761 results match your criteria Journal of Patient Safety [Journal]


Perceptions of Pediatric Hospital Safety Culture in the United States: An Analysis of the 2016 Hospital Survey on Patient Safety Culture.

J Patient Saf 2019 Mar 29. Epub 2019 Mar 29.

Marcell Niehoff School of Nursing, Loyola University, Chicago, Illinois.

Introduction: Medical errors in the pediatric population can quickly cause. Research identified that hospitals with positive safety cultures work collaboratively to reduce errors. Strategies that identify gaps in hospital's safety culture within the pediatric milieu have not been initiated. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000602DOI Listing

Psychological and Psychosomatic Symptoms of Second Victims of Adverse Events: a Systematic Review and Meta-Analysis.

J Patient Saf 2019 03 26. Epub 2019 Mar 26.

Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

Objectives: Despite growing interest in the second-victim phenomenon and greater awareness of its consequences, there has not been a meta-analysis quantifying the negative impact of adverse events on providers involved in adverse events. This study systematically reviewed the types and prevalence of psychological and psychosomatic symptoms among second victims.

Methods: We conducted a systematic review of nine electronic databases up to February 2017, without restrictions to publication date or language, examining also additional sources (e. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000589DOI Listing

Teamwork Among Medicine House Staff During Work Rounds: Development of a Direct Observation Tool.

J Patient Saf 2019 Mar 26. Epub 2019 Mar 26.

From the Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.

Objective: Teamwork is integral to effective health care but difficult to evaluate. Few tools have been tested outside of classroom or medical simulation settings. Accordingly, we aimed to develop and pilot test an easy-to-use direct observation instrument for measuring teamwork among medical house staff. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000597DOI Listing
March 2019
5 Reads

Impact of Medication Reviews Delivered by Community Pharmacist to Elderly Patients on Polypharmacy: A Meta-analysis of Randomized Controlled Trials.

J Patient Saf 2019 Mar 26. Epub 2019 Mar 26.

From the Faculty of Pharmaceutical Sciences, and.

Objective: The aim of the study was to assess the impact of medication reviews delivered by community pharmacists to elderly patients on polypharmacy.

Methods: A systematic literature search was performed in four bibliographic databases/search engine (PubMed, Embase, CENTRAL, and IPA) and three gray literature sources (OpenGrey, ClinicalTrials.gov, and Digital Access to Research Theses - Europe) from inception to January 2018. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000599DOI Listing
March 2019
2 Reads

Managing Missing Data in the Hospital Survey on Patient Safety Culture: A Simulation Study.

J Patient Saf 2019 Mar 22. Epub 2019 Mar 22.

Service de biostatistique, Hospices Civils de Lyon, Laboratoire de biométrie et biologie évolutive, UMR 5558 CNRS, Lyon.

Background: Case-wise analysis is advocated for the Hospital Survey on Patient Safety culture (HSOPS).

Objectives: Through a computer-intensive simulation study, we aimed to evaluate the accuracy of various imputation methods in managing missing data in the HSOPS.

Methods: Using the original data from a cross-sectional survey of 5064 employees at a single university hospital in France, we produced simulation data on two levels. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000595DOI Listing
March 2019
0.877 Impact Factor

Using Lean to Improve Patient Safety and Resource Utilization After Pediatric Adenotonsillectomy.

J Patient Saf 2019 Mar 21. Epub 2019 Mar 21.

From the Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.

Objective: The objective of this quality improvement project was to decrease the rate of nonemergent use of emergency department (ED) resources in children undergoing adenotonsillectomy by 50% and/or reach a future state of 5% or less overall ED visits among all postoperative patients within 1 year. A secondary objective was to standardize the preoperative, intraoperative, and postoperative management of these patients.

Methods: The study was a quality improvement project using Lean. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000573DOI Listing
March 2019
1 Read

Examining Causes and Prevention Strategies of Adverse Events in Deceased Hospital Patients: A Retrospective Patient Record Review Study in the Netherlands.

J Patient Saf 2019 Mar 20. Epub 2019 Mar 20.

Objective: To improve patient safety and possibly prevent mortality from adverse events (AEs) in hospitals, it is important to gain insight in their underlying causes. We aimed to examine root causes and potential prevention strategies of AEs in deceased hospital patients.

Methods: Data on 571 AEs were used from two retrospective patient record review studies of patients who died during hospitalization in the Netherlands. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000586DOI Listing
March 2019
5 Reads

Hospital Surveys by the Centers for Medicare and Medicaid Services: An Analysis of More Than 34,000 Deficiencies.

J Patient Saf 2019 Mar 20. Epub 2019 Mar 20.

From the University of California Davis, Davis, California; and The Joint Commission, Oakbrook Terrace, Illinois.

Objectives: The aims of the study were to analyze hospital deficiencies reported by the Centers for Medicare and Medicaid Services (CMS) for a 10-year period (2007-2017) and thereby determine the specific conditions of participation (CoP) cited in each deficiency.

Methods: Deficiency data from the CMS Web site was downloaded and analyzed. A determination was made regarding the CoP assigned to each deficiency. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000588DOI Listing

Critical Care Beds With Continuous Lateral Rotation Therapy to Prevent Ventilator-Associated Pneumonia and Hospital-Acquired Pressure Injury: A Cost-effectiveness Analysis.

J Patient Saf 2019 Mar 20. Epub 2019 Mar 20.

Johns Hopkins Bayview Medical Center, Baltimore, MD.

Objectives: Mechanical ventilation increases the risk of hospital-acquired conditions (HACs) such as ventilator-associated pneumonia (VAP) and pressure injury (PrI). Beds with continuous lateral rotation therapy (CLRT) are shown to reduce HAC incidence, but the value of switching to CLRT beds is presently unknown. We compared the cost-effectiveness of CLRT beds with standard care in intensive care units. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000582DOI Listing
March 2019
1 Read

Influence of Gender, Profession, and Managerial Function on Clinicians' Perceptions of Patient Safety Culture: A Cross-National Cross-Sectional Study.

J Patient Saf 2019 Mar 15. Epub 2019 Mar 15.

FHNW School of Applied Psychology, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.

Objectives: In recent years, several instruments for measuring patient safety culture (PSC) have been developed and implemented. Correct interpretation of survey findings is crucial for understanding PSC locally, for comparisons across settings or time, as well as for planning effective interventions. We aimed to evaluate the influence of gender, profession, and managerial function on perceptions of PSC and on the interplay between various dimensions and perceptions of PSC. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000585DOI Listing

The Relationship Between Culture of Safety and Rate of Adverse Events in Long-Term Care Facilities.

J Patient Saf 2019 Mar 18. Epub 2019 Mar 18.

Royal College of Surgeons in Ireland-Bahrain, Al Sayh, Bahrain.

Objective: The aim of the study was to assess the relationship of culture of safety dimensions and the rate of unanticipated care outcomes in long-term care facilities (LTCFs) using the Agency for Healthcare Research and Quality framework of resident safety culture.

Methods: Cross-sectional survey data were collected on 13 dimensions of culture of safety in five LTCFs from registered nurses, licensed practical nurses (LPNs), nursing assistants, administrators/managers, administrative support, and rehabilitation staff. Secondary data on falls in the five LTCFs from quarters 1 to 3 of 2014 were obtained from the Centers for Medicare and Medicaid Services in February 2015. Read More

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http://Insights.ovid.com/crossref?an=01209203-900000000-9926
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http://dx.doi.org/10.1097/PTS.0000000000000587DOI Listing
March 2019
7 Reads

Effectiveness of Discharge Education With the Teach-Back Method on 30-Day Readmission: A Systematic Review.

J Patient Saf 2019 Mar 13. Epub 2019 Mar 13.

College of Nursing, Graduate School, Yonsei University, Seoul, Korea.

Objectives: Teach-back methods are reported to improve patient outcomes by encouraging patient understanding and participation and are increasingly being used in various clinical settings. This study attempts to identify the effectiveness of discharge education using the teach-back method on 30-day readmission.

Methods: MEDLINE, CINAHL, Embase, The Cochrane Library, and Web of Science were used to search experimental studies. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000596DOI Listing
March 2019
2 Reads

A Qualitative Analysis of Outpatient Medication Use in Community Settings: Observed Safety Vulnerabilities and Recommendations for Improved Patient Safety.

J Patient Saf 2019 Mar 13. Epub 2019 Mar 13.

University of California San Francisco, Richard H. Fine People's Clinic at Zuckerberg San Francisco General Hospital, San Francisco, California.

Objective: The aim of the study was to analyze diverse patients' experiences throughout the medication use process to inform the development of overarching interventions that support safe medication use in community settings.

Methods: Using a qualitative observational approach, we conducted approximately 18 hours of direct observation of the medication use process across multiple settings for a sample of vulnerable, high-risk patients. Observers recorded detailed field notes during the observations. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000590DOI Listing
March 2019
2 Reads

Is Physician Mentorship Associated With the Occurrence of Adverse Patient Safety Events?

J Patient Saf 2019 Mar 13. Epub 2019 Mar 13.

Healthcare Safety Investigation Branch, Farnborough, United Kingdom.

Background: Mentorship has been identified as a beneficial practice for doctors and key aspect of continuing professional development, associated with a number of potential clinical and nonclinical gains. The likely contribution of mentorship to enhancing patient safety is acknowledged, but there is a dearth of empirical studies that attempt to make associations between the impact of mentorship for physicians on patient safety outcomes. This article begins to fill this gap by exploring whether a physician with a mentor reports having fewer near-misses or adverse events, compared with a physician with no mentor. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000592DOI Listing
March 2019
2 Reads

Capturing Patients' Perspectives on Medication Safety: The Development of a Patient-Centered Medication Safety Framework.

J Patient Saf 2019 Mar 11. Epub 2019 Mar 11.

Division of Primary Care, School of Medicine, University of Nottingham, The Medical School, Queen's Medical Centre, Nottingham, United Kingdom.

Objectives: Medication safety incidents are common in primary care and contributory factors frameworks can assist in our understanding of their causes. A framework that is positioned from the perspective of patients would be advantageous in practice when seeking patient insights into medication safety. The aim of this study was to develop a patient-centered contributory factors framework for examining medication safety incidents. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000583DOI Listing

Error Detection and Cost Savings With an Image-Based Workflow Management System Connected to a Computerized Prescription Order Entry Program for Antineoplastic Compounding.

J Patient Saf 2019 Mar 6. Epub 2019 Mar 6.

From the Pharmacy Department.

Objective: The aim of the study was to analyze both the prevalence of errors with the implementation of an image-based workflow management system during the antineoplastic compounding process, and the estimated costs associated with the negative clinical outcome if the errors had not been intercepted.

Methods: Three months after the implementation of Phocus Rx system at a hospital pharmacy department, the identification, classification (type, preparation stage, and cause), and potential severity degree (from negligible to catastrophic) of the errors intercepted were determined. The probability of an error causing an adverse event if it had reached the patient (from nil [0] to high [0. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000591DOI Listing

The Association Between Complications, Incidents, and Patient Experience: Retrospective Linkage of Routine Patient Experience Surveys and Safety Data.

J Patient Saf 2019 Mar 6. Epub 2019 Mar 6.

Biomedical Data Sciences, and.

Objectives: Linkage of safety data to patient experience data may provide information to improve surgical care. This retrospective observational study aimed to assess associations between complications, incidents, patient-reported problems, and overall patient experience.

Methods: Routinely collected data from safety reporting on complications and incidents, as well as patient-reported problems and experience on the Picker Patient Experience Questionnaire 15, covering seven experience dimensions, were linked for 4236 surgical inpatients from an academic center (April 2014-December 2015, 41% response). Read More

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http://dx.doi.org/10.1097/PTS.0000000000000581DOI Listing

Factors Influencing Falls in High- and Low-Risk Patients in a Tertiary Hospital in Korea.

J Patient Saf 2019 Mar 8. Epub 2019 Mar 8.

College of Nursing, Seoul National University, Seoul, Korea.

Objective: The purpose of this study was to explore the characteristics and predictors of falls in high- and low-risk inpatients in a tertiary hospital in Korea.

Methods: Fallers' data were extracted from quality improvement reports and electronic health records from June 1, 2014, to May 31, 2015. Data on nonfallers matched by the length of hospitalization and medical departments of fallers were extracted from electronic health records. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000593DOI Listing
March 2019
5 Reads

Impact of Adoption of Smart Pump System With Continuous Capnography Monitoring on Opioid-Related Adverse Event Rates: Experience From a Tertiary Care Hospital.

J Patient Saf 2019 Mar 4. Epub 2019 Mar 4.

From the Wesley Medical Center, Wichita, Kansas.

Objectives: The use of opioid analgesics for pain management in hospitalized patients is associated with a high risk of adverse events, including respiratory depression which may lead to respiratory arrest and death. Patients who experience opioid-related adverse drug reactions (ADRs) have been shown to experience longer and more costly hospital stays and have a higher risk of requiring a readmission after discharge. In this study, we report on the impact of the introduction of Wesley Medical Center's Safe Medication Practice Protocol on opioid-related ADRs. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000584DOI Listing
March 2019
2 Reads

Establishing the Foundation to Support Health System Quality Improvement: Using a Hand Hygiene Initiative to Define the Process.

J Patient Saf 2019 Mar 4. Epub 2019 Mar 4.

Icahn School of Medicine at Mount Sinai, New York, New York.

Objectives: As hospitals are increasingly consolidating into larger health systems, they are becoming better positioned to have far reaching and material impacts on safety and quality of care. When the Mount Sinai Health System (MSHS) was formed in 2013, it sought to ensure the delivery of safe, high-quality care to every patient. In 2014, the MSHS addressed hand hygiene as the first major system-wide process improvement project focused on quality and safety. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000578DOI Listing
March 2019
9 Reads

Psychometric Testing of Errors of Care Omission Survey: A New Tool on Patient Safety in Primary Care.

J Patient Saf 2019 Mar 1. Epub 2019 Mar 1.

From the Columbia University School of Nursing, New York, NY.

Objective: The aim of the study was to evaluate the psychometric properties of a newly developed survey tool measuring omissions in primary care.

Methods: The Errors of Care Omission Survey (ECOS) is the only known tool to measure critical omissions ("errors") in primary care from the perspectives of primary care providers (PCPs), both physicians and nurse practitioners. The tool has 31 items grouped into the following four subscales: Self-Management Support, Follow-up, Emotional Health Support, and Care Integration. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000575DOI Listing
March 2019
7 Reads

Maintaining Updated Patient's Medication Records: Introduction of an Order-on-Behalf Service by Pharmacists.

J Patient Saf 2019 Feb 21. Epub 2019 Feb 21.

From the KK Women's and Children's Hospital, Singapore.

Introduction: Accurate medication records are integral to healthcare, especially for obstetrics and gynecology and pediatric patients. When pharmacists perform verbal interventions with prescribers, these were often not updated in the patients' medication records. To address this issue, the order-on-behalf (OOB) service by pharmacists was implemented in late November 2015, with the aim of providing timely updates of patients' medication records. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000572DOI Listing
February 2019
2 Reads

Unintended Patient Safety Risks Due to Wireless Smart Infusion Pump Library Update Delays.

J Patient Saf 2019 Mar;15(1):e8-e14

Purdue University College of Pharmacy, West Lafayette, Indiana.

Objective: Our previous study showed that the issue of drug library update delays on wireless intravenous (IV) infusion pumps of one major vendor was widespread and significant. However, the impact of such a delay was unclear. The objective of this study was to quantify the impact of pump library update delays on patient safety in terms of missed and false infusion programming alerts. Read More

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http://Insights.ovid.com/crossref?an=01209203-201903000-0001
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http://dx.doi.org/10.1097/PTS.0000000000000562DOI Listing
March 2019
6 Reads

Identification of Design Criteria to Improve Patient Care in Electronic Health Record Downtime.

J Patient Saf 2019 Feb 9. Epub 2019 Feb 9.

Grado Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia.

Objective: Design criteria specifications (needs, obstacles, and context-of-use considerations) for continuing safe and efficient patient care activities during downtime were identified by using phenomenological analysis.

Methods: Interview transcripts from medical personnel who had experience with downtime incidents were examined using a phenomenological approach. This process allowed for the identification of design criteria for performing downtime patient care activities. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000580DOI Listing
February 2019
1 Read

Pursuing Patient Safety at the Intersection of Design, Systems Engineering, and Health Care Delivery Research: An Ongoing Assessment.

J Patient Saf 2019 Feb 9. Epub 2019 Feb 9.

From the Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland.

Objectives: Despite endorsements for greater use of systems approaches and reports from national consensus bodies calling for closer engineering/health care partnerships to improve care delivery, there has been a scarcity of effort of actually engaging the design and engineering disciplines in patient safety projects. The article describes a grant initiative undertaken by the Agency for of Healthcare Research and Quality that brings these disciplines together to test new ideas that could make health care safer.

Methods: Collectively known as patient safety learning laboratories, grantee teams engage in phase-based activities that parallel a systems engineering process-problem analysis, design, development, implementation, and evaluation-to gain an in-depth understanding of related patient safety problems, generate fresh ideas and rapid prototypes, develop the prototypes, ensure that developed components are implemented as an integrated working system, and evaluate the system in a simulated or clinical setting. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000577DOI Listing
February 2019
1 Read

Patient Safety Incidents Describing Patient Falls in Critical Care in North West England Between 2009 and 2017.

J Patient Saf 2019 Feb 9. Epub 2019 Feb 9.

University of Manchester Medical School, Manchester, United Kingdom.

Aim: The aim of the study was to review reported falls in critical care units to see whether the causes and results were different from those described in a general hospital population.

Methods: We reviewed and classified patient safety incidents describing falls from critical care units in the North West of England between 2009 and 2017. The classification reviewed patient and staff factors contributing to the fall, the environment of the fall, and the reported consequences. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000574DOI Listing
February 2019
7 Reads

Nursing Home Senior Managers and Direct Care Staff: Are There Differences in Their Perceptions of Safety Climate?

J Patient Saf 2019 Feb 9. Epub 2019 Feb 9.

Objectives: Improving nursing home safety is important to the quality of resident care. Increasing evidence points to the relationship between actual safety and a strong safety climate, i.e. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000569DOI Listing
February 2019

Allergic Reactions Captured by Voluntary Reporting.

J Patient Saf 2019 Jan 31. Epub 2019 Jan 31.

Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital and the Massachusetts General Professional Organization.

Background: The epidemiology of hospital adverse reactions (ARs), particularly allergic reactions, or hypersensitivity reactions (HSRs), is poorly defined. To determine priorities for allergy safety in healthcare, we identified and described safety reports of allergic reactions.

Methods: We searched the safety report database of a large academic medical center from April 2006 to March 2016 using 101 complete, truncated, and/or misspelled key words related to allergic symptoms, treatments, and culprits (e. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000568DOI Listing
January 2019
5 Reads

Developing Evidence for New Patient Safety Bundles Through Multihospital Collaboration.

J Patient Saf 2019 Jan 31. Epub 2019 Jan 31.

Associates in Process Improvement, Austin, Texas.

Objective: Multihospital collaboration for safety improvements is increasingly common, but strategies for developing bundles when effective evidence-based practices are not well described are limited. The Children's Hospitals' Solutions for Patient Safety (SPS) Network sought to further reduce patient harm by developing improvement bundles when preliminary evidence was limited.

Methods: As part of the novel Pioneer process, cohorts of volunteer SPS hospitals collaborated to identify a harm reduction bundle for carefully selected hospital-acquired harm categories where evidence-based practices were limited. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000564DOI Listing
January 2019

Supplying Pharmacist Home Visit and Anticoagulation Professional Consultation During Transition of Care for Patients With Venous Thromboembolism.

J Patient Saf 2019 Jan 29. Epub 2019 Jan 29.

University of Massachusetts Medical School.

Objective: The aim of the study was to assess the feasibility, satisfaction, and effectiveness of a care transition intervention with pharmacist home visit and subsequent anticoagulation expert consultation for patients with new episode of venous thromboembolism within a not-for-profit health care network.

Methods: We randomized patients to the intervention or control. During the home visit, a clinical pharmacist assessed medication management proficiency, asked open-ended questions to discuss knowledge gaps, and distributed illustrated medication instructions. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000571DOI Listing
January 2019
1 Read

Development and Validation of a Safety Scale Perceived by the Witness of Prehospital Emergency Care.

J Patient Saf 2019 Jan 21. Epub 2019 Jan 21.

Puerta del Mar Hospital in Cadiz, Andalusian Health Service, Regional Government of Andalusia, Seville.

Objective: The aim of the study was to design and validate a new tool to measure the security perceived by witnesses of patient care and hospital transfers, after requesting urgent assistance via the "061" phone number.

Methods: This is a descriptive observational, cross-sectional, design, and validation study of a scale conducted by telephone interview. Witnesses of urgent assistance and transfers by prehospital emergency medical services in the province of Cadiz, in the south of Spain, were the subjects of study. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000567DOI Listing
January 2019
4 Reads

The Burden of Opioid-Related Adverse Drug Events on Hospitalized Previously Opioid-Free Surgical Patients.

J Patient Saf 2019 Jan 21. Epub 2019 Jan 21.

Mallinckrodt Pharmaceuticals, Health Economics and Outcomes Research Department, Bedminster.

Objective: Opioid analgesics are a mainstay for acute pain management, but postoperative opioid administration has risks. We examined the prevalence, risk factors, and consequences of opioid-related adverse drug events (ORADEs) in a previously opioid-free surgical population.

Methods: A retrospective, observational, cohort study using administrative, billing, clinical, and medication administration data from two hospitals. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000566DOI Listing
January 2019
1 Read

Multilevel Analysis of Individual, Organizational, and Regional Factors Associated With Patient Safety Culture: A Cross-Sectional Study of Maternal and Child Health Institutions in China.

J Patient Saf 2019 Jan 10. Epub 2019 Jan 10.

School of Psychology and Public Health, La Trobe University, Bundoora, Australia.

Objectives: The aim of this study was to assess patient safety culture (PSC) in maternal and child health (MCH) institutions in China and its individual, organizational, and regional variations.

Methods: Using the PSC survey for MCH institutions (PSCS-MCHI), 2021 valid respondents from 25 participating institutions were investigated in three regions (Beijing, Zhejiang, and Jiangxi) of China. Patient safety culture and its subscale scores (1-5) and factors associated with PSC as revealed by multilevel modeling. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000570DOI Listing
January 2019
2 Reads

Assessment of Public Perception Regarding Patient Engagement for Patient Safety in Korea.

J Patient Saf 2019 Jan 10. Epub 2019 Jan 10.

Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.

Objectives: This study conducted a survey to examine how the general public in Korea perceives patient engagement for patient safety and to identify vulnerable groups and contents priorities of patient engagement education for the general public.

Methods: We developed a questionnaire based on previous studies and conducted one-on-one interviews with 600 individuals from the public. Then, we conducted descriptive statistical analyses (i. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000565DOI Listing
January 2019
8 Reads

Comparing the Evolution of Risk Culture in Radiation Oncology, Aviation, and Nuclear Power.

J Patient Saf 2018 Dec 19. Epub 2018 Dec 19.

Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York.

Objectives: All organizations seek to minimize the risks that their operations pose to public safety. This task is especially significant if they deal with complex or hazardous technologies. Five decades of research in quantitative risk analysis have generated a set of risk management frameworks and practices that extend across a range of such domains. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000560DOI Listing
December 2018
1 Read

The Association Between Organizational Culture and the Ability to Benefit From "Just Culture" Training.

J Patient Saf 2019 Mar;15(1):e3-e7

From the Department of Quality and Patient Safety, Universal Health Services, Temecula, CA.

Objective: This study aimed to determine whether there was an association between the organizational culture and the hospital's readiness to benefit from "Just Culture" training.

Methods: The "Just Culture" Assessment Tool and the Competing Values Framework surveys were administered before and 6 weeks after a structured "Just Culture" training session to 172 care providers and administrators on similar units at two community for-profit hospitals of compatible size and offering comparable services in suburban communities. Data were analyzed for significance using IBM SPSS software. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000561DOI Listing
March 2019
1 Read

The Association of the Nurse Work Environment and Patient Safety in Pediatric Acute Care.

J Patient Saf 2018 Dec 28. Epub 2018 Dec 28.

Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Objectives: Eighteen years ago, the Institute of Medicine estimated that medical errors in hospital were a major cause of mortality. Since that time, reducing patient harm and improving the culture of patient safety have been national health care priorities. The study objectives were to describe the current state of patient safety in pediatric acute care settings and to assess whether modifiable features of organizations are associated with better safety culture. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000559DOI Listing
December 2018
4 Reads

Race Differences in Reported Harmful Patient Safety Events in Healthcare System High Reliability Organizations.

J Patient Saf 2018 Dec 21. Epub 2018 Dec 21.

Quality and Safety, MedStar Health, Columbia, MD.

Objectives: The aim of the study was to determine whether race differences exist in voluntarily reported harmful patient safety events in a large 10 hospital healthcare system on a high reliability organization journey.

Methods: From July 1, 2015, to June 30, 2017, employees in a healthcare system based in Washington, District of Columbia, and Maryland voluntarily reported harmful patient safety events by type using a Patient Safety Event Management System. Inpatients, outpatients, and observation patients were identified as "black," "white," or "other" (N = 5038). Read More

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http://Insights.ovid.com/crossref?an=01209203-900000000-9929
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http://dx.doi.org/10.1097/PTS.0000000000000563DOI Listing
December 2018
3 Reads

The Second Victim: A Contested Term?

J Patient Saf 2018 Dec 18. Epub 2018 Dec 18.

From the School of Law, University College Cork, Cork, Ireland.

Objectives: The term "second victim" was seminally coined by Wu, in recognition of the profound and long-lasting impact adverse events and medical errors may have on medical practitioners. Since the conception of this vocable over a decade ago, the term second victim has been internationally accepted and is widely used in discussion of this important topic. Notwithstanding its widespread use, controversy surrounds the term second victim in light of the traditional connotations with the word "victim. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000558DOI Listing
December 2018
14 Reads

Double Reading of Outsourced CT/MR Radiology Reports: Retrospective Analysis.

J Patient Saf 2018 Aug 13. Epub 2018 Aug 13.

From the department of Radiology, Nîmes University Hospital, Nîmes, France.

Objectives: Our objective was to determine disagreement rates in radiological reports provided by using a double-reading protocol in a national teleradiology company.

Methods: From January 2015 to July 2016, 134169 radiological exams from 36 French centers, benefited outsourced interpretations by certified radiologists, in both regular and after-hours activities. Of these, 2040 CT and MR-scans (1. Read More

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http://Insights.ovid.com/crossref?an=01209203-900000000-9932
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http://dx.doi.org/10.1097/PTS.0000000000000525DOI Listing
August 2018
9 Reads

Miscarriage Treatment-Related Morbidities and Adverse Events in Hospitals, Ambulatory Surgery Centers, and Office-Based Settings.

J Patient Saf 2018 Dec 3. Epub 2018 Dec 3.

Center for Applied Studies in Health Economics, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.

Objective: The aim of the study was to examine whether miscarriage treatment-related morbidities and adverse events vary across facility types.

Methods: A retrospective cohort study compared miscarriage treatment-related morbidities and adverse events across hospitals, ambulatory surgery centers (ASCs), and office-based settings. Data on women who had miscarriage treatment between 2011 and 2014 and were continuously enrolled in their insurance plan for at least 1 year before and at least 6 weeks after treatment were obtained from a large national private insurance claims database. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000553DOI Listing
December 2018
4 Reads

Eyes and Ears on Patient Safety: Sources of Notifications About the Health, Performance, and Conduct of Health Practitioners.

J Patient Saf 2018 Nov 21. Epub 2018 Nov 21.

Stanford University School of Medicine and Stanford Law School, Stanford, California.

Objective: The aim of the study was to describe the sources of notifications of concern ("notifications") regarding the health, performance, and conduct of health practitioners from 14 registered professions in Australia.

Methods: This retrospective cohort study analyzed 43,256 notifications lodged with the Australian Health Practitioner Regulation Agency and the Health Professional Councils Authority between 2011 and 2016. We used descriptive statistical analysis to describe the characteristics of these notifications, including their source, issue and domain, and subject. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000544DOI Listing
November 2018
2 Reads

UDI2Claims: Planning a Pilot Project to Transmit Identifiers for Implanted Devices to the Insurance Claim.

J Patient Saf 2018 Nov 21. Epub 2018 Nov 21.

College of Health Solutions, Arizona State University, Phoenix, Arizona.

Background: In response to problems with the current postmarket surveillance of medical devices, the U.S. Food and Drug Administration mandated device labelers to include a unique device identifier (UDI), composed of a device identifier (DI) and production identifier. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000543DOI Listing
November 2018
7 Reads

OD, OS, and OU: Talking in Code?

J Patient Saf 2019 Mar;15(1):e1-e2

University of Arizona, College of Medicine, Tucson, Arizona Burrell College of Osteopathic Medicine, Las Cruces, New Mexico.

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http://dx.doi.org/10.1097/PTS.0000000000000556DOI Listing
March 2019
10 Reads

Establishing a Culture of Patient Safety, Quality, and Service in Plastic Surgery: Integrating the Fractal Model.

J Patient Saf 2018 Nov 23. Epub 2018 Nov 23.

Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.

Problem: There are obstacles to effective nationwide implementation of a culture of patient safety. Plastic surgery faces unique challenges in this area because quality measures are not as well-established as in other fields. Plastic surgery may also require emphasis on patient-reported outcomes as a quality-of-life specialty with distinct concomitant analytical methods. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000554DOI Listing
November 2018
1 Read

Patient Experiences With Handling of Analgesic Transdermal Patches and Challenges in Correct Drug Administration: A Pilot Study on Patient Education.

J Patient Saf 2018 Dec;14(4):e97-e101

Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany.

Background: Although problems during transdermal patch administration are primarily caused by insufficient knowledge, patient education programs are lacking. We compared patient education by a clinical pharmacist on knowledge on correct patch administration with routine counseling during patient-physician consultation in a pilot study.

Methods: After baseline assessment of knowledge and difficulties with patch administration, patients in the outpatient pain clinic of Heidelberg University Hospital were allocated to intervention (n = 12) or control group (n = 11). Read More

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http://dx.doi.org/10.1097/PTS.0000000000000538DOI Listing
December 2018
12 Reads

Patient Safety: An Important yet Neglected Issue in Nursing Education: Erratum.

Authors:

J Patient Saf 2018 Dec;14(4):246

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http://dx.doi.org/10.1097/PTS.0000000000000557DOI Listing
December 2018
15 Reads

Transitioning to E-Prescribing: Preformatted Prescription Forms Improve Safety, Formulary Compliance, Prescribing Satisfaction, and Perceived Efficiency.

J Patient Saf 2018 Dec;14(4):241-245

Internal Medicine, Olive View-UCLA Medical Center, Sylmar, CA.

Objectives: Compared with blank prescriptions, electronic prescribing (e-prescribing) is safer and more formulary-compliant, satisfying, and efficient. Owing to cost, fewer publicly funded organizations use e-prescribing but may afford preformatted prescription forms. We investigated whether preformatted prescription forms confer similar benefits as e-prescribing. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000198DOI Listing
December 2018
5 Reads

Anonymity Decreases the Punitive Nature of a Departmental Morbidity and Mortality Conference.

J Patient Saf 2018 Nov 16. Epub 2018 Nov 16.

Department of Emergency Medicine, Brigham and Women's Hospital.

Objectives: We sought to analyze the effect of an anonymous morbidity and mortality (M&M) conference on participants' attitudes toward the educational and punitive nature of the conference. We theorized that an anonymous conference might be more educational, less punitive, and would shift analysis of cases toward systems-based analysis and away from individual cognitive errors.

Methods: We implemented an anonymous M&M conference at an academic emergency medicine program. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000555DOI Listing
November 2018
2 Reads

The Ambulatory Version of the Safety Attitude Questionnaire: Psychometric Validation and Measurement Properties in Nigerian Clinical Setting.

J Patient Saf 2018 Nov 13. Epub 2018 Nov 13.

From the Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Nigeria.

Background: Understanding the safety culture of health care providers can help administrators improve patient safety. However, it is difficult to measure complex constructs such as safety culture without valid and reliable tools. This study determined the measurement properties of the ambulatory version of the safety attitude questionnaire (SAQ-AV) in the Nigerian clinical setting. Read More

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http://dx.doi.org/10.1097/PTS.0000000000000551DOI Listing
November 2018
12 Reads