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.

Safety Culture in Irish Community Pharmacies: a cross-sectional study using the Community Pharmacy Survey on Patient Safety Culture

Introduction: Safety culture is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organisation's health and safety management.(1) Community pharmacists play a vital role in ensuring optimum medication safety however the study of patient safety culture in this setting is less developed than in secondary care. Aim(s): The study aim was to measure patient safety culture in Irish community pharmacies using the validated Community Pharmacy Survey on Patient Safety Culture (PSOPSC).(2) Methods: The survey consisted of 39 questions based on a 5-point Likert scale, within 11 dimensions. Demographic questions were asked including the pharmacist's role within the pharmacy. A free-text box allowed respondents to give comments on the survey topic. The online questionnaire, hosted on Microsoft Forms, was emailed to all 3943 community pharmacists registered with the Pharmaceutical Society of Ireland in November 2021. A reminder email was sent 14 days later. Data were analysed in Microsoft Excel. Categorical data were presented as frequencies (%). The positive rate response (PRR) of each survey question and dimension was calculated.(2) The PRR is the mean percentage of positive Likert scale responses to each item and each dimension of the survey. A PRR >75% indicated a strong safety culture, while a PRR <50% indicated a dimension that may be improved upon. Free-text responses were explored by thematic analysis. Result(s): The survey was completed by 173 pharmacists, response rate 4.5%. Of these, 33 (19.1%) were superintendent pharmacist, 65 (37.6%) supervising pharmacist, 53 (30.6%) staff pharmacist and 22 (12.7%) locum pharmacist. The mean %PRR across the 11 survey dimensions was 72.3%. Individual statements with highest PRR were Our pharmacists tell patients important information about their new prescriptions (PRR=91.3%) and Staff are treated fairly when they make mistakes (PRR=87.3%). Individual statements with lowest PRR were Interruptions/distractions in this pharmacy (from phone calls, faxes, customers, etc.) make it difficult for staff to work accurately (PRR=6.4%) and We feel rushed when processing prescriptions (PRR=8.1%). The dimension of Organizational Learning-Continuous Improvement demonstrated the highest PRR (81.6%), followed by Response to Mistakes (PRR=81.2%). The dimension of Staffing, work pressure and pace demonstrated the lowest PRR (35.6%). Respondents rated overall patient safety in their pharmacy as excellent/very good/good (88.4%). Differences in perception of patient safety emerged between pharmacists with different levels of responsibility. Patient safety rating was described as fair/poor by 0.0% of superintendent pharmacists, 6.3% of supervising pharmacists, 17.0% of staff pharmacists and 31.8% of locum pharmacists. Fifty-one (29.0%) respondents provided free-text comments. Emergent themes were impact on safety culture of staffing issues;staff training;dispensary workload;and dispensary work pressures. Conclusion(s): The study was limited by low response rate. This may reflect its timing during the COVID-19 pandemic and pharmacists' prioritisation of clinical roles at that time. Respondents reported a broadly positive patient safety culture in the pharmacy in which they work. Differences in perception of safety culture were observed between those with differing levels of responsibility in community pharmacy practice.

CULTURE TRANSFORMATION - ENCULTURATION TO ACCULTURATION

Enculturation is learning the culture you grow up in and Acculturation is learning a culture different from that in which you grew up. The situation becomes more challenging when you are doing business in a developing country having low literacy rate and high cultural & language barriers. This paper describes the cultural transformation, behavioral systems and improvement initiatives Fatima Fertilizers Limited (FFL) has successfully implemented in past 9 years to improve the safety culture dimensions and to ensure compliance with standards. This resulted in improvement of FFL safety records to world class level. It will also describe the details of implementation process and maturing steps of systems on Behavioral/Cultural aspects and elements such as Process Safety Leadership & Engagement Program, Management Safety Audit Program, Perception Surveys, Operational Discipline & Excellence, Field vigilance & Area audits Program, Line Management Responsibility, Observation Reporting, Analysis & Action Plans and Contractor Safety Management Program etc which resulted in achievement of such remarkable results. The paper also includes the Organizations' vision & future plans on sustaining and further improving process safety culture as per changing & challenging scenarios across the globe especially post COVID-19. © 2022 AIChE Spring Meeting and 18th Global Congress on Process Safety, GCPS 2022. All rights reserved.

The SECURE STAIRS framework: preliminary evaluation of the impact on therapeutic climate in a secure children's home (SCH)

PurposeThe SECURE STAIRS framework for integrated care is a trauma-informed approach to supporting staff and young people within the Children and Young People's Secure Estate (CYPSE) in the UK. Within secure settings, therapeutic climate is a concept that encapsulates an individual's perception of safety, connectedness with others and level of support within the environment. To support evaluation of the SECURE STAIRS framework, a Secure Children's Home (SCH) within the North East of England examined therapeutic climate for staff and young people annually using the Essen Climate Evaluation Schema (EssenCES) over a three-year period. This paper aims to present the findings.Design/methodology/approachOver the three years, a total of 71 young people and 214 staff EssenCES questionnaires were administered. Between 2020 and 2021, the setting also experienced significant changes resulting from the COVID-19 pandemic. Numbers of young people also decreased within the setting over the three-year period.FindingsResults indicated a positive trend for therapeutic climate sub-scores. For example, Experienced Safety for young people significantly increased from 2020 to 2021. Additionally, therapeutic hold for staff was significantly higher in 2020 and 2021 in comparison to 2018.Originality/valueFindings are discussed in relation to implementation of the SECURE STAIRS framework and providing trauma-informed care for vulnerable young people within secure settings. Implications for practice are explored.

Development of Safety Culture in the Republic of Belarus in 2020–2021

: Safety culture is a very important tool to improve safety at nuclear energy facilities. It develops abilities of personnel to efficiently mitigate potential threats to nuclear and radioactive material, promoting correct attitude and behavior, as a consequence of which the personnel gain more stringent and cautious approach to their duties in the field of physical safety. In the companies with high culture of physical nuclear safety, the chance of a malicious act by personnel is hardly probable owing to persuasion that nuclear safety is important as well as owing to the factor of vigilance and professional compliance with the practices of physical nuclear safety. This article discusses the issue of development of safety culture in the Republic of Belarus in 2020–2021. This time period coincided, on one hand, with the commissioning of the first nuclear power unit in Ostrovets and, on the other hand, with the spread of COVID-19. The role of safety culture has increased as mentioned in some regulations approved in 2020. The role, the functions, and the requirements for safety culture have been formulated not only for the Belarussian NPP but also for the companies operating sources of ionizing irradiation. The current times are dealing with the spread of COVID-19. Introduction of sanitary norms added corrections to arrangement of measures required for formation and improvement of safety culture. This article presents the approach and summarizes the measures developed by Joint Institute for Power and Nuclear Research—Sosny, National Academy of Sciences of Belarus, aiming at a higher level of safety culture. © 2022, Pleiades Publishing, Ltd.

Research on the Characteristics of Safety Culture and Obstacle Factors among Residents under the Influence of COVID-19 in China.

This study established a comprehensive evaluation indicator model for the safety culture among residents during COVID-19 and an obstacle degree model for the identification of the major factors affecting the residents' safety culture. The results show that the overall level of the safety culture among residents was 0.6059. Safety education, channels for learning knowledge regarding safety, and implementation of safety management systems are currently the major obstacles affecting safety culture among residents, but there is still space for improvement in the future. Furthermore, the level of safety culture was strongly related to the distance from the infected, because this changes the risk of viral infection. There are also differences in obstacle factors in different regions. Therefore, it is necessary to implement measures targeting the improvement of safety culture in accordance with the risk of viral infection. Strategies for strengthening the safety culture are also given in this study for consideration in strategic decision making with the aim of promoting the improvement of safety culture among residents, which may help to reduce the risk of infection with COVID-19 for residents.

Assessing patient safety culture in obstetrics ward: a pilot study using a modified Manchester Patient Safety Framework in China.

AIM: The primary objective of this study was to assess the patient safety culture in a general hospital in Shanghai, China, through a modified Manchester Patient Safety Framework (MaPSaF). DESIGN: This study has a qualitative interview design. Data were collected through group interviews and analyses performed through content analysis. METHODS: The MaPSaF was translated into Chinese and used to assess the patient safety culture in a large general hospital in Shanghai, China. Group interviews using the MaPSaF were conducted with 15 nurses in the obstetric ward. Participants rated their safety practice individually on each of the nine MaPSaF safety culture dimensions. The dimensions and scores were then collectively discussed and a practice-wide consensus score for each dimension was agreed. Discussions were recorded, transcribed and analysed to assess patient safety in the obstetric ward. RESULTS: It took about 2 hr to complete the discussion focusing on patients' safety employing the MaPSaF. Most participants recognized the process as acceptable and useful. The MaPSaF directed team discussion about patient safety issues and facilitated communication, prompting some practice changes. All participants responded positively to the discussion and perceived MaPSaF as a good safety culture assessment tool, with clear, comprehensive and understandable entries. The process demonstrated that the department of obstetrics in the hospital already had a positive patient safety culture, but certain areas were highlighted as still needing improvement. Based on participants' positive experience and perception of the MaPSaF, it can be concluded that there is potential benefit in its adaptation and use in obstetrics wards of Chinese hospitals. The MaPSaF has the potential to strengthen existing safety cultures and improve general safety through collaborative measures.

Fear of making a mistake: a prominent cause of stress for COVID-19 ICU staff-a mixed-methods study.

INTRODUCTION: The COVID-19 pandemic has had a profound effect on many domains of healthcare. Even in high-income countries such as Sweden, the number of patients has vastly outnumbered the resources in affected areas, in particular during the first wave. Staff caring for patients with COVID-19 in intensive care units (ICUs) faced a very challenging situation that continued for months. This study aimed to describe burnout, safety climate and causes of stress among staff working in COVID-19 ICUs. METHOD: A survey was distributed to all staff working in ICUs treating patients with COVID-19 in five Swedish hospitals during 2020 and 2021. The numbers of respondents were 104 and 603, respectively. Prepandemic data including 172 respondents from 2018 served as baseline. RESULTS: Staff exhaustion increased during the pandemic, but disengagement decreased compared with prepandemic levels (p<0.001). Background factors such as profession and work experience had no significant impact, but women scored higher in exhaustion. Total workload and working during both the first and second waves correlated positively to exhaustion, as did being regular ICU staff compared with temporary staff. Teamwork and safety climate remained unchanged compared with prepandemic levels.Respondents reported 'making a mistake' as the most stressful of the predefined stressors. Qualitative analysis of open-ended questions identified 'lack of knowledge and large responsibility', 'workload and work environment', 'uncertainty', 'ethical stress' and 'organization and teamwork' as major causes of stress. CONCLUSION: Despite large workloads, disengagement at work was low in our sample, even compared with prepandemic levels. High levels of exhaustion were reported by the ICU staff who carried the largest workload. Multiple significant causes of stress were identified, with fear of making a mistake the most significant stressor.

Cross-cultural adaptation and validation of the Hospital Survey on Patient Safety Culture 2.0 - Brazilian version.

BACKGROUND: Patient safety culture concerns the values, beliefs and standards shared by an organisation's health staff and other personnel which influence their care provision actions and conduct. Several countries have made a priority of strengthening patient safety culture to improve the quality and safety of health care. In this direction, measuring the patient safety culture through validated instruments is a strategy applied worldwide. The purpose of this study was to adapt transculturally and validate the HSOPSC 2.0 to Brazilian Portuguese and the hospital context in Brazil. METHODS: Of the various validated scales for measuring safety culture, the instrument most used internationally is the Hospital Survey on Patient Safety Culture (HSOPSC) developed by the United States Agency for Healthcare Research and Quality in 2004 and revised in 2019, when version 2.0 was released. Adaptation was conducted on a universalist approach and the adapted instrument was then applied to a sample of 2,702 respondents (56% response rate) comprising staff of a large general hospital in the city of São Paulo. Construct validity was investigated by Exploratory Structural Equation Modelling-within-Confirmatory Factor Analysis (ESEM-within-CFA) and reliability was measured in each dimension by means of Cronbach alpha coefficients. RESULTS: ESEM fit indexes showed good data fit with the proposed model: χ2 = 634.425 df = 221 χ2/df ratio = 2.9 p-value < 0.0000; RMSEA = 0.045 (90% C.I. = 0.041-0.050) and probability RMSEA < = .05 = 0.963; CFI = 0.986; TLI = 0.968. However, ten items had loads lower than 0.4. Cronbach alpha values were 0.6 or more for all dimensions, except Handoffs and information exchange ([Formula: see text]= 0.50) and Staffing and work pace ([Formula: see text] = 0.41). CONCLUSION: The psychometric properties of the Brazilian version were found to be satisfactory, demonstrating good internal consistency and construct validity as expressed by estimates of reliability and indexes of model fit. However, given factor loadings smaller than 0.4 observed in ten items and considering that the scale translated and adapted to Portuguese was tested on a single sample during the Covid-19 pandemic, the authors recognize the need for it to be tested on other samples in Brazil to investigate its validity.

An evolving safety culture journey: Cross-border methodologies and findings in safety and security culture between Switzerland and Austria

For many safety operators, the measurement of safety culture is not just a requirement, but a valuable tool for the health check of systems, future safety investment planning, and insight into day-to-day human performance. But the collection of data, especially qualitative is often costly, time consuming and requires considerable effort in processing. In 2021, Austro Control and Skyguide created a cross-border methodology utilizing both existing surveying methodologies and the introduction of asset-based qualitative workshops via MS Teams to collect safety culture data. Additional questions pertaining to security culture and Covid-19 responses at both companies were also collected. A total of 998 employees between both companies responded. The results of both organizations were collected independently and are compared and analysed within this paper. An overview of the strengths and weaknesses of the joint methodology are shared and discussed. It is concluded that for smaller Air Navigation Service Providers-especially for those with similarities in culture-this approach is beneficial and cost-effective. Moreover, the use of asset-based qualitative workshops has shown to be beneficial not only for quality of subjective data but for encouraging individuals to take immediate actions generating stronger bottom-up initiatives. The quantitative results showed that despite two years of the Covid-19 pandemic, the safety culture at both organizations for operators has remained high and robust with future work needing to focus on rebuilding trust in the industry as well as maintaining high level of safety in times of transformation and adaptation to changing industry demands. © 2022 The Authors.

Usage of Regular Safety Surveys to Assess and Improve Safety Culture in the Radiation Treatment Department

Aim: The Radiation Treatment Quality Assurance Committee (RTQAC) is a multidisciplinary committee within the Radiation Treatment department. As a newly established committee in 2013, the RTQAC had a desire to obtain feedback from staff and to evaluate the existing safety culture. Safety culture surveys have been continued with the aim to assess and improve the safety culture within our department. Process: The RTQAC has since completed six safety culture surveys. The surveys have ranged from 9-15 questions in length with the most recent one sent in 2021. Some questions were edited or modified with each survey as the committee saw fit. The surveys were sent to all current staff across various disciplines in the Radiation Treatment department. Themes have emerged over the years as with some general categories, including: Reporting Program, Barriers to Reporting, Communication and Discussion of Incidents and Suggestions for Improving Quality and Safety. Results are collected and analyzed in comparison with previous results and are shared with the department in a summarizing report. Benefits/Challenges: Regular collection of safety culture survey results have highlighted successes within the department and the RTQAC. It has provided staff an opportunity to talk openly and anonymously about safety concerns. Themes emerging from results have provided content for group discussion and review of potential areas of improvement. Opportunities for education in the department have been highlighted. The results have also allowed the RTQAC to reflect on the scope of the committee tasks. One consistent challenge faced has been the low number of respondents, which limits creation of conclusions and potential suggestions or recommendations. There can also be a great deal of time associated with reviewing a large number of comments. The committee takes all comments seriously and some negative comments can be difficult to read. Impact/Outcomes: The implementation of safety culture surveys in our department has proven invaluable. It has allowed the committee to obtain current opinions about safety culture and incident learning processes given that these are dynamic and changing over time. Trends, both positive and negative, have been observed over the last 8 years. Safety culture is something that has to be constantly evolving as it can change with various staff and external challenges such as COVID-19. Copyright © 2022

Usage of Regular Safety Surveys to Evaluate and Strengthen Safety Culture in the Radiation Treatment Department

Purpose: The Radiation Treatment Quality Assurance Committee (RTQAC) is a multidisciplinary committee within the Radiation Treatment department. As a newly established committee in 2013, the RTQAC had a desire to obtain feedback from staff and to evaluate the existing safety culture. This practice has continued in subsequent years, with six surveys conducted over an 8-year period. The purpose of the safety culture surveys is to measure staff comfort with reporting incidents and the informationgathering process which follow an incident, to gather staff feedback on ways to improve the quality of treatment delivery, to measure and assess the current state of the safety culture in the department, and to identify themes from the results to drive quality improvement initiatives. Material(s) and Method(s): The safety culture surveys are developed in an electronic format and have been sent to all staff across various disciplines in the Radiation Treatment department, including radiation oncologists, medical physicists, physics associates, electronics engineers, radiation therapists, nurses, and clerical staff. The most recent survey was conducted in 2021. The surveys have ranged from nine to fifteen questions in length. Many of the questions have remained the same across the years, while some have been modified with each survey as seen fit by the committee. Responses are collected in both a multiple-choice format as well as written responses. Responses collected from each survey are analyzed, and when possible, compared against similar questions asked in previous years. The results are compiled into a report which is shared with the department. Result(s): Safety culture is something that is dynamic, as it can change with the implementation of new procedures, updates to incident reporting systems, changes in staffing, and external challenges such as COVID-19. Regular collection of safety culture survey results have highlighted both successes and areas of improvement within the department and the RTQAC. While in many areas, trends are positive, those areas which illustrate progressively negative responses have identified common issues which can be addressed. Feedback that has been collected has subsequently helped guide quality improvement initiatives. Conclusion(s): The implementation of safety culture surveys in our department has proven invaluable. It has provided staff an opportunity to talk openly and anonymously about safety concerns. Through assessment of responses, quality improvement strategies can be undertaken, which in turn can advance the culture of safety in the program. Copyright © 2022 Elsevier Ireland Ltd. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Practical resiliency training for healthcare workers during COVID-19: results from a randomised controlled trial testing the Community Resiliency Model for well-being support.

OBJECTIVE: To introduce the Community Resiliency Model (CRM) as mental well-being support for healthcare workers working through the height of the COVID-19 pandemic. DESIGN: Randomised controlled trial with a no treatment control group. SETTING: Two large urban health systems in the Southern United States between October 2020 and June 2021. PARTICIPANTS: Eligible participants were currently employed as healthcare workers within the participating healthcare systems. 275 employees registered and consented electronically in response to email invitations. 253 participants completed the baseline survey necessary to be randomised and included in analyses. INTERVENTION: Participants were assigned 1:1 to the control or intervention group at the time of registration. Intervention participants were then invited to 1-hour virtual CRM class teaching skills to increase somatic awareness in the context of self and other care. MAIN OUTCOME MEASURES: Self-reported data were collected rating somatic awareness, well-being, symptoms of stress, work engagement and interprofessional teamwork. RESULTS: Baseline data on the total sample of 275 (53% nurses) revealed higher symptoms of stress and lower well-being than the general population. The intervention participants who attended a CRM class (56) provided follow-up survey data at 1 week (44) and 3 months (36). Significant improvement for the intervention group at 3 months was reported for the well-being measures (WHO-5, p<0.0087, d=0.66; Warwick-Edinburgh Mental Well-Being Scale, p<0.0004, d=0.66), teamwork measure (p≤0.0002, d=0.41) and stress (Secondary Traumatic Stress Scale, p=0.0058, d=46). CONCLUSION: Baseline results indicate mental health is a concern for healthcare workers. Post intervention findings suggest that CRM is a practical approach to support well-being for healthcare workers during a crisis such as this pandemic. The simple tools that comprise the model can serve as a starting point for or complement self-care strategies to enhance individual resilience and buffer the effects of working in an increasingly stressful work environment.

Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave.

INTRODUCTION: Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. METHODS: Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System¼ published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ2 and ANOVA tests were used. RESULTS: Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 ("Staffing", with 27.57% of positive responses) and 10 ("Support of the hospital management in safety", with 17.64% of positive responses). The dimensions considered as strengths were 3 ("Expectation of actions by management/supervision of the service") with 85.29% of positive responses, and 5 ("Teamwork") with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. CONCLUSIONS: The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

Safety management in times of crisis: Lessons learned from a nationwide status-analysis on German intensive care units during the COVID-19 pandemic.

Background: The status of Safety Management is highly relevant to evaluate an organization's ability to deal with unexpected events or errors, especially in times of crisis. However, it remains unclear to what extent Safety Management was developed and sufficiently implemented within the healthcare system during the COVID-19 pandemic. Providing insights of potential for improvement is expected to be directional for ongoing Safety Management efforts, in times of crisis and beyond. Method: A nationwide survey study was conducted among healthcare professionals and auxiliary staff on German Intensive Care Units (ICUs) evaluating their experiences during the first wave of the COVID-19 pandemic. Error Management and Patient Safety Culture (PSC) measures served to operationalize Safety Management. Data were analyzed descriptively and by using quantitative content analysis (QCA). Results: Results for n = 588 participants from 53 hospitals show that there is a gap between errors occurred, reported, documented, and addressed. QCA revealed that low quality of safety culture (27.8%) was the most mentioned reason for errors not being addressed. Overall, ratings of PSC ranged from 26.7 to 57.9% positive response with Staffing being the worst and Teamwork Within Units being the best rated dimension. While assessments showed a similar pattern, medical staff rated PSC on ICUs more positively in comparison to nursing staff. Conclusion: The status-analysis of Safety Management in times of crisis revealed relevant potential for improvement. Human Factor plays a crucial role in the occurrence and the way errors are dealt with on ICUs, but systemic factors should not be underestimated. Further intensified efforts specifically in the fields of staffing and error reporting, documentation and communication are needed to improve Safety Management on ICUs. These findings might also be applicable across nations and sectors beyond the medical field.

Exploring the Evidence: Focusing on the Fundamentals Exploring the Evidence: Considerations for the Dialysis Practice Setting Approach to Staffing

Nursing remains one of the most in-demand jobs in the American workforce. The impact of the COVID-19 pandem-ic has created strain on nursing resources throughout the health care industry and drawn attention to longstanding workforce issues. Inadequate staffing is often a multidi-mensional problem that warrants a comprehensive assessment of elements that may contribute to recruit-ment and retention issues. In the dialysis practice setting, nursing shortages remain an ongoing issue due to an aging workforce and ongoing issues for recruiting nurses both new and skilled into the field of nephrology. This article explores the evidence on approaches to staffing in the dial-ysis practice setting by defining core elements to consider when designing a staffing model. These elements include federal/state regulations, patient acuity, staff ratios, work-force perceptions, patient outcomes, and dialysis modali-ties offered.

Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study.

The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice.

The Perception of the Patient Safety Climate by Health Professionals during the COVID-19 Pandemic-International Research.

The patient safety climate is a key element of quality in healthcare. It should be a priority in the healthcare systems of all countries in the world. The goal of patient safety programs is to prevent errors and reduce the potential harm to patients when using healthcare services. A safety climate is also necessary to ensure a safe working environment for healthcare professionals. The attitudes of healthcare workers toward patient safety in various aspects of work, organization and functioning of the ward are important elements of the organization's safety culture. The aim of this study was to determine the perception of the patient safety climate by healthcare workers during the COVID-19 pandemic. METHODS: The study was conducted in five European countries. The Safety Attitude Questionnaire (SAQ) short version was used for the study. A total of 1061 healthcare workers: physicians, nurses and paramedics, participated in this study. RESULTS: All groups received the highest mean results on the stress recognition subscale (SR): nurses 98.77, paramedics 96.39 and physician 98.28. Nurses and physicians evaluated work conditions (WC) to be the lowest (47.19 and 44.99), while paramedics evaluated perceptions of management (PM) as the worst (46.44). Paramedics achieved statistically significantly lower scores compared to nurses and physicians in job satisfaction (JS), stress recognition (SR) and perception of management (PM) (p < 0.0001). Paramedics compared to nurses and physicians rank better in working conditions (WC) in relation to patient safety (16.21%). Most often, persons of lower seniority scored higher in all subscales (p = 0.001). In Poland, Spain, France, Turkey, and Greece, healthcare workers scored highest in stress recognition (SR). In Poland, Spain, France, and Turkey, they assessed working conditions (WC) as the worst, while in Greece, the perception of management (PM) had the lowest result. CONCLUSION: Participant perceptions about the patient safety climate were not at a particularly satisfactory level, and there is still a need for the development of patient safety culture in healthcare in Europe. Overall, positive working conditions, good management and effective teamwork can contribute to improving employees' attitudes toward patient safety. This study was carried out during the COVID-19 pandemic and should be repeated after its completion, and comparative studies will allow for a more precise determination of the safety climate in the assessment of employees.

The COVID-19 Pandemic and Patient Safety Culture: A Cross-Sectional Study among Community Pharmacies in Jordan.

The COVID-19 pandemic has dramatically imposed stressful conditions that may impact the ability of healthcare staff to provide safe and effective care. Research on patient safety culture among community pharmacies during the pandemic is limited. This study aimed to assess the patient safety culture among community pharmacies in Jordan during the COVID-19 pandemic. Pharmacists and pharmacy assistants from 450 community pharmacies were approached through online means, with 378 answering the questionnaire written in Arabic that had been adapted from the Community Pharmacy Survey on Patient Safety Culture (PSOPSC). This study showed that various patient safety standards were addressed to a high degree during the COVID-19 pandemic, as represented by the high positive response rate (PRR) measures that were mainly observed in the dimensions "Teamwork" (90.1%), "Patient Counseling" (85.2%), and "Staff Training and Skills" (82.7%). Furthermore, significantly higher PRR scores for the "Teamwork", "Staffing, Work Pressure, and Pace", "Response to Mistakes", "Organizational Learning-Continuous Improvement", and "Overall Perceptions of Patient Safety" dimensions were observed among participants who worked in independent pharmacies than those who worked in chain pharmacies. Despite an overall positive patient safety culture in the current context of community pharmacies in Jordan during the COVID-19 pandemic, pitfalls were observed in the "Staffing, Work Pressure, and Pace" dimension.

Impact of implementing an electronic radiation oncology-specific in-house incident learning system

Purpose or Objective Incident learning systems (ILS) provide a formalised framework for incident reporting, analysis, data visualisation, feedback, and learning. Robust ILS can identify quality improvement (QI) areas and strengthen quality assurance (QA) pathways. A QI project to develop a digital in-house radiation oncology (RO) ILS was undertaken, with success demonstrated in the first 12 months of use. Materials and Methods A needs assessment was performed in 2019, including an in-house survey on staff knowledge and understanding of current incident reporting methods, ILS and the safety culture climate. Additionally, relevant literature was reviewed. From this, the QI team designed and implemented an electronic reporting system to suit departmental needs and tested its impact at 12 months via a follow-up survey. Results The needs assessment identified that the paper-based ILS in use required improvement. Barriers to reporting were perceived by 67% of respondents and most staff (75%) preferred an electronic in-house system. The state-wide hospitallevel reporting system did not meet the detailed needs of RO. Therefore, a customised electronic departmental-level reporting system was developed on the Varian AriaTM oncology information system platform. It supported actual incident reporting and lower level reporting (e.g., near miss, protocol non-compliance) to increase capacity for learning and QA/QI guidance. It works in parallel with the state-wide system to ensure clinical governance of higher-level reports being reported correctly. The new ILS includes a dedicated triage team, ensuring accurate data capture and rapid coordination of further analysis/escalation when required. Increased data accuracy has been demonstrated in the new ILS, with easy access for all staff to see reports. Clear data visualisation tools are used in Microsoft ExcelTM and Power BITM. The triage team provides increased communication and rapid feedback to staff and management when needed for urgent QI, education or reminders. Monthly meetings to discuss learning opportunities and potential QI ideas are now open to all, rather than the previous separate senior staff meetings. Follow up survey results after 12-months of system use showed: decreased perception of barriers (from 67% to 57%);increased participation in reporting (48% to 70% of respondents having been involved);increased perception of a no-blame culture (49% to 58%);and increased ability to learn from reported incidents (49% to 86%). Conclusion The creation of a customised electronic ILS, suited to RO department needs, addressed issues with the previous system. Overall, the new ILS had a positive impact and adapted rapidly when Covid-19 impacted the standard hospital workflow. Increased feedback loops to the RO team are well integrated into the new ILS. The move to electronic an ILS has enabled easy access to data that highlight weaknesses in processes and protocols and has supported continuing QI initiatives.