Patient safety
Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors.[1] Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern.[2] Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety[3] with mobile health apps being a growing area of research.[4]
Psychological Safety[edit]
Building a culture for patient safety requires psychologically safe teams. Psychological safety is an interpersonal construct which is experienced at the team or group level. It is an environment where people feel comfortable sharing concerns and mistakes without fear of embarrassment or retribution. This safe environment enables not just speaking up, which is clearly relevant to patient safety, but also to share new ideas and give candid feed back. Through this process, a broader variety of information is shared in the organisation, allowing for creativity, innovation and learning, but also providing a better basis on which to make decisions, in turn leading to better outcomes.[26]
Psychological safety has been found to play an important role for both patient safety culture and for enabling quality improvement in the health care setting.[27]
Quality and safety initiatives in community pharmacy practice[edit]
Community pharmacy practice is making important advances in the quality and safety movement despite the limited number of federal and state regulations that exist and in the absence of national accreditation organizations such as the Joint Commission - a driving force for performance improvement in health care systems. Community pharmacies are using automated drug dispensing devices (robots), computerized drug utilization review tools, and most recently, the ability to receive electronic prescriptions from prescribers to decrease the risk for error and increase the likelihood of delivering high quality of care.
Quality Assurance (QA) in community practice is a relatively new concept. As of 2006, only 16 states have some form of legislation that regulates QA in community pharmacy practice. While most state QA legislation focuses on error reduction, North Carolina has recently approved legislation[110] that requires the pharmacy QA program to include error reduction strategies and assessments of the quality of their pharmaceutical care outcomes and pharmacy services.[111]
New technologies facilitate the traceability tools of patients and medications. This is particularly relevant for drugs that are considered high risk and cost.[112]
Working Hours of nurses and patient safety[edit]
A recent increase in work hours and overtime shifts of nurses has been used to compensate for the decrease in numbers of registered nurses (RNs). Logbooks completed by nearly 400 RNs have revealed that about "40 percent of the 5,317 work shifts they logged exceeded twelve hours."[125] Errors by hospital staff nurses are more likely when work shifts extend beyond 12 hours, or they work over 40 hours in one week. Studies have shown that overtime shifts have harmful effects on the quality of care provided to patients, but some researchers "who evaluated the safety of 12-hour shifts did not find increases in medication errors."[126] The errors which these researchers found were "lapses of attention to detail, errors of omission, compromised problem solving, reduced motivation"[127] due to fatigue as well as "errors in grammatical reasoning and chart reviewing."[128] Overworked nurses are a serious safety concern for their patients' wellbeing. Working back to back shifts, or night shifts, is a common cause of fatigue in hospital staff nurses. "Less sleep, or fatigue, may lead to increased likelihood of making an error, or even the decreased likelihood of catching someone else's error."[129] Limiting working hours and shift rotations could "reduce the adverse effects of fatigue"[130] and increase the quality of patient care.
Health literacy[edit]
Health literacy is a common and serious safety concern. A study of 2,600 patients at two hospitals determined that between 26% and 60% of patients could not understand medication directions, a standard informed consent, or basic health care materials.[131] This mismatch between a clinician's level of communication and a patient's ability to understand can lead to medication errors and adverse outcomes.
The Institute of Medicine (2004) report found low health literacy levels negatively affects healthcare outcomes.[132] In particular, these patients have a higher risk of hospitalization and longer hospital stays, are less likely to comply with treatment, are more likely to make errors with medication,[133] and are more ill when they seek medical care.[134][135]