Underlying risk factors for prescribing errors in long-term aged care: a qualitative study
Conclusions
The study highlights several system-related factors including laborious methods for exchanging medication information, which often act together to contribute to prescribing errors. Multiple interventions (eg, technology systems, team communication protocols) are required to support the collaborative nature of RACF prescribing. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 16, 2016 Category: Journals (General) Authors: Tariq, A., Georgiou, A., Raban, M., Baysari, M. T., Westbrook, J. Tags: Original research Source Type: research
Do patients with gastrointestinal cancer want to decide where they have tests and surgery? A questionnaire study of provider choice
Conclusions
There was a substantial unmet desire for greater involvement in provider choice among study participants. Respondents attached particular importance to surgery-specific information. Efforts should be made to increase involvement of patients with gastrointestinal cancer in provider decisions, across primary and secondary care, to deliver more patient-centred care. The reported lack of patient involvement in provider choice suggests it is unlikely to be working as an effective lever to drive quality improvement at present. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 16, 2016 Category: Journals (General) Authors: Byrne, B. E., Faiz, O. D., Vincent, C. Tags: Original research Source Type: research
A mixed-methods investigation of health professionals perceptions of a physiological track and trigger system
Conclusions
These findings reveal that non-compliance with PTTS protocol is unlikely to be attributable to negative perceptions of PTTSs. Instead, there are a number of barriers to the implementation of the system. These findings suggest that interprofessional training in PTTSs is essential while increased support for PTTS implementation among senior doctors would also yield improved adherence to protocol. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 16, 2016 Category: Journals (General) Authors: Lydon, S., Byrne, D., Offiah, G., Gleeson, L., O'Connor, P. Tags: Original research Source Type: research
Patient safety climate strength: a concept that requires more attention
Conclusions
Most PSC survey results focus solely on climate level. To facilitate improvement in PSC, we advocate a simple, holistic safety climate profile including three metrics: climate level (using mean or per cent positive climate scores), climate strength (using the Rwg(j), or SD as a proxy) and the shape of the distribution (using histograms to see the distribution of scores within units). In PSC research, we advocate paying attention to climate strength as an important variable in its own right. Focusing on PSC level and strength can further understanding of the extent to which PSC is a key variable in the domain of...
Source: BMJ Quality and Safety - August 16, 2016 Category: Journals (General) Authors: Ginsburg, L., Gilin Oore, D. Tags: Open access Original research Source Type: research
The prevalence of medical error related to end-of-life communication in Canadian hospitals: results of a multicentre observational study
Conclusions
Medical errors related to the use of life-sustaining treatments are very common in internal medicine wards. Many patients are at risk of receiving inappropriate end-of-life care. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 16, 2016 Category: Journals (General) Authors: Heyland, D. K., Ilan, R., Jiang, X., You, J. J., Dodek, P. Tags: Editor's choice, BMJQS Noteworthy articles Original research Source Type: research
Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: a retrospective cohort study
Conclusions
Older, multimorbid and more deprived patients are more likely to be exempted from the scheme. Exception reported patients are more likely to die in the following year, whether they are exempted by the practice for a contraindication or by themselves through informed dissent. Further research is needed to understand the relationship between exception reporting and patient outcomes. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 16, 2016 Category: Journals (General) Authors: Kontopantelis, E., Springate, D. A., Ashcroft, D. M., Valderas, J. M., van der Veer, S. N., Reeves, D., Guthrie, B., Doran, T. Tags: Open access, BMJQS Noteworthy articles Original research Source Type: research
Should doctors be able to exclude patients from pay-for-performance schemes?
In 2004, the UK introduced what was at the time the world's most ambitious pay-for-performance scheme, the Quality and Outcomes Framework or ‘QOF’. Twenty five per cent of general practitioners’ (GPs’) pay was tied to a complex set of 136 quality indicators, the majority of which were extracted electronically from GPs’ medical records.1 Typical indicators related to blood pressure control in hypertension or blood sugar control in patients with diabetes. However, GPs were given the opportunity to exclude patients from these quality calculations, and this was called exception reporting. If a GP ...
Source: BMJ Quality and Safety - August 16, 2016 Category: Journals (General) Authors: Roland, M. Tags: BMJQS Noteworthy articles Editorials Source Type: research
Safety climate strength: a promising construct for safety research and practice
Despite some notable advances in patient safety (eg, an average 17% reduction across a set of hospital-acquired conditions including adverse drug events and urinary tract infections in the USA between 2010 and 20151), substantially reducing or eliminating harm remains elusive for nearly every healthcare organisation. One consistent recommendation for becoming harm-free is developing a strong safety climate or shared employee perceptions that safety is organisationally rewarded, supported, valued and prioritised relative to other organisational goals.2 3 Safety climate is closely related to safety culture in that the former...
Source: BMJ Quality and Safety - August 16, 2016 Category: Journals (General) Authors: Vogus, T. J. Tags: Editorials Source Type: research
The case for routine goals-of-care documentation
This study at 16 Canadian hospitals convincingly depicts inadequate documentation of goals of care. The authors calculated error rates using interviews with 500 hospitalised patients and 408 family members of hospitalised patients to learn their goals of care. They compared these goals with the documented goals of care in the patient orders and uncovered a 35% rate of potential overtreatment, defined as the proportion of patients who preferred to forego CPR while the chart lacked corresponding orders. The authors also measured a 2% rate of potential undertreatment, defined as... (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - August 16, 2016 Category: Journals (General) Authors: Yarnell, C., Fowler, R. Tags: BMJQS Noteworthy articles Editorials Source Type: research
Comment on 'Ethnography asa methodological descriptor:the editors reply
We appreciated the thoughtful commentary by Dixon-Woods and Shojania1 in response to emerging issues around methods and scholarship, particularly those using qualitative methods. Dixon-Woods and Shojania make important points in this commentary, but there are two issues with which we are concerned. Most importantly, we are concerned about both ends of a continuum in using ‘quick’ approaches that draw on the rich traditions of ethnography. On one side, the pressure to learn methods quickly and adapt them for rapid use can lead to loss of richness, dumbing down the study. On the other, insistence on purity of met...
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Sales, A., Iwashyna, T. J. Tags: Correspondence Source Type: research
Maintaining the link between methodology and method in ethnographic health research
We read with interest the debate around the use, and representation, of ethnography in the journal following the publication of Lamba et al's article on the identification of patient safety problems during ward rounds.1 In correspondence, Tanisha Jowsey saw the study, which involved observational methods to catalogue safety issues and then applied descriptive statistics as a method of analysis, as misappropriating the ethnographic tradition.2 We share with Jowsey her concerns about the way ethnography can sometimes be used as a label to describe observational studies where, in broad terms, a researcher counts or categorize...
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Waring, J., Jones, L. Tags: Correspondence Source Type: research
Ethnography as a methodological descriptor: the editors' reply
Dr Jowsey worries that the use of the term ‘ethnographic’ in the title of a recent short report by Lamba et al1 of a study of patient safety in team rounds risks watering down the meaning of ethnography as a research methodology. The data for the study were collected by one observer, who used a structured data collection form to record patient safety issues that were brought up or occurred during team rounds, as well as identifying any consequences and whether the issue was actionable. The observational data regarding issues were categorised using a set of thematic categories derived from the London Protocol, a...
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Dixon-Woods, M., Shojania, K. G. Tags: BMJQS Noteworthy articles Correspondence Source Type: research
Watering down ethnography
As a medical anthropologist who has worked in primary healthcare research and medical education for many years, I was delighted to come across a recent article by Lamba et al,1 entitled ‘Identifying patient safety problems during team rounds: an ethnographic study.’ I am currently working on several research projects that involve observing healthcare practitioners in various settings—the clinic, wards, surgical theatres—with a view to applying anthropological methods to understanding the phenomena under observation. It is the term ‘ethnography’ in the title that first captured my attenti...
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Jowsey, T. Tags: BMJQS Noteworthy articles Correspondence Source Type: research
How safe is primary care? A systematic review
Conclusions and relevance
Millions of people throughout the world use primary care services on any given day. This review suggests that safety incidents are relatively common, but most do not result in serious harm that reaches the patient. Diagnostic and prescribing incidents are the most likely to result in avoidable harm.
Systematic review registration
This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42012002304). (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Panesar, S. S., deSilva, D., Carson-Stevens, A., Cresswell, K. M., Salvilla, S. A., Slight, S. P., Javad, S., Netuveli, G., Larizgoitia, I., Donaldson, L. J., Bates, D. W., Sheikh, A., Aibar, Al-Bulushi, Al-Mudaf, Aljadhey, Amin, Avery, Barker, Brami, Chi Tags: Editor's choice, BMJQS Noteworthy articles Systematic review Source Type: research
Missed nursing care is linked to patient satisfaction: a cross-sectional study of US hospitals
Conclusions
Missed nursing care is common in US hospitals and varies widely. Most patients rate their hospital care experience highly, but this also varies widely across hospitals. Patients have poorer care experiences in hospitals where more nurses miss required nursing care. Supporting nurses’ ability to complete required care may optimise the patient care experience. As hospitals face changing reimbursement landscapes, ensuring adequate nursing resources should be a top priority. (Source: BMJ Quality and Safety)
Source: BMJ Quality and Safety - June 16, 2016 Category: Journals (General) Authors: Lake, E. T., Germack, H. D., Viscardi, M. K. Tags: Original research Source Type: research
