RESUMEN
Background: Medical errors occur frequently, yet they are often under-reported and strategies to increase the reporting of medical errors are lacking. In this work, we detail how a level 1 trauma center used a secure messaging application to track medical errors and enhance its quality improvement initiatives. Methods: We describe the formulation, implementation, evolution, and evaluation of a chatroom integrated into a secure texting system to identify performance improvement and patient safety (PIPS) concerns. For evaluation, we used descriptive statistics to examine PIPS reporting by the reporting method over time, the incidence of mortality and unplanned ICU readmissions tracked in the hospital trauma registry over the same, and time-to-loop closure over the study period to quantify the impact of the processes instituted by the PIPS team. We also categorized themes of reported events. Results: With the implementation of a PIPS chatroom, the number of events reported each month increased and texting became the predominant way for users to report trauma PIPS events. This increase in PIPS reporting did not appear to be accompanied by an increase in mortality and unplanned ICU readmissions. The PIPS team also improved the tracking and timely resolution of PIPS events and observed a decrease in time-to-loop closure with the implementation of the PIPS chatroom. Conclusions: The adoption of clinical texting as a way to report PIPS events was associated with increased reporting of such events and more timely resolution of concerns regarding patient safety and healthcare quality.
RESUMEN
Aneurysmal subarachnoid hemorrhage (aSAH) caused by a ruptured aneurysm is a devastating event that can lead to severe disability or death. Although published guidelines on the management of aSAH exist, research is limited regarding the role of nursing in the care of aSAH patients. The purpose of this study was to describe the interventions and assessments that nurses provide while caring for aSAH patients in the critical care setting. A mixed methods design was utilized for this study. Individual interview sessions with 10 neurocritical care nurses were completed and transcribed verbatim. The transcripts were analyzed and categorized using a predetermined code list based on a theoretical framework derived from the work of McNett and Giankis. The predetermined code list included four areas: (a) neurophysiological, (b) psychosocial, (c) injury prevention, and (d) maintaining therapeutic milieu. Frequencies were also computed based on an investigator-developed questionnaire to identify the most common interventions and assessments. The qualitative data supported the four main areas in the predetermined code list. The neurophysiological theme focused on blood pressure management and detailed neurological exams. The psychosocial theme addressed education, support, and communication. The injury prevention theme involved repositioning and reorienting/distracting the patients. The theme of maintaining a therapeutic milieu focused on decreasing the patients' stimulation. An additional theme emerged and was labeled, "Giving the Patient a Chance." Quantitative data revealed that neurophysiological and psychosocial interventions were most frequent. Nurses are responsible for the complex care of aSAH patients and their families and must implement a variety of nursing interventions and assessments. Further research is needed to identify the impact of these interventions and assessments on the outcome of aSAH patients while in the critical care setting.
