The Journal of Patient Safety最新文献

{"title":"Does Physician's Training Induce Overconfidence That Hampers Disclosing Errors?","authors":"M. Brezis, Yael Orkin-Bedolach, Daniel Fink, A. Kiderman","doi":"10.1097/PTS.0000000000000255","DOIUrl":"https://doi.org/10.1097/PTS.0000000000000255","url":null,"abstract":"PURPOSE\u0000Although transparency is critical for reducing medical errors, physicians feel discomfort with disclosure. We explored whether overconfidence relates to physician's reluctance to admit that an error may have occurred.\u0000\u0000\u0000METHOD\u0000At 3 university medical centers, a survey presented a clinical vignette of a girl with urinary infection and penicillin allergy to medical students and physicians, asking them to rate their level of confidence for each step of the diagnosis and management. After anaphylaxis develops after cephalosporin administration, respondents were asked about their willingness to admit that an error might have occurred and to rate their level of discomfort in doing so. We analyzed levels of confidence, accuracy, willingness to admit mistake, and discomfort.\u0000\u0000\u0000RESULTS\u0000Respondents reported high levels of confidence for their answers to the questions of diagnosis and management, even when wrong-indicating miscalibration of confidence and accuracy. Compared with students, physicians had significantly higher levels of confidence, lower accuracy, and lower willingness to admit mistake. Although most respondents agreed in principle that errors should be disclosed, in the presented case, significantly less agreed to admit that a mistake might have occurred or to say so explicitly to the family. An association was found between overconfidence and discomfort with disclosure.\u0000\u0000\u0000CONCLUSIONS\u0000Our study shows overconfidence associated with clinician's training and with reluctance to admit mistake, suggesting a contributing role to the difficulty in leveraging safety events into quality improvement. Training physicians to have both knowledge and adequate self-doubt is an educational challenge.","PeriodicalId":206245,"journal":{"name":"The Journal of Patient Safety","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130956040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tune-in and Time-out: Toward Surgeon-Led Prevention of \"Never\" Events.","authors":"Niall M Jones","doi":"10.1097/PTS.0000000000000259","DOIUrl":"https://doi.org/10.1097/PTS.0000000000000259","url":null,"abstract":"INTRODUCTION\u0000The World Health Organization (WHO) distributed a surgical safety checklist in 2008 in a bid to improve patient safety and quality of care in the operating theater. Adherence to the checklist has been shown to reduce \"never\" events, for example, wrong site surgery. The aim of this quality improvement study was to determine the current adherence by surgeons to the checklist at The Royal Hobart Hospital.\u0000\u0000\u0000METHODS\u0000This is a retrospective audit of the digital medical records of 100 consecutive emergency operations performed at The Royal Hobart Hospital. The time-out section of the WHO Surgical Safety Checklist was assessed for completeness. Second, an anonymized survey of theater nursing staff was performed to determine current adherence by surgeons with the time-out.\u0000\u0000\u0000RESULTS\u0000The time-out was completed in 79% of emergency procedures. There were no never events in the patient cohort studied. There was overwhelming support among theater nurses for a surgeon-led time-out. Formal education on the use of the WHO Safe Surgery Checklist is lacking. Most theater nurses have experienced hostility from surgeons when conducting a time-out.\u0000\u0000\u0000DISCUSSION\u0000This work is a step on the way to surgeon-led prevention of never events. Finding a completed time-out in the patient notes does not guarantee surgeon support for or contribution to the time-out process. The findings will inform combined nursing and surgeon education sessions, and together with executive-level support, improved surgeon cooperation with the time-out will inculcate a culture of safety for patients and improve harmony among staff groups.","PeriodicalId":206245,"journal":{"name":"The Journal of Patient Safety","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133381473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Information Transfer at Hospital Discharge: A Systematic Review.","authors":"Sharma Kattel, D. Manning, P. Erwin, Harrison Wood, D. Kashiwagi, M. Murad","doi":"10.1097/PTS.0000000000000248","DOIUrl":"https://doi.org/10.1097/PTS.0000000000000248","url":null,"abstract":"BACKGROUND\u0000Prompt, complete, and accurate information transfer at the time of discharge between hospital-based and primary care providers (PCPs) is needed for the provision of safe and effective care.\u0000\u0000\u0000PURPOSE OF THE STUDY\u0000To evaluate timeliness, quality, and interventions to improve timeliness and quality of hospital discharge summaries.\u0000\u0000\u0000DATA SOURCES\u0000PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus database published in English between January 2007 and February 2014 were searched. We also hand-searched bibliographies of relevant articles.\u0000\u0000\u0000STUDY SELECTION\u0000Observational studies investigating transfer of information at hospital discharge (n = 7) and controlled studies evaluating interventions to improve timeliness and quality of discharge information (n = 12) were included.\u0000\u0000\u0000DATA EXTRACTION\u0000We extracted data on availability, timeliness, and content of hospital discharge summaries and on the effectiveness of interventions targeting discharge summaries. Results of studies are presented narratively and using descriptive statistics.\u0000\u0000\u0000DATA SYNTHESIS\u0000Across the studies, discharge summaries were completed within 48 hours in a median of 67% and were available to PCPs within 48 hours only 55% of the time. Most of the time, discharge summaries included demographics, primary diagnosis, hospital course, and discharge instructions. However, information was limited to pending test results (25%), diagnostic tests performed (60%), and postdischarge medications (78%). In 6 interventional studies, implementation of electronic discharge summaries was associated with improvement in timeliness but not quality.\u0000\u0000\u0000CONCLUSIONS\u0000Delayed or insufficient transfer of discharge information between hospital-based providers and PCPs remains common. Creation of electronic discharge summaries seems to improve timeliness and availability but does not consistently improve quality.","PeriodicalId":206245,"journal":{"name":"The Journal of Patient Safety","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122642530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring Patients' Knowledge About Adverse Effects of Angiotensin-Converting Enzyme Inhibitors.","authors":"S. Janković, Milica Dajić, Saša Jacović, S. Markovic, T. Papić, Tamara Petrušić, M. Radojković, A. Ranković, Marko Tanaskovic, Marko Vasic, Dušan Vukićević, R. Ž. Zaric, M. Kostić","doi":"10.1097/PTS.0000000000000244","DOIUrl":"https://doi.org/10.1097/PTS.0000000000000244","url":null,"abstract":"BACKGROUND\u0000Knowledge about adverse effects of medications is an important part of proper medication use and prerequisite for good treatment adherence.\u0000\u0000\u0000OBJECTIVE\u0000The aim of our study was to construct, develop, and test a new questionnaire for the measurement of patients' knowledge about adverse drug reactions of angiotensin-converting enzyme (ACE) inhibitors.\u0000\u0000\u0000METHODS\u0000The 8-item questionnaire was constructed to measure adverse reactions to ACE inhibitors. The questions were closed, with 7 offered answers, in the form of a Likert scale. It was tested for psychometric properties on patients who visited their general practitioners at state-owned health facilities in 5 Serbian cities: Belgrade, Kragujevac, Banja Luka, Gracanica, and Despotovac.\u0000\u0000\u0000RESULTS\u0000The questionnaire was tested on 259 patients from general practice, taking an ACE inhibitor for more than 3 months. Experience with at least 1 adverse effect of ACE inhibitor was reported in 64 patients (24.7%), only 94 patients (36.3%) previously received any form of information about at least 1 adverse effect of ACE inhibitors from health workers, and only 42% expressed knowledge of any adverse events. The patients who were informed knew about the following adverse events as phrased in the official patient information leaflets: severe dizziness or light-headedness (44%); cough (37%); swelling of the hands, face, lips, or tongue (32%); indigestion (22%); headache (51%); and difficulty in breathing (15%). The questionnaire showed satisfactory internal consistency, with Cronbach α of 0.767, and individual scores correlated with general education of the patients. Factorial analysis revealed 2 domains (subscales): the first one with 5 questions is directed to adverse effects the patients may physically experience directly, whereas the second with 3 questions measures knowledge about adverse effects that could be experienced only indirectly, through conditions caused by the adverse effects.\u0000\u0000\u0000CONCLUSIONS\u0000The questionnaire about knowledge of ACE inhibitors' adverse effects is a reliable and probably valid instrument for measuring patients' knowledge about adverse effects of ACE inhibitors.","PeriodicalId":206245,"journal":{"name":"The Journal of Patient Safety","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116546694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of Emergency Department Triage Nurses About Prehospital Emergency Rescuers in Italy: A Latent Threat to Clinical Handover.","authors":"Francesco Dojmi Di Delupis, Niccolò Mancini, M. Ruggeri, P. Pisanelli","doi":"10.1097/PTS.0000000000000249","DOIUrl":"https://doi.org/10.1097/PTS.0000000000000249","url":null,"abstract":"OBJECTIVES\u0000In Italy, volunteer rescuers respond to most prehospital emergency calls. These rescuers provide the majority of patient information during handover at the emergency department triage. Standardized terminology between rescuers and triage nurses is lacking in Italy, and miscommunication may cause a poor handover. Even though rescuers are professional health providers, their qualification is not legally recognized, and triage nurses have a pervasive sense of inadequacy about the rescuers' competences.This work explored triage nurses' perceptions of rescuers and the causes of these perceptions to verify whether difficult interprofessional relationships negatively influence the clinical handover process.\u0000\u0000\u0000METHODS\u0000We performed a survey among 402 triage nurses for 3 main areas of rescuers' competency: communication, knowledge, and decision making. For each area, we identified communications, decision making, and knowledge indicators. A scale score of 6 or higher was considered not sufficient.\u0000\u0000\u0000RESULTS\u0000We found that 75.5% (n = 302/400) of triage nurses regard rescuers' ability to recognize life-threatening situations as not sufficient (communication ability indicator). Approximately 66% (n = 264/401) of triage nurses regard rescuers' ability to administer oxygen as not sufficient (decision-making indicator), and approximately 58% (n = 232/402) of nurses regard rescuers' ability to report the reason for the emergency call as not sufficient (knowledge indicator).\u0000\u0000\u0000CONCLUSIONS\u0000The results of this survey show that the overall perception of triage nurses about prehospital rescuers is slightly below sufficiency. This perception could cause errors during the prehospital or hospital handover at the triage and could lead to delayed decisions and incorrect treatment.","PeriodicalId":206245,"journal":{"name":"The Journal of Patient Safety","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130658198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Assessment on Patient Safety Curricula in Undergraduate Medical Education: Results From the 2012 Clerkship Directors in Internal Medicine Survey.","authors":"C. Jain, Meenakshy K. Aiyer, E. Murphy, Eric A Alper, S. Durning, J. Aldag, D. Torre","doi":"10.1097/PTS.0000000000000229","DOIUrl":"https://doi.org/10.1097/PTS.0000000000000229","url":null,"abstract":"OBJECTIVES\u0000Patient safety is a cornerstone of quality patient care, and educating medical students about patient safety is of growing importance. This investigation was a follow-up to a 2006 study to assess the current status of patient safety curricula within undergraduate medical education in North America with the additional goals of identifying areas for improvement and barriers to implementation.\u0000\u0000\u0000METHODS\u0000Thirteen items regarding patient safety were part of the 2012 Clerkship Directors in Internal Medicine annual survey. Questions addressed curriculum content, delivery, and barriers to implementation.\u0000\u0000\u0000RESULTS\u0000Ninety-nine clerkship directors (82%) responded. Forty-one (45.6%) reported that their medical school had a patient safety curriculum taught during medical school as compared with 25% in a 2006 survey. Fifteen (20%) reported satisfaction with students' level of safety competency at the end of the clerkship. Barriers to implementation included lack of faculty time (n = 57, 78.1%), lack of trained faculty (n = 47, 65.3%), and lack of a mandate from school's dean's office (n = 27, 38.0%).\u0000\u0000\u0000CONCLUSIONS\u0000Our study found that less than half of North American medical schools have a formal patient safety curriculum; although this is higher than in 2006, it still exemplifies a major gap in undergraduate medical education.","PeriodicalId":206245,"journal":{"name":"The Journal of Patient Safety","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131020668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Missing Record of Mental Status in Written Sign-outs.","authors":"Michael Croix, Donna M. Miller, J. Whittle, Siddhartha Singh, M. Schapira, J. Carnahan, Jessica Kuester, C. Kallio, S. Framberg, K. Fletcher","doi":"10.1097/PTS.0000000000000280","DOIUrl":"https://doi.org/10.1097/PTS.0000000000000280","url":null,"abstract":"OBJECTIVE\u0000The aim of the study was to determine how frequently mental status and mental status changes are documented in the written patient summary (\"sign-out\") provided to covering physicians.\u0000\u0000\u0000PATIENTS AND METHODS\u0000This was a retrospective cohort study of general medical patients hospitalized between March 16, 2009, and March 15, 2010, conducted at 2 teaching hospitals. Participants included patients with mental status change adverse events (MSAEs) and their providers. Chart review was performed to identify patients with MSAEs and details about these events. Sign-outs were reviewed for documentation of mental status. Main outcome measures were (1) proportion of patients with MSAEs who had mental status ever recorded in sign-out entries and (2) the proportion of patients with MSAEs whose change in mental status was recorded in the sign-out.\u0000\u0000\u0000RESULTS\u0000Sixty-eight patients had MSAEs and were included in the sample. Fifty percent of MSAEs were attributed to medications; 75% of these events were first detected by nurses. Only 25% of patients with MSAEs had their change in mental status recorded in sign-outs.\u0000\u0000\u0000CONCLUSIONS\u0000Recording mental status in written sign-outs is uncommon. Particularly concerning is that patients with MSAEs identified by chart review seldom had sign-outs that reflected those events. Interventions should be designed to increase the recording of this information in sign-outs.","PeriodicalId":206245,"journal":{"name":"The Journal of Patient Safety","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121495549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}