Psychometric properties of the Hospital Survey on Patient Safety Culture: findings from the UK

Background: Patient safety culture is measured using a range of survey tools. Many provide limited data on psychometric properties and few report findings outside of the USA healthcare context. This study reports an assessment of the psychometric properties and suitability of the American Hospital Survey on Patient Safety Culture (HSOPC) for use within the UK. Methods: A questionnaire survey of three hospitals within a large UK Acute NHS Trust. 1,437 questionnaires were completed (37% response rate). Exploratory factor analysis, confirmatory factor analysis, and reliability analyses were carried out to assess the psychometric performance of this survey instrument and explore potential improvements. Results: Reliability analysis of the items within each proposed scale showed that over half failed to achieve satisfactory internal consistency (Cronbach’s Alpha < 0.7). Furthermore, a confirmatory factor analysis carried out on the UK dataset achieved a poor fit when compared to the original American model. An optimal measurement model was then constructed via exploratory and confirmatory factor analysis with split-half sample validation, and consisted of 9 dimensions compared to the original 12 in the American model. Conclusion: This is one of the few studies to provide an evaluation of an American patient safety culture survey using data from the UK. The results indicate that there is need for caution in using the HSOPC survey in the UK and underline the importance of appropriate validation of safety culture surveys before extending their usage to populations outside of the specific geographical and health care contexts in which they were developed

Design, architecture, pharmacy: making a difference to understanding anti-microbial resistance (AMR)

This paper presents the work of the AHRC-funded cross-disciplinary project, ‘Information and Architecture in Persuasive Pharmacy Space: combating antimicrobial resistance’ (IDAPPS) which is designed to support one of the strategic aims of the UK 5-Year Antimicrobial Resistance strategy 2013-18, how to ‘improve the knowledge and understanding of antimicrobial resistance’. The paper introduces the working methods and outcomes of work to consider how we can use space within a pharmacy to encourage people to engage with information about AMR and self-care; and how we can design information so it is understood, whether on paper or in digital form. The research methods included review and analysis of archival material relevant to presenting information about drug-resistant infections; hierarchical task analysis; and co-design workshops with pharmacy workers and users. One of the IDAPPS research outputs was a competition, designed to reinforce the cross-disciplinary approach that we propose is key to the challenge of communicating about AMR. The paper discusses and shows examples of the ideas and prototypes that emerged from the teams of designers, architects, behavioural scientists, and pharmacists

Patient safety in dentistry: development of a candidate 'never event' list for primary care

Introduction The 'never event' concept is often used in secondary care and refers to an agreed list of patient safety incidents that 'should not happen if the necessary preventative measures are in place'. Such an intervention may raise awareness of patient safety issues and inform team learning and system improvements in primary care dentistry. Objective To identify and develop a candidate never event list for primary care dentistry. Methods A literature review, eight workshops with dental practitioners and a modified Delphi with 'expert' groups were used to identify and agree candidate never events. Results Two-hundred and fifty dental practitioners suggested 507 never events, reduced to 27 distinct possibilities grouped across seven themes. Most frequently occurring themes were: 'checking medical history and prescribing' (119, 23.5%) and 'infection control and decontamination' (71, 14%). 'Experts' endorsed nine candidate never event statements with one graded as 'extreme risk' (failure to check past medical history) and four as 'high risk' (for example, extracting wrong tooth). Conclusion Consensus on a preliminary list of never events was developed. This is the first known attempt to develop this approach and an important step in determining its value to patient safety. Further work is necessary to develop the utility of this method

Automated link analysis using radio frequency identification (RFID)

Being able to accurately record the interactions which take place within any environment is beneficial for understanding human behaviour in a wide range of industries. Link Analysis is a standard technique which is often used, but traditional pen and paper methods are cumbersome and time consuming. This paper details a way to automate recording the interactions between a human and their current environment by using radio frequency identification (RFID) tags and a subject-mounted receiver. Using the results from the system, it is possible to instantly create conventional Link Analysis diagrams and tables, reducing the time and resources required for data collection and analysis. The system has been developed in partnership with the Healthcare Ergonomics and Patient Safety Unit (HEPSU) at Loughborough University, with initial focus being on monitoring paramedics, patients and environment interactions within an ambulance; however, the technologies and the analyser system are not limited to use within this particular field

Aerosol Characteristics at a High Altitude Location in Central Himalayas: Optical Properties and Radiative Forcing

Collocated measurements of the mass concentrations of aerosol black carbon (BC) and composite aerosols near the surface were carried out along with spectral aerosol optical depths (AODs) from a high altitude station, Manora Peak in Central Himalayas, during a comprehensive aerosol field campaign in December 2004. Despite being a pristine location in the Shivalik Ranges of Central Himalayas, and having a monthly mean AOD (at 500 nm) of 0.059 $\pm$ 0.033 (typical to this site), total suspended particulate (TSP) concentration was in the range 15 - 40 micro g m^(-3) (mean value 27.1 $\pm$ 8.3 micro g m^(-3)). Interestingly, aerosol BC had a mean concentration of 1.36 $\pm$ 0.99 micro g m^(-3), contributed to ~5.0 $\pm$ 1.3 % to the composite aerosol mass. This large abundance of BC is found to have linkages to the human activities in the adjoining valley and to the boundary layer dynamics. Consequently, the inferred single scattering albedo lies in the range of 0.87 to 0.94 (mean value 0.90 $\pm$ 0.03), indicating significant aerosol absorption. The estimated aerosol radiative forcing was as low as 4.2 W m^(-2) at the surface, +0.7 W m^(-2) at the top of the atmosphere, implying an atmospheric forcing of +4.9 W m^(-2). Though absolute value of the atmospheric forcing is quite small, which arises primarily from the very low AOD (or the column abundance of aerosols), the forcing efficiency (forcing per unit optical depth) was $\sim$88 W m^(-2), which is attributed to the high BC mass fraction.Comment: 32 Pages, Accepted in JGR (Atmosphere

Life values as predictors of pain, disability and sick leave among Swedish registered nurses: a longitudinal study

<p>Abstract</p> <p>Background</p> <p>Prospective studies on high-risk populations, such as subgroups of health care staff, are limited, especially prospective studies among staff not on sick-leave. This paper is a report of a longitudinal study conducted to describe and compare the importance and consistency of life domains among registered nurses (RNs) working in a Swedish hospital and evaluate a model based on the consistency of valued life domains for prediction of pain, disability and sick leave.</p> <p>Method</p> <p>Importance and consistency ratings of life values, in 9 domains, were collected during 2003 and 2006 from 196 RNs using the Valued Living Questionnaire (VLQ). Logistic regression analyses were used for prediction of pain, disability and sick leave at the three-year follow-up. The predictors family relations, marriage couples/intimate relations, parenting, friends/social life, work, education, leisure time, psychological well-being, and physical self-care were used at baseline.</p> <p>Results</p> <p>RNs rated life values regarding parenting as most important and with the highest consistency both at baseline and at follow-up. No significant differences were found between RNs' ratings of importance and consistency over the three-year period, except for friends/social relations that revealed a significant decrease in importance at follow-up. The explanatory models for pain, disability and sick leave significantly predicted pain and disability at follow-up. The odds of having pain were significantly increased by one consistency rating (psychological well-being), while the odds were significantly decreased by physical self-care. In the model predicting disability, consistency in psychological well-being and education significantly increased the odds of being disabled, while consistency in physical self-care significantly decreased the odds.</p> <p>Conclusion</p> <p>The results suggest that there might be a link between intra-individual factors reflecting different aspects of appraised life values and musculoskeletal pain (MSP).</p

Variation in the provision and practice of implant-based breast reconstruction in the UK: Results from the iBRA national practice questionnaire

Introduction The introduction of biological and synthetic meshes has revolutionised the practice of implant-based breast reconstruction (IBBR) but evidence for effectiveness is lacking. The iBRA (implant Breast Reconstruction evAluation) study is a national trainee-led project that aims to explore the practice and outcomes of IBBR to inform the design of a future trial. We report the results of the iBRA National Practice Questionnaire (NPQ) which aimed to comprehensively describe the provision and practice of IBBR across the UK. Methods A questionnaire investigating local practice and service provision of IBBR developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Summary data for each survey item were calculated and variation between centres and overall provision of care examined. Results 81 units within 79 NHS-hospitals completed the questionnaire. Units offered a range of reconstructive techniques, with IBBR accounting for 70% (IQR:50–80%) of participating units' immediate procedures. Units on average were staffed by 2.5 breast surgeons (IQR:2.0–3.0) and 2.0 plastic surgeons (IQR:1.0–3.0) performing 35 IBBR cases per year (IQR:20-50). Variation was demonstrated in the provision of novel different techniques for IBBR especially the use of biological (n = 62) and synthetic (n = 25) meshes and in patient selection for these procedures. Conclusions The iBRA-NPQ has demonstrated marked variation in the provision and practice of IBBR in the UK. The prospective audit phase of the iBRA study will determine the safety and effectiveness of different approaches to IBBR and allow evidence-based best practice to be explored