Residents transitioning between hospital and care homes: protocol for codesigning a systems-level response to safety issues (SafeST study)

IntroductionThe aim of this study is to develop a better understanding of incident reporting in relation to transitions in care between hospital and care home, and to codesign a systems-level response to safety issues for patients transitioning between hospital and care home.Methods and analysisTwo workstreams (W) will run in parallel. W1 will aim to develop a taxonomy of incident reporting in care homes, underpinned by structured interviews (N=150) with care home representatives, scoping review of care home incident reporting systems, and a review of incident reporting policy related to care homes. The taxonomy will be developed using a standardised approach to taxonomy development. W2 will be structured in three phases (P). P1a will consist of ≤40 interviews with care home staff to develop a better understanding of their specific internal systems for reporting incidents, and P1b will include ≤30 interviews with others involved in transitions between hospital and care home. P1a and P1b will also examine the impact of the SARS-CoV-2 pandemic on safe transitions. P2 will consist of a retrospective documentary analysis of care home data relating to resident transitions, with data size and sampling determined based on data sources identified in P1a. A validated data extraction form will be adapted before use. P3 will consist of four validation and codesign workshops to develop a service specification using National Health Service Improvement’s service specification framework, which will then be mapped against existing systems and recommendations produced. Framework analysis informed by the heuristic of systemic risk factors will be the primary mode of analysis, with content analysis used for analysing incident reports.Ethics and disseminationThe study has received university ethical approval and Health Research Authority approval. Findings will be disseminated to commissioners, providers and regulators who will be able to use the codesigned service specification to improve integrated care.

96小時重置周邊靜脈導管之效應：資料庫分析

<p>目的：透過異常通報資料庫分析，探討96小時對照72小時重置周邊靜脈導管，對於靜脈炎發生率之影響。</p> <p>方法：方便取樣臺灣南部某醫學中心之異常通報資料庫，分析2011年9月1日至2014年8月31日之72小時重置組，與2014年9月1日至2017年8月31日之96小時重置組，2個時期之住院個案的靜脈炎發生率。</p> <p>結果：96小時對照72小時重置周邊靜脈導管，並未增加靜脈炎發生率。靜脈炎總發生率（勝算比[odds ratio,OR] = 0.70, p=.0290）與細菌性靜脈炎發生率(OR= 0.11, p=.0097)顯著減少，化學性與機械性靜脈炎發生率則無顯著差異。</p> <p>結論：本土性資料庫分析結果為在臺灣熱帶海島型潮濕氣候，三班評估無靜脈炎症狀下，96小時重置周邊靜脈導管並不會顯著增加靜脈炎風險，建議醫療機構可據此調整臨床作業規範，落實實證知識轉譯。</p> <p>&nbsp;</p><p>&quot;Purpose: To compare the effect of replacement of peripheral venous catheters at 96-hour intervals on the incidence of phlebitis with that at 72-hour intervals through analysis of an incident-reporting database.</p> <p>Methods: Convenience sampling of records from the incident-reporting database of a medical center in southern Taiwan was used to analyze the incidence of phlebitis among hospitalized patients with replacement of peripheral venous catheters at 72-hour intervals (from September 1, 2011, to August 31, 2014) or 96-hour intervals (from September 1, 2014, to August 31, 2017).</p> <p>Result: The analysis revealed that replacing peripheral venous catheters every 96 hours rather than every 72 hours did not increase the incidence of phlebitis. The total incidence of phlebitis (odds ratio [OR]=0.70, p=.0290) and the incidence of bacterial phlebitis (OR=0.11, p=.0097) decreased significantly, and no significant differences in the incidence rates of chemical or mechanical phlebitis were identified.</p> <p>Conclusion: According to the analysis results of a local database, under the humid tropical insular climate of Taiwan, replacement of peripheral venous catheters at 96-hour intervals did not significantly increase the risk of phlebitis in patients who exhibited no symptoms of phlebitis as assessed in three shifts. Medical institutions can adjust their clinical operation standards and implement knowledge translation accordingly.</p> <p>&nbsp;</p>

Addressing Mistreatment of Providers by Patients and Family Members as a Patient Safety Event

OBJECTIVE: Mistreatment of health care providers (HCPs) is associated with burnout and lower-quality patient care, but mistreatment by patients and family members is underreported. We hypothesized that an organizational strategy that includes training, safety incident reporting, and a response protocol would increase HCP knowledge, self-efficacy, and reporting of mistreatment. METHODS: In this single-center, serial, cross-sectional study, we sent an anonymous survey to HCPs before and after the intervention at a 213-bed tertiary care university children’s hospital between 2018 and 2019. We used multivariable logistic regression to examine the effect of training on the outcomes of interest and whether this association was moderated by staff role. RESULTS: We received 309 baseline surveys from 72 faculty, 191 nurses, and 46 residents, representing 39.1%, 27.1%, and 59.7%, respectively, of eligible HCPs. Verbal threats from patients or family members were reported by 214 (69.5%) HCPs. Offensive behavior was most commonly based on provider age (85, 28.5%), gender (85, 28.5%), ethnicity or race (55, 18.5%), and appearance (43, 14.6%) but varied by role. HCPs who received training had a higher odds of reporting knowledge, self-efficacy, and experiencing offensive behavior. Incident reporting of mistreatment increased threefold after the intervention. CONCLUSIONS: We report an effective organizational approach to address mistreatment of HCPs by patients and family members. Our approach capitalizes on existing patient safety culture and systems that can be adopted by other institutions to address all forms of mistreatment, including those committed by other HCPs.

Significant differences in the quality of incident reports - a comparison of four acute hospitals in Finland

ObjectivesThe aim of the study was to compare the quality of the content of patient safety incident reports of “near miss” and “adverse event” occurrences, and to examine whether the contributing factors behind the incident were identified.MethodsData were collected from an electronic incident reporting system for a one-year period (2015) at four acute hospitals in Finland. The analysis framework was based on the incident reporting guidelines, and the results were analyzed using statistical methods.ResultsThe most deficiencies were in records of the consequences of the event for the staff and unit (47%) and the consequences of the event (35%). The description of the content of “near miss” situations did not differ significantly from “adverse event” situations, but statistically significant differences were found between the hospitals in the quality of the description of the content of incident reports.ConclusionIncident reports did not always identify the processes behind the incident or the factors that contributed to the occurrence of the incident, such as human error. Blaming was still evident in the incident report descriptions.

Mobile Application for Incident Reporting

In the Philippines, reporting an incident always depends on self-reporting to the nearest law enforcer's office or calling a channel using a mobile phone. 911 is the National Emergency hotline to get assistance when an emergency occurs. However, the emergency hotline operated by the Emergency Network Philippines (ENP), cannot retrieve the reporter's location details immediately. Only when the reporters describe the exact location clearly. Yet, many circumstances that the reporters do not know when they are, or sometimes they have imprecise position information. Then, the law enforcers team may not be able to come to the right place efficiently on time. The incident reporting application incorporates the three types of incidents, classified as public disturbance, ordinance violation, and crime incident. To report an incident the application will automatically get the latitude and longitude of the mobile user or an option to manually pinned the location on the google map include also the incident type, description, and photos will be sent to the nearest barangay responder officer. The barangay responder officer able to request a backup officer, the rescue emergency unit such as a hospital ambulance or firefighters, or transfer a report to the nearest police station. The system also manages web admin for responder locations and generates statistical reports including charts and graphs. The positive feedback of the participants during the evaluation stage signifies that the application was accepted as tested and verified by the evaluation results.