Assessment of Medication Errors Among Anesthesia Clinicians in Saudi Arabia: A Cross-Sectional Survey Study

ABSTRACT Introduction Anesthetic drugs are prepared and administrated without referral to the pharmacy or other medical departments. We aimed to assess the occurrence of anesthetic drug errors in Saudi Arabia. We also determined the contributing factors, reporting strategies, and clinicians' opinions of the preventive measures. Methods We conducted a cross-sectional web-based survey study using a validated tool. A total of 300 anesthesia clinicians completed the survey (146 anesthesiologists and 154 anesthesia technology specialists). We measured descriptive statistics to describe the demographic characteristics and performed inferential statistics to examine associations and differences. Results Sixty-nine percent of respondents had experienced an anesthetic drug error at least once in their career. The two primary factors that caused drug errors were haste (60.3%) and heavy workload (60.3%). On syringe labeling, 56.3% withdrew the drug then labeled the syringe, and 43.7% labeled the syringe then withdrew the drug. The chi-square test revealed that clinicians who labeled the syringe first then withdrew the drug made errors more frequently (p = 0.036). The test also showed that clinicians with less experience had committed more errors (p = 0.015). On reporting drug errors, 77.7% of respondents identified the fear of medicolegal issues as the most common barrier to reporting errors. Respondents believed that double-checking the medication and color-coded syringe labels were the most effective strategies to reduce errors (82% and 64%, respectively). The Mann-Whiney U test revealed significant differences between the two specialties about their opinions of the preventive measures. Conclusions There was a high occurrence rate of anesthetic drug errors in Saudi Arabia. Policymakers need to unify the syringe-labeling practice, and future research needs to focus on what makes a nonpunitive culture to encourage reporting errors.

Do We Feel Safe About the Surgical Safety Checklist? A Cross-Sectional Study Between Two Periods

ABSTRACT Introduction The aim of this study was to evaluate the change in the healthcare providers' perceptions regarding the World Health Organization Surgical Safety Checklist (WHO SSC) and patient safety in the operating room (OR) at a tertiary hospital in Riyadh, Saudi Arabia. Methods This cross-sectional study was conducted at King Abdulaziz Medical City. Data were collected from two years (2011 and 2019) for comparison. The co-investigators distributed a self-administered Likert scale questionnaire in the various operating areas (35 ORs). Results The total sample was 461. Number of participants enrolled from both years was 235 (51%) and 226 (49%), respectively. The results indicated a statistically significant difference in the attitude of the participants regarding all aspects of patient safety in the OR when the two periods were compared (p < 0.001). Similarly, healthcare providers' perceptions regarding the importance of the WHO SSC increased from 50% (2011) excellent to 68% excellent (2019) (p < 0.001). Conclusions Currently, more healthcare providers recognize the importance of the WHO SSC, and more have a positive attitude toward teamwork, communication, and feeling free to speak out when surgical safety is compromised. All of these cultural changes have positive impact on the overall safety of the OR; however, there are still aspects requiring improvement to provide a safer OR and surgery. Educational interventions regarding the importance of communication and teamwork would improve the safety of surgical care in the OR.

Hospital at Home: An Evolving Model for Comprehensive Healthcare

ABSTRACT Hospital at Home (HaH) is a sustainable, innovative, and next-generation model of healthcare. From the healthcare management point of view, this model provides cost benefits and quality improvement, and from the physicians' point of view, it helps in providing patient-centered medical care and keeps patients away from hospital admission and its complications. The HaH model was first introduced at John Hopkins in the United States in 1995, which showed very promising results in context to the length of stay, readmission rates, patient satisfaction, and hospital-acquired infections. The HaH model of care provides acute critical care to patients at home and reduces unnecessary hospitalization and related complications. The identified patients for this model of care are elderly patients with chronic conditions and multiple comorbidities. The emergence of technology in today's world and the impact of coronavirus disease 2019 (COVID-19) have increased the demand for the HaH model of care. Although there are many benefits and advantages, the HaH model of care has significant barriers and limitations, such as reimbursement for payment, physician and patient resistance, patient safety, and lack of quantifying research data to support the use of this model. Specific training for the physician, nursing, and other members of the HaH multidisciplinary team is necessary for HaH treatment protocols, along with patient and family caregiver education for those who elect the HaH model of care. HaH is the future of comprehensive healthcare services and helps in achieving the triple aim of access to healthcare, improved quality of care, and reduced cost for healthcare.

Psychological Responses Among Healthcare Workers Providing Care for Patients with COVID-19: A Web-Based Cross-Sectional Survey in Riyadh, Saudi Arabia

ABSTRACT Introduction Coronavirus disease (COVID-19) is a pandemic of international concern that has caused significant physical and psychological health challenges to healthcare workers worldwide. This study aimed to assess and evaluate the psychological responses of healthcare workers who provided hands-on care for patients with COVID-19 at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, as it was converted to a dedicated COVID-19 hospital during the pandemic. Methods This study used a descriptive cross-sectional design to recruit 500 participants at KFMC between April 10 and May 5, 2020. This study used the 21-item Depression, Anxiety, and Stress Scale (DASS-21) to assess the psychological responses among the study participants. Results The findings of this study showed that of 500 respondents, 304 (60.9%) reported having depressive symptoms, 281 (56.3%), 318 (63.3%) having stress and anxiety symptoms. Moreover, 250 participants (50%) who lived with their families reported severe stress and anxiety. However, the results of our study indicated that healthcare workers were committed to providing care to COVID-19 patients. Conclusions Depression, anxiety, and stress symptoms were highly prevalent among healthcare workers at KFMC. Therefore, there is an urgent need for psychological interventions to identify healthcare workers with heavy psychological burdens.

Impact of Accreditation Certification on Improving Healthcare Quality and Patient Safety at Johns Hopkins Aramco Healthcare

ABSTRACT Introduction Accreditation gained worldwide attention as a means of increasing awareness of medical errors, improving healthcare quality, and ensuring a culture of safety. Johns Hopkins Aramco Healthcare has been accredited by Joint Commission International (JCI) since 2002. The aim of this study was to evaluate the effect of the accreditation process on healthcare quality performance by maintaining compliance with the requirements of JCI's international patient safety goals (IPSGs) over a 4-year period and how this was reflected by patient safety and satisfaction. Methods In Johns Hopkins Aramco Healthcare, the six JCI IPSGs are part of the as key performance indicators that reflect organizational performance in different services. For this study, data from January 2017 to the end of 2020 were analyzed apropos performance and correlation with patient experience. Results The IPSGs data analysis showed that general performance was maintained above the target values (> 90%–96%) in all IPSGs. This was significantly reflected in high patient satisfaction during this period, with Pearson correlation of 0.9 and p < 0.000. Conclusions Maintaining accreditation status over time enhances patients' confidence in an organization and its leadership as providers of safe, quality healthcare services. However, individual staff perception, commitment, accountability, and responsibility have an influence on performance, the organization's accreditation status, and patients' experiences.

Primary Healthcare in Saudi Arabia: An Evaluation of Emergent Health Trends

ABSTRACT Introduction The Kingdom of Saudi Arabia (KSA) is experiencing an increasing demand for healthcare due to a growing population and unhealthy changes in lifestyle, fostering the need for critical examination of the current status of primary healthcare in the KSA with analysis of health-related trends among its growing population. Methods A review of the literature was therefore undertaken, followed by a survey of primary healthcare centers at three facilities in Riyadh, to assess the current activities, understand challenges, compare existing practices with international best practices, and asses the level of patient satisfaction. The level of satisfaction with primary care services was examined by using observational surveys and retrospective reviews from the previous 20 years. Results The more rural areas with populations with lower education and income ranked factors such as cleanliness, competence of staff, and environment the highest (82–95%), whereas urban areas with populations with higher education and income rated their level of satisfaction lower (74–82%). The influence of population diversity and the country's unique cultural sensitivities on the awareness and uptake of cancer surveillance services available in the community was examined. The incidence of diabetes, asthma, obesity, along with breast and cervical cancer trends, has illustrated the importance of health education and disease prevention. Conclusion An investment in resources for primary healthcare staff and medical facilities is strongly recommended to support primary care providers in becoming the accepted and preferred community frontline for healthcare needs' assessment and care delivery. With its nursing staff comprised predominantly of expatriates, the emphasis needs to be on recruitment and training of a Saudi national workforce in line with succession planning strategy toward a sustainable Saudi workforce.

Achieving Continuous Improvement in CSSD Management through Performance Measurements using User Satisfaction Surveys and Interventions

ABSTRACT Introduction The objective of the study was to achieve continuous improvement in Central Sterile Supply Department (CSSD) management through performance measurements using user satisfaction surveys and interventions. Methods A brainstorming session was conducted with the multidisciplinary process improvement team in 2012 on the reasons for dissatisfaction with CSSD services. A baseline survey questionnaire was prepared to assess levels of dissatisfaction for key indicators and to establish target benchmarks for improvement. Charge nurses in the wards were chosen as respondents. The report was presented by the Quality Management Cell (QMC) to the steering committee in the presence of the CSSD managers. Solutions and support were offered to the team for improvement. Similar surveys were conducted in 2014, 2016, 2017, 2018, and 2019 to understand the impact of the changes implemented. Results The overall satisfaction of the respondents with the CSSD services increased from 54% in 2012 to 89% in 2019, which is statistically significant (95% Cl: −0.56 to −0.25) with p-value < 0.001. Conclusion This exercise helped to build a strong team and create a culture of openness in the CSSD. Improvement measures were data driven and other departments like Radiology and Laundry were motivated to embrace the idea of understanding their user perceptions. This study demonstrates the effectiveness of internal user satisfaction surveys as a valuable tool for continuous quality improvement. This exercise proved beyond doubt that regular monitoring improves quality of services.

Comparison of the Assessment of Patient Satisfaction Using Active and Passive Feedback

ABSTRACT Introduction The outpatient department of any hospital is the first direct point of contact to the patients with the hospital. To understand the difficulties faced by the patients and to understand their perceptions, it is important to assess patient satisfaction. This study was designed to compare the difference in patient satisfaction responses and outcomes using two methods: active feedback collection (AFC) and passive feedback collection (PFC). Methods The study was conducted for a period of 2 months using a validated, structured questionnaire in four languages. To differentiate the questionnaires, those for PFC were marked P and those for AFC as A. The questionnaire consisted of 21 questions. PFC was obtained when patients voluntarily filled out the feedback forms placed at different locations, and AFC was obtained by systematically approaching randomly selected patients. Results Of the 809 patients who participated in the study, 131 were passive and 678 active. The study revealed that the satisfaction level was higher in the AFC group. It was observed that 82% of those in the PFC group and 35% of those in the AFC group had given specific written comments. The negative comments were higher in the PFC group than in the AFC group. Conclusions The AFC method gives a good overview of the patients' journeys through the system and it can be used for systemic feedback collection. The PFC method provides an avenue to get more written suggestions and adverse comments that could help in planning remedial measures. The study showed that both methods collect complementary information for the managers to facilitate improvement of services.