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The epidemiology of patient safety
The articles grouped under this theme attempt to establish the identification, nature, classification, type, and causes of medical error. They also provide details regarding the approaches used by the various researchers in the measurement of adverse events and clinical incidents in organisations and different countries. The authors also quantify adverse events in different countries in order to expose the extent to which medical error and patient safety are international public health problems. An Australian study on hospital adverse events [79] revealed that up to 16.6% of all hospital admissions were associated with adverse events. More than half of these (51%) were considered to be preventable. This finding contrasts with a finding from an earlier Harvard Medical Practice study that was conducted in the USA [72;73], which reported that 3.7% of all hospital admissions were associated with adverse events, half of these were preventable, and 13.6% of these adverse events led to fatalities. A USA study conducted by Leape et al [80] indicated that the most common adverse events in hospital settings were adverse drug events (19%), wound infections (14%) and technical complications (13%). Leape et al [80] also found that while a significant number of adverse events were linked with surgery (48%), these were not necessarily as a result of negligence. The findings are closely related to those of a Canadian study [81], which found that: adverse events were associated with 12.7% of admissions; 4.8% of these were found to be preventable; and 3% of these were fatal. The majority of these adverse events were due to drug treatment, technical complications and hospital-associated infections. A Spanish study [82] reports that 8.4% of hospital admissions were associated with adverse events and up to 42.8% of these were preventable. Those associated with medication were 37.4%, technical complications 25.5%, and those due to hospitalassociated infections were 25.3%. A total of 17.7% of these admissions were also found to have multiple adverse events. A New Zealand study [83] on the other hand reports that adverse events are associated with 12.9% of admissions, that 35% of these were preventable and 15% of the adverse events became fatalities. A British study [84] found that 10.8% of admissions were associated with adverse events that 11.7% of these adverse events were multiple events and 50% of all adverse events were found to be preventable.
Paper-based reporting system: Data collection
The reporting of incidents and adverse events using the paper-based system relied on incidents that occurred at ward or unit level being reported to the unit manager, who in turn reported to the Head of Nursing, Head of Clinical Services and ultimately the Chief Executive Officer of the Hospital or District Manager. The paper-based system produced results that were difficult to analyse and was not user friendly. The reporting of these incidents was dependent on several factors. Firstly, most incidents that were reported were those that were so severe that they had resulted in permanent disability or death. These were also the incidents that would have been reported through the media or legal department because of their severity. In other words many incidents that were reported using this system were those that could not be hidden from the public eye due to their nature and severity. The rest of the incidents that were reported are those that the CEO or District Manager thought were interesting and required inputs on their management from his or her peers from other institution. The policy was, however, clear that serious incidents needed to be reported to the Head of Clinical Services (HOCS), Head of Nurses (HON), CEO within a specified period. The near misses and hazards were not seen to be important enough to be reported. The non-reporting of an incident or adverse event was seen more as an aggravation factor during the disciplinary process rather than an act of misconduct by itself.
CHAPTER ONE: INTRODUCTION
1.1 Motivation for the study
1.2 Relationship between patient safety and health system performance- a closer look
1.3 Rationale for the study
1.4 The research hypothesis
1.5 Research design and methodology
1.6 Outline of the remainder of the thesis
CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
2.2 Epidemiology of patient safety
2.3 Introspective articles on patient safety
2.4 Patient safety and links with other high-risk industries
2.5 Patient safety and professional training
2.6 Clinical competence and patient safety
2.7 Patient safety and working conditions for professionals
2.8 Patient safety and the law
2.9 Patient safety and the media
2.10 The economics of patient safety
2.11 Patient safety and healthcare quality
2.12 Patient safety at the clinical level
2.13 Medication and patient safety
2.14 Healthcare associated infections and patient safety
2.15 Patients and patient safety
2.16 Patient safety reporting systems
2.17 Implementation challenges of patient safety reporting systems
2.18 Patient safety and technology
CHAPTER THREE: THEORETICAL FRAMEWORK
3.1 Background
3.2 Patient safety is a health care quality issue
3.3 Medical error and patient safety are two sides of the same coin
3.4 Balancing systems and individual contribution to medical error
3.5 Reporting systems and patient safety
CHAPTER FOUR: METHODOLOGY AND DESIGN
4.1 Introduction
4.2 Aims
4.3 Objectives
Section A
4.4 AIMS [Advanced Incident Management System]
4.5 Survey of the personnel’s perceptions on AIMS
4.6 Paper-based reporting system
Section B
4.7 Safety climate and hospital safety culture surveys
4.8 Patient satisfaction survey
4.9 COHSASA standards evaluation
4.10 Ethical considerations for all the secondary interventions
CHAPTER FIVE: RESULTS
5.1 Background
Section A: AIMS results
5.2 Successful implementation and sustained operationalization of AIMS
5.3 Identified risk factors associated with reported incidents
Section B
5.4 AMCu and patient safety outcomes
CHAPTER SIX: DISCUSSIONS, STUDY LIMITATIONS AND CONCLUSIONS
6.1 Introduction
6.3 Discussion of results
Section A
6.3. Successful implementation and sustained operationalization of AIMS
6.4 Identified risk factors associated with reported incidents
Section B
6.5 Effects of AMCu on patient safety climate
6.6 Effects of AMCu on patient safety culture
6.7 Effects of AMCu on patient satisfaction
6.8 Effectiveness of AMCu in improving health care quality as measured by COHSASA evaluation scores
6.9 Study Limitations
CHAPTER SEVEN: THE MODEL
7.1 Introduction
7.2 Key elements of the model
7.3 Putting the model together
7.4 Implementation of managing interventions aimed at improving patient safety and overall health care quality
7.5 Lessons learned
7.6 Conclusion
CHAPTER EIGHT: RECOMMENDATIONS
8.1 Introduction
8.2 High-level recommendations
8.3 Model based recommendations
8.4 Design and methodology recommendations
8.5 Specific operational recommendations
