Reconceptualizing Patient Safety Beyond Harm: Insights From a Mixed-Methods Qualitative Inquiry.

BACKGROUND: Although patients' and care partners' perspectives on patient safety can guide health care learning and improvements, this information remains underutilized. Efforts to leverage this valuable data require challenging the narrow focus of safety as the absence of harm. PURPOSE: The purpose of this study was to gain a broader insight into how patients and care partners perceive and experience safety. METHODS: We used a mixed-methods approach that included a literature review and interviews and focus groups with patients, care partners, and health care providers. An emergent coding schema was developed from triangulation of the 2 data sets. RESULTS: Two core themes-feeling unsafe and feeling safe-emerged that collectively represent a broader view of safety. CONCLUSION: Knowledge from patients and care partners about feeling unsafe and safe needs to inform efforts to mitigate harm and promote safety, well-being, and positive outcomes and experiences.

Measuring and Monitoring Healthcare-Associated Infections: A Canadian Collaboration to Better Understand the Magnitude of the Problem.

Patients should never have to worry about getting an infection while in hospital. Yet every year, many hospitalized Canadians continue to acquire an infection during their hospital stay and experience increased morbidity and mortality as a result of these healthcare-associated infections (HAIs) (PHAC 2019b). Measuring and monitoring HAIs provide key data to better understand the magnitude of the problem. In Canada, there are inconsistencies in the use of standardized HAI case definitions and surveillance practices. These inconsistencies make it difficult to provide benchmarks and set targets to help reduce the rate of HAIs in Canadian hospitals.

New Tools for Measuring and Improving Patient Safety in Canadian Hospitals.

The Canadian Institute for Health Information (CIHI) and the Canadian Patient Safety Institute (CPSI) have collaborated on a new measure of patient safety, along with a resource of evidence-informed practices. This measure captures four broad categories of harm in acute care hospitals, consisting of 31 clinical groups selected by clinicians. Analysis showed that harm was experienced in 1 of 18 hospital stays in Canada in 2014ߝ2015 and that no single category accounted for the majority of harmful events. Although CIHI and CPSI continue to work with hospitals and experts to further refine the methodology, the measure and associated Improvement Resource are useful new tools for monitoring and identifying harm, and have the potential to improve patient safety.

Divergences between healthcare-associated infection administrative data and active surveillance data in Canada.

Background: Although Canada has both a national active surveillance system and administrative data for the passive surveillance of healthcare-associated infections (HAI), both have identified strengths and weaknesses in their data collection and reporting. Active and passive surveillance work independently, resulting in results that diverge at times. To understand the divergences between administrative health data and active surveillance data, a scoping review was performed. Method: Medline, Embase and Cumulative Index to Nursing and Allied Health Literature along with grey literature were searched for studies in English and French that evaluated the use of administrative data, alone or in comparison with traditional surveillance, in Canada between 1995 and November 2, 2020. After extracting relevant information from selected articles, a descriptive summary of findings was provided with suggestions for the improvement of surveillance systems to optimize the overall data quality. Results: Sixteen articles met the inclusion criteria, including twelve observational studies and four systematic reviews. Studies showed that using a single source of administrative data was not accurate for HAI surveillance when compared with traditional active surveillance; however, combining different sources of data or combining administrative with active surveillance data improved accuracy. Electronic surveillance systems can also enhance surveillance by improving the ability to detect potential HAIs. Conclusion: Although active surveillance of HAIs produced the most accurate results and remains the gold-standard, the integration between active and passive surveillance data can be optimized. Administrative data can be used to enhance traditional active surveillance. Future studies are needed to evaluate the feasibility and benefits of potential solutions presented for the use of administrative data for HAI surveillance and reporting in Canada.

National healthcare-associated infections surveillance programs: A scoping review.

Background: National surveillance of healthcare-associated infections (HAIs) is necessary to identify areas of concern, monitor trends, and provide benchmark rates enabling comparison between hospitals. Benchmark rates require representative and large sample sizes often based on pooling of surveillance data. We performed a scoping review to understand the organization of national HAI surveillance programs globally. Methods: The search strategy included a literature review, Google search and personal communications with HAI surveillance program managers. Thirty-five countries were targeted from four regions (North America, Europe, United Kingdom and Oceania). The following information was retrieved: name of surveillance program, survey types (prevalence or incidence), frequency of reports, mode of participation (mandatory or voluntary), and infections under surveillance. Results: Two hundred and twenty articles of 6,688 identified were selected. The four countries with most publications were the US (48.2%), Germany (14.1%), Spain (6.8%) and Italy (5.9%). These articles identified HAI surveillance programs in 28 of 35 countries (80.0%), operating on a voluntary basis and monitoring HAI incidence rates. Most HAIs monitored surgical site infections in hip (n=20, 71.4%) and knee (n=19, 67.9%) and Clostridoides difficile infections (n=17, 60.7%). Conclusion: Most countries analyzed have HAI surveillance programs, with characteristics varying by country. Patient-level data reporting with numerators and denominators is available for almost every surveillance program, allowing for reporting of incidence rates and more refined benchmarks, specific to a given healthcare category thus offering data that can be used to measure, monitor, and improve the incidence of HAIs.

Utilizing quality improvement methods to prevent falls and injury from falls: enhancing resident safety in long-term care.

INTRODUCTION: Internationally, the growing evidence related to preventable adverse events within healthcare settings has resulted in the creation of numerous patient safety and quality improvement initiatives. In Canada, Safer Healthcare Now!, a national patient safety initiative of the Canadian Patient Safety Institute, and the Registered Nurses' Association of Ontario, the professional association representing registered nurses in Ontario, have partnered to combine quality improvement expertise with evidence-based practice expertise to accelerate improvement in the area of falls prevention and injury reduction. The synergistic relationship between Safer Healthcare Now! and the Registered Nurses' Association of Ontario has resulted in the evolution of the Safer Healthcare Now! national Falls Prevention intervention. The ultimate goal of the Falls Prevention intervention is to improve care by translating "what we know" into "what we do," by supporting quality improvement teams to make changes at the local level to enhance the patient experience. METHOD: This article provides an overview of Safer Healthcare Now! as a national patient safety initiative, and highlights the results of a National Collaborative on Falls Prevention as a knowledge translation strategy utilized within the long-term care setting. A description of expanding supports for knowledge translation will also be provided.