Translation and validation of the Dutch version of the health professional education in patient safety survey amongst nursing students in Belgium: A psychometric analysis.

OBJECTIVES: Evaluate the psychometric properties of the Dutch version of the Health Professional Education in Patient Safety Survey (H-PEPSSDutch), an instrument used to assess self-efficacy regarding patient safety competence. METHODS: The H-PEPSSDutch was administered to 610 students in two Belgian nursing schools. We used confirmatory factor analysis, for both classroom and clinical learning, to examine the psychometric properties. RESULTS: The analysis of construct validity showed a good fit to the hypothesised models. Cronbach's alpha values ranged from 0.70 to 0.87 for classroom learning and from 0.56 to 0.86 for clinical learning, indicating good reliability. Differentiating between the H-PEPSS constructs in the clinical setting showed to be complicated; hence, discriminant validity was not supported for all dimensions. CONCLUSIONS: Overall, this provides us with a reliable instrument to measure self-reported patient safety competence among nursing students. Further research is needed to validate the H-PEPSS as a longitudinal monitoring tool and as a pre-and-post measurement on the impact of interventions related to patient safety in the nursing curricula.

Clinical handover and handoff in healthcare: a systematic review of systematic reviews.

PURPOSE: The purpose of this systematic review is to appraise and summarize existing literature on clinical handover. DATA SOURCES: We searched EMBASE, MEDLINE, Database of Abstracts of Reviews of Effects and Cochrane Database of Systematic Reviews. STUDY SELECTION: Included articles were reviewed independently by the review team. DATA EXTRACTION: The review team extracted data under the following headers: author(s), year of publication, journal, scope, search strategy, number of studies included, type of studies included, study quality assessment, used definition of handover, healthcare setting, outcomes measured, findings and finally some comments or remarks. RESULTS OF DATA SYNTHESIS: First, research indicates that poor handover is associated with multiple potential hazards such as lack of availability of required equipment for patients, information omissions, diagnosis errors, treatment errors, disposition errors and treatment delays. Second, our systematic review indicates that no single tool arises as best for any particular specialty or use to evaluate the handover process. Third, there is little evidence delineating what constitutes best handoff practices. Most efforts facilitated the coordination of care and communication between healthcare professionals using electronic tools or a standardized form. Fourth, our review indicates that the principal teaching methods are role-playing and simulation, which may result in better knowledge transfer to the work environment, better health and patients' well-being. CONCLUSIONS: This review emphasizes the importance of staff education (including simulation-based and team training), non-technical skills and the implementation process of clinical handover in healthcare settings.

Exploring and Evaluating Patient Safety Culture in a Community-Based Primary Care Setting.

OBJECTIVES: The primary aim was to measure patient safety culture in two home care services in Belgium (Flanders). In addition, variability based on respondents' profession was examined. METHODS: A cross-sectional study was conducted by administering the SCOPE-Primary Care questionnaire in two home care service organizations. RESULTS: In total, 1875 valid questionnaires were returned from 2930 employees, representing a response rate of 64%. The highest mean patient safety culture score was found for "organizational learning" (mean [SD] = 3.81 [0.53]), followed by "support and fellowship" (mean [SD] = 3.76 [0.61]), "open communication and learning from error" (mean [SD] = 3.73 [0.64]), and "patient safety management" (mean [SD] = 3.71 [0.60]). The lowest mean scores were found for "handover and teamwork" (mean [SD] = 3.28 [0.58]) and "adequate procedures and working conditions" (mean [SD] = 3.30 [0.56]). Moreover, managers/supervisors scored significantly higher on the dimensions "open communication and learning from error," "adequate procedures and working conditions," "patient safety management," "support and fellowship," and "organizational learning" than clinical and nonclinical staff. CONCLUSIONS: In conclusion, organizational learning is perceived as most positive. However, large gaps remain in the continuity of care as "handover and teamwork" is perceived as the most negative safety culture dimension. With knowledge of the current patient safety culture, organizations can redesign processes or implement improvement strategies to avoid patient safety incidents and patient harm in the future.

Assessing Resident Safety Culture in Six Nursing Homes in Belgium.

OBJECTIVES: The primary aim was to measure resident safety culture in six nursing homes in northern Belgium (Flanders). In addition, differences in safety culture perceptions between professions were also examined. Finally, results of the present study were compared with the Nursing Home Comparative Database from the Agency for Healthcare Research and Quality (USA). METHODS: A cross-sectional study was conducted by administering the Nursing Home Survey on Patient Safety Culture in six nursing homes in Belgium (Flanders). Each nursing home has 92 to 170 licensed nursing home beds. Data collection occurred between December 2016 and January 2017. RESULTS: Highest mean scores were found for "feedback and communication about incidents" (mean [SD] = 4.20 [0.58]), "overall perceptions of resident safety" (mean [SD] = 4.07 [0.52]), and "supervisor expectations and actions promoting resident safety" (mean [SD] = 4.04 [0.70]). The lowest mean score was found for "staffing" (mean [SD] = 2.99 [0.61]). In addition, managers/supervisors scored significantly higher on all resident safety dimensions, with the exception of the dimensions "teamwork" and "supervisor expectations and actions promoting resident safety." Finally, the present study scored higher on the dimensions "teamwork," "nonpunitive response to mistakes," "handoffs," "feedback and communication about incidents," and "communication openness" than the benchmarking data from the Nursing Home Comparative Database. CONCLUSIONS: More work is necessary to improve the safety of resident care in nursing homes, especially regarding staffing issues and turnover rates. The present research findings serve to shine a light on an often-overlooked patient population and emphasize the need to develop improvement strategies for preventing resident safety incidents in nursing homes.

Organization, quality and cost of oncological home-hospitalization: A systematic review.

BACKGROUND: Home-hospitalization might be a patient-centred approach facing the increasing burden of cancer on societies. This systematic review assessed how oncological home-hospitalization has been organized and to what extent its quality and costs were evaluated. RESULTS: Twenty-four papers describing parenteral cancer drug administration to adult patients in their homes were included. Most papers concluded oncological home-hospitalization had no significant effect on patient-reported quality of life (7/8 = 88%), but large majority of patients were satisfied (12/13, 92%) and preferred home treatment (7/8, 88%). No safety risks were associated with home-hospitalization (10/10, 100%). The cost of home-hospitalization was found beneficial in five trials (5/9, 56%); others reported no financial impact (2/9, 22%) or additional costs (2/9, 22%). CONCLUSION: Despite heterogeneity, majority of reported models for oncological home-hospitalization demonstrated that this is a safe, equivalent and acceptable alternative to ambulatory hospital care. More well-designed trials are needed to evaluate its economic impact.

Seen through the patients' eyes: surgical safety and checklists.

OBJECTIVE: We sought to explore the views patients have towards surgical safety and checklists. As a secondary aim, we explored if previous experience of error or other patient characteristics influence these views. DESIGN: A cross-sectional survey study design was applied. PARTICIPANTS: The Flemish Patients' Platform network and social media were used to recruit participants. MAIN OUTCOME MEASURE(S): An 11-item questionnaire was designed to assess the following constructs: perception of surgical safety, attitudes towards the WHO surgical safety checklist and attitudes regarding checklist usage. RESULTS: Respondents' view (N = 444) on the risk of an adverse event showed considerable variation. Respondents were positive towards the checklist, strongly agreeing that it would impact positively on their safety. However, this positive perception did not translate into an attitude where patients will actively inform themselves whether a checklist is used. The majority of respondents have no difficulty with repetitive verification of identity, procedure and location of the surgery. Respondents with a clinical background were the least anxious. Views were divided regarding hearing discussions around blood loss or airway problems. CONCLUSIONS: Patients perceive the checklist as a reliable safety tool. They do not mind repetitive verification of identity and procedure. However, hearing staff discussing specific, explicit, risks could cause anxiousness in some patients. Building a supportive and collaborative environment is needed to involve and empower patients to contribute in the realization of a safe hospital environment.

Systematic psychometric review of self-reported instruments to assess patient safety culture in primary care.

AIMS: To give an overview of empirical studies using self-reported instruments to assess patient safety culture in primary care and to synthesize psychometric properties of these instruments. BACKGROUND: A key condition for improving patient safety is creating a supportive safety culture to identify weaknesses and to develop improvement strategies so recurrence of incidents can be minimized. However, most tools to measure and strengthen safety culture have been developed and tested in hospitals. Nevertheless, primary care is facing greater risks and a greater likelihood of causing unintentional harm to patients. DESIGN: A systematic literature review of research evidence and psychometric properties of self-reported instruments to assess patient safety culture in primary care. DATA SOURCES: Three databases until November 2016. REVIEW METHODS: The review was carried out according to the protocol for systematic reviews of measurement properties recommended by the COSMIN panel and the PRISMA reporting guidelines. RESULTS: In total, 1.229 records were retrieved from multiple database searches (Medline = 865, Web of Science = 362 and Embase = 2). Resulting from an in-depth literature search, 14 published studies were identified, mostly originated from Western high-income countries. As these studies come with great diversity in tools used and outcomes reported, comparability of the results is compromised. Based on the psychometric review, the SCOPE-Primary Care survey was chosen as the most appropriate instrument to measure patient safety culture in primary care as the instrument had excellent internal consistency with Cronbach's alphas ranging from 0.70-0.90 and item factor loadings ranging from 0.40-0.96, indicating a good structural validity. CONCLUSION: The findings of the present review suggest that the SCOPE-Primary Care survey is the most appropriate tool to assess patient safety culture in primary care. Further psychometric techniques are now essential to ensure that the instrument provides meaningful information regarding safety culture.

Seen through the patients' eyes: quality of chronic illness care.

Background: Most well-developed healthcare systems are facing the challenge of managing the increasing prevalence of patients with chronic diseases. Comprehensive frameworks, such as the chronic care model (CCM), receive widespread acceptance for improving care processes, clinical outcomes and costs. Objective: The purpose of this study was to explore chronic patients' perceptions of the quality of chronic care and the alignment with the CCM. Since previous research indicated that a patient's assessment may depend on socio-demographic or disease-related characteristics, the relationship between the mean Patient Assessment of Chronic Illness Care (PACIC) score and possible aforementioned predictors was also explored. Methods: An observational, cross-sectional study design was applied, and participants were recruited from the Flemish Patients' Platform (Belgium). An online questionnaire was designed to assess chronic patients' socio-demographic characteristics, medical consumption, quality of life (EuroQol-5D survey) and the perspective of chronic illness care PACIC survey. Results: The mean overall PACIC score was 2.87 on a maximum score of 5. The highest mean score for the PACIC subscales was found for 'patient activation' (3.26), followed by 'delivery system design/decision support' (3.23), 'problem solving/contextual counselling' (2.86), 'goal setting/tailoring' (2.70) and 'follow-up/coordination' (2.59). Quality of life, as measured by the EuroQol Visual Analogue Scale, had a significantly positive correlation with the mean PACIC score (P = 0.005). Conclusion: The CCM is considered an important step towards improved care for patients with chronic diseases. However, the findings of this study showed that elements from the CCM have not yet been fully implemented. Aspects such as dealing with problems which interfered with achieving predefined goals, helping patients to set specific goals for their care delivery and arranging follow-ups are less common in today's care of chronic diseases.

The SCOPE-PC instrument for assessing patient safety culture in primary care: a psychometric evaluation.

INTRODUCTION: Primary healthcare differs from hospitals in terms of - inter alia - organisational structure. Therefore, patient safety culture could differ between these settings. Various instruments have been developed to measure collective attitudes of personnel within a primary healthcare organisation. However, the number of valid and reliable instruments is limited. OBJECTIVES: Psychometric properties of the SCOPE-Primary Care instrument were tested to examine the instrument's applicability in home care services in Belgium. METHODS: A cross-sectional study was conducted by administering the SCOPE-PC questionnaire in a single home care organisation with more than 1000 employees, including nurses, midwives, healthcare assistants, diabetes educators and nursing supervisors. First, a confirmatory factor analysis was performed to test whether the observed dataset fitted to the proposed seven-factor model of the SCOPE-PC instrument. Second, Cronbach's alphas were calculated to examine internal consistency reliability. Finally, the instrument's validity was also examined. RESULTS: In total, 603 questionnaires were retained for further analysis, representing an overall response rate of 43.9%. Most respondents were nursing staff, followed by healthcare assistants and nursing supervisors. The results of the confirmatory factor analyses satisfied the chosen cut-offs, indicating an acceptable to good model fit. With the exception of the dimension 'organizational learning' (0.58), Cronbach's alpha scores of the SCOPE-PC scales indicated a good level of internal consistency: 'open communication and learning from error' (0.86), 'handover and teamwork' (0.78), 'adequate procedures and working conditions' (0.73), 'patient safety management' (0.81), 'support and fellowship' (0.75), and 'intention to report events (0.85). Moreover, inter-correlations between the seven dimensions as well as with the patient safety grade were moderate to good. CONCLUSIONS: The present study indicated that the SCOPE-Primary Care instrument has good psychometric properties for home care services in Belgium. No modifications are required to the original questionnaire in order to allow benchmarking between primary healthcare settings.

Seen through the patients' eyes: Safety of chronic illness care.

OBJECTIVE: Due to the increasing burden of chronic diseases, a considerable part of care delivery will continue to shift from secondary to primary care, and home care settings. Despite the growing importance of primary care, concerns about the safety of patients in hospitals have thus far driven most research in the field. Therefore, the present study sought to explore patients' perceptions and experiences of the safety of primary chronic care. DESIGN: An observational, cross-sectional study design was applied. PARTICIPANTS: Participants were recruited from the Flemish Patients' Platform, an independent organization that defends patients' rights and strives for more care quality. MAIN OUTCOME MEASURE(S): An online questionnaire was designed to assess: socio-demographic characteristics, medical consumption and patients' perspectives of the quality and safety of chronic care. RESULTS: Respondents (n = 339) had positive perceptions of the safety of primary chronic care as they indicated to receive safe care at home (68.1%), receive enough care support at home (70.8%) and experience good communication between their healthcare professionals (51.6%). Almost one quarter of respondents experienced an incident, mainly related to self-reported fall incidents (50.4%), wrong diagnoses or treatments (37.8%) and adverse drug events (11.8%). Also, more than half of respondents who experienced an incident (64.9%) indicated that poor communication between their healthcare professionals was the main cause. CONCLUSIONS: Information on patients' experiences is critical to identify patient safety incidents and to ultimately reduce patient harm. More research is needed to fully understand patient safety in primary chronic care to further improve patient safety.

Economic Impact of Integrated Care Models for Patients with Chronic Diseases: A Systematic Review.

OBJECTIVES: To assess the costs and potential financial benefits of integrated care models for patients with chronic diseases, that is, type 2 diabetes mellitus, schizophrenia, and multiple sclerosis, respectively. METHODS: A systematic search of the literature was performed using EMBASE, MEDLINE, and Web of Science. Studies that conducted a cost analysis, considered at least two components of the chronic care model, and compared integrated care with standard care were included. RESULTS: Out of 575 articles, 26 were included. Most studies examined integrated care models for type 2 diabetes mellitus (n = 18) and to a lesser extent for schizophrenia (n = 6) and multiple sclerosis (n = 2). Across the three disease groups, the incremental cost per patient per year ranged from - €3860 to + €613.91 (x¯ = - €533.61 ± €902.96). The incremental cost for type 2 diabetes mellitus ranged from - €1507.49 to + €299.20 (x¯ = - €518.22 ± + €604.75), for schizophrenia from - €3860 to + €613.91 (x¯ = - €677.21 ± + €1624.35), and for multiple sclerosis from - €822 to + €339.43 (x¯ = - €241.29 ± + €821.26). Most of the studies (22 of 26 [84.6%]) reported a positive economic impact of integrated care models: for type 2 diabetes mellitus (16 of 18 [88.9%]), schizophrenia (4 of 6 [66.7%]), and multiple sclerosis (1 of 2 [50%]). CONCLUSIONS: In this systematic literature review, predominantly positive economic impacts of integrated care models for patients with chronic diseases were found.