Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study.
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ABSTRACT: Background
Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions.Methods
The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents.Results
Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97).Conclusions
We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents.
SUBMITTER: Panagioti M
PROVIDER: S-EPMC5729978 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesThe aim of this study was to investigate the scope and severity of the second victim problem among nurses by examining the experiences and effects of patient safety incidents (PSIs) on them.Participants/setting492 nurses who had experienced PSIs and provide direct care in South Korean medical institutions.DesignA cross-sectional study with anonymous online self-report questionnaires was conducted to nurses in order to examine the experiences and effects of PSIs. Scales measuring post-traumatic stress disorder (PTSD) and post-traumatic embitterment disorder (PTED) were used for a more quantitative examination of the effects of PSIs. A ?2 test was administered to find any difference in responses to difficulties due to PSIs between the direct and indirect experience of PSIs. Furthermore, linear regression analysis was conducted to investigate the factors related to scores on the PTSD and PTED scales.ResultsA statistically significant difference was observed for participants who reported having experienced sleeping disorders, with those with direct experience showing 42.4% sleeping disorders and indirect experience at 21.0%. Also, there was a statistically significant difference between the 34.3% with direct experience and the 22.1% with indirect experience regarding having considered duty or job changes (resignation). Regression analysis showed total PTSD scores for indirect experience at 11.97 points (95% CI: -17.31 to -6.63), lower than direct experience. Moreover, those who thought the medical error was not involved in PSI had a total PTED score 4.39 points (95% CI: -7.23 to -1.55) lower than those who thought it was involved.ConclusionsA considerable number of nurses experienced psychological difficulties due to PSIs at levels that could interfere with their work. The effect of PSIs on nurses with direct experience of PSIs was greater compared with those with indirect experience. There need to be psychological support programmes for nurses to alleviate the negative effects of PSIs.
| S-EPMC7783619 | biostudies-literature
Project description:PURPOSE: To consider wrong intraocular lens (IOL) implant events in cataract surgical care reported through a national incident reporting database. To propose potential solutions for such events where possible. METHODS: Thematic retrospective review of wrong IOL implantation incidents, as reported through clinical incident reporting methods in NHS care in England and Wales from 2003 to 2010, ascertained from database mining at the National Patient Safety Agency. RESULTS: In total, 164 patient safety incident (PSI) reports of wrong IOL implantation were located from the study period and considered. There were 47 reports where further surgical intervention was required. All, but one of these required IOL exchange surgery. A total of 62 reports did not provide any causal reason for the wrong IOL implantation and thus provide little if any potential learning. Inaccurate biometry (n=29), wrong IOL selection (n=21), transcription errors (n=10) and handwriting misinterpretations (n=7) were causal reasons reported and are thus potential areas for ophthalmic teams to review and improve practice. CONCLUSION: Although infrequent, biometry/IOL implant errors or wrong implants do occasionally occur during cataract care and are thus a threat to quality. There is room for improvement in incident reporting in NHS cataract care as root causation of error was usually lacking in the PSI reports. Nevertheless, lessons for improvement of care from a national incident reporting database for a frequently undertaken surgical procedure were found. Suggestions are proposed for improving quality by reducing wrong IOL problems in cataract care based on analysis of such reports.
| S-EPMC3178144 | biostudies-other
Project description:BackgroundPatient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement.ObjectiveThe aim of this study was to characterise the nature of patient-reported safety incidents in primary care.DesignSecondary analysis of two cross sectional studies.ParticipantsAdult patients from Australian and English primary care settings.MeasuresPatients' self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented.ResultsA total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent.ConclusionsThe nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.
| S-EPMC8094340 | biostudies-literature
Project description:BACKGROUND:Medical professionals who experience patient safety incidents (PSIs) are vulnerable to emotional pain and other difficulties; such individuals are referred to as "second victims." This study quantitatively examines the characteristics of physicians' experiences of PSIs, along with the consequent difficulties and levels of post-traumatic stress disorder (PTSD), and post-traumatic embitterment disorder (PTED) regarding the events. METHODS:An anonymous, self-report online survey was administered to physicians. This collected information regarding PSI characteristics (e.g., type, severity of harm) and impact (e.g., sleep disorder, consideration of career change), as well as participants' socio-demographic characteristics. Meanwhile, to quantitatively assess PSI impacts, PTSD and PTED scales were also administered. PSI characteristics and impacts were analyzed using frequency analysis, and the differing effects of indirect and direct PSI experience regarding consequent difficulties were analyzed using chi-square tests. Factors associated with PTSD and PTED scores were identified using linear regression. RESULTS:Of 895 physicians, 24.6% and 24.0% experienced PSI-induced sleep disorder and eating disorder, respectively. Moreover, 38.9% reported being overly cautious in subsequent similar situations, and 12.6% had considered changing jobs or career. Sleep disorder was significantly more common among participants who directly experienced a PSI (32.8%) than among those with indirect experience (15.3%; P < 0.001). Linear regression showed that indirectly involved physicians had a lower mean PTSD score (by 8.44; 95% confidence interval, -12.28 to -4.60) than directly involved physicians. CONCLUSION:This study found that many physicians experience PSI-induced physical symptoms and behavioral responses, and that the severity of these symptoms varies depending on the type of incident and degree of harm involved. Our findings can provoke more active discussion regarding programs for supporting second victims, and can also encourage the establishing of a system for addressing PSIs that have already occurred, such as through disclosure of PSIs.
| S-EPMC7200176 | biostudies-literature
Project description:The present study investigated physicians' perceptions regarding the need for, effects of, and barriers to disclosure of patient safety incidents (DPSI). An anonymous online questionnaire survey was conducted to investigate physicians' perception regarding DPSI, in particular of when DPSI was needed in various situations and of methods for facilitating DPSI. Physicians' perceptions were then compared to the general public's perceptions regarding DPSI identified in a previous study. A total of 910 physicians participated. Most participants (94.9%) agreed that any serious medical error should be disclosed to patients and their caregivers, whereas only 39.8% agreed that even near-miss errors, which did not cause harm to patients, should be disclosed. Among the six known effects of DPSI presented, participating physicians showed the highest level of agreement (89.6%) that "DPSI will lead physicians to pay more attention to patient safety in the future." Among six barriers to DPSI, participants showed the most agreement (75.9%) that "It is unreasonable to demand DPSI in only the medical field, and disclosure is not actively conducted in other fields." With respect to methods for facilitating DPSI, participants agreed that "A guideline for DPSI is needed" (91.2%) and "Manpower to support DPSI in hospitals is required" (89.1%). Meanwhile, 79.3% agreed that "If an apology law is enacted, physicians will perform more DPSI" and 72.4% that "I support the introduction of an apology law." Korean physicians generally have a positive perception of DPSI, but less than the general public.
| S-EPMC7544042 | biostudies-literature
Project description:ObjectiveThe study aimed to investigate the impacts of patient safety incident (PSI) experienced by the general public.MethodsWe conducted a self-administered online survey, in which we examined the following experiences of the patients and the caregivers: the level of harm induced by PSIs, difficulties due to PSIs, posttraumatic stress disorder (PTSD), and posttraumatic embitterment disorder, etc. A χ test was performed to identify differences in difficulties because of the direct and indirect experience of PSIs. A 1-way analysis of variance was performed to identify the differences in the total PTSD and posttraumatic embitterment disorder scores according to the characteristics of PSIs.ResultsOf the survey participants who indirectly experienced PSIs, 27.2% and 29.3% reported that they experienced sleep disorder and eating disorder, respectively. However, of the participants who directly experienced PSIs, 40.7% and 42.6% reported experiencing sleep disorder and eating disorder, respectively. The average PTSD scores of the participants who experienced permanent disability and death were 83.8 points for less than 6 months of elapsed time since the incident, 80.8 points for 6 months to less than 5 years, and 94.7 points for 5 years or more; they did not demonstrate a statistically significant difference (P = 0.217).ConclusionsThis study suggested that the general public who experienced PSIs have numerous difficulties at the time of the incident and the trauma or the resentment of the general public does not quickly regress even if time passes.
| S-EPMC8612920 | biostudies-literature
Project description:Disclosure of patient safety incidents is a healthcare management strategy that primarily involves responding after incidents. We investigated the association between nursing students' moral sensitivity, attitudes about patient safety, and perceptions of open disclosure of patient safety incidents in Korea. Data were collected from 407 nursing students at four nursing universities using self-reported moral sensitivity, attitudes about patient safety, and perceptions about open disclosure of patient safety incidents as measures. The data were analyzed using t-test, one-way analysis of variance, and a multiple regression. As moral sensitivity and attitudes about patient safety improved, nursing students' perceptions regarding the open disclosure of patient safety incidents improved significantly. After controlling for gender, grade, and major satisfaction, the effect of changing attitudes about patient safety was greater than that of moral sensitivity for all perceptions of open disclosure. An education and intervention program is needed to improve nursing students' attitudes about patient safety and promote the open disclosure of patient safety incidents during undergraduate training.
| S-EPMC6954072 | biostudies-literature
Project description:ObjectivesPrisoners use healthcare services three times more frequently than the general population with poorer health outcomes. Their distinct healthcare needs often pose challenges to safe healthcare provision. This study aimed to characterise patient safety incidents reported in prisons to guide practice improvement and identify health policy priorities.Design: We carried out an exploratory multi-method analysis of anonymised safety incidents from prisons.SettingSafety incidents had been reported to the National Reporting and Learning System by prisons in England between April 2018 and March 2019.ParticipantsReports were reviewed to identify any unintended or unexpected incident(s) which could have, or did, lead to harm for prisoners receiving healthcare.Main outcome measuresFree-text descriptions were examined to identify the type and nature of safety incidents, their outcomes and harm severity. Analysis was contextualised with subject experts through structured workshops to explain relationships between the most common incidents and contributory factors.ResultsOf 4112 reports, the most frequently observed incidents were medication-related (n = 1167, 33%), specifically whilst administering medications (n = 626, 54%). Next, were access-related (n = 559,15%), inclusive of delays in patients accessing healthcare professionals (n = 236, 42%) and managing medical appointments (n = 171, 31%). The workshops contextualised incidents involving contributing factors (n = 1529, 28%) into three key themes, namely healthcare access, continuity of care and the balance between prison and healthcare priorities.ConclusionsThis study highlights the importance of improving medication safety and access to healthcare services for prisoners. We recommend staffing level reviews to ensure healthcare appointments are attended, and to review procedures for handling missed appointments, communication during patient transfers and medication prescribing.
| S-EPMC10387805 | biostudies-literature
Project description:Objectives(1) To describe the epidemiology of patient safety (PS) incidents registered in an electronic notification system in primary care (PC) health centres; (2) to define a risk map; and (3) to identify the critical areas where intervention is needed.DesignDescriptive analytical study of incidents reported from 1 January to 31 December 2018, on the TPSC Cloud™ platform (The Patient Safety Company) accessible from the corporate website (Intranet) of the regional public health service.Setting24 Catalan Institute of Health PC health centres of the Tarragona region (Spain).ParticipantsProfessionals from the PC health centres and a Patient Safety Functional Unit.MeasurementsData obtained from records voluntarily submitted to an electronic, standardised and anonymised form. Data recorded: healthcare unit, notifier, type of incident, risk matrix, causal and contributing factors, preventability, level of resolution and improvement actions.ResultsA total of 1544 reports were reviewed and 1129 PS incidents were analysed: 25.0% of incidents did not reach the patient; 66.5% reached the patient without causing harm, and 8.5% caused adverse events. Nurses provided half of the reports (48.5%), while doctors reported more adverse events (70.8%; p < 0.01). Of the 96 adverse events, 46.9% only required observation, 34.4% caused temporary damage that required treatment, 13.5% required (or prolonged) hospitalization, and 5.2% caused severe permanent damage and/or a situation close to death. Notably, 99.2% were considered preventable. The main critical areas were: communication (27.8%), clinical-administrative management (25.1%), care delivery (23.5%) and medicines (18.4%); few incidents were related to diagnosis (3.6%).ConclusionsPS incident notification applications are adequate for reporting incidents and adverse events associated with healthcare. Approximately 75% and 10% of incidents reach the patient and cause some damage, respectively, and most cases are considered preventable. Adequate and strengthened risk management of critical areas is required to improve PS.
| S-EPMC8430626 | biostudies-literature
Project description:BackgroundThe rapid diffusion of the internet has decreased consumer reliance on health care providers for health information and facilitated the patients' ability to be an agent in control of their own health. However, empirical evidence is limited regarding the effects of health-related internet use among older adults, which is complicated by the proliferation of online health and medical sources of questionable scientific accuracy.ObjectiveWe explore the effects of health-related internet use, education, and eHealth literacy on medical encounters and patient-reported outcomes. Patient-reported outcomes are categorized into two dimensions: (1) self-reported health problem and (2) affective distress (feeling worried and anxious) due to information obtained. We were particularly interested in whether education and eHealth literacy moderate the association between perceived strain in medical encounters and patient-reported outcomes.MethodsOur study sample consisted of online panel members who have used the internet as a resource for health information, randomly drawn from one of the largest probability-based online research panels. This paper specifically reports results obtained from older panel members (age≥60 years: n=194). First, we examined descriptive statistics and bivariate associations (Pearson correlations and independent samples t tests). We used hierarchical ordinary least squares regression analyses by running separate regressions for each patient-reported outcome. In model 1, we entered the main effects. In model 2, technology and medical encounter variables were included. Model 3 added the statistical interaction terms.ResultsAge (β=-.17; P=.02), gender (β=-.22; P=.01), and medical satisfaction (β=-.28; P=.01) were significant predictors of self-reported health problems. Affective distress was positively predicted by gender (β=.13; P=.05) and satisfaction with medical encounters (β=.34; P<.001) but negatively predicted by education (β=-.18; P=.03) and eHealth literacy (β=-.32; P=.01). The association between experiencing a health problem in relation to health-related internet use and perception of strained medical encounters was greater among respondents with lower levels of education (β=-.55; P=.04). There was also a significant interaction between education and eHealth literacy in predicting the level of affective distress (β=-.60; P=.05), which indicated that higher levels of education predicted lower averages of feeling anxiety and worry despite lower eHealth literacy. Older women reported higher averages of affective distress (β=.13; P=.05), while older men reported higher averages of experiencing a self-reported health problem (β=-.22; P=.01).ConclusionsThis study provides evidence for the effect of health-related internet use on patient-reported outcomes with implications for medical encounters. The results could be used to guide educational and eHealth literacy interventions for older individuals.
| S-EPMC8663692 | biostudies-literature