Search

BACKGROUND Cancer care is complex, involving highly toxic drugs, critically ill patients, and various different care providers. Because it is important for clinicians to have the latest and complete information about the patient available, this study focused on patient safety issues in information management developing from health information technology (HIT) use in oncology ambulatory infusion centers. OBJECTIVE The aim was to exploratively and prospectively assess patient safety risks from an expert perspective: instead of retrospectively analyzing safety events, we assessed the information management hazards inherent to the daily work processes; instead of asking healthcare workers at the front line, we used them as information sources to construct our patient safety expert view on the hazards. METHODS The work processes of clinicians in three ambulatory infusion centers were assessed and evaluated based on interviews and observations with a nurse and a physician of each unit. The 125 identified patient safety issues were described and sorted into thematic groups. RESULTS A broad range of patient safety issues was identified, such as data fragmentation, or information islands, meaning that patient data are stored across different cases or software and that different professional groups do not use the same set of information. CONCLUSIONS The current design and implementation of HIT systems do not support adequate information management: clinicians needed to play very close attention and improvise to avoid errors in using HIT and treat cancer patients safely. It is important to take the clinical front-end practice into account when evaluating or planning further HIT improvements.

BACKGROUND Anaesthesiology is one of the safest fields in medicine today in relation to mortality. Deaths directly because of anaesthesia have fortunately now become rare exceptions. Nevertheless, important findings can still be drawn from the rare deaths that still occur. OBJECTIVE The aim of this study was to identify and analyse the causes of deaths related to anaesthesia alone over a 10-year period. DESIGN Retrospective structured analysis of a database of medical liability claims. SETTING Hospitals at all levels of care in Germany. PATIENTS The database of a large insurance broker included data for 81 413 completed liability claims over the 10-year period from 2006 to 2015. Among 1914 cases associated with anaesthetic procedures, 56 deaths were identified. Of these, 30 clearly involved anaesthesia (Edwards category 1) and were included in the evaluation. INTERVENTIONS None (retrospective database analysis). MAIN OUTCOME MEASURES Causes of anaesthesia-related death identified from medical records, court records, expert opinions and autopsy reports. RESULTS The 30 deaths were analysed in detail at the case and document level. They included high proportions of 'potentially avoidable' deaths, at 86.6%, and what are termed 'never events', at 66.7%. Problems with the airway were the cause in 40% and problems with correct monitoring in 20%. In addition, communication problems were identified as a 'human factor' in 50% of the cases. CONCLUSION The majority of the anaesthesia-related deaths investigated could very probably have been avoided with simple anaesthesiological measures if routine guidelines had been followed and current standards observed. Actions to be taken are inferred from these results, and recommendations are made. In future, greater care must be taken to ensure that the level of safety already achieved in anaesthesiology can be maintained despite demographic developments and increasing economic pressures.

Zusammenfassung Hintergrund Die Medikationssicherheit ist ein wichtiger Hot-Spot der Patientensicherheit. Diese Tatsache nahm die Stiftung Patientensicherheit Schweiz zum Anlass, ihren jahrlichen CIRRNET-Meldemonat (Critical Incident Reporting & Reacting NETwork) zum Thema «Masseinheiten von Medikamenten und Berechnungsfehler bei der Verordnung/Abgabe (mg, g, mmol etc.)» durchzufuhren. Methode Die CIRS-Verantwortlichen (Critical Incident Reporting System) der am CIRRNET beteiligten Gesundheitsinstitutionen leiteten wahrend des CIRRNET-Meldemonats 2018 alle Meldungen zum Thema an die CIRRNET-Datenbank weiter. Zudem wurde das Archiv auf verwertbare Meldungen zum gleichen Thema durchsucht. Die Meldungen wurden nach Art der involvierten Medikation (Applikationsart und Medikamentenklasse nach ATC-Codes), nach betroffenem Prozessschritt (Verordnung, Zubereitung, Verabreichung und Dokumentation) und nach Fehlerkategorie analysiert. Ergebnisse Von den insgesamt 110 analysierten Meldungen stammten 27 Meldungen direkt aus dem Meldemonat, 83 Meldungen wurden erganzend aus dem Archiv extrahiert. 67 Meldungen (60%) betrafen intravenos verabreichte Medikamente und Analgetika (Opioide und Nicht-Opioide, wie beispielsweise NSAR) waren mit 21 Meldungen (18%) die am haufigsten betroffene/involvierte Medikamentenklasse. Beim Prozessschritt Zubereitung/Berechnung/Richten geschahen die meisten der analysierten Fehler. Insgesamt 48 Meldungen (44 %) wurden hier eingeteilt. Betrachtet man die Fehlerkategorien wird ersichtlich, dass Fehler der Kategorien «Ableitung der Abgabeeinheit (Volumen/Stuck) von Starke oder Konzentration» mit 33 (30 %), «Masseinheit ml – mg» mit 20 (18 %) sowie «Dosis/Volumen pro Zeit» mit 14 Meldungen (13 %) am haufigsten berichtet wurden. Schlussfolgerung Fehler im Zusammenhang mit Masseinheiten oder dem Berechnen der Medikation wurden von den CIRRNET-Institutionen zahlreich gemeldet. Haufig handelte es sich um Falle, bei denen beispielsweise das Verabreichungsvolumen eines Medikaments fehlerhaft hergeleitet wurde. Diese Berechnungen sind anspruchsvoll, fehleranfallig und stellen ein Systemproblem dar. Es bedarf daher guter Losungsstrategien, um die Medikationssicherheit und somit auch die Patientensicherheit nachhaltig zu verbessern.

BACKGROUND Multicentre intervention studies tackling urinary catheterization and its infections and non-infectious complications are lacking. AIM To decrease urinary catheterization and consequently catheter-associated urinary tract infections (CAUTI) and non-infectious complications. METHODS Before/after non-randomized multicenter intervention study in seven hospitals in Switzerland. Intervention bundle consisting of 1) a concise list of indications for urinary catheterization, 2) daily evaluation of the need for ongoing catheterization, and 3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTI, non-infectious complications, and process indicators such as proportion of indicated catheters and frequency of catheter evaluation. FINDINGS We included 25,880 patients [13,171 before the intervention (August-October 2016) and 12,709 after the intervention (August-October 2017)]. Catheter utilization dropped from 23.7% to 21.0% (p=0.001), and catheter-days per 100 patient-days from 17.4 to 13.5 (p=0.167). CAUTI remained stable on a low level with 0.02 infections per 100 patient-days (before) and 0.02 infections (after), (p=0.98). Measuring infections per 1,000 catheter-days, the rate was 1.02 (before) and 1.33 (after), (p=0.60). Non-infectious complications dropped significantly, from 0.79 to 0.56 events per 100 patient-days (p

AIMS: Atrial fibrillation is a commonly occurring arrhythmia after cardiac surgery (postoperative AF, poAF) and is associated with poorer outcomes. Considering that reduced atrial contractile function is a predictor of poAF and that Ca2+ plays an important role in both excitation-contraction coupling and atrial arrhythmogenesis, this study aims to test whether alterations of intracellular Ca2+ handling contribute to impaired atrial contractility and to the arrhythmogenic substrate predisposing patients to poAF.METHODS AND RESULTS: Right atrial appendages were obtained from patients in sinus rhythm undergoing open-heart surgery. Cardiomyocytes were investigated by simultaneous measurement of [Ca2+]i and action potentials (AP, patch-clamp). Patients were followed-up for 6 days to identify those with and without poAF. Speckle-tracking analysis of preoperative echocardiography revealed reduced left atrial contraction strain in poAF patients. At the time of surgery, cellular Ca2+ transients (CaT) and the sarcoplasmic reticulum (SR) Ca2+ content were smaller in the poAF group. CaT decay was slower in poAF, but the decay of caffeine-induced Ca2+ transients was unaltered, suggesting preserved NCX function. In agreement, western blots revealed reduced SERCA2a expression in poAF patients but unaltered phospholamban expression/phosphorylation. Computational modeling indicated that reduced SERCA activity promotes occurrence of CaT- and AP-alternans. Indeed, alternans of CaT and AP occurred more often and at lower stimulation frequencies in atrial myocytes from poAF patients. Resting membrane potential and AP duration were comparable between both groups at various pacing frequencies (0.25-8 Hz).CONCLUSIONS: Biochemical, functional and modeling data implicate reduced SERCA-mediated Ca2+ reuptake into the SR as a major contributor to impaired preoperative atrial contractile function and to the pre-existing arrhythmogenic substrate in patients developing poAF.TRANSLATIONAL PERSPECTIVE: Development of atrial fibrillation (AF) within the immediate postoperative period (poAF), represents one of the most frequent complications after cardiac surgery and is associated with poorer outcomes. Our results suggest that reduced Ca2+ uptake into the sarcoplasmic reticulum (SR), associated with increased cellular susceptibility to Ca2+-transient (CaT)- and action potential (AP)-alternans, contributes to the arrhythmogenic substrate predisposing patients to the development of poAF. Therefore, modulation of SERCA activity may represent a novel mechanistic target to prevent development of poAF.Furthermore, we show that the impaired SR Ca2+ uptake contributes to reduced systolic Ca2+ release and impaired atrial contractility in poAF patients. Atrial contractility may therefore represent an important factor for identification of patients at risk for poAF development.

Zusammenfassung Hintergrund. Hämodialysepatienten, die operativ mit einem Gefäßzugang versorgt werden müssen, sind eine vulnerable Patientengruppe, die aufgrund von Multimorbidität, der intensiven und oft fragmentierten Behandlung und vieler Schnittstellen ein erhöhtes Risiko für vermeidbare unerwünschte Ereignisse tragen. Fragestellung. Aktuelle Entwicklungen und Maßnahmen zur Förderung der Patientensicherheit mit Fokus auf die Shuntchirurgie. Material und Methoden. Auswertung und Aufarbeitung aktueller Daten zur Patientensicherheit und Instrumenten zu ihrer Förderung. Ergebnisse. Fehler im nicht operativen Management verursachen einen wesentlichen Anteil der unerwünschten Ereignisse. Checklisten, präoperative Seitenmarkierung, Zählkontrollen und interprofessionelle Teamtrainings sind wichtige Instrumente der Patientensicherheit im OP. Standardisierungen von postoperativen Übergaben durch einfache Protokolle können erheblich zur Reduktion von Fehlern und Schädigungen beitragen. Die Sicherheitskultur einer Abteilung ist ein Umgebungsfaktor, der für die Effektivität dieser Sicherheitsbarrieren wesentlich ist. Schlussfolgerungen. Es existieren wirksame Instrumente, die die Patientensicherheit in der Shuntchirurgie fördern. Gerade an den Schnittstellen zur weiteren Versorgung können durch die konsequente Implementierung und Nutzung dieser Maßnahmen und ein aktives Sicherheitsmanagement unerwünschte Ereignisse vermieden werden. Die interprofessionelle und interdisziplinäre Zusammenarbeit und der Einbezug der Patienten sind wichtige Ressource für die Behandlungssicherheit, die stärker genutzt werden sollten., Background. Patients on hemodialysis who undergo vascular access surgery represent a vulnerable patient population and have an increased risk for suffering preventable adverse events due to multimorbidity and intense but fragmented health care involving multiple interfaces. Objectives. Current developments and instruments for improving patient safety with emphasis on vascular access surgery. Material and methods. Analysis and discussion of current patient safety data and instruments for improvement. Results. Errors in non-operative management cause a considerable proportion of the adverse events. Checklists, preoperative site marking, surgical counting procedures and interprofessional team training are important instruments for patient safety in the operating room (OR). Standardization of postoperative handover using simple protocols can decrease the frequency of errors and patient harm. The safety climate in a department is an important factor which is essential for the effectiveness of safety tools. Conclusion. Several effective instruments exist which improve patient safety in vascular access surgery. The consistent implementation and use of these instruments and an activesafety management, in particular at the interfaces between OR, ward care and outpatient care, can decrease adverse events. Interprofessional and interdisciplinary teamwork and involvement of patients are central resources for patient safety and should be intensified.

Introduction: Ensuring scientific reproducibility and compliance with documentation guidelines of funding bodies and journals is a topic of greatly increasing importance in biomedical research. Failure to comply, or unawareness of documentation standards can have adverse effects on the translation of research into patient treatments, as well as economic implications. In the context of the German Research Foundation-funded collaborative research center (CRC) 1002, an IT-infrastructure sub-project was designed. Its goal has been to establish standardized metadata documentation and information exchange benefitting the participating research groups with minimal additional documentation efforts. Methods: Implementation of the self-developed menoci-based research data platform (RDP) was driven by close communication and collaboration with researchers as early adopters and experts. Requirements analysis and concept development involved in person observation of experimental procedures, interviews and collaboration with researchers and experts, as well as the investigation of available and applicable metadata standards and tools. The Drupal-based RDP features distinct modules for the different documented data and workflow types, and both the development and the types of collected metadata were continuously reviewed and evaluated with the early adopters. Results: The menoci-based RDP allows for standardized documentation, sharing and cross-referencing of different data types, workflows, and scientific publications. Different modules have been implemented for specific data types and workflows, allowing for the enrichment of entries with specific metadata and linking to further relevant entries in different modules. Discussion: Taking the workflows and datasets of the frequently involved experimental service projects as a starting point for (meta-)data types to overcome irreproducibility of research data, results in increased benefits for researchers with minimized efforts. While the menoci-based RDP with its data models and metadata schema was originally developed in a cardiological context, it has been implemented and extended to other consortia at GÃűttingen Campus and beyond in different life science research areas.

Myelodysplastic syndromes (MDSs) represent a heterogeneous group of hematological stem cell disorders with an increasing burden on health care systems. Evidence-based MDS guidelines and recommendations (G/Rs) are published but do not necessarily translate into better quality of care if adherence is not maintained in daily clinical practice. Guideline-based indicators (GBIs) are measurable elements for the standardized assessment of quality of care and, thus far, have not been developed for adult MDS patients. To this end, we screened relevant G/Rs published between 1999 and 2018 and aggregated all available information as candidate GBIs into a formalized handbook as the basis for the subsequent consensus rating procedure. An international multidisciplinary expert panel group (EPG) of acknowledged MDS experts (n = 17), health professionals (n = 7), and patient advocates (n = 5) was appointed. The EPG feedback rates for the first and second round were 82% (23 of 28) and 96% (26 of 27), respectively. A final set of 29 GBIs for the 3 domains of diagnosis (n = 14), therapy (n = 8), and provider/infrastructural characteristics (n = 7) achieved the predefined agreement score for selection (>70%). We identified shortcomings in standardization of patient-reported outcomes, toxicity, and geriatric assessments that need to be optimized in the future. Our GBIs represent the first comprehensive consensus on measurable elements addressing best practice performance, outcomes, and structural resources. They can be used as a standardized instrument with the goal of assessing, comparing, and fostering good quality of care within clinical development cycles in the daily care of adult MDS patients.

Zusammenfassung Hintergrund Die Reduktion von unerwunschten Arzneimittelereignissen bei Bewohnenden von Alters- und Pflegeheimen ist ein zentrales Anliegen der Patientensicherheit. Ziel dieser Studie war es zu ermitteln, wie haufig ausgewahlte Medikationsprozesse zur Erhohung der Medikationssicherheit in Schweizer Pflegeheimen bereits umgesetzt werden und wie sich Heime, die diese Prozesse noch nicht umsetzen, durch organisationale Merkmale charakterisieren lassen. Methode Querschnittstudie mittels Online-Befragung von Pflegedienstleitungen in Schweizer Alters- und Pflegeheimen. Ergebnisse Es nahmen 420 von 1525 eingeladenen Personen an der Befragung teil (Rucklaufquote: 27.5%). Davon gaben 65.0% an, dass in ihrer Einrichtung eine regelmasige systematische Uberprufung der Medikation vorgesehen ist. In 9.5% der Pflegeheime wird eine Liste zur Identifikation von potenziell inadaquater Medikation eingesetzt und 6.7% der Heime haben einen standardisierten Prozess, um Nebenwirkungen von Medikamenten zu uberwachen. 66.0% der teilnehmenden Heime setzen mindestens einen dieser Prozesse um, 34.0% setzen keinen der drei Prozesse um. Statistisch signifikante Unterschiede in der Umsetzung der Prozesse zeigten sich nach Standort des Pflegeheims, der Art des Dokumentationssystems fur die Medikation, dem Arztmodell, der Anzahl externer Arzte/Arztinnen sowie dem Bezugskanal der Medikamente und der gesetzlichen Verpflichtung zur Zusammenarbeit mit Apothekern/Apothekerinnen. Keine Unterschiede zeigten sich nach Heimgrose. Schlussfolgerung In Schweizer Alters- und Pflegeheimen sind zentrale sicherheitsrelevante Medikationsprozesse noch nicht flachendeckend umgesetzt. Besonders in Einrichtungen, in denen viele externe Belegarzte Bewohnende betreuen, ist die Umsetzung noch wenig fortgeschritten. Die organisationalen Merkmale mussen fur eine erfolgreiche Implementierung von Verbesserungsmassnahmen berucksichtigt werden.

Zusammenfassung Ziele der Studie Sorgfaltiges Management von patientenbezogener Information ist in der Behandlung krebskranker Patienten wichtig, um Fehler zu vermeiden. Klinisch Tatige benotigen vollstandige, aktuelle Information, um sich ein adaquates „mentales Abbild“ der Situation des Patienten machen zu konnen. Das Ziel der vorliegenden Studie war, Patientensicherheitsgefahrdungen, die bei der Nutzung von HIT (Health Information Technology) entstehen, zu identifizieren: Zum einen wurden explorativ Patientensicherheitsgefahrdungen in drei onkologischen Ambulatorien erfasst und ubergeordnete Themen identifiziert. Zum anderen wurde systematisch die Anzahl an Informationsquellen erfasst, die die klinisch Tatigen nutzen mussen, um sich ein Bild vom Patienten zu machen. Dafur wurden Interviews und Beobachtungen mit je einer Pflegefachperson und einem Arzt durchgefuhrt. Ergebnisse Informationsmanagement-bezogene Patientensicherheitsgefahrdungen waren in der taglichen Versorgung allgegenwartig: Ausgehend von 125 erfassten Patientensicherheitsgefahrdungen wurden elf Themenfelder identifiziert. Drei waren besonders relevant fur die Entwicklung eines adaquaten mentalen Modells uber den Patienten der klinisch Tatigen: Patientenbezogene Informationen wurden nicht an einem Ort, sondern haufig fragmentiert in verschiedenen HIT-Systemen verteilt gespeichert; trotz der Einfuhrung von HIT blieb fur bestimmte Informationen die Papierdokumentation bestehen, was den Zugriff darauf erschwerte und die Anzahl an relevanten Quellen erhohte; die mangelnde Benutzerfreundlichkeit der HIT-Systeme machte es schwierig, zeitgerecht Patienteninformation abzurufen. Klinisch Tatige mussten zwischen funf und elf Informationsquellen nutzen, um sich ein Bild uber den Patienten zu machen. Schlussfolgerungen Gesamthaft zeigte sich, dass die Gestaltung der HIT-Systeme nur unzureichend an die Arbeitsprozesse angepasst ist und es nicht begunstigt, sich vollstandig uber einen Patienten zu informieren. Die identifizierten Themenfelder zeigen auf, wo zukunftige Systemgestaltung und -verbesserung ansetzen kann. Dabei ist es von groser Bedeutung, die eigentlichen Anforderungen der Arbeitsprozesse auf die Gestaltung der HIT abzustimmen und die tatsachliche Implementierung und Nutzung von HIT eng zu begleiten.

Introduction Morbidity and mortality conferences (M&MCs) are an instrument for learning from past complications, unexpected follow-ups and deaths in hospitals and are important for improving patient safety. However, there are currently no quantitative data on the implementation of M&MCs in Austria. The aim of the study was to determine the status quo of the M&MCs in Austria. Materials and methods A national cross-sectional study was conducted by means of a survey of 982 chief physicians of surgical disciplines, internal medicine, anesthesiology, intensive care, gynecology/obstetrics and pediatrics. The questionnaire focused on overall goals, structure and procedures of hospital M&MCs. Results Of the 982 contacted chief physicians, 314 (32.0%) completed the survey. Almost two thirds of the respondents, i.e. 203 (64.7%), had already implemented M&MCs. Of the 111 chief physicians who had not yet introduced M&MCs, 62 (55.9%) were interested in introducing such conferences in the future. Of the 203 respondents that had implemented M&MCs, 100 stated that their M&MC could be improved. They reported issues with "shame and blame" culture, hierarchical structures, too little knowledge about the capability of M&MC and, in particular, time constraints. Overall, the participating chief physicians showed that they are striving to improve their existing M&MCs. Discussion/Conclusion While we found a relatively high number of already implemented M&MCs we also identified a large heterogeneity in the format of the M&MCs. A highly structured M&MC including guidelines, checklists or templates does not only considerably improve its outcome but can also alleviate the main limiting factor which is the lack of time.

ObjectivesDouble checking is used in oncology to detect medication errors before administering chemotherapy. The objectives of the study were to determine the frequency of detected potential medication errors, i.e., mismatching information, and to better understand the nature of these inconsistencies.DesignIn observing checking procedures, field noteswere taken of all inconsistencies that nurses identified during double checking the order against the prepared chemotherapy.SettingOncological wards and ambulatory infusion centres of three Swiss hospitals.ParticipantsNurses’ double checking was observed.Outcome measuresIn a qualitative analysis, (1) a category system for the inconsistencies was developed and (2) independently applied by two researchers.ResultsIn 22 (3.2%) of 690 observed double checks, 28 chemotherapy-related inconsistencies were detected. Half of them related to non-matching information between order and drug label, while the other half was identified because the nurses used their own knowledge. 75% of the inconsistencies could be traced back to inappropriate orders, and the inconsistencies led to 33 subsequent or corrective actions.ConclusionsIn double check situations, the plausibility of the medication is often reviewed. Additionally, they serve as a correction for errors and that are made much earlier in the medication process, during order. Both results open up new opportunities for improving the medication process.

STUDY AIM The aim of this study was to identify the prevalence of organisational structures and processes for the support of second victims in Swiss hospitals. METHODS To identify institutional policies and support for health professionals who have been involved in an adverse patient event and become traumatised from the event, also called second victims, we conducted a cross-sectional, multicentre survey study. We targeted Swiss acute care, university and psychiatric hospitals, as well as rehabilitation and speciality clinics. A 13-item questionnaire was used to collect information from hospital quality managers regarding their institutions’ policies and support practices with respect to second victims. Data were analysed using descriptive statistics. RESULTS Overall, respondents from 116 hospitals completed the questionnaire (response rate 50.2%). Most institutional respondents reported both that they would like to receive information about adverse events and that their institutions offer related support. Of participating institutions, 60% indicated that they actively inform their personnel about second-victim support possibilities; however, only 31% specifically train supervisory personnel to deliver that support, and only 32% have hospital-specific guidelines in place for second victim support. University, acute care and speciality clinics were more likely to use such guidelines than psychiatric and rehabilitation clinics. Analysis indicated an association between hospital size and the existence of guidelines. CONCLUSIONS In Swiss hospitals, second victim support is generally prevalent, but often in an unstructured way. This lack of methodology increases the risk that, following adverse events, both the quantity and quality of support provided to health professionals will be insufficient. A firm commitment on the part of institutional leaders to implement related policies could foster the adoption of high-quality second victim guidelines in Swiss hospitals.

Objectives: Globally, healthcare policy promotes supported self-management as a strategy for people with long-term conditions. This meta-review aimed to explore how people with hypertension make sense of their condition, to assess the effectiveness of supported self-management in hypertension, and to identify effective components of support.Methods: From a search of eight databases (Jan 1993-Oct 2012; update June 2017) we included systematic syntheses of qualitative studies of patients’ experiences, and systematic reviews of randomised controlled trials evaluating the impact of supported self-management on blood pressure and medication adherence. We used metaethnography, meta-Forrest plots and narrative analysis to synthesise the data.Results: Six qualitative and 29 quantitative reviews provided data from 98 and 446 unique studies, respectively. Self-management support consistently reduced systolic BP (by between 2 and 6mmHg), and diastolic BP (by between 1 and 5mmHg). Information about hypertension and treatment, home BP monitoring (HBPM) and feedback (including telehealth) were widely used in effective interventions. Patients’ perceptions of a disease with multiple symptoms contrasted with the professional view of an asymptomatic condition. HBPM, in the context of a supportive patient professional relationship, changed perceptions of the significance of symptoms and fostered confidence in ability to self-manage hypertension.Conclusions: Our systematic qualitative and quantitative meta-reviews tellcomplementary stories. Supported self-management can improve blood pressure control. Interventions are complex and encompass a broad range of support strategies. Self-management support for hypertension 3 HBPM (with or without telehealth) within the context of a supportive patient-professionalpartnership can bridge the gap between medical and lay perspectives of hypertension and enable effective self-management.

Empirical research shows that medication safety is an urgent area of concern in the Swiss healthcare system. Adverse drug events and medication errors are common and risks such as polypharmacy are widespread. No comprehensive national strategy explicitly dedicated to medication safety exists in Switzerland. The federalist system of government with relative autonomy of the cantons relating to healthcare laws influences the implementation of national healthcare reforms, also to the disadvantage of medication safety. Direct dispensing of drugs by the prescribing physician is permitted in almost all German-speaking cantons. This special feature of the Swiss system implies specific challenges for medication safety. Nonetheless, there is an increasing number of national activities dealing with various aspects of medication safety, such as the "progress!" programmes within the National Quality Strategy. Within the National Research Programme "Smarter Health Care" (NRP 74) of the Swiss National Science Foundation, several research projects are currently focusing on medication safety. Clinical pharmacy activities in hospitals are relatively widespread. In the primary care sector, pharmaceutical care practice and the corresponding competencies for pharmacists are being further developed. However, a comprehensive strategy, priority-setting and effectiveness studies involving all stakeholders are required in order for the Swiss healthcare system, to meet the challenges facing medication safety in a forward-looking manner.

ObjectivesTo determine frequencies of healthcare workers (HCWs) speak up-related behaviours and the association of speak up-related safety climate with speaking up and withholding voice.DesignCross-sectional survey of doctors and nurses. Data were analysed using multilevel logistic regression modelsSetting4 hospitals with a total of nine sites from the German, French and Italian speaking part of Switzerland.ParticipantsSurvey data were collected from 979 nurses and doctors.Main outcome measuresFrequencies of perceived patient safety concerns, of withholding voice and of speaking up behaviour. Speak up-related climate measures included psychological safety, encouraging environment and resignation.ResultsPerceived patient safety concerns were frequent among doctors and nurses (between 62% and 80% reported at least one safety concern during the last 4 weeks depending on the single items). Withholding voice was reported by 19%–39% of HCWs. Speaking up was reported by more than half of HCWs (55%–76%). The frequency of perceived concerns during the last 4 weeks was positively associated with both speaking up (OR=2.7, pConclusionsOur results strengthen the importance of a speak up-supportive safety climate for staff safety-related communication behaviours, specifically withholding voice. This study indicates that a poor climate, in particular high levels of resignation among HCWs, is linked to frequent ‘silence’ of HCWs but not inversely associated with frequent speaking up. Interventions addressing safety-related voicing behaviours should discriminate between withholding voice and speaking up.

ObjectivesThe aim of the study was to develop quality standards reflecting minimal requirements for safe medication processes in nursing homes.DesignIn a first step, relevant key topics for safe medication processes were deducted from a systematic search for similar guidelines, prior work and discussions with experts. In a second step, the essential requirements for each key topic were specified and substantiated with a literature-based rationale. Subsequently, the requirements were evaluated with a piloted, two-round Delphi study.SettingNursing homes in Switzerland.ParticipantsInterprofessional panel of 25 experts from science and practice.Primary and secondary outcome measuresEach requirement was rated for its relevance for a safer and resident-oriented medication on a 9-point Likert-Scale based on the RAND/UCLA method. The requirements were considered relevant if, in the second round, the median relevance rating was ≥7 and the proportion of ratings ≥7 was ≥80%.ResultsFive key topics with a total of 87 requirements were elaborated and rated in the Delphi study. After the second round (response rate in both rounds 100%), 85 requirements fulfilled the predefined criteria and were therefore included in the final set of quality standards. The five key topics are: (I) ‘The medication is reviewed regularly and in defined situations’, (II) ‘The medication is reviewed in a structured manner’, (III) ‘The medication is monitored in a structured manner’, (IV) ‘All healthcare professionals are committed to an optimal interprofessional collaboration’ and (V) ‘Residents are actively involved in medication process’.ConclusionsWe developed normative quality standards for a safer and resident-oriented medication in Swiss nursing homes. Altogether, 85 requirements define the medication processes and the behaviour of healthcare professionals. A rigorous implementation may support nursing homes in taking a step towards safer and resident-oriented medication.

RATIONALE, AIMS AND OBJECTIVES Early warning score systems (EWS-S) have been shown to be valuable tools to recognize otherwise unnoticed clinical deterioration (CDET) of patients. They have been associated with fewer unplanned transfers to the intensive care unit (UTICU) and lower in-hospital mortality. Little is known about their current usage in Switzerland and about the attitudes towards such tools among chief physicians. We aimed to assess the use of EWS-S in Switzerland and the attitudes of chief physicians towards EWS-S depending on previously experienced CDET followed by UTICU, reanimation, or death. METHODS Chief physicians of medical and surgical departments from all acute care hospitals in Switzerland were asked to participate within a project that aims to develop recommendations for the use of EWS-S in Switzerland (n = 118). The explorative study assessed perceived CDET, which led to UTICU, reanimation, or death of a patient, the knowledge and usage about different EWS-S and attitudes towards EWS-S in a written questionnaire. Means and percentages were used, and differences were assessed with independent t tests, chi-square, or Fisher exact test, as appropriate. RESULTS Adverse events based on CDET were reported frequently, and awareness among chief physicians was high. Less than half of the chief physicians knew tools that systematically assess CDET with one-fifth of responders reporting using tools at their department. Previous experiences of UTICU, reanimation, or death after due to CDET were associated with more positive attitudes towards EWS-S. CONCLUSIONS Adverse events based on CDET of patients are frequent and the awareness of this problem is high among chief physicians. Positive attitudes were more common with previous experiences of adverse events due to CDET. Our results strengthen the argumentation that the recommendation and future implementation of EWS-S in Switzerland would be meaningful.

Objectives To identify the spectrum of patient safety issues in office-based surgery and anaesthesia in Switzerland. Methods Purposive sample of 23 experts in surgery and anaesthesia and quality and regulation in Switzerland. Data were collected via individual qualitative interviews using a researcher-developed semi-structured interview guide between March 2016 and September 2016. Interviews were transcribed and analysed using conventional content analysis. Issues were categorised under the headings “structure”, “process”, and “outcome”. Results Experts identified two key overarching patient safety and regulatory issues in relation to office-based surgery and anaesthesia in Switzerland. First, experts repeatedly raised the current lack of data and transparency of the setting. It is unknown how many surgeons are operating in offices, how many and what types of operations are being done, and what the outcomes are. Secondly, experts also noted the limited oversight and regulation of the setting. While some standards exists, most experts felt that more minimal safety standards are needed regarding the requirements that must be met to do office-based surgery and what can and cannot be done in the office-based setting are needed, but they advocated a self-regulatory approach. Conclusion There is a lack of empirical data regarding the quantity and quality office-based surgery and anaesthesia in Switzerland. Further research is needed to address these research gaps and inform health policy in relation to patient safety in office-based surgery and anaesthesia in Switzerland.

Behandlungsfehler — insbesondere, wenn es zu einer Schadigung kam — stellen fur Patienten, aber auch fur das involvierte Fachpersonal eine schwerwiegende Situation dar. Sie konnen langanhaltende und belastende Konsequenzen haben. Neben der fachlichen Aufarbeitung eines unerwunschten Ereignisses kommt dem angemessenen und empathischen Umgang mit allen Beteiligten eine zentrale Bedeutung zu, um eine „zweite Traumatisierung“ zu vermeiden.

BACKGROUND To protect patients from potential hazards of hospitalization, health care professionals need an adequate situational awareness. The Room of Horrors is a simulation-based method to train situational awareness that is little used in Switzerland. OBJECTIVES This study aimed to evaluate (1) the performance of health care staff in identifying patient safety hazards, (2) the participants' subjective experiences, and (3) the group interactions in Rooms of Horrors. METHODS The study was conducted in 13 Swiss hospitals that implemented a Room of Horrors. Health care professionals participated as individuals or in groups and were asked to identify as many errors as possible within a certain time and to complete an evaluation questionnaire. Observations of group interactions were carried out in 8 hospitals. t Tests and χ2 tests were used to examine differences in performance between participants solving the task alone versus in groups. RESULTS Data of 959 health care professionals were included in the analysis. Single participants identified on average 4.7 of the 10 errors and additional 10 errors and hazards that were not part of the official scenario. However, they also overestimated their performance, with 58% feeling the errors to be easy to find. Group observations indicated that participants rarely reflected on possible consequences of the hazards for the patient or their daily work. Participants feedback to the method was very positive. CONCLUSIONS Our findings suggest that the Room of Horrors is a popular and effective method to raise situational awareness for patient safety issues among health care staff. More attention should be given to debriefing after the experience and to benefits of interprofessional trainings.

Background Different international organizations recommend safety measures for the use of vincristine to prevent wrong route administrations. A central recommendation is to use infusion bags instead of syringes to prevent confusion with intrathecal chemotherapy. This study aimed to investigate the implementation of safety measures for vincristine and intrathecal chemotherapies in Switzerland. Method We conducted a written survey among hospital pharmacies of all general care and pediatric hospitals in Switzerland (n = 102). A responsible person of each hospital pharmacy was invited by email to participate in the online survey in May 2018. Results Of 66 responding hospitals (response rate 65%), 27 have a hospital pharmacy preparing parenteral chemotherapy. All of these hospitals prepared vincristine in 2017, while 21 also prepared intrathecal chemotherapy. Of these 21, 16 hospitals prepared vincristine as syringes, with small volume syringes being the most widely distributed dosage form. A switch from syringes to infusion bags was discussed in seven hospitals, and discussions led to plans for switch in two. The most prevalent safety measures were labeling for vincristine and special delivery for intrathecal drugs. Of hospitals preparing both vincristine syringes and intrathecal chemotherapy, four reported to have no safety measures implemented neither for vincristine nor for intrathecal chemotherapy. Conclusion International recommendations are not widely implemented in Swiss hospitals. Syringes are still in use and other safety measures are sparsely disseminated. Thus, Swiss vincristine patients are still at an increased risk for wrong route application. Recommendations have to be further disseminated and implementation could be enhanced.

ObjectiveTo evaluate changes in staff perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project.DesignRepeated cross-sectional survey at baseline (October 2016) and 12-month follow-up (October 2017).SettingSeven acute care hospitals in Switzerland.ParticipantsThe survey was targeted at all nursing and medical staff members working at the participating hospitals at the time of survey distribution. A total of 1579 staff members participated in the baseline survey (T0) (49% response rate) and 1527 participated in the follow-up survey (T1) (47% response rate).InterventionA multimodal intervention bundle, consisting of an evidence-based indication list, daily re-evaluation of ongoing catheter need and staff training, was implemented over the course of 9 months.Main outcome measuresStaff knowledge (15 items), perception of current practices and culture (scale 1–7), self-reported responsibilities (multiple-response question) and determinants of behaviour (scale 1–7) before and after implementation of the intervention bundle.ResultsThe mean number of correctly answered knowledge questions increased significantly between the two survey periods (T0: 10.4, T1: 11.0; p0: 5.3, T1: 5.5; p0: 5.3, T1: 5.6; pConclusionWe found small but significant changes in staff perceptions after implementation of an evidence-based intervention bundle. Efforts now need to be targeted at sustaining and reinforcing these changes, so that restrictive use of IUCs becomes an integral part of the hospital culture.

Since the publication of the report “To Err Is Human: Building a Safer Health System” by the US Institute of Medicine in 2000, much has changed with regard to patient safety. Many of the more recent initiatives to improve patient safety target the behavior of health care staff (e.g., training, double-checking procedures, and standard operating procedures). System-based interventions have so far received less attention, even though they produce more substantial improvements, being less dependent on individuals’ behavior. One type of system-based intervention that can benefit patient safety involves improvements to hospital design. Given that people’s working environments affect their behavior, good design at a systemic level not only enables staff to work more efficiently; it can also prevent errors and mishaps, which can have serious consequences for patients. While an increasing number of studies have demonstrated the effect of hospital design on patient safety, this knowledge is not easily accessible to clinicians, practitioners, risk managers, and other decision-makers, such as designers and architects of health care facilities. This is why the Swiss Patient Safety Foundation launched its project, “More Patient Safety by Design: Systemic Approaches for Hospitals,” which is presented in this chapter.

Group Name: Watussi Study GroupBackground: A positive safety climate is an important precursor of safe care outcomes. However, only limited evidence supports the association of low surgical-site infection (SSI) rates and positive safety climate. We investigated the role that perceptions of SSI prevention measures play for both safety climate level and strength as a subjective norm, that is, the social pressure perceived to perform the prevention measures, commitment to observe SSI prevention measures despite other situational pressures, and the level of knowledge about the prevention measures. Methods: The safety climate scale of the Safety Attitudes Questionnaire and 3 scales assessing subjective norm, commitment, and knowledge were used. All items were translated and retranslated from German to French and to Italian. All translated scales were pretested for understandability. Operating room (OR) personnel in 54 Swiss acute-care hospitals were surveyed, resulting in 2,769 analyzed responses with data aggregated on the hospital level. Two regression analyses were conducted: one using the percentage of positive responses per hospital as a safety climate level indicator, and another using the standard deviation of the safety climate ratings per hospital as a safety climate strength indicator. As independent variables, the hospital means of subjective norm, commitment, and knowledge were investigated and appropriately adjusted for number of respondents and sample composition. Results: The sample consisted of 1,495 nurses (54%) and 1,101 physicians (40%). Commitment and subjective norm were significant predictors (p < 0.001 and p < .05, respectively) of safety climate level, in the expected positive direction, but KNOW was not (R2, adjusted: 0.48); for safety climate strength, only COM was significant p < 0.001 (R2, adjusted: 0.27). Conclusions: The extent to which OR personnel were committed to perform the measures, such as timely administration of antibiotics, was associated with their safety climate rating level and strength. Thus, the rather general safety climate assessments are related to more specific safety behaviors necessary to achieve good outcomes such as low infection rates. Subjective norm was related to safety climate level only, indicating that in work environments with a good safety climate, the perceived social pressure to adhere to infection prevention measures may be higher. Knowledge about SSI prevention had no significant impact on safety climate, pointing to future research regarding the role of education in implementing prevention measures. Investigating how attitudes and knowledge about measures to prevent specific patient safety outcomes furthers our understanding of the role of safety climate in patient safety improvement.Funding: NoDisclosures: None

Die Lebenserwartung bei vielen bosartigen Erkrankungen ist in den letzten Jahren deutlich gestiegen. Diese Entwicklung ist zu einem erheblichen Teil auf moderne onkologische Arzneimitteltherapien zuruckzufuhren.

BackgroundMortality and morbidity conferences (M&MCs) are used to retrospectively discuss adverse events. Recently, the focus of the M&MC shifted from a clinical learning tool to a forum for analysing events using systems-based approaches. The aim of this study was to explore the M&MC characteristics that are associated with perceived improvement needs reported by chief physicians.MethodsA cross-sectional survey among chief physicians assessed characteristics of currently implemented M&MCs in Switzerland (44 items). A summative score was developed covering information on procedural and structural characteristics commonly recommended for design of M&MCs.ResultsOf 223 participants, 145 (65%) indicated that their M&MC could be improved. Regression analysis revealed that the score (ie, the sum of structural and procedural features of the M&MC) was associated with self-perceived need for improvement of M&MCs (OR=0.73, CI 0.62 to 0.85, PConclusionOur study provides important insights into the factors contributing to chief physicians’ evaluation of M&MCs. Offering support for addressing the procedural and structural features of the M&MCs may be a good lever to improve them.

Purpose of the Study: In perioperative care, communication about patient safety concerns is both difficult and valuable. Research into speaking up has mostly been conducted in single countries; the...

INTRODUCTION Safe practice and safety culture are important issues in outpatient diagnostic imaging services. As questionnaires assessing safety culture through the measurement of safety climate in this setting are not yet available, the present study aimed to develop and validate such an instrument. MATERIALS AND METHODS After adaptation of an existing questionnaire and qualitative pretesting, the instrument was tested by collaborators from three outpatient imaging services in Switzerland. Results were first assessed using descriptive statistics. Scores of individual services were compared using a Wilcoxon test assessing differences between rank distributions. The final instrument was tested for validity using inter-rater agreement measures, such as reliability within groups (r), and an intraclass correlation coefficient measure (ICC(1)). These measures allowed the assessment of validity of aggregation into a total score (r) and validated the instrument for its capacity to distinguish various safety climates of different groups by comparing inter-rater agreement in the overall sample to inter-rater agreement of individual services (r) and by measuring group effects (ICC(1)). Furthermore, the final instrument was tested for internal consistency and reliability using Cronbach's Alpha. RESULTS Safety climate scores vary significantly between services. Inter-rater agreement measures show that item aggregation is justified and that the instrument distinguishes various patterns of safety climate. The final instrument proves to be valid, consistent and reliable. CONCLUSIONS The final instrument presents a valid, consistent and reliable option to measure safety climate in outpatient diagnostic imaging services. Results can be used as a basis for quality improvement. KEY POINTS • An adapted questionnaire that assesses safety climate in outpatient diagnostic imaging services was developed and tested in Switzerland. • Psychometric evaluation showed the questionnaire to be a valid, consistent and reliable instrument. • Results are of interest for imaging services as well as for stakeholders interested more globally in monitoring and quality improvement.

In order to ensure high-quality cooperation between referring physicians and imaging services, it is important to assess the quality of imaging services as perceived by referring physicians. The present study aimed to develop and validate a questionnaire for referring physicians to assess the quality of outpatient diagnostic imaging services. The questionnaire was developed by discussing and modifying an existing instrument by the German Association of Surgeons. After qualitative pretesting, the instrument was tested with physicians referring to four outpatient diagnostic imaging services in Switzerland. The results were first assessed using descriptive statistics. The final instrument was tested for validity using the concept of known-groups validity. The hypothesis underlying this procedure was that physicians referring frequently to services estimated the quality of these services to be higher than physicians who referred less often to services. The differences in ratings were assessed using a one-sided two-sample Wilcoxon test. The final questionnaire was tested for internal consistency and reliability using Cronbach's Alpha. Results show a high level of satisfaction of referring physicians with the relevant services but also potential for quality improvement initiatives. The psychometric evaluation of the final questionnaire shows that it is a valid instrument, showing significant differences between the ratings of physicians referring with high and low frequency. Furthermore, the instrument proves to be consistent and reliable. The final instrument presents a valid, consistent and reliable option for assess the quality of outpatient diagnostic imaging services as perceived by referring physicians. Results can be used as a basis for quality improvement. · A newly developed questionnaire assesses the quality of outpatient diagnostic imaging services as perceived by referring physicians. The questionnaire was developed and tested in Switzerland.. · Psychometric evaluation showed the questionnaire to be a valid, consistent and reliable instrument.. · Results are of interest for imaging services as well as for initiatives encompassing several services..· Jossen M, Valeri F, Heilmaier C et al. Referring Physicians Assess the Quality of Outpatient Diagnostic Imaging Services: Development and Psychometric Evaluation of a Questionnaire. Fortschr Röntgenstr 2019; 191: 725 - 731.ZIEL: Um die Qualität der Kooperation zwischen Zuweisenden und Radiologie-Instituten zu verbessern, ist die Einschätzung der Qualität der erbrachten Leistung seitens der Zuweisenden essenziell. Die vorliegende Studie hat das Ziel, die Entwicklung und Validierung eines Fragebogens, mittels dessen Zuweisende die Qualität ambulanter Radiologie-Institute einschätzen, zu beschreiben. Der Fragebogen wurde auf der Grundlage eines bestehenden Instruments der Deutschen Gesellschaft für Chirurgie entwickelt, welches diskutiert und modifiziert wurde. Der neu entstandene Fragebogen wurde einem qualitativen Pre-Test unterzogen und anschließend bei Ärzten, die Patienten an ambulante Radiologie-Institute in der Schweiz zuweisen, erstmals eingesetzt. Die Resultate wurden mittels deskriptiver Statistik analysiert. Das finale Instrument wurde bezüglich seiner Validität mit dem “Known-Groups”-Konzept getestet. Diesem Verfahren unterliegt die Annahme, dass Ärzte, die häufig Patienten an ein Institut überweisen, mit diesem Institut eher zufrieden sind, als Ärzte, die selten Patienten an dieses Institut überweisen. Differenzen in der Bewertung wurden mittels eines einseitigen two-sample-Wilcoxon-Test gemessen. Das finale Instrument wurde mittels Cronbachs-Alpha bezüglich seiner internen Konsistenz und Reliabilität gemessen. Die Resultate zeigen, dass die Zuweisenden generell sehr zufrieden sind mit der Arbeit der Radiologie-Institute, die Antworten weisen aber auch auf Verbesserungspotenzial hin. Die psychometrische Evaluation des finalen Instruments zeigt, dass dieses valide ist, da es signifikante Differenzen zwischen den Einschätzungen von häufiger und weniger häufig zuweisenden Ärzten zeigt. Zudem ist das finale Instrument konsistent und reliabel. Das finale Instrument ermöglicht eine valide, reliable und konsistente Überprüfung der Einschätzung der Qualität ambulanter Radiologie-Institute durch ihre Zuweisenden. Die Resultate können als Grundlage für Qualitätsverbesserungen genutzt werden. · Ein neu entwickelter Fragebogen misst die Qualität ambulanter Radiologie-Institute aus der Sicht der Zuweisenden. Der Fragebogen wurde in der Schweiz entwickelt und pilotiert.. · Die psychometrische Evaluation zeigt, dass der Fragebogen valide, konsistent und reliabel ist.. · Die Resultate sind sowohl für Radiologie-Institute als auch für Initiativen, die über einzelne Institute hinausgehen, von Interesse..

Cardiff is a pre-dispersal, arrival centre for asylum seekers (AS) to the UK. Following NICE guidelines, the Cardiff TB team screens and treats AS for latent TB infection (LTBI). However, many of these AS do not remain in Cardiff as they are subsequently dispersed by UK Visa and Immigration (UKVI), often at short notice. We aimed to investigate whether treatment completion is affected by dispersal away from Cardiff and whether treatment initiation should be delayed until it is known whether an AS will be dispersed. We completed a retrospective case note analysis of all AS offered treatment for LTBI in Cardiff, between 1/1/2014 and 31/12/2016. We collected data on patient demographics, dispersal destination, whether treatment completion was confirmed and any reasons for non-completion of treatment. We then contacted 17 other TB teams in the areas to which records showed AS had been dispersed, by mail and telephone, in order to obtain details of treatment outcomes. We identified 264 AS diagnosed with LTBI in Cardiff over 3 years: 122 (46%) remained in Cardiff for the duration of treatment, with 92% of these completing treatment. Confirmation of treatment completion was significantly lower in AS dispersed both prior to starting treatment (69%) and during treatment (71%). We further analysed results after excluding 9 AS for whom follow up information was missing,having been dispersed to the care of 3 TB teams whom we were unable to contact: The difference in completion between AS remaining in Cardiff and those dispersed elsewhere remained statistically significant. Our data highlight the difficulties that TB teams face in following-up AS who are frequently dispersed abruptly around England and Wales. The results of this analysis provide insufficient evidence that treatment should be delayed in case an AS is subsequently dispersed, however this finding may depend on accurate and timely knowledge of AS dispersal destinations and adequate communication between TB teams. A more cohesive relationship between the UKVI service and TB teams and a centralised database of AS receiving treatment for LTBI are two recommendations to improve follow-up and treatment completion.

Background The disease modifying potential of osteoarthritis therapies are of increasing interest, including their effects on delaying total knee replacement (TKR). To date, there have been no studies to determine the effect of LMWF-5A, a novel anti-inflammatory compound derived from human serum albumin, on delaying TKR. Methods We evaluated time to TKR three years after patients participated in a randomized trial of three intra-articular injections of LMWF-5A or saline. Patients were contacted via last known phone number and were asked to participate in a short nine item telephone questionnaire; verbal consent was obtained. The primary endpoint was incidence of TKR (%). Results In total, 39 of 45 patients responded (87% response rate). The overall incidence of TKR was 38.5% (15/39). TKR rates were higher in patients with more severe osteoarthritis defined by Kellgren-Lawrence grade 4, compared to patients with moderate osteoarthritis defined by Kellgren-Lawrence grade 3 (56% vs. 26%, p = 0.06). Overall, there were no differences in TKR rates by treatment arm (39% LMWF-5A vs. 38% saline, p = 0.92). In the severe osteoarthritis subset (n = 16), treatment with LMWF-5A resulted in a lower incidence of TKR compared to saline vehicle arm (40% vs. 83%, p = 0.15). TKR rates were significantly lower with LMWF-5A in patients who responded to treatment (14% with LMWF-5A, vs. 100% with saline, p = 0.03). Conclusion This study demonstrates significant delays in TKR for patients with severe osteoarthritis treated with LMWF-5A, suggesting that LMWF-5A has the potential to provide structure modifying/preserving therapy in this population.

OBJECTIVES Indwelling urinary catheters (IUCs) are commonly used devices in acute care that may lead to catheter-associated urinary tract infections or noninfectious complications. Responsibilities for IUC are usually shared between nurses and physicians, and a common mental model among the two professional groups is thus essential for a successful reduction in catheter use. The aim of this study was to determine variation in the perceptions of current practices and culture regarding IUC use between these two groups. METHODS Nurses and physicians (N = 1579) from seven Swiss hospitals completed a written survey on safe IUC use in their institution. The survey assessed participant's perceptions of current practices and culture in their institution, and their perceived responsibilities related to IUC care. t tests and logistic regression were used to examine differences in responses between physicians and nurses. RESULTS Nurses and physicians each have their own tasks but also share responsibilities for catheter placement, care, and removal. Overall, nurses were more positive than physicians about current practices and culture regarding IUC use within their institution (mean scale scores = 5.4 for nurses versus 5.1 for physicians, P < 0.001). Perceptions of the two professional groups diverged most strongly on practices to avoid unnecessary placement of IUCs, the presence of shared values and attitudes in support of restrictive catheter use, and the other group's leadership commitment. CONCLUSIONS Indwelling urinary catheter management is a strong interprofessional domain and a shared responsibility. It is crucial that measures to raise awareness and to communicate new standards target both nurses and physicians and are discussed in interprofessional formats.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Objective To determine the implementation status and current practice of morbidity and mortality conferences (M&MCs) in Switzerland. Design A national cross-sectional online survey was conducted in spring 2017. The questionnaire focused on overall goals, structure and procedures of hospital M&MCs. Further topics included satisfaction, perceived effectiveness and support requirements. Setting A total of 913 chief physicians of surgery and internal medicine, and specialist fields of obstetrics and gynaecology, anaesthesiology and intensive care from Swiss acute care hospitals were invited to the survey. 321 completed the questionnaire, resulting in a 35.2% response rate. Participants Chief or senior physicians in charge of the M&MCs in their department. Intervention No intervention. Main Outcome Measures Numbers and percentages of M&MCs within the surveyed disciplines fulfilling certain characteristics and procedural features. Results Among 321 respondents, the majority are conducting M&MCs in their departments. Within and between the medical disciplines considerable heterogeneity was found in structural and procedural features of M&MCs. Only a small part of the reported M&MCs is following a systematic approach and meeting recommended procedural features. Although the respondents are satisfied and perceive the M&MCs as an efficient tool, they agree that there is a need for professionalization and standardization. Conclusion M&MCs are widely used to promote medical education, patient safety and quality improvements. However, the term M&MC seems to cover different types of meetings. Although the overall goals are similar, various types of M&MCs are used in practice and different objectives are pursued. Tools such as checklists, guidelines and templates are considered helpful.

Purpose: To increase medication safety in oncology, checking procedures are increasingly applied by nurses, physicians, and pharmacists. However, little is known about the number, types, and consistency of implemented checks. The aim of the study was to assess the number and types of different checking procedures that are performed along the lifecycle of a chemotherapy prescription across three hospitals, different care settings, administration routes, and professional groups. Methods: A scheme to evaluate checking procedures and a mapping approach to illustrate the checks along the phases of the medication process were developed. Checking procedures were assessed on the basis of analysis of internal guidelines and interviews with nurses and physicians who work on wards and in ambulatory infusion units of three hospitals. Results: There were considerable differences in number and type of checking procedures among administration routes, professional groups, wards and ambulatory infusion units, and hospitals. During the prescribing phase, the lowest number of checks was performed. In internal guidelines, checking procedures were documented poorly, though the pharmacy process was an exception. Conclusion: In contrast to the pharmacists, nurse and physician clinician checking procedures are less standardized within and across hospitals. The results point to different checking habits for the professional groups; for example, physicians would rather perform plausibility reviews than checks. Our evaluation scheme to categorize checks and the visualized mapping approach was feasible and understandable for practitioners.

BACKGROUND Clinicians involved in medical errors can experience significant distress. This study aims to examine (1) how medical errors impact anaesthesiologists in key work and life domains; (2) anaesthesiologists' attitudes regarding support after errors; (3) and which anaesthesiologists are most affected by errors. METHODS This study is a mailed cross-sectional survey completed by 281 of the 542 clinically active anaesthesiologists (52% response rate) working at Switzerland's five university hospitals between July 2012 and April 2013. RESULTS Respondents reported that errors had negatively affected anxiety about future errors (51%), confidence in their ability as a doctor (45%), ability to sleep (36%), job satisfaction (32%), and professional reputation (9%). Respondents' lives were more likely to be affected as error severity increased. Ninety per cent of respondents disagreed that hospitals adequately support them in coping with the stress associated with medical errors. Nearly all of the respondents (92%) reported being interested in psychological counselling after a serious error, but many identified barriers to seeking counselling. However, there were significant differences between departments regarding error-related stress levels and attitudes about error-related support. Respondents were more likely to experience certain distress if they were female, older, had previously been involved in a serious error, and were dissatisfied with their last error disclosure. CONCLUSION Medical errors, even minor errors and near misses, can have a serious effect on clinicians. Health-care organisations need to do more to support clinicians in coping with the stress associated with medical errors.

Background Double-checking medications is a widely used strategy to enhance safe medication administration in oncology, but there is little evidence to support its effectiveness. The proliferated use of double-checking may be explained by positive attitudes towards checking among nurses. This study investigated oncology nurses’ beliefs towards double-checking medication, its relation to beliefs about safety and the influence of nurses’ level of experience and proximity to clinical care. Methods This was a survey of all oncology nurses in three Swiss hospitals. The questionnaire contained 41 items on 6 domains. Responses were recorded using a 7-point Likert scale. Multiple regression analysis was used to identify factors linked to strong beliefs in the effectiveness of double-checking. Results Overall, 274 (70%) out of 389 nurses responded (91% female, mean age 37 (standard deviation = 10)). Nurses reported very strong beliefs in the effectiveness and utility of double-checking. They were also confident about their own performance in double-checking. Nurses widely believed that double checking produced safety (e.g., 86% believed errors of individuals could be intercepted with double-checks). In contrast, some limitations of double-checking were also recognized, e.g., 33% of nurses reported that double checking caused frequent interruptions and 28% reported that double-checking was done superficially in their unit. Regression analysis revealed that beliefs in effectiveness of double-checking were mainly associated with beliefs in safety production (p

Objective To analyze speaking up behavior and safety climate with a validated questionnaire for the first time in an Austrian university hospital. Design Survey amongst healthcare workers (HCW). Data were analyzed using descriptive statistics, Cronbach's alpha was calculated as a measure of internal consistencies of scales. Analysis of variance and t-tests were used. Setting The survey was conducted in 2017. Participants About 2.149 HCW from three departments were asked to participate. Intervention To measure speaking up behavior and safety climate. Main Outcome Measure To explore psychological safety, encouraging environment and resignation towards speaking up. Results About 859 evaluable questionnaires were returned (response rate: 40%). More than 50% of responders perceived specific concerns about patient safety within the last 4 weeks and observed a potential error or noticed rule violations. For the different items, between 16% and 42% of HCW reported that they remained silent though concerns for safety. In contrast, between 96% and 98% answered that they did speak up in certain situations. The psychological safety for speaking up was lower for HCW with a managerial function (P < 0.001). HCW with managerial functions perceived the environment as less encouraging to speak up (P < 0.05) than HCW without managerial function. Conclusions We identified speaking up behaviors for the first time in an Austrian university hospital. Only moderately frequent concerns were in conflict with frequent speaking up behaviors. These results clearly show that a paradigm shift is needed to increase speaking up culture.

BACKGROUND Speaking up by healthcare professionals (HCPs) is an important resource to reduce risks to patient safety. Due to complex tradeoffs, HCPs are often reluctant to voice their concerns. A survey investigated HCPs' likelihood to speak up. METHODS A cross-sectional survey study among HCPs in 5 Swiss hospitals addressed speaking-up behaviors, safety climate, and likelihood to speak up about poor hand hygiene practice described in a vignette. Likelihood to speak up was analyzed using a multilevel regression model. RESULTS Of surveyed HCPs (n = 1217), 56% reported that they would speak up to a colleague with poor hand hygiene practice. Nurses as compared to doctors rated the situation as more realistic (5.25 vs 4.32, P

Objectives In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technicians. Design Qualitative study with semistructured interviews. Data were analysed using a qualitative content analysis approach. Setting Internal medicine units in two mid-sized Swiss hospitals. Participants 21 staff members working at the two sites (6 pharmacy technicians, 2 pharmacists, 6 nurses, 5 physician residents and 2 senior physicians). Results Pharmacy technicians generally appreciated their new tasks in obtaining a BPMH. However, they also experienced challenges associated with their new role. Interviewees reported unease with direct patient interaction and challenges with integrating the new BPMH tasks into their regular daily duties. We found that pharmacists played a key role in the BPMH process, since they act as coaches for pharmacy technicians, transmit information to the physicians and reconcile preadmission medication lists with admission orders. Physicians stated that they benefitted from the delegation of administrative tasks to pharmacy technicians. Regarding the interprofessional collaboration, we found that pharmacy technicians in the study acted on a preliminary administrative level and did not become part of the larger treatment team. There was no direct interaction between pharmacy technicians and physicians, but rather, the supervising pharmacists acted as intermediaries. Conclusion The tasks assumed by pharmacy technicians need to be clearly defined and fully integrated into existing processes. Engaging pharmacy technicians may generate new patient safety risks and inefficiencies due to process fragmentation. Communication and information flow at the interfaces between professional groups therefore need to be well organised. More research is needed to understand if and under which circumstances such a model can be efficient and contribute to improving medication safety.

Rationale, aims and objectives Safety climate measurements are a broadly used element of improvement initiatives. In order to provide a sound and easy-to-administer instrument for the use in Swiss hospitals, we translated the Safety Climate Survey into German and French. Methods After translating the Safety Climate Survey into French and German, a crosssectional survey study was conducted with health care professionals (HCPs) in operating room (OR) teams and on OR-related wards in 10 Swiss hospitals. Validity of the instrument was examined by means of Cronbach’s alpha and missing rates of the single items. Item-descriptive statistics group differences and percentage of ‘problematic responses’ (PPR) were calculated. Results 3153 HCPs completed the survey (response rate: 63.4%). 1308 individuals were excluded from the analyses because of a profession other than doctor or nurse or invalid answers (n = 1845; nurses = 1321, doctors = 523). Internal consistency of the translated Safety Climate Survey was good (Cronbach’s alpha German = 0.86; Cronbach’s alpha French = 0.84). Missing rates at item level were rather low (0.23–4.3%). We found significant group differences in safety climate values regarding profession, managerial function, work area and time spent in direct patient care. At item level, 14 out of 21 items showed a PPR higher than 10%. Conclusions Results indicate that the French and German translations of the Safety Climate Survey might be a useful measurement instrument for safety climate in Swiss hospital units. Analyses at item level allow for differentiating facets of safety climate into more positive and critical safety climate aspects.

Objective. To assess patients’ and healthcare workers’ (hcw) attitudes and experiences with a patient safety advisory, to investigate predictors for patients’ safety-related behaviors and determinants for staff support for the advisory. Design. Cross-sectional surveys of patients (n ¼ 1053) and hcw (n ¼ 275). Setting. Three Swiss hospitals. Participants. Patients who received the safety advisory and hcw caring for these patients. Intervention. Patient safety advisory disseminated to patients at the study hospitals. Main Outcome Measures. Attitudes towards and experiences with the advisory. Hcw support for the intervention and patients’ intentions to apply the recommendations were modelled using regression analyses. Results. Patients (95%) and hcw (78%) agreed that hospitals should educate patients how to prevent errors. Hcw and patients’ evaluations of the safety advisory were positive and followed a similar pattern. Patients’ intentions to engage in safety were significantly predicted by behavioral control, subjective norms, attitudes, safety behaviors during hospitalization and experiences with taking action. Hcw support for the campaign was predicted by rating of the advisory (Odds ratio (OR) 3.4, confidence interval (CI) 1.8 – 6.1, P , 0.001), the belief that it prevents errors (OR 1.7, CI 1.2– 2.5, P ¼ 0.007), perceived increased vigilance of patients (OR 1.9, CI 1.1 – 3.3, P ¼ 0.034) and experience of unpleasant situations (OR 0.6, CI 0.4– 1.0, P ¼ 0.035). Conclusions. The safety advisory was well accepted by patients and hcw. To be successful, the advisory should be accompanied by measures that target norms and barriers in patients, and support staff in dealing with difficult situations.

Safety Climate has been acknowledged as an unspecific factor influencing patient safety. However, studies rarely provide in-depth analysis of climate data. As a helpful approach, the concept of "climate strength" has been proposed. In the present study we tested the hypotheses that even if safety climate remains stable on mean-level across time, differences might be evident in strength or shape. The data of two hospitals participating in a large national quality improvement program were analysed for differences in climate profiles at two measurement occasions. We analysed differences on mean-level, differences in percent problematic response, agreement within groups, and frequency histograms in two large hospitals in Switzerland at two measurement occasions (2013 and 2015) applying the Safety Climate Survey. In total, survey responses of 1193 individuals were included in the analyses. Overall, small but significant differences on mean-level of safety climate emerged for some subgroups. Also, although agreement was strong at both time-points within groups, tendencies of divergence or consensus were present in both hospitals. Depending on subgroup and analyses chosen, differences were more or less pronounced. The present study illustrated that taking several measures into account and describing safety climate from different perspectives is necessary in order to fully understand differences and trends within groups and to develop interventions addressing the needs of different groups more precisely.

Traditionally, health economics have been orientated on the question as to how the limited resources should be allocated, on the efficiency criterion. The limited resources should be used in such a way that the additionally achievable health in the population is maximised. The increased health benefits (life expectance, quality of life) are the factor to is maximised. A purely efficency-orientated allocation of resources can, however, have a strong distribution effect that would be considered as unfair and unjust by many people and consequently not be accepted. In the meantime there is a body of empirical data evidence about the alternatives or additional criteria that are important for members of the population in the assesment of utility of medical interventions. Three of these possible criteria are discussed as examples here. Although the improvement in health is an important, perhaps even central criterion, a poor state of health, a limited health potential as well as other personal factors for the afflicted patient may, in part considerably, compensante for the achievable improvement in health. Systems for the evaluation of utility that will be accepted and supported by the general public must in future take into consideration the various explicit factors of the societal and individual benefits of health-care interventions and balance their relative importances.