International Journal of Risk & Safety in Medicine - Volume 31, issue 4
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The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed.
This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety. Our journal wants to publish high quality interdisciplinary papers related to patient safety, not the ones for domain specialists. For quite some time we have also been devoting some pages in every issue to what we simply call WHO news. This affinity with WHO underlines both the International character of the journal and the subject matter we want to cover. Basic research, reports of clinical experience and overviews will all be considered for publication, but since major reviews of the literature are often written at the invitation of the Editorial Board it is generally advisable to consult with the Editor in advance. Submission of news items will be appreciated, as will be the contribution of letters on topics which have been dealt with in the journal.
Abstract: National Health Systems are facing a very serious health emergency related to COVID-19. In this phase of emergency, it is essential to ensure the care of all affected patients but also to ensure the economic stability of the National Health System. This stability is undermined by the potential exponential increase in claims caused by healthcare-associated infections related to COVID-19. That is why it will be essential to use all means necessary to prevent this economic crisis, which could overlap with the health crisis.
Abstract: A few ideas that deserve to see the light of day. I wrote this essay on 23/3/2020. I have started updating in the form of post scripts. Please relate the information to the date on which it was written.
Abstract: BACKGROUND: The prerequisite for promoting safety culture is to assess the existing safety culture level of institutes, because safety precautions without appropriate evaluation increase costs and unforeseen risks. OBJECTIVE: This study aimed to systematically review the status of patient safety culture from the perspective of clinical personnel at Iranian hospitals through a meta-analysis of studies using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire. METHODS: The present systematic review and meta-analysis was conducted in 2018. Data were gathered by searching Google Scholar, Scopus, PubMed, and Web of Science databases up to November 2018. Search keywords…were “patient”, “safety”, “culture”, “healthcare”, “hospital”, “medical center”, “HSOPSC tool”, and “Iran”. The search protocol was limited to 10 years. To estimate the PSC score, computer software CMA:2 (Comprehensive Meta-Analysis) was used. The presence of heterogeneity across the studies was assessed with the I 2 statistic. A forest plot was used to report the results. Publication bias was assessed through a funnel plot. RESULTS: The meta-analysis of studies showed that the PSC score based on the random effect model was 52.7% (95% CI: 50.2%–55.2%), (Q = 522.3, df = 54, P < 0.05, I 2 = 89.6). A mean of 12 dimensions of HSOPSC showed that the “Teamwork within units” dimension had the highest PSC score (67.2%) and “Non-punitive response to error” had the lowest score (40.4%). CONCLUSIONS: Managers and policymakers should be directed towards non-punitive responses to errors and persuade staff to report errors and execute the approach to learn from mistakes. Also, a periodic government evaluation of the patient safety culture will help further its sustainable development.
Keywords: Patient safety, safety culture, HSOPSC, medical staff, Iran
Abstract: BACKGROUND: The correct and safe use of electrosurgery requires medical specialists to be proficient. Minimum proficiency requirements and proficiency tests are a manner to structurally assure proficiency. The objective of this study is to explore attitudes and perceptions of medical specialists on proficiency, proficiency requirements and proficiency tests for the safe use of electrosurgery. METHODS: A qualitative study among medical specialists using semi-structured interviews. RESULTS: The participants recognized that the use of electrosurgery poses risks to the safety of patients and perioperative staff. According to some participants, increased awareness on the risks of electrosurgery is required.…Most medical specialists however thought that proficiency of users of electrosurgery is sufficiently assured. Medical specialists stated to support proficiency requirements when they are endorsed by their scientific association. Proficiency tests encountered much resistance. Medical specialists argued that electrosurgery should not be tested as a single device but should be embedded in a larger entity, for example in a broader course or proficiency test. CONCLUSIONS: When assuring proficiency of users of electrosurgery, the positive attitude towards proficiency requirements and the more negative attitude towards proficiency tests should be taken into account.
Keywords: Proficiency, competency, requirements, tests, medical specialists, electrosurgery
Abstract: BACKGROUND: Physicians and nurses are responsible for reporting medical adverse events. Each views these events through a different lens subject to their role-based perceptions and barriers. Physicians typically engage with diagnosis and treatment while nurses primarily care for patients’ daily lives and mental well-being. This results in reporting and describing medical adverse events differently. OBJECTIVE: We aimed to compare adverse medical event reports generated by physicians and nurses to better understand the differences and similarities in perspective as well as the nature of adverse medical events using social network analysis (SNA) and latent Dirichlet allocation (LDA).…METHODS: The current study examined data from the Maccabi Healthcare Community. Approximately 17,868 records were collected from 2000 to 2017 regarding medical adverse events. Data analysis used SNA and LDA to perform descriptive text analytics and understand underlying phenomenon. RESULTS: A significant difference in harm levels reported by physicians and nurses was discovered. Shared topic keyword lists broken down by physicians and nurses were derived. Overall, communication, lack of attention, and information transfer issues were reported in medical adverse events data. Specialized keywords, more likely to be used by a physician were determined as: repeated prescriptions, diabetes complications, and x-ray examinations. For nurses, the most common special adverse event behavior keywords were vaccine problem, certificates of fitness, death and incapacity, and abnormal dosage. CONCLUSIONS: Communication and inattentiveness appeared most frequently in medical adverse events reports regardless of whether doctors or nurses did the reporting. Findings suggest feedback and information sharing processes could be implemented as a step toward alleviating many issues. Institutional management, healthcare managers and government officials should take actions to decrease medical adverse events, many of which may be preventable.
Keywords: Patient safety, social network analysis (SNA), latent Dirichlet allocation (LDA), medical adverse event, medical adverse event reporting system, physician, nurse
Abstract: BACKGROUND: Near-miss analysis is an effective method for preventing serious adverse events, including never events such as wrong-site surgery. OBJECTIVE: To analyze all near-miss incidents reported in a large general hospital in southern Brazil between January 2013 and August 2017. METHOD: We performed a descriptive retrospective study of near-miss incidents recorded in the hospital’s electronic reporting system in a large non-profit hospital (497 beds). The results are expressed as absolute (n ) and relative frequencies (%). Pearson’s chi-square test, Fisher’s exact test (Monte Carlo simulation) and linear regression were used. RESULTS: A total of…12,939 near-miss incidents were recorded during the study period, with linear growth in the number of reports. Near-miss incidents were most frequent for medication, followed by processes unspecified in the International Classification for Patient Safety framework, followed by information control (patient chart and fluid balance data), followed by venous/vascular puncture. The highest prevalence of reports was observed in inpatient wards, in adult, pediatric, and neonatal intensive care units, and in the surgical center/post-anesthesia care unit. Pharmacists and nursing personnel recorded most of the reports during the day shift. CONCLUSION: The most frequent categories of near-miss incidents were medication processes, other institutional protocols, information control issues, and venous/vascular puncture. The significant number of reported near-miss incidents reflects good adherence to the reporting system.
Keywords: Near miss, patient safety, medical errors, hospital incident reporting, patient harm, quality of care
Abstract: Background: Disease-modifying therapies for multiple sclerosis have been developed tremendously over the last two decades. Objective: The aim of this study was to review the short-, medium-, and long-term safety of alemtuzumab in relapsing remitting multiple sclerosis (RRMS). Method: This retrospective observational study (2015–2019) included all patients with highly active or rapidly progressing and aggressive RRMS who were treated with alemtuzumab at the Cabueñes University Hospital. The short-, medium-, and long-term adverse effects were evaluated following the risk management program of the European Medicines Agency. Results: 39 patients were included, 23 of them received…at least two cycles of treatment. Most patients showed at least one adverse event. The following adverse reactions were reported: infusional reactions (17), urinary tract infections (six), thrombopenia (five), and thyroid dysfunction (six). Conclusion: In clinical practice alemtuzumab showed an acceptable safety profile in selected patients even if all of them suffered at least one adverse effect. Thorough and prolonged follow-up is required to further confirm the safety of this drug.
Abstract: BACKGROUND: Nosocomial infection is a significant burden on healthcare facilities. Its multifactorial nature renders it challenging to control. However, quality healthcare necessitates a safer service that poses no harm to the patient. OBJECTIVE: The aim of this project was to reduce the infection rates in the adult ITU to the benchmark levels. METHOD: We conducted an internal audit as a result of the high infection rates in the adult ITU. The audit started with root cause analysis using the fishbone quality tool. FOCUS-PDCA quality tool was used to design the framework. We introduced a change in…the staff uniform laundry and organized a campaign to improve hand hygiene compliance using a multimodality approach. Moreover, we conducted training on aseptic techniques in ventilation, urinary catheter, and central lines insertion. Finally, we changed the ventilator filter to a higher quality brand which meets the standard specifications. Infection rates were monitored before and after the proposed changes. RESULTS: There was a marked reduction in ventilator-associated pneumonia; however, it did not reach the benchmark rates. Catheter line-associated bloodstream infection declined from above to below the benchmark. Catheter-associated urinary tract infection rates were below the benchmark; however, they showed a noticeable reduction. Hand hygiene adherence showed an improvement from 80% to 84%. However, this was below the predetermined target level of 90%. CONCLUSIONS: In-hospital laundry of staff uniforms is safer to control nosocomial infections. A multimodal approach is necessary to improve hand hygiene adherence and adoption of aseptic techniques. Quality improvement is a continuous process.