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Er læringsnettverk effektive i forbedringsarbeid?

Nasjonal enhet for pasientsikkerhet formidler oversikter og rapporter om kvalitet og pasientsikkerhet. Blant de nyeste er en om læringsnettverk fra britiske The Health Foundation. Er de effektive i forbedringsarbeid, og hvilke faktorer har sammenheng med et godt resultat?

1.   Perioperative protocol
Card R, Sawyer M, Degnan B, Harder K, Kemper J, Marshall M, et al
Bloomington, MN: Institute for Clinical Systems Improvement, 2014

The protocol describes appropriate evaluation for operative procedures for adult and pediatric patients. Pediatric patients for whom this protocol is intended are those between the ages of 2 and 15 years. Patients over age 15 are considered adults for the purposes of this protocol. Emergent and urgent procedures are outside the scope of this protocol, but the topics of this protocol may still apply.

2.  Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: A systematic review and meta-analysis
Chan WC, Fai Yeung JW, Man Wong CS, Wa Lam LC, Chung KF, Hay Luk JK, et al
J Am Med Dir Assoc 2014

The present analysis suggests that physical exercise has a positive effect on preventing falls in older adults with cognitive impairment. Further studies will be required to determine the modality and frequency of exercise that are optimal for the prevention of falls in this population.

3.  Diagnostic errors in the pediatric and neonatal ICU: A systematic review Custer JW, Winters BD, Goode V, Robinson KA, Yang T, Pronovost PJ, et al.
Pediatr Crit Care Med 2014

Diagnostic errors in PICU/neonatal ICU populations are most commonly due to infection. Further research is needed to better quantify pediatric intensive care-related misdiagnosis and to define potential strategies to reduce their frequency or mitigate misdiagnosis-related harm.

4. Data use and effectiveness in electronic surveillance of healthcare associated infections in the 21st century: a systematic review
de Bruin JS, Seeling W, Schuh C
J Am Med Inform Assoc 2014;21(5):942-951

Driven by the increased availability of electronic patient data, electronic HAI surveillance systems use more data, making systems more sensitive yet less specific, but also allow systems to be tailored to the needs of healthcare institutes' surveillance programs.

5.  Improvement collaboratives in health care
de Silva D

London: The Health Foundation, 2014

Collaboratives have been used as an improvement approach in health care for the past 20 years or so, but with mixed results. In the NHS, collaboratives have been proposed as a potential vehicle for change so it is important to ensure that the design of these initiatives makes the best use of evidence about what works to enable a successful collaborative approach.

This evidence scan therefore addresses the questions:
• are collaboratives effective for improving the quality of health care?
• what factors may be associated with success?

6.  Reducing the risks of wrong-site surgery: Safety practices from The Joint Commission Center for Transforming Healthcare Project
Health Research & Educational Trust and Joint Commission Center for Transforming Healthcare
Chicago, IL: Health Research & Educational Trust, 2014

Although rare and difficult to study, wrong-site surgery is a serious risk recognized by health care organizations. This report describes the types of risks introduced during each stage of the perioperative process, the root causes for those risks, and the solutions designed to reduce them, and includes examples and lessons learned

7.  The cost of opioid-related adverse drug events
Kane-Gill SL, Rubin EC, Smithburger PL, Buckley MS, Dasta JF
J Pain Palliat Care Pharmacother 2014;28(3):282-293

The purpose of this review is to describe the frequency and cost associated with different types of opioid-related ADEs to better understand their economic impact. Nausea, vomiting, and constipation are frequent and increased costs occur in all types of pain (surgical, nonsurgical, cancer, noncancer) in both inpatients and outpatients. Given the large economic burden of opioid-related ADEs, prevention rather than treatment may be the most effective strategy.

8.  Systematic literature analysis and review of targeted preventive measures to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus
Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al
Euro Surveill 2014;19(29)

Meticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections in Europe. Many examples have demonstrated that the spread of MRSA within healthcare settings can be reduced by targeted infection control measures. Overall, this review highlighted that when planning the implementation of preventive interventions, there is a need to consider the prevalence of MRSA, the incidence of infections, the competing effect of standard control measures (e.g. hand hygiene) and the likelihood of transmission in the respective settings of implementation.

9.  Patient safety in primary health care: a systematic review
Marchon SG, Mendes Junior WV
Cad Saude Publica 2014;30(9):1815-1835

The aim of this study was to identify methodologies to evaluate incidents in primary health care, types of incidents, contributing factors, and solutions to make primary care safer. The most frequently used method was incident analysis from incident reporting systems (45%). The most frequent types of incidents in primary care were related to medication and diagnosis. The most relevant contributing factors were communication failures among member of the healthcare team. Research methods on patient safety in primary care are adequate and replicable, and they will likely be used more widely, thereby providing better knowledge on safety in this setting.

10.   Hourly rounding to improve nursing responsiveness: a systematic review
Mitchell MD, Lavenberg JG, Trotta RL, Umscheid CA
J Nurs Adm 2014;44(9):462-472

There is moderate-strength evidence that hourly rounding programs improve patients' perception of nursing responsiveness. There is also moderate-strength evidence that these programs reduce patient falls and call light use. Nurse administrators should consider implementing an hourly rounding program while controlled trials discern the most cost-effective approach.

11.  Effectiveness of computerized decision support systems linked to electronic health records: A systematic review and meta-analysis
Moja L, Kwag KH, Lytras T, Bertizzolo L, Brandt L, Pecoraro V, et al
Am J Public Health 2014:e1-e11

We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes.

12.   Benefits and risks of using smart pumps to reduce medication error rates: A systematic review
Ohashi K, Dalleur O, Dykes PC, Bates DW
Drug Saf 2014

Smart infusion pumps have been introduced to prevent medication errors and have been widely adopted nationally in the USA, though they are not always used in Europe or other regions. Despite widespread usage of smart pumps, intravenous medication errors have not been fully eliminated. The literature suggests that smart pumps reduce but do not eliminate programming errors. Although the hard limits of a drug library play a main role in intercepting medication errors, soft limits were still not as effective as hard limits because of high override rates. Compliance in using smart pumps is key towards effectively preventing errors. Opportunities for improvement include upgrading drug libraries, developing standardized drug libraries, decreasing the number of unnecessary warnings, and developing stronger approaches to minimize workarounds. Also, as with other clinical information systems, smart pumps should be implemented with the idea of using continuous quality improvement processes to iteratively improve their use.

13.  Interventions to improve the appropriate use of polypharmacy for older people
Patterson Susan M, Cadogan Cathal A, Kerse N, Cardwell Chris R, Bradley Marie C, Ryan C, et al
Cochrane Database of Systematic Reviews 2014 (10):CD008165

Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence interest in appropriate polypharmacy, where many medicines may be used to achieve better clinical outcomes for patients, is growing. It is unclear whether interventions to improve appropriate polypharmacy, such as pharmaceutical care, resulted in clinically significant improvement; however, they appear beneficial in terms of reducing inappropriate prescribing.

14.  A systematic review and critical appraisal of quality measures for the emergency care of acute ischemic stroke
Sauser K, Burke JF, Reeves MJ, Barsan WG, Levine DA
Ann Emerg Med 2014;64(3):235-244.e235

Acute stroke is an important focus of quality improvement efforts. There are many organizations involved in quality measurement for acute stroke, and a complex landscape of quality measures exists. Our objective is to describe and evaluate existing US quality measures for the emergency care of acute ischemic stroke patients in the emergency department (ED) setting. There remains room for improvement in the development and use of measures that reflect high-quality emergency care of acute ischemic stroke patients in the United States.

15.  Pharmacist-led interventions to reduce unplanned admissions for older people: a systematic review and meta-analysis of randomised controlled trials
Thomas R, Huntley AL, Mann M, Huws D, Elwyn G, Paranjothy S, et al
Age Ageing 2014;43(2):174-187

Medication problems are thought to cause between 10 and 30% of all hospital admissions in older people. This systematic review aimed to evaluate the effectiveness of interventions led by hospital or community pharmacists in reducing unplanned hospital admissions for older people. Evidence from three randomised controlled trials suggests that interventions led by hospital pharmacists reduce unplanned hospital admissions in older patients with heart failure, although these trials were heterogeneous. Data from 16 trials do not support the concept that interventions led by hospital or community pharmacists for the general older population reduces unplanned admissions.

16.  National action plan for adverse drug event prevention
U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion
Washington DC: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2014

The ADE Action Plan identifies efforts to date to measure and prevent ADEs, and promote medication safety. In addition, this plan outlines future opportunities to advance patient safety with regard to the prevention of adverse drug events among three primary drug classes: anticoagulants, diabetes agents, and opioids. The ADE Action Plan is intended to encourage nationwide efforts to coordinate Federal resources and activities that will reduce preventable adverse drug events and increase awareness of the importance of medication safety.

17.  Transitional care interventions prevent hospital readmissions for adults with chronic illnesses
Verhaegh KJ, MacNeil-Vroomen JL, Eslami S, Geerlings SE, de Rooij SE, Buurman BM
Health Aff (Millwood) 2014;33(9):1531-1539

Transitional care interventions aim to improve care transitions from hospital to home and to reduce hospital readmissions for chronically ill patients. The objective of our study was to examine if these interventions were associated with a reduction of readmission rates in the short (30 days or less), intermediate (31-180 days), and long terms (181-365 days). Our analysis showed that transitional care was effective in reducing all-cause intermediate-term and long-term readmissions. Only high-intensity interventions seemed to be effective in reducing short-term readmissions. Our findings suggest that to reduce short-term readmissions, transitional care should consist of high-intensity interventions that include care coordination by a nurse, communication between the primary care provider and the hospital, and a home visit within three days after discharge.

18.  At skabe sikkerhed, effektivitet og tryghed – operations-assisterende arbejde på hospitaler
Wentzer HS, Meier N
København: Det Nationale Institut for Kommuners og Regioners Analyse og Forskning (KORA), 2014

Operationsassisterende arbejde er komplekst og foregår i et dynamisk og teknologisk medieret teamsamarbejde, som formes af en lang række faktorer: patientens diagnose, specialets og indgrebets risici, operationsprogrammet, kommunikationsformen i teamet og med personaler uden for stuen, teknologiens brugervenlighed, dokumentation, hygiejne og sikkerhedsregler, patientens angst eller smerter og trygheden i teamet ved akut samarbejde.

19.  A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety
Xie A, Carayon P
Ergonomics 2014:1-17

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.


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