: Semi-structured interviews were conducted in Ireland with a wide range of healthcare professionals (HCPs) involved with medicines reconciliation at transitions of care. Thematic analysis was undertaken using an adaptation of a combined theoretical framework of Grol, Cabana and Sluisveld to classify the barriers and facilitators to implementation of medicines reconciliation.Results : Thirty-five participants were interviewed, including eleven community pharmacists (CPs), eight hospital pharmacists (HPs), nine hospital consultants (HCs), five general practitioners (GPs), and two non-consultant hospital doctors (NCHDs). Themes were categorized into barriers and facilitators. Barriers included resistance from existing professional cultures, staff interest and training, poor communication and minimal information and communications technology (ICT) support. Solutions (facilitators) suggested included supporting effective multidisciplinary teams, greater involvement of pharmacists in medicines reconciliation, ICT solutions (linked prescribing databases, decision support systems) and increased funding to provide additional (e.g. admission and discharge reconciliation) and more advanced services (e.g. community pharmacist delivered medicines use review).Conclusions: Medicines reconciliation is advocated as a solution to the known problem of medication error at transitions of care. This study identifies the key challenges and potential solutions that policy makers, managers and HCPs should consider when reviewing the practices and processes of medicines reconciliation in their own organisations.

scholarly journals Laxative Use in the Community: A Literature Review

2021 ◽  
Vol 10 (1) ◽  
pp. 143
Author(s):  
Barry L. Werth ◽  
Sybèle-Anne Christopher
Keyword(s):  
Literature Review ◽  
Healthcare Professionals ◽  
Community Dwelling ◽  
Self Management ◽  
Geographical Differences ◽  
True Prevalence ◽  
Healthcare Settings ◽  
Laxative Use ◽  
Wide Range ◽  
Intended Use

Laxatives are widely available without prescription and, as a consequence, they are commonly used for self-management of constipation by community-dwelling adults. However, it is not clear to what extent laxatives are used. Nor is it clear how laxatives are chosen, how they are used and whether consumers are satisfied with their performance. This review of published literature in the last 30 years shows the prevalence of laxative use in community-dwelling adults varied widely from 1% to 18%. The prevalence of laxative use in adults with any constipation (including both chronic and sporadic constipation) also varied widely from 3% to 59%. Apart from any geographical differences and differences in research methodologies, this wide range of estimated prevalence may be largely attributed to different definitions used for laxatives. This review also shows that laxative choice varies, and healthcare professionals are infrequently involved in selection. Consequently, satisfaction levels with laxatives are reported to be low and this may be because the laxatives chosen may not always be appropriate for the intended use. To improve constipation management in community and primary healthcare settings, further research is required to determine the true prevalence of laxative use and to fully understand laxative utilisation.

scholarly journals An interprofessional education conference approach to antimicrobial education: a mixed methods evaluation

2019 ◽  
Author(s):  
Clare Guilding ◽  
Jessica Hardisty ◽  
Elsa Randles ◽  
Louise Statham ◽  
Alan Green ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Medical Students ◽  
Interprofessional Education ◽  
Healthcare Professionals ◽  
Learning Opportunities ◽  
Pharmacy Students ◽  
Contact Theory ◽  
Infection Management ◽  
Workshop Evaluation

Abstract Background: Arguably, Medical School curricula are deficient in learning opportunities related to the safe and effective use of medicines, in particular antimicrobials. Infection management is complex and multidisciplinary, and undergraduate learning opportunities should therefore reflect these principles. Aligned to the complexity of the subject matter, simulation and interprofessional based teaching are methods that can foster the collaborative skills required of future healthcare professionals. There have been calls to develop these methods in the teaching of safe prescribing and the management of infections; however, reports of such studies are limited. Methods: We developed an interprofessional education (IPE) conference for second year undergraduate medical and pharmacy students based in the North East of England. We considered contact theory in the design of three small-group interprofessional workshops, on the broad themes of antimicrobial stewardship, infection management and patient safety. A mixed methods approach assessed students’ attitudes towards IPE, barriers and facilitators of learning, and perceived learning gains. Qualitative data from workshop evaluation forms were analysed thematically, while quantitative data were analysed descriptively and differences between medical and pharmacy cohorts analysed using unpaired two-tailed t-tests. Results:226/352 students returned the workshop evaluation forms (66% of pharmacy students, 62% of medical students). 281/352 students responded to a series of Likert scale questions on the value of interprofessional working (88% of pharmacy students, 70% of medical students). Students reported acquisition of knowledge and skills, including concepts and procedures related to infection management and antimicrobial prescribing, and the development of problem-solving and critical evaluation skills. Students reflected on their attitude towards interprofessional collaboration. They reported a greater understanding of the roles of other healthcare professionals, reflected on the importance of effective communication in ensuring patient safety, and were more confident to work in interprofessional teams after the conference. Conclusions: A robust IPE event, theoretically underpinned by contact theory and developed collaboratively, achieved interprofessional learning at scale and helped develop healthcare professionals willing to collaborate across disciplines. The resources, and evaluation insights based on the 3P (presage, process, and product) model of learning and teaching, will be of value to other educators who seek to develop theoretically-sound IPE interventions.

scholarly journals Sexual orientation disclosure in health care: a systematic review

2018 ◽  
Vol 68 (668) ◽  
pp. e187-e196 ◽  
Author(s):  
Hannah Brooks ◽  
Carrie D Llewellyn ◽  
Tom Nadarzynski ◽  
Fernando Castilho Pelloso ◽  
Felipe De Souza Guilherme ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sexual Orientation ◽  
Mixed Methods ◽  
Communication Skills ◽  
Healthcare Professionals ◽  
Same Sex ◽  
Qualitative Synthesis ◽  
Healthcare Settings ◽  
Poor Treatment ◽  
Perceived Relevance

BackgroundSignificant health disparities between sexual minority individuals (that is, lesbian, gay, bisexual, or transgender [LGBT]) and heterosexual individuals have been demonstrated.AimTo understand the barriers and facilitators to sexual orientation (SO) disclosure experienced by LGBT adults in healthcare settings.Design and settingMixed methods systematic review, including qualitative, quantitative, and mixed methods papers following PRISMA guidelines.MethodStudy quality was assessed using the Mixed Methods Appraisal Tool (MMAT) and a qualitative synthesis was performed. Studies were included if their participants were aged ≥18 years who either identified as LGBT, had a same-sex sexual relationship, or were attracted to a member of the same sex.ResultsThe review included 31 studies representing 2442 participants. Four overarching themes were identified as barriers or facilitators to SO disclosure: the moment of disclosure, the expected outcome of disclosure, the healthcare professional, and the environment or setting of disclosure. The most prominent themes were the perceived relevance of SO to care, the communication skills and language used by healthcare professionals, and the fear of poor treatment or reaction to disclosure.ConclusionThe facilitators and barriers to SO disclosure by LGBT individuals are widespread but most were modifiable and could therefore be targeted to improve healthcare professionals’ awareness of their patients’ SO. Healthcare professionals should be aware of the broad range of factors that influence SO disclosure and the potential disadvantageous effects of non-disclosure on care. The environment in which patients are seen should be welcoming of different SOs as well as ensuring that healthcare professionals’ communication skills, both verbal and non-verbal, are accepting and inclusive.

scholarly journals Barriers and facilitators of medicines reconciliation at transitions of care in Ireland – a qualitative study

2020 ◽  
Author(s):  
Patrick Redmond ◽  
Khalid Munir ◽  
Oludare Alabi ◽  
Tamasine Grimes ◽  
Barbara Clyne ◽  
...  
Keyword(s):  
Medication Error ◽  
Healthcare Professionals ◽  
Community Pharmacists ◽  
Information And Communications Technology ◽  
Barriers And Facilitators ◽  
Transitions Of Care ◽  
Multidisciplinary Teams ◽  
Structured Interviews ◽  
Medicines Reconciliation ◽  
Wide Range

Abstract Background Medication error at transitions of care is common. The implementation of medicines reconciliation processes to improve this issue has been recommended by many regulatory and safety organisations. Aim The aim of this study was to gain insight from healthcare professionals on the barriers and facilitators to the medicines reconciliation implementation process. Design Setting Semi-structured interviews were conducted in Ireland with a wide range of healthcare professionals (HCPs) involved with medicines reconciliation at transitions of care. Method Thematic analysis was undertaken using an existing theoretical framework previously applied to implementation of medicines reconciliation. Results and conclusion Thirty-five participants were interviewed, including eleven community pharmacists (CPs), eight hospital pharmacists (HPs), nine hospital consultants (HCs), five general practitioners (GPs), and two non-consultant hospital doctors (NCHDs). Themes were categorized into barriers and facilitators. Barriers included resistance from existing professional cultures, staff interest and training, poor communication and minimal information and communications technology (ICT) support. Solutions (facilitators) suggested included supporting effective multidisciplinary teams, greater involvement of pharmacists in medicines reconciliation, ICT solutions (linked prescribing databases, decision support systems) and increased funding to provide additional (e.g. admission and discharge reconciliation) and more advanced services (e.g. community pharmacist delivered medicines use review). Medicines reconciliation is advocated as a solution to the known problem of medication error at transitions of care. This study identifies the key challenges and potential solutions that policy makers, managers and HCPs should consider when reviewing the practices and processes of medicines reconciliation in their own organisations.

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