Patient safety

Medication errors can lead to damage to patients with various disabilities or death. This study aims to identify factors affecting the incidence of medication error and its association with patient safety culture from the nurse’s perspective during the COVID-19 pandemic.

This cross-sectional study was conducted among 340 employed in the hospitals affiliated with Shiraz University of Medical Sciences in 2021. Data were collected by applying a questionnaire for medication error and the standard questionnaire of the Hospital Survey on Patient Safety Culture. Descriptive statistics, the independent t-test, ANOVA, and Pearson correlation were applied using SPSS software version 23.

The main reasons for medication errors were fatigue due to the workload (3.13±1.16 out of 5), method of supervision in the hospital units (3.06±0.98 out of 5), and massive pile-up of duties (3.00±1.19 out of 5). Other results indicated a significant negative association between factors affecting medication error and patient safety culture (r=-0.574, p=0.002). A significant correlation was observed among factors affecting medication error and patient safety culture with demographic determinants of age and years of working experience (p<0.05). Significant differences were also observed among the two main studied variables, the number of monthly work shifts, and the number of patients (p<0.05).

Applying strategies for the reduction of physical fatigue and mental exhaustion along with balancing work shifts and managing the accumulative duties and massive tasks can help decrease the rates of medication errors.

Delivering healthcare is among the most complicated tasks in which humans engage. Medical errors are prone to arise during this process. This matter could compromise the patient's safety, likely leading to serious damage. Patient safety culture is an essential factor of patient safety, encompassing the organizational culture that fosters and advances patient safety. The concept of patient safety culture involves various aspects, with one prominent feature being the level of support offered through management towards ensuring patient safety. Healthcare managers are legally and ethically responsible for ensuring that patients receive high-quality treatment and making ongoing efforts to improve the quality of care provided. During the investigations based on the structure and conditions of Iran's health system, the situation of management's support for patient safety has been reported as unfavorable in some cases. In this paper, we tried to present Management Support actions that can improve patient safety culture by considering the structure and conditions of Iran's health system.

Clinical deterioration occurs due to changes in vital signs, which can be identified early to prevent negative outcomes. We used the NEWS2 system to assess the potential for early clinical deterioration in adult inpatient units at a public university hospital in southeastern Brazil.

This was an exploratory study conducted at a public hospital in southeastern Brazil, following the guidelines of the Reporting of Strengthening Observational Studies in Epidemiology (STROBE) initiative. Data was collected from January to April 2021, involving 251 inpatients. A questionnaire was used to gather sociodemographic and clinical data, and the Brazilian version of NEWS2 was used to assess the risk of clinical deterioration. Data analysis included descriptive analyses, linear correlation tests, and comparative tests.

The average NEWS2 score was 2.9 points among 251 patients, indicating a moderate level of care complexity and recommending assessment by a registered nurse every 4–6 hours. There was no significant correlation between age and NEWS2 score, but the NEWS2 score was significantly higher for men.

This study highlights the necessity of using robust assessment tools to evaluate the risk of early clinical deterioration, enabling clinicians to manage patient conditions effectively.

Pre-anesthetic evaluation is the initial stage of anesthesia procedures for patients. This evaluation involves elucidating the patient's medical history, determining patient readiness, screening for undisclosed disorders, and identifying risk factors. Safety measures help mitigate patient-related risks within medical environments. The aim of this study is to investigate the role of Pre-anesthetic evaluation in patient safety.

The present study was a review conducted in the year 2024. Databases including PubMed, Direct Science, MEDLINE, Proquest, SID, Scopus, Google Scholar, Magiran, and library resources were searched using keywords such as Pre-anesthetic evaluation, pre-anesthetic visit, anesthesia clinic, patient safety, and their English equivalents. A logical combination of these keywords was performed using "OR," "AND," and "NOT" operators. The search was conducted in relevant articles from the year 2000 to January 2024.

Initially, 22,000 articles were screened, and ultimately, 16 relevant articles were used for preparing this paper. In all the reviewed articles, pre-anesthetic evaluation played a key role in patient safety.

Studies indicate that pre-anesthetic evaluation is a key improver of surgical outcomes. These measures not only mitigate potential risks but also enhance surgical outcomes. Overall, pre-anesthetic evaluation has a direct correlation with patient safety, playing a significant role in postoperative improvement and elevating the quality of medical care.

The aim of this study was to examine and compare the dimensions of patient safety culture in different departments of Imam Hossein Hospital before and after interventional management actions (IMA), as well as to identify issues related to patient safety culture based on data analysis.

This semi-experimental study was conducted from late December 2023 to early May 2024, with a random sample of 210 staff members from Imam Hossein Hospital in Tehran. The IMA consisted of an educational intervention on patient safety and quality of care, which took place over four months (February to May 2023). Patient safety culture in clinical and paraclinical departments was assessed twice: Once before the IMA and again after one year, using the hospital survey on patient safety culture (HSOPSC) tool.

The overall mean score for safety culture after the IMA was significantly improved compared to before (mean difference = 13.16 ± 24.90, P-value < 0.001). These improvements were also reflected in the overall percentage of positive responses, which increased from 41.07% to 51.83%. The frequency of reported patient safety events increased from 50.95% to 61.90% following the IMA. The organizational learning-continuous improvement dimension (87.14%) received the highest positive score after the IMA, while staffing received the lowest positive score both before (15.83%) and after (17.13%) the IMA.

The improvement in patient safety culture, based on the results of this study, highlights the value of teamwork and underscores the importance of prioritizing this area for hospital managers. Addressing the challenges associated with providing safe healthcare requires proactive actions, including encouraging staff to report safety incidents and supporting organizational learning.

 During COVID-19 pandemic, the emergency department (ED) was challenged to treat patients with COVID-19-related symptom. Therefore, the aim of this study was to investigate treatment delay and prognostic outcomes in ST-segment elevation myocardial infarction (STEMI) patients during COVID-19 pandemic due to isolation or precaution and compare it with pre-COVID-19 period.

This was a retrospective observation study using multicenter data with different case mix. Anonymized data were collected through each center’s electronic medical data of common case report form. Primary outcomes were number and rate of in-hospital mortality within 28 days. Secondary outcomes were door-to-balloon time and length of stay in the ED. Kaplan-Meier estimation and Cox proportional hazard regression analysis were performed to determine impact of predictors on 28-day in-hospital mortality.

Door-to-balloon time was longer in STEMI patients with COVID-19-related symptom(s) than those without symptom during the COVID-19 period (97.0 [74.8, 139.8] vs. 69.0 [55.0, 102.0] minutes, P<.001). However, there was no significant statistical difference in door-to-balloon time between STEMI patients with and without COVID-19-related symptom(s) during the pre-COVID-19 period (73.0 [61.0, 92.0] vs. 67.0 [54.5, 80.0] minutes, P=.2869). The 28-day mortality rate did not show a statistically significant difference depending on symptoms suggestive of COVID-19 during the pre-COVID-19 period (15.4% vs. 6.8%, P=.1257). However, it was significantly higher during the COVID-19 period (21.1% vs. 6.7%, P=.0102) in patients with COVID-19 suggestive symptoms than in patients without the symptoms.

 In Korea, symptoms suggestive of COVID-19 during the pandemic had a significant effect on the increase of door-to-balloon time and 28-day mortality in STEMI patients. Thus, health authorities need to make careful decision in designating symptoms indicated for isolation in ED based on opinions of various medical field experts.

 Diagnostic excellence refers to the optimal process to attain an accurate and precise explanation about a patient’s condition and incorporates the perspectives of patients and their care partners. Patient-reported measures (PRMs), designed to capture patient-reported information, have potential to contribute to achieving diagnostic excellence. We aimed to craft a set of roadmaps illustrating goals and guiding the development of PRMs for diagnostic excellence (“Roadmaps”).

 We used iterative inputs from environmental literature scans, expert consultations, and patient voice and employed human-centred design (HCD) and equity-focused road-mapping. The culminating activity of these approaches was an Expert Convening.

 Use of PRMs can achieve multiple goals for diagnostic excellence, including but not limited to: (1) PRMs for diagnostic continuity, (2) diagnostic PRM alerts, (3) PRM-based quality improvement, (4) PRMs for research, (5) PRMs for routine screening, (6) PRM-based diagnostic excellence population-level patterns, and (7) PRMs supporting patient storytelling. Equity is considered as a cross-cutting goal. Altogether these and future goals support operationalising a vision of patient-reported diagnostic excellence. Roadmaps were developed as a dynamic tool to illustrate PRMs in relation to specific steps with feedback loops to accomplish goals, anticipated timeframes (8-15 years), synergies to foster, and challenges to overcome. Roadmaps are practical in their following PRMs through the stages of development, endorsement, implementation and scaling, and acting upon those measures. Timeframe estimates assume immediate transitions between these stages and no acceleration through incentives and active coordination.

 PRMs for diagnostic excellence have potential to connect patient perspectives, equity, and achievable goals. Roadmaps offer a design approach to enable coordinating measurement activities among diverse stakeholders. Roadmaps also highlight versatility in ways patient-reported information can be collected and used, from clinical settings to public health contexts. Patient-reported diagnostic excellence cannot be established as a solely top-down endeavour, but inherently benefits from bottom-up approaches.

Patient safety remains a critical concern for healthcare systems, particularly in developed nations. A substantial proportion of patients experience complications and adverse events attributable to healthcare delivery, exacerbating their initial health issues. Many adverse events are likely to go unnoticed, unreported, and consequently unaddressed. This issue largely stems from inadequate surveillance methods that require significant improvement to achieve excellence in delivering safe, high-quality care for emergency patients.

This study aimed to develop an emergency department trigger tool (EDTT) to identify adverse events in the emergency department (ED) to enhance patient safety and quality improvement.

Conducted under the supervision of Mashhad University of Medical Sciences, this study comprised four stages: (1) a systematic review, (2) refinement and automation of empirical triggers, (3) a modified Delphi process to compile a list of validated triggers from experts, and (4) final environmental data collection to determine the most effective triggers.

The study included a systematic review of electronic resources, revealing no prior Persian equivalent of a trigger tool. A total of 502 articles were identified in PubMed, 100 in Google Scholar, and 410 in Scopus. After removing duplicates and adding four articles based on reference searches, 1,016 article titles were initially reviewed. Two independent researchers evaluated the articles on the same day in two locations. In cases of disagreement, a third researcher's opinion was sought. Ultimately, 295 articles were selected, with high inter-rater reliability (0.82). Forty-two articles were included in the final analysis. The developed tool contained 50 triggers organized into six groups. In a review of 100 ED cases, an average of 1.2 triggers was identified per patient file, with 99 (79.8%) of these triggers attributed to medical errors.

This study successfully designed an emergency department trigger tool (EDTT) utilizing a systematic review and the Delphi method. The resulting trigger tool can be employed to assess high-risk situations and potential emergency medical errors. A significant advantage of this tool over previous versions is its focus on high-risk conditions without relying solely on the absence of appropriate actions as indicators of danger.

Hospital-acquired fungal infections are becoming an increasingly significant cause of morbidity, mortality, and healthcare costs. Nurses play a pivotal role in preventing and managing these infections, yet their knowledge levels often remain unevaluated.

This study aimed to assess the knowledge of nursing staff in educational-medical hospitals in Zahedan, Iran, regarding fungal infections in 2023.

This descriptive, cross-sectional study was conducted among nurses in three educational hospitals (Khatam Al Anbia, Ali ebn Abitaleb, and Bu Ali) in Zahedan. A total of 342 nurses with at least one year of work experience were included using convenience sampling. Data were collected using a two-part questionnaire: A demographic information form and a researcher-made questionnaire assessing knowledge about fungal infections across four domains—epidemiology, prevention, diagnosis, and treatment. Data were analyzed using SPSS software, with a P-value of less than 0.05 considered significant.

The mean age of participants was 40.70 ± 8.36 years, with an average work experience of 237.85 ± 133.02 months. Of the 342 nurses, 52.92% were female. The mean total awareness score was 12.63 ± 4.53 out of 25. Overall, 19.30% had very low awareness, 52.05% had low awareness, 26.32% had moderate awareness, and only 2.34% had high awareness. In the epidemiology domain, 69.30% had very low or low knowledge. For prevention, 61.11% showed very low or low awareness. In diagnosis, 61.40% had very low or low knowledge, and in treatment, 63.45% demonstrated very low or low awareness. No significant differences were found based on work experience, gender, age, educational level, or hospital affiliation (P > 0.05).

The study reveals a critical knowledge deficit among nursing staff in Zahedan regarding fungal infections. Over 70% of nurses demonstrate low or very low overall awareness, a trend consistent across all evaluated domains. This systemic issue underscores the urgent need for comprehensive, targeted educational interventions, ongoing professional development, and institutional policy changes to enhance nurses' competency in managing fungal infections. Such measures are crucial for improving patient safety, reducing infection rates, and ultimately saving lives.

Disruptive behaviors (DBs) can have a negative impact on patient safety and employee satisfaction. Therefore, this study aimed to investigate the prevalence and clinical and psychological outcomes of DBs among physicians and nurses in the emergency departments of teaching hospitals in Iran.

In this cross-sectional study, 105 participants, including 33 physicians and 72 nurses working in the emergency departments of two teaching hospitals affiliated to Alborz University of Medical Sciences, who were selected using a convenience sampling method during May-June 2020. They filled out a demographic form and Rosenstein and O’Daniel’s DB scale. The data were analyzed in SPSS software version 20 using descriptive statistics and independent t-test. 

The DBs were prevalent in the emergency departments. All respondents reported that they had witnessed DBs in their hospitals. The primary barrier to reporting was the feeling that nothing ever changes (47.6%). The majority of physicians and nurses (81%) indicated that DBs had a significant impact on patient outcomes. There was a significant difference between nurses’ and physicians’ responses to the seriousness of nurse DBs (t=-13.05, P<0.001) and the seriousness of the impact of DBs on patient outcomes (t=-5.75, P<0.001).

Addressing DBs in the emergency departments requires practical and effective educational interventions for the personnel, increasing awareness of hospital managers, developing policies and guidelines, and monitoring their implementation.

The phenomenon of rationed nursing care represents a global problem that jeopardizes the provision of quality and safe care. To date, there are a limited number of studies that focus on the occurrence of this phenomenon in the private care setting.

To explore the frequency and patterns of rationed nursing care and the factors that contribute to its frequency in selected private hospitals in Slovakia.

This descriptive cross-sectional study was conducted between November 2022 and January 2023. Data collection was carried out using the Basel Extent Rationing of Nursing Care – Revised. The study sample consisted of 174 nurses working in three selected Slovak private hospitals. In data analysis, we used descriptive statistics for the evaluation of the instrument and the sample characteristics. Additionally, differences in the frequency of rationed nursing care based on selected variables were analyzed using nonparametric tests (Mann-Whitney U test; Kruskal-Wallis test). For numerical variables the Spearman correlation coefficient (r) was used. The results were tested at a significance level of p <0.05.

The frequency of rationed nursing care was 49.3%. The most frequently withheld nursing care activity was increased supervision of confused patients and the need for their restraint (69.8%; 2.26 ± 1.09). Differences in the evaluation of rationed nursing care were identified based on the type of unit and the position of the job. The occurrence of rationed nursing care was influenced by nurse experience in the current position, evaluation of quality care, overall patient safety degree, number of patients/shifts, number of admitted ad discharged patients/shifts, job satisfaction, satisfaction with the current position, and satisfaction with teamwork in our study (p <0.05).

This study serves as a catalyst for nurse managers to take proactive steps in addressing rationed nursing care, fostering a culture of safety, and promoting excellence in patient-centered care delivery within private hospital settings in Slovakia. By embracing innovation, collaboration, and a commitment to continuous improvement, we can overcome the challenges posed by rationed care and uphold the principles of quality, safety, and compassion in nursing practice.

Patient safety is the most important priority in the healthcare system. Medical universities always attempt to find innovative and more effective educational methods to improvethe students’ abilities for clinical decision-making and quality and safe care. Thus, this study was designed to evaluate the effect of scenario-based learning on the knowledge, attitude, andperception of nursing students about patient safety. This quasi-experimental study was conducted between September 2023 and January 2024. The study sample comprised 78 nursing and midwifery students from the fourth and fifth semesters of their bachelor’s degrees, each of whom was systematically reviewed. The participants were allocated to the intervention (n=43) and control groups (n=35) randomly, using simple randomization. The educational content was presented via scenario-based learning for participants in the intervention group, while it was presented through lecture and discussion in the control group. The questionnaire was standardized and structured, and its validity and reliability were assessed. Data gathering was performed one month after the intervention using a knowledge, attitude, and practice questionnaire. Data were analyzed in SPSS software version 16 using descriptive statistical methods and inferential tests, including the chi-square test, independent T-test, paired T-test, and ANCOVA.
The study findings indicated that there were no significant differences in attitude (P=0.152) and perception (P=0.264) scores between the intervention and control groups before the intervention. However, after the intervention, a significant difference was observed (P<0.001). [Knowledge 14.97±3.70 vs. 19.37±3.31), attitude (31.74±5.38 vs. 34.62±9.59), perception(35.60±7.51 vs.38.95±8.21)]. Scenario-based learning can be a more effective way to teach nursing and midwifery students about patient safety. Thus, researchers recommend that this educational method should be used by nursing and midwifery instructors to improve the students’ ability to provide safer care for patients.

Nowadays, attention to patient safety is important in providing hospital services and any failure to do so can have adverse consequences. Safety is one of the most salient rights of patients when receiving health services. The purpose of this study was to evaluate personnel perspective about patient safety culture in Shahid Beheshti Hospital in Hamadan, Iran.

This descriptive cross-sectional study was carried out on 101 medical personnel of Shahid Beheshti Hospital in Hamadan in operating rooms, intensive care, endocrine surgery, pulmonary, and emergency surgery in December 2019. Patient Safety Culture Survey Standard Questionnaire was used to assess patient safety culture. The first part of the questionnaire contained demographic information and the second part contained 42 questions. The results were analyzed by SPSS software.

27.7% of study participants were operating room personnel. 36.6% (n = 37) of personnel were men and 63.4% (n = 64) were women. In terms of attitude toward patient safety in different parts of the hospital, the operating room received the highest score (143) and the emergency room the lowest score (124).

Increasing attention to the patient safety culture will lead to the development and advancement of the country's hospitals and will lead them to a patient-friendly hospital. Moreover, the lower average dimensions in this study should be considered in order to enhance these dimensions.

Accreditation means systematic evaluation of health service centers with specific standards. One of the most important goals of the accreditation process is to improve patient safety. Patient safety visits are one of the most important standards for improving safety. One of the ways to increase the effectiveness of visits is holding feedback sessions.

The present study was conducted with the aim of assessing the effect of feedback provision on improving patient safety indices based on the hospital accreditation model in Shahid Rahnemoon Hospital, Yazd.

The present study is a semi-experimental study with a before-and-after design that was conducted in Shahid Rahnemoon Hospital, Yazd, from September to December 2021 and January to August 2022. After each visit, formal feedback sessions were held with the attendance of patient safety team members and officials of the visited wards/units. Evaluation indicators included patient safety indicators in accreditation standards, such as error reporting, rate of unwanted events, and patient safety culture score. These were measured before and after feedback. The tools used were the patient safety standards evaluation checklist based on the accreditation model, the patient safety culture questionnaire, and other indicators extracted using documentation. The Patient Safety Culture Evaluation Questionnaire was completed by 360 nurses working in the hospital in the form of a census. Analysis was done using descriptive statistical tests and paired t-tests with STATA 14.2 software.

Based on the results of the study, safety feedback was provided to increase patient safety indicators in different departments and units of hospitals [t = - 4.8652, w/df = 10, P = 0.0007, (P = 0.05)]. A significant difference was observed in the amount of error reporting (P = 0.031) and patient safety (P < 0.001) before and after the intervention. The degree of compliance with the dimensions of the patient safety culture had a statistically significant difference before and after the intervention (P < 0.001).

Providing a safety feedback program had a significant positive effect on the cons umption and consequences of the patient’s safety culture. Therefore, conducting regular safety visits and setting up a direct feedback program to each department/unit after the visit, and the follow-up of corrective measures, will lead to an increase in patient safety standards.