Wissenschaftliche Publikationen

Der vorliegende Bericht gibt einen Überblick über potenziell relevante Handlungsfelder und wirksame Patientensicherheitsmassnahmen für nationale Qualitätsverbesserungsprojekte, beschreibt vielversprechende Implementierungspraktiken, evaluiert die «progress! Pilotprogramme», skizziert Methoden und Inhalte für zukünftige Interventionsprogramme und identifiziert prioritäre Handlungsfelder.

Eine Executive Summary, welche einen Überblick über die Hautperkenntnisse gibt, ist in deutscher, englischer, italienischer und französischer Sprache verfügbar. Der vollständige englische Bericht ist frei zugänglich.

• Annemarie Fridrich; Yvonne Pfeiffer; Andrea Niederhauser; David Schwappach; Patient safety interventions and their implementation: Current status and directions for the future; Konzept April 2021, Project-Nr. 736.2-6/8

Results
Data of 959 health care professionals were included in the analysis. Single participants identified on average 4.7 of the 10 errors and additional 10 errors and hazards that were not part of the official scenario. However, they also overestimated their performance, with 58% feeling the errors to be easy to find. Group observations indicated that participants rarely reflected on possible consequences of the hazards for the patient or their daily work. Participants feedback to the method was very positive.

Conclusions
Our findings suggest that the Room of Horrors is a popular and effective method to raise situational awareness for patient safety issues among health care staff. More attention should be given to debriefing after the experience and to benefits of interprofessional trainings.

Source
Journal of Patient Safety

Authors
Chantal Zimmermann, Annemarie Fridrich, David Schwappach

Abstract

Results
In 22 (3.2%) of 690 observed double checks, 28 chemotherapy-related inconsistencies were detected. Half of them related to non-matching information between order and drug label, while the other half was identified because the nurses used their own knowledge. 75% of the inconsistencies could be traced back to inappropriate orders, and the inconsistencies led to 33 subsequent or corrective actions.

Conclusions
In double check situations, the plausibility of the medication is often reviewed. Additionally, they serve as a correction for errors and that are made much earlier in the medication process, during order. Both results open up new opportunities for improving the medication process.

Source
BMJ open

Authors
Dr. Yvonne Pfeiffer, Chantal Zimmermann, Prof. Dr. David Schwappach, Patientensicherheit Schweiz

Abstract

Potenziell inadäquate Verschreibungen („potentially inappropriate prescribing“, PIP, inklusive potenziell inadäquate Medikation, PIM) sind verbreitet. In Praxis und Forschung können PIP-Listen verwendet werden, um die Medikation eines Patienten zu optimieren. Trotzdem werden diese selten verwendet, vermutlich aufgrund ihrer begrenzten Benutzerfreundlichkeit. Ziel dieser Studie war die Evaluation der Meinungen der Apotheker- und Ärzteschaft, die Pflegeheimbewohnende betreut, zur Benutzerfreundlichkeit, zum Kenntnisstand und zur Verwendung von PIP-Listen.

Ergebnisse
Insgesamt konnten 30 Fachpersonen befragt werden, acht von ihnen im Rahmen eines Telefoninterviews. Die Teilnehmer hatten häufig (43 %, 13/30) schon von PIP-Listen gehört, und 46 % (6/13) verwendeten bereits eine PIP-Liste. Weniger erfahrene Fachpersonen hatten schon häufiger von PIP-Listen gehört als erfahrenere Kollegen. Für die Interviewten waren es am wichtigsten, dass PIP-Listen mit kurzem Zeitaufwand angewendet werden können, dass sie elektronisch verfügbar und klar strukturiert sind und dass sie Gründe angeben, weshalb eine Medikation potenziell inadäquat ist.
Die Ärzteschaft bevorzugte im Vergleich zur Apothekerschaft eine an den Arzneimittelmarkt der Schweiz angepasste PIP-Liste.

Schlussfolgerung
Damit PIP-Listen häufiger verwendet werden, sollten die Aspekte der Benutzerfreundlichkeit berücksichtigt werden. Personalisierbare PIP-Listen könnten eine interessante Weiterentwicklung sein.

Quelle
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen

Autorschaft
Simone C.Lüscher, Kurt E.Hersbergera, Lea D.Brühwiler

Abstract
 

Results
We screened relevant G/Rs published between 1999 and 2018 and aggregated all available information as candidate GBIs into a formalized handbook as the basis for the subsequent consensus rating procedure. An international multidisciplinary expert panel group (EPG) of acknowledged MDS experts (n = 17), health professionals (n = 7), and patient advocates (n = 5) was appointed. The EPG feedback rates for the first and second round were 82% (23 of 28) and 96% (26 of 27), respectively. A final set of 29 GBIs for the 3 domains of diagnosis (n = 14), therapy (n = 8), and provider/infrastructural characteristics (n = 7) achieved the predefined agreement score for selection (>70%).

Conclusion
We identified shortcomings in standardization of patient-reported outcomes, toxicity, and geriatric assessments that need to be optimized in the future. Our GBIs represent the first comprehensive consensus on measurable elements addressing best practice performance, outcomes, and structural resources. They can be used as a standardized instrument with the goal of assessing, comparing, and fostering good quality of care within clinical development cycles in the daily care of adult MDS patients.

Source
Blood advances

Authors
Kristina Stojkov, Tobias Silzle, Georg Stussi, David Schwappach, Juerg Bernhard, David Bowen et al

Abstract
 

Findings
We included 25,880 patients [13,171 before the intervention (August-October 2016) and 12,709 after the intervention (August-October 2017)]. Catheter utilization dropped from 23.7% to 21.0% (p=0.001), and catheter-days per 100 patient-days from 17.4 to 13.5 (p=0.167). CAUTI remained stable on a low level with 0.02 infections per 100 patient-days (before) and 0.02 infections (after), (p=0.98). Measuring infections per 1,000 catheter-days, the rate was 1.02 (before) and 1.33 (after), (p=0.60). Non-infectious complications dropped significantly, from 0.79 to 0.56 events per 100 patient-days (p<0.001), and from 39.4 to 35.4 events per 1,000 catheter-days (p=0.23). Indicated catheters increased from 74.5% to 90.0% (p<0.001). Reevaluations increased from 168 to 624 per 1,000 catheter-days (p<0.001).

Conclusion
In this before/after intervention study of urinary catheter utilization, a straightforward bundle of three evidence-based measures (providing a catheter indication list, promoting daily catheter evaluation, and teaching state-of-the-art catheter insertion) reduced catheter utilization and led to increases in indicated urinary catheters and daily evaluations. The intervention had an impact on non-infectious complications, whereas the CAUTI rate remained on a low level.The next step is planning the national roll-out of both the surveillance module and the intervention bundle, the components of which have been made available to the public (surveillance module, intervention bundle)

Source
The Journal of Hospital Infection

Authors
Dr. Alexander Schweiger, Prof. Dr. med. Jonas Marschall, PD Dr. med. Stefan P. Kuster, Judith Maag, Prof. Hugo Sax, Swissnoso
Andrew Atkinson, Inselspital Bern
Dr. med. Sonja Bertschy, Kantonsspital Luzern
Emmanuelle Bortolin, Ente Ospidaliero Cantonale Bellinzona
Dr. Gregor John, Hôpital Neuchâtelois
PhD Andreas Limacher, Universität Bern
Prof. Dr. David Schwappach und Dr. Stephanie Züllig, Patientensicherheit Schweiz

Abstract

To identify institutional policies and support for health professionals who have been involved in an adverse patient event and become traumatised from the event, also called second victims, we conducted a cross-sectional, multicentre survey study. We targeted Swiss acute care, university and psychiatric hospitals, as well as rehabilitation and speciality clinics. A 13-item questionnaire was used to collect information from hospital quality managers regarding their institutions’ policies and support practices with respect to second victims. Data were analysed using descriptive statistics.

Results
Overall, respondents from 116 hospitals completed the questionnaire (response rate 50.2%). Most institutional respondents reported both that they would like to receive information about adverse events and that their institutions offer related support. Of participating institutions, 60% indicated that they actively inform their personnel about second-victim support possibilities; however, only 31% specifically train supervisory personnel to deliver that support, and only 32% have hospital-specific guidelines in place for second victim support. University, acute care and speciality clinics were more likely to use such guidelines than psychiatric and rehabilitation clinics. Analysis indicated an association between hospital size and the existence of guidelines.

Conclusions
In Swiss hospitals, second victim support is generally prevalent, but often in an unstructured way. This lack of methodology increases the risk that, following adverse events, both the quantity and quality of support provided to health professionals will be insufficient. A firm commitment on the part of institutional leaders to implement related policies could foster the adoption of high-quality second victim guidelines in Swiss hospitals.

Source
Swiss Medical Weekly

Authors

Franziska Reiser Crelier, MSN, Institute of Nursing Science, Department Public Health, University of Basel Switzerland

Prof. Dr. David Schwappach, Swiss Patient Safety Foundation, Zurich, Switzerland and Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland

PD Dr. René Schwendimann, Patient Safety Office, University Hospital Basel, Switzerland and Institute of Nursing Science, Department Public Health, University of Basel, Switzerland

Abstract
 

Results
Clinical risk managers representing 95 hospitals completed the survey (55% response rate). Among responding risk and quality managers, only 45% would be formally notified through a designated reporting channel if a never event has happened in their hospital. Averaged over a list of 8 specified events, only half of hospitals could report a systematic count of the number of events. Hospital size was not associated with never- event-management. Respondents reported that their hospital pays “too little attention” to the recording (46%), the analysis (34%), and the prevention (40%) of never events. All respondents rated the systematic registration and analysis of never events as very (81%) or rather important (19%) for the improvement of patient safety.

Conclusions
A substantial fraction of Swiss hospitals do not have valid data on the occurrence of never events available and do not have reliable processes installed for the registration and exam of these events. Surprisingly, larger hospitals do not seem to be better prepared for never events management.

Source
Journal of Patient Safety

Authors
Prof. Dr. David Schwappach and Dr. Yvonne Pfeiffer from Swiss Patient Safety Foundation

Abstract

Objective
The aim was to exploratively and prospectively assess patient safety risks from an expert perspective: instead of retrospectively analyzing safety events, we assessed the information management hazards inherent to the daily work processes; instead of asking healthcare workers at the front line, we used them as information sources to construct our patient safety expert view on the hazards.

Methods
The work processes of clinicians in three ambulatory infusion centers were assessed and evaluated based on interviews and observations with a nurse and a physician of each unit. The 125 identified patient safety issues were described and sorted into thematic groups.

Results
A broad range of patient safety issues was identified, such as data fragmentation, or information islands, meaning that patient data are stored across different cases or software and that different professional groups do not use the same set of information.

Conclusions
The current design and implementation of HIT systems do not support adequate information management: clinicians needed to play very close attention and improvise to avoid errors in using HIT and treat cancer patients safely. It is important to take the clinical front-end practice into account when evaluating or planning further HIT improvements.

Source
Journal of Patient Safety

Authors
Dr. Yvonne Pfeiffer; Chantal Zimmermann; Prof. Dr. David Schwappach von Patientensicherheit Schweiz.

Abstract
 

As double checking uses considerable resources of nurses’ time and cognitive capacity, there is a pressing need to know whether existing empirical evidence supports using double checking despite its mentioned shortcomings.
We present a framework for classifying checking procedures and differentiating them from other medication-related safety behaviours in order to structure future research and practice. In addition, the concept of independence is discussed.

Source
BMJ Quality and Safety

Authors
Dr. Yvonne Pfeiffer; Chantal Zimmermann; Prof. Dr. David Schwappach von Patientensicherheit Schweiz.

Abstract
 

The QI project was modelled after other successful QI initiatives in the USA.The overall project goal was to reduce IUC use and to promote safe catheter insertion and maintenance by implementing an evidence-based intervention bundle in seven Swiss acute care hospitals.With the present study, we aimed to assess the changes in staff perspectives in the participating hospitals using survey data collected before and after implementation of the intervention bundle.

Conclusion
Changing staff attitudes, knowledge and behaviour are important prerequisites for an effective reduction of catheter use and catheter-associated complications. We found small but significant changes in staff perceptions after implementation of an evidence-based intervention bundle. The positive trends were present in all subgroups, indicating that regardless of responsibilities and practice of catheter placement, perspectives on urinary catheter use changed over time. Efforts now need to be targeted at reinforcing and sustaining these changes, so that restrictive use of IUCs becomes an integral part of the hospital culture.

Source
BMJ Open

Authors
Andrea Niederhauser, Stephanie Züllig, Jonas Marschall, Alexander Schweiger, Gregor John, Stefan P Kuster, David LB Schwappach on behalf of the progress! Safe Urinary, Catheterization Collaboration Group

Abstract

Conclusions
Speaking up for patient safety is an important topic in the psychiatric healthcare setting. Speaking up to prevent harm to patients should be further promoted in psychiatric clinics as an important safety measure. In order to fully enact their role as advocates for patient safety, nurses should be empowered to voice concerns even in difficult situations. Further research is needed to gain more insights into the complex trade‐offs and considerations that influence decisions to speak up or withholding voice in the psychiatric healthcare setting.

Source
International Journal of Mental Health Nursing

Authors
David L. B. Schwappach PhD, MPH; Andrea Niederhauser MPH

Abstract

 work more efficiently; it can also prevent errors and mishaps, which can have serious consequences for patients.While an increasing number of studies have demonstrated the effect of hospital design on patient safety, this knowledge is not easily accessible to clinicians, practitioners, risk managers, and other decision-makers, such as designers and architects of health care facilities. This is why the Swiss Patient Safety Foundation launched its project, «More Patient Safety by Design: Systemic Approaches for Hospitals», which is presented in this chapter.

Source
Advances in Health Care Management

Authors
Irene Kobler, Prof. Dr. Alfred Angerer, Prof. Dr. David Schwappach, MPH

Abstract

Results
326 individuals completed the questionnaire (response rate 24%). 37% of responders were in their 5th- 6th clinical term, 32% were in their 7th-8th term and 31% were in the 9th-12th term. 69% of students had a specific safety concern in the past four weeks, 48% had observed an error and 68% noticed the violation of a patient safety rule. Though students perceived specific patient safety concerns, 56% did not speak up in a critical situation. All predefined barriers seemed to play an important role in inhibiting students’ voicing concerns. The scores on the psychological safety scale were overall moderately favourable. Students felt little encouraged by colleagues and, in particular, by supervisors to speak up.

Conclusion
Speaking up behaviour of students was assessed for the first time in an Austrian academic teaching hospital. The higher the term the more frequent students reported perceived patient safety concerns or rule violations and withholding voice. These results suggest the need to adapt the curriculum concept of the faculty in order to address patient safety as a relevant topic.

Source
PLOS ONE

Authors
David Schwappach, Gerald Sendlhofer, Lars-Peter Kamolz, Wolfgang Köle, Gernot Brunner

Abstract
 

Ziel der Leitlinie ist es, den Fachpersonen in der chirurgischen Versorgung zu helfen, eine unbeabsichtigte perioperative Hypothermie zu vermeiden. Sie enthält evidenzbasierte Empfehlungen sowie konkrete Massnahmen zur Implementierung und Umsetzung.

Die Leitlinie ist im Verbund der klinischen Fachgesellschaften in Deutschland, Österreich und der Schweiz und unter Federführung der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI) entstanden. Prof. Dr. David Schwappach, wissenschaftlicher Leiter bei Patientensicherheit Schweiz, hat bei der Erarbeitung mitgewirkt.

Source
AWMF online

Autoren
Federführende Fachgesellschaft: Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e.V. (DGAI)

Beteiligung weiterer Fachgesellschaften/Organisationen:

Schweizerische Gesellschaft für Anästhesiologie und Reanimation (SGAR)

Österreichische Gesellschaft für Anästhesiologie, Reanimation und Intensivmedizin (ÖGARI)

Deutsche Gesellschaft für Fachkrankenpflege und Funktionsdienste e. V., DGF

Stiftung Patientensicherheit Schweiz

Leitlinie

Ergebnisse
Es nahmen 420 von 1525 eingeladenen Personen an der Befragung teil (Rücklaufquote: 27.5%). Davon gaben 65.0% an, dass in ihrer Einrichtung eine regelmäßige systematische Überprüfung der Medikation vorgesehen ist. In 9.5% der Pflegeheime wird eine Liste zur Identifikation von potenziell inadäquater Medikation eingesetzt und 6.7% der Heime haben einen standardisierten Prozess, um Nebenwirkungen von Medikamenten zu überwachen. 66.0% der teilnehmenden Heime setzen mindestens einen dieser Prozesse um, 34.0% setzen keinen der drei Prozesse um. Statistisch signifikante Unterschiede in der Umsetzung der Prozesse zeigten sich nach Standort des Pflegeheims, der Art des Dokumentationssystems für die Medikation, dem Arztmodell, der Anzahl externer Ärzte/Ärztinnen sowie dem Bezugskanal der Medikamente und der gesetzlichen Verpflichtung zur Zusammenarbeit mit Apothekern/Apothekerinnen. Keine Unterschiede zeigten sich nach Heimgröße.

Schlussfolgerung
In Schweizer Alters- und Pflegeheimen sind zentrale sicherheitsrelevante Medikationsprozesse noch nicht flächendeckend umgesetzt. Besonders in Einrichtungen, in denen viele externe Belegärzte Bewohnende betreuen, ist die Umsetzung noch wenig fortgeschritten. Die organisationalen Merkmale müssen für eine erfolgreiche Implementierung von Verbesserungsmassnahmen berücksichtigt werden.

Source
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen

Autoren
Andrea Niederhauser, Dr. Lea Brühwiler, Dr. Liat Fishmann, Prof. Dr. David Schwappach der Stiftung Patientensicherheit Schweiz.

Abstract