Measurement and monitoring of safety: impact and challenges of putting a conceptual framework into practice.

BACKGROUND: The Measurement and Monitoring of Safety Framework provides a conceptual model to guide organisations in assessing safety. The Health Foundation funded a large-scale programme to assess the value and impact of applying the Framework in regional and frontline care settings. We explored the experiences and reflections of key participants in the programme. METHODS: The study was conducted in the nine healthcare organisations in England and Scotland testing the Framework (three regional improvement bodies, six frontline settings). Post hoc interviews with clinical and managerial staff were analysed using template analysis. FINDINGS: Participants reported that the Framework promoted a substantial shift in their thinking about how safety is actively managed in their environment. It provided a common language, facilitated a more inquisitive approach and encouraged a more holistic view of the components of safety. These changes in conceptual understanding, however, did not always translate into broader changes in practice, with many sites only addressing some aspects of the Framework. One of the three regions did embrace the Framework in its entirety and achieved wider impact with a range of interventions. This region had committed leaders who took time to fully understand the concepts, who maintained a flexible approach to exploring the utility of the Framework and who worked with frontline staff to translate the concepts for local settings. CONCLUSIONS: The Measuring and Monitoring of Safety Framework has the potential to support a broader and richer approach to organisational safety. Such a conceptually based initiative requires both committed leaders who themselves understand the concepts and more time to establish understanding and aims than might be needed in a standard improvement programme.

Learning from preventable deaths: exploring case record reviewers' narratives using change analysis.

OBJECTIVE: To determine if applying change analysis to the narrative reports made by reviewers of hospital deaths increases the utility of this information in the systematic analysis of patient harm. DESIGN: Qualitative analysis of causes and contributory factors underlying patient harm in 52 case narratives linked to preventable deaths derived from a retrospective case record review of 1000 deaths in acute National Health Service Trusts in 2009. PARTICIPANTS: 52 preventable hospital deaths. SETTING: England. MAIN OUTCOME MEASURES: The nature of problems in care and contributory factors underlying avoidable deaths in hospital. RESULTS: The change analysis approach enabled explicit characterisation of multiple problems in care, both across the admission and also at the boundary between primary and secondary care, and illuminated how these problems accumulate to cause harm. It demonstrated links between problems and underlying contributory factors and highlighted other threats to quality of care such as standards of end of life management. The method was straightforward to apply to multiple records and achieved good inter-rater reliability. CONCLUSION: Analysis of case narratives using change analysis provided a richer picture of healthcare-related harm than the traditional approach, unpacking the nature of the problems, particularly by delineating omissions from acts of commission, thus facilitating more tailored responses to patient harm.

Impact of host plant connectivity, crop border and patch size on adult Colorado potato beetle retention.

Tagged Colorado potato beetles (CPB), Leptinotarsa decemlineata (Say), were released on potato plants, Solanum tuberosum L., and tracked using a portable harmonic radar system to determine the impact of host plant spatial distribution on the tendency of the pest to remain on the colonized host plant or patch. Results confirmed the long residency time on the host plant and showed that close connection of the plant to neighboring plants hastened dispersal between plants. Tracking walking CPB for over 6 h in small potato plots revealed that all types of mixed borders tested (potato/bare ground, potato/timothy and potato/woodland) acted as a strong barrier and retained beetles within the patch. In another experiment in potato patches surrounded by bare ground borders, tracked walking CPB displayed similar behaviour for up to four days. The distribution of turning angles in the CPB walking paths was not uniform and corresponded to beetles following the edge rows of potato patches in response to the crop border barrier or reversing their direction as they reached the end of a row and therefore a border. Patch size had no or little effect on beetle retention in the patch. The relative distribution of counts of tagged beetles detected among small (16 m2), medium (64 m2) and large size (256 m2) patches of potato four days after initial release remained similar to that of numbers released. Even though mixed crop borders were a strong barrier to walking CPB emigrating from potato patches, the departure rate of beetles over time was high. Results suggest that the effect of mixed borders is largely limited to dispersal by walking and does not apply to beetles leaving host patches by flight. The manipulation of crop borders and patch size seem to have limited potential for the management of CPB emigrating from potato fields.

Unannounced in situ simulations: integrating training and clinical practice.

Simulation-based training for healthcare providers is well established as a viable, efficacious training tool, particularly for the training of non-technical team-working skills. These skills are known to be critical to effective teamwork, and important in the prevention of error and adverse events in hospitals. However, simulation suites are costly to develop and releasing staff to attend training is often difficult. These factors may restrict access to simulation training. We discuss our experiences of 'in situ' simulation for unannounced cardiac arrest training when the training is taken to the clinical environment. This has the benefit of decreasing required resources, increasing realism and affordability, and widening multidisciplinary team participation, thus enabling assessment and training of non-technical team-working skills in real clinical teams. While there are practical considerations of delivering training in the clinical environment, we feel there are many potential benefits compared with other forms of simulation training. We are able to tailor the training to the needs of the location, enabling staff to see a scenario that is relevant to their practice. This is particularly useful for staff who have less exposure to cardiac arrest events, such as radiology staff. We also describe the important benefit of risk assessment for a clinical environment. During our simulations we have identified a number of issues that, had they occurred during a real resuscitation attempt, may have led to patient harm or patient death. For these reasons we feel in situ simulation should be considered by every hospital as part of a patient safety initiative.

Factors predicting change in hospital safety climate and capability in a multi-site patient safety collaborative: a longitudinal survey study.

OBJECTIVE: The study had two specific objectives: (1) To analyse change in a survey measure of organisational patient safety climate and capability (SCC) resulting from participation in the UK Safer Patients Initiative and (2) To investigate the role of a range of programme and contextual factors in predicting change in SCC scores. DESIGN: Single group longitudinal design with repeated measurement at 12-month follow-up. SETTING: Multiple service areas within NHS hospital sites across England, Wales, Scotland and Northern Ireland. PARTICIPANTS: Stratified sample of 284 respondents representing programme teams at 19 hospital sites. INTERVENTION: A complex intervention comprising a multi-component quality improvement collaborative focused upon patient safety and designed to impact upon hospital leadership, communication, organisation and safety climate. MEASURES: A survey including a 31-item SCC scale was administered at two time-points. RESULTS: Modest but significant positive movement in SCC score was observed between the study time-points. Individual programme responsibility, availability of early adopters, multi-professional collaboration and extent of process measurement were significant predictors of change in SCC. Hospital type and size, along with a range of programme preconditions, were not found to be significant. CONCLUSION: A range of social, cultural and organisational factors may be sensitive to this type of intervention but the measurable effect is small. Supporting critical local programme implementation factors may be an effective strategy in achieving development in organisational patient SCC, regardless of contextual factors and organisational preconditions.

Harmonic radar: efficacy at detecting and recovering insects on agricultural host plants.

BACKGROUND: In pest management research, harmonic radar systems have been largely used to study insect movement across open or vegetation-poor areas because the microwave signal is attenuated by the high water content of vegetation. This study evaluated whether the efficacy of this technology is sufficient to track insects in vegetative landscapes. RESULTS: Field efficacy data were collected using portable harmonic microwave radar and electronic dipole tags mounted on adults of three economically important pests: Leptinotarsa decemlineata (Say), Diabrotica virgifera virgifera (LeConte) [corrected] and Conotrachelus nenuphar Herbst. Detection and recovery of tagged Colorado potato beetles, plum curculios and western corn rootworms was high within and among potato plants, moderate within apple trees and high within, but not between, corn plants respectively. The efficacy of the radar depends on the ability of the operator to move around the host, scanning for a signal 'sightline' with the tagged insect among plant structures. CONCLUSION: The detection rate of tagged insects by harmonic radar systems is high enough to track the walking path of pests through low row crops such as potato, tall row crops such as corn or tall but well-separated trees of orchard-type crops by adapting the scanning procedure to the vegetative architecture.

Wild Solanum resistance to aphids: antixenosis or antibiosis?

The type (antixenosis or antibiosis) of resistance against the aphids Myzus persicae (Sulzer) and Macrosiphum euphorbiae (Thomas) was characterized for the wild tuber-bearing potatoes, Solanum chomatophilum Bitter and Solanum stoloniferum Schltdl. & Bouché through behavioral (olfactometry and electrical penetration graph) and physiological studies. In dual-choice assays, only S. stoloniferum exerted attraction to M. euphorbiae. This ruled out the possibility that plant volatiles of S. chomatophilum and S. stoloniferum may contribute to the high resistance expressed. In electrical penetration graph experiments, aphids feeding on S. stoloniferum showed increased salivation phases, whereas phloem ingestion was drastically reduced for both aphid species. Because reaching phloem elements was not delayed in both species, the resistance mechanism was phloem-located. The antixenosis exhibited by S. stoloniferum was similar on young and mature leaves. S. chomatophilum also showed phloem-located antixenosis against M. persicae. In contrast, M. euphorbiae had no difficulty to reach S. chomatophilum phloem tissues and to ingest sap. S. chomatophilum resistance against M. euphorbiae was antibiosis and only expressed in mature leaves, where a complete nymphal mortality was observed.

Unexpected effects of chitinases on the peach-potato aphid (Myzus persicae Sulzer) when delivered via transgenic potato plants (Solanum tuberosum Linné) and in vitro.

With the aim of producing insect-resistant potato plants, internode explants of Solanum tuberosum L. cv. Désirée were transformed with an Agrobacterium strain C58pMP90 containing an insect (Phaedon cochleariae: Coleoptera, Chrysomelidae) chitinase gene and the neomycin phosphotransferase (nptII) gene as selectable marker, both under the control of the viral CaMV 35S promoter. Three transformed potato lines (CH3, CH5 and CH25) exhibiting the highest chitinolytic activities were selected for feeding experiments with the peach-potato aphid, Myzus persicae (Sulzer), under controlled photoperiod and temperature conditions. Aphids fed on transgenic potato plants showed a reduced pre-reproductive period and an enhanced daily fecundity. Transgenic potato lines did not affect nymphal mortality, but improved several biological parameters related to aphid population's growth. Artificial diets were used to provide active (1, 10, 100 and 500 microg ml(-1)) and inactive (500 microg ml(-1)) bacterial (Serratia marcescens) chitinase to M. persicae. These compounds increased nymph survival at all active chitinase doses when compared to the control diet, while inactive chitinase did not. Although the pre-reproductive period was slightly shortened and the daily fecundity slightly higher, active and inactive chitinase provided as food led a reduction from 1 to 1.5 day population's doubling time. Therefore chitinase activity was responsible for the probiotic effects on aphids. Our results question the relevance of a chitinase-based strategy in the context of potato culture protection.

Rapid method to screen resistance of potato plants against Myzus persicae (Homoptera: Aphididae) in the laboratory.

With the objective to develop a potato, Solanum tuberosum L., resistance program against aphids, we propose a rapid screening method with Myzus persicae (Sulzer) in the laboratory. We aimed to optimize the duration of the whole procedure and to decrease the frequency of measurements. In a first experiment, intrinsic rate of natural increase (r(m)) values were compared between adult aphids reared throughout their entire life and adults reared only during a period equivalent to their prereproductive period. No significant differences were observed. In a second experiment, four groups of aphids were distinguished according to the sampling frequency, i.e., those whose biological parameters were evaluated every single, second, third, and fourth day. Except for the fourth-day experiment, the r(m) values estimated on aphids reared on the three potato lines were not significantly different whatever sampling frequency of single, second, or third day used to check aphids. Thus, screening efforts in laboratory can be largely optimized by evaluating adult aphids only during a period equivalent to their prereproductive period and assessing M. persicae populations every third day. Our method is reliable and adapted to screen a large number of potato plants against M. persicae because it allows an average 70% reduction in the time required for the whole experimental process.