Tanja Manser

Infectious Risk Moments: A Novel, Human Factors–Informed Approach to Infection Prevention

We pilot tested a novel human factors-informed concept to identify infectious risk moments (IRMs) that occur with high frequency during routine intensive care. Following 30 observation-hours, 28 potential IRMs related to hand hygiene, gloves, and objects were expert rated. A comprehensive IRM inventory may provide valuable taxonomy for research, training, and intervention.

Job satisfaction among chairs of surgery from Europe and North America

BACKGROUNDnStrong evidence exists associating job satisfaction and risk of burnout with productivity, efficiency, and creativity in many organizations. However no data are available assessing chairs of surgery. This study assessed job satisfaction and risk for burnout of surgical chairs from Europe and North America and identified contributing factors.nnnMETHODSnA survey among 650 chairs in surgery from 23 European and 2 North American countries was conducted in 2012. Satisfaction at work was analyzed using the validated Global Job Satisfaction (GJS) instrument and the abbreviated Maslach Burnout Inventory. Additional items targeting personal and environmental factors were included.nnnRESULTSnThe rate of chairs reached successfully was 86%, the overall response rate was 29% (188/650), with 1% female. Median age was 58 years. 11% of chairs were dissatisfied with work. Younger age and being fewer years in practice as a chair was associated with higher job satisfaction (P = .054 and P = .003). Surgical specialty with the greatest median GJS score was hepatopancreatobiliary, whereas vascular surgery scored lowest. Chairs desire to devote 20% more of their time on research. Clerical support as well as the ability to be innovative was suggested by 51% and 45%, respectively, to improve job satisfaction. Compared with Europeans, North American chairs were overall more satisfied and would recommend their job to their children.nnnCONCLUSIONnNorth American chairs seem to be more satisfied at work and at less risk for burnout than European chairs. The overall job satisfaction was greater among chairs compared with previously published reports of young, board-certified surgeons or residents (89% vs 87% and 66%, respectively). The superior satisfaction in chairs is strongest related to career achievements, innovation, and lifestyle.

DNVF-Memorandum III „Methoden für die Versorgungsforschung“, Teil 3: Methoden der Qualitäts- und Patientensicherheitsforschung

The German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e.V. (DNVF)] fosters the methodological quality of health services research studies by memoranda and other initiatives. Quality of care and patient safety research (QCPSR) form core areas of health services research. The present memorandum explicates principal QCPSR questions and methods. Based on the issues particular relevance for health policy, the memorandum exemplifies methods for developing and testing indicators, risk adjustment techniques, methods for collecting patient safety data, tools to analyse patient safety incidents and methods for evaluating often complex and multicomponent QCPS interventions. Furthermore, we point out urgent research topics.

Using Failure mode and Effects Analysis to reduce patient safety risks related to the dispensing process in the community pharmacy setting

HighlightsVarious failure modes compromising patient safety during the dispensing of medicines in community pharmacies were revealed.Corrective actions were developed to prevent dispensing errors, indicating considerable potential for risk reduction.Failure Mode and Effects Analysis is capable of improvement of patient safety during the dispensing in community pharmacies.

Perceived barriers to computerised quality documentation during anaesthesia: a survey of anaesthesia staff

BackgroundUnderreporting of intraoperative events in anaesthesia is well-known and compromises quality documentation. The reasons for such omissions remain unclear. We conducted a questionnaire-based survey of anaesthesia staff to explore perceived barriers to reliable documentation during anaesthesia.MethodsParticipants anonymously completed a paper-based questionnaire. Predefined answers referred to potential barriers. Additional written comments were encouraged. Differences between physician and nurse anaesthetists were tested with t-tests and chi-square tests.ResultsTwenty-five physician and 30 nurse anaesthetists (81% of total staff) completed the survey. The reported problems referred to three main categories: (I) potential influences related to working conditions and practices of data collection, such as premature entry of the data (indicated by 85% of the respondents), competing duties (87%), and interfering interruptions or noise (67%); (II) problems referring to institutional management of the data, for example lacking feedback on the results (95%) and lacking knowledge about what the data are used for (75%); (III) problems related to specific attitudes, e.g., considering these data not useful for quality improvement (47%). Physicians were more sceptical than nurses regarding the relevance of these data for quality and patient safety.ConclusionsThe common perceived difficulties reported by physician and nurse anaesthetists resemble established barriers to incident reporting and may similarly act as barriers to quality documentation during anaesthesia. Further studies should investigate if these perceived obstacles have a causal impact on quality reporting in anaesthesia.Trial registrationClinicalTrials.gov identifier is NCT01524484. Registration date: January 21, 2012.

Prospective systemic risk analysis of the dispensing process in German community pharmacies

BACKGROUNDnMedicine dispensing represents an error-prone activity, carrying a considerable risk for patients.nnnOBJECTIVEnTo prospectively identify and prioritize potential failure modes in the medicine dispensing process as well as to develop corrective actions for patient safety improvement in German community pharmacies.nnnMETHODnFailure mode and effects analysis was performed in 2 community pharmacies in North Rhine-Westphalia, Germany, in October 2016. A 9-member team was assembled, comprising of a leader and process experts who prospectively assessed the medicine dispensing process by brainstorming, quantified the attributed risks, proposed corrective actions, and reassessed the risks.nnnRESULTSnThe analysis identified 39 failure modes, out of which the highest criticality scores were assigned to inadequate assessment of therapy appropriateness (Risk Priority Number 45), reluctance to deviate from rebate contracts (36), and dispensing the wrong medicine (30). The corrective actions proposed demonstrated a considerable potential for risk reduction in most failure modes, the most effective of which were introducing obligatory continuous education for pharmacists, organizing communication training, and implementing electronic prescribing.nnnCONCLUSIONnThis analysis not only detected various potential safety issues concerning the dispensing in Germany but also strongly indicated that application of failure mode and effects analysis could be highly effective in prospective risk reduction in community pharmacies.

Likelihood of Infectious Outcomes Following Infectious Risk Moments During Patient Care—An International Expert Consensus Study and Quantitative Risk Index

OBJECTIVE To elicit expert consensus on the likelihood of infectious outcomes (patient colonization or infection) following a broad range of infectious risk moments (IRMs) from observations in acute care. DESIGN Expert consensus study using modified Delphi technique. PARTICIPANTS Panel of 40 international experts including nurses, physicians and microbiologists specialized in infectious diseases and infection prevention and control (IPC). METHODS The modified Delphi process consisted of 3 online survey rounds, with feedback of mean ratings and expert comments between rounds. The Delphi survey comprised 52 care scenarios representing observed IRMs organized into 6 sections: hands, gloves, medical devices, mobile objects, invasive procedures, and additional moments. For each scenario, experts indicated the likelihood of both patient colonization and infection on a scale from 0 to 5 (high). Expert ratings were plotted against frequencies of IRMs observed during actual patient care resulting in a risk index. RESULTS Following 3 rounds, consensus was achieved for 92 of 104 items (88.5%). The mean ratings across all scenarios for likelihood of colonization and infection were 2.68 and 2.02, respectively. The likelihood of colonization was rated higher than infection for 48 of 52 scenarios. Ratings were significantly higher for colonization (P=.001) and infection (P<.0005) when the scenario involved transfer of pathogens to critical patient sites. CONCLUSIONS The design of effective IPC strategies requires the selection of behaviors according to their impact on patient outcomes. The IRM index reported here provides a basis for standardizing and prioritizing targets for quality improvement initiatives, training, and future research in acute health care. Infect Control Hosp Epidemiol 2018;39:280-289.

Frequency and Nature of Infectious Risk Moments During Acute Care Based on the INFORM Structured Classification Taxonomy

OBJECTIVE In this study, we sought to establish a comprehensive inventory of infectious risk moments (IRMs), defined as seemingly innocuous yet frequently occurring care manipulations potentially resulting in transfer of pathogens to patients. We also aimed to develop and employ an observational taxonomy to quantify the frequency and nature of IRMs in acute-care settings. DESIGN Prospective observational study and establishment of observational taxonomy. SETTING Intensive care unit, general medical ward, and emergency ward of a university-affiliated hospital. PARTICIPANTS Healthcare workers (HCWs) METHODS Exploratory observations were conducted to identify IRMs, which were coded based on the surfaces involved in the transmission pathway to establish a structured taxonomy. Structured observations were performed using this taxonomy to quantify IRMs in all 3 settings. RESULTS Following 129.17 hours of exploratory observations, identified IRMs involved HCW hands, gloves, care devices, mobile objects, and HCW clothing and accessories. A structured taxonomy called INFORM (INFectiOus Risk Moment) was established to classify each IRM according to the source, vector, and endpoint of potential pathogen transfer. We observed 1,138 IRMs during 53.77 hours of structured observations (31.25 active care hours) for an average foundation of 42.8 IRMs per active care hour overall, and average densities of 34.9, 36.8, and 56.3 IRMs in the intensive care, medical, and emergency wards, respectively. CONCLUSIONS Hands and gloves remain among the most important contributors to the transfer of pathogens within the healthcare setting, but medical devices, mobile objects, invasive devices, and HCW clothing and accessories may also contribute to patient colonization and/or infection. The INFORM observational taxonomy and IRM inventory presented may benefit clinical risk assessment, training and education, and future research. Infect Control Hosp Epidemiol 2018;39:272-279.