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INTRODUCTION: Maternal and infant mortality rates in Finland are among the lowest in the world, yet preventable obstetric injuries occur every year. The aim of this study was to describe obstetric claims, their compensation rates, and temporal trends of claims reported to the Patient Insurance center. MATERIAL AND METHODS: A nationwide, register-based study was conducted. Data consisted of obstetric claims reported to the Patient Insurance Center between 2012 and 2022. Data analyzed included the year of injury, compensation criteria, maternal age, birth hospital, delivery method, reported causes of injury, and maternal or neonatal injury. The data were analyzed with descriptive statistics and logistic regression models. RESULTS: A total of n = 849 obstetric claims were filed during the study period, of which n = 224 (26.4%) received compensation. The rate of claims was 0.15%, and the rate of compensation was 0.04% in relation to the total volume of births during the period. Substandard care was the most common (97.3%) criterion for compensation. There was a curvilinear increase in the claims rate and a linear increase in compensation rates from 2013 to 2019. More claims were filed and compensated for cesarean and vacuum-assisted deliveries than for unassisted vaginal deliveries. Delayed delivery (18.7%) and surgical technique failure (10.9%) were the most reported causes of injuries. Retained surgical bodies were the induced cause of injury with the highest rate of compensated claims (86.7%). The most common maternal injury was infection (17.9%) and pain (11.7%). Among neonatal injuries, severe (19.2%) and mild asphyxia (16.6%) were the most frequent. Burn injuries (93.3%) and fetal or neonatal death (60.5%) had the highest rate of compensated claims. CONCLUSIONS: The study provided new information on substandard care and injuries in obstetric care in Finland. An increasing trend in claims and compensation rates was found. Identifying contributors to substandard care that lead to fetal asphyxia is important for improving obstetric safety. Further analysis of the association of claims and compensation rates with operative deliveries is needed to determine their causality. Frequent review of obstetric claims would be useful in providing more recent data on substandard care and preventable injuries.
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Parto Obstétrico , Sistema de Registros , Humanos , Finlândia/epidemiologia , Feminino , Gravidez , Adulto , Parto Obstétrico/estatística & dados numéricos , Recém-Nascido , Compensação e Reparação , Traumatismos do Nascimento/epidemiologiaRESUMO
AIMS: To examine the relationship between the second victim distress and outcome variables, specifically: 'turnover intentions, absenteeism and resilience'. Furthermore, this study also assessed how organizational support mediates the relationship between second victim distress and outcome variables. DESIGN: Cross-sectional survey. METHODS: A cross-sectional survey study using regression and mediation analysis with bootstrapping was conducted among (n = 149) healthcare professionals in two university hospitals in Finland from September 2022 to April 2023 during different time periods. The Finnish version of the revised Second Victim Experience and Support Tool (FI-SVEST-R) was used to assess second victim distress, level of organizational support and related outcomes. RESULTS: Psychological distress was the most frequently experienced form of reported second victim distress, and institutional support was the lowest perceived form of support by healthcare professionals. The study found second victim distress to have a significant association with work-related outcomes: turnover intention and absenteeism. However, no significant relationship was found with resilience. Mediation models with organizational support revealed a partially mediated relationship between second victim distress and work-related outcomes. CONCLUSIONS: The findings from this study indicate that second victim experiences if not adequately addressed can lead to negative work-related outcomes such as increased job turnover and absenteeism. Such outcomes not only affect healthcare professionals but can also have a cascading effect on the quality of care. However, the mediating effect of organizational support suggests that if comprehensive support is provided, it is possible to mitigate the negative impact of the second victim phenomenon. IMPACT: Raising awareness regarding the second victim phenomenon, promoting a culture of safety and shifting the paradigm from a blame to just culture helps in identifying the system flaws thus improving both patient and provider safety. REPORTING METHOD: The study adheres to the STROBE reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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AIMS: To identify the contributing factors behind the second victim phenomenon, describe the emotional responses of nurses after medication errors, assess the support received by them after errors and recognize the need for a suitable support program for second victims. DESIGN: Qualitative descriptive design. METHODS: Eleven in-depth semi-structured interviews were conducted among registered nurses studying advanced degrees at a University in Finland during November 2021-April 2022. Data were analysed using thematic analysis. RESULTS: The study results revealed four themes with various sub-themes which included: contributing factors behind the second victim phenomenon; emotional responses of nurses after error; support received by nurses; and the desired need for a support program for second victims. The severity of the error and the negative work environment acted as catalysts for the second victim phenomenon among nurses. A "bitter aftermath" of emotions and a sense of insufficient support added further risk to already stressed and anxious nurses. CONCLUSIONS: This study identifies the early exploratory and enduring impact of memories associated with medication errors, some of them haunting nurses for long periods of time. Further, the need for support at different levels is highlighted to reduce the impact of negative emotions generated among nurses after medication errors. IMPLICATIONS FOR THE PROFESSION: Through the lens of this study, it has been possible to identify contributing factors behind the second-victim phenomenon and enduring symptoms that make nurses vulnerable to becoming second victims of medication incidents. IMPACT: This study addresses the aftermath effect of medication errors from the perspective of nurses involved with such incidents. It provides valuable insights for healthcare managers and nurse leaders to establish a just and blame-free culture in healthcare organizations and help emotionally traumatized nurses cope effectively after error. REPORTING METHOD: The research adheres to Consolidated criteria for reporting qualitative research (COREQ) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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AIM: To systemically identify and synthesize information on health professionals' and students' perceptions regarding the development needs of incident reporting software. DESIGN: A systematic review of qualitative studies. DATA SOURCES: A database search was conducted using Medline, CINAHL, Scopus, Web of Science and Medic without time or language limits in February 2023. REVIEW METHODS: A total of 4359 studies were identified. Qualitative studies concerning the perceptions of health professionals and students regarding the development needs of incident reporting software were included, based on screening and critical appraisal by two independent reviewers. A thematic synthesis was conducted. RESULTS: From 10 included studies, five analytical themes were analysed. Health professionals and students desired the following improvements or changes to incident reporting software: (1) the design of reporting software, (2) the anonymity of reporting, (3) the accessibility of reporting software, (4) the classification of fields and answer options and (5) feedback and tracking of reports. Wanted features included suitable reporting forms for various specialized fields that could be integrated into existing hospital information systems. Rapid, user-friendly reporting software using multiple reporting platforms and with flexible fields and predefined answer options was preferred. While anonymous reporting was favoured, the idea of reporting serious incidents with both patient and reporter names was also suggested. CONCLUSION: Health professionals and students provided concrete insights into the development needs for reporting software. Considering the underreporting of healthcare cases, the perspectives of healthcare professionals must be considered while developing user-friendly reporting tools. Reporting software that facilitates the reporting process could reduce underreporting. REPORTING METHOD: The ENTREQ reporting guideline was used to support the reporting of this systematic review. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution. PROTOCOL REGISTRATION: The protocol is registered in the International Prospective Register of Systematic Reviews with register number CRD42023393804.
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Pesquisa Qualitativa , Gestão de Riscos , Software , Humanos , Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologiaRESUMO
AIM: To investigate nurses' and other users' perceptions and knowledge regarding patient safety incident reporting software and incident reporting. DESIGN: A cross-sectional online survey. METHODS: The survey, 'The Users' Perceptions of Patient Safety Incident Reporting Software', was developed and used for data collection January-February 2024. We aimed to invite all potential users of reporting software in two wellbeing service counties in Finland to participate in the survey. Potential users (reporters/handlers/others) were nurses, other health professionals and employees. Satisfaction was classified as dissatisfied, neutral, or satisfied. The association between overall satisfaction and demographics was tested using cross-tabulation and a Chi-square test. RESULTS: The completion rate was 54% (n = 755). Some respondents (n = 25) had never used reporting software, most often due to no perceived need to report, although their average work experience was 15 years. Of other respondents (n = 730), mostly nurses (n = 432), under half agreed that the software was quick to use and easy to navigate. The biggest dissatisfaction was with the report processing features. Over a fifth did not trust that reporting was anonymous. Training and frequency of using the software were associated with overall satisfaction. CONCLUSION: Reporting software has not reached its full potential and needs development. Report handling is essential for shared learning; however, the processing features require the most improvements. Users' perceptions must be considered when developing reporting software and processes. IMPACT: Incident reporting software usability is central to reporting, but nurses' and other users' perceptions of software are poorly understood. This survey shows weaknesses in reporting software and emphasizes the importance of training. The survey can contribute to paying more attention to organizing training, getting users to participate in software development, and deepening knowledge of issues in reporting software. Making the needed improvements could improve patient safety. REPORTING METHOD: The STROBE Checklist (Supplement-S1). PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.
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AIM: To describe the contributing factors and types of reported medication incidents in home care related to the flow of information in different phases of the medication process, as reported by multi-professional healthcare groups. DESIGN: This descriptive, qualitative study used retrospective data. METHODS: An incident-reporting database was used to collect 14,289 incident reports from 2017 to 2019 in a city in Finland. We used this data to select medication incidents (n = 1027) related to the flow of information in home care and between home care and hospitals. Data were divided into five groups based on the medication phase: (1) prescribing, (2) dispensing, (3) administration, (4) documentation and (5) self-administration. In addition, the types of medication-related incidents were described. The data were examined using abductive content analysis. The EQUATOR SRQR checklist was used in this report. RESULTS: Four main categories were identified from the data: (1) issues related to information management, (2) cooperation issues between different actors, (3) work environment and lack of resources and (4) factors related to healthcare workers. Cooperation issues contributed to medication-related incidents during each phase. Incomplete communication was a contributing factor to medication incidents. This occurred between home care, remote care, hospital, the client and the client's relatives. Specifically, a lack of information-sharing occurred in repatriation situations, where care transitioned between different healthcare professionals. CONCLUSION: Healthcare professionals, organisations, clients and their relatives should focus on the efficient and safe acquisition of medications. Specifically, the use of electronic communication systems, together with oral reports and checklists for discharge situations, and timely cooperation with pharmacists should be developed to manage information flows. RELEVANCE TO CLINICAL PRACTICE: These findings demonstrate that healthcare professionals require uniform models and strategies to accurately and safely prescribe, dispense and administer medications in home care settings. No patient or public contributions.
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Erros de Medicação , Gestão de Riscos , Humanos , Estudos Retrospectivos , Hospitais , Pessoal de SaúdeRESUMO
BACKGROUND: Pandemics such as COVID-19 pose threats to the physical safety of healthcare workers and students. They can have traumatic experiences affecting their personal and professional life. Increasing rates of burnout, substance abuse, depression, and suicide among healthcare workers have already been identified, thus making mental health and psychological wellbeing of the healthcare workers a major issue. The aim of this systematic review is to synthesize the characteristics of emotional support programs and interventions targeted to healthcare workers and students since the onset of COVID-19 and other SARS-CoV pandemics and to describe the effectiveness and experiences of these programs. METHOD: This was a mixed method systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the review was registered on PROSPERO [CRD42021262837]. Searches were conducted using Medline, CINAHL, PsycINFO, Cochrane Library, and Scopus databases. The COVIDENCE systematic review management system was used for data selection and extraction by two independent reviewers. The JBI (Joanna Briggs Institute) critical appraisal tools were used to assess the quality of selected studies by two additional reviewers. Finally, data extraction and narrative analysis were conducted. RESULTS: The search retrieved 3161 results including 1061 duplicates. After screening, a total of 19 articles were included in this review. Participants in studies were nurses, physicians, other hospital staff, and undergraduate medical students mostly working on the front-line with COVID-19 patients. Publications included RCTs (n = 4), quasi-experimental studies (n = 2), cross-sectional studies (n = 6), qualitative interview studies (n = 3), and systematic reviews (n = 4). Most (63.4%) of the interventions used online or digital solutions. Interventions mostly showed good effectiveness (support-seeking, positive emotions, reduction of distress symptoms etc.) and acceptance and were experienced as helpful, but there were some conflicting results. CONCLUSION: Healthcare organizations have developed support strategies focusing on providing emotional support for these healthcare workers and students, but it is difficult to conclude whether one program offers distinct benefit compared to the others. More research is needed to evaluate the comparative effectiveness of emotional support interventions for health workers.
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COVID-19 , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Humanos , COVID-19/epidemiologia , Pandemias/prevenção & controle , Estudos Transversais , Pessoal de Saúde , Adaptação Psicológica , EstudantesRESUMO
AIMS: To describe nurse managers' perceptions of interventions to support nurses as second victims of patient safety incidents and to describe the management of interventions and ways to improve them. DESIGN: A qualitative study using interviews. METHODS: A purposive sample of nurse managers (n = 16) recruited from three hospital districts in Finland was interviewed in 2021. The data were analysed using elements of inductive and deductive content analysis. RESULTS: The study identified three main categories: (1) Management of second victim support, which contained three sub-categories related to the nurse manager's role, support received by the nurse manager and challenges of support management; (2) interventions to support second victims included existing interventions and operating models; and (3) improving second victim support, based on the sub-categories developing practices and developing an open and non-blaming patient safety culture. CONCLUSION: Nurse managers play a crucial role in supporting nurses as second victims of patient safety incidents and coordinating additional support. Operating models for managing interventions could facilitate nurse managers' work and ensure adequate support for second victims. The support could be improved by increasing the awareness of the second victim phenomenon. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Mitigating the harmful effects of patient safety incidents can improve nurses' well-being, reduce burden and attrition risks and positively impact patient safety. IMPACT: Increasing awareness of the second victim phenomenon and coherent operation models would provide equal support for the nurses and facilitate nurse managers' work. REPORTING METHOD: COREQ checklist was used. What does this paper contribute to the wider global clinical community? Nurse managers' role is significant in supporting the second victims and coordinating additional support. Awareness of the second victim phenomenon and coherent operating models can secure adequate support for the nurses and facilitate nurse managers' work.
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AIM: The aim of the study was to describe the alleged abuse of social care clients committed by nurses and other social services employees and actions as well as sanctions that followed the alleged abuse. DESIGN: A retrospective study using a descriptive qualitative analysis. METHODS: The data comprised mandatory reports made by social service employees under the Social Welfare Act. This study focused on the reported abuses of clients (n = 75) by social services employees from 11 October 2016 to 31 December 2020 in Finland. The data were analysed using inductive content analysis and quantification. RESULTS: The majority of the reports were submitted practical nurses and other nursing personnel and by registered nurses. The severity of the abuse was most often mild or moderate. The most common abusers were nurses. The types of alleged abuse committed by professionals were as follows: (1) neglect of care, (2) physical violence/strong-arm treatments, (3) neglect of hygiene, (4) inappropriate or threatening behaviour and (5) sexual abuse. The actions and sanctions that followed the alleged abuse were: (1) discussing the situation together, requesting an explanation, initiating hearing or defining developmental measures, (2) initiating disciplinary actions and providing verbal or written warnings, (3) dismissing or terminating the employee and (4) initiating a police investigation. CONCLUSION: Nurses are an important group working in social services and might also be involved in cases of abuse. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: It is important that risks, wrongdoings and abuses are reported. Transparent reporting indicates strong professional ethics. IMPACT: Knowledge about abuse in social services from the viewpoint of nursing is important for ensuring the quality and safety of services. REPORTING METHOD: The Standards for Reporting Qualitative Research guideline was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
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Enfermeiras e Enfermeiros , Apoio Social , Humanos , Estudos Retrospectivos , Agressão , Serviço SocialRESUMO
BACKGROUND: Increasing number of nurse prescribers could be part of a solution to the shortage of physicians, improve access to treatment and curb the rise in healthcare costs; however, readmissions after nurse prescribers' appointments are under-researched. AIMS: To describe and compare clients' initial appointments with nurse prescribers and physicians. In addition, client readmissions within 60 days in the target organisation after nurse prescribers' and physicians' appointments were investigated. DESIGN: Retrospective register-based follow-up study. METHODS: Data included client appointments (n = 3986) with nurse prescribers and physicians, and clients' readmissions (n = 9038) from 1 January 2018 to 31 December 2019 from one hospital district in Finland. Data were analysed statistically using frequencies, percentages, rate ratios and cross-tabulation. STROBE checklist was used. RESULTS: Initial appointments including trimethoprim, pivmecillinam, phenoxymethyl penicillin, chloramphenicol, fusidic acid and cephalexin prescriptions with nurse prescribers (n = 36) were 2131, and physicians (n = 140) 1855. On average, client readmissions (within 60 days) per initial appointment were 2.10 after appointments with nurse prescribers and 2.46 after physicians. After initial appointments, including phenoxymethyl penicillin prescriptions, with nurse prescribers, clients had more readmissions in all age groups than after initial appointments with physicians. However, in all, after initial appointments with physicians, clients had a higher proportion of readmissions. CONCLUSION: Clients have fewer readmissions after appointments with nurse prescribers than physicians, including the same prescriptions. Nurse prescribers' skills may not have been fully utilised. Physicians treated many patients whose diseases nurse prescribers might have been able to treat based on the nurse prescribers' rights. However, physician clients may have more demanding service requirements.
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Readmissão do Paciente , Penicilina V , Humanos , Estudos Retrospectivos , Seguimentos , Prescrições de MedicamentosRESUMO
BACKGROUND: Communication challenges are one of the main contributors for medication incidents in hospitals, but health professionals' perceptions about variety of the contributing communication factors and the factors' occurrence frequencies are studied little. This cross-sectional descriptive study aimed to (1) operationalize a literature-based framework into a scale for measuring health professionals' perceptions of communication factors, which contribute to medication incidents either directly or indirectly in hospitals, (2) to measure the construct validity and internal consistency of the scale and (3) to describe the primary results of the measured weekly perceived communication challenges. METHODS: The structured online questionnaire with 82 communication related items was developed based on a framework in literature. A content validity index of expert panelists' answers was used for item reduction. Data was collected between November 1st, 2019, and January 31st, 2020, by convenience sampling. The study sample (n = 303) included multiple health professional groups in diverse specialties, unit types and organizational levels in two specialized university hospital districts in Finland. Exploratory factor analysis with Maximum Likelihood method and Oblique rotation produced a six factors scale consisting of 57 items and having acceptable construct validity and internal consistency. RESULTS: The six communication factors contributing to medication incidents concerned (1) medication prescriptions, (2) guidelines and reporting, (3) patient and family, (4) guideline implementation,5) competencies and responsibilities, and 6) attitude and atmosphere. The most frequently perceived communication challenges belonged to the Medication prescription related factor. Detailed item frequencies suggested that the most usual weekly challenges were: (1) lack or unclarity of communication about medication prescriptions, (2) missing the prescriptions which were written outside of the regular physician-ward-rounds and (3) digital software restricting information transfer. CONCLUSIONS: The scale can be used for determining the most frequent detailed communication challenges. Confirmatory factor analysis of the scale is needed with a new sample for the scale validation. The weekly perceived communication challenges suggest that interventions are needed to standardize prescribing documentation and to strengthen communication about prescriptions given outside of regular ward-rounds.
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The aim of this integrative literature review is to describe the information provided to patients with psychotic disorders regarding their medication and to consider the effectiveness of providing such information. Searches of four databases identified 16 articles that met inclusion criteria. Results indicated that patients had relatively poor knowledge about their medications overall. Knowledge about side effects was found to improve significantly following education, with better knowledge leading to positive patient outcomes including increased adherence. Findings offer a comprehensive description of antipsychotic medication information provided to patients and an indication of the positive impact of information provision.
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Antipsicóticos , Transtornos Psicóticos , Humanos , Antipsicóticos/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Adesão à MedicaçãoRESUMO
BACKGROUND: Medication errors regardless of the degree of patient harm can have a negative emotional impact on the healthcare staff involved. The potential for self-victimization of healthcare staff following medication errors can add to the moral distress of healthcare staff. The stigma associated with errors and their disclosure often haunts healthcare professionals, leading them to question their own professional competence. This paper investigates the negative emotions expressed by healthcare staff in their reported medication administration error incidents along with the immediate responses they received from their seniors and colleagues after the incident. METHOD: This is a retrospective study using a qualitative descriptive design and text mining. This study includes free-text descriptions of medication administration error incidents (n = 72,390) reported to National Reporting & Learning System in 2016 from England and Wales. Text-mining by SAS text miner and content analysis was used to analyse the data. RESULTS: Analysis of data led to the extraction of 93 initial codes and two categories i.e., 1) negative emotions expressed by healthcare staff which included 4 sub-categories of feelings: (i) fear; (ii) disturbed; (iii) sadness; (iv) guilt and 2) Immediate response from seniors and colleagues which included 2 sub-categories: (i) Reassurance and support and (ii) Guidance on what to do after an error. CONCLUSION: Negative emotions expressed by healthcare staff when reporting medication errors could be a catalyst for learning and system change. However, negative emotions when internalized as fear, guilt, or self-blame, could have a negative impact on the mental health of individuals concerned, reporting culture, and opportunities for learning from the error. Findings from this study, hence, call for future research to investigate the impact of negative emotions on healthcare staff well-being and identify ways to mitigate these in practice.
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Mineração de Dados , Instalações de Saúde , Humanos , Estudos Retrospectivos , Emoções , Atenção à SaúdeRESUMO
AIMS: (1) To identify and analyse the conceptual framework and operationalise the concept of communication issues related to medication incidents in hospital to facilitate the development of a future tool for measuring frequencies of the communication issues. (2) To determine how the concept is distinct from related concepts. DESIGN: Concept analysis. DATA SOURCES: Twenty-three articles from seven scientific databases covering the years 2010-2020 and two official documents. METHODS: Walker and Avant's concept analysis method was used. That was started by a systematised literature review on 2 November 2020 using specified criteria. Two authors evaluated articles' quality by Joanna Brigg's Institute's criteria. Literature review results were analysed deductive-inductively; conceptual framework was developed and concept defined presenting case scenarios. EQUATOR's standards were used in study reporting. RESULTS: A conceptual framework and the concept of 'communication related to medication incidents in hospitals' were defined, comprising six main attribute categories: (1) communication dyads involved in communication, (2) patients' or professionals' individual issues, (3) institutional, (4) contextual and process issues, (5) communication concerning medication prescriptions and (6) qualitative characteristics of communication. The categories consisted of 128 quantitatively measurable and 10 qualitative attributes describing communication issues. The concept is distinct from related concepts by collating fragmented communication issues into the same concept. CONCLUSION: The 128-item conceptual framework and the concept of communication related to medication incidents in hospitals were defined, as there was not one. The concept assembled parts of previous theories and fragmented information to one entity. The concept needs further condensing and validation to develop a tool for measuring communication issues. IMPACT ON MEDICATION SAFETY: The conceptual framework can be used in practice and education as indicative rationale for reflection of current communication issues. The concept contributes to research by providing necessary grounding for tool development for measuring communication factors relating medication incidents.
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Comunicação , HumanosRESUMO
BACKGROUND: Communication challenges contribute to medication incidents in hospitals, but it is unclear how communication can be improved. The aims of this study were threefold: firstly, to describe the most common communication challenges related to medication incidents as perceived by healthcare professionals across specialized hospitals for adult patients; secondly, to consider suggestions from healthcare professionals with regard to improving medication communication; and thirdly, to explore how text mining compares to manual analysis when analyzing the free-text content of survey data. METHODS: This was a cross-sectional, descriptive study. A digital survey was sent to professionals in two university hospital districts in Finland from November 1, 2019, to January 31, 2020. In total, 223 professionals answered the open-ended questions; respondents were primarily registered nurses (77.7 %), physicians (8.6 %), and pharmacists (7.3 %). Text mining and manual inductive content analysis were employed for qualitative data analysis. RESULTS: The communication challenges were: (1) inconsistent documentation of prescribed and administered medication; (2) failure to document orally given prescriptions; (3) nurses' unawareness of prescriptions (given outside of ward rounds) due to a lack of oral communication from the prescribers; (4) breaks in communication during care transitions to non-communicable software; (5) incomplete home medication reconciliation at admission and discharge; (6) medication lists not being updated during the inpatient period due to a lack of clarity regarding the responsible professional; and (7) work/environmental factors during medication dispensation and the receipt of verbal prescriptions. Suggestions for communication enhancements included: (1) structured digital prescriptions; (2) guidelines and training on how to use documentation systems; (3) timely documentation of verbal prescriptions and digital documentation of administered medication; (4) communicable software within and between organizations; (5) standardized responsibilities for updating inpatients' medication lists; (6) nomination of a responsible person for home medication reconciliation at admission and discharge; and (7) distraction-free work environment for medication communication. Text mining and manual analysis extracted similar primary results. CONCLUSIONS: Non-communicable software, non-standardized medication communication processes, lack of training on standardized documentation, and unclear responsibilities compromise medication safety in hospitals. Clarification is needed regarding interdisciplinary medication communication processes, techniques, and responsibilities. Text mining shows promise for free-text analysis.
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Comunicação , Mineração de Dados , Adulto , Estudos Transversais , Atenção à Saúde , Humanos , PercepçãoRESUMO
AIMS: The aim of this review was to identify methods for measuring Registered Nurses' medication administration skills and to describe these skills. DESIGN: A systematic literature review. DATA SOURCES: The CINAHL, PubMed, Scopus, Cochrane, PsycInfo and Medic databases were searched for articles from the period 2007-2018. REVIEW METHODS: Two researchers independently selected the articles and evaluated their quality using the National Heart, Lung and Blood Institute study quality assessment tools. The data were analysed using content analysis. RESULTS: A total of 727 studies were identified of which 22 studies were included in this review. A total of six different measurement methods were identified: questionnaire or survey, observation, knowledge test or exam, focus group interviews, chart reviews and voluntarily reported errors. Different methods provided different information on medication administration skills. Medication administration skills were classified under nine areas: (1) safe ordering, handling, storing and discarding of medications, (2) preparing of medications, (3) the administration of medications to patients, (4) documentation, (5) evaluation and assessment of medication-related issues, (6) drug calculation skills, (7) cooperation with other professionals and (8) with the patients and (9) reporting of medication information. The results demonstrated that there are many areas that need to be improved to increase medication safety. CONCLUSIONS: Medication administration includes many different phases, as a result of which nurses need to have many various skills to cope with medication administration as required by their profession. This review shows that nurses' medication administration skills need to be developed, and special attention should be paid to the preparation and administration phases. It is important to regularly utilise different teaching strategies and verify nurses' medication competence. As each research method has different limitations, it is vital that further studies combine different methods to form a comprehensive picture of nurses' medication administration skills.
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Enfermeiras e Enfermeiros , Preparações Farmacêuticas , Competência Clínica , HumanosRESUMO
PURPOSE: (a) To describe trigger terms that can be used to identify reports of inadequate staffing contributing to medication administration errors, (b) to identify such reports, (c) to compare the degree of harm within incidents with and without those triggers, and (d) to examine the association between the most commonly reported inadequate staffing trigger terms and the incidence of omission errors and "no harm" terms. DESIGN AND SETTING: This was a retrospective study using descriptive statistical analysis, text mining, and manual analysis of free text descriptions of medication administration-related incident reports (N = 72,390) reported to the National Reporting and Learning System for England and Wales in 2016. METHODS: Analysis included identifying terms indicating inadequate staffing (manual analysis), followed by text parsing, filtering, and concept linking (SAS Text Miner tool). IBM SPSS was used to describe the data, compare degree of harm for incidents with and without triggers, and to compare incidence of "omission errors" and "no harm" among the inadequate staffing trigger terms. FINDINGS: The most effective trigger terms for identifying inadequate staffing were "short staffing" (n = 81), "workload" (n = 80), and "extremely busy" (n = 51). There was significant variation in omission errors across inadequate staffing trigger terms (Fisher's exact test = 44.11, p < .001), with those related to "workload" most likely to accompany a report of an omission, followed by terms that mention "staffing" and being "busy." Prevalence of "no harm" did not vary statistically between the trigger terms (Fisher's exact test = 11.45, p = 0.49), but the triggers "workload," "staffing level," "busy night," and "busy unit" identified incidents with lower levels of "no harm" than for incidents overall. CONCLUSIONS: Inadequate staffing levels, workload, and working in haste may increase the risk for omissions and other types of error, as well as for patient harm. CLINICAL RELEVANCE: This work lays the groundwork for creating automated text-analytical systems that could analyze incident reports in real time and flag or monitor staffing levels and related medication administration errors.
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Mineração de Dados/métodos , Erros de Medicação/prevenção & controle , Erros de Medicação/estatística & dados numéricos , Admissão e Escalonamento de Pessoal , Coleta de Dados/métodos , Inglaterra/epidemiologia , Mão de Obra em Saúde , Humanos , Qualidade da Assistência à Saúde , Projetos de Pesquisa , Estudos Retrospectivos , Gestão de Riscos/organização & administração , País de Gales/epidemiologia , Carga de TrabalhoRESUMO
AIMS: To describe the characteristics of medication administration (MA) incidents reported to have occurred in patients' own homes (reporters' profession, incident types, contributing factors, patient consequence, and most common medications involved) and to identify the connection terms related to the most common contributing factors based on free text descriptions. DESIGN: A retrospective study using descriptive statistical analysis and text mining. METHODS: Medication administration incidents (N = 19,725) reported to have occurred in patients' homes between 2013-2018 in one district in Finland were analysed, describing the data by the reporters' occupation, incident type, contributing factors, and patient consequence. SAS® Text Miner was used to analyse free text descriptions of the MA incidents to understand contributing factors, using concept linking. RESULTS: Most MA incidents were reported by practical (lower level) nurses (77.8%, N = 15,349). The most common category of harm was 'mild harm' (40.1%, N = 7,915) and the most common error type was omissions of drug doses (47.4%, N = 9,343). The medications most commonly described were Marevan [warfarin] (N = 2,668), insulin (N = 811), Furesis [furosemide] (N = 590), antibiotic (N = 446), and Panadol [paracetamol] (N = 416). The contributing factors most commonly reported were 'communication and flow of information' (25.5%, N = 5,038), 'patient and relatives' (22.6%, N = 4,451), 'practices' (9.9%, N = 1,959), 'education and training' (4.8%, N = 949), and 'work environment and resources' (3.0%, N = 598). CONCLUSION: There is need for effective communication and clear responsibilities between home care patients and their relatives and health providers, about MA and its challenges in home environments. Knowledge and skills relating to safe MA are also essential. IMPACT: These findings about MA incidents that have occurred in patients' homes and have been reported by home care professionals demonstrate the need for medication safety improvement in home care.
Assuntos
Erros de Medicação , Preparações Farmacêuticas , Mineração de Dados , Finlândia , Humanos , Estudos Retrospectivos , Gestão de RiscosRESUMO
AIM: To identify the types and frequencies of communication issues (communication pairs, person related, institutional, structural, process and prescription-related issues) detected in medication incident reports and to compare communication issues that caused moderate or serious harm to patients. BACKGROUND: Communication issues have been found to be among the main contributing factors of medication incidents, thus necessitating communication enhancement. DESIGN: A sequential exploratory mixed-method design. METHODS: Medication incident reports from Finland (n = 500) for the year 2015 in which communication was marked as a contributing factor were used as the data source. Indicator phrases were used for searching communication issues from free texts of incident reports. The detected issues were analysed statistically, qualitatively and considering the harm caused to the patient. Citations from free texts were extracted as evidence of issues and were classified following main categories of indicator phrases. The EQUATOR's SRQR checklist was followed in reporting. RESULTS: Twenty-eight communication pairs were identified, with nurse-nurse (68.2%; n = 341), nurse-physician (41.6%; n = 208) and nurse-patient (9.6%; n = 48) pairs being the most frequent. Communication issues existed mostly within unit (76.6%, n = 383). The most commonly identified issues were digital communication (68.2%; n = 341), lack of communication within a team (39.6%; n = 198), false assumptions about work processes (25.6%; n = 128) and being unaware of guidelines (25.0%; n = 125). Collegial feedback and communication from patients and relatives were the preventing issues. Moderate harm cases were often linked with lack of communication within the unit, digital communication and not following guidelines. CONCLUSIONS: The interventions should be prioritised to (a) enhancing communication about work-processes, (b) verbal communication about digital prescriptions between professionals, (c) feedback among professionals and (f) encouraging patients to communicate about medication. RELEVANCE TO CLINICAL PRACTICE: Upon identifying the most harmful and frequent communication issues, interventions to strengthen medication safety can be implemented.
Assuntos
Relações Interprofissionais , Erros de Medicação/prevenção & controle , Gestão de Riscos/métodos , Finlândia , Humanos , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Pesquisa QualitativaRESUMO
AIM: To describe medication safety, transformational leadership and their relationship as evaluated by Registered Nurses. BACKGROUND: Medication safety is one of the aspects of patient safety and an important part of nurses' daily practices. Nurse managers can ensure medication safety by adopting a transformational leadership style. However, little evidence exists regarding how transformational leadership relates to medication safety. METHODS: Data were collected from Registered Nurses (n = 161) in three Finnish hospitals in May 2016 using an electronic questionnaire incorporating the Transformational Leadership Scale (TLS) and Medication Safety Scale (MSS). Data were analysed using statistical analyses including descriptive analyses, principal component analysis and multivariate analyses. STROBE reporting guidelines were followed (see Appendix S1). FINDINGS: Nurses evaluated medication safety and transformational leadership in their units to be excellent and good, respectively. There was a moderate but statistically significant correlation between transformational leadership and medication safety. The medication competence of nurses and the management of nursing processes were significantly related to medication safety. CONCLUSIONS: Nurse managers' transformational leadership style can promote medication safety in units. The medication competence of nurses must be addressed because assurance and confidence in their own expertise in pharmacotherapeutic tasks positively affects their perceptions of medication safety.