BMJ Open Quality最新文献

{"title":"Decreasing prevalence of anaemia in pregnant women at delivery: a quality improvement initiative.","authors":"Tanisha Gupta, K Aparna Sharma, Aditya Sarkar, Srinidhi Y Reddy, Swati Sharma, Anushka Rathi, Nambrath Sunita, Joby Titto, Vidushi Kulshrestha, Neena Malhotra","doi":"10.1136/bmjoq-2024-003300","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003300","url":null,"abstract":"<p><p>Anaemia in pregnancy is a critical public health challenge associated with adverse maternal and neonatal outcomes. Despite national programmes and guidelines, India continues to face high anaemia prevalence during pregnancy, with 42.2% in Delhi (National Family Health Survey-5). Addressing gaps in systematic screening, timely diagnosis and effective management is essential to reduce anaemia at delivery and improve maternal health outcomes. At AIIMS, New Delhi, baseline data revealed a 35.57% prevalence of anaemia among booked pregnant women at delivery. Key issues included limited screening, inconsistent management and poor patient adherence to anaemia treatment protocols. This prospective quality improvement (QI) initiative employed the Plan-Do-Study-Act (PDSA) cycle methodology to address anaemia in pregnancy. Interventions focused on systematic screening of women at 30-34 weeks gestation using point-of-care haemoglobin testing (HemoCue), the establishment of a dedicated anaemia management room and the development of standardised operating procedures for diagnosis and management. Weekly team meetings facilitated the identification of challenges and iterative improvements. Sustainability measures, such as structured intern orientation, real-time monitoring through WhatsApp and enhanced team communication, addressed barriers like frequent staff rotations and workflow integration. Over four PDSA cycles, screening coverage reached 95%-100%, with a median anaemia prevalence of 20.04% at delivery, reduced from 35.57% at baseline. Sustained improvements were achieved, with a 3-month median prevalence of 15%. Challenges included integrating workflows and ensuring continuity with rotating staff, mitigated through structured protocols and team reorientation. This QI initiative demonstrates a successful model for reducing anaemia at delivery through systematic screening, effective management and multidisciplinary collaboration. The findings provide a replicable framework for addressing anaemia in resource-limited settings, aligning with national initiatives like the 'T4 Anemia Room' concept.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085608","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":"Monitoring the safe delivery of new invasive interventional procedures and devices: an analysis of NHS organisation policies.","authors":"Lucy Wallis, Sian Cousins, Phei Yi Lim, Hollie S Richards, Leila Rooshenas, Jane M Blazeby","doi":"10.1136/bmjoq-2024-003301","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003301","url":null,"abstract":"<p><strong>Background: </strong>The introduction and monitoring of innovative invasive procedures and devices (IP/Ds) was included in the Independent Medicines and Medical Devices Safety (IMMDS) Review led by Baroness Cumberlege. Currently, innovative IP/Ds may be undertaken with local National Health Service (NHS) organisation approval via new procedure committees (NPCs) or approval from the Health Research Authority (HRA). The National Institute for Health and Care Excellence Interventional Procedures Advisory Committee (NICE IPAC) provides guidance for appropriate approvals. Outcome monitoring is performed to inform decisions about continuing with the new IP/D or abandoning/pausing if safety data show signals of harm; this is the responsibility of local hospitals. Hospital policies for this process have hitherto not been investigated.</p><p><strong>Aim: </strong>To explore local hospital NPC processes for monitoring clinical and safety outcomes and decision-making regarding the delivery of new IP/Ds.</p><p><strong>Methods: </strong>NHS organisation policies for the introduction of new IP/Ds from England and Wales were systematically examined using a standardised extraction form developed a priori. All policies and associated documents were analysed using the principles of content analysis, and information extracted included (1) the collection of safety and outcome data for approved IP/Ds; (2) requirements to adhere to NICE guidance and (3) how committees decide to abandon/pause the use of new IP/Ds.</p><p><strong>Results: </strong>All policies (n=113) included information about monitoring outcomes of new IP/Ds. Substantial variation between hospitals in monitoring requirements was observed. Just 66 provided details of safety reporting oversight methods. Only 72 policies explicitly recommended following NICE IPAC guidance for the IP. Information about how decisions were made to abandon/pause new IP/Ds was included in 25 policies.</p><p><strong>Conclusion: </strong>There is a disparity among hospitals in how outcome and safety data of new IP/Ds are monitored. This has implications for patient safety. Our findings support the IMMDS report recommendations for the need for better oversight and governance of innovative IP/Ds, including collecting and sharing robust outcome data to inform decision-making.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085525","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":"Optimisation of aetiological examination processes for enhanced quality and efficiency in hospitalised patients prior to antimicrobial therapy: a multicentre quasi-experimental study.","authors":"Xiao Zhong, Li-Hua Xiao, Yan Liu, Lan-Fang Mo, Shan-Wen Yang, Lan-Fang He, Qin-Fei Wu, Xiao-Feng Luo, Mei Lin","doi":"10.1136/bmjoq-2024-003257","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003257","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to optimise the aetiological examination process in hospitalised patients to enhance pathogen detection quality and efficiency. The hypothesis was that process management strategies would improve specimen submission rates, quality, timeliness and antimicrobial use adjustment.</p><p><strong>Design: </strong>A multicentre quasi-experimental pre-post comparison design was used, with baseline and postoptimisation phases.</p><p><strong>Setting: </strong>Two hospitals in Guangming District, Shenzhen, China.</p><p><strong>Participants: </strong>34 790 inpatients in the baseline and 34 361 in the postoptimisation phase, across all departments.</p><p><strong>Interventions: </strong>Implemented process clarification, standardisation of specimen collection/submission and multidisciplinary collaboration, with comprehensive staff training.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome measures were the pathogen submission rate before antimicrobial therapy. The secondary outcome measure was the adjustment rate of antimicrobial use based on test results, specimen qualification rate and specimen submission time. These measures were evaluated before and after process optimisation.</p><p><strong>Results: </strong>Postoptimisation, key metrics improved significantly: pathogen submission rate (50.82%-71.77%), specimen qualification rate (90.20%-98.71%), submission time (192-104 min) and antimicrobial adjustment rate (74.11%-93.24%; all p<0.001).</p><p><strong>Conclusions: </strong>Process management effectively enhanced aetiological examination quality and efficiency, with potential for widespread adoption.</p><p><strong>Trial registration number: </strong>Not applicable as this was a quasi-experimental study.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085527","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":"Experiences of the development and use of a Paediatric Oncology Trigger Tool.","authors":"Charlotte Engvall, Maria Unbeck, Margaretha Stenmarker, Axel Ros, Ann-Christine Andersson","doi":"10.1136/bmjoq-2025-003306","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003306","url":null,"abstract":"<p><strong>Background: </strong>Trigger tools are widely used for detecting adverse events. Within the multicentre study Patient Safety in Paediatric Oncology, a trigger tool was created to address the unique needs of paediatric oncology. Although trigger tools are highly valued for detecting adverse events, concerns about their usability and reliability persist. Understanding the perspectives of medical record reviewers using these tools may provide valuable insights for improving their usability and reliability. This study aimed to explore the experiences of medical record reviewers involved in the development and use of a Paediatric Oncology Trigger Tool.</p><p><strong>Methods: </strong>A descriptive qualitative case study was conducted to investigate the experiences of medical record reviewers participating in the development and use of the Paediatric Oncology Trigger Tool. Data were collected through a semi-structured focus group interview conducted via Zoom, involving six reviewers with varying levels of experience in paediatric oncology and trigger tool methodology. The interview was audio-recorded and transcribed verbatim. The written text was analysed in its entirety using reflexive thematic analysis.</p><p><strong>Results: </strong>The analysis revealed an overarching theme of <i>knowledge building</i> with three themes: <i>competencies</i>, <i>resources</i> and <i>usefulness</i>. The findings highlight the importance of collaborative learning, expert support and adequate resources, while also noting challenges such as time consumption and the emotional impact of reviewing medical records of critically ill children.</p><p><strong>Conclusions: </strong>This study offers a comprehensive examination and clarity regarding the development and use of a patient safety instrument, a process marked by both challenges and facilitators from the perspective of medical record reviewers. The study underscores the need for resources, training and support during the review process to ensure the reliability and usefulness of the trigger tool.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085619","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":"Rapid review of the ideal clinic realisation and maintenance programme among primary healthcare providers in the Gauteng Province, South Africa.","authors":"Dorina Onoya, Idah Mokhele, Refiloe Cele, Nozipho Musakwa, Sharon Kgowedi, Khumbo Shumba, Cornelius Nattey, Nelly Jinga, Alice Kono, Jacqui Miot","doi":"10.1136/bmjoq-2024-003212","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003212","url":null,"abstract":"<p><strong>Background: </strong>The ideal clinic realisation and maintenance (ICRM) programme in South Africa aims to elevate primary healthcare clinic (PHC) service quality in preparation for the National Health Insurance rollout. This study investigated ICRM implementation from clinic workers' and patients' experiences in the Gauteng province.</p><p><strong>Methods: </strong>A mixed-methods cross-sectional survey was conducted across 45 Gauteng PHCs. Anonymous semistructured interviews with 335 clinic staff explored their knowledge and experiences with the ICRM programme. Facility assessments captured structural factors impacting ICRM implementation. Log-binomial regression was used to assess factors related to confidence in ICRM implementation and improvements in ICRM certification, and thematic analysis examined patient and staff experiences.</p><p><strong>Results: </strong>While 86.9% of clinical/management staff (95% CI 75.1 to 93.6) reported understanding ICRM, only 41.9% (95% CI 32.6 to 53.0) could cite specific guidelines. Enablers included guideline training (reported by 47.9% of staff, 95% CI 39.6 to 56.3) and support from district teams (44.6%, 95% CI 36.6 to 52.8). Barriers included facility size (32.9%, 95% CI 25.7 to 40.9) and infrastructure challenges (28.4%, 95% CI 21.6 to 36.2). Staff confidence in ICRM implementation was moderate (63.1%, 95% CI 56.1 to 69.6), higher when ICRM champions were present (relative risk ratio (RRR) 2.3 vs not present, 95% CI 1.0 to 5.2), guidelines were clear to staff (RRR 2.3, 95% CI 1.1 to 5.0) and sufficient training was perceived (RRR 2.7, 95% CI 1.4 to 5.3). From 2018 to 2021, 60.3% of facilities (95% CI 43.8 to 74.8) improved in ICRM classification. Compared with facilities with no status change, staff from clinics with downgraded stats were less likely to report clear guidelines (RRR 0.5, 95% CI 0.2 to 1.0) to identify an ICRM champion (RRR 0.3, 95% CI 0.1 to 0.7) or have a knowledgeable manager (RRR 0.01, 95% CI 0.01 to 0.3).</p><p><strong>Conclusion: </strong>Challenges in ICRM implementation persist. Staff knowledge, training and district support play significant roles, while clear guidelines, sufficient resources and effective leadership are essential for sustaining and enhancing ICRM performance.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085545","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":"Evaluating organisational performance in healthcare: a mixed-method study using the McKinsey 7S framework.","authors":"Imane Bounjerte, Sara Khalidy, Ilham Mazouzy, Joumana El Turk, Ibtisam Haidar, Anass Kettani, Rachid Saile, Houda Bennani","doi":"10.1136/bmjoq-2025-003317","DOIUrl":"https://doi.org/10.1136/bmjoq-2025-003317","url":null,"abstract":"<p><strong>Background: </strong>The Moroccan healthcare sector faces numerous quality challenges. Therefore, various strategies-such as the implementation of quality management systems (QMSs)-were put into practice to improve the quality of care and reinforce the healthcare system. Among these, ISO 9001 represents one formalised QMS framework. Despite its increasing adoption, only a few studies have attempted to evaluate how ISO 9001-certified QMSs influence hospital performance and effectiveness. Our study aimed to fill this gap by exploring the impact of an ISO 9001-certified QMS on organisational performance in a hospital centre in Casablanca, Morocco.</p><p><strong>Methods: </strong>Initially, we employed the McKinsey 7S model as a diagnostic tool to evaluate organisational performance across seven key dimensions. Data were collected via structured interviews and a questionnaire administered to hospital staff. Additionally, clause 9 of the ISO 9001:2015 standard-focused on performance evaluation-was used to assess the QMS implementation. As for data analysis, the software Sphinx V5 was used for data entry, and IBM SPSS Statistics V.25 was used for reliability analysis and non-parametric tests.</p><p><strong>Results: </strong>The results indicated a positive staff perception of the QMS's performance and its impact on patient satisfaction, continuous improvement and overall hospital effectiveness. The results also highlighted gaps in organisational factors such as internal communication and staff training, suggesting areas for future improvement.</p><p><strong>Conclusions: </strong>This study provided a dual-framework approach to evaluating and enhancing hospital performance by integrating ISO 9001 standard requirements with the McKinsey 7S model. The findings show the value of combining a formal QMS (ISO 9001) with organisational diagnostic tools (7S Model) in understanding and driving quality improvements in healthcare settings.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085615","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":"Implementing a Rapid Improvement Event with anonymised individual performance reporting on benign hysterectomy care: a retrospective comparative analysis.","authors":"Jason Shau Khng Lim, Celestine Loh, Yang Lv, Jia Xuan Yeo, Rhoda Su Hui Lew, Xu Ying Leow, Hairil Rizal Abdullah","doi":"10.1136/bmjoq-2024-003172","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-003172","url":null,"abstract":"<p><strong>Introduction: </strong>Value-Based Healthcare (VBHC) aims to enhance patient outcomes while managing costs. Building on VBHC principles, the Ministry of Health Singapore introduced the Value-Driven Care programme, including initiatives like Enhanced Recovery After Surgery and Patient Blood Management. However, clinical quality remained suboptimal despite these measures due to limited clinician performance transparency. To address this, the Office of Value-Based Healthcare led a Rapid Improvement Event that implemented Individual Clinical Reports (ICRs) to provide clinicians with performance feedback. This study hypothesises that an active feedback loop using ICRs, combined with regular departmental dashboard reviews, would improve clinical quality, measured by the Clinical Quality Index (CQI).</p><p><strong>Methods: </strong>A quasi-experimental design compared pre-ICR and post-ICR implementation data, analysing improvements using Fisher's exact tests and logistic regression. Adjustments were made for multiple variables such as comorbidities, surgery type and American Society of Anesthesiologists classification.</p><p><strong>Results: </strong>ICR implementation significantly improved CQI performance (p=0.013) and reduced blood transfusion (p=0.046). Secondary outcomes, including length of stay, complications and readmission rates, also showed improvements with trends towards significance.</p><p><strong>Conclusion: </strong>An active feedback loop consisting of ICRs and multidisciplinary team discussions enhanced CQI for hysterectomy patients at a tertiary hospital in Singapore. They represent a valuable feedback tool with the potential to improve care quality in other standardised surgeries.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085522","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":"Ending nuclear weapons, before they end us.","authors":"Chris Zielinski","doi":"10.1136/bmjoq-2025-003509","DOIUrl":"10.1136/bmjoq-2025-003509","url":null,"abstract":"","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping patient encounters to identify recruitment timepoints after brain tumour surgery: a cohort and cross-sectional study.","authors":"James Booker, Jack Penn, Naomi Fersht, John G Hanrahan, Michael Kosmin, Nicola Newall, Siddharth Sinha, Simon C Williams, Lewis Thorne, Ciaran S Hill, Hani J Marcus","doi":"10.1136/bmjoq-2024-003065","DOIUrl":"10.1136/bmjoq-2024-003065","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to develop a comprehensive process map for patients with brain tumours to identify opportunities for quality improvement and automated data collection. Through optimising workflows, the overall goal is to improve patient recruitment to clinical trials.</p><p><strong>Design: </strong>A two-stage mixed methods design, combining qualitative development of a process map with quantitative validation using electronic health records (EHR). Following this, a cross-sectional survey was conducted to assess how patients learn about clinical trials.</p><p><strong>Setting: </strong>A single neurosurgery centre in the United Kingdom.</p><p><strong>Participants: </strong>The process map was developed through stakeholder interviews with neuro-oncology multidisciplinary team members and patients (n=13). Clinical encounters were validated with EHR data from 50 patients. A cross-sectional survey presented the validated process map to 25 postoperative patients to identify the resources they used to learn about ongoing clinical trials.</p><p><strong>Interventions: </strong>Postoperative questionnaires were given to patients after brain tumour surgery, either on the ward or in follow-up clinic.</p><p><strong>Primary and secondary outcome measures: </strong>The primary outcome was the percentage of the study cohort that was present at encounters on the process map. Key timepoints were defined if >80% of patients were present. They represent high-yield opportunities to offer information on clinical trial recruitment. The secondary outcome was the resources used by patients to learn about ongoing clinical trials.</p><p><strong>Results: </strong>Quantitative validation of patient pathways identified 345 encounters involving 19 discrete events, including clinics, telephone follow-ups and treatments. The flow of encounters reflected the process map with 90.7% accuracy, with key timepoints identified at imaging and biopsy/surgical procedures. A cross-sectional survey conducted during outpatient neuro-oncology clinics identified that patients predominantly used self-directed internet searches (n=17, 68%) and verbal information from their neurosurgeon (n=16, 64%) to learn about clinical trials.</p><p><strong>Conclusions: </strong>This study demonstrates the effectiveness of process mapping in identifying key timepoints for automated data collection and opportunities for quality improvement for clinical trial recruitment. Integrating online and in-clinic education strategies could enhance patient awareness and participation in clinical trials.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse stress and patient safety in the ICU: physician-led observational mixed-methods study.","authors":"Manju Mathew, Anjum John, Reshma Vazhakkalayil Ramachandran","doi":"10.1136/bmjoq-2024-003109","DOIUrl":"10.1136/bmjoq-2024-003109","url":null,"abstract":"<p><strong>Introduction: </strong>Nurses working in intensive care settings are required to maintain constant vigilance, yet they often experience high stress and burnout, which can compromise the quality of patient care.</p><p><strong>Objectives: </strong>To identify stress and burnout among intensive care nurses, contributing risk factors and impact on patient safety, while providing an opportunity for nurses to discuss their work-related challenges.</p><p><strong>Methods: </strong>Setting: Observational mixed-methods study done in intensive care unit (ICU), tertiary teaching hospital, Kerala, India in July 2024.</p><p><strong>Participants: </strong>Thirty nurses in the ICU (all females, mostly aged 25-35 years, >5 years of work experience) completed standardised questionnaires on stress levels, workload, burnout and work satisfaction. From this group, six nurses underwent structured interviews. Purposive sampling was done to capture diverse experience and roles. Reported patient safety incident data were collected.Severity of stress, workload, burnout and work satisfaction were classified into high or low levels based on predefined cut-off scores.</p><p><strong>Results: </strong>86.7% reported moderate to high levels of combined outcomes of workload, stress or burnout, with 46.7% experiencing high levels of stress. Four major themes were identified in the qualitative analysis: stress, attitudes, patient safety and nurses' unmet demands and aspirations. Positive attitudes identified were passion, motivation and empathy. Key stressors included work overload, inadequate staffing, logistics, team and management support. Coping strategy was family-centred. A perceived need for a non-punitive, learning-oriented environment was identified for fostering patient safety culture. Nurses' demands included facility safety, managerial support and better resources, both man and machine.</p><p><strong>Conclusions: </strong>Despite the specific challenges faced by ICU nurses in developing countries, they upheld positive values. Institutional leadership's commitment to implement patient safety culture and improve nurses' work environment is important. Future research should involve larger multicentre interventional studies.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 2","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12083376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}