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      Patients for Patient Safety and Inpatients’ Perceptions of Safety in three Hospitals in Tshwane, South Africa

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          Abstract

          Background:

          It has been found that an increasing number of patients are being harmed while receiving hospital care, and many reporting models are woefully insufficient. Patients' involvement in their own safety during hospitalization has been shown to make healthcare systems safer. Their perception of safety may differ from that of health care workers, but their contribution to safety brings a different perspective. There is currently no data on patients for patient safety and their perception of safety in Pretoria's Tshwane District.

          Methods:

          This was a cross-sectional study using a semi-structured validated questionnaire and a calculated sample size 281. Data were analysed using both Microsoft Excel and Instat software programs. Simple descriptive statistics were employed and the results were presented in tables. Inferential statistics were calculated for the association of variables, and statistical significance was set at p <0.05.

          Results:

          The majority of inpatients were single (184; 65.5%), and were female (163, 58%) with a secondary school education (175; 62.3%). Patients were not informed about hospital rules (205; 73%), or about the importance of wearing an identification bracelet (232; 82.6%) and the meaning of the colour-coding (271; 96.4%). They were informed about the care provided (146; 52%) and were asked to get involved in their safety (54; 54.8%). They were happy regarding issues of confidentiality and privacy (166, 59.1%). They were satisfied with their pain control (221; 78.6%).

          Conclusion:

          The ‘patients for patient safety’ principle is not effective in these institutions. Patients were unaware of the precautionary measures. Standard procedures should be established to allow inpatients to participate in safety.

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          Most cited references21

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          A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

          Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.
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            Multimorbidity and Patient Safety Incidents in Primary Care: A Systematic Review and Meta-Analysis

            Background Multimorbidity is increasingly prevalent and represents a major challenge in primary care. Patients with multimorbidity are potentially more likely to experience safety incidents due to the complexity of their needs and frequency of their interactions with health services. However, rigorous syntheses of the link between patient safety incidents and multimorbidity are not available. This review examined the relationship between multimorbidity and patient safety incidents in primary care. Methods We followed our published protocol (PROSPERO registration number: CRD42014007434). Medline, Embase and CINAHL were searched up to May 2015. Study design and quality were assessed. Odds ratios (OR) and 95% confidence intervals (95% CIs) were calculated for the associations between multimorbidity and two categories of patient safety outcomes: ‘active patient safety incidents’ (such as adverse drug events and medical complications) and ‘precursors of safety incidents’ (such as prescription errors, medication non-adherence, poor quality of care and diagnostic errors). Meta-analyses using random effects models were undertaken. Results Eighty six relevant comparisons from 75 studies were included in the analysis. Meta-analysis demonstrated that physical-mental multimorbidity was associated with an increased risk for ‘active patient safety incidents’ (OR = 2.39, 95% CI = 1.40 to 3.38) and ‘precursors of safety incidents’ (OR = 1.69, 95% CI = 1.36 to 2.03). Physical multimorbidity was associated with an increased risk for active safety incidents (OR = 1.63, 95% CI = 1.45 to 1.80) but was not associated with precursors of safety incidents (OR = 1.02, 95% CI = 0.90 to 1.13). Statistical heterogeneity was high and the methodological quality of the studies was generally low. Conclusions The association between multimorbidity and patient safety is complex, and varies by type of multimorbidity and type of safety incident. Our analyses suggest that multimorbidity involving mental health may be a key driver of safety incidents, which has important implication for the design and targeting of interventions to improve safety. High quality studies examining the mechanisms of patient safety incidents in patients with multimorbidity are needed, with the goal of promoting effective service delivery and ameliorating threats to safety in this group of patients.
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              Patient safety issues and concerns in Bhutan’s healthcare system: a qualitative exploratory descriptive study

              Objectives To investigate what healthcare professionals perceived and experienced as key patient safety concerns in Bhutan’s healthcare system. Design Qualitative exploratory descriptive inquiry. Settings Three different levels of hospitals, a training institute and the Ministry of Health, Bhutan. Participants In total, 140 healthcare professionals and managers. Methods Narrative data were collected via conversational in-depth interviews and Nominal Group Meetings. All data were subsequently analysed using thematic analysis strategies. Results The data revealed that medication errors, healthcare-associated infections, diagnostic errors, surgical errors and postoperative complications, laboratory/blood testing errors, falls, patient identification and communication errors were perceived as common patient safety concerns. Human and system factors were identified as contributing to these concerns. Instituting clinical governance, developing and improving the physical infrastructure of hospitals, providing necessary human resources, ensuring staff receive patient safety education and promoting ‘good’ communication and information systems were, in turn, all identified as processes and strategies critical to improving patient safety in the Bhutanese healthcare system. Conclusion Patient safety concerns described by participants in this study were commensurate with those identified in other low and middle-income countries. In order to redress these concerns, the findings of this study suggest that in the Bhutanese context patient safety needs to be conceptualised and prioritised.
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                Author and article information

                Journal
                The Open Public Health Journal
                TOPHJ
                Bentham Science Publishers Ltd.
                1874-9445
                December 27 2022
                December 27 2022
                : 15
                : 1
                Article
                10.2174/18749445-v15-e221018-2022-52
                c95f9f1e-b429-4d01-b0eb-fd10430d3a4e
                © 2022

                Free to read

                https://creativecommons.org/licenses/by/4.0/legalcode

                History

                Medicine,Chemistry,Life sciences
                Medicine, Chemistry, Life sciences

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