Regulating complementary medicine implications for the nursing profession

Aligning Healthcare Safety and Quality Competencies: Quality and Safety Education for Nurses (QSEN), The Joint Commission, and American Nurses Credentialing Center (ANCC) Magnet® Standards Crosswalk

Fiduciary What?

BackgroundImproving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems.MethodsWe used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources.ResultsBoth Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking. Importantly, incentive systems that link contractual agreement, regulations, accreditation, and performance indicators are underutilized in Lebanon and absent in Jordan. At the healthcare organizational level, there is a need to instill a culture of continuous quality improvement and promote professional training in quality improvement and patient safety.ConclusionStudy findings highlight the importance of aligning policies, organizations, methods, capacities and resources in order to institutionalize quality improvement and patient safety practices in health systems. Gaps and dysfunctions identified can help inform national deliberations and dialogues among key stakeholders in each study country. Findings can also inform future quality improvement efforts in the EMR and beyond, with a particular emphasis on LMICs.

Nurses' sleep, work hours, and patient care quality, and safety

To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care.

Health Information Consumers are increasingly seeking access to timely, accurate and accessible information, as made possible through Information Technology (IT). These technological developments have direct implications for access, awareness and use of health information by consumers, as well as patient decision making, safety, and quality of health care provision. Healthcare information systems are expected to reduce medical errors, improve quality of patient care and safety. These systems are increasingly supporting evidence-based medicine and patientcentric technologies, including monitoring of patient outcomes and adverse events, as well as better informing and empowering consumers themselves to work for better outcomes. This mini-track embraces all aspects of consumer health informatics and consumer-centric technologies or studies aimed at improving patient safety and quality of care, including: supporting consumers taking an active role in understanding, deciding about and/or managing their health; doctor-patient communication; clinical guideline and protocol support; monitoring and prevention of adverse events; and electronic health records (especially, security and privacy, access control rights, and consumer ability to make entries into the health record, including home monitoring). The Consumer Health Informatics, Patient Safety and Quality of Practice Minitrack uses the international and interdisciplinary forum provided by HICSS for the expression of practical, theoretical, academic and industrial insight in this area.

BackgroundWorkplace bullying (WPB) is a physical or emotional harm that may negatively affect healthcare services. The aim of this study was to determine to what extent healthcare practitioners in Saudi Arabia worry about WPB and whether it affects the quality of care and patient safety from their perception.MethodsA cross-sectional study was conducted in 2018. An online survey was distributed among all practitioners at a multi-regional healthcare facility. A previously validated tool was sourced from an integrative literature review by Houck and Colbert. Responses to 15 themes were rated on a 5-point Likert scale, converted to percentage mean scores (PMS) and compared across participants’ characteristics using bivariate and regression analyses.ResultsA total of 1074/1350 (79.5%) completed the questionnaire. The overall median [interquartile range] score of worrying about WPB was 81.7 [35.0]. Participants were mainly worried about the effect of WPB on their stress, work performance, and communication between staff members. A significant negative relationship developed between the quality of care and worrying about WPB, P < 0.001. More educated practitioners were 1.7 times more likely to be worried about WPB compared with their counter group, adj.P = 0.034. Junior practitioners were 1.6 times more likely to be worried about WPB, adj.P = 0.017. The group who has not been trained in handling WPB (1.7 times), and those who had been exposed to WPB (2.2 times) were both more likely to be worried about WPB compared with their counter groups, adj.P = 0.026 and adj.P < 0.001 respectively.ConclusionsMost healthcare practitioners worry about WPB, especially its negative impact on the quality of care and patient safety. A greater proportion of practitioners with higher levels of education and their less experienced counterparts were more worried about WPB. Previous exposure to a WPB incident amplifies the practitioners’ worry, but being trained on how to counteract bullying incidents makes them less likely to be worried.

BackgroundHealthcare systems aim to enhance the health status and well-being of the individuals and populations they serve. To achieve this, measuring and evaluating the quality and safety of services provided and the outcomes achieved is essential. Like other countries, Romania faces challenges regarding the quality of care provided in its public hospitals. To address this, the Romanian Ministry of Health initiated reforms in 2022, including implementing a pay-for-performance model based on quality indicators. This paper presents a descriptive analysis of processes, methods, results and lessons learned from developing and piloting a set of Quality of Care indicators for Romanian public hospitals.MethodsWorld Health Organization’s Athens Office on Quality of Care and Patient Safety assisted Romania in developing and piloting a set of quality-of-care indicators for public hospitals. The development phase included defining indicator domains, identifying potential indicators across these domains, and defining the final indicator set. The piloting phase involved selecting and recruiting piloting hospitals, developing data collection and validation methods and tools, training hospital staff, and collecting and analysing indicator data. Piloting ended with an evaluation workshop. Mixed, quantitative and qualitative methods were used, including literature reviews, stakeholder consultation workshops, survey instruments developed for this study, modified Delphi panels and consensus-building meetings. National stakeholders were actively involved throughout the process.ResultsFour priority domains were defined for quality-of-care indicators for Romanian public hospitals: patient safety, patient experience, healthcare workforce training and safety, and clinical effectiveness. 25 core indicators were selected across these domains. During the pilot, hospitals achieved an average completion rate of 90% for data submission, with all domains rated equally relevant during post-pilot evaluations. Lessons included the need for supportive legislation, improved internal auditing practices and enhanced staff training, refinement of indicator data collection methods and alignment of indicators with hospital-specific contexts.ConclusionsThis work presents a significant stride in improving Romanian public hospitals’ quality of care and patient safety. It underscores the importance of high-level commitment, stakeholder engagement, and robust data practices in driving successful quality improvement efforts. Emphasising the role of data-driven and patient-centric approaches in achieving optimal healthcare outcomes, lessons learned offer insights for the continuation of quality improvement work in Romania but also for healthcare systems elsewhere.

This scoping review explored: (i) the role of unregulated care providers in the healthcare system; (ii) their potential role on interprofessional teams; (iii) the impact of unregulated care provider's role on quality of care and patient safety; and (iv) education and employment standards. Unregulated care providers in Canada assist older adults with personal support and activities of daily living in a variety of care settings. As the care needs of an aging population become increasingly complex, the role of unregulated care providers in healthcare delivery has also evolved. Currently, many unregulated care providers are performing tasks previously performed by regulated health professionals, with potential implications for quality of care and patient safety. Information is fragmented on the role, education and employment standards of unregulated care providers. A scoping review was conducted following the methods outlined by Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) and Levac, Colquhoun, and O'Brien (Implementation Science, 5, 2010, 69). An iterative search of published and grey literature was conducted from January 2000 to September 2016 using Medline, CINAHL, SCOPUS and Google. Inclusion and exclusion criteria were applied to identify relevant studies published in English. The search yielded 63 papers for review. Results highlight the evolving role of unregulated care providers, a lack of recognition and a lack of authority for unregulated care provider decision-making in patient care. Unregulated care providers do not have a defined scope of practice. However, their role has evolved to include activities previously performed by regulated professionals. Variations in education and employment standards have implications for quality of care and patient safety. Unregulated care providers are part of an important workforce in the long-term care and community sectors in Canada. Their evolving role should be recognised and efforts made to leverage their experience on interprofessional teams and reduce variations in education and employment standards. This study highlights the evolving role of unregulated care providers in Canada and presents a set of recommendations for implementation at micro, meso, and macro policy levels.

The workload remained one of the major problems in the health care system. All Health professionals dealing with this issue of increased workload such as doctors, nurses, Paramedic’s etc. Objective: To assess the effect of workload on patient safety and quality of care in the medical and surgical units of Jinnah Hospital, Lahore. Methods: A descriptive cross sectional research study design was conducted among 178 patients at Jinnah Hospital, Lahore. The convenient sampling technique was used. The population that is targeted was patients of Jinnah Hospital, Lahore. Results: The general finding of the study demonstrated that workload affect the patient safety and quality of care. The descriptive statistics applied, frequency and mean checked, formed for quality, cronbach alpha, bartlett's, KMO and kolmogorov-smirnov test values have been checked to insure the validity and reliability and data normality in our context. The values showed positive and significant results and tools were consider as reliable and valid for performing statistical analysis. Conclusions: The study concluded that nurse to patient ratio is not appropriate. And this inappropriate nurse to patient ratio cause lack of patient safety and decrease quality care. In addition to patient condition and staffing numbers, the structure of the nursing work system also has an impact on nursing workload. The outcomes demonstrated a significant relation between nursing workload and patient safety.

Introduction: Emergency department nurses use patient-centered interventions to boost patient safety and quality of care. This study evaluates the effect of emergency nurses using patient-centered interventions in promoting quality and safe care.&nbsp; Methods: The study embarks on a systematic review on patient-centered care in the emergency department. 10 articles were selected for the review from CINAHL, Cochrane Library, PubMed, and Google Scholar.&nbsp; Results: 2 articles embarked on patient-centered care in the emergency department. 3 articles embarked on the role of communication as a patient-centered intervention in promoting patient safety and quality of care in the emergency department. 5 articles covered barriers and facilitators to emergency nurses delivering patient centered care. &nbsp;&nbsp;&nbsp;&nbsp; Discussion: Nurses use patient-centered interventions to promote the health and well-being of emergency patients. These interventions are communication, collaboration, and shared-decision making. In addition, there are facilitators and barriers to these interventions in the emergency department.&nbsp;&nbsp; Conclusion: Although the study has considerable limitations, patient-centered interventions promote patient care in the emergency department. As such, nurses should embark on standardized framework, teamwork, and knowledge sharing to promote quality of care and patient safety in emergency department.

BackgroundMedical care for admitted patients in hospitals is increasingly reallocated to physician assistants (PAs). There is limited evidence about the consequences for the quality and safety of care. This study aimed to determine the effects of substitution of inpatient care from medical doctors (MDs) to PAs on patients’ length of stay (LOS), quality and safety of care, and patient experiences with the provided care.MethodsIn a multicenter matched-controlled study, the traditional model in which only MDs are employed for inpatient care (MD model) was compared with a mixed model in which besides MDs also PAs are employed (PA/MD model). Thirty-four wards were recruited across the Netherlands. Patients were followed from admission till one month after discharge. Primary outcome measure was patients’ LOS. Secondary outcomes concerned eleven indicators for quality and safety of inpatient care and patients’ experiences with the provided care.ResultsData on 2,307 patients from 34 hospital wards was available. The involvement of PAs was not significantly associated with LOS (β 1.20, 95%CI 0.99–1.40, p = .062). None of the indicators for quality and safety of care were different between study arms. However, the involvement of PAs was associated with better experiences of patients (β 0.49, 95% CI 0.22–0.76, p = .001).ConclusionsThis study did not find differences regarding LOS and quality of care between wards on which PAs, in collaboration with MDs, provided medical care for the admitted patients, and wards on which only MDs provided medical care. Employing PAs seems to be safe and seems to lead to better patient experiences.Trial registrationClinicalTrials.gov Identifier: NCT01835444

South Africa’s Healthcare system being in transitional phase presented opportunity for pharmaceutical service development within the public sector, however, strong leadership with visionary advocacy and stewardship is indispensable. The National Health Insurance (NHI) mandate and the growing emphasis on primary healthcare (PHC) re-engineering, further strengthens the prominence of many healthcare professionals and processes towards equitable and quality healthcare service delivery, among them pharmaceutical services. This research sought to identify the gap in the provision of pharmaceutical care services within the rural public context. There are several reasons why an investigation into the role of the pharmacist in PHC facilities is warranted. Firstly, several pharmaceutical processes within the public sector have and are contributing to a void in the pharmacist primary role and responsibility, thereby promoting their expansion into PHC, which at present is limited. Secondly, the growing incidence of communicable and non-communicable diseases (NCDs) by the lack of clinical governance questions the quality of patient-centred care and outcomes. Thirdly, the absence of antibiotic and anti-retroviral clinical stewardship and the World Health Organization calling for professional collaboration in managing NCDs highlights the need for pharmaceutical care (PhC) intergration. Therefore, the study focus aimed to guide the development of a collaborative pharmaceutical care model, within the rural domain, by applying a mixed methodology to describe the roles and responsibilities of the Primary Care Drug Therapy (PCDT) pharmacist; identifying enabling and disenabling factors to consider in developing a collaborative health care team through the perceptions of key informants, authorized nurse prescribers, visiting doctors and pharmacists working at the public primary healthcare clinics, and by conducting the South African Pharmacy Council (SAPC) legislative assessment of the ‘ideal’ clinics. The basis of the argument encompassed philosophical perspectives, legislation, role and collaborative advantage theory including moral theory of Ubuntu and care ethics related to rules and regulations of pharmaceutical care practice. The study harnessed healthy discussions among public healthcare professionals. The outcome supported unanimously a need to integrate pharmaceutical care and that a Pharmacist can add a meaningful role to the delivery of optimal patient care. A role of collaborative practice was preferred, citing conclusively themes of role clarity, resources &amp; location and drug supply management by 100% of the respondents. An interprofessional team of doctor, authorized nurse prescriber and pharmacist at facility level to ensure a public health, primary care, clinical patient outcome focus was favoured by 97% of the respondents. Continued training of nursing staff and pharmacists was advocated by 94% and 62% of respondents respectively. Further themes of patient safety (82%) and quality of care (76%) were highlighted. The Kruskal Wallis test (p&lt;0.05), illustrated statistically significant differences for doctors and authorized nurse prescribers in four medication related processes, diagnosis &amp; prescribing; administration/documentation; education &amp; training and medication review, with nurses moreover monitoring patient safety. Pharmacists instead placed more emphasis on monitoring compliance, educating patients about chronic medication, providing drug information to prescribers and identifying prescribing errors than over prescribing rights. The barriers identified were transport unavailability for outreach services, language deficiencies, scarce resource equipment and the shortage of doctors and authorized nurse prescribers.The pharmacist advocacy in these under-resourced rural communities that was demonstrated beneficial is one that drives pharmacovigilance in adverse drug reporting, antibiotic stewardship, clinical governance with continuous prescription audits followed by structured training for PHC authorized nurse prescribers, patient engagement and interaction to ensure optimal patient outcomes and safety. The factors to be considered for such an intergration rely on facility infrastructure, co-location, SAPC legislative compliance standards among them, role clarity building on relationship and trust, leadership, principles of Ubuntu and care, a culture of accountability and responsibility, implementation time, and local context. Encounterted limitations of time, distance and challenging terrain confined the research study to two rural districts wherein selective sampling further narrowed the clinics to ideal status. Future action research of a larger sample across more rural health districts and primary healthcare clinics is hence recommended to validate and expand the findings of the study which commits to apprise significant role players in Sub-Saharan Africa that may wish to pursue similar practice within a rural context, in the hope of changing “Africa’s health care landscape”.

In countries with public health system, hospital bed reductions and increasing social and medical frailty have led to the phenomenon of "outliers" or "outlying hospital in-patients." They are often medical patients who, because of unavailability of beds in their clinically appropriate ward, are admitted wherever unoccupied beds are. The present work is aimed to systematically review literature about quality and safety of care for patients admitted to clinically inappropriate wards. We performed a systematic review of studies investigating outliers, published in peer-reviewed journals with no time restrictions. Search and screening were conducted by two independent researchers (MLR and ER). Studies were considered potentially eligible for this systematic review if aimed to assess the quality and/or the safety of care for patients admitted to clinically inappropriate units. Our search was supplemented by a hand search of references of included studies. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. We collected 17 eligible papers and grouped them into six thematic categories. Despite their methodological limits, the included studies show increased trends in mortality and readmissions among outliers. Quality of care and patient safety are compromised as patients and health professionals declare and risk analysis displays. Reported solutions are often multicomponent, stress early discharge but have not been investigated in the control group. Published literature cannot definitely conclude on the quality and safety of care for patients admitted to clinically inappropriate wards. As they may represent a serious threat for quality and safety, and moreover often neglected and under valued, well-designed and powered prospective studies are urgently needed.

This study is part of a result of the research project Prevention and control of adverse events in the pre-analytical phase of the clinical laboratory process at the Hospital León Becerra of Guayaquil. It is focused on offering a theoretical, analytical and comparative contribution of previous research carried out at the León Becerra Hospital in Guayaquil. Principle of the form The general objective of this work is to evaluate the quality of care in the clinical laboratory processes of different studies and to provide feedback for the quality of care and patient safety in the clinical laboratory process.