Andrea Bishop

Patient Involvement in Patient Safety: A Qualitative Study of Nursing Staff and Patient Perceptions.

Objectives The risk associated with receiving health care has called for an increased focus on the role of patients in helping to improve safety. Recent research has highlighted that patient involvement in patient safety practices may be influenced by patient perceptions of patient safety practices and the perceptions of their health care providers. The objective of this research was to describe patient involvement in patient safety practices by exploring patient and nursing staff perceptions of safety. Methods Qualitative focus groups were conducted with a convenience sample of nursing staff and patients who had previously completed a patient safety survey in 2 tertiary hospital sites in Eastern Canada. Six focus groups (June 2011 to January 2012) were conducted and analyzed using inductive thematic analysis. Findings Four themes were identified: (1) wanting control, (2) feeling connected, (3) encountering roadblocks, and (4) sharing responsibility for safety. Both patient and nursing staff participants highlighted the importance of building a personal connection as a precursor to ensuring that patients are involved in their care and safety. However, perceptions of provider stress and nursing staff workload often reduced the ability of the nursing staff and patient participants to connect with one another and promote involvement. Conclusions Current strategies aimed at increasing patient awareness of patient safety may not be enough. The findings suggest that providing the context for interaction to occur between nursing staff and patients as well as targeted interventions aimed at increasing patient control may be needed to ensure patient involvement in patient safety.

Patient safety culture: finding meaning in patient experiences

PURPOSE The purpose of this paper is to determine what patient and family stories can tell us about patient safety culture within health care organizations and how patients experience patient safety culture. DESIGN/METHODOLOGY/APPROACH A total of 11 patient and family stories of adverse event experiences were examined in September 2013 using publicly available videos on the Canadian Patient Safety Insitute web site. Videos were transcribed verbatim and collated as one complete data set. Thematic analysis was used to perform qualitative inquiry. All qualitative analysis was done using NVivo 10 software. FINDINGS A total of three themes were identified: first, Being Passed Around; second, Not Having the Conversation; and third, the Person Behind the Patient. Results from this research also suggest that while health care organizations and providers might expect patients to play a larger role in managing their health, there may be underlying reasons as to why patients are not doing so. PRACTICAL IMPLICATIONS The findings indicate that patient experiences and narratives are useful sources of information to better understand organizational safety culture and patient experiences of safety while hospitalized. Greater inclusion and analysis of patient safety narratives is important in understanding the needs of patients and how patient safety culture interventions can be improved to ensure translation of patient safety strategies at the frontlines of care. ORIGINALITY/VALUE Greater acknowledgement of the patient and family experience provides organizations with an integral perspective to assist in defining and addressing deficiencies within their patient safety culture and to identify opportunities for improvement.

Using the Health Belief Model to explain patient involvement in patient safety.

With the knowledge that patient safety incidents can significantly impact patients, providers and health‐care organizations, greater emphasis on patient involvement as a means to mitigate risks warrants further research.

Public perceptions of pharmacist expanded scope of practice services in Nova Scotia

Background: Community pharmacists have been transitioning from traditional dispensing roles toward a much broader scope of practice. The objective of this research was to explore public perceptions of expanded scope of practice (ESOP) services as they relate to pharmacy and pharmacist characteristics. Methods: The Survey on New Services Offered by Nova Scotia Pharmacists was developed and deployed using in-pharmacy intercept surveys and online public surveys in Nova Scotia. The survey focused on 4 key ESOP elements/services: 1) prescribing for minor ailments (ambulatory conditions), 2) injections and vaccinations, 3) prescription renewals and 4) medication reviews. Data were analyzed using comparisons between groups (multivariate analysis of variance) and principal component analysis. Results: A total of 385 surveys were obtained from the public regarding their perceptions and use of ESOP services (online n = 237, in-pharmacy intercept n = 148). A number of significant differences were found on the basis of respondent sex, age and the location of survey deployment. Discussion: Overall, public perceptions of pharmacists’ knowledge and skills in providing ESOP services are positive. A pharmacist’s ability to communicate, protect confidentiality and provide quality information regarding medications is important to the public. Conclusion: Respondents who already have a good relationship with their pharmacist are more likely to see value in ESOP services. Future public education strategies should focus on factors positively affecting the public’s perceptions of ESOP services and should encourage public use of these services through intentional patient education of the benefits of ESOP services and strengthening of the patient-provider relationship.

Keeping the “continuous” in continuous quality improvement: Exploring perceived outcomes of CQI program use in community pharmacy

BACKGROUND Given the significant potential of continuous quality improvement (CQI) programs in enhancing overall levels of patient safety, community pharmacies in North America are under increasing pressure to have a formal and documented CQI program in place. However, while such initiatives may seem great on paper, in practice the outcomes of such programs to community pharmacy practice remain unclear. OBJECTIVE To explore the perceived outcomes identified by community pharmacies that adopted and actively used a standardized (i.e., common across pharmacies) CQI program for at least 1 year and to develop a framework for how such outcomes were achieved. METHODS A multi-site study of SafetyNET-Rx, a standardized and technologically sophisticated (e.g., online reporting of medication errors to a national database) CQI program, involving community pharmacies in Nova Scotia, Canada, was performed. During the summer and fall of 2011, 22 interviews were conducted with the CQI facilitators in 12 Nova Scotia community pharmacies; equally split between independent/banners and corporate chains. Of the CQI facilitators, 14 were pharmacists, while the remaining eight were pharmacy technicians. Thematic analysis following the procedures presented by Braun and Clarke was adopted to identify and explore the major outcomes. RESULTS Results of the thematic analysis highlighted a number of perceived outcomes from the use of a standardized CQI program in community pharmacies, specifically: (1) perceived reduction in the number of medication errors that were occurring in the pharmacy, (2) increased awareness/confidence of individual actions related to dispensing, (3) increased understanding of the dispensing and related processes/workflow, (4) increased openness to talking about medication errors among pharmacy staff, and (5) quality and safety becoming more entrenched in the workflow (e.g., staff is more aware of their roles and responsibilities in patient safety and confident that the dispensing processes are safe and reliable). In achieving such outcomes, pharmacies had to balance customizing the CQI program to address a number of operational challenges, with ensuring that the core standardized components remained in place. CONCLUSIONS This research identified the perceived outcomes of CQI program use by CQI facilitators. Additionally, the findings are incorporated into a framework for CQI implementation that can be used by pharmacy managers, corporate head offices, and regulatory authorities to leverage greater CQI adoption and success.

The Role of Safety Culture in Influencing Provider Perceptions of Patient Safety.

Objectives To determine how provider perceptions of safety culture influence their involvement in patient safety practices. Methods Health-care providers were surveyed in 2 tertiary hospitals located in Atlantic Canada, composed of 4 units in total. The partial least squares (PLS) approach to structural equation modeling was used to analyze the data. Latent variables provider PLS model encompassed the hypothesized relationships between provider characteristics, safety culture, perceptions of patient safety practices, and actual performance of patient safety practices, using the Health Belief Model (HBM) as a guide. Data analysis was conducted using SmartPLS. Results A total of 113 health-care providers completed a survey out of an eligible 318, representing a response rate of 35.5%. The final PLS model showed acceptable internal consistency with all four latent variables having a composite reliability score above the recommended 0.70 cutoff value (safety culture = 0.86, threat = 0.76, expectations = 0.83, PS practices = 0.75). Discriminant validity was established, and all path coefficients were found to be significant at the &agr; = 0.05 level using nonparametric bootstrapping. The survey results show that safety culture accounted for 34% of the variance in perceptions of threat and 42% of the variance in expectations. Conclusions This research supports the role that safety culture plays in the promotion and maintenance of patient safety activities for health-care providers. As such, it is recommended that the introduction of new patient safety strategies follow a thorough exploration of an organization’s safety culture.

Reflections on the role of the pharmacy regulatory authority in enhancing quality related event reporting in community pharmacies

BACKGROUND Given the demanding nature of providing pharmacy services, coupled with the expanded scope of practice of the professions in jurisdictions around the world, greater commitment to continuous quality improvement through adoption of quality-related event (QRE) reporting is necessary to ensure patient safety. Pharmacy regulatory authorities (PRAs) are in a unique position to enhance QRE reporting and learning through the standardization of expected practice. OBJECTIVE This study was aimed to gain a better understanding of the perceived roles of PRAs in enhancing QRE reporting and learning in community pharmacies, and identifying regulatory best practices to execute such roles. METHODS A purposive case sampling approach was used to identify PRA staff members from two groups (Deputy registrars and pharmacy inspectors) in 10 Canadian jurisdictions to participate in focus groups in the fall of 2011. Focus groups were used to explore perceptions of the role of PRAs in enhancing and promoting QRE reporting and learning, and perceived barriers to effective implementation in practice. Thematic analysis was used to analyze the qualitative data. RESULTS Two focus groups were conducted, one with seven Deputy registrars/Practice managers, and one with nine pharmacy inspectors. Five themes were identified, including (1) defining QRE reporting and compliance, (2) navigating role conflict, (3) educating for enhanced QRE reporting and learning, (4) promoting the positive/removing the fear of QREs, and (5) tailoring QRE reporting and learning consistency. CONCLUSIONS Overall, participants perceived a strong role for PRAs in enhancing QRE reporting and learning and providing education for pharmacies to support their compliance with reporting standards. However, PRAs must navigate the conflict inherent in both educating and promoting a process for achieving a standard while simultaneously inspecting compliance to that standard. Ensuring pharmacies have autonomy in operationalizing standards may help to mitigate this conflict. Finally, greater education for PRAs themselves to better inspect compliance and in order to better communicate the benefits of QRE reporting and learning to pharmacies would be beneficial.

Development and feasibility testing of the Pediatric Emergency Discharge Interaction Coding Scheme

Discharge communication is an important aspect of high‐quality emergency care. This study addresses the gap in knowledge on how to describe discharge communication in a paediatric emergency department (ED).

Essential Content for Discharge Instructions in Pediatric Emergency Care: A Delphi Study

Objective The aim of this study was to identify the 5 most essential discharge instruction content elements that should be communicated to all caregivers of children who present to the emergency department (ED) with asthma, vomiting/diarrhea, abdominal pain, fever, minor head injury, or bronchiolitis. Methods A discharge information content list was developed for each illness presentation following a review of the literature. Using a modified Delphi technique, 6 lists were distributed to a panel of experts from EDs across Canada using a secure online survey tool with the goal of achieving the 5 most essential discharge instruction elements. Results A total of 37 emergency clinicians completed all 4 rounds of the Delphi. Consensus for the final 30 content items ranged from 51.4% to 100%. Items pertaining to diarrhea/vomiting, abdominal pain, fever, and bronchiolitis obtained relatively high levels of consensus for all top 5 items. The majority of items (n = 19 [63.3%]) that reached consensus across the illness presentations were associated with instructions intended to educate caregivers on instances when they should return to the ED department. Conclusions Findings from this study provide a better understanding of what should be communicated to caregivers of children who present to the ED with a number of different illness presentations. Results from this study suggest that health care providers agree on the importance of providing information to caregivers regarding when to return to the ED with their child. Reaching consensus among all experts in this study provides insight into the difficulty of standardizing discharge communication in the absence of widely accepted guidelines.

Uptake of Quality-Related Event Standards of Practice by Community Pharmacies.

Quality-related events (QREs), including medication errors and near misses, are an inevitable part of community pharmacy practice. As QREs have significant implications for patient safety, pharmacy regulatory authorities across North America are increasing their expectations regarding QRE reporting and learning. Such expectations, commonly encapsulated as standards of practice (SoP), vary greatly between pharmacy jurisdictions and may range from the simple requirement to document QREs occurring within the pharmacy, all the way to requiring that quality improvement plans have been put in place. This research explores the uptake of QRE reporting and learning SoP and how this uptake varies based on pharmacy characteristics including location, prescription volume, and pharmacy type. Secondary data analysis of 91 community pharmacy assessments in Nova Scotia, Canada, was used to explore uptake of QRE standards. Overall, pharmacies are performing relatively well on reporting QREs. However, despite initial success with basic QRE reporting, community pharmacy uptake of QRE learning activities is lagging.