Readmissions after appointments with nurse prescribers: A register-based study.

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.

Differences between professionals' views on patient safety culture in long-term and acute care? A cross-sectional study.

PURPOSE: This paper aims to assess how patient safety culture and incident reporting differs across different professional groups and between long-term and acute care. The Hospital Survey On Patient Safety Culture (HSPOSC) questionnaire was used to assess patient safety culture. Data from the organizations' incident reporting system was also used to determine the number of reported patient safety incidents. DESIGN/METHODOLOGY/APPROACH: Patient safety culture is part of the organizational culture and is associated for example to rate of pressure ulcers, hospital-acquired infections and falls. Managers in health-care organizations have the important and challenging responsibility of promoting patient safety culture. Managers generally think that patient safety culture is better than it is. FINDINGS: Based on statistical analysis, acute care professionals' views were significantly positive in 8 out of 12 composites. Managers assessed patient safety culture at a higher level than other professional groups. There were statistically significant differences (p = 0.021) in frequency of events reported between professional groups and between long-term and acute care (p = 0.050). Staff felt they did not get enough feedback about reported incidents. ORIGINALITY/VALUE: The study reveals differences in safety culture between acute care and long-term care settings, and between professionals and managers. The staff felt that they did not get enough feedback about reported incidents. In the future, education should take these factors into consideration.

Action after Adverse Events in Healthcare: An Integrative Literature Review.

Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009-2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed.

Problems with incident reporting: Reports lead rarely to recommendations.

AIM AND OBJECTIVE: To analyse trends in incident reporting over the last 5 years and determine how many reports led to recommendations? BACKGROUND: Patient safety incident reporting systems have been used in health care for years. However, they have a significant weakness in that reports often do not lead to any visible action. DESIGN: The study is a retrospective register study. STROBE checklist was applied in the preparation of the paper. METHODS: Data were collected from a web-based incident reporting database (HaiPro) for a social- and healthcare organisation in Finland, covering the period from 2011-2015. RESULTS: In total, 16,019 incident reports were analysed. In 2.7% (n = 426) of all reports, there was written recommendation to develop action that such incidents would not happen again. Those reports were classified into seven categories: education, introduction and information, introduction to work, patient care, guidelines, instruments and IT programmes, and the physical environment. CONCLUSIONS: Managers get major amount incident reports. There should be (a) a definition what kind of events should be reported, (b) a definition for how serious events managers have to make a recommendation and (c) control that recommendations are implemented. RELEVANCE TO CLINICAL PRACTICE: There is a need for more action to promote patient safety based on incident reports.

How transformational leadership appears in action with adverse events? A study for Finnish nurse manager.

AIM: The aim of this study was to determine whether elements of transformational leadership are present in nursing managers' actions following adverse events. BACKGROUND: Transformational leadership exerts a positive influence on organisational culture and patient safety. METHOD: Eleven nursing managers were interviewed individually using a semi-structured format. Data were analysed using inductive content analysis. RESULTS: Four themes emerged relating to nursing managers' actions following adverse events: patient-centredness as a principle for common action, courage to reform operational models to prevent future adverse events, nursing staff's encouragement of open and blame-free discussion, and challenge to recognize adverse events. CONCLUSION: Nursing managers must understand their responsibilities and the importance of making it clear to staff that patient-centredness should be evident in all health care actions. Nursing managers must also recognize the need to ensure that staff treat patients' interests as the top priority. IMPLICATIONS FOR NURSING MANAGEMENT: If an adverse event occurs, the situation should be discussed with the nursing staff and any unique aspects of the event must be accounted for. Nursing managers must have the skill to motivate and empower staff to find new ways to work, to prevent adverse events and to promote patient safety.

What do nursing students learn about patient safety? an integrative literature review.

Preventing adverse events and enhancing patient safety in health care are key objectives of nursing education. This integrative literature review critically appraises the content of patient safety in prelicensure nursing education, the teaching and learning methods used, and subsequent nursing student learning. The studies (N = 20) reviewed reveal that patient safety in nursing curricula was not necessarily obvious. However, patient safety was taught within both academic settings and clinical environments. The identified content of patient safety was learning from errors, responsible individual and interprofessional team working, anticipatory action in complex environments, and patient safety-centered nursing. The teaching and learning methods used included combining multiple methods. Patient safety curricula included continuing improvement in patient safety competency, sensitivity to nursing students' role, and having a supportive learning environment. Patient safety in the nursing curriculum requires broad, comprehensive attention and development as a specific theme with an interprofessional approach.