Susan E. Sheridan

Patient participation: current knowledge and applicability to patient safety.

Patient participation is increasingly recognized as a key component in the redesign of health care processes and is advocated as a means to improve patient safety. The concept has been successfully applied to various areas of patient care, such as decision making and the management of chronic diseases. We review the origins of patient participation, discuss the published evidence on its efficacy, and summarize the factors influencing its implementation. Patient-related factors, such as acceptance of the new patient role, lack of medical knowledge, lack of confidence, comorbidity, and various sociodemographic parameters, all affect willingness to participate in the health care process. Among health care workers, the acceptance and promotion of patient participation are influenced by other issues, including the desire to maintain control, lack of time, personal beliefs, type of illness, and training in patient-caregiver relationships. Social status, specialty, ethnic origin, and the stakes involved also influence patient and health care worker acceptance. The London Declaration, endorsed by the World Health Organization World Alliance for Patient Safety, calls for a greater role for patients to improve the safety of health care worldwide. Patient participation in hand hygiene promotion among staff to prevent health care-associated infection is discussed as an illustrative example. A conceptual model including key factors that influence participation and invite patients to contribute to error prevention is proposed. Further research is essential to establish key determinants for the success of patient participation in reducing medical errors and in improving patient safety.

Improved Hand Hygiene to Prevent Health Care-Associated Infections

StAtement of tHe Problem And ImPAC t: It is estimated that at any one time, more than 1.4 million people worldwide are suffering from infections acquired in hospitals (1,2). Health care-associated infections (HAI) occur worldwide and affect both developed and developing countries. In developed countries, between 5% and 10% of patients acquire one or more infections and 15%–40% of patients admitted to critical care are thought to be affected (3). In resource-poor settings, rates of infection can exceed 20% (4), but available data are scanty and more research is urgently needed to assess the burden of disease in developing and transitional countries.

Assuring Medication Accuracy at Transitions in Care: Patient Safety Solutions, Volume 1, Solution 6, May 2007

STATeMenT of ProbleM And IMPAC T: Errors are common as medications are procured, prescribed, dispensed, administered, and monitored but, they occur most frequently during the prescribing and administering actions (1). The impact is significant, as medication errors harm an estimated 1.5 million people and kill several thousand each year in the United States of America (USA) , costing the nation at least US

Performance of Correct Procedure at Correct Body Site: Patient Safety Solutions, Volume 1, Solution 4, May 2007

3.5 billion annually (1). Other industrialized countries around the world have also found that medication adverse events are a leading cause of injury and death within their health-care systems (2,3).

Communication During Patient Hand-Overs

A Standard Operating Protocol (SOP) is a set of instructions for implementing a defined patient care process by multiple users in a consistent and measurable manner. In the High 5s initiative, each SOP targets a specific patient safety problem, defines a standardized care process for addressing the problem, and prescribes an implementation plan that includes relevant measures and analytic procedures. These High 5s SOPs are to be implemented in a group of selected hospitals within participating countries for the purpose of demonstrating the feasibility of implementation of standardized care process across multiple hospitals and countries, as well as determining the impact of this standardization effort on the targeted patient safety problem.