Challenge of optimising medication in people with severe mental illness
Mental health problems affect at least 1 in 4 people, cost the UK £105 billion annually and represent 28% of the total UK disease burden affecting all levels of society.1 Internationally, mental health accounts for 1 in 5 years lived with disability, and in 2019 WHO launched a special initiative specifically focused on mental health.2 COVID-19 is widely acknowledged to have increased this burden; early research identified a reduction in reported problems, but this most likely simply reflects the difficulty in accessing healthcare because many non-COVID services had limited capacity.3 Primary care is key to identifyin...
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Maidment, I., Sud, D., Chew-Graham, C. Tags: Editorials Source Type: research
Applying a systems lens to understand patient safety effectiveness in low-and-middle-income countries
Ensuring patient safety in low-and-middle-income countries (LMICs) requires tailored approaches that are appropriate to the unique challenges faced by health systems in LMICs. To date, the evidence on how to effectively improve patient safety in LMICs is limited and although we can infer lessons from high-income countries (HICs), there are meaningful differences between HICs and LMICs that require careful study. The study by Hall et al1 in this issue of BMJ Quality & Safety, which used implementation science methods to study what helped or hindered the roll-out of a patient safety programme in Guatemala, is therefore a...
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Kimball, M., Wagenaar, B. Tags: Editorials Source Type: research
Physician variation in opioid prescribing: the importance of sex and gender
Concern about the link between opioid prescribing and preventable adverse drug events has led to a series of initiatives to reduce opioid use, with opioids identified as one of three high-priority drug classes targeted to reduce patient harms in the United States (US)’s National Action Plan for Adverse Drug Event Prevention.1 Variation in opioid prescribing practices by physicians has been observed, yet the reasons why these differences exist remain largely unknown. A better understanding of these differences may help to improve prescribing practice for opioids. Sex and gender considerations in opioid prescribing pra...
Source: Quality and Safety in Health Care - April 19, 2022 Category: Health Management Authors: Rochon, P., Borhani, P., Akerman, J., Mishra, A. Tags: Editorials Source Type: research
Improving responses to safety incidents: we need to talk about justice
The promotion of a ‘just culture’ features prominently in patient safety research and policy. This has come about, in part, from a recognition that a so-called ‘blame culture’ discourages openness and learning.1 It also reflects a growing understanding that people caught up in safety events (patients, their families and healthcare staff) can experience feelings of sadness, guilt and anger, and need to be treated fairly and sensitively. Despite this growing understanding, there remain significant difficulties in listening to and involving patients and families in the organisational responses to safet...
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Cribb, A., O'Hara, J. K., Waring, J. Tags: Open access Viewpoints Source Type: research
The problem with 'My Five Moments for Hand Hygiene
‘The problem with...’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended, but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution. Introduction Healthcare-associated infections (HCAIs) are the most common adverse events affecting patients.1 The pathogens responsible are often carried on health workers’ hands, and on the evidence of epidemiological and microbiological studies, in theory hand hygiene ought to break the chain of infection.2 The WHO3 promotes ‘My Five Moments for Hand Hygiene&...
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Gould, D., Purssell, E., Jeanes, A., Drey, N., Chudleigh, J., McKnight, J. Tags: Open access, COVID-19 The problem with... Source Type: research
Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review
Conclusions
QI interventions were associated with large declines in infection rates and net costs to hospitals that varied greatly but that, on average, were not significantly different from zero over 3 years. Future research should examine specific practices associated with cost-savings and clinical effectiveness, and examine whether or not more comprehensive interventions offer hospitals and patients the best value. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: McCleskey, S. G., Shek, L., Grein, J., Gotanda, H., Anderson, L., Shekelle, P. G., Keeler, E., Morton, S., Nuckols, T. K. Tags: Systematic review Source Type: research
Interventions targeted at reducing diagnostic error: systematic review
Conclusion
Technique-based interventions, technology-based system interventions and structured process changes have been the most studied interventions over the time period of this review and hence are seen to be effective in reducing diagnostic error. However, more high-quality RCTs are required, particularly evaluating educational interventions and personnel changes, to demonstrate the value of these interventions in diverse settings. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Dave, N., Bui, S., Morgan, C., Hickey, S., Paul, C. L. Tags: Systematic review Source Type: research
Development and validation of an A3 problem-solving assessment tool and self-instructional package for teachers of quality improvement in healthcare
Conclusion
This study provides evidence of the reliability of a tool to assess healthcare QI project proposals that use the A3 problem-solving approach. The tool also demonstrated evidence of measurement, content and construct validity. QI educators and practitioners can use the free online materials to assess learners’ A3s, provide formative and summative feedback on QI project proposals and enhance their teaching. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Myers, J. S., Kin, J. M., Billi, J. E., Burke, K. G., Harrison, R. V. Tags: Editor's choice Original research Source Type: research
Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study
Conclusion
A multicentre medication reconciliation QI initiative using mentored implementation of a refined best practices toolkit, including patient-level and system-level interventions, was associated with a substantial decrease in unintentional medication discrepancies over time. Future efforts should focus on sustainability and spread. (Source: Quality and Safety in Health Care)
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Schnipper, J. L., Reyes Nieva, H., Mallouk, M., Mixon, A., Rennke, S., Chu, E., Mueller, S., Smith Jr, G. R., Williams, M. V., Wetterneck, T. B., Stein, J., Dalal, A., Labonville, S., Sridharan, A., Stolldorf, D. P., Orav, E. J., Levin, B., Gresham, M., Y Tags: Original research Source Type: research
Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data
Conclusions
Two factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could ...
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Sakai-Bizmark, R., Kumamaru, H., Estevez, D., Neman, S., Bedel, L. E. M., Mena, L. A., Marr, E. H., Ross, M. G. Tags: Original research Source Type: research
Starting off on the right foot: providing timely feedback to learners in quality improvement education
Quality improvement (QI) education, when optimised, can improve both educational and clinical outcomes, often through learner engagement in QI projects.1 2 However, just as in QI work more broadly, it is hard to improve a QI curriculum when learning outcomes are not measured. With the proliferation of QI education programmes, a variety of tools now exist to assess QI knowledge and skill acquisition to enable evaluation of QI education effectiveness. For example, the Beliefs, Attitudes, Skills, and Confidence in Quality Improvement (BASiC-QI) Scale is a self-assessment tool that assesses learner beliefs, skills and confiden...
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Mayo, A. L., Wong, B. M. Tags: Editorials Source Type: research
'My Five Moments: understanding a user-centred approach to hand hygiene improvement within a broader implementation strategy
Between 2006 and 2009, WHO elaborated and issued the concept of ‘My Five Moments for Hand Hygiene’ in healthcare1–4 in collaboration with the pioneering infection prevention and control (IPC) research group at the University of Geneva. The primary objective of this approach is to facilitate behavioural change and prioritise hand hygiene action at the exact times needed to prevent the transmission of pathogens and avoid harm to patients and health workers during care delivery. Importantly, the Five Moments approach overcomes some relevant barriers to hand hygiene practices identified before its launch, suc...
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Allegranzi, B., Kilpatrick, C., Sax, H., Pittet, D. Tags: Editorials Source Type: research
Research to improve diagnosis: time to study the real world
More than a decade ago, diagnostic errors were named as the ‘next frontier’ in patient safety.1 In spite of this, our understanding of the epidemiology of diagnostic errors and approaches to preventing them has only recently begun to mature. Recent systematic reviews document an unacceptably high burden of diagnostic error in both outpatients2 and hospitalised patients.3 Given this landscape, clinicians and healthcare leaders would benefit from understanding which approaches to preventing diagnostic error are effective. A systematic review of strategies to reduce diagnostic error published in 20134 identified s...
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Ranji, S. R., Thomas, E. J. Tags: Editorials Source Type: research
Call for emergency action to limit global temperature increases, restore biodiversity and protect health
Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (Conference of the Parties (COP)26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature and protect health. Health is already being harmed ...
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Atwoli, L., H Baqui, A., Benfield, T., Bosurgi, R., Godlee, F., Hancocks, S., Horton, R., Laybourn-Langton, L., Monteiro, C. A., Norman, I., Patrick, K., Praities, N., Rikkert, M. G. O., Rubin, E. J., Sahni, P., Smith, R., Talley, N. J., Turale, S., Vazqu Tags: Open access Editorials Source Type: research
Is it time for greater patient involvement to enhance transitional medication safety?
In this issue of BMJ Quality & Safety, Schnipper et al report the effects of a refined evidence-based toolkit and mentored implementation of a complex medication reconciliation intervention, ‘MARQUIS2’, at 18 North American hospitals.1 This pragmatic quality improvement study used interrupted time series analysis to quantify the effects of implementation on medication discrepancy rates relative to baseline trends. The MARQUIS2 toolkit was developed by refining the earlier MARQUIS1 toolkit, shown to be associated with a reduction in medication discrepancies but with inconsistent improvement among the five st...
Source: Quality and Safety in Health Care - March 17, 2022 Category: Health Management Authors: Grimes, T. C. Tags: Editorials Source Type: research
