Surgeons in the operating theatre: preparing to lead by example

2008 ◽  
Vol 90 (9) ◽  
pp. 306-307
Author(s):  
K Woo
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Adverse Events ◽  
Operating Theatre ◽  
Traditional Practices ◽  
Consent Forms ◽  
Operative Site ◽  
Current Climate ◽  
Theatre Staff

Surgeons, anaesthetists and theatre staff have always worked to ensure that no harm comes to their patients, particularly within the operating theatre environment. Patient safety and the prevention of adverse events underlie many of our traditional practices such as the use of identity bracelets, consent forms and marking of the operative site. Perhaps even more so today than ever, unnecessary or avoidable mistakes in the operating theatre cannot be afforded, with the current climate of increasing standards of health care and rising expectations.

Development of the perceptions of preventable adverse events assessment tool (PPAEAT): measurement properties and patients’ mental health status

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Franziska Maria Keller ◽  
Christina Derksen ◽  
Lukas Kötting ◽  
Martina Schmiedhofer ◽  
Sonia Lippke
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Patient Safety ◽  
Primary Health Care ◽  
Adverse Events ◽  
Health Care Professionals ◽  
Discriminant Validity ◽  
Assessment Tool ◽  
Primary Health ◽  
Item Scale

Abstract Background Patient-centered care and patient involvement have been increasingly recognized as crucial elements of patient safety. However, patient safety has rarely been evaluated from the patient perspective with a quantitative approach aiming at making patient safety and preventable adverse events measurable. Objectives The objectives of this study were to develop and evaluate the psychometric properties of a questionnaire assessing patient safety by perceived triggers of preventable adverse events among patients in primary health-care settings while considering mental health. Methods Two hundred and ten participants were recruited through various digital and print channels and asked to complete an online survey between November 2019 and April 2020. Exploratory factor analysis was performed to identify domains of triggers of preventable adverse events affecting patient safety. Furthermore, a multi-trait scaling analysis was performed to evaluate internal reliability as well as item-scale convergent–discriminant validity. A multivariate analysis of covariance evaluated whether individuals below and above the symptom threshold for depression and generalized anxiety perceive triggers of preventable adverse events differently. Results The five factors determined were information and communication with patients, time constraints of health-care professionals, diagnosis and treatment, hygiene and communication among health-care professionals, and knowledge and operational procedures. The questionnaire demonstrated a good total and subscale internal consistency (α = 0.90, range = 0.75–0.88), good item-scale convergent validity with significant correlations between 0.57 and 0.78 (P < 0.05; P < 0.01) for all items with their associated subscales, and satisfactory item-scale discriminant validity between 0.14 and 0.55 (P > 0.05) with no significant correlations between the items and their competing subscales. The questionnaire further revealed to be a generic measure irrespective of patients’ mental health status. Patients older than 50 years of age perceived a significantly greater threat to their own safety compared to patients below that age. Conclusion The developed Perceptions of Preventable Adverse Events Assessment Tool (PPAEAT) exhibits good psychometric properties, which supports its use in future research and primary health-care practice. Further validation of the PPAEAT in different settings, languages and larger samples is needed. The results of this study need to be considered when assessing patient safety in the context of health-care research.

scholarly journals The surgical journey: exploring the OR-PACU handover

2021 ◽  
Author(s):  
Marketa Gross
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Content Analysis ◽  
Qualitative Study ◽  
Adverse Events ◽  
Team Processes ◽  
Team Members ◽  
Handover Process ◽  
Collective Competence ◽  
Transfer Of Information

Patient safety in health care remains a serious concern in Canada. Adverse events can lead to physiological and psychological complications and pose a significant economic burden on the health care system. The purpose of this descriptive qualitative study was to explore the team processes, roles and factors that underpin effective communication between team members during an OR-PACU handover. Content analysis revealed four major categories: Ownership, Distractions and Interruptions, Transfer of Information and Workflow. The results of this study, informed by the Theory of Collective Competence enhance our understanding of the OR-PACU handover and support the need for the development of a structured OR-PACU team handover process.

Improving Patient Safety with Telemedicine

2013 ◽  
pp. 56-70 ◽  
Author(s):  
I. H. Monrad Aas
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Adverse Events ◽  
Potential Role ◽  
Professional Communities ◽  
Network Organization ◽  
Quality Problem ◽  
Do No Harm ◽  
Centralization And Decentralization

The patient safety and quality problem in health care are considerable. To err is human, but primum non nocere (first, do no harm) means work against the adverse events and work for good quality. The purpose of the chapter is to explore the potential role for patient safety of a telemedicine network organization with centralization and decentralization taken into consideration. Network organization is of importance for strengthening of professional communities and competence complementation. For the building of strong professional communities, some size can be necessary, and this can be promoted by centralization. In the telemedicine era, a new way of organizing can be network organization, combined with centralization and decentralization. Not to do anything with the significant patient safety and quality problem is fundamentally wrong and morally indefensible. To err is human, to continue to err is diabolic, and to forgive is divine.

scholarly journals CORRECT PATIENT IDENTIFICATION: EXPERIENCE WITH THE IMPLEMENTATION OF A PATIENT SAFETY CORE

2019 ◽  
Vol 5 ◽  
Author(s):  
Paula Eduarda Oliveira Honorato ◽  
Tania Monteiro Teixeira
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Adverse Events ◽  
Lower Risk ◽  
Public Hospital ◽  
Experience Report ◽  
Patient Identification ◽  
Multiprofessional Team ◽  
Identification Process

Objective: to report and evaluate the implementation of the Patient Safety Center, with emphasis on the identification of patients in a public hospital in Piauí. Method: experience report, in which the activities were performed from January to April 2019. The information for analysis came from the situations experienced by the authors in the implementation of the NSP and the patient identification process. Results: There was an improvement and facilitation in the work of the multiprofessional team enabling lower risk of patient exchange, and consequent avoidable adverse events. Conclusion: the implementation of the NSP was reported and analyzed, with a significant improvement in the organization of services, suggesting improvement with the team, highlighting the importance of protocols for better health care.

Postdischarge Adverse Events Among Patients Who Received Home Health Care Services

2019 ◽  
Vol 31 (4) ◽  
pp. 257-262
Author(s):  
Dennis Tsilimingras ◽  
Liying Zhang ◽  
Askar Chukmaitov
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Patient Safety ◽  
Adverse Events ◽  
Home Health Care ◽  
Health Care Services ◽  
Home Health ◽  
Health Concern ◽  
Care Services ◽  
Safety Research

Adverse events that occur in urban and rural adults during the posthospitalization period have become a major public health concern. However, postdischarge adverse events for patients receiving home health care have been understudied. The objective of this study was to identify the prevalence and risk factors associated with postdischarge adverse events for patients who received home health care services. We analyzed data from a prospective cohort study that was conducted among patients who were hospitalized in the Tallahassee Memorial Hospital from December 2011 to October 2012. Telephone interviews were conducted by trained nurses who contacted patients within 4 weeks after discharge. Physicians reviewed cases with possible adverse events that were triaged by the nurses. The adverse events that were identified were categorized as preventable, ameliorable, and nonpreventable/nonameliorable. Nearly 39% of 85 patients who received home health care experienced postdischarge adverse events that were predominantly preventable or ameliorable. The associated risk factors were living alone (odds ratio [OR] = 7.860, p = .020), insured by Medicare or Medicaid (OR = 6.402, p = .048), type 2 diabetes mellitus (OR = 6.323, p = .004), pneumonia (OR = 5.504, p = .004), and other infections (OR = 4.618, p = .031). This study was able to identify that nearly one in every two patients who received home health care after hospital discharge experienced an adverse event. Patient safety research needs to focus in the home by developing specific interventions to avert adverse events and improve patient safety during the delivery of home health care services.

scholarly journals Patient Safety in the World

2020 ◽  
pp. 93-98
Author(s):  
Neelam Dhingra-Kumar ◽  
Silvio Brusaferro ◽  
Luca Arnoldo
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Adverse Events ◽  
Population Aging ◽  
Fundamental Principle ◽  
High Income ◽  
Institute Of Medicine ◽  
Middle Income ◽  
Common Strategy ◽  
New Treatments

AbstractPatient safety is a fundamental principle of health care. However, many medical practices and risks associated with health care are emerging as major challenges for patient safety globally and contribute significantly to the burden of harm due to unsafe care. Available evidence suggests hospitalizations in low- and middle-income countries lead annually to 134 million adverse events, contributing to 2.6 million deaths. About 134 million adverse events worldwide give rise to 2.6 million deaths every year. Estimates indicate that in high-income countries, about 1 in 10 patients is harmed while receiving hospital care. This problem affects both high-income countries and low- and middle countries even if priorities and issues may differ. The most important adverse events concern medication procedures, healthcare-associated infections, surgical procedures, injection safety, blood transfusions, venous thromboembolism, sepsis, and diagnostic and radiation errors. Since 1999 when the Institute of Medicine (IOM) published its report “To err is human,” some progress has been made but patient harm is still a daily problem in healthcare. As a matter of fact, new threats are emerging due to population aging, along with new treatments and technologies which must be dealt with in addition to still-unresolved, long-standing problems. In this context, it is very important to adopt an international common strategy that creates networks, shares knowledge, programs, tools, good practices and develop and track indicators focusing on the specific priorities of each country and region.

Adverse Events and Patient Safety in the Operating Theatre: Perspectives of 549 Surgeons

2010 ◽  
Vol 92 (6) ◽  
pp. 1-4 ◽  
Author(s):  
C Pritchard ◽  
J Brackstone ◽  
J MacFie
Keyword(s):  
Adverse Event ◽  
Patient Safety ◽  
Adverse Events ◽  
Operating Theatre ◽  
Near Misses ◽  
The Uk

The Chief Medical Officer's recent report, 'Making surgery safer', was a response to widespread concern about patient safety in the operating theatre. Annually there are an estimated 129,416 'untoward events' in the UK. These range from 'near misses' (NM), in which a patient is 'nearly harmed', to an 'adverse event' (AE), usually defined as 'an unintended injury or complication, including death'.

scholarly journals A Identificação do paciente no alcance de práticas seguras: concepções e práticas

2019 ◽  
Vol 87 (25) ◽  
Author(s):  
Andréia Guerra
Keyword(s):  
Health Care ◽  
Patient Safety ◽  
Adverse Events ◽  
Safety Culture ◽  
Descriptive Study ◽  
Quality And Safety ◽  
Patient Identification ◽  
Nursing Team ◽  
Study Sites

Objetivo: Avaliar as dificuldades, ações e estratégias realizadas pela equipe de enfermagem para alcançar a meta de segurança de identificação dos pacientes em uma unidade de internação de um hospital filantrópico. Método: estudo descritivocom abordagem qualitativa. A coleta de dados foi realizada de junho a julho de 2016, por meio de entrevistas, com roteirosemiestruturado, com vinte profissionais da equipe de enfermagem. Resultados: foram construídas três categorias temáticas: Identificação do Paciente: concepções, ações e dificuldades vivenciadas; Identificação do Paciente: riscos existentes;Estratégias para desenvolver a cultura de segurança do paciente. Conclusão: evidenciou-se a falta de cultura de segurançado paciente nos locais de estudo. Surge a necessidade de criar estratégias educativas que possibilitem uma melhor capacitação, planejamento e organização das ações, assim como as notificações de eventos adversos garantindo qualidade esegurança aos pacientes.Palavras chave: Segurança do Paciente. Qualidade da Assistência à Saúde. Cultura Organizacional. ABSTRACTObjective: To evaluate the difficulties, actions and strategies carried out by the nursing team in order to achieve the goalof identifying patients in an inpatient unit of a philanthropic hospital. Method: descriptive study with qualitative approach.Data collection was carried out from June to July of 2016, through interviews, with semi-structured script, with twentyprofessionals of the nursing team. Results: three thematic categories were constructed: Patient Identification: conceptions,actions and difficulties experienced; Patient identification: existing risks; Strategies for developing a patient safety culture.Conclusion: the lack of safety culture of the patient in the study sites was evidenced. The need to create educationalstrategies that allow better training, planning and organization of actions, as well as the notifications of adverse events,guaranteeing quality and safety to the patients.Keywords: Patient Safety. Quality of Health Care. Organizational Culture

scholarly journals Health Care Safety Management in Modern Health Care

2019 ◽  
pp. 18-31 ◽  
Author(s):  
Yuriy Voskanyan ◽  
Irina Shikina
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Patient Safety ◽  
Adverse Events ◽  
Medical Care ◽  
Safety Management ◽  
Meta Analysis ◽  
Modern Health Care ◽  
Health Care Safety

The article is a systematic review of the research devoted to the study of epidemiology, mechanisms of adverse events associated with the provision of medical care, as well as the principles of patient safety management. The meta-analysis allowed to establish that cases of harm in the provision of medical care (adverse events) are recorded in 10.6% of patients. At the heart of the development of adverse events are systemic causes – latent threats, the management of which is the basis of the modern strategy of ensuring the safety of medical care.

scholarly journals Patient Safety in Hemodialysis

2022 ◽  
Author(s):  
Renata De Paula Faria Rocha
Keyword(s):  
Health Care ◽  
Chronic Kidney Disease ◽  
Patient Safety ◽  
Kidney Disease ◽  
Adverse Events ◽  
Care Process ◽  
Patient Health ◽  
Complex Procedure ◽  
Risk Potential

Patient safety addresses the risks involved in health care, simplifying or eliminating adverse events, these are defined as incidents that occur during the provision of health care and that result in harm to the patient. Health care is increasingly complex and can increase the potential for incidents, errors or failures to occur. Hemodialysis is a technically complex procedure, with many potential sources of error and which can cause harm to patients. Dialysis is a therapy that in recent years has benefited many patients, but it is a care process that involves important dangers and risks. Hemodialysis is a hospital sector with a great risk potential for the occurrence of adverse events, this occurs for several reasons such as complex procedures, the use of high technology, the characteristic of chronic kidney disease, the high use of medications. Strategies need to be taken to reduce the occurrence of adverse events, thus ensuring the quality of dialysis, consequently the quality of life of patients with chronic kidney disease undergoing dialysis treatment.

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