Patient safety climate research in primary care dentistry: A systematic scoping review.

BACKGROUND: Patient safety climate constitutes an important element for quality improvement. Its current evidence base has been generated in hospital settings in developed countries. Studies in dentistry are limited. OBJECTIVE: To systematically explore the evidence regarding assessing patient safety climate in dentistry. METHODS: We developed a search strategy to explore MEDLINE, SCOPUS, and Web of Science databases from January 1st, 2002, to December 31st, 2022, to include observational studies on patient safety culture or patient safety climate assessment. Methodological features and item data concerning the dimensions employed for assessment were extracted and thematically analyzed. Reported scores were also collected. RESULTS: Nine articles out of 5584 were included in this study. Most studies were generated from high-income economies. Our analysis revealed methodological variations. Non-randomized samples were employed (ranging from 139 to 656 participants), and response rates varied from 28% to 93.7%. Three types of measurement instruments have been adapted to assess patient safety climate. These mainly consisted of replacing words or rewording sentences. Only one study employed an instrument previously validated through psychometric methods. In general, patient safety climate levels were either low or neutral. Only one study reported scores equal to or greater than 75. DISCUSSION: Despite diverse assessment tools, our two-decade analysis reveals a lag compared with medicine, resulting in methodological variations for assessing patient safety climate. Collaboration is vital to elevate standards, prioritize patient safety across oral healthcare services, and advocate for integrating safety climate into local and national quality and patient safety strategies.

Estimating the impact of label design on reducing the risk of medication errors by applying HEART in drug administration.

Medication errors are one of the biggest problems in healthcare. The medicines' poor labelling design (i.e. look-alike labels) is a well-recognised risk for potential confusion, wrong administration, and patient damage. Human factors and ergonomics (HFE) encourages the human-centred design of system elements, which might reduce medication errors and improve people's well-being and system performance. OBJECTIVE: The aim of the present study is twofold: (i) to use a human reliability analysis technique to evaluate a medication administration task within a simulated scenario of a neonatal intensive care unit (NICU) and (ii) to estimate the impact of a human-centred design (HCD) label in medication administration compared to a look-alike (LA) label. METHOD: This paper used a modified version of the human error assessment and reduction technique (HEART) to analyse a medication administration task in a simulated NICU scenario. The modified technique involved expert nurses quantifying the likelihood of unreliability of a task and rating the conditions, including medicine labels, which most affect the successful completion of the task. RESULTS: Findings suggest that error producing conditions (EPCs), such as a shortage of time available for error detection and correction, no independent checking of output, and distractions, might increase human error probability (HEP) in administering medications. Results also showed that the assessed HEP and the relative percentage of contribution to unreliability reduced by more than 40% when the HCD label was evaluated compared to the LA label. CONCLUSION: Including labelling design based on HFE might help increase human reliability when administering medications under critical conditions.

Frontiers in human factors: integrating human factors and ergonomics to improve safety and quality in Latin American healthcare systems.

BACKGROUND: The importance of human factors/ergonomics (HFE) is well established in all high-reliability systems but only applied in the healthcare sector relatively recently. Across many sectors, low-/middle-income countries (LMICs) lag behind more economically developed countries in their application of this safety science, due to resource and, in some cases, awareness and expertise. Most previous applications of HFE related to occupational ergonomics rather than healthcare safety. METHODS: The paper details how the reputation of HFE is being developed within healthcare communities of Latin America (LatAm), through increasing awareness and understanding of its role as safety science in the healthcare sector. It starts by articulating the need for HFE and then provides examples from Mexico, Colombia and Peru. RESULTS: The practical examples for research and education illustrate a developing awareness of the relevance of HFE to the healthcare sectors in LatAm and an appreciation of its worth to improve health service quality and patient safety through healthcare community engagement. A new LatAm Network of HFE in Healthcare Systems (RELAESA) was formed in 2019, which has provided a platform for HFE advice during the COVID-19 pandemic. CONCLUSION: There is a real opportunity in LatAm and other LMIC health services to make more rapid and sustainable progress in healthcare-embedded HFE than has been experienced within healthcare services of more developed nations.

The role of perceived pedestrian safety on designing safer built environments.

OBJECTIVE: This study aimed to explore how pedestrians´ safety perception concerning the built environmental characteristics can assist in designing a safer built environment in an urban area in Mexico. METHODS: The study involved two stages of data collection. In the first stage, a physical audit on selected urban roads was performed to assess the characteristics that may increase the perceived risk of a collision. An observational framework to evaluate the crossing areas, sidewalks and organizational factors was developed and used for data collection. In the second stage, an on-street questionnaire was applied to collect the perception of a group of 299 pedestrians about safety risks, road characteristics and their ideas for designing a safer built environment. RESULTS: The physical road audit identified several features in the crossing areas and sidewalks, such as parked cars, movable and fixed obstacles, and lack of traffic signage, which may increase the risk of a pedestrian being involved in a collision. More than half of the road users who were interviewed either agree (27%) or strongly agree (29%) with the statement that crossing the roads in the area was safe. However, pedestrians also identified the following elements as detrimental for the safe use of roads: lack of traffic lights, too much traffic, lack of signs, and parked cars that obstruct visibility. Participants also raised issues beyond the physical infrastructure; for instance, a lack of respect shown by drivers to pedestrians. For designing a safer built environment, participants suggested several ideas highlighting pedestrianization of the road and widening the sidewalks, along with restricting parking of cars on the road. CONCLUSIONS: This combination of findings provide valuable support for the premise that pedestrians may have a good sense of recognizing safety problems and the ability to see the solutions. Although the research was undertaken in the context of a municipality in Guadalajara, the role of pedestrian safety perception may be applicable in other urban settings in low and middle-income countries (LMICs), where local authorities are in charge of designing the road environment. This study highlights the relevance of including pedestrians' participation for a safer and human-centred design of our cities.

Environmental information for people with visual impairment in Mexico - or what they need and how they use it.

From an ergonomics perspective, the environmental characteristics should facilitate user activities. Matching user capabilities to demands of the environment is essential. However, about some users such as those with visual impairments, there is little information available for use in designing products and spaces. There is also a gap in information regarding the commutes and needs of the visually impaired, making it even more difficult to establish how environments should be designed to include this population.This study aimed to identify the information needs of people with visual impairment in terms of: 1) Daily life activities, 2) Wayfinding in the complex built environments, 3) Use of the signals provided by the environment 4) Characteristics of the environment which reduce the usability of a space and may put the user in danger, and 5) Safety perception. Data were obtained through a semi-structured interview to which eighteen adults responded. All had either complete blindness or severe visual impairment. For orientation, the most common references were texture or changes in ground level/surface, along with such ambient elements as noise or smells. Information presented in Braille was reported as little used, due to difficulty in finding such information. Regarding safety, participants reported feeling unsafe; most mentioned crossing the street as a major risk. Using auditory, tactile or even olfactory signals may provide important information while commuting: thus, designing signals which consider and highlight these senses is paramount. Assessing features and location of existing tactile signals is also required, to identify opportunities for improving the safety and independence of people with visual impairment.

An observational comparison of the older and younger bus passenger experience in a developing world city.

This study was an unobtrusive observational analysis of 333 older and younger bus passengers in Guadalajara, Mexico. A set of data were collected for each observed passenger, as well as more general observations related to driver behaviour, bus design and bus service characteristics. There were significant differences between older and younger passengers in terms of boarding and alighting times, use of handrails, seat location preferences, passenger stability and coping strategies in order to maintain postural stability. The conditions of travel are conducive to a poor passenger experience for the older passengers in particular. Although the problems may be attributed to bus design and driver behaviour typical of that in developing countries, they are also influenced by the wider transport infrastructure, and a lack of a regulatory regime which places drivers under time pressure and in direct competition with each other. Practitioner Summary: Bus services must cater for all ages of passengers, including the elderly. This unobtrusive observational study investigated the passenger experience in a developing world city. Bus and wider service design were found to compromise the journey experience, with the older users being particularly negatively impacted. Design recommendations are provided.

Low back pain and depression: a study in a population of Mexican workers.

The objective of this study was to analyze whether lumbar spondyloarthrosis is associated with depression. A cross-sectional comparative survey was conducted, in which 99 workers insured by the Mexican Social Security Institute (IMSS, according to its designation in Spanish), ranging from 23-55 years of age, participated. Conditional logistic regression analysis showed that chronic lumbar spondyloarthrosis illness, when adjusted for participation in sports activity, was found to be associated with depression (OR = 3.4; CI 95% 1.2-9.4). This suggests that among those suffering said physical condition there is greater association with depressive symptoms. The study's results indicate the necessity of evaluating all workers with lumbar spondyloarthrosis for the presence of depression, and the suggestion is made that psychological support treatment be implemented in conjunction with physical treatment as a means of preventing depression.

Occupational driving as a risk factor in low back pain: a case-control study in a Mexican population.

The objective of this study was to assess and quantify the degree to which interaction between occupational driving and lifting tasks is a risk factor in lumbar spondyloarthrosis etiology. A case-control study was performed with 231 workers, 18-55 years old, insured by the Mexican Social Security Institute (IMSS, according to its designation in Spanish). A multivariate analysis using conditional logistical regression showed that driving tasks, when combined with lifting tasks, are associated with this illness (OR = 7.3; 95% CI 1.7-31.4). Occupational driving as it interacted with daily lifting frequency resulted in a greater risk (OR = 10.4; 95% CI 2.0-52.5). No exposure-response relationship was found with daily hours spent working as a driver. The attributable risk for driving tasks was 0.86, suggesting that 86% of lumbar spondyloarthrosis could be decreased if risk factors were reduced through ergonomic redesign of the workplace and Manual Materials Handling (MMH) tasks, along with development of educational programs.