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2.
Stud Health Technol Inform ; 264: 1159-1163, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438107

RESUMO

Patient safety is a critical component of health care services; however, it has beent mostly conceptualized for the hospital sector. As home health care expands, it is important to examine the concept of patient safety in the home and identify opportunity for personal health information management (PHIM) tools to support and maximize patient safety. The goal of this study is to explore how PHIM can be a facilitator for patient safety in the home. We explore a comprehensive framework of patient safety in the home and identify the role of PHIM in this context. We analyzed the coded transcripts of in-depth interviews with 88 older adults (60 year and older), 56 family members or informal caregivers and 27 clinicians. Findings demonstrate the physical, emotional, social and functional dimensions of patient safety in the home and concrete ways for informatics tools to maximize safety aspects.


Assuntos
Gestão da Informação em Saúde , Registros de Saúde Pessoal , Serviços de Assistência Domiciliar , Cuidadores , Humanos , Pessoa de Meia-Idade , Segurança do Paciente
3.
Stud Health Technol Inform ; 264: 1847-1848, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438373

RESUMO

In Taiwan, the safety of intra-hospital patient transportation (IHT) is an important issue of patient safety. However, the effects on the quality of patient transportation and the results of patient safety in applying informatics and communication technology were less discussed. The purpose of this study is aimed to understand the current status of IHT events through the patient transportation management system as a reference for further improving the IHT quality.


Assuntos
Tecnologia da Informação , Transporte de Pacientes , Hospitais , Humanos , Segurança do Paciente , Taiwan , Transportes
4.
Stud Health Technol Inform ; 264: 983-987, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438071

RESUMO

Despite U.S. federal agencies increasing their investment since 1999's release of To Err Is Human, recent reports suggest there is a lack of measurable outcomes in patient safety research. The present study sought to explore the associations between federal incentives of patient safety research and the outcomes from 1995 to 2014, in which the two historical events - the release of To Err Is Human and the American Recovery and Reinvestment Act - were considered in the analysis. We employed Poisson distribution models to provide a longitudinal picture of (1) how the federal incentives drove sponsored research projects; (2) how hot research topics changed over time. Our findings suggested a positive outcome in patient safety research. We also found trending health information technology (HIT) related topics including "natural language processing", "user-computer interface", and "clinical decision support systems" that are prevalent approaches to patient safety research.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Segurança do Paciente , Órgãos Governamentais , Humanos , Estados Unidos
5.
Stud Health Technol Inform ; 264: 1714-1715, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438307

RESUMO

openEHR's Guideline Definition Language is designed for standardizing clinical decision support systems. In this study, we use Guideline Definition Language to represent patient safety rules in pre-operation of Percutaneous Coronary Intervention for the dynamic checklist system. After using Guideline Definition Language in this case, we had some results about its expression adaptability to requirements of patient safety rules.


Assuntos
Lista de Checagem , Sistemas de Apoio a Decisões Clínicas , Intervenção Coronária Percutânea , Fidelidade a Diretrizes , Humanos , Linguagem , Segurança do Paciente , Intervenção Coronária Percutânea/normas
6.
Rev Lat Am Enfermagem ; 27: e3167, 2019 Aug 19.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31432920

RESUMO

OBJECTIVE: analyze the safety culture of multidisciplinary teams from three neonatal intensive care units of public hospitals in Minas Gerais, Brazil. METHOD: a cross-sectional survey conducted with 514 health professionals, using the Hospital Survey on Patient Safety Culture; data were subjected to a descriptive statistical analysis in software R-3.3.2. RESULTS: the findings showed that none of the dimensions had a positive response score above 75% to be considered as a strength area. The dimension 'Nonpunitive response to error' was classified as a critical area of the patient safety culture, present in 55.45% of the responses. However, areas with potential for improvements were identified, such as 'Teamwork within units' (59.44%) and 'Supervisor/manager's expectations and actions to promote patient safety' (49.90%). CONCLUSION: none of the dimensions was considered as a strength area, which indicates safety culture has not been fully implemented in the evaluated units. A critical look at the weaknesses of the patient safety process is recommended in order to seek strategies for the adoption of a positive safety culture to benefit patients, family members and health professionals.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Adulto , Brasil , Estudos Transversais , Feminino , Hospitais Públicos/normas , Humanos , Unidades de Terapia Intensiva Neonatal/normas , Masculino , Cultura Organizacional , Equipe de Assistência ao Paciente/normas , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Gestão da Segurança/normas , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Carga de Trabalho/estatística & dados numéricos , Adulto Jovem
7.
J Nurs Adm ; 49(9): 418-422, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436739

RESUMO

The need for continuous observation (1:1) of patients for safety precautions, including fall risk, elopement risk, confusion, and aggressive behavior, is highly variable, and it is therefore difficult to plan accurate staffing levels. The high variability in determining when 1:1 staffing for safety is indicated, and for how long, leads to resource strain and high cost to the hospital. A multidisciplinary team analyzed current processes for assigning, monitoring, and discontinuing safety 1:1 care for nonsuicidal patients using Six Sigma methodologies. The team implemented a standardized weaning process to reduce the duration of time on continuous observation and a standardized 4-hour reassessment using a behavior observation-tracking tool to validate the continued need for 1:1 coverage. The interventions resulted in reducing average monthly safety 1:1 staffing hours by 25.6% and saving an estimated $142 000 annually across 6 units. Phase 2 of the project integrated the observation-tracking tool and reassessment check-in into the hospital's electronic medical record for improved tracking and documentation.


Assuntos
Monitoramento Ambiental/economia , Monitoramento Ambiental/métodos , Segurança do Paciente/economia , Gestão da Segurança/economia , Gestão da Segurança/organização & administração , Gestão da Qualidade Total/organização & administração , Eficiência Organizacional , Humanos , Pennsylvania , Projetos Piloto
8.
J Nurs Adm ; 49(9): 436-440, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436742

RESUMO

OBJECTIVE: The purpose of this study was to describe current practices for onboarding travel nurses (TRNs) and identify TRNs' specific onboarding needs. BACKGROUND: Onboarding must be streamlined and organized for TRNs to provide safe patient care. METHODS: Cross-sectional descriptive survey was used with 306 TRNs throughout United States who were recruited electronically from a closed social media group page. RESULTS: The TRNs identified critical information, including unit patient ratios, onboarding schedule 7 to 14 days before travel assignment start, and login IDs/accesses on day 1. Travel nurse onboarding and competency assessment checklists should be specific to the unit/facility where they will work. CONCLUSION: Findings from this study have the potential to support hospitals in the development of streamlined and tailored TRN onboarding to support regulatory compliance and patient safety as well as realize significant cost savings for TRN onboarding.


Assuntos
Capacitação em Serviço/organização & administração , Recursos Humanos de Enfermagem no Hospital/normas , Segurança do Paciente/normas , Seleção de Pessoal/normas , Admissão e Escalonamento de Pessoal/normas , Enfermagem de Viagem/estatística & dados numéricos , Enfermagem de Viagem/normas , Adulto , Estudos Transversais , Feminino , Previsões , Humanos , Capacitação em Serviço/tendências , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/tendências , Segurança do Paciente/estatística & dados numéricos , Seleção de Pessoal/tendências , Admissão e Escalonamento de Pessoal/tendências , Enfermagem de Viagem/tendências , Estados Unidos
9.
J Nurs Adm ; 49(9): 441-446, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436743

RESUMO

OBJECTIVE: This study uses Leader-Member Exchange theory to explore the associations between contact frequency (CF) of nurse leaders and their team members, leader-member relationship, and patient safety culture. BACKGROUND: Leader-member relationships are an important part of patient safety culture development. The behaviors of leaders to achieve these relationships are unknown. This study explores CF as a leader behavior to improve patient safety culture. METHODS: Cross-sectional survey of bedside nurses (N = 746) from an 8-hospital system. RESULTS: A significant association was found between relationship strength and patient safety culture; CF's effect on relationship and patient safety culture was demonstrated. CONCLUSION: Contact frequency may support relationships between leaders and members and improve patient safety culture on nursing units. Future studies should explore factors that could be enhancing and limiting CF.


Assuntos
Atitude do Pessoal de Saúde , Relações Interprofissionais , Enfermeiras Administradoras/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Segurança do Paciente/normas , Gestão da Segurança/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Adulto Jovem
11.
Am Surg ; 85(7): 747-751, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405421

RESUMO

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Admissão e Escalonamento de Pessoal/organização & administração , Adulto , Feminino , Cirurgia Geral/educação , Pesquisas sobre Serviços de Saúde , Humanos , Tempo de Internação , Masculino , Profissionais de Enfermagem , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Carga de Trabalho
12.
Medicine (Baltimore) ; 98(31): e16562, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374022

RESUMO

BACKGROUND: Distal radius fractures (DRFs) is one of the most common bone injuries in children, which may lead to deformity and other complications if the treatment is not prompt or appropriate. Splints external fixation is a common conservative treatment for such fractures. Therefore, we conducted a systematic review and meta-analysis to explore the efficacy, safety and cost benefits of splints in the treatment of DRFs in children. METHODS: PubMed, Web of Science, Embase, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov, Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Database, and VIP Database were searched for eligible randomized controlled trials (RCTs). The methodological quality of the included studies and the level of evidence for results were assessed, respectively, using the risk bias assessment tool of Cochrane and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. Statistical analysis was conducted with Revman 5.3. RESULTS: This study will analyze and integrate the existing evidence for effectiveness, safety and cost benefits of splints on DRFs in children. CONCLUSION: The conclusion of this study will provide evidence to effectiveness, safety and cost benefits of splints on DRFs in children, which can further guide the selection of appropriate interventions. PROSPERO REGISTRATION NUMBER: CRD42019123429.


Assuntos
Fraturas do Rádio/terapia , Contenções/efeitos adversos , Contenções/normas , Adolescente , Criança , Pré-Escolar , Humanos , Segurança do Paciente/normas , Pediatria/instrumentação , Pediatria/métodos , Fraturas do Rádio/economia , Contenções/economia
14.
Stud Health Technol Inform ; 264: 729-733, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438020

RESUMO

The review of pathology test results for missed diagnoses in Emergency Departments is time-consuming, laborious, and can be inaccurate. An automated solution, with text mining and clinical terminology semantic capabilities, was developed to provide clinical decision support. The system focused on the review of microbiology test results that contained information on culture strains and their antibiotic sensitivities, both of which can have a significant impact on ongoing patient safety and clinical care. The system was highly effective at identifying abnormal test results, reducing the number of test results for review by 92%. Furthermore, the system reconciled antibiotic sensitivities with documented antibiotic prescriptions in discharge summaries to identify patient follow-ups with a 91% F-measure - allowing for the accurate prioritization of cases for review. The system dramatically increases accuracy, efficiency, and supports patient safety by ensuring important diagnoses are recognized and correct antibiotics are prescribed.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Segurança do Paciente , Eficiência , Serviço Hospitalar de Emergência , Sistemas Especialistas , Humanos
15.
Stud Health Technol Inform ; 264: 753-757, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438025

RESUMO

Healthcare systems worldwide are investing in networked health IT systems that link healthcare providers across multiple organisations. Much of the policy arguments in favour of such investment rely on the assumption that networked health IT will lead to improved patient safety. As part of the first stage of a realist review to determine how and in what contexts networked, inter-organisational health IT does lead to improved patient safety, we elicited stakeholders' theories from the literature that reveal possible answers to this question. A key mechanism appears to be that the information provided supports improved decision making. Greatest benefits are likely to be found in relation to medication information, in scenarios where the patient is less able to provide accurate information about their medications themselves. However, access and use of this information depends on ease of access, clinicians' perception of the likelihood that the desired information will be available, and clinicians' trust in the information.


Assuntos
Tomada de Decisões , Segurança do Paciente , Assistência à Saúde , Pessoal de Saúde , Humanos , Tecnologia da Informação
16.
Niger Postgrad Med J ; 26(3): 143-151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441451

RESUMO

Introduction: Surgical site infection (SSI) is a major patient safety concern in hospitals. Unlike most developed countries, Nigeria does not yet have an established national system to monitor the occurrence of this infection. This meta-analysis was thus designed to determine the pooled cumulative incidence of SSIs and various determinants of its occurrence in Nigeria. Methods: The electronic databases were systematically searched for articles reporting the occurrence and risk factors associated with SSIs in Nigeria from January 2000 to December 2018. The eligible articles were evaluated using a set of pre-defined criteria. The extracted data were analysed using the comprehensive meta-analysis software. The Begg and Egger's regression tests were used to assess the risk of bias of the included publications. Results: Thirty-two articles emanating from the six geopolitical regions of Nigeria were included in this meta-analysis. The pooled cumulative incidence of SSIs was 14.5% (95% confidence interval [CI]: 0.113-0.184) with the highest incidence reported in the north-eastern region (27.3%, 95% CI: 0.132-0.481) of the country. It was also found to occur more predominantly following colorectal and abdominal surgeries, among elderly patients and in patients with co-morbid conditions. The most frequently reported was the superficial incisional SSIs occurring in 62.5% (95% CI: 0.333-0.848). Higher preponderance was also observed among patients with dirty wounds (52.7%, 95% CI: 0.367-0.682). Conclusion: This meta-analysis documents for the first time the national burden of SSIs in Nigeria. Control measures geared towards its reduction should be strengthened and a national policy on SSI surveillance, prevention and control developed.


Assuntos
Procedimentos Cirúrgicos Operatórios/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Humanos , Incidência , Nigéria/epidemiologia , Segurança do Paciente , Fatores de Risco
17.
Stud Health Technol Inform ; 264: 447-451, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437963

RESUMO

Process mining helps healthcare professionals understand processes within healthcare. While often used in secondary care, there is little work in process mining using primary care data. Serious adverse events that result from hazardous prescribing are common and costly. For example, non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelets can cause gastro-intestinal bleeds (GiBs). Prescribing typically occurs during primary care; therefore we used this setting to attempt process mining. We extracted events (drug started, drug stopped, GiB) for understanding three prescribing pathways, and applied process mining. We found NSAIDs are often short-term prescriptions whereas antiplatelets are often long-term. This perhaps explains our finding that co-prescription of gastro-protection is more prevalent for antiplatelets than NSAIDs. We identified reasons why primary care data is harder to process mine and proposed solutions. Process mining primary care data is possible and likely useful for improving patient safety and reducing costs.


Assuntos
Atenção Primária à Saúde , Anti-Inflamatórios não Esteroides , Prescrições de Medicamentos , Humanos , Segurança do Paciente , Padrões de Prática Médica
18.
Stud Health Technol Inform ; 264: 639-643, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438002

RESUMO

Patient falls, a subcategory of patient safety events, cause further harm and anxiety to patients in healthcare systems. Patient fall reports are a valuable resource to identify safety issues that demand further attention. Still, the main challenge for patient fall reports is the lack of quality and detail in writing. A method of evaluating patient fall reports would help us better understand the root causes of falls and prevent their recurrence to improve patient safety. Employing the Agency for Healthcare and Quality rubric for assessing the quality of fall reports, we compared three different machine-learning models and identified the most effective method for scoring fall reports using AHRQ's rubric. The results of this study are intended to be applicable in healthcare facilities to score reports during reporting for reporters to improve report quality. The ultimate goal is to increase learning from fall reports for better prevention of patient falls.


Assuntos
Acidentes por Quedas , Aprendizado de Máquina , Segurança do Paciente , Humanos , Redação
20.
Stud Health Technol Inform ; 266: 83-88, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397306

RESUMO

The paper applies an artificial intelligence centered method to classify 12 clinical safety incident (CSI) classes. The paper aims to establish a taxonomy that classifies the CSI reports into their correct classes automatically and with high accuracy. The study investigates feasibility of applying the C4.5 decision tree (DT) classifier and the random forest (RF) classifier for this purpose. The classifiers were trained using randomly selected 3600 CSIs from an Incident Information Management System (IIMS) used by seven hospitals. The taxonomies investigated were the Generic Reference Model (GRM) and the World Health Organization (WHO) patient safety classification. The classifiers trained 13 GRM CSI classes and 9 WHO CSI classes using a bag-of-words approach. The overall taxonomies performance on the RF classifier was better than on the DT classifier. The performance achieved by the classifier applying the WHO taxonomy was better than the GRM taxonomy. Four of the five poorly performing classes in the GRM taxonomy significantly improved their performance on changing the taxonomy. To improve the WHO taxonomy performance the improved WHO (WHO-I) taxonomy was built by adding a new class that did not exist in WHO but existed in GRM. The performance of the RF classifier applied to the WHO-I taxonomy further improved.


Assuntos
Inteligência Artificial , Árvores de Decisões , Gestão de Riscos , Humanos , Segurança do Paciente
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