Patient safety culture among community pharmacists in Cairo.

BACKGROUND: Measuring perception of patient safety culture among pharmacists working in community pharmacies is crucial to identify opportunities and areas that require improvement. The aim of this work is to measure patient safety culture among pharmacists working in community pharmacies in Cairo. METHODS: A cross-sectional study was conducted among pharmacists working in community pharmacies in the center and south regions of Cairo. The Pharmacy Survey on Patient Safety Culture (PSOPSC), developed by the Agency for Healthcare Research and Quality (AHRQ) was used to collect data. RESULTS: The study included 210 community pharmacies with a 95% response rate. The mean age of pharmacists was 28 ± 5.4 years. The overall positive response percentage (PRP) ranged between 35 and 69% with a mean of 57.4%. The highest PRP was identified in the domains of "teamwork" (68.97%), "organizational learning-continuous improvement" (64.93%) and "patient counseling" (61.83%). The PRP was less than 60% in 6 out of the 11 composites. The lowest PRP was found in the domain of "staffing, work pressure, and pace", which scored 34.98%. CONCLUSION: The study identified areas of patient safety culture that require improvement in community pharmacies, especially in allocating staff, appropriate working hours, and training community pharmacists on the importance and principles of patient safety. The overall mean PRP of patient safety culture among community pharmacists highlights the need to include patient safety as the strategic priority at the level of community pharmacies.

Patient and visitor aggression de-escalation training for nurses in a teaching hospital in Cairo, Egypt.

BACKGROUND: Workplace violence (WPV) has been recognized as a major occupational hazard worldwide. Healthcare professions are particularly at a higher risk of WPV. Patients and their relatives are commonly the most common perpetrators for WPV against physicians. Trainings on the universal precautions of violence, how to effectively anticipate, recognize and manage potentially violent situation is recommended by OSHA as a part of a written, effective, comprehensive, and interactive WPV prevention program. OBJECTIVE: To implement and evaluate the effectiveness of a training session delivered to nurses. The training session aimed to increase nurses' ability to identify potentially violent situations and to effectively manage these situations in a teaching hospital in Egypt. METHODOLOGY: A total of 99 nurses attended the training sessions. Confidence in coping with aggressive patient scale, along with nurses' attitudes toward WPV, were used to assess the effectiveness of the training sessions. RESULTS: Nurses' perceived confidence to deal with aggression increased after attending the training sessions. Nurses' attitudes toward WPV positively changed after attending the training session. CONCLUSION AND RECOMMENDATIONS: Increasing awareness of the problem among healthcare professions as well as the public is warranted. Violence prevention program with a zero-tolerance policy is warranted.

Association of patient safety indicator 03 and clinical outcome in a surgery hospital.

PURPOSE: Patient safety indicators (PSIs) were developed as a tool for hospitals to identify potentially preventable complications and improve patient safety performance. The study aimed at measuring the incidence of the Agency for Healthcare Research and Quality (AHRQ) PSI03 (pressure ulcer [PU] rate) and to identify the association between PSI03 and clinical outcomes including death, readmission within 30 days and length of stay (LOS) at the cardiothoracic surgery hospital at Ain Shams University, Cairo, Egypt. DESIGN/METHODOLOGY/APPROACH: An exploratory prospective cohort study was conducted to follow up patients, who fulfilled the inclusion criteria, from admission until one month after discharge at the cardiothoracic surgery hospital. Data were collected through basic information and follow-up sheets. The total number of included participants in the study was 330. FINDINGS: PSI03 incidence rate was 67.7 per 1,000 discharges. Patients aged 60 years and above had the highest risk among all age groups. In patients who developed PSI03, the risk ratio (RR) of death was 8.8 [95% CI (3.79-20.24)], RR of staying more than 30 days at the hospital was 1.5 [95% CI (1.249-1.872)] and of readmission within 30 days in patients who developed PSI03 was 1.5 [95% CI (0.38-6.15)]. In the study's hospital, the patients who developed PSI03 were at higher risk of death and stayed longer at the hospital than patients without PSI03. This study demonstrated a clear association between PSI03 and patient outcomes such as LOS and mortality. Early detection, prevention and proper management of PSI03 are recommended to decrease unfavorable clinical outcomes. ORIGINALITY/VALUE: The importance of PSIs lies in the fact that they facilitate the recognition of the adverse events and complications which occurred during hospitalization and give the hospitals a chance to improve the possible clinical outcomes. Therefore, the current study aimed at measuring the association between AHRQ PSI03 ( PU rate) and the clinical outcomes including death, readmission within 30 days and the LOS at the cardiothoracic surgery hospital at Ain Shams University. This study will provide the hospital management with baseline data for this type of adverse event and guide them to develop a system for identifying the high-risk group of patients and to upgrade relevant hospital policies and guidelines that lead to improved patient outcomes.

Medication Administration Errors in a University Hospital.

OBJECTIVE: To measure the rates of medication administration errors in medical wards at Ain Shams University Hospital and to identify significant determinants of medication administration errors. METHODS: A descriptive direct-observational study of drug administration errors was carried out at medical wards of Ain Shams University hospital for a period of 3 months. A standardized observational checklist was used to observe the nurse during giving medications, and a medical record audit form was used to assess documentation. The error rates per observation, nurse, and patient were calculated, and the association between error rates and characteristics of each category was tested using linear regression to identify potential risk factors. RESULTS: The study included 237 patients and 28 nurses. The final number of drug administration observations was 2090 after excluding 310 omissions. A total of 5531 errors were observed with an average number of 2.67 errors per observation. More than 85% of the observations had at least one error, and the overall error rate was 37.68% (per hundred error opportunities). The highest error rate was detected in injections especially the intravenous route (39.58%). The most frequent errors were wrong documentation (90.96%) and wrong technique (78.90%), and the least was wrong patient (0.05%). The significant independent determinants of medication administration errors were high number of shifts taken by nurse per month, night shifts, weekends, elderly patient, and illiteracy. CONCLUSION: Medication administration errors represent a major problem in the hospital that needs urgent intervention to optimize medication administration process. The intervention should consider the identified significant determinants of medication administration errors.

A Study of Rate and Predictors of Fall Among Elderly Patients in a University Hospital.

INTRODUCTION: Falls represent a serious problem facing hospital-admitted patients, and the severity of fall-related complications rises steadily after the age of 65 years. OBJECTIVES: The aims of this study were (a) to calculate the rate of falls among elderly patients in the internal medicine departments in Ain Shams University Hospital, (b) to identify different predictors and characteristics of falls, and (c) to assess clinical consequences and hospitalization outcomes of falls. SUBJECTS AND METHODS: An observational longitudinal study has been conducted in Ain Shams University Hospital, where 411 elderly patients admitted to the internal medicine departments were included. Upon admission, the patients were assessed for their risk for falling using the Morse Fall Scale (MFS). Information about their medical condition and drugs administered was obtained. Functional assessment of the patients regarding their ability to perform different daily activities was also performed. The patients were followed up during their stay, and once a fall event occurred, complete details regarding the circumstances and consequences of that event were obtained. RESULTS: The incidence rate of falls was found to be 16.9 per 1000 patient days. The fallers had a significantly high risk for falling according to the MFS (P = 0.02). The MFS was able to predict patients at risk for falling and identified correctly 82.6% of the fallers. The most common medical conditions associated with falls were diabetes (48.7%), hypertension (58.7%), and visual impairment (41.3%). Anemia (P = 0.05) and osteoporosis (P = 0.02) showed a statistically significant difference between the fallers and the nonfallers. Presence of a history of a fall and increased length of hospital stay were highly significant (P = 0.01) factors that predisposed to falls. Logistic regression analysis showed that anemia, osteoporosis, and history of a fall were independent predictors of falls. Most falls had no serious consequences, approximately 18% had contusions, 2% had subdural hematomas, and 4% had fractures and lacerations. CONCLUSIONS: Elderly patients with anemia, osteoporosis, and history of a fall are more prone to falls and should be considered in fall protective measures.

Developing severity adjusted quality measures for intensive care units.

PURPOSE: Intensive care unit performance evaluation is usually affected by variations in the severity of inpatients' health status. This paper aims, therefore, to standardize two performance measures: intensive care unit survival and length of stay using the Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of illness score. DESIGN/METHODOLOGY/APPROACH: A records study in three Ain Shams University Hospital intensive care units, from January 1-December 31, 2003 was carried out to examine illness severity effect using APACHE II, length of stay and survival. Retrospective data were used to model length of stay in days and the survival using the APACHE II score as a predictor. This was followed by a prospective study to monitor the standardized measures in two intensive care units for one year. FINDINGS: APACHE II scores predicted length of stay of those who were discharged and control charts for severity-adjusted length of stay were drawn up. The APACHE II score predicted survival for those with APACHE II score >16. The model is significant with a specificity of 89.9 percent while sensitivity was 25 percent. Control charts for severity-adjusted mortality were drawn up to monitor mortality. RESEARCH LIMITATIONS/IMPLICATIONS: Only 60 percent of the files examined in the retrospective part of the study had enough data to calculate APACHE II scores. PRACTICAL IMPLICATIONS: Standardized APACHE II severity of illness score can monitor intensive care unit length of stay and mortality. ORIGINALITY/VALUE: The paper underlines the need to implement a standardized measurement system to evaluate intensive care patient outcomes.

Evaluation of accreditation program in non-governmental organizations' health units in Egypt: short-term outcomes.

OBJECTIVE: To determine the effect of accreditation of non-governmental organizations' health units on patient satisfaction and provider satisfaction and the output of accreditation on compliance to some accreditation standards. SUBJECTS AND METHODS: Sixty non-governmental health units were selected as follows: 30 units already submitted for accreditation in three governorates and 30 pair-matched units not programmed for accreditation. Matching was done according to the socioeconomic standard and administration type, and from the same governorate. Satisfaction was measured by an interview questionnaire using the Likert scale. Assessment of compliance to some accreditation standards was done using a checklist. RESULTS: Mean patient satisfaction scores were significantly higher among the accredited non-governmental health units regarding: cleanliness, waiting area, waiting time, unit staff and overall satisfaction. No significant differences were noticed in provider satisfaction except for the overall satisfaction score. Most of the checked standards had compliance above 90% in the accredited units and were significantly higher than in the non-accredited units. CONCLUSION: Accreditation of the non-governmental health units has a positive effect regarding patient satisfaction and the continuation of performance according to the accreditation standards compared with non-accredited health units. This short-term effect was shown within the first year from accreditation. Future research is needed to assess long duration effects of applying accreditation in non-governmental health units.