Support for healthcare workers and patients after medical error through mutual healing: another step towards patient safety.

BACKGROUND: Medical errors, especially those resulting in patient harm, have a negative psychological impact on patients and healthcare workers (HCWs). Healing may be promoted if both parties are able to work together and explore the effect and outcome of the event from each of their perspectives. There is little existing research in this area, even though this has the potential to improve patient safety and wellness for both HCWs and patients. METHODS: Using a patient-oriented research approach with constructive grounded theory methodology, we examined the potential for patients and HCWs to heal together after harm from a medical error. Individual interviews were conducted and transcribed verbatim. We conducted concurrent data collection and analysis according to grounded theory principles. With our findings, we created a framework and visual breakdown of the communication process between patients and HCWs. RESULTS: Our findings suggest that, after a medical error causing harm, both patients and HCWs have feelings of empathy and respect towards each other that often goes unrecognised. Barriers to communication for patients were related to their perception that HCWs did not care about them, showed no remorse or did not admit to the error. For HCWs, communication barriers were related to feelings of blame or shame, and fear of professional and legal consequences. Patients reported needing open and transparent communications to help them heal, and HCWs required leadership and peer support, including training and space to talk about the event(s). DISCUSSION: Our resulting framework suggests that if there was an opportunity for an open and purposeful conversation early or before increased emotional suffering, there might be an opportunity to bridge the barriers, and help patients and HCWs heal together. This, in turn, contributes to improved health quality and patient safety.

A Scoping Review on the Attributes of Cluster Randomized Controlled Trials in Long-Term Care Facilities.

Cluster randomized trial design, where groups of participants are randomized instead of individual participants, is increasingly being used in long-term care research. The purpose of this review was to determine the characteristics of cluster randomized trials in long-term care facilities. A medical librarian conducted the literature search. Two independent reviewers reviewed each paper. Studies were included if the design was cluster randomized and participants were from long-term care facilities. For each included study, two independent data extractors captured data on study attributes, including: journal, location, year published, author discipline, funding, methodology, number of participants, and intervention target. The literature search yielded 7,679 unique studies, with 195 studies meeting the selection criteria and being included for data extraction. The included studies were published between 1976 and 2017, with 53% of studies published after 2009. The term cluster randomized was in the title of only 45% of the studies. The studies were conducted worldwide; the United States had the largest number of studies (23%), followed by the United Kingdom (18%). Ten percent of studies were published in journals with an impact factor >10. The most frequent discipline of the first and last authors was medicine (34%), followed by nursing (17%). Forty-nine percent of the studies had government funding, while only 20% had medical industry funding. In studies with <1000 residents, 85% of the studies obtained consent from the resident and/or their proxy, while in studies with ≥ 1000 residents, it was 31%. The most frequent intervention targets were infection (13%), falls/fracture (13%), and behavior/physical restraint (13%). Cluster randomized controlled trials in long-term care have a unique set of characteristics. Results of this review will provide guidance to researchers conducting studies in long-term care facilities.

Validation of the BIOS BD240 home blood pressure monitor in a multi-racial, multi-morbid Canadian population according to the International Standards Organization 2018 Protocol.

OBJECTIVE: Assess the accuracy of the BIOS BD240 home blood pressure (BP) monitor and wide-range cuff according to the International Organization for Standardization (ISO) 2018 standard. METHODS: Eighty-five subjects (aged ≥18 y) with arm circumferences between 24 and 43 cm were studied. Blinded, two-observer, mercury-based auscultation performed using a two-piece cuff chosen for upper arm size was used for reference measurements. Accuracy criteria 1 and 2 of the ISO standard were determined and Bland-Altman plots generated. RESULTS: Sixty percent of the study sample was female and 42% had hypertension. Mean device-to-reference standard differences in SBP/DBP were 0.0 ± 6.2/-0.2 ± 6.3 for criterion 1 and 0.0 ± 4.8/-0.2 ± 5.8 for criterion 2. CONCLUSION: The BIOS BD240 passed the requirements of the American National Standards Institute/Association for the Advancement of Medical Instrumentation/ISO standard for both SBP and DBP and can be recommended for use.