医护人员是否在安全标准范围内工作,我们是否应该担心?范围审查。

IF 5.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Debbie Clark, Rebecca Lawton, Ruth Baxter, Laura Sheard, Jane K O'Hara
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引用次数: 0

摘要

背景:医疗保健人员在提供医疗保健服务时,会通过变通方法来适应所面临的挑战。有时,安全标准,也就是在医疗保健中用来降低风险的常规标准,会成为员工变通的障碍。虽然变通方法具有负面含义,但有观点认为,在某些情况下,变通方法有助于提供安全的医疗服务:在这篇范围综述中,我们探讨了在提供一线医疗服务时采用安全标准变通方法(SSWAs)的情况及其影响:方法:我们检索了 MEDLINE、CINAHL、PsycINFO 和 Web of Science 中有关医疗保健中安全标准变通方法的情况和认知影响的文章。数据图表由两名研究人员绘制。研究人员对研究结果进行了叙述性综合总结:我们在综述中收录了 27 篇论文,报告了 21 项安全标准的变通方法。超过一半的论文(59%)介绍了与药品安全相关的标准的变通方法。由于用药标准经常出现在论文中,67%的论文中报告了由注册护士、41%的论文中报告了由医生、19%的论文中报告了由药剂师实施的安全标准变通。组织原因是采取变通方法的最主要原因。论文报告了 SSWA 对护理质量的预期影响。有时,SSWA 被用于支持提供以人为本、及时、高效和有效的护理。SSWA 对安全的影响多种多样。一些论文称,SSWA 同时对安全产生了积极和消极的影响。据报道,SSWA对患者的益处多于弊端:在日常护理过程中,特别是在与用药相关的过程中,经常会用到SSWA。这些变通方法通常用于平衡不同的风险,并在某些情况下实现安全护理。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Do healthcare professionals work around safety standards, and should we be worried? A scoping review.

Background: Healthcare staff adapt to challenges faced when delivering healthcare by using workarounds. Sometimes, safety standards, the very things used to routinely mitigate risk in healthcare, are the obstacles that staff work around. While workarounds have negative connotations, there is an argument that, in some circumstances, they contribute to the delivery of safe care.

Objectives: In this scoping review, we explore the circumstances and perceived implications of safety standard workarounds (SSWAs) conducted in the delivery of frontline care.

Method: We searched MEDLINE, CINAHL, PsycINFO and Web of Science for articles reporting on the circumstances and perceived implications of SSWAs in healthcare. Data charting was undertaken by two researchers. A narrative synthesis was developed to produce a summary of findings.

Results: We included 27 papers in the review, which reported on workarounds of 21 safety standards. Over half of the papers (59%) described working around standards related to medicine safety. As medication standards featured frequently in papers, SSWAs were reported to be performed by registered nurses in 67% of papers, doctors in 41% of papers and pharmacists in 19% of papers. Organisational causes were the most prominent reason for workarounds.Papers reported on the perceived impact of SSWAs for care quality. At times SSWAs were being used to support the delivery of person-centred, timely, efficient and effective care. Implications of SSWAs for safety were diverse. Some papers reported SSWAs had both positive and negative implications for safety simultaneously. SSWAs were reported to be beneficial for patients more often than they were detrimental.

Conclusion: SSWAs are used frequently during the delivery of everyday care, particularly during medication-related processes. These workarounds are often used to balance different risks and, in some circumstances, to achieve safe care.

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来源期刊
BMJ Quality & Safety
BMJ Quality & Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
9.80
自引率
7.40%
发文量
104
审稿时长
4-8 weeks
期刊介绍: BMJ Quality & Safety (previously Quality & Safety in Health Care) is an international peer review publication providing research, opinions, debates and reviews for academics, clinicians and healthcare managers focused on the quality and safety of health care and the science of improvement. The journal receives approximately 1000 manuscripts a year and has an acceptance rate for original research of 12%. Time from submission to first decision averages 22 days and accepted articles are typically published online within 20 days. Its current impact factor is 3.281.
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