Patient safety in health care professional educational curricula: examining the learning experience

This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge? contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study. NHS policy is being taken seriously by course leaders, and Patient Safety material is being incorporated into both formal and informal curricula. Patient safety in the curriculum is largely implicit rather than explicit. All students very much value the practice context for learning about patient safety. However, resource issues, peer pressure and client factors can influence safe practice. Variations exist in students? experience, in approach between university tutors, different placement locations – the experience each offers – and the quality of the supervision available. Relationships with the mentor or clinical educator are vital to student learning. The role model offered and the relationship established affects how confident students feel to challenge unsafe practice in others. Clinicians are conscious of the tension between their responsibilities as clinicians (keeping patients safe), and as educators (allowing students to learn under supervision). There are some apparent gaps in curricular content where relevant evidence already exists – these include the epidemiology of adverse events and error, root cause analysis and quality assessment. Reference to the organisational context is often absent from course content and exposure limited. For example, incident reporting is not being incorporated to any great extent in undergraduate curricula. Newly qualified staff were aware of the need to be seen to practice in an evidence based way, and, for some at least, the need to modify „the standard? way of doing things to do „what?s best for the patient?. A number of recommendations have been made, some generic and others specific to individual professions. Regulators? expectations of courses in relation to patient 9 safety education should be explicit and regularly reviewed. Educators in all disciplines need to be effective role models who are clear about how to help students to learn about patient safety. All courses should be able to highlight a vertical integrated thread of teaching and learning related to patient safety in their curricula. This should be clear to staff and students. Assessment for this element should also be identifiable as assessment remains important in driving learning. All students need to be enabled to constructively challenge unsafe or non-standard practice. Encounters with patients and learning about their experiences and concerns are helpful in consolidating learning. Further innovative approaches should be developed to make patient safety issues 'real' for students

Integrated assessment : new assessment methods evaluation of an innovative method of assessment-critical incident analysis

For many people, the term “assessment” is associated with tasks, which are less than inspiring, which are undertaken only because they are hurdles, which must be crossed in order to achieve some form of accreditation or to enable entry into work or a further course of study. In this worldview, what is important for the student is the final determination or grade assigned to their work. While summative assessment, in which students submit work that is marked by experts and which contributes partially or fully to a final grade, plays an important role in the lives of students and educators, contemporary thinking about “assessment” is much more expansive

Enhancing cultural competence: Trans-Atlantic experiences of European and Canadian nursing students

This paper describes the enhancement of cultural competence through trans-Atlantic rural community experiences of European and Canadian nursing students using critical incident technique (CIT) as the students' reflective writing method. The data generated from 48 students' recordings about 134 critical incidents over a 2-year project were analysed by qualitative content analysis. Five main learning categories were identified as: cross-cultural ethical issues; cultural and social differences; health-care inequalities; population health concerns; and personal and professional awareness. Four emergent cultural perspectives for the health sector that became apparent from the reflections were: health promotion realm; sensitivity to social and cultural aspects of people's lives; channels between the health sector and society; cultural language and stories of local people. CIT was successfully used to foster European and Canadian undergraduate students' cultural reflections resulting in considerations and suggestions for future endeavours to enhance cultural competence in nursing education

A pilot study of operating department practitioners undertaking high-risk learning: a comparison of experiential, part-task and hi-fidelity simulation teaching methods

Health care learners commonly rely on opportunistic experiential learning in clinical placements in order to develop cognitive and psychomotor clinical skills. In recent years there has been an increasing effort to develop effective alternative, non-opportunistic methods of learning, in an attempt to bypass the questionable tradition of relying on patients to practice on. As part of such efforts, there is an increased utilisation of simulation-based education. However, the effectiveness of simulation in health care education arguably varies between professions (Liaw, Chan, Scherpbier, Rethans, & Pua, 2012; Oberleitner, Broussard, & Bourque, 2011; Ross, 2012). This pilot study compares the effectiveness of three educational (or ‘teaching’) methods in the development of clinical knowledge and skills during Rapid Sequence Induction (RSI) of anaesthesia, a potentially life-threatening clinical situation. Students of Operating Department Practice (ODP) undertook either a) traditional classroom based and experiential learning, b) part-task training, or c) fully submersive scenario-based simulated learning

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

An Evidence-based Framework for Reporting Student Nurse Medication Incidents: Errors, Near Misses and Discovered Errors

Purpose: To share an evidence-based framework for reporting and analysing three types of medication incidents in an undergraduate nursing program. Incident types include errors, near misses and discovered errors. Background: Medication errors are underreported. Published studies on errors by nursing students indicate that although errors occur during clinical placements, there is a lack of consensus on how the factors that contributed to the errors are reported and analyzed. This limits our understanding of the factors that impact safe medication administration and reduces our ability to apply this knowledge to education and practice. Method: Quality improvement project. Results: Our reporting framework quantifies system factors that are supported by the literature as contributing to errors but not usually captured in incident reporting. Contributing factors for errors and near misses varied. This finding has not been documented in the literature. Conclusion: Nursing schools should prepare nursing students with a strong commitment to report all incidents and provide them with the competencies and a reporting system that allows them to report efficiently and effectively. As these graduates enter the workforce, they can influence the reporting practices of seasoned nurses. The ten factor framework provides nursing schools with the ability to quantify the individual and system factors that influence the safety of the student nurse medication administration process and the opportunity to implement strategies to reduce and/or prevent these incidents from occurring. Objectif : Présenter un cadre fondé sur des résultats probants pour signaler et analyser trois types d’incidents liés aux médicaments dans un programme de premier cycle en sciences infirmières, soit les erreurs, les quasi-incidents et les erreurs découvertes. Contexte : Les erreurs de médication ne sont pas toutes signalées. Les études publiées portant sur les erreurs causées par des étudiantes infirmières indiquent que, même si les erreurs se produisent durant les stages cliniques, la manière de signaler et d’analyser les facteurs contributifs ne fait pas consensus. Cela limite notre compréhension des facteurs influant sur l’administration sécuritaire des médicaments et réduit notre capacité à mettre en application ces connaissances en formation et en pratique. Méthode : Projet d’amélioration de la qualité. Résultats : Notre cadre de signalements quantifie les facteurs systémiques qui, selon la littérature sur le sujet, contribuent à des erreurs, mais ne figurent pas normalement dans les déclarations d’incident. Les facteurs ayant contribué à des erreurs et quasi-incidents étaient variables. Ce résultat n’a pas été rapporté dans la littérature. Conclusion : Les écoles de sciences infirmières devraient enseigner aux étudiantes infirmières l’importance de signaler l’ensemble des incidents tout en leur fournissant les habiletés et un système de déclaration qui leur permet de les déclarer de façon efficace et efficiente. Lorsque les diplômées intègreront le marché du travail, elles pourront influencer les pratiques des infirmières chevronnées en matière de signalement. Le cadre composé de dix facteurs permet aux écoles de sciences infirmières de quantifier les facteurs individuels et systémiques ayant un impact sur la sécurité du processus d’administration des médicaments par des étudiantes infirmières; il leur permet aussi de mettre en œuvre des stratégies de réduction ou de prévention de tels incidents

Characteristics of Real-Time, Non-Critical Incident Debriefing Practices in the Emergency Department.

INTRODUCTION: Benefits of post-simulation debriefings as an educational and feedback tool have been widely accepted for nearly a decade. Real-time, non-critical incident debriefing is similar to post-simulation debriefing; however, data on its practice in academic emergency departments (ED), is limited. Although tools such as TeamSTEPPS® (Team Strategies and Tools to Enhance Performance and Patient Safety) suggest debriefing after complicated medical situations, they do not teach debriefing skills suited to this purpose. Anecdotal evidence suggests that real-time debriefings (or non-critical incident debriefings) do in fact occur in academic EDs;, however, limited research has been performed on this subject. The objective of this study was to characterize real-time, non-critical incident debriefing practices in emergency medicine (EM). METHODS: We conducted this multicenter cross-sectional study of EM attendings and residents at four large, high-volume, academic EM residency programs in New York City. Questionnaire design was based on a Delphi panel and pilot testing with expert panel. We sought a convenience sample from a potential pool of approximately 300 physicians across the four sites with the goal of obtaining \u3e100 responses. The survey was sent electronically to the four residency list-serves with a total of six monthly completion reminder emails. We collected all data electronically and anonymously using SurveyMonkey.com; the data were then entered into and analyzed with Microsoft Excel. RESULTS: The data elucidate various characteristics of current real-time debriefing trends in EM, including its definition, perceived benefits and barriers, as well as the variety of formats of debriefings currently being conducted. CONCLUSION: This survey regarding the practice of real-time, non-critical incident debriefings in four major academic EM programs within New York City sheds light on three major, pertinent points: 1) real-time, non-critical incident debriefing definitely occurs in academic emergency practice; 2) in general, real-time debriefing is perceived to be of some value with respect to education, systems and performance improvement; 3) although it is practiced by clinicians, most report no formal training in actual debriefing techniques. Further study is needed to clarify actual benefits of real-time/non-critical incident debriefing as well as details on potential pitfalls of this practice and recommendations for best practices for use

The emerging discourse of patient safety – the research and publication contribution of Frank Milligan

A thesis submitted to the University of Bedfordshire, in fulfilment of requirements for the degree of PhD by publicationIntroduction - This thesis presents the portfolio of evidence required for the award of a PhD by publication at the University of Bedfordshire. The theme that runs throughout is the contribution of the work analysed to the discourse of patient safety in terms of the theoretical, educational, practice development and research contribution made by the author. Aim and objectives - The aim of the portfolio is to provide a critical analysis of the contribution made by the author to the growing discourse of patient safety. The objectives were to synthesise those contributions through a narrative analysis of the publications with particular reference to: 1. The delineation of patient safety as a viable discourse in healthcare 2. The changing role of medicine as a profession within the context of patient safety 3. The centrality of human factors theory in improving future patient safety practice 4. Safety culture, its definition and problematic relationship with safeguarding 5. Education and healthcare practice. The literature - The publications included here range in time scale from 1998 to 2017. Twenty-four pieces of literature are analysed and consist of a co-edited book, three research reports, four chapters from two different books and sixteen peer-reviewed journal articles. A citation summary for these publications is provided in Appendix 1. Key themes - Early publications focused on a critique of western medicine in order to highlight the unnecessary harm that was occurring in medically dominated healthcare systems. This critique moved through the concepts of iatrogenesis and adverse events before settling on patient safety as the key concept through which to influence quality enhancement in healthcare practice. The range and scale of the authors publications reviewed here added value to concepts such as safety culture and the centrality of patient safety incident reporting in such cultural shifts. Other aspects of human factors theory were promoted, most notably the Human Factors Analysis and Classification System leading on to research in the field of medication safety, human factors and safety culture in the context of the nursing home setting. These and other recent publications have highlighted inconsistencies in the relationship between patient safety and safeguarding, and argue that safeguarding has led to something of a return to the blame culture that has been historically present in healthcare. Conclusion - Patient safety is now a priority in healthcare, although one that has to operate within the political and financial constraints that are inevitably associated with healthcare provision. The evidence and analysis given here shows that the publication and research record generated has both reflected and facilitated the growing discourse of patient safety