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Aktuelt om pasientsikkerhet

Usikkert om undervisning øker pasientens sikkerhet

Publisert

Undervisning_COLOURBOX10413456_cropped.
Undervisning_COLOURBOX10413456_cropped.

Undervisning i pasientsikkerhet og kvalitetsforbedring gir økt kunnskap og bedre ferdigheter og kan også endre atferd og holdninger til pasientsikkerhet – men det er usikkert om det gir effekt i form av økt sikkerhet for pasientene.


Aktuelt om pasientsikkerhet

Folkehelseinstituttet innhenter og videreformidler jevnlig aktuell informasjon som kan være nyttig for dem som er opptatt av pasientsikkerhet.

Referansene kommer fra to typer kilder: 1) bibliografiske databaser eller 2) nyhetsbrev fra fagmiljøer som arbeider med kvalitet og pasientsikkerhet i helsetjenesten.

For å kvalifisere til formidling skal innholdet være relevant og fortrinnsvis basert på oppsummert forskning. Vi vurderer ikke metodisk kvalitet på publikasjoner som videreformidles.

Les mer om søkekriteriene i Metodebeskrivelse - Aktuelt om pasientsikkerhet (pdf)

Har du funnet en feil?

Dette er blant funnene i en av de systematiske oversiktene som Nasjonal enhet for pasientsikkerhet i Kunnskapssenteret videreformidler til alle som er opptatt av pasientens sikkerhet.

Gir læringsutbytte

Pasientsikkerhet og kvalitetsforbedring er oftere enn før en del av pensum i både grunn- og etterutdanning av helsepersonell. Den systematiske oversikten fra Storbritannia oppsummerer studier om effekt av undervisning og kurs om pasientsikkerhet (1). Oversikten er en oppdatering av et tilsvarende arbeid publisert i 2010. Funnene i de to oversiktene sammenlignes og mulige utviklingstrekk drøftes.

De oppsummerte studiene dokumenterer at undervisningstiltak gir læringsutbytte i form av økt kunnskap og bedre ferdigheter. Kursdeltakelse kan også endre studenters og helsepersonells atferd og holdninger til pasientsikkerhet. Forfatterne fant ingen studier som kunne dokumentere klinisk effekt i form av økt sikkerhet for pasientene.

En finsk oversikt har en tilsvarende problemstilling og oppsummerer forskningsartikler om blant annet hva helsepersonell kan og ikke kan om pasientsikkerhet (2).

Publikasjoner om andre temaer

Nasjonal enhet for pasientsikkerhet informerer også disse publikasjonene:

  • Diagnose- eller prosedyrespesifikke sjekklister for pasienter (3)
  • God praksis for fallforebygging i sykehus (4)
  • Ergonomitiltak og pasientsikkerhet (5)
  • Farmakologisk behandling av delir hos intensivpasienter (6)
  • Tilbakeblikk på pasientsikkerhetsarbeid i Sverige (7)
  • Kan kateterlås med antibiotika forebygge infeksjon hos nyfødte? (8)

 
Se kriteriene for formidling av oversiktsartikler i høyre kolonne.

1. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review
Kirkman MA, Sevdalis N, Arora S, Baker P, Vincent C, Ahmed M
BMJ open 2015;5(5):e007705

There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread.

2. Healthcare professionals' knowledge, attitudes and skills regarding patient safety: a systematic literature review
Brasaite I, Kaunonen M, Suominen T
Scand J Caring Sci 2015;29(1):30-50

The purpose of this literature review was to determine the extent of existing knowledge about healthcare professionals' knowledge, attitudes and skills related to patient safety. The investigated themes regarding healthcare professionals' knowledge of patient safety were their existing knowledge level, knowledge deficits and knowledge improvement. Results considered the target groups' overall attitudes to patient safety, attitudes to event reporting and safety attitude improvement. The investigations into healthcare professionals' skills included mathematical skills and those related to achieving patient safety. From this review, it is concluded that further research should be conducted into the investigation of healthcare professionals' knowledge and skills in patient safety.

3. Concepts for the development of a customizable checklist for use by patients
Fernando RJ, Shapiro FE, Rosenberg NM, Bader AM, Urman RD
Journal of patient safety 2015

Checklists are tools that are developed to complete tasks by drawing on specific and relevant knowledge and supporting communication at critical times. If checklists were designed specifically for patient use, they could promote patient engagement, potentially leading to improved quality of care. Sample content for inclusion in potential checklists for patients with diabetes and patients undergoing anesthesia was devised. Developed by physicians with input from patients and other involved health-care providers such as nurses, this relatively novel concept of a patient's checklist creates a role for the patient to ensure their own safety. Providers can use these checklists as a method to gauge a patient's understanding of an intervention, solidify the patient-doctor relationship, and improve patient safety.

4. Prevention of in-hospital falls: development of criteria for the conduct of a multi-site audit
Giles K, Stephenson M, McArthur A, Aromataris E
International journal of evidence-based healthcare 2015;13(2):104-111

Patient falls are a significant issue for hospitals due to the high rates of morbidity and mortality associated with these events, as well as the financial costs for the healthcare system. Existing research evidence and consultation with stakeholders has allowed the development of applicable, evidence-based audit criteria for fall prevention in acute care settings. This model can promote engagement, impact clinical practice and lead to improved outcomes.

5. An evaluation of the effects of human factors and ergonomics on health care and patient safety practices: a systematic review
Mao X, Jia P, Zhang L, Zhao P, Chen Y, Zhang M
PLoS One 2015;10(6):e0129948

Human factors and ergonomics (HFE) is a scientific discipline concerned with understanding interactions between human behavior, system design and safety. This review aims to evaluate the effectiveness of HFE interventions (physical, cognitive, organizational or multifaceted ergonomics) in improving health care workers' outcomes and patient safety and to assess the quality of the available evidence. Five broad categories of outcomes were identified in this study: 1) medical errors or patient safety, 2) health care workers' quality of working life (e.g. reduced fatigue, discomfort, workload, pain and injury), 3) user performance (e.g., efficiency or accuracy), 4) health care workers' attitudes towards the interventions(e.g., satisfaction and preference), and 5) economic evaluations. The results showed that the interventions positively affected the outcomes of health care workers. Few studies considered the financial merits of these interventions. Most of the included studies were of moderate quality. This review highlights the need for scientific and standardized guidelines regarding how HFE should be implemented in health care.

6. Pharmacologic prevention and treatment of delirium in intensive care patients: a systematic review
Serafim RB, Bozza FA, Soares M, do Brasil PE, Tura BR, Ely EW, et al.
J Crit Care 2015

The purpose of the study is to determine if pharmacologic approaches are effective in prevention and treatment of delirium in critically ill patients. The use of antipsychotics for surgical ICU patients and dexmedetomidine for mechanically ventilated patients as a preventive strategy may reduce the prevalence of delirium in the ICU. None of the studied agents that were used for delirium treatment improved major clinical outcome, including mortality.

7. På väg mot en säkrare vård
Sveriges Kommuner och Landsting.Stockholm: Sveriges Kommuner och Landsting, 2015

Patientsäkerhetssatsningen har under de senaste fyra åren bidragit till ett intensifierat patientsäkerhetsarbete, och idag är patientsäkerhetsfrågorna i fokus i hela vården, från högsta ledningsnivå till kliniskt verksamma medarbetare som varje dag möter patienter. Det intensiva patientsäkerhetsarbetet har resulterat i minskad antibiotikaanvändning (nästan en halv miljon färre antibiotikarecept förskrevs under 2014 jämfört med 2010) och antalet allvarliga vårdskador (både med och utan dödlig utgång) har minskat.

Mycket återstår dock att göra för att patienten ska möta en säkrare vård. Viktiga utmaningar på vägen framåt:

  • Involvera patienten i säkerhetsarbetet på ett nytt sätt.
  • Skapa en balans mellan system- och individsyn.
  • Fortsätta kunskapsutvecklingen och lära av varandra.
  • Integrera patientsäkerhetsperspektivet i all hälso- och sjukvård.
  • Samarbeta på alla nivåer med olika aktörer.
  • Våga tänka om och tänka nytt.

8. Antibiotic lock for the prevention of catheter-related infection in neonates
Taylor JE, Tan K, Lai NM, McDonald S, J.
Cochrane Database of Systematic Reviews 2015 (6):CD010336

Use of a central venous catheter (CVC) in neonates is associated with an increase in nosocomial infection. Numerous strategies exist to prevent catheter-related bloodstream infection (CRBSI); however, CRBSI continues to be a major problem. Antibiotic locking catheters is a new and promising treatment that potentially prevents this severe condition. We compared an antibiotic lock technique with no antibiotic lock or placebo, such as heparinised saline, for any duration of time. Based on a small number of trials and neonates, antibiotic lock solution appeared to be effective in preventing CRBSI in the neonatal population. However, as each included study used a different antibiotics and antibiotic resistance could not be reliably assessed, the evidence to-date is insufficient to determine the effects of antibiotic lock on infections in neonates.