Clinical Informatics Team Members' Perspectives on Health Information Technology Safety After Experiential Learning and Safety Process Development: Qualitative Descriptive Study.

BACKGROUND: Although intended to support improvement, the rapid adoption and evolution of technologies in health care can also bring about unintended consequences related to safety. In this project, an embedded researcher with expertise in patient safety and clinical education worked with a clinical informatics team to examine safety and harm related to health information technologies (HITs) in primary and community care settings. The clinical informatics team participated in learning activities around relevant topics (eg, human factors, high reliability organizations, and sociotechnical systems) and cocreated a process to address safety events related to technology (ie, safety huddles and sociotechnical analysis of safety events). OBJECTIVE: This study aimed to explore clinical informaticians' experiences of incorporating safety practices into their work. METHODS: We used a qualitative descriptive design and conducted web-based focus groups with clinical informaticians. Thematic analysis was used to analyze the data. RESULTS: A total of 10 informants participated. Barriers to addressing safety and harm in their context included limited prior knowledge of HIT safety, previous assumptions and perspectives, competing priorities and organizational barriers, difficulty with the reporting system and processes, and a limited number of reports for learning. Enablers to promoting safety and mitigating harm included participating in learning sessions, gaining experience analyzing reported events, participating in safety huddles, and role modeling and leadership from the embedded researcher. Individual outcomes included increased ownership and interest in HIT safety, the development of a sociotechnical systems perspective, thinking differently about safety, and increased consideration for user perspectives. Team outcomes included enhanced communication within the team, using safety events to inform future work and strategic planning, and an overall promotion of a culture of safety. CONCLUSIONS: As HITs are integrated into care delivery, it is important for clinical informaticians to recognize the risks related to safety. Experiential learning activities, including reviewing safety event reports and participating in safety huddles, were identified as particularly impactful. An HIT safety learning initiative is a feasible approach for clinical informaticians to become more knowledgeable and engaged in HIT safety issues in their work.

Characterization of Safety Events Involving Technology in Primary and Community Care.

BACKGROUND: The adoption of technology in health care settings is often touted as an opportunity to improve patient safety. While some adverse events can be reduced by health information technologies, technology has also been implicated in or attributed to safety events. To date, most studies on this topic have focused on acute care settings. OBJECTIVES: To describe voluntarily reported safety events that involved health information technology in community and primary care settings in a large Canadian health care organization. METHODS: Two years of safety events involving health information technology (2016-2018) were extracted from an online voluntary safety event reporting system. Events from primary and community care settings were categorized according to clinical setting, type of event, and level of harm. The Sittig and Singh sociotechnical system model was then used to identify the most prominent sociotechnical dimensions of each event. RESULTS: Of 104 reported events, most (n = 85, 82%) indicated the event resulted in no harm. Public health had the highest number of reports (n = 45, 43%), whereas home health had the fewest (n = 7, 7%). Of the 182 sociotechnical concepts identified, many events (n = 61, 59%) mapped to more than one dimension. Personnel (n = 48, 46%), Workflow and Communication (n = 37, 36%), and Content (n = 30, 29%) were the most common. Personnel and Content together was the most common combination of dimensions. CONCLUSION: Most reported events featured both technical and social dimensions, suggesting that the nature of these events is multifaceted. Leveraging existing safety event reporting systems to screen for safety events involving health information technology, and applying a sociotechnical analytic framework can aid health organizations in identifying, responding to, and learning from reported events.

Simulation-Based Mock-Up Evaluation of a Universal Operating Room.

Designing or renovating a physical environment for healthcare is a complex process and is critical for both the staff and the patients who rely on the environment to support and facilitate patient care. Conducting a simulation-based mock-up evaluation as part of the design process can enhance patient safety, staff efficiency, as well as user experience, and can yield financial returns. A large urban tertiary care center located in Vancouver, Canada followed a framework to evaluate the proposed design template for 28 universal operating rooms (ORs) included within the OR Renewal Project scope. Simulation scenarios were enacted by nursing staff, surgeons, anesthesiologists, residents, radiology techs, and anesthesia assistants. Video and debriefing data were used to conduct link analyses, as well as analyses of observed behaviors including congestions and bumps to generate recommendations for evidence-based design changes that were presented to the project team. Recommendations incorporated into the design included relocating doors, booms, equipment, and supplies, as well as reconfigurations to workstations. These recommendations were also incorporated into the mock-up and retested to iteratively develop and evaluate the design. Findings suggest that incorporating the recommended design changes resulted in better room utilization, decreased congestion, and enhanced access to equipment.

Postdischarge decontamination of MRSA, VRE, and Clostridium difficile isolation rooms using 2 commercially available automated ultraviolet-C-emitting devices.

BACKGROUND: Two ultraviolet-C (UVC)-emitting devices were evaluated for effectiveness in reducing methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile (CD). METHODS: Six surfaces in rooms previously occupied by patients with MRSA, VRE, or CD were cultured before and after cleaning and after UVC disinfection. In a parallel laboratory study, MRSA and VRE suspended in trypticase soy broth were inoculated onto stainless steel carriers in triplicate, placed in challenging room areas, subjected to UVC, and subcultured to detect growth. RESULTS: Sixty-one rooms and 360 surfaces were assessed. Before cleaning, MRSA was found in 34.4%, VRE was found in 29.5%, and CD was found in 31.8% of rooms. Cleaning reduced MRSA-, VRE-, and CD-contaminated rooms to 27.9%, 29.5%, and 22.7%, respectively (not statistically significant). UVC disinfection further reduced MRSA-, VRE-, and CD-contaminated rooms to 3.3% (P = .0003), 4.9% (P = .0003), and 0% (P = .0736), respectively. Surface colony counts (excluding floors) decreased from 88.0 to 19.6 colony forming units (CFU) (P < .0001) after manual cleaning; UVC disinfection further reduced it to 1.3 CFU (P = .0013). In a multivariable model of the carrier study, the odds of detecting growth in broth suspensions after UVC disinfection were 7 times higher with 1 machine (odds ratio, 6.96; 95% confidence interval, 3.79-13.4) for a given organism, surface, and concentration. CONCLUSIONS: UVC devices are effective adjuncts to manual cleaning but vary in their ability to disinfect high concentrations of organisms in the presence of protein.

Improving Quality and Safety through Positive Patient Identification.

The World Health Organization recognizes that patient misidentification can contribute to medication, surgical and charting errors. Accreditation Canada has set national standards and the Joint Commission on Accreditation of Healthcare Organizations has listed patient identification as a national patient safety goal. A qualitative and observational evaluation of patient identification practices in the Pre-Admission Clinic, Admitting Department and the Perioperative Care Center uncovered confusion, with 90% (n = 55) of patient verification occurrences not matching current policies. These discrepancies identify an opportunity to reassess and standardize workflow, clarify what identification methods are acceptable and determine additional appropriate identification verification practices with ID bracelets and patient charts.

What would I want for my surgery?

If you were to have an operation tomorrow, would you want your surgical team members to feel comfortable speaking up, to defy hierarchy, to interact with each other just as well as they perform technical aspects of the procedure? Would you want to feel like part of the team? Your answers to these admittedly leading questions are based on the culture of the surgical team and the interdependence of team members and are at the heart of a current debate around the surgical checklist's effectiveness. In British Columbia (BC), many individuals responded to the paper by Urbach et al. (2014) that described the minimal impact on patient mortality after implementation of the surgical safety checklist in Ontario. They wrote to the Surgical Quality Action Network (SQAN) to express their perspectives, and interestingly, some refuted and others supported the conclusions. Given the strong reaction this study created in the surgical community, a number of key stakeholders have prepared a response in order to provide another perspective to the article and emphasize the checklist's value for improving the culture of surgical teams.