Journal of Patient Safety最新文献

{"title":"A Prospective Quasi-Experimental Study of Multifaceted Interventions Including Computerized Drug Utilization Evaluation to Improve an Antibiotic Stewardship Program.","authors":"Sunudtha Suksamai, Sirinporn Sajak, Kanokporn Thongphubeth, Thana Khawcharoenporn","doi":"10.1097/PTS.0000000000001211","DOIUrl":"10.1097/PTS.0000000000001211","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine and evaluate interventions that improve an antibiotic stewardship program (ASP) in reduction of the amount of antibiotic use and errors in drug utilization evaluation (DUE) form completion.</p><p><strong>Methods: </strong>A prospective quasi-experimental study was conducted to evaluate the effectiveness of the multifaceted interventions (preauthorization with computerized DUE, self-supervised checklists, and short active reminders of the antibiotic guidelines recommendations) incorporating an ASP among hospitalized internal medicine patients in a Thai tertiary care center. The preintervention period was from January to December 2018, and the postintervention period was from February 2019 to January 2020.</p><p><strong>Results: </strong>A total of 9188 and 9787 patient data were analyzed during the preintervention and postintervention periods, respectively. The overall median antibiotic use (defined daily dose/1000 bed-days) was significantly decreased in the postintervention period compared with the preintervention period (867.68 versus 732.33; P < 0.001). The reduction in antibiotic use was predominantly observed among broad-spectrum antibiotics, including cefoperazone/sulbactam (15.35 versus 9.75; P = 0.04), cefepime (13.09 versus 6.37; P = 0.003), ciprofloxacin (32.99 versus 17.83; P < 0.001), piperacillin/tazobactam (99.23 versus 91.93; P = 0.03), meropenem (2.01 versus 0.99; P < 0.001), imipenem/cilastatin (9.53 versus 4.59; P = 0.04), and colistin (74.70 versus 22.34; P < 0.0001). The overall rate of errors in DUE form completion was significantly decreased after the intervention (40% versus 28%; P < 0.001). The incidence of carbapenem-resistant Enterobacteriaceae infections/colonization was significantly lower in the postintervention period (0.27 versus 0.12/1000 bed-days; P = 0.02).</p><p><strong>Conclusions: </strong>The study multifaceted interventions incorporating ASP were associated with significant reduction in the amount of broad-spectrum antibiotic use, DUE form completion errors, and incidence of carbapenem-resistant Enterobacteriaceae infection/colonization.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900776","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":"Impact of Collaborative Nursing Care Delivery on Patient Safety Events in an Emergency Intensive Care Unit: A Retrospective Observational Study.","authors":"Masato Obayashi, Keiichiro Shimoyama, Koji Ono","doi":"10.1097/PTS.0000000000001215","DOIUrl":"10.1097/PTS.0000000000001215","url":null,"abstract":"<p><strong>Objectives: </strong>Patient safety events (PSEs) have detrimental consequences for patients and healthcare staff, highlighting the importance of prevention. Although evidence shows that nurse staffing affects PSEs, the role of an appropriate nursing care delivery system remains unclear. The current study aimed to investigate whether nursing care delivery systems could prevent PSEs.</p><p><strong>Methods: </strong>This retrospective study was conducted in Japan. The study examined the collaborative 4:2 nursing care delivery system in which 2 nurses are assigned to care for 4 patients, collaborating to perform tasks, and provide care. The cohort receiving care from a collaborative 4:2 nursing care delivery system was labeled the postintervention, whereas the cohort receiving care from a conventional individualized system, in which one nurse provides care for 2 patients, was labeled the preintervention. The primary outcome was the occurrence of PSEs.</p><p><strong>Results: </strong>The preintervention and postintervention comprised 561 and 401 patients, respectively, with the latter consisting of a younger and more critically ill population. The number of PSEs per 1000 patient-days was not significantly different between the 2 groups (10.3 [95% confidence interval, 7.1-13.5] versus 6.0 [95% confidence interval, 3.2-8.9], P = 0.058). Multiple logistic regression analysis showed that the collaborative 4:2 nursing care delivery system was significantly associated with PSEs (adjusted odds ratio, 0.53; 95% confidence interval, 0.29-0.95; P = 0.037).</p><p><strong>Conclusions: </strong>These findings suggest that in an emergency intensive care unit, a collaborative nursing care delivery system was associated with a decrease in PSEs.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040659","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":"Evolution of Intravenous Medication Errors and Preventive Systemic Defenses in Hospital Settings-A Narrative Review of Recent Evidence.","authors":"Sini Kuitunen, Marja Airaksinen, Anna-Riia Holmström","doi":"10.1097/PTS.0000000000001222","DOIUrl":"10.1097/PTS.0000000000001222","url":null,"abstract":"<p><strong>Objectives: </strong>Intravenous drug administration has been associated with severe medication errors in hospitals. The present narrative review is based on a systematic literature search, and aimed to describe the recent evolution in research on systemic causes and defenses in intravenous medication errors in hospitals.</p><p><strong>Methods: </strong>This narrative review was based on Reason's theory of systems-based risk management. A systematic literature search covering the period from June 2016 to October 2021 was conducted on Medline (Ovid). We used the search strategy and selection criteria developed for our previous systematic reviews. The included articles were analyzed and compared to our previous reviews.</p><p><strong>Results: </strong>The updated search found 435 articles. Of the 63 included articles, 16 focused on systemic causes of intravenous medication errors, and 47 on systemic defenses. A high proportion (n = 24, 38%) of the studies were conducted in the United States or Canada. Most of the studies focused on drug administration (n = 21/63, 33%) and preparation (n = 19/63, 30%). Compared to our previous review of error causes, more studies (n = 5/16, 31%) utilized research designs with a prospective risk management approach. Within articles related to systemic defenses, smart infusion pumps remained most widely studied (n = 10/47, 21%), while those related to preparation technologies (n = 7/47, 15%) had increased.</p><p><strong>Conclusions: </strong>This narrative review demonstrates a growing interest in systems-based risk management for intravenous drug therapy and in introducing new technology, particularly smart infusion pumps and preparation systems, as systemic defenses. When introducing new technologies, prospective assessment and continuous monitoring of emerging safety risks should be conducted.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295059","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":"Development of a Psychological Scale for Measuring Disruptive Clinician Behavior: Erratum.","authors":"","doi":"10.1097/PTS.0000000000001250","DOIUrl":"10.1097/PTS.0000000000001250","url":null,"abstract":"","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922493","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":"Implementation of Guidelines Limiting Postoperative Opioid Prescribing at a Children's Hospital.","authors":"Krista J Stephenson, Derek J Krinock, Isabel L Vasquez, Connor N Shewmake, Beverly J Spray, Bavana Ketha, Lindsey L Wolf, Melvin S Dassinger","doi":"10.1097/PTS.0000000000001209","DOIUrl":"10.1097/PTS.0000000000001209","url":null,"abstract":"<p><strong>Objectives: </strong>Variability in opioid-prescribing practices after common pediatric surgical procedures at our institution prompted the development of opioid-prescribing guidelines that provided suggested dose limitations for narcotics. The aims of this study were to improve opioid prescription practices through implementation of the developed guidelines and to assess compliance and identify barriers preventing guideline utilization.</p><p><strong>Methods: </strong>We conducted a single-center cohort study of all children who underwent the most common outpatient general surgery procedures at our institution from August 1, 2018, to February 1, 2020. We created guidelines designed to limit opioid prescription doses based on data obtained from standardized postoperative telephone interviews. Three 6-month periods were evaluated: before guideline implementation, after guideline initiation, and after addressing barriers to guideline compliance. Targeted interventions to increase compliance included modification of electronic medical record defaults and provider educations. Differences in opioid weight-based doses prescribed, filled, and taken, as well as protocol adherence between the 3 timeframes were evaluated.</p><p><strong>Results: </strong>A total of 1033 children underwent an outpatient procedure during the 1.5-year time frame. Phone call response rate was 72.22%. There was a significant sustained decrease in opioid doses prescribed ( P < 0.0001), prescriptions filled ( P = 0.009), and opioid doses taken ( P = 0.001) after implementation, without subsequent increase in reported pain on postoperative phone call ( P = 0.96). Protocol compliance significantly improved (62.39% versus 83.98%, P < 0.0001) after obstacles were addressed.</p><p><strong>Conclusions: </strong>Implementation of a protocol limiting opioid prescribing after frequently performed pediatric general surgery procedures reduced opioids prescribed and taken postoperatively. Interventions that addressed barriers to application led to increased protocol compliance and sustained decreases in opioids prescribed and taken without a deleterious effect on pain control.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139492611","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":"Comparison of WHO-UMC and Naranjo Scales for Causality Assessment of Reported Adverse Drug Reactions.","authors":"Sukant Pandit, Dhruve Soni, Bhaskar Krishnamurthy, Mahesh N Belhekar","doi":"10.1097/PTS.0000000000001213","DOIUrl":"10.1097/PTS.0000000000001213","url":null,"abstract":"<p><strong>Objectives: </strong>The 2 most commonly used scales worldwide are the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) and the Naranjo scales. The present study was planned to assess the degree of agreement between the 2 scales when the same adverse drug reactions (ADR) were assessed by 5 raters independently.</p><p><strong>Methods: </strong>One hundred individual case safety reports were selected randomly from the ADR database of our institute and the details were emailed to 5 different experts (raters), who were DM Clinical Pharmacology residents from different institutes in India. An independent causality assessment of these ADRs was performed independently by these raters using both the WHO-UMC and Naranjo causality assessment scales. The agreement between the 2 scales was assessed for each rater using Cohen κ, and the overall interrater agreement was assessed using Fleiss κ.</p><p><strong>Results: </strong>The Cohen κ level of agreement between the 2 scales for the 5 raters were substantial, fair, substantial, moderate, and substantial, respectively. The most common causality assessment category as per WHO-UMC scale was \"possible\" but varied among the raters on the Naranjo scale. No ADR was categorized as \"certain\" by any rater on the Naranjo scale. The Fleiss κ value for agreement among the 5 raters was found to be 0.2 (slight) for the WHO-UMC scale and 0.297 (fair) for the Naranjo scale.</p><p><strong>Conclusions: </strong>A moderate level of agreement was observed in this study between the WHO-UMC and Naranjo scales. The level of agreement among these 5 raters was found to be similar for the WHO-UMC and the Naranjo scales, indicating a similar degree of subjectivity for the 2 scales. Hence, more robust and less subjective scales are required for causality assessment.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724646","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 Safety Indicators During the Initial COVID-19 Pandemic Surge in the United States.","authors":"Jorge A Rodriguez, Lipika Samal, Sandya Ganesan, Nina H Yuan, Matthew Wien, Kenney Ng, Hu Huang, Yoonyoung Park, Amol Rajmane, Gretchen Purcell Jackson, Stuart R Lipsitz, David W Bates, David M Levine","doi":"10.1097/PTS.0000000000001216","DOIUrl":"10.1097/PTS.0000000000001216","url":null,"abstract":"<p><strong>Objective: </strong>The COVID-19 pandemic presented a challenge to inpatient safety. It is unknown whether there were spillover effects due to COVID-19 into non-COVID-19 care and safety. We sought to evaluate the changes in inpatient Agency for Healthcare Research and Quality patient safety indicators (PSIs) in the United States before and during the first surge of the pandemic among patients admitted without COVID-19.</p><p><strong>Methods: </strong>We analyzed trends in PSIs from January 2019 to June 2020 in patients without COVID-19 using data from IBM MarketScan Commercial Database. We included members of employer-sponsored or Medicare supplemental health plans with inpatient, non-COVID-19 admissions. The primary outcomes were risk-adjusted composite and individual PSIs.</p><p><strong>Results: </strong>We analyzed 1,869,430 patients admitted without COVID-19. Among patients without COVID-19, the composite PSI score was not significantly different when comparing the first surge (Q2 2020) to the prepandemic period (e.g., Q2 2020 score of 2.46 [95% confidence interval {CI}, 2.34-2.58] versus Q1 2020 score of 2.37 [95% CI, 2.27-2.46]; P = 0.22). Individual PSIs for these patients during Q2 2020 were also not significantly different, except in-hospital fall with hip fracture (e.g., Q2 2020 was 3.42 [95% CI, 3.34-3.49] versus Q4 2019 was 2.45 [95% CI, 2.40-2.50]; P = 0.01).</p><p><strong>Conclusions: </strong>The first surge of COVID-19 was not associated with worse inpatient safety for patients without COVID-19, highlighting the ability of the healthcare system to respond to the initial surge of the pandemic.</p>","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140111864","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":"Perceptions of U.S. and U.K. Incident Reporting Systems: A Scoping Review.","authors":"Pamela J Gampetro, Anne Nickum, Celeste M Schultz","doi":"10.1097/pts.0000000000001231","DOIUrl":"https://doi.org/10.1097/pts.0000000000001231","url":null,"abstract":"The aim of the study is to evaluate the extent, range, and nature of the literature that concerns healthcare providers' perceptions following the use of incident reporting systems (IRSs) in the United States (U.S.) and the United Kingdom (U.K.). Literature was compared describing providers' perceptions of reporting patient safety incidents using IRSs from healthcare systems built on public, private, for-profit, or nonprofit insurers in the U.S., with providers' perceptions using an IRS within a universal government supported healthcare system in the U.K.","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140828252","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":"Major Clinical Adverse Events of Breast Implant in the Manufacturer and User Facility Device Experience Database.","authors":"Bing Su, Lichuan Chen, Bohan Zhang, Hong Wang, Jie Zhou, Benjun Du","doi":"10.1097/pts.0000000000001219","DOIUrl":"https://doi.org/10.1097/pts.0000000000001219","url":null,"abstract":"Search the Manufacturer and User Facility Device Experience database to collect information on adverse events of breast implant. We analyzed the local complications and the breast implant illness (BII) of silicone breast implants, as well as saline breast implants separately, aim to provide a reference for women who want to breast augmentation.","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140630069","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":"Enhanced Free-Text Search for Aggregated Medication Error Report Analysis and Risk Detection.","authors":"Ville Valkonen, Susanna Saano, Kaisa Haatainen, Miia Tiihonen","doi":"10.1097/pts.0000000000001218","DOIUrl":"https://doi.org/10.1097/pts.0000000000001218","url":null,"abstract":"Detecting medication errors (MEs) and learning from them are the key elements of medication safety management in health care. While the aggregation of the data and learning across the ME reports could help detect and manage organizational risks, the inconsistent and partly missing structural data complicate the analysis. The objective of this study was to examine whether an analysis of free-text data of aggregated ME reports could contribute to the detection of organizational risks.","PeriodicalId":48901,"journal":{"name":"Journal of Patient Safety","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140575694","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}