Taxonomy development methods regarding patient safety in health sciences - A systematic review.

BACKGROUND: Taxonomies are needed for automated analysis of clinical data in healthcare. Few reviews of the taxonomy development methods used in health sciences are found. This systematic review aimed to describe the scope of the available taxonomies relative to patient safety, the methods used for taxonomy development, and the strengths and limitations of the methods. The purpose of this systematic review is to guide future taxonomy development projects. METHODS: The CINAHL, PubMed, Scopus, and Web of Science databases were searched for studies from January 2012 to April 25, 2023. Two authors selected the studies using inclusion and exclusion criteria and critical appraisal checklists. The data were analysed inductively, and the results were reported narratively. RESULTS: The studies (n = 13) across healthcare concerned mainly taxonomies of adverse events and medication safety but little for specialised fields and information technology. Critical appraisal indicated inadequate reporting of the used taxonomy development methods. Ten phases of taxonomy development were identified: (1) defining purpose and (2) the theory base for development, (3) relevant data sources' identification, (4) main terms' identification and definitions, (5) items' coding and pooling, (6) reliability and validity evaluation of coding and/or codes, (7) development of a hierarchical structure, (8) testing the structure, (9) piloting the taxonomy and (10) reporting application and validation of the final taxonomy. Seventeen statistical tests and seven software systems were utilised, but automated data extraction methods were used rarely. Multimethod and multi-stakeholder approach, code- and hierarchy testing and piloting were strengths and time consumption and small samples in testing limitations. CONCLUSION: New taxonomies are needed on diverse specialities and information technology related to patient safety. Structured method is needed for taxonomy development, reporting and appraisal to strengthen taxonomies' quality. A new guide was proposed for taxonomy development, for which testing is required. Prospero registration number CRD42023411022.

Health professionals' perceptions of the development needs of incident reporting software: A qualitative systematic review.

AIM: To systemically identify and synthesize information on health professionals' and students' perceptions regarding the development needs of incident reporting software. DESIGN: A systematic review of qualitative studies. DATA SOURCES: A database search was conducted using Medline, CINAHL, Scopus, Web of Science and Medic without time or language limits in February 2023. REVIEW METHODS: A total of 4359 studies were identified. Qualitative studies concerning the perceptions of health professionals and students regarding the development needs of incident reporting software were included, based on screening and critical appraisal by two independent reviewers. A thematic synthesis was conducted. RESULTS: From 10 included studies, five analytical themes were analysed. Health professionals and students desired the following improvements or changes to incident reporting software: (1) the design of reporting software, (2) the anonymity of reporting, (3) the accessibility of reporting software, (4) the classification of fields and answer options and (5) feedback and tracking of reports. Wanted features included suitable reporting forms for various specialized fields that could be integrated into existing hospital information systems. Rapid, user-friendly reporting software using multiple reporting platforms and with flexible fields and predefined answer options was preferred. While anonymous reporting was favoured, the idea of reporting serious incidents with both patient and reporter names was also suggested. CONCLUSION: Health professionals and students provided concrete insights into the development needs for reporting software. Considering the underreporting of healthcare cases, the perspectives of healthcare professionals must be considered while developing user-friendly reporting tools. Reporting software that facilitates the reporting process could reduce underreporting. REPORTING METHOD: The ENTREQ reporting guideline was used to support the reporting of this systematic review. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution. PROTOCOL REGISTRATION: The protocol is registered in the International Prospective Register of Systematic Reviews with register number CRD42023393804.

Readmissions after appointments with nurse prescribers: A register-based study.

BACKGROUND: Increasing number of nurse prescribers could be part of a solution to the shortage of physicians, improve access to treatment and curb the rise in healthcare costs; however, readmissions after nurse prescribers' appointments are under-researched. AIMS: To describe and compare clients' initial appointments with nurse prescribers and physicians. In addition, client readmissions within 60 days in the target organisation after nurse prescribers' and physicians' appointments were investigated. DESIGN: Retrospective register-based follow-up study. METHODS: Data included client appointments (n = 3986) with nurse prescribers and physicians, and clients' readmissions (n = 9038) from 1 January 2018 to 31 December 2019 from one hospital district in Finland. Data were analysed statistically using frequencies, percentages, rate ratios and cross-tabulation. STROBE checklist was used. RESULTS: Initial appointments including trimethoprim, pivmecillinam, phenoxymethyl penicillin, chloramphenicol, fusidic acid and cephalexin prescriptions with nurse prescribers (n = 36) were 2131, and physicians (n = 140) 1855. On average, client readmissions (within 60 days) per initial appointment were 2.10 after appointments with nurse prescribers and 2.46 after physicians. After initial appointments, including phenoxymethyl penicillin prescriptions, with nurse prescribers, clients had more readmissions in all age groups than after initial appointments with physicians. However, in all, after initial appointments with physicians, clients had a higher proportion of readmissions. CONCLUSION: Clients have fewer readmissions after appointments with nurse prescribers than physicians, including the same prescriptions. Nurse prescribers' skills may not have been fully utilised. Physicians treated many patients whose diseases nurse prescribers might have been able to treat based on the nurse prescribers' rights. However, physician clients may have more demanding service requirements.

Abuse of social care clients committed by nurses and other social service employees-Analysis of employees' reports.

AIM: The aim of the study was to describe the alleged abuse of social care clients committed by nurses and other social services employees and actions as well as sanctions that followed the alleged abuse. DESIGN: A retrospective study using a descriptive qualitative analysis. METHODS: The data comprised mandatory reports made by social service employees under the Social Welfare Act. This study focused on the reported abuses of clients (n = 75) by social services employees from 11 October 2016 to 31 December 2020 in Finland. The data were analysed using inductive content analysis and quantification. RESULTS: The majority of the reports were submitted practical nurses and other nursing personnel and by registered nurses. The severity of the abuse was most often mild or moderate. The most common abusers were nurses. The types of alleged abuse committed by professionals were as follows: (1) neglect of care, (2) physical violence/strong-arm treatments, (3) neglect of hygiene, (4) inappropriate or threatening behaviour and (5) sexual abuse. The actions and sanctions that followed the alleged abuse were: (1) discussing the situation together, requesting an explanation, initiating hearing or defining developmental measures, (2) initiating disciplinary actions and providing verbal or written warnings, (3) dismissing or terminating the employee and (4) initiating a police investigation. CONCLUSION: Nurses are an important group working in social services and might also be involved in cases of abuse. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: It is important that risks, wrongdoings and abuses are reported. Transparent reporting indicates strong professional ethics. IMPACT: Knowledge about abuse in social services from the viewpoint of nursing is important for ensuring the quality and safety of services. REPORTING METHOD: The Standards for Reporting Qualitative Research guideline was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.