Green Cross method in a postanaesthesia care unit: a qualitative study of the healthcare professionals' experiences after 3 years, including the COVID-19 pandemic period.

OBJECTIVES: Unsafe medical care causes morbidity and mortality among the hospital patients. In a postanaesthesia care unit (PACU), increasing patient safety is a joint effort between different professions. The Green Cross (GC) method is a user-friendly incident reporting method that incorporates daily safety briefings to support healthcare professionals in their daily patient safety work. Thus, this study aimed to describe healthcare professionals' experiences with the GC method in a PACU setting 3 years after its implementation, including the period of the coronavirus disease 2019 pandemic's three waves. DESIGN: An inductive, descriptive qualitative study was conducted. The data were analysed using qualitative content analysis. SETTING: The study was conducted at a PACU of a university hospital in South-Eastern Norway. PARTICIPANTS: Five semistructured focus group interviews were conducted in March and April 2022. The informants (n=23) were PACU nurses (n=18) and collaborative healthcare professionals (n=5) including physicians, nurses and a pharmacist. RESULTS: The theme 'still active, but in need of revitalisation' was created, describing the healthcare professionals' experiences with the GC method, 3 years post implementation. The following five categories were found: 'continuing to facilitate open communication', 'expressing a desire for more interprofessional collaboration regarding improvements', 'increasing reluctance to report', 'downscaling due to the pandemic' and 'expressing a desire to share more of what went well'. CONCLUSIONS: This study offers information regarding the healthcare professionals' experiences with the GC method in a PACU setting; further, it deepens the understanding of the daily patient safety work using this incident reporting method.

Risk management in gynaecology

Healthcare providers are obliged to reduce the risk of harm to patients using their services. Robust risk management embraces a blame-free reporting culture and learning from clinical errors whilst adopting a proactive approach to the measurement of patient safety indicators. A good safety culture within an organisation provides assurance to service users, staff, and the public, that there is commitment to provision of high quality safe and effective care. Risk management is everybody's responsibility. Therefore, all clinicians must possess an understanding of risk management processes. This review outlines the key elements of risk management within gynaecology and explains how risks are identified, assessed, quantified and managed. Examples from within the gynaecological setting and the challenges and the emergent risks posed by the COVID19 pandemic, are also discussed. © 2022

The effect of COVID-19 on workplace violence in California's hospitals: An interrupted time series analysis.

AIM: This study used California's unique Workplace Violent Incident Reporting System (WVIRS) to describe changes in workplace violence (WV) exposure for hospital-based healthcare workers during the pandemic. DESIGN: Interrupted time series analysis. METHODS: We compared the linear trends in weekly WV incidents reported during the period before the COVID-19 pandemic (7/1/2017-3/20/2020) to the period following California's shutdown (3/21/2020-6/30/2021). We created mixed effects models for incidents reported in emergency departments (EDs) and in other hospital units. We used hospital volume data from the California Department of Health Care Access and Information. RESULTS: A total of 418 hospitals reported 37,561 incidents during the study period. For EDs, the number of reported incidents remained essentially constant, despite a 26% drop in outpatient visits between the first and second quarters of 2020. For other hospital units, weekly incidents initially dropped-parallel to a 13% decrease in inpatient days between the first and second quarters of 2020-but then continued parallel to the trend seen in the pre-COVID period. CONCLUSION: WV persists steadily in California's hospitals. Despite major reductions in patient volume due to COVID-19, weekly reported ED incidents remained essentially unchanged. IMPACT: Surveys and media reported that WV increased during the pandemic, but it has been difficult to measure these changes using a large-scale database. The absolute number of WV incidents did not increase during the pandemic; however, the trend in reported incidents remained constant in the context of dramatic decreases in patient volume. New federal WV prevention legislation is being considered in the U.S. California's experience of implementation should be considered to improve WV reporting and prevention. PUBLIC CONTRIBUTION: There was no public contribution to this study. The goal of this analysis was to summarize findings from administrative data. The findings presented can inform future discussion of public policy and action.

Risk management in gynaecology

Healthcare providers are obliged to reduce the risk of harm to patients using their services. Robust risk management embraces a blame-free reporting culture and learning from clinical errors whilst adopting a proactive approach to the measurement of patient safety indicators. A good safety culture within an organisation provides assurance to service users, staff, and the public, that there is commitment to provision of high quality safe and effective care. Risk management is everybody's responsibility. Therefore, all clinicians must possess an understanding of risk management processes. This review outlines the key elements of risk management within gynaecology and explains how risks are identified, assessed, quantified and managed. Examples from within the gynaecological setting and the challenges and the emergent risks posed by the COVID19 pandemic, are also discussed.

[Impact of the COVID-19 pandemic on patient safety incident and medication error reporting systems]. / Impacto de la pandemia COVID-19 en los sistemas de notificación de incidentes de seguridad del paciente y errores de medicación.

BACKGROUND AND AIM: To determine the impact of the COVID-19 pandemic on the epidemiology of safety incidents (SI) and medication errors (ME) reported to the CISEMadrid notification system in the hospital and primary care settings of the Madrid Health Service (SERMAS). MATERIALS AND METHODS: Observational and descriptive study with a retrospective analysis of data including all CISEMadrid notifications from 01-Jan-2018 to 31-Dec-2020, from 33 hospitals and 262 health care centres of the SERMAS. The two periods in 2020 with the greatest increase in COVID-19 cases were identified to compare incidents reported in the pre-pandemic and pandemic periods. RESULTS: 36,494 incidents were reported. Comparing both periods, an overall decrease in pandemic notifications of 60.7% was observed, being higher in primary care, falling to 33% of previous levels. The reduction in notifications was similar in the peaks and valleys of the waves. The three most frequent SIs in both periods and care settings were: diagnostic tests, medical devices/equipment/clinical furniture and organisational management/citations. In ME, dose failure and inappropriate selection were the most frequent in both settings and periods. There were no relevant differences in patient consequences in both periods. CONCLUSIONS: During the pandemic, patient safety notifications decreased although the most frequent types remained the same, as did their impact on the patient, both in hospitals and in primary care. The safety culture of organisations is a critical aspect for the maintenance of reporting systems.

Analyzing changes in radiotherapy treatment planning error reporting during the COVID-19 pandemic.

The 2019 coronavirus (COVID-19) pandemic has affected medical physics and radiation oncology departments and the delivery of radiation therapy. Among the changes implemented in response to the onset of the pandemic was a shift to remote treatment planning by health care institutions. The purpose of this study was to determine whether the overall frequency of errors changed after the implementation of remote radiation therapy treatment planning during the COVID-19 pandemic. Reported incidents were obtained from an incident reporting database operated by a multisite cancer care facility in the Northeast. Researchers compared the frequency of reported events in a period prior to the start of the pandemic (March 2019 to February 2020) with a period after the onset of the pandemic (March 2020 to February 2021). No significant increase in reported incidents was detected suggesting the efficiency and safety of remote radiotherapy treatment planning.

Detecting Patient Safety Errors by Characterizing Incidents Reported by Medical Imaging Staff.

The objectives of the study were to characterize events related to patient safety reported by medical imaging personnel in Finland in 2007-2017, the number and quality of reported injuries, the risk assessment, and the planned improvement of operations. The information was collected from a healthcare patient safety incident register system. The data contained information on the nature of the patient safety errors, harms and near-misses in medical imaging, the factors that lead to the events, the consequences for the patient, the level of risks, and future measures. The number of patient safety incident reports included in the study was 7,287. Of the incident reports, 75% concerned injuries to patients and 25% were near-misses. The most common consequence of adverse events and near-misses were minor harm (37.2%) related to contrast agent, or no harm (27.9%) related to equipment malfunction. Supervisors estimated the risks as low (47.7%) e.g., data management, insignificant (35%) e.g., verbal communication or moderate (15.7%) e.g., the use of contrast agent. The most common suggestion for learning from the incident was discussing it with the staff (58.1%), improving operations (5.7%) and submitting it to a higher authority (5.4%). Improving patient safety requires timely, accurate and clear reporting of various patient safety incidents. Based on incident reports, supervisors can provide feedback to staff, develop plans to prevent accidents, and monitor the impact of measures taken. Information on the development of occupational safety should be disseminated to all healthcare professionals so that the same mistakes are not repeated.

Incident reporting reduction during the COVID-19 pandemic in a tertiary Italian hospital: A retrospective analysis.

BACKGROUND: Incident reporting (IR) is one of the most used systems to gain knowledge of adverse events (AEs) and to identify sources of risk. During COVID-19 pandemic, several organizational changes have been implemented to respond adequately and effectively to the emergency; this required the suspension of most deferrable activities. OBJECTIVE: The aim of this study is to investigate whether IR attitude of health workers has been reduced during the pandemic event. METHOD: A retrospective analysis was conducted at the Azienda Ospedale - Università di Padova (Italy), considering IR of years 2019 and 2020. To standardize the effects of the decrease in admissions, we considered the number of incidents per 1000 admissions. RESULTS: Data shows that during the first (March-May 2020) and second waves (October-December 2020) of the COVID-19 pandemic there was a statistically significant reduction in the rate of IR for every 1000 admissions (P = 0.001-Wilcoxon test), especially for AEs and in COVID-19 units. CONCLUSION: This study shows a reduction in IR especially during the first and second pandemic waves of COVID-19 in year 2020. Education and training interventions could be fundamental to raise awareness of the importance of IR in health workers, as this could provide opportunities to understand what is impacting on safety in a particular healthcare context and enable continuous improvement.

Guiding axes for drug safety management of pharmacovigilance centres during the COVID-19 era.

The COVID-19 pandemic presents several challenges to the organisation and workflow of pharmacovigilance centres as a result of the massive increase in reports, the need for quick detection, processing and reporting of safety issues and the management of these within the context of lack of complete information on the disease. Pharmacovigilance centres permanently monitor the safety profile of medicines, ensuring risk management to evaluate the benefit-risk relationship. However, traditional pharmacovigilance approaches of spontaneous reporting, are not suitable in the context of a pandemic; the scientific community and regulators need information on a near real-time point. The aim of this commentary is to suggest six interrelated multidimensional guiding axes for drug safety management by pharmacovigilance centres during the COVID-19 pandemic. This working plan can increase knowledge on COVID-19 and associated therapeutic approaches, support decisions by the regulatory authorities, oppose fake news and promote more efficient public health protection.

[Handling critical incidents as organizational-ethical challenges using the example of "medical errors"]. / Der Umgang mit belastenden Ereignissen als organisationsethische Herausforderung am Beispiel "Behandlungsfehler".

Definition of the problem: Employees in the healthcare sector are expected to deal professionally with patients and their families at all times. Accompanying them through existential crises, disease, dying, and death is highly demanding. A situation which employees can experience as particularly stressful is when a decision needs to be made and they find themselves in a moral conflict or dilemma. Arguments: Such situations range from extremely rare triage decisions to comparably "everyday" involvement in (alleged) medical error. Conclusion: In some cases the outcome for patients and their families, who had placed their trust in the institution, can be tragic, and this already burdensome situation for employees is further exacerbated when there is no credible concept established within the organization for dealing with such events in a structured manner, and when colleagues and their superiors have little to no knowledge about helpful support options.