The Impact of Medical Profession Type, Gender, and Years of Experience on Thinking Styles: What Are the Implications for Patient Safety?

Background: Healthcare providers were faced daily with many decision-making that impacted patients’ safety. According to dual process theory, there were two types of thinking: Experiential style (ES) and Rational Style (RS). Both thinking styles had an impact on individuals’ decisions making. Therefore, the aim of this study was to find out nurses’ and physicians’ styles of thinking and how this impacted patients’ safety. Design: A cross-sectional study. Methods: Nurses and physicians sample of adults (n = 308), 190 (61.7%) of the sample were nurses and 118 (38.3%) of the sample were physicians. Participants completed a self-report online survey, which included demographic information followed by questionnaires to measure thinking style and a cognitive puzzle to see if the medical error was associated with certain styles of thinking. Results: The main findings were that nurses (M = 2.41, SD = 0.37) had significantly higher scores compared to physicians (M = 2.29, SD = 0.39) in their ES, t(305) = 2.73, p = 0.007;with medium effect size, d = 0.37692. Conclusion: Nurses differed from physicians in ES where nurses had a significantly higher score than physicians which could be positive for patients’ safety as higher ES would report errors compared to lower ES.

Patient Safety Efforts in Tanzania: A Rapid Review of Two-Decades Efforts (2002-2022) to Inform Interventions towards Attainment of 2030 Targets

Introduction: The need to address the problem of patient safety has been a focus of World Health Assembly (WHA) meetings of 2002, 2019 and 2021. The 2019 WHA Resolution urged the Member States to take action on patient safety. We aimed to review patient safety efforts in Tanzania from 2002 to 2022 to inform improvement efforts towards the 2030 target. Methods: A rapid literature review was conducted between January 2002 and April 2022. We searched Google, PubMed and PubMed Central in April and May 2022 using the following search terms: PubMed—“patient safety Tanzania”, “blood safety in Tanzania”, “safe surgery Tanzania”, and “healthcare-associated infections Tanzania”;Google—“blood safety in Tanzania”, injection safety in Tanzania”, “infection prevention and control”, “radiation safety in health facilities in Tanzania”;and PubMed Central—“injection safety in Tanzania. Results: The search identified 4160 articles, of which 4053 were removed in initial screening;21 were duplicates, giving 86 relevant articles for full screening. Of the 86 articles, 04 were removed after the full screening, hence remaining with 82 articles. Among the 82 eligible articles, 27 are on IPC, 26 on safe surgery, 12 on blood safety, 07 on radiation safety, 06 on injection safety, and 02 on medication safety. One article was relevant to—blood safety, IPC and injection safety;and one article was relevant to—IPC and injection safety. Conclusion: Most of the eligible literature was on IPC and safe surgery, followed by blood safety, radiation safety, injection safety and medication safety. The literature on IPC has highlighted the need to strengthen efforts to address AMR. Findings from the implementation of the safe surgery 2020 intervention warrants for its scale-up to other zones. There is a need to strengthen hemovigilance and pharmacovigilance functions;and strengthen quality management and assurance systems and regulatory functions to ensure radiation safety.

Patient safety practices and medical errors: Perception of health care providers at Jimma University Specialized Hospital, Southwest Ethiopia

Background: Even though evidences are limited in developing countries, the probability of patients being harmed in hospitals when receiving care might be much greater than that of the industrialized nations. Thus, aim of this study was to assess patient safety practice and the perceived prevalence of medical errors at Jimma University Specialized Hospital, Southwest Ethiopia. Methods: A facility based cross-sectional study was conducted during June, July and August 2010 in Jimma University Specialized Hospital. Patient safety grade and the perceived prevalence of medical errors were computed descriptively. Then, the effect of various independent variables on patient safety grade was assessed using multiple linear regressions analysis. Result: The overall patient safety grade as rated by the participants was excellent (7.2%), very good (20.7%), acceptable (36.0%), poor (30.0%) and failing (6.4%). Complications related to anesthesia occurred sometimes, rarely and never according to 30.8%, 43% and 15.8% of the respondents, respectively. Death in low mortality patients was reported to occur most of the time by 10.4% of the respondents. In addition, failure to rescue, infection due to medical care, postoperative hemorrhage, postoperative sepsis, birth injury to the neonate, obstetric trauma to the mother were reported to happened. Supervisor expectation and actions promoting patient safety (p < 0.001), and communication openness and feedback about errors (p = 0.002) had positive correlation with patient safety grade. Conclusion: this study indicated that poor patient safety practice and potentially preventable medical errors in the hospital.

Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

Knowledge Representation in Patient Safety Reporting: An Ontological Approach

Purpose： The current development of patient safety reporting systems is criticized for loss of information and low data quality due to the lack of a uniformed domain knowledge base and text processing functionality. To improve patient safety reporting, the present paper suggests an ontological representation of patient safety knowledge. Design/methodology/approach： We propose a framework for constructing an ontological knowledge base of patient safety. The present paper describes our design, implementation,and evaluation of the ontology at its initial stage. Findings： We describe the design and initial outcomes of the ontology implementation. The evaluation results demonstrate the clinical validity of the ontology by a self-developed survey measurement. Research limitations： The proposed ontology was developed and evaluated using a small number of information sources. Presently, US data are used, but they are not essential for the ultimate structure of the ontology.Practical implications： The goal of improving patient safety can be aided through investigating patient safety reports and providing actionable knowledge to clinical practitioners.As such, constructing a domain specific ontology for patient safety reports serves as a cornerstone in information collection and text mining methods.Originality/value： The use of ontologies provides abstracted representation of semantic information and enables a wealth of applications in a reporting system. Therefore, constructing such a knowledge base is recognized as a high priority in health care.

Safety of the Patient from the Medication

Currently, more than 7% of admissions to acute care hospitals am related with AEMs （adverse events to medications）. AEMs are the sixth cause of death, causing a cost of over $5.6 million dollars （USD） per hospital per year. There is an estimate that between 19% and 23% of hospitalized patients will have an adverse effect within the first 30 days after being discharged, 14.3% will be re-admitted and 70% of these events will be related to a medication prescription. Fortunately, at least 58% of these AEMs are preventable, since they result from a lack of information on the medication, prescription and dosage errors and from the abuse and underuse of the same. Polymedicated patients, especially the elderly with multiple pathologies and/or chronic patients that need to be admitted into the hospital more frequently, usually to internal medicine, neurology, psychiatry, rehabilitation and intensive care, are precisely the most liable to suffer from medication errors. It must be the objective to aim for the increase in the patient safety standards when it comes to medications.

Medical Information Breaches Occurrence with Respect to Social Media Usage, in Selected Medical Institutions in Uganda

The purpose of this manuscript is to present research findings based on the reported cases of medical information breaches due to Social Media (SM) usage, in selected medical institutions in Uganda. The study employed online survey techniques. Altogether, 710 questionnaires (Google forms) were developed, and operationalized. The main respondents included 566 medical students, and 143 medical staff from Mbarara University of Science and Technology (MUST), and Kampala International University (KIU), accordingly. Using SPSS, the main statistical analysis tools employed include frequency distribution summary, and Chi-square (x2) test. According to the frequency distribution summary, 27% to 42% of the respondents within categorical divides acknowledged occurrence of medical information breaches due to SM usage. Notably, higher levels of the breaches were reported among male students (64%), age-group 18 to 35 years (68%), and WhatsApp users (63%). On the other hand, Chi-square results showed significant levels (p p > 0.05) between medical institutions and medical information breaches. Overall, the vulnerable areas of the breaches identified would serve as important reference points in the process of rationalizing SM usage in medical institutions. Nevertheless, further studies could focus on identification of the key SM usage factors associated with medical information breaches in medical institutions in Uganda.

Personality Traits, Thinking Styles, and Emotional Intelligence in Nursing, towards Healthcare Providers’ Characterization and Safer Patient Care

Background: This study explored nursing personality traits (Big Five Inventory BFI), emotional intelligence (EI), and thinking styles (Rational, RS, and Experiential, ES) together with demographic data to see how they could relate and the implication of this on nurses and patient safety. Design: A cross-sectional study. Methods: Nursing sample (n = 435). Participants completed a self-report online survey, which included demographic information, followed by questionnaires to measure personality traits, thinking styles, and emotional intelligence. Results: Spearman’s rank correlation was computed to assess the relationship between EI and Extraversion;there was a moderate positive correlation between the two variables, r = 0.487, p r = 0.731, p r = 0.723, p r = -0.666, p r = 0.467, p Conclusion: Different studies consolidated each other, and all converge and channel into the concept of characterization of healthcare providers for better support to them and safer patient care. EI correlated with all BFI components, and both positively impacted all desirable behaviors. Therefore, it would be valuable if organizations invested in increasing EI in their providers as it might highlight areas for improvement and equip providers with appropriate and advantageous coping strategies.

护士用药安全管理实践现状与思考

用药安全管理是患者安全管理的重要内容。护士作为患者用药的最终执行者,其用药安全管理水平对于保证住院患者的治疗安全至关重要。文章回顾了国内外用药安全管理与实践现状,总结我国护士在用药安全管理实践中取得的进展与成效,为进一步推动住院患者用药安全水平的提升提供参考。

上海市标准化非急救医疗转运服务规范的确立及应用

目的 分析上海市非急救医疗转运现存问题及行业标准制定过程,为建立标准化非急救医疗转运服务规范提供参考。方法 回顾我国非急救医疗转运发展历程,分析现阶段非急救医疗转运问题,建立非急救医疗转运团体标准,并进行推广,满足患者非急救医疗转运需求,提供以患者为中心的医疗服务。结果 成功制定了上海市非急救医疗转运的行业标准并应用推广,提升了医疗转运效率。结论 非急救医疗转运是院前急救的补充,有助于缓解院前急救压力,提高医疗转运效率。

肿瘤放射治疗医学物理实习生的患者安全教育课程探索

放射治疗的技术复杂,患者治疗安全性备受医患家属关注。在这一背景下,放射治疗物理实习生的患者安全培训成为实习课程中非常重要的环节。患者安全培训不仅要求实习生掌握基础理论知识,更需要培养临床紧急情况时的综合应对能力,以确保患者在接受治疗时的安全。该研究介绍了解放军总医院第一医学中心针对放疗医学物理实习生制定的患者安全教育培训课程,并评估学习效果。该课程为期2个月,涵盖了基础理论、临床技能、质量保证、沟通教育和伦理等12个教学主题领域;通过结合在线资源自主学习、课堂授课理论教学、模拟临床情境演练和故障模式分析讨论实践教学,全面提升了实习生在放射治疗中的患者安全意识和应对能力。培训反馈结果显示,62名参与培训的医学物理实习生在患者安全知识、质量控制流程、辐射防护原则、团队协作能力以及医患沟通技巧等方面均有显著提升;在理论知识方面,实习生从培训前的Level1(基础理解)提升至Level3.5(深入理解),并在模拟实践技能上展现出能够独立处理复杂临床情况的能力。

公立医院急诊患者安全管理与救援能力提升研究

在公立医院高质量发展的大背景下,提升疾病救治能力,为广大人民群众提供高质量、高水平的医疗服务,已成为各级公立医院的追求目标。急诊是反映医院医疗质量管理的窗口,各项急救工作高度依赖医生的判断以及医护人员的协作,属于高风险流程,需要医院管理者高度重视。淮安某公立医院利用医疗失效模式与效应分析工具(healthcare failure mode and effect analysis,HFMEA)对急诊患者进行安全管理,包括成立HFMEA团队,绘制现况价值流程,计算风险指数和决策树分析后实施改善方案,有效提升了急诊医疗质量与安全。同时通过建立健全应急救援组织架构、强化应急救援管理内涵质量、打造一流救援平台和优秀应急救援队伍,全面提升了医院在应急状态下的综合救援能力。

Ten misconceptions regarding decision-making in critical care

Diagnostic errors are prevalent in critical care practice and are associated with patient harm and costs for providers and the healthcare system.Patient complexity,illness severity,and the urgency in initiating proper treatment all contribute to decision-making errors.Clinician-related factors such as fatigue,cognitive overload,and inexperience further interfere with effective decision-making.Cognitive science has provided insight into the clinical decision-making process that can be used to reduce error.This evidence-based review discusses ten common misconceptions regarding critical care decision-making.By understanding how practitioners make clinical decisions and examining how errors occur,strategies may be developed and implemented to decrease errors in Decision-making and improve patient outcomes.

医疗机构药品使用风险管理立意探究

药品作为特殊商品,其使用环节的复杂性导致药品风险管理颇具挑战性。新修订《药品管理法》明确提出风险管理是药品管理的原则之一,要切实保障公众用药安全。本文通过对药品使用风险管理的研究成果和实践探索进行全面阐述,探讨了药品使用风险管理的内涵及其在医疗机构中的应用,强调了医疗机构在此过程中应承担的责任,提出医疗机构应建立涵盖早期预警、系统评估、科学防范、有效交流和总体评价等多个环节的全面药品使用风险管理体系,贯穿药品从遴选采购到患者使用的全过程。此外,本文探讨了药品使用风险管理的未来发展方向,包括利用真实世界数据、数据挖掘和人工智能技术等手段,进一步推动药品使用风险管理的科学化和系统化,促进医药卫生体系的高质量发展。

医疗机构医患沟通管理体系的构建与管理实践探索

在《基本医疗卫生与健康促进法》《民法典》等法律法规实施背景下,为提升医疗安全管理水平,保障患者知情同意权,促进医患之间有效沟通,四川大学华西医院致力于构建和完善医患沟通管理体系的实践探索,开展了明确管理架构,制定规章制度;分层分类进行医患沟通能力培训;规范化使用和管理知情同意书,强化医务人员在诊疗活动过程中对疾病诊断、治疗方案、医疗风险、替代医疗方案、治疗费用等的告知义务,保障患者知情同意权;拟定各类特殊情形下的医患沟通流程;建立专用谈话室,运用信息技术予以保障;开展医患沟通问题分析,不断持续改进等一系列举措。实施以来,院内医患沟通规范化水平显著提高,有效保障了患者知情同意权,为构建医患和谐关系奠定了坚实基础。

《患者安全课程思政教学指南》的编制及初步应用

目的设计及编制《患者安全课程思政教学指南》,并探讨其初步应用效果。方法以重庆医科大学患者安全课程建设为基础,以教育部《医学人文课程思政教学指南编写要求》为依据,组建编制团队,基于文献研究、专题讨论构建指南初稿,经12名专家论证后修改完善指南内容,形成《患者安全课程思政教学指南》。在2022年秋学期开课时随机选取2个小班的三年级护理本科生(n=80)应用该指南进行教学,在课程结束时采用问卷调查课程思政教学满意度;同时开展教师座谈会,讨论应用该指南进行授课的教学感受及对该指南的评价反馈。结果《患者安全课程思政教学指南》分为总论、各章节课程思政教学指南、附录3个部分;绝大部分学生对应用该指南教学表示满意;15名授课教师对该指南均持肯定态度,认为其具有较高的操作性、实用性和科学性,提出需加强思政元素挖掘、开展素材选取方面的培训等建议。结论编制的《患者安全课程思政教学指南》内容全面,科学、合理且具有可行性,能够为授课教师提供从理论原则、实际教学到评估评价的全程教学指导与参考;在教学实践中得到了验证,获得了学生和教师的一致好评。

我国老年人莫西沙星用药错误报告分析及防范建议

目的分析我国老年人莫西沙星用药错误(ME)的发生特点,并提出防范建议。方法收集全国临床安全用药监测网2012年9月22日至2022年9月22日的我国老年人(≥60岁)莫西沙星ME报告,分析其等级、内容、引发人员、发生场所、发现人员、引发因素等。结果收集到莫西沙星ME报告共177份,来自全国15个省级行政区的64家医院,涉及患者177例,其中男109例(61.58%)、女68例(38.42%),年龄60~97岁(中位年龄73岁)。ME报告中,B级124例(70.06%),C级33例(18.64%),D级10例(5.65%),E级7例(3.95%),F级3例(1.69%)。其中,严重ME(E级及以上)10例,包括肝功能相关ME 5例,滴速过快至皮肤发红1例,患者身份识别错误致输液反应1例,联用胺碘酮致QT间期延长1例,有莫西沙星过敏史患者再次使用该药致头晕、口干1例,未根据药敏试验结果调整治疗方案致住院时间延长1例。ME引发人员主要为医师(177例,66.10%);发生场所主要为病房(81例,45.76%);发现人员主要为药师(129例,72.88%);最多见的错误内容为(药物的)品种(54例次,27.55%);引发ME的因素主要为人员因素(126例次,68.48%)。结论对于我国老年(≥60岁)患者,临床使用莫西沙星时需重点关注处方和调配环节的ME。

基于微信小程序的疼痛药物剂量设置工具研发与应用

目的研发关于疼痛药物剂量设置微信小程序,并测试其可用性。目的2020年1-2月,根据临床需求组建团队研发。3-4月,采用方便抽样法行预实验,选取某三甲医院的医生和护士各20名,分别使用该小程序和传统计算器进行不同阿片类药物的剂量转换(医生)及患者自控镇痛泵的药物参数设置(护士)各400次,比较所需时间及正确性,并采用易用性量表(USE)评价小程序。目的医生、护士运用小程序计算的准确率为100%,均高于传统方法(p<0.01);计算所需时间均快于传统方法(p<0.01);医生和护士USE量表的平均得分分别为6.56±0.20分、6.60±0.19分。目的研发的小程序为医生转换疼痛药物剂量提供参考,满足护士对镇痛泵参数的准确计算和设置的需求,医护人员的接受度较高,可用性好。

基于德尔菲法初步编制门诊慢性病患者参与用药安全能力自评量表

背景患者用药安全已成为世界关注的医疗卫生问题,患者对于促进自身用药安全发挥着重要作用。目的基于德尔菲法初步编制门诊慢性病患者参与用药安全能力自评量表,为评估及促进门诊慢性病患者参与用药安全能力提供客观标准。方法通过文献研究和半结构化访谈法拟定门诊慢性病患者参与用药安全能力量表初始条目。根据研究目的,采用德尔菲法对来自北京、上海、广东、天津、浙江、内蒙古的28名专家进行两轮函询,请专家对量表各维度的熟悉程度及判断依据进行评分,采用Likert 5级评分法对条目重要性及可行性进行评分。2021-09-30—10-12进行第一轮专家咨询,2021-11-05—15进行第二轮专家咨询,最后通过专家小组会议讨论确定最终条目。计算问卷回收率,以此反映专家积极性;采用权威系数衡量咨询结果的权威程度;采用变异系数及协调系数Kendall's W评价专家意见协调程度;重要性和可行性评分的算术均数≥3.5分且变异系数<0.25作为条目筛选的初步参考,同时结合专家意见,经研究小组成员和专家小组会议充分讨论后确定条目调整结果。结果两轮专家咨询均发出28份问卷,回收问卷28份,专家积极系数均为100%。两轮咨询专家权威系数为0.877。第二轮条目重要性和可行性的专家意见协调系数Kendall's W相较第一轮均有所提高。第一轮专家咨询结果显示,各条目重要性评分为3.964~4.964分,变异系数为0.038~0.211;可行性评分为3.964~4.821分,变异系数为0.081~0.265。第二轮专家咨询结果显示,各条目的重要性评分为4.321~5.000分,变异系数为0~0.168;可行性评分为4.036~4.893分,变异系数为0.064~0.186。两轮专家咨询及专家小组会议后最终确定了包括用药知识、用药信念、参与用药决策、用药自我管理4个维度、33个条目的门诊慢性病患者参与用药安全能力自评量表。结论本研究构建了一个包含用药知识、用药信念、参与用药决策、用药自我管理4个维度、33个条目的门诊慢性病患者参与用药安全能力自评量表,该自评量表能够对门诊慢性病患者参与用药安全能力进行评估,为制订相应措施以促进患者参与用药过程、提高用药安全提供参考。

权力距离在老年慢性病患者健康素养和参与用药安全行为间的中介作用

目的探讨权力距离在老年慢性病患者健康素养与参与用药安全行为间的中介效应,为制定相关护理干预提供参考。方法采用一般资料调查表、慢性病患者健康素养量、患者权力距离量表、患者参与用药安全行为量表对296名老年慢性病患者进行问卷调查。结果老年慢性病患者健康素养得分(96.51±25.57)分,患者权力距离得分(40.05±14.60)分,参与用药安全行为得分(80.85±22.92)分。老年慢性病患者健康素养与患者权力距离呈负相关,与参与用药安全行为呈正相关,患者权力距离与参与用药安全行为呈负相关(均P<0.05);结构方程模型结果显示,老年慢性病患者健康素养能正向预测参与用药安全行为,患者权力距离在健康素养与参与用药安全行为间起部分中介效应,中介效应占总效应的31.88%。结论权力距离在老年慢性病患者健康素养与参与用药安全行为间起中介效应,医护人员应提高老年慢性病患者健康素养,关注患者权力距离,提高老年慢性病患者参与用药安全行为。