Journal of Patient Safety最新文献

{"title":"The Implementation of Perioperative Geriatric Management Could Decrease the Incidence of Postoperative Delirium in the Elderly Undergoing Major Orthopedic Surgeries.","authors":"Yan Zou, Tingzhi Deng, Yu Xu, Qing Zheng, Yuan Wu, Shan Hui, Cuizhong Liu, An Wei","doi":"10.1097/PTS.0000000000001307","DOIUrl":"10.1097/PTS.0000000000001307","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to explore the association of perioperative geriatric management (PGM) in major orthopedic surgeries.</p><p><strong>Methods: </strong>One hundred seventy-five participants aged 75 and older were in-hospital patients who underwent major orthopedic surgery from September 2020 to September 2021, and they received PGM and necessary treatment for indicators with abnormal value (the PGM group). Another 175 participants in the control group only received the evaluation part of the PGM, recruited by filtering in the electronic medical record system from March 2016 to March 2017. The treatment included joint intervention of psychiatrists and rehabilitation physicians. For example, for patients at risk for falling, evaluation of inadequate blood volume, delirium, abnormal gait, and visual impairment should be performed. The logistic regression analysis was adopted to determine the association of PGM and postoperative delirium.</p><p><strong>Results: </strong>The prevalence of postoperative delirium among participants was 13.71%. Compared with the empirical treatment group, the postoperative delirium was significantly decreased (7.43% versus 14.29%) ( P <0.05). Compared with the control group, participants were in the PGM group were at lower risk of postoperative delirium, mainly attributed to these following factors: Charlson comorbidity index <5 [odds ratio (OR)=0.620; 95% CI: 0.010-0.623], mini cog >2 (OR=0.224; 95% CI: 0.061-0.824), Confusion Assessment Method score indicating low risk (OR=0.079; 95% CI: 0.010-0.623), nutritional risk screening scale <3 (OR=0.306; 95% CI: 0.095-0.989), and major adverse cardiovascular events <3 (OR=0.253; 95% CI: 0.073-0.720). After adjusting for the length of hospital stay and reason for hospitalization, the association between the parameters above and postoperative delirium is still significant ( P <0.05).</p><p><strong>Conclusions: </strong>The implementation of the PGM could decrease the incidence of postoperative delirium significantly, which might contribute to improving the overall prognosis in elderly patients who underwent major orthopedic surgeries.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":"95-100"},"PeriodicalIF":1.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Misinformation Risks of Generative AI in Health Care: A Patient-centered Perspective.","authors":"Mohammed Asad, Nawarh Faran","doi":"10.1097/PTS.0000000000001329","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001329","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-endoscopy Anesthesiology Clinic Evaluation Does Not Reduce Adverse Event Rates for High-risk for Sedation Patients.","authors":"Tamar Thurm, Niv Zmora, Rafael Bruck, Nir Bar, Adam Philips, Oren Shibolet, Liat Deutsch","doi":"10.1097/PTS.0000000000001327","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001327","url":null,"abstract":"<p><strong>Objectives: </strong>Preoperative or preanesthesia evaluation is an established practice in patients undergoing surgery. The efficacy of a similar practice before endoscopic procedures has not yet been determined. At our medical center, patients with severe comorbidities, deemed at high risk for sedation, were assigned to an anesthesiologist-supervised endoscopic procedure (ASEP). Since late 2016 they are assessed at anesthesiology clinic pre-endoscopy. Our objective was to compare adverse events (AEs) between these 2 strategies.</p><p><strong>Methods: </strong>A retrospective review of all ambulatory upper and lower endoscopies between 2016 and 2017 was performed. Data on postprocedural (14 d) emergency department (ED) admissions, hospitalizations, operations, and mortality before and after policy change (BPC and APC) were compared.</p><p><strong>Results: </strong>During the study period 18,240 ambulatory upper and lower endoscopic procedures were performed in 14,906 patients, 7447 (49.96%) BPC, and 7459 (50.04%) APC; 580 were ASEP. The proportions of ASEP were comparable between the 2 time periods (BPC 295 versus APC 285; P=0.721); however, APC there was a 25-fold increase in pre-endoscopy anesthesiology clinic assessments [BPC-6 patients (2.03%) versus APC-146 patients (51.22%), P<0.001]. Postprocedural sedation-related AEs were comparable between the groups [0.07%-BPC (head injury, stroke, myocardial infarction, and aspiration) versus 0.03%-APC (aspiration and dyspnea), P=0.256]. None of these patients were sedated by an anesthesiologist.</p><p><strong>Conclusions: </strong>Policy change of pre-endoscopy evaluation for high-risk for sedation patients was not associated with a change in AE rates. Policy adherence was limited. The lack of AE rate reduction may indicate a marginal impact on an already low event rate with ASEP for high-risk patients.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Qualitative Study Exploring the Acceptability and Usability of the e-Prescribing Risk and Safety Evaluation (ePRaSE) Assessment Within English Hospitals.","authors":"Jude Heed, Andrew Heed, Stephanie Klein, Ann Slee, Neil Watson, Andrew K Husband, Sarah P Slight","doi":"10.1097/PTS.0000000000001322","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001322","url":null,"abstract":"<p><strong>Objectives: </strong>The e-prescribing risk and safety evaluation (ePRaSE) tool was developed to support the evaluation of hospital e-prescribing (EP) systems. The tool uses fictitious patients alongside previously validated prescribing scenarios to detect whether these systems provide appropriate prescribing advice to users. We sought to evaluate the usability and acceptability of ePRaSE across different EP systems in England.</p><p><strong>Materials and methods: </strong>NHS hospitals in England with live EP systems were invited to participate. A combination of observations and semi-structured interviews were used to explore participants' perspectives on the acceptability and usability of ePRaSE throughout all stages of the tool development. The data were transcribed verbatim, coded, and analyzed using the Framework Approach.</p><p><strong>Results: </strong>The study was conducted over 2 periods: April-December 2019 and September 2022-January 2023. Thirty-two health care professionals across 22 different NHS hospitals participated in semi-structured interviews (n=25) and 13 observations (n=20) involving 11 different EP systems in total. The ePRaSE assessment was completed in 2 to 3 hours and participants described the tool as easy to use with clinically relevant prescribing tasks. However, some participants experienced difficulties inputting clinical data, such as laboratory results, due to restricted access to different parts of the electronic health record. Many participants suggested areas for further improvement such as capturing a broader range of implemented clinical decision support and requested more detailed feedback on the performance of their systems.</p><p><strong>Conclusions: </strong>EP system users found ePRaSE to be a useful and acceptable tool. Further refinement is desirable, particularly in recording EP system responses and providing detailed results to optimize EP systems for safety benefits.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations and Challenges When Using Clinical and Vital Record Review for Suicide Research.","authors":"Sarah A Arias, Brandon A Gaudiano, Gary Epstein-Lubow, Sarah Zylberfuden, Lauren M Weinstock","doi":"10.1097/PTS.0000000000001325","DOIUrl":"10.1097/PTS.0000000000001325","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive Capacity Within the Homecare Setting: The Importance and Value of a Shared Perception of Risk.","authors":"Ingvild Idsøe-Jakobsen, Heidi Dombestein, Rebecca Lawton, Siri Wiig","doi":"10.1097/PTS.0000000000001323","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001323","url":null,"abstract":"<p><strong>Objectives: </strong>Patients receiving homecare are living their everyday lives in their own homes. Adapting care to individual needs, preferences, risks, and family situations is seen as essential. The overall aim of this study was to develop empirical knowledge of risk perception in homecare services. The research question that guided the study was: How is a shared perception of risk between health care professionals and leaders a part of providing high-quality care within a homecare setting?</p><p><strong>Methods: </strong>The research design was a multiple-embedded case study including 3 single cases. Participants were recruited from 3 Norwegian municipalities. Two focus group interviews were conducted in each municipality. In total, 19 informants participated, including 11 homecare department leaders and 8 health care professionals. The data were analyzed using thematic analysis according to Braun and Clarke's 6-phase thematic analysis.</p><p><strong>Findings: </strong>Two higher-order themes were developed from the data: \"Risk perception is a collective understanding\" and \"A flawed system requires adapting just to make it work.\" The study showed that, in the homecare departments, leaders' and health care professionals' opinion, flexibility and professional discussions are key to enhancing the system's adaptive capacity. High-quality care is always perceived as person-centered and adaptive. Overgeneralizations and the use of guidelines were perceived as demanding. The findings also showed that making sense of and managing risks within a homecare setting is complex.</p><p><strong>Conclusions: </strong>Bridging the gaps by conceptualizing and acting upon risks in the homecare setting constitutes a fundamental part of adaptive capacity at a system level. However, better alignment of system demands to local risks is needed for sustainable and safe services.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dental Anesthesia Guidelines and Regulations of US States and Major Professional Organizations: A Review.","authors":"Natalie B Simon, Kara M Barnett, BobbieJean Sweitzer, Nicole Gates, Steve Yun, Kristie Kim, Bridget Marcinkowski, Joseph M Hendrix","doi":"10.1097/PTS.0000000000001320","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001320","url":null,"abstract":"<p><p>This summary reviews guidelines and regulations pertaining to dental anesthesia across the United States, including guidelines of the American Dental Association (ADA), American Association of Oral and Maxillofacial Surgeons (AAOMS), and American Society of Anesthesiologists (ASA). The analysis addresses a range of requirements, including definitions of anesthesia and requirements for training and certification across professional societies and the 50 US states, with a focus on office-based settings. Strikingly, substantial variation exists among state rules and regulations and the ADA, AAOMS, and ASA guidelines with implications for variations of care, outcomes, and patient safety. We examined definitions of sedation and general anesthesia, patient selection and evaluation, fasting requirements, emergency preparedness, drug administration, monitoring, equipment, procedure selection, education and training requirements, permit requirements, life support certifications, reporting of adverse events, and inspection requirements. This comprehensive analysis serves to educate dental practitioners and office staff, patients, primary care providers, and state dental boards about the regulatory landscape of dental anesthesia. Our findings establish a foundation for future research and policy development aimed at improving consistency, best practices, and safety in dental anesthesia practices.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and Reliability Study of the Turkish Adaptation of the \"Medical Office Survey on Patient Safety Culture\".","authors":"Vildan Mevsim, Mustafa Erdem, Oğulcan Çöme, İncim Bezircioğlu","doi":"10.1097/PTS.0000000000001319","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001319","url":null,"abstract":"<p><strong>Introduction: </strong>The safety culture within health care organizations is essential for ensuring patient well-being and optimizing health care delivery. This study addresses the pressing need to establish a culture of patient safety within primary health care settings. The aim is to conduct a comprehensive validity and reliability study for the Turkish adaptation of the \"Medical Office Survey on Patient Safety Culture\" (MOSPSC) scale, designed to assess patient safety culture in primary care medical offices.</p><p><strong>Methods: </strong>The research model follows rigorous methodology, including a systematic translation and adaptation process aligned with World Health Organization guidelines. A diverse sample of 402 family physicians from primary health care centers across Turkey participated in the study. Descriptive results highlight participants' characteristics, work environments, and experiences in primary care. The scale's construct validity is evaluated using the Kaiser-Meyer-Olkin (KMO) and Bartlett tests, while its reliability is assessed through internal consistency analyses, including Cronbach α, split-half reliability, and item-total correlation.</p><p><strong>Results: </strong>Results indicate strong internal consistency, with Cronbach α values ranging from 0.42 to 0.91 for scale dimensions and an overall value of 0.89. Construct validity assessment attests to the scale's appropriateness for assessing patient safety culture. Challenges in conducting factor analysis due to participant responses are discussed.</p><p><strong>Conclusions: </strong>The study contributes to the field by providing a validated and reliable tool specifically tailored for assessing patient safety culture in primary care medical offices. The Turkish adaptation of the MOSPSC scale offers health care professionals and organizations a valuable instrument for enhancing patient safety culture, identifying areas for improvement, and ultimately optimizing patient care within primary health care settings.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Prevention and Treatment of Postoperative Delirium in the Elderly: A Narrative Systematic Review of Reviews.","authors":"Simon Deblois, Nicolas Bergeron, Thien Tuong Minh Vu, Gabriel Paquin-Lanthier, Bénédicte Nauche, Alfons Pomp","doi":"10.1097/PTS.0000000000001318","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001318","url":null,"abstract":"<p><strong>Objectives: </strong>Postoperative delirium (POD) is a common complication after major surgeries, posing significant challenges to patient recovery and outcomes, particularly among the elderly. A narrative systematic review was conducted to assess the clinical effectiveness and safety of interventions aimed at preventing and treating POD.</p><p><strong>Methods: </strong>A review of the literature from 2017 to September 29, 2023, was conducted using MEDLINE, EMBASE, and CINAHL. Systematic reviews, with or without meta-analyses, as well as practice guidelines, were included. Participants were adults, ≥60 years. The methodological quality of included reviews was appraised using AMSTAR 2.</p><p><strong>Results: </strong>After the search strategy identified 2295 references, 36 review studies were selected. Multicomponent interventions, incorporating both pharmacological and nonpharmacological approaches, demonstrate promise, particularly in hip fracture patients. Notably, dexmedetomidine emerges as a potential preventive measure, showing a notable reduction in delirium incidence following cardiac surgery. While several pharmacological interventions show potential, evidence remains inconclusive, necessitating further investigation. Similarly, varying anesthesia type and monitoring methods has mixed outcomes on delirium prevention. Despite methodological variations and quality appraisal limitations, this review underscores the importance of multicomponent interventions and the potential efficacy of dexmedetomidine in mitigating POD. Integration of evidence-based protocols into clinical practice is advocated to improve patient outcomes. However, the complex interplay between intervention components calls for further research to optimize delirium management strategies.</p><p><strong>Conclusions: </strong>The strength of evidence associated with multicomponent interventions and dexmedetomidine use should require a genuine commitment from health care institutions to support their integration into efficient strategies to prevent and treat POD. Ongoing research is vital to uncover their full potential and refine clinical protocols, ultimately enhancing patient care outcomes.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Falls in the Operating Room: The Danger of an Obese Patient on an Unlocked Operating Room Table.","authors":"Russell K McAllister, Craig J Lilie, Emily H Garmon","doi":"10.1097/PTS.0000000000001317","DOIUrl":"https://doi.org/10.1097/PTS.0000000000001317","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}