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Target areas for the Norwegian campaign for patient safety

A secretariat for the campaign is established and has identified a list of possible target areas for the campaign.

A secretariat for the campaign is established and has identified a list of possible target areas for the campaign.


Key message

The Norwegian Knowledge Centre for the Health Services is preparing a Norwegian campaign for patient safety. A secretariat for the campaign is established and has identified a list of possible target areas for the campaign. A group of health care experts used a formalized consensus process to rate possible target areas. They met twice in May 2010. On the first meeting the participants were introduced to the consensus process.  Before the second meeting they rated the eleven areas based on both descriptive and evidence based documentation provided by the secretariat. In the second meeting the results of rankings were presented and discussed before the final ranking of the areas. The final results are presented in table 1. It’s only marginal distinctions between areas 6-8.

The campaigns steering group has established following target areas for the campaign: Safe surgery with a specific attention to infections, medication errors and harm, treatment of stroke and mental health care.

Table 1. Ranking of targeted patient safety areas

Rank

Target area

Evaluation

1

Safe surgery

Appropriate

2

Medication errors and harm

Appropriate

3

Postoperative infections

Appropriate

4

Urinary tract infections

Appropriate

5

CVK-infections

Potential

6

Treatment of stroke

Potential

7

Waiting times for cancer patients

Potential

8

Patient falls in institutions

Potential

9

Decubitus ulcer

Potential

10

Early rehabilitation after hip fracture

Inadequate

11

Rapid Response Team

Inadequate

Summary

In 2009 the Norwegian Knowledge Centre for the Health Services were commissioned to prepare a national campaign for patient safety. To prepare the campaign a secretariat was established in the National Unit for Patient Safety within the Knowledge Center from 1/1 2010. The secretariat is responsible for planning and implementing the national patient safety campaign. The campaign's steering group is led by the Director General of Health. The steering group is authorized to decide on the organisation and design of the campaign. In addition, the secretariat appointed a group of health care experts that will assist with their expertise throughout campaign period. The expert group is composed in order to represent a broad knowledge of Norwegian healthcare service, with high clinical legitimacy, good research skills and knowledge of national data sources.

In line with the definition of the World Health Organization and definitions in the other Nordic countries the Knowledge Center has defined patient safety as: protection against unnecessary harm associated with health care or lack of care.

The assignment to prepare a campaign was given with some recommendations from the Ministry of Health and Care Services. A basic guideline was that medication harm and errors, along with hospital infections should be addressed in the campaign. The Ministry emphasised a thorough preparation and process that ensured broad participation from all parts of the health care service.

The secretariat has reviewed the various target areas and interventions presented in the campaigns in Canada, Denmark, England, Scotland and the United States. Reduction of unnecessary deaths, reductions of hospital infections and medication errors are common target areas in the different campaigns. Another common feature is focusing on the system perspective. A system perspective implies emphasising the responsibility of the system rather than the individual health worker when an adverse event occur. It implies that leaders must focus on using and learning of information from reporting systems, and an active use of measurements and reporting.

In 2008 the Knowledge Center conducted interviews with the patient safety managers in the 28 Norwegian Health Care Trusts. The purpose of the study was to gain insight about how the Norwegian hospitals administered their patient safety efforts both at a strategic and organizational level, as well as to gain insight in the ongoing patient safety projects in the Norwegian hospitals. In the spring of 2010 the secretariat asked all the Norwegian Health Care Trusts for input on target areas and missions for a national patient safety campaign. The feedback  from the trusts reflected a broad support of the ministry’s guidelines regarding hospital infections and medication. Two proposals were new: mental health care and treatment of stroke.

A group of health care experts used a formalized consensus process to rate possible target areas. A formalised consensus processes can briefly be described as a three-step evaluation process. The first step in a consensus processes is identification and obtaining documentation for the targeted area. Researchers from the Norwegian Knowledge Centre for the Health Services, with a competence in systematic literature review provided an overview of existing relevant evidence, and it was also included studies that do not fulfil the same strict method criteria as evidence based literature reviews do. 

The group of experts evaluated and rated the available documentation according to agreed upon criterias: 

1)     The area must have a great potential for clinical improvement in Norway

2)     Interventions must be documented as effective

3)     Access to good data and methods to evaluate the effect of the interventions

4)     Areas must have support among health care professionals in Norway

The results of the ranking were presented for the expert group before a final ranking of the eleven proposed areas. Overall, only minor changes in the results were observed from the first to the second ranking. The debate in the expert group provided essential information to the secretariat about the different patient safety areas and advice for the further actions and plan for implementation.

The campaign's expert group arrived at a recommendation of the areas for a Norwegian patient safety campaign. The secretariat has summarised the result of the rankings in a table and categorised the target areas as either “appropriate”, “potential” or “inadequate” (table 1).

On the basis of the recommendations the secretariat started worked with the two main areas: hospital infections and reduction of medication errors and harm. Hospital infections includes the actions connected to the safe surgery checklist, postoperative infections and CVK-infections. For both areas there is established an expert group to give further advice on implementation and measurement.

The campaign’s steering group has established following target areas for the campaign: Safe surgery with special attention to infections, Medication errors and harm, treatment of stroke and mental health care. 

Table 2.

Rank

Target area

Evaluation

1

Safe surgery

Appropriate

2

Medication errors and harm

Appropriate

3

Postoperative infections

Appropriate

4

Urinary tract infections

Appropriate

5

CVK-infections

Potential

6

Treatment of stroke

Potential

7

Waiting times for cancer patients

Potential

8

Patient falls in institutions

Potential

9

Decubitus ulcer

Potential

10

Early rehabilitation after hip fracture

Inadequate

11

Rapid Response Team

Inadequate

 

In 2010 the expert groups for Safe surgery (with a specific attention to infections) and the expert group for medication errors and harm, have had four meetings each to plan the design and measurement for the target areas.

Meeting agenda:

1. Refinement of the patient safety targeted area

  1. Population
  2. Issues

2. Objectives and targets

3. Measurement and registration at different levels (local, regional, national)

4. Implementation and alignment with the campaign strategy

Additional approach and design of measures will take place in cooperation with the health services through pilot projects in the spring of 2011.

About this publication

  • Year: 2011
  • Authors Saunes IS, Krogstad U.
  • ISSN (digital): 1890-1298
  • ISBN (digital): 978-82-8121-384-5