Healthcare safety research

Burtscher, M. J., Manser, T. (2012). Team mental models and their potential to iminove teamwork and safety A review and implications for future research in healthcare. Safety Science, 50, 1344-1354. 

Hale and Hovden (1998) described management and culture as the third age of safety. The first age was about technical measures, the second about human factors and individual behaviour (Hale and Glendon 1987) and these merged with the technological approaches. Catchpole et al. (2011) in their summary of the development of patient safety research in healthcare, characterised early human factors work in patient safety as focusing on attempts to locate the source of error within medicine. Other exploratory work, took a number of forms, including review of patient s case notes (Vincent et al. 

Tumberg, W. and Daniell, W. 2008. Evaluation of a healthcare safety climate measurement tool. Journal of Safety Research, 39, 563-8. 

Patient safety researchers have developed several surveys to assess patient safety climate, including the Safety Attitudes Questionnaire (SAQ), AHRQ s Hospital Survey on Patient Safety Culture (SOPS see Chapter 12 for more detailed information), and Patient Safety Climate in Healthcare Organizations. Our chapter provides an in-depth examination of the SAQ in terms of what it measures, key findings and limitations and future areas in need of research. 

It appears that the modern patient safety movement started in 1991 with the publication of the results of the Harvard Medical Practice Study in the New England Journal of Medicine [2-4], In the study, the medical records of 30,000 patients hospitalized in acute care hospitals in New York State in 1984 were examined. In 1996, the American Medical Association announced the formation of the National Patient Safety Foundation [2], In 1999, the National Academy of Sciences Institute of Medicine released its report entitled "To Err Is Human Building a Safer Health System" [5]. The report stated that medical errors are causing 44,000-98,000 preventable deaths annually in the United States. In 2001, the United States Congress appropriated 50 million per year for patient safety research to the Agency for Healthcare Research and Quality (AHRQ) [2],... 

Woods, D.D. 2000a. Behind human error human factors research to improve patient safety. National Summit on Medical Errors and Patient Safety Research, Quality Interagency Coordination Task Force and Agency for Healthcare Research and Quality, September 11, 2000. www.apa.org/ppo/issues/shumfactors2.html. 

Sexton, J.B., Thomas, E.J., Helmreich, R.L., Neilands, T.B., Rowan, K., Vella, K., Boyden, J. and Roberts, P.R. (nndated). Frontline Assessments of Healthcare Cnltnre Safety Attitndes CJuestioimaire Norms and Psychometric Properties , Technical Report 04-01, The Uiuversity of Texas Center of Excellence for Patient Safety Research and Practice. 

There is no doubt that the continuing evaluation of the safety of medicines into the post-marketing period is an expanding and stiU developing area of research. Matters relating to safety spread over into efficacy, which together imply risks and benefits which, in the present international climate of healthcare provision, have consequences for outcomes and costs. A whole new field of research - pharmacoeconomics - is in the process of development and it is to be anticipated that many of the methods used for safety evaluation will be modified and applied in this area. 

In addition, the U.S. Department of Health and Human Services (HHS) and other federal agencies formed the Quality Interagency Coordination Task Force in 2000 and issued an action plan for reducing medical errors. In 2001, former HHS Secretary Tommy G. Thompson announced a Patient Safety Task Force to coordinate a joint effort to improve data collection on patient safety. The lead agencies are the FDA, the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the Agency for Healthcare Research and Quality. 

SIG (prescription instructions), and RxNorm (standard name, dose, and form availability) were not considered ready for implementation because of numerous approaches used in these three areas across health information technology. Electronic prescribing is not required under MMA, but plans are to have it available should providers choose to use it. As standards are developed, the adoption of e-prescribing is expected to improve patient safety by reducing prescribing and dispensing errors (Agency for Healthcare Research Quality, 2007). 

To Err Is Human contains a four-part plan for decreasing the number of medical errors, and each part has implications for the pharmacy profession. To provide leadership and a research focus for patient safety. Part one recommends the creation of a center for patient safety within the Agency for Healthcare Research and Quality (AHRQ). Pharmacy organizations and pharmacists have the opportunity to contribute by including the study of medical errors in their applied research agendas. Using their expertise, pharmacists can provide input to the national goals, their content, and professional responsibilities for medicahon safety. ... 

When gender differences in safety or efficacy were found to be clinically significant, most respondent companies (94%) opted to put the data in the product label, the Physicians Desk Reference and the product literature (72%), and to publish in the medical journals (69%). Presumably, the two companies that did not amend their labels acted thus because the products were only intended for one-gender use. By December 1999, there were 348 medicines in development for diseases only in women or where women are disproportionately affected (Holden, 2000). Not only has industry stepped up its research efforts, but many large firms have units devoted to women s healthcare. 

The measurement of outcomes is critical to the conduct of pharmaceutical research. Clinical outcomes (efficacy and safety) are the hallmarks of Food and Drug Administration (FDA) approval of a product for marketing. Clinical outcomes are necessary but no longer sufficient as a sole consideration in weighing decisions, and for reimbursement in socialized healthcare systems (where reimbursement essentially governs marketability). 

Patients have become more involved in their own healthcare decisions, and economic considerations have increased in importance. All have contributed to the movement to extend outcomes measured beyond the traditional clinical outcomes associated with pharmaceutical research. Healthcare decision makers are pressed to know more than simply the safety and efficacy parameters of an intervention. It is important for them to know how a specific intervention will impact budgets and use of other resources, and how it will impact the patient from the patient s perspective. 

Another major function of the Medical Affairs department is that of providing information about a company s products. Their customers range from fellow healthcare professionals to the public and internal company clients. The frontline is usually comprised of nurses and registered pharmacists who respond to telephone and written requests for medical information about products, spanning clinical safety and efficacy questions. Companies often offer this service as needed and most can respond to clinical questions within 24 h of a request with specific and detailed information. A frequently asked question document is prepared to enhance rapidity of response. If this document does not provide the needed information, further research by Medical Information specialist, often in collaboration with internal clinical staff, is... 

Quality me a.t are merit and improvement requires developing and testing quality measures and investigating the best ways to collect, compare, and communicate these data so they are useful to decision makers. AHRQ s research emphasizes studies of the most effective ways to implement these measures and strategies in order to improve patient safety and healthcare quality. 

Since its establishment in 1989, AHRQ has sponsored and conducted research to improve the quality of health care, reduce its cost, and increase access. It also supports research to address patient safety issues and medication errors. AHRQ s goal is to provide information that allows people to make better decisions about healthcare. 

To enhance the quality, appropriateness, and effectiveness of health care services, and access to these services the federal government in the Omnibus Budget Reconciliation Act of 1989 (Public Law 101-239) established the AHCPR. The act, sometimes referred to as the Patient Outcome Research Act, called for the establishment of a broad-based, patient-centered outcomes research program. In addition to the traditional measures of survival, clinical endpoints and disease- and treatment-specific symptoms and problems, the law mandated measures of functional status and well-being and patient satisfaction. In 1999, then President Clinton signed the Healthcare Research and Quality Act, reauthorizing AHCPR as the AHRQ until the end of fiscal year 2005. Presently, its mission is to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, broaden access to effective services, and improve the quality of health care services. 

---