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Aktuelt om pasientsikkerhet

Foreslår fem strategier for økt pasientsikkerhet

Publisert Oppdatert

Dette er et bilde av en hånd fra en pasient som får intravenøs.
Foto: Colourbox.com

Det er et gap mellom den standarden som blir skissert i retningslinjer og hva som er mulig å få til i en kompleks klinisk hverdag. For å komme videre i pasientsikkerhetsarbeidet foreslår toneangivende fagfolk fem strategier med en rekke tiltak.


De to internasjonalt kjente pasientsikkerhetsekspertene Charles Vincent og René Amalberti har skrevet en ny, fritt tilgjengelig oversiktsbok om pasientsikkerhet. Boken er blant åtte nye publikasjoner om pasientsikkerhet som Avdeling for kvalitet og pasientsikkerhet i Kunnskapssenteret i Folkehelseinstituttet videreformidler til alle som er opptatt av pasientens sikkerhet.

Fremhever fem forbedringsområder

Gjennom boken ”Safer healthcare: Strategies for the real world” gir forfatterne et overblikk over status og utfordringer for arbeidet med pasientsikkerhet. Undertittelen refererer til det forfatterne beskriver som et gap mellom den pleie og behandling som er skissert i standarder og retningslinjer, og hva som er mulig å få til i en kompleks hverdag i klinikken, gjerne med multisyke pasienter.

For å komme videre i arbeidet med pasientsikkerhet fremhever Vincent og Amalberti spesielt disse fem forbedringsområdene (se side 139 i boken):

  • se på sikkerhet og risiko gjennom pasientens øyne
  • vurdere nytte og risiko gjennom hele behandlingskjeden
  • håndtere risikoområder over tid, ikke begrenset til å forebygge uønskede hendelser
  • tilpasse sikkerhetsstrategien til situasjonen
  • utvikle et bredere spekter av sikkerhetsstrategier

 Til hvert av disse punktene foreslår forfatterne et sett av tiltak.

De andre publikasjonene

Avdeling for kvalitet og pasientsikkerhet trekker også frem publikasjonener om disse temaene:

Se kriteriene for formidling av disse publikasjonene i høyre kolonne.

1. Safer healthcare: Strategies for the real world
Vincent C, Amalberti R
Cham: Springer Open; 2016.

Patient safety has been driven by studies of specific incidents in which people have been harmed by healthcare. Eliminating these distressing, sometimes tragic, events remains a priority, but this ambition does not really capture the challenges before us. While patient safety has brought many advances, we believe that we will have to conceptualise the enterprise differently if we are to advance further. We argue that we need to see safety through the patient’s eyes, to consider how safety is managed in different contexts and to develop a wider strategic and practical vision in which patient safety is recast as the management of risk over time.

Contents:

  1. Progress and Challenges for Patient Safety
  2. The Ideal and the Real
  3. Approaches to Safety: One Size Does Not Fit All
  4. Seeing Safety Through the Patient’s Eyes
  5. The Consequences for Incident Analysis
  6. Strategies for Safety
  7. Safety Strategies in Hospitals
  8. Safety Strategies for Care in the Home
  9. Safety Strategies in Primary Care
  10. New Challenges for Patient Safety
  11. A Compendium of Safety Strategies and Interventions
  12. Managing Risk in the Real World

2. Medication review in hospitalised patients to reduce morbidity and mortality
Christensen M, Lundh A
Cochrane Database of Systematic Reviews 2016(2):CD008986

The concept of medication review is a key element in improving the quality of prescribing and in preventing adverse drug events. Although there is no generally accepted definition of medication review, it can be broadly defined as a systematic assessment of pharmacotherapy for an individual patient that aims to optimise patient medication by providing a recommendation or by making a direct change.

We found no evidence that medication review reduces mortality or hospital readmissions, although we did find evidence that medication review may reduce emergency department contacts. However, because of short follow-up ranging from 30 days to one year, important treatment effects may have been overlooked.

3. 12 h shifts and rates of error among nurses: A systematic review
Clendon J, Gibbons V
Int J Nurs Stud 2015;52(7):1231-1242

The risk of making an error appears higher among nurses working 12 h or longer on a single shift in acute care hospitals. Hospitals and units currently operating 12 h shift systems should review this scheduling practice due to the potential negative impact on patient outcomes. Further research is required to consider factors that may mitigate the risk of error where 12 h shifts are scheduled and this cannot be changed.

4. Tools for 'safety netting' in common paediatric illnesses: A systematic review in emergency care
de Vos-Kerkhof E, Geurts DH, Wiggers M, Moll HA, Oostenbrink R
Arch Dis Child 2016;101(2):131-139

The review intended to systematically identify evaluated safety-netting/follow-up strategies after ED discharge and to describe determinants of paediatric ED revisits. Limited evidence was observed for different strategies of safety netting, with educational interventions being mostly studied. Young children, a relevant medical history, infectious/respiratory symptoms or seizures and progression/persistence of symptoms were strongly associated with ED revisits. Gender, emergency crowding, physicians' characteristics and diagnostic tests and/or therapeutic interventions at the index visit were not associated with revisits.

Within the heterogeneous available evidence, we identified a set of strong determinants of revisits that identify high-risk groups in need for safety netting in paediatric emergency care being related to age and clinical symptoms. Gaps remain on intervention studies concerning specific application of a uniform safety-netting strategy and its included time frame.

5. Patients' views of adverse events in primary and ambulatory care: A systematic review to assess methods and the content of what patients consider to be adverse events
Lang S, Velasco Garrido M, Heintze C
BMC Fam Pract 2016;17(1):6

We aimed to better assess patients' perceptions in primary and ambulatory care.

We included 19 studies. Patients were able to identify events that were traditionally recognised by the medical community as technical medical aspects (e.g. errors in diagnosis). An important field of patient participation in prevention of adverse events was proposed in the medication process. Most reported events however could be described as service quality incidents. Communication problems were shown to have implications on the occurrence of technical medical aspects and patients' satisfaction of their care. Further, unsatisfied patients were more likely to recognize adverse events.

6. Nonpharmacologic interventions to prevent pressure ulcers in older patients: An overview of systematic of reviews (the Software ENgine for the Assessment and optimization of drug and non-drug Therapy in Older persons [SENATOR] definition of Optimal evidence-based Non-drug Therapies in Older People [ONTOP] series)
Lozano-Montoya I, Velez-Diaz-Pallares M, Abraha I, Cherubini A, Soiza RL, O'Mahony D, et al.
J Am Med Dir Assoc 2016

Pressure ulcers (PUs) are frequent in older patients, and the healing process is usually challenging, therefore, prevention should be the first strategic line in PU management.

There is moderate quality evidence to support the use of alternating pressure support mattresses over usual hospital mattresses in medical and surgical inpatients, low quality evidence to support constant low pressure devices and Australian medical sheepskin over usual mattresses, and very low quality evidence to support nutrition interventions in hospital settings. No recommendations on hydration, repositioning, standardized risk assessment, or multicomponent interventions can be done.

7. Diagnostic accuracy and effectiveness of automated electronic sepsis alert systems: A systematic review
Makam AN, Nguyen OK, Auerbach AD
J Hosp Med 2015;10(6):396-402

The purpose of this review was to determine whether automated real-time electronic sepsis alerts can: (1) accurately identify sepsis and (2) improve process measures and outcomes.

Diagnostic accuracy of sepsis identification was measured by sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio (LR). Effectiveness was assessed by changes in sepsis care process measures and outcomes.

Though definition of sepsis alert thresholds varied, most included systemic inflammatory response syndrome criteria +/- evidence of shock. Diagnostic accuracy varied greatly, with PPV ranging from 20.5% to 53.8%, NPV 76.5% to 99.7%, LR+ 1.2 to 145.8, and LR- 0.06 to 0.86.

There was modest evidence for improvement in process measures (ie, antibiotic escalation), but only among patients in non-critical care settings; there were no corresponding improvements in mortality or length of stay.

Minimal data were reported on potential harms due to false positive alerts.

8. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: A systematic review and meta-analysis
Mekonnen AB, McLachlan AJ, Brien JA
BMJ Open 2016;6(2):e010003

The aim of this study was to systematically investigate the effect of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions. Most studies targeted multiple transitions and compared comprehensive medication reconciliation programmes including telephone follow-up/home visit, patient counselling or both, during the first 30 days of follow-up.

The pooled relative risks showed a more substantial reduction of 67%, 28% and 19% in adverse drug event-related hospital revisits (RR 0.33; 95% CI 0.20 to 0.53), emergency department (ED) visits (RR 0.72; 95% CI 0.57 to 0.92) and hospital readmissions (RR 0.81; 95% CI 0.70 to 0.95) in the intervention group than in the usual care group, respectively. The pooled data on mortality (RR 1.05; 95% CI 0.95 to 1.16) and composite readmission and/or ED visit (RR 0.95; 95% CI 0.90 to 1.00) did not differ among the groups. There was significant heterogeneity in the results related to readmissions and ED visits, however.