AIM and Patient Safety

Patient safety has constituted a huge public health concern for a long period of time. The focus of safety in the healthcare context is around reducing preventable harms, such as medical errors and treatment-related injuries. COVID-19 pandemic, if anything, has act as a wake-up call for health experts to address latent safety problems. Advancements in the field of artificial intelligence have highlighted the use of intelligent systems as a proven means of improving patient safety and enhancing quality of care. This chapter explores trends in quality and safety research, the use of machine learning and natural language processing in the context of improving patient safety and outcomes, the use of patient safety databases as a source of data for machine learning, and the future of artificial intelligence in quality and safety. © Springer Nature Switzerland AG 2022.

Three Missed Critical Nursing Care Processes on Labor and Delivery Units During the COVID-19 Pandemic.

OBJECTIVE: To examine the relationships of three missed critical nursing care processes on labor and delivery units with reduced nursing time at the bedside and adequacy of unit staffing during the COVID-19 pandemic in the United States. DESIGN: A cross-sectional survey. SETTING: Online distribution from January 14 to February 26, 2021. PARTICIPANTS: A national convenience sample (N = 836) of registered nurses employed on labor and delivery units. METHODS: We conducted descriptive analyses on respondent characteristics and critical missed care items adapted from the Perinatal Missed Care Survey. We conducted robust logistic regression analyses to assess the relationships of three missed critical nursing care processes (surveillance of fetal well-being, excessive uterine activity, and development of new maternal complications) with reduced nursing time at the bedside and adequacy of unit staffing during the COVID-19 pandemic. RESULTS: Less nursing time at the bedside was associated with greater odds of missing any of the critical aspects of care, adjusted odds ratio = 1.77, 95% confidence interval [1.12, 2.80]. Adequate staffing greater than or equal to 75% of the time was associated with lower odds of missing any of the critical aspects of care compared to adequate staffing less than or equal to 50% of the time, adjusted odds ratio = 0.54, 95% confidence interval [0.36, 0.79]. CONCLUSION: Perinatal outcomes are dependent on the timely recognition of and response to abnormal maternal and fetal conditions during childbirth. In times of unexpected complexity in care and resource constraints, a focus on three critical aspects of perinatal nursing care is needed to maintain patient safety. Strategies that enable bedside presence of nurses, including maintaining adequate unit staffing, may help to mitigate missed care.

CRISPR/Cas-based Aptasensor as an Innovative Sensing Approaches for Food Safety Analysis: Recent Progresses and New Horizons.

Food safety is one of the greatest public problems occurring around the world. Chemical, physical, and microbiological hazards could lead to food safety problems, which might occur at all stages of the supply chain. To tackle food safety problems and protect consumer health, specific, accurate, and rapid diagnosis techniques meeting various requirements are the imperative measures to ensure food safety. CRISPR-Cas system, a novel emerging technology, is effectively repurposed in (bio)sensing and has shown a tremendous capability to develop on-site and portable diagnostic methods with high specificity and sensitivity. Among numerous existing CRISPR/Cas systems, CRISPR/Cas13a and CRISPR/Cas12a are extensively employed in the design of biosensors, owing to their ability to cleave both non-target and target sequences. However, the specificity limitation in CRISPR/Cas has hindered its progress. Nowadays, nucleic acid aptamers recognized for their specificity and high-affinity characteristics for their analytes are incorporated into CRISPR/Cas systems. With the benefits of reproducibility, high durability, portability, facile operation, and cost-effectiveness, CRISPR/Cas-based aptasensing approaches are an ideal choice for fabricating highly specific point-of-need analytical tools with enhanced response signals. In the current study, we explore some of the most recent progress in the CRISPR/Cas-mediated aptasensors for detecting food risk factors including veterinary drugs, pesticide residues, pathogens, mycotoxins, heavy metals, illegal additives, food additives, and other contaminants. The nanomaterial engineering support with CRISPR/Cas aptasensors is also signified to achieve a hopeful perspective to provide new straightforward test kits toward trace amounts of different contaminants encountered in food samples.

Evaluation of patient safety culture as perceived by nurses during the COVID-19 pandemic

Objectives: A good patient safety culture (PSC) is linked to a reduced risk of patient problems and minimal undesirable occurrences. This study investigated the PSC levels from nurses' perspectives during the COVID-19 pandemic. Methods: A descriptive cross-sectional design was applied. The Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire was administered to 315 nurses working at 2 major hospitals in Jeddah, Saudi Arabia. The data were analyzed using descriptive statistics, a t-test, and a one-way ANOVA test. The statistical significance of the correlation was determined at the 0.05 level. Results: PSC was rated as medium overall according to the nurses, with a weighted mean of 2.88-0.76 and a relative weight of 57.57%. In addition, all PSC composites were rated from medium to high, except organizational learning, which was rated low. The correlation between sociodemographic variables as well as PSC levels was investigated using the t-test and one-way ANOVA test. The association is statistically significant when P ≤ 0.05. The findings revealed a statistically significant correlation between nurse nationality (t = -4.399, P = 0.000), age (F = 7.917, P = 0.000), experience in years (F = 3.760, P = 0.024), and hospital (t = -0.401, P = 0.689). Conclusions: The nurses in this study had a medium overall PSC level, and all PSC composites ranged from a medium to a high level, except organizational learning, which had a low level. In addition, the findings showed that there is a significant relationship between PSC levels, nurses' nationalities, experience in years, and the hospital itself. © 2023 Anood M. Alabbasa et al., published by Sciendo.

Applications of water activated by ozone, electrolysis, or gas plasma for microbial decontamination of raw and processed meat

A raw or processed meat product can be a breeding ground for spoilage bacteria (Enterobacteriaceae, Lactobacillus spp., Pseudomonas spp., etc.). Failure of decontamination results in food quality loss and foodborne illnesses caused by pathogens such as Salmonella, Escherichia coli, Staphylococcus aureus, and Listeria monocytogenes. Often, meat processors decontaminate the carcass using cheap chemicals or artificial antimicrobial agents not listed on the ingredient list, which is discouraged by health-conscious consumers. Foods with clean labels became more popular during the COVID-19 pandemic, which led consumers to choose healthier ingredients. Novel methods of controlling or improving meat safety are constantly being discovered. This review focuses on novel means of electrochemically activate water that is being investigated as a sanitizing agent for carcasses and processing area decontamination during production or at the end. Water can be activated by using non-thermal techniques such as ozonation, electrolysis, and cold plasma technologies. Recent studies showed that these activated liquids are powerful tools for reducing microbial activity in raw and processed meat. For instance, plasma-activated water can be used to enhance microbiological safety and avoid the negative effects of direct gaseous plasma on the organoleptic aspects of food products. In addition, electrolyzed water technology offers hurdle enhancement by combining with non-thermal strategies that have great potential. Ozonation is another way of activating water which provides a very convenient way to control microbiological safety and finds several recent applications as aqueous ozone for meat decontamination. These solutions are highly reactive and convenient for non-conventional applications in the meat industry related to food safety because of their antimicrobial or antiviral impact. The present review highlights the efficacy of activated-water decontamination of raw and processed meat via non-thermal solutions. Copyright © 2023 Roobab, Madni, Ranjha, Khan, Selim, Almuhayawi, Samy, Zeng and Aadil.

The Process of Developing a New Safe Normal in (Dental) Healthcare in Terms of an Integrated (Individual and Systemic) Response to the Covid-19 Epidemic: A Case Study

The COVID-19 pandemic rapidly affected every aspect of our day-to-day lives and soon also became a global challenge for healthcare systems. The key issues concern the health system's readiness for the "shock", the speed at which the outbreak of the "shock" was detected and responded to, how to cope with the "shock effect", and how to restore the system and learn. It is about what is known as system resistance. The aim of the research was to demonstrate the importance of collective and individual responsibility in the response to the pandemic "shock" in the chosen field of medicine: dentistry. A qualitative study of the case of the Slovenian healthcare system's resistance to the COVID-19 epidemic in terms of dental care in Slovenia was carried out. © 2021 Slovenian Sociological Association. All rights reserved.

Decision-Making Behaviour Evolution Among Pork Supply and Demand Subjects Under Normalisation of COVID-19 Prevention and Control: A Case Study in China.

Affected by the coronavirus disease 2019 (COVID-19), there were short-term uncertainties in China's live pig industry supply chain. Due to the insufficient supply of pork, the price of pork rose from 33.21 yuan/kg at the end of 2019 to 37.46 yuan/kg in mid-February and fell to 26.41 yuan/kg in mid-May. To restore pig supply and stabilise prices, China issued relevant policies. Given the current effective control of COVID-19 in China, this paper constructed an evolutionary game model of China's pork supply and demand stakeholders under normalisation of COVID-19 prevention and control, analysed the behavioural strategies of consumers, government, and pig farmers, used MATLAB software for data simulation, and expounded on the evolution path and the characteristic rule of tripartite decision-making behaviours. The results showed that government supervision costs, evaluation of government by consumers and pig farmers, government subsidies to pig farmers and consumers, and the proportion of stakeholder behaviours affected the formation of tripartite relationships. The results provide a useful reference for the government to formulate effective policies, increase pig supply, and stabilise pork prices.

An Africa point of view on quality and safety in imaging.

Africa has seen an upsurge in diagnostic imaging utilization, with benefits of efficient and accurate diagnosis, but these could easily be offset by undesirable effects attributed to unjustified, unoptimized imaging and poor quality examinations. This paper aims to present Africa's position regarding quality and safety in imaging, give reasons for the rising interest in quality and safety, define quality and safety from an African context, list drivers for quality and safety in Africa, discuss the impact of COVID-19 on quality and safety, and review Africa's progress using the Bonn Call for Action framework while proposing a way forward for imaging quality and safety in Africa. In spite of a healthcare setting characterized by meagre financial, human and technology resources, a rapidly widening disease-burden spectrum, growing proportion of non-communicable diseases and resurgence of tropical and global infections, Africa has over the last ten years made significant strides in quality and safety for imaging. These include raising radiation-safety awareness, interest and application of evidence-based radiation safety recommendations and guidance tools, establishing facility and national diagnostic reference levels (DRLs) and strengthening end-user education and training. Major challenges are: limited human resource, low prioritization of imaging in relation to other health services, low level of integration of imaging into the entire health service delivery, insufficient awareness for radiation safety awareness, a radiation safety culture which is emerging, insufficient facilities and opportunities for education and training. Solutions to these challenges should target the entire hierarchy of health service delivery from prioritization, policy, planning, processes to procedures.

"Well, I Signed Up to Be a Soldier; I Have Been Trained and Equipped Well": Exploring Healthcare Workers' Experiences during COVID-19 Organizational Changes in Singapore, from the First Wave to the Path towards Endemicity.

(1) Background: As COVID-19 transmission continues despite vaccination programs, healthcare workers (HCWs) face an ongoing pandemic response. We explore the effects of this on (1) Heartware, by which we refer to morale and commitment of HCWs; and identify how to improve (2) Hardware, or ways of enabling operational safety and functioning. (2) Methods: Qualitative e-diary entries were shared by HCWs during the early phases of the outbreak in Singapore from June to August 2020. Data were collected via an online survey of n = 3616 HCWs of all cadres. Nine institutions-restructured hospitals (n = 5), affiliated primary partners (n = 2) and hospices (n = 2)-participated. Applied thematic analysis was undertaken and organized according to Heartware and Hardware. Major themes are in italics (3) Results: n = 663 (18%) HCWs submitted a qualitative entry. Dominant themes undermining (1) Heartware consisted of burnout from being overworked and emotional exhaustion and at times feeling a lack of appreciation or support at work. The most common themes overriding morale breakers were a stoic acceptance to fight, adjust and hold the line, coupled with motivation from engaging leadership and supportive colleagues. The biggest barrier in (2) Hardware analysis related to sub-optimal segregation strategies within wards and designing better protocols for case detection, triage, and admissions criteria. Overall, the most cited enabler was the timely and well-planned provision of Personal Protective Equipment (PPE) for front-liners, though scope for scale-up was called for by those not considered frontline. Analysis maps internal organizational functioning to wider external public and policy-related narratives. (4) Conclusions: COVID-19 surges are becoming endemic rather than exceptional events. System elasticity needs to build on known pillars coupling improving safety and care delivery with improving HCW morale. Accordingly, a model capturing such facets of Adaptive Pandemic Response derived from our data analyses is described. HCW burnout must be urgently addressed, and health systems moved away from reactive "wartime" response configurations.

The Association between Mental Health Symptoms and Quality and Safety of Patient Care before and during COVID-19 among Canadian Nurses.

(1) Background: While the association between nurse mental health and quality and safety of patient care delivery was well documented pre-pandemic, fewer research studies have examined this relationship in the context of COVID-19. This study examines the impact of various mental health symptoms experienced by nurses on quality and safety before and during the COVID-19 pandemic; (2) Methods: A secondary analysis of cross-sectional survey data from 4729 and 3585 nurses in one Canadian province between December 2019 and June-July 2020 was conducted. Data were analyzed using between group difference tests and logistic regression; (3) Results: Compared to pre-COVID-19, during COVID-19 nurses reported a higher safety grade, a greater likelihood of recommending their units for care and lower quality of nursing care. Most mental health symptoms were higher during COVID-19 and higher levels of mental health symptoms were correlated with lower ratings of quality and safety both pre- and during COVID-19; (4) Conclusion: Mental health symptoms have implications for nurses' quality and safety of patient care delivery, with the association between mental health symptoms and quality and safety following a dose-response relationship before and during COVID-19. These findings suggest that it is worthwhile for nurse mental health symptoms to be included as hospital level performance metrics.

Supervision, Interprofessional Collaboration, and Patient Safety in Intensive Care Units during the COVID-19 Pandemic.

Background: To meet coronavirus disease (COVID-19) demands in the spring of 2020, many intensive care (IC) units (ICUs) required help of redeployed personnel working outside their regular scope of practice, causing an expansion and change of staffing ratios. Objective: How did this composite alternative ICU workforce experience supervision, interprofessional collaboration, and quality and safety of care under the unprecedented clinical circumstances at the height of the first pandemic wave as lived experiences uniquely captured during the first peak of the pandemic? Methods: An international, cross-sectional survey was conducted among physicians, nurses, and allied personnel deployed or redeployed to ICUs in Utrecht, New York, and Dublin from April to May of 2020. Data were analyzed separately for the three sites. Quantitative data were treated for descriptive statistics; qualitative data were analyzed thematically and combined for general interpretations. Results: On the basis of 234, 83, and 34 responses (response rates of 68%, 48%, and 41% in Utrecht, New York, and Dublin, respectively), we found that the amount of supervision and the quality and safety of care were perceived as being lower than usual but still acceptable. The working atmosphere was overwhelmingly felt to be collaborative and supportive. Where IC-certified nurse-to-patient ratios had decreased most (Utrecht), nurses voiced criticism about supervision and quality of care. Continuity within the work environment, team composition, and informal ("curbside") consultations were critical mediators of success. Conclusion: In the exceptional circumstances encountered during the COVID-19 pandemic, many ICUs were managed by a composite workforce of IC-certified and redeployed personnel. Although supervision is critical for safe care, supervisory roles were not clearly related to the amount of prior ICU experience. Vital for satisfaction with the quality of care was the span of control for those who assumed supervisory roles (i.e., the ratio of certified to noncertified personnel). Stable teams that matched less experienced personnel with more experienced personnel; a strong, interprofessional, collaborative atmosphere; a robust culture of informal consultation; and judicious, more flexible use of rules and regulations proved to be essential.

Patient safety, quality of care and missed nursing care at a cardiology department during the COVID-19 outbreak.

AIM: To evaluate missed nursing care and patient safety during the first wave of the COVID-19 pandemic at in-patient cardiology wards. DESIGN: A cross-sectional design with a comparative approach. METHOD: Registered nurses and nurse assistants at a cardiology department were invited to answer the MISSCARE Survey-Swedish version, and questions on patient safety and quality of care during the COVID-19 pandemic. The data were compared with a reference sample. RESULTS: A total of 43 registered nurses and nurse assistants in the COVID-19 sample and 59 in the reference sample participated. The COVID-19 sample reported significantly more overtime hours and more absence from work due to illness in comparison with the reference sample. The patient safety and quality of care were perceived significantly worse, 76.7% (N = 33) versus 94.7% (N = 54), and 85.7% (N = 36) versus 98.3% (N = 58, respectively. The COVID-19 sample reported more missed nursing care in wound care and in basic nursing.

[Evaluation of professional practice in the context of Covid-19]. / L'évaluation des pratiques professionnelles appliquée au contexte de la Covid-19.

An evaluation of professional practices was carried out in a cancer centre in the wake of the management of the health crisis linked to the severe acute respiratory syndrome coronavirus 2 pandemic. Hospital teams questioned the relevance of the measures adopted, internally and during home care, to manage suspected or confirmed Covid-19 patients and prevent contagion for all.

Effects of the first COVID-19 lockdown on quality and safety in mental healthcare transitions in England.

BACKGROUND: The COVID-19 pandemic forced the rapid implementation of changes to practice in mental health services, in particular transitions of care. Care transitions pose a particular threat to patient safety. AIMS: This study aimed to understand the perspectives of different stakeholders about the impact of temporary changes in practice and policy of mental health transitions as a result of coronavirus disease 2019 (COVID-19) on perceived healthcare quality and safety. METHOD: Thirty-four participants were interviewed about quality and safety in mental health transitions during May and June 2020 (the end of the first UK national lockdown). Semi-structured remote interviews were conducted to generate in-depth information pertaining to various stakeholders (patients, carers, healthcare professionals and key informants). Results were analysed thematically. RESULTS: The qualitative data highlighted six overarching themes in relation to practice changes: (a) technology-enabled communication; (b) discharge planning and readiness; (c) community support and follow-up; (d) admissions; (e) adapting to new policy and guidelines; (f) health worker safety and well-being. The COVID-19 pandemic exacerbated some quality and safety concerns such as tensions between teams, reduced support in the community and increased threshold for admissions. Also, several improvement interventions previously recommended in the literature, were implemented locally. DISCUSSION: The practice of mental health transitions has transformed during the COVID-19 pandemic, affecting quality and safety. National policies concerning mental health transitions should concentrate on converting the mostly local and temporary positive changes into sustainable service quality improvements and applying systematic corrective policies to prevent exacerbations of previous quality and safety concerns.

Implementing the National Incident Management System at schools of nursing in response to COVID-19.

Unprecedented financial and logistical barriers in educating nurses during COVID-19 have threatened nursing education. The purpose of this article is to provide a template to facilitate the maintenance and stability of teaching and learning in a pandemic environment for nursing school administration and faculty leaders. The National Incident Management System (NIMS), previously used in training nurses for emergency preparation and response, has been applied as a guiding framework. The framework consists of five elements: Preparedness, Communication/Information Management, Resource Management, Command and Ongoing Management/Maintenance. This paper addresses how schools of nursing may apply each of these elements to address both the needs of the institution and community. The Comprehensive Vulnerability Management paradigm is further offered as a lens for professional development. Free preparedness education is showcased from leading nursing and healthcare professional and government organizations. Finally, the Quality and Safety Education for Nurses competencies are used for integrating NIMS and social dimensions of disaster. Such tools may equip academic leaders at schools of nursing to surmount challenges posed by the pandemic, and to ensure educational readiness to respond to global health crisis through use of the NIMS framework.

Characterization of initial North American pediatric surgical response to the COVID-19 pandemic.

INTRODUCTION: The impact of COVID-19 pandemic on pediatric surgical care systems is unknown. We present an initial evaluation of self-reported pediatric surgical policy changes from hospitals across North America. METHODS: On March 30, 2020, an online open access, data gathering spreadsheet was made available to pediatric surgeons through the American Pediatric Surgical Association (APSA) website, which captured information surrounding COVID-19 related policy changes. Responses from the first month of the pandemic were collected. Open-ended responses were evaluated and categorized into themes and descriptive statistics were performed to identify areas of consensus. RESULTS: Responses from 38 hospitals were evaluated. Policy changes relating to three domains of program structure and care processes were identified: internal structure, clinical workflow, and COVID-19 safety/prevention. Interhospital consensus was high for reducing in-hospital staffing, limiting clinical fellow exposure, implementing telehealth for conducting outpatient clinical visits, and using universal precautions for trauma. Heterogeneity in practices existed for scheduling procedures, implementing testing protocols, and regulating use of personal protective equipment. CONCLUSIONS: The COVID-19 pandemic has induced significant upheaval in the usual processes of pediatric surgical care. While policies evolve, additional research is needed to determine the effect of these changes on patient and healthcare delivery outcomes. LEVEL OF EVIDENCE: III.

Challenges and Priorities in Responding to COVID-19 in Inpatient Psychiatry.

This Open Forum focuses on specific challenges, contingency planning considerations, and downstream impacts of COVID-19 on inpatient psychiatric care. COVID-19 is a novel coronavirus that has been declared a pandemic. Challenges for inpatient psychiatry include risky close contact among staff and patients, space constraints, and structural barriers in care delivery. Nuanced considerations of five contingency planning strategies in response to COVID-19 are described, including COVID-19-specific precautions, visitor restrictions, physician workforce considerations, operational adjustments, and group therapy changes. Organized leadership and clear communication are identified as early priorities in pandemic response to minimize misinformation and address immediate challenges.