Patients' safety

Organizational framework for health information technology

Patient Safety: Grantmakers Join The Effort To Reduce Medical Errors

We are pleased to dedicate this special theme issue of the Journal to the important topic of perioperative patient safety. Anesthesiologists take justifiable pride in the development and implementation of robust patient safety initiatives throughout the world. At the same time, many of us are challenged daily in caring for patients with everincreasing medical complexity. We provide anesthesia for routine and complex surgical and interventional procedures in the operating room and ‘‘remote settings’’ within the context of an ever-complex working environment. In considering these contemporary and patient-focused challenges, some months ago, our editorial team invited experts from Canada and internationally to address current key issues in perioperative patient safety in a series of brief review articles. I acknowledge with special thanks our Board Member, Dr. Alan F. Merry, for his thoughtful input and contribution to this issue, and for his instrumental role as co-editor and editorialist. According to Journal policy, these articles have all been externally reviewed and edited, and for the benefit of our readers, we have harmonized the outline of each article to include a structured abstract, a list of key words, and two or three multiple choice questions to guide readers’ attention to the key points. In the first review article, Dr. John H. Eichhorn provides an overview of practical current issues in perioperative patient safety. He emphasizes the fact that important gains in patient safety over the past three decades have been attributed largely to the development of behaviours known as ‘‘safety monitoring’’. Extension of the human senses through electronic monitors, such as capnography and pulse oximetry, has been a major advance, but Dr. Eichhorn cautions that, ‘‘in the highly developed world, this current success is threatened by complacency and production pressure’’ which bring forth new challenges. Electronic medical records, hence, anesthesia information management systems (AIMS), provide enormous potential to enhance patient safety. Anesthesiologists have the opportunity to become key leaders in the adoption, implementation, and integration of AIMS and healthsystem information technology (IT) solutions in general. In their review article on the evolving role of IT in perioperative patient safety, Drs. Michael Stabile and Lebron Cooper identify that uptake of health IT and AIMS remains variable despite the potential benefits, and they identify advantages and barriers to the adoption and implementation of IT in general and AIMS in particular. Later articles in this theme issue address specific clinical issues that present ongoing challenges to the practicing clinician. Medication error remains a leading cause of adverse events in the perioperative setting. In their article ‘‘Improving drug safety for patients undergoing anesthesia and surgery,’’ Drs. Beverley A. Orser, Sylvia Hyland, C. Ruth Wilson, David U, and Ian Sheppard summarize recent advances, tools and interventions designed to improve drug safety, relevant to the practicing anesthesiologist. Important Canadian and international initiatives such as new standards for labelling of drug ampoules and vials, and the development of bar code systems that provide as systematic approach to ‘‘double checking’’ or drug verification in the operating room, are reviewed. This article also addresses the important subject of medication reconciliation as a means to enhance patient safety. There is now fairly compelling evidence that implementation of checklists into clinical practice can enhance D. R. Miller, MD (&) Department of Anesthesia, The Ottawa Hospital and University of Ottawa, General Campus CCW 1401, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada e-mail: dmiller@ottawahospital.on.ca

Pengambilan kebijakan terkait implementasi teknologi informasi pada perguruan tinggi harus disertai dengan komitmen yang didukung oleh analisa mengenai besarnya kontribusi teknologi informasi pada kinerja institusi. Sehingga implementasi tersebut tidak serta merta hanya mengikuti tren yang berlaku, dimana hampir semua perguruan tinggi yang lain telah melakukan implementasi teknologi informasi. Serta menghindari adanya investasi yang sia-sia dikarenakan adanya kesalahan kebijakan dalam implementasi teknologi informasi. Information Technology Productivity Paradox merupakan sebuah perspektif baru dalam bidang tatakelola teknologi informasi untuk mengetahui besarnya kontribusi teknologi informasi pada peningkatan kinerja. Implementasi teknologi informasi selalu melibatkan banyak pihak dan membutuhkan biaya yang cukup besar, sehingga selalu timbul sebuah pertanyaan dalam benak pengambil kebijakan, apakah biaya dan sumberdaya yang dialokasikan untuk implementasi teknologi informasi adalah sebuah investasi yang tepat atau sia-sia. Tujuan penelitian ini adalah mendapatkan sebuah model konseptual tentang variabel yang berperan dalam pengaruh implementasi IT/Teknologi Informasi terhadap peningkatan produktivitas pada perguruan tinggi dengan menggunakan pendekatan secara langsung dan tidak langsung. Diharapkan dengan adanya model ini, pimpinan perguruan tinggi mampu menghindari/meminimalisasi terjadinya kegagalan investasi Teknologi Informasi/ Paradox. Dari hasil penelitian, dapat disimpulkan bahwa sumberdaya TI memiliki pengaruh secara langsung yang lebih signifikan daripada pengaruh secara tidak langsung,

T his article aims to provide an Introduction to the work of the National Patient Safety Agency (NPSA), established as a special health authority within the NHS in July 2001. Patient safety, medical error and adverse incident reporting are high priorities in healthcare systems across the world. The NPSA will coordinate the efforts to report, and more importantly, learn from, adverse events occurring in the NHS. Part of the remit of the NPSA is to produce working solutions to prevent harm, specify national goals and establish mechanisms to track progress. This article will highlight some of the projects that will impact positively upon the work of infection control practitioners. The ‘Handy Hygiene’ project being undertaken by the NPSA will address the familiar concern of preventable healthcare-associated infection (HAI), which is estimated to cost the NHS nearly #1 billion a year.

The adoption of new technologies in medicine is frequently met with both enthusiasm and resistance. The universal adoption of health information technology (IT) and anesthesia information management systems (AIMS) remains low despite the potential benefits. Electronic medical records, and hence AIMS, are at the intersection of patient safety. This article highlights advantages and barriers to adoption and implementation of IT in general and AIMS in particular, with a focus on clinical decision support systems (CDSS) and computerized physician order entry (CPOE) as hallmarks that may lead to improvement in patient safety and quality in the perioperative setting. The advantages of health IT and AIMS include improved legibility of documentation; the ability to integrate new scientific evidence into practice; enhanced management and exchange of complex health information; the ability to standardize order sets, incorporate computerized physician order entry, and provide clinical decision support; and the ability to capture data for management, research, and quality monitoring and reporting. While not foolproof, AIMS have been shown to improve safety, quality, and patient outcomes. Barriers to the adoption of health IT and AIMS include costs, lack of truly interoperable AIMS components in health-system IT solutions, and lack of clinician involvement in implementation, planning, design, and installation of many IT or AIMS products. Health IT and AIMS are at the intersection of patient safety and technology. Anesthesiologists are perfectly positioned to be the physician leaders of adoption, design, implementation, and integration, not only for AIMS but also for health-system IT solutions in general.

Classification of antecedents towards safety use of health information technology: A systematic review

Medical and care errors are common in health care, posing serious risks to patient safety, with over 10% of patients being harmed annually. Despite efforts to reduce errors, underreporting persists, as nurses report only about 20% of incidents. Understanding the factors that influence nurses' intention to report errors is essential for developing effective strategies to improve reporting and patient safety. This systematic review aimed to identify factors associated with nurses' intention to report medical and care errors. A comprehensive search was conducted in 3 databases (PubMed, CINAHL, and PsycINFO) and Google Scholar using a combination of MeSH and synonymous terms related to medication errors, medical errors, care errors, intention to report, and nurses. Twenty-seven articles were included in the analysis. The review revealed that interpersonal characteristics such as attitude, subjective norms, and perceived behavioral control were found to have a significant relationship with nurses' intention to report medical errors. In addition, organizational environmental factors like patient safety culture and climate, nonpunitive responses to errors, open communication, teamwork, management support, task-oriented culture, organizational learning, reporting awareness, leadership behavior, and psychological safety positively influence error-reporting intentions. Furthermore, some demographic characteristics, including nurses' age, level of education, years of experience, and prior exposure to medication errors positively impacted reporting behaviors. This review results highlight the multifaceted nature of factors influencing nurses' intention to report medical errors. Understanding the complex interplay of attitude, subjective norms, perceived behavioral control, and other contextual factors is crucial to promote a reporting culture that enhances patient safety.

According to the United Kingdom's National Patient Safety Agency, one out of every 10 National Health Service (NHS) patients will experience a patient safety incident. Team-based working may help reduce errors. Using an abbreviated Operating Room Management Attitudes Questionnaire, researchers recorded clinical and non-clinical grades' experience of, and attitudes towards teamworking at an NHS District General Hospital. Two hundred and twenty-six employees completed a questionnaire. Data revealed a pronounced mis-match between most employees' preferred method of working (effective inter- and intra-disciplinary teamwork) and that which obtained (a generally hierarchical system of top-down management). Eighty per cent of respondents “agreed strongly” with the statement “I enjoy working as part of a team” and 73%“agreed strongly” with the statement “Senior medical staff should encourage questions and input …” (no respondent disagreed with this statement). Only 33%“agreed strongly” with the statement “I feel fully integrated with and valued by my colleagues in my work area”. While 68% of respondents preferred a consultative style of management, only 35% experienced it. Three conclusions were drawn. First, managers at the subject hospital must improve teamworking (because effective teamworking can help reduce levels of medical error). Secondly, adaptations of proven team-building techniques, like aviation's crew resource management protocol, may provide a solution. Thirdly, those members of the staff responsible for the status quo at the hospital may resist reform.

To remain competitive in the present dynamic environment, ‘governance for agility’ has become a key solution. Past literature paid little attention to understanding how governance for agility, particularly in regard to the delivery of Information Technology (IT) implementation. Using agile organisation and IT-governance theory as lenses to analyse data from a hospital case study, a strategic process model of governance for agility is empirically derived. This model suggests that agile healthcare information technology implementation is achievable via phase-based IT-governance strategies and forms which authorise decision makers to maneuver resources strategically in a dynamic environment. Theoretically, this study contributes to the dearth of empirical understanding of IT governance in the Healthcare IT literature and advances knowledge by making a conceptual distinction through introducing the use of phase-based IT-governance strategies and forms to generate agile organisational capabilities to achieve agile Healthcare IT implementation. The findings serve as a foundation for future research within the information systems (IS) discipline. Practitioners could plan an agile Healthcare IT implementation by referring to the model—a systematic roadmap for governing and strategising hospital resources and capabilities.

Patients have the right to safe and quality health care (HC). They contact hospitals or other health care institutions (HCI) expecting help in restoringor strengthening health and do not expect to suffer any health damage or lose life. However, research shows that every tenth hospitalised patient suffers from adverse events (AE) resulting from shortcomings characteristic of a HC organisation orservice provision. More than half of AE could have been prevented provided systematic prevention measures had been implemented. The prevalence of AE and their damage to patients, HC organisations, the entire HC sector and national economies remains unacceptably high. Implementation of actions to improve patient safety (PS) and ensure the provision of safer patient care has become the most important HC challenge of the 21st century. Notwithstanding the extensive international PS movement that has emerged during the last two decades and plenty of international and national initiatives aimed at improving PS, a substantial breakthrough in ensuring safe patient care still remains a goal to be achieved. The main cause of disappointment is failure to implement international and national level PS improvement initiatives at the local (health care organization and its departments) level. There is no managerial adaptation mechanism to customize international and national level PS practices thus adapting them for hospital needs, specifics and potential. The article presents and substantiates the comprehensive management model of PS events (Model) for hospitals and other HC organisations to use as a basis in developing and implementing comprehensive systems for PS management with the aim of more effectively expanding the scope of safe practices and implementing prevention of PS events as well as improving their management. The proposed Model consists of three structural blocks the integrated interaction of which is aimed at ensuring: (a) identification of the best international and national PS practice and its implementation at hospitals; (b) creation of conditions necessary to develop safe practice with the aim of ensuring and improving PS at hospitals; (c) detection, evaluation and development of safe practice; (d) comprehensive prevention and management of unsafe practice at hospitals thus ensuring and improving PS and contributing to the improvement of performance and achievement of the goals of the entire organisation. The article discusses structure and functions of the Model, its integration witho ther activities within the organization, interaction with other institutions and organizations that participate in ensuring PS at hospitals, including problems related to its implementation at different hospitals.

About 850 000 medical errors occur in NHS hospitals every year, resulting in 40 000 deaths.w1In the United Kingdom, the National Patient Safety Agency (NPSA) was created to learn from...

Information technology is essential and critical for companies when collaborating with external partners. This study examines the effect of information technology (IT) implementation on organizational performance through information sharing and inventory management. The study involved a distribution of questionnaires to 500 manufacturing companies that was followed by a data screening, resulting in 93 valid questionnaires. Partial Least Square (PLS) technique was employed for data processing. The results show that IT implementation affects information sharing, inventory management, and organizational performance. Meanwhile, information sharing has an influence on inventory management and organizational performance. In addition, inventory management affects organizational performance. This study also reveals that information sharing and inventory management mediate the relationship between IT implementation and organizational performance. IT implementation can improve organizational performance, particularly in punctual product delivery. Information sharing with partners will improve inventory, especially in maintaining safety stock while improving the company's performance. This result paves the way for practitioners to improve organizational performance in the context of supply chain management.

Medical errors are the eighth leading cause of death in the United States and are estimated to account for somewhere between 44 000 and 98 000 deaths in the United States each year.1 An exact number of deaths remains both uncertain and controversial, with arguments that the actual figure may be lower2 or higher.3 Each year in the United States, the estimated 450 000 preventable medication-related adverse events cost $3.5 billion.4 In the Health Grades Inc Patient Safety in American Hospitals study, which examined 37 million patient records, it was estimated that 195 000 Medicare patients die due to preventable, in-hospital medical errors annually.3 Medication errors are the most common type of medical error, and cardiovascular medications prescribed to inpatients account for a large proportion of these errors. An average of 1 medication error occurs per hospitalized patient per day, and one quarter of all medication-related injuries are preventable. The emergency department (ED) and acute hospital setting remain locations at high risk for medication errors. Since the Institute of Medicine’s 2000 report, “To Err Is Human: Building a Safer Health System,” there has been heightened awareness of medical and medication errors.1 In 2001, Congress appropriated $50 million for major initiatives in patient safety and directed the Agency for Healthcare Research and Quality to establish the Center for Quality Improvement and Patient Safety. The following year, the American Heart Association (AHA) issued its first scientific statement on medication errors in acute cardiac care.5 In 2003, Congress passed the Medicine Modernization Act to charge the Institute of Medicine with formulating a national agenda aimed at reducing medication errors. In these early years after the Institute of Medicine’s report, the topic of patient safety became a frequent focus for healthcare leaders, journalists, and concerned citizens. Although …

Recent reports indicate that approximately 10% of in-patients in UK hospitals are involved in an adverse event (these reports also state that 50% of these events are preventable). This is indeed a worrying finding, and indicates the need to look at how these incidents are handled or indeed, what is done to minimize their occurrence. The Department of Health, via the National Patient Safety Agency (NPSA) published a guide which is aimed at encouraging accurate reporting, learning from past events and changing the attitudes of key stakeholders (healthcare managers, frontline staf etc) towards risk taking and risk management. Our aim was to compare informally-learned and used risk assessment strategies volunteered by staff with the 'how to do it' guide published by the NPSA. We have compared each step of the NPSA guide with our empirical data relating to that activity. We interviewed forty-eight healthcare professionals (doctors from several specialties; nurses from a variety of settings; and an array of allied healthcare professionals). We used semi-structured interviews in order to discuss participants' views on their everyday working life, working relationships and patient safety. Our results indicate that healthcare professionals develop their own unique way to approach the issue of patient safety and risk, based on their professional raining, seniority and role within the hospital. They did share the conviction that frontline and support staff need to have immediate and easy access to information about past adverse events. They see this as a powerful tool in minimizing the reoccurrence of the same errors/problems, as well as a vehicle to improve staff morale by feeling valued and having their opinion heard. We believe that patient safety and welfare can benefit from the adoption of a more flexible and person-centred approach to how risk assessments are carried out. Enriching formal guidelines such as the 'Risk Assessment made easy' document with successful techniques and strategies which healthcare staff have informally developed has the potential to not only improve patient safety (since it will be based on the accumulated experience and knowledge of such staff) but also foster higher levels of self esteem amongst healthcare professionals.