ABSTRACT
Safety culture is a term originally coined by The International Nuclear Safety Advisory Group which was indented to denote the conditional dysfunction and the decision process that led to disaster of Chernobyl nuclear during 1986 illustrated by the group of International Atomic Commission Energy (1986). This concept has been adapted in almost the concept was adapted in almost every applicable areas for identifying the behavioral observation sand patterns in attitudes associated with the healthcare industry ever since then.
INTRODUCTION
Potential performances that are delivered are the more focused areas in healthcare industry in terms of Safety Culture than the outcomes that are general. These Safety Culture aspects are preconditioned and are set well before consideration of proposed number of tasks at a specific situation which usually vary with true situation elaborated by Reiman T, et al. (2010, vl 19(5), e20). Safety Culture interventions involving improved outcomes and better safety practices are put forward by the new generation medical institution as discussed by Pronovost P, et al (2005, vol:1 iss:1 p:33–40) and Huang DT, et al (2010 vol: 22(3) ,p: 151–161).
Castle NG, et al. (2007, vol: 32(1), p: 66–76) and Wagner LM, et al. (2009; vol: 41(2), p:184–192) suggest that in general studies it is usually observed that nursing homes are poorly developed from a safety culture aspect. Nursing homes are still in a pitiful situation for improving their safety cultures.
According to P. Aspden (2007) Medication Errors (MEs) causing the Adverse Events (AEs) are posing continued challenges when it comes to acute care situations. It was recently stated by WHO that there has been statistical increase in MEs giving an estimate of about 1.5 million patients affected due to MEs in major countries like United States and United Kingdom. P. Aspden (2007) also illustrated that risk factors from ME’s are supported by substantial evidences. “Preventing Medication Errors” reports discusses that on average annually 5% to 10% of patients who are affected due to MEs end in deaths cases and this rounds to be about 7000 deaths, which is a number covering only United States and increasing in different countries.
MEDICAL ERRORS
The main definition of ME is inconsistent, although several attempts are being made on developing international definitions. NCC MERPP (2012) – The National Coordination Council for Medication Error Reporting and Protection discusses that “The Medication Errors are preventable which might cause due to inappropriate medicinal uses and wrong diagnosis in early stages or this may be due to control of health care professionals. These could be related to the lack in practice of healthcare products, systems and procedures.” The range of errors is usually widened due to many factors like miss communication, nomenclature, wrong product labeling, packaging, to wrong monitoring, and usage directions included.
The fundamental for the process of improving patient care A. Page, Ed (2004) J. G. Samuels (2010, vol. 40, no. 11, pp. 471-476) is creation of reliable health organizations. Safe and reliable practice environments M. Stergiou-Kita (2010, vol. 57, no. 2, pp. 76-87) A.F. Pantoja and J. R. Britton (2011, Vol. 23, no. 3, pp. 309-316) can be established by usage of evidence-based practice guidelines which is need of the time in order to improve patient care but organizational barriers limit/prevent implementation of these guidelines S.D.S Scott et. al. (2008, vol 3. no. 1, article 41) K. Stenger et. al. (2001, vol. 13, no. 2, pp. 319-327). M. It was found by Ricart et. al. (2003, vol. 31, no. 1, pp. 32-41) that fear among nurses causing potential harm to the patients rendered to the non adherence to these guidelines. Doherty (2006, vol. 19, no. 1 , pp. 32-41) stated that lack of regular nursing staff educational meetings as a major setback to implementation of safety guidelines in emergency room particularly those involving asthma cases. Estabrooks et al. (2007, vol. 56, no. 4, pp. s7-s23) stated that there was variability or difference observed between communication pattern characteristics of nurses and their decision making process which again varied in different organizations. It was observed that a positive perception led to more appropriate use of research finding as opposed to adverse patient outcomes G.G. Cummings et. al. (2010, vol. 10, article 68) S. E. McLean et al. (2006, vol. 5, no. 3, pp. 299-309) L. Harwood (2007, vol. 17, no. 1, pp 22-29). This perception varied across various disciplines with different healthcare settings and professional ranks D.T. Huang et al. (2007, vol. 35, no. 1, pp. 165-167) J. B. Sexton et al. (2006, vol. 26, no. 8, pp. 463-470). The perception towards safety culture varied at different levels where leaders showed higher level of perception compared to frontline workers and manager and physicians demonstrated higher level of perception compared to staff nurses S. Singer et al. (2007, vol. 42, no. 5, pp. 1999-2021) reviewed that factors like work experience and work position among nurses significantly affected their perception towards safety culture with higher levels observed among those nurses who help more than 10 years of experience. Kim et al. (2007, vol. 29, no. 7, pp. 827-844) found differences in perception of patient safety culture between staff nurses and managers of healthcare organization.
At nursing unit levels nurses work as charge nurses or non charge nurses . Charge nurses function by shift-by-shift pattern and their duties vary within and across the organization M. Krugman and V. Smith (2003, vol. 33, no. 5, 284-292) L. M. Connely et al. (2003, vol. 12, no. 5, pp. 298-306). Staff nurses that are recently hired provide direct patient care supervised by charge nurses D. S Wilson et. al (2011, vol. 33, no. 6, pp. 805-524) . In evidence based practice criteria the role of nurses could be charge or non-charge P Wong et al. (2002, vol. 28, no. 7, pp. 363 -372) R. E. Keith et al. (2010, vol. 5, article 99).
Studies conducted by M. Lisby (2010, vol. 22, no. 6, pp. 507–518) identifies the range of medication error between 19-70% which were performed at various setting of healthcare. The research methodology states that despite increased level of awareness and precautions regarding ME, the high rate of errors still persist in the healthcare industry over past decade. A considerable amount of technological designs and developments have been put forward for MEs reductions. L. L. Leape, et al (1995, vol. 274, no. 1, pp. 35–43) draws a result about the MEs based on the situations such as 39% errors occurred during order placing process and 38% during medical administrations process, 12% during transcription process, and overall 11% during medicinal dispensing and process of medication. Barker.K.N (2002, vol. 162, no. 16, pp. 1897–1903) and the colleagues presented a report showing resulted errors occurring during the fifth dose of medication administration which also included the dysfunction in the timing of administrations, which was nearly 43% as counted and omission of dosage which counted to be 30%, wrong prescription and dose was 17% including external factors that result in 10% of error factor.
Cooper (2003, vol.37, p: 212–14) states that there are no standard definitions for culture in existence but few very commonly cited definitions that are short and provide intuitive understandings of the culture that are stated by very common statement “is this the way things work here”. “This is the way work done here” provides a good reflection of safety culture where it is expected by the learning outcome of the teamwork, among the staff, institution members, , open for good and bad communication irrespective of the positions, collecting proper feedbacks from patients as well as from the staff, and non punitive error responses. JCAHO- Joint Commission International Center for Patient Safety has mentioned that it is necessary for an organization to adopt above-mentioned qualities and put them effectively into practice as part of improvement efforts for the goals of national patient safety. The safety goals vary based on the standards and institutional levels which also include the constraints like care durations, treatment terms, health and behavior, and finally the facilities that are provided by the nursing home or/and the hospitals. Based on the common downfalls , the goals are set also taking into consideration medication errors, communication factors of the patient, patient, resident, or attendee identifications, the care giver, and lastly but not limited here is the infections in the healthcare associations.
PATIENT SAFETY
The next section is considering the safety culture from patient perspectives. JCAHO has been dealing with broad variety of situations in order to establish the patient safety goals. A considerable difference has been observed towards safety culture adoption when it comes to nursing homes and general hospitals. First point to consider is the type of patients as they differ in nursing homes and hospitals. All age groups of patients can be accommodated by hospitals considering both short and long term care giving and deciding duration of stay based on the term of the care, high end technology emphasizing with high accreditation value from JCAHO. The nursing homes can be considered as care centers for the old age group with varied long or short term stay and the treatment plan designed. Nursing homes do not focus much on the JCAHO accreditation and the innovative technology in comparison to the hospitals. Secondary consideration can be given to focus on safety of the patient and implementation of good safety culture which has been an inpatient setting.
The safety culture examination is the first step for developing the understanding capability for the safety of the residents in the nursing homes. Cooper (2003, vol.37, p: 212–14) suggest that healthcare organization’s safety cultures are identified as “the most basic constraint to improve the safety for the resident care”. The safety cultures of the patients in the hospitals are the performance indicators of the concerned hospitals and also serve as comparison factor between hospitals and nursing homes.
SAFETY CULTURE IN CLINICAL RESEARCH
This section is about the adaption and discussion about the safety culture among the clinicians and the researcher’s perspectives. Laura M. W., et al (May 2012, vol.38 No.5) and Reiman T, et al (2010, vol 19(5), e20) describe that units of Healthcare are identified as the complex adaptive system (CAS) which involves interdependent organizational levels with multiple involutions. Pronovost P, et al. .( 2005, vol:1 iss:1 p:33–40) and Huang DT, et al. (2010 vol: 22(3) ,p: 151–161) say that it is unpredictable and nonlinear when it comes to complex challenges stating the transforming changes in relationship within the CAS at the same time. Castle NG, et al. (2007, vol: 32(1), p: 66–76), Wagner LM, et al. (2009; vol: 41(2), p: 184–192) and Cooper (2003, vol.37, p: 212–14) specify that echoed challenges in the field of enhancement of quality specified by the leaders who indentify the shortcomings, like limitation in research involvement methods, immature and weak designing evaluation, and study failure in verbal context. It is a challenge for an individual investigator to nail down entire healthcare system considering the shortcomings since the process is interwoven . This calls for need of collaborative model that can integrate perspectives at multiple layers and numerous disciplines, which is expected to be helpful at advanced levels of safety culture investigations. It is also expected that this model will improve scientific design and development strategies by facilitating the disseminations.
It was explained by P. Aspden, (2007), that Trans disciplinary collaborative models are particularly effective and potential as they bring together diverse individual group that are fully functional and integrated with frameworks, methods, and theories in their respective area of expertise combined together to work on the complex problems. The level of collaboration varies from interdisciplinary and multidisciplinary stages where it is expected that numerous individuals work together and are grounded strong enough to their individual roles and ideologies at the same time. D. W. Bates (1999, vol. 159, no. 21, pp. 2553–2560) and L. L. Leape, (1991, vol. 324, no. 6, pp. 377–384) suggest that transdisciplinary effective collaboration are considered for development of the healthcare system according to the recent studies. Wagner LM, et al. (2009; vol: 41(2), p:184–192) and M. Lisby, et al (2010, vol. 22, no. 6, pp. 507–518) describe that Individual’s research intervention particularly involves the healthcare research development considering either any single clinical unit , nursing home or any one hospital. As inefficient approach towards the complexity changes , single researcher’s perspective is inadequate considering occurrences in the healthcare institutional changes under influence of contextual impact in the intervention effectiveness and implementation.
Castle NG, et al. (2007, vol: 32(1), p: 66–76) and the NCCMERP (2012) explain that stage improvement and advanced scientific research implementation are the massive requirement for addressing complex issues concerning the healthcare industry. In specific a hand-in-hand work coordination between the clinicians and the researchers is expected by adapting the redefined design and development strategy, which will establish a healthy communication relationship for the betterment of the safety cultures in the healthcare organizations. K. N. Barker, et al (2002, vol. 162, no. 16, pp. 1897–1903) states that at any given situations transdiciplinary models are expected to serve the purpose at the current stage. Moreover sustainable and effective intervention programs will be promoted with the implementation of scientific framework.
Transdisciplinary multisite investigation site models that involves the movement from individual analysis to group analysis gives an alarm for the interactions in unique way for the clinicians and the researchers. For individual interventions, there are several other tools and models but in case of transdiscipline there are few competencies and models for team performances and building the context for the better tomorrow.
CONCLUSION AND FUTURE
The future work of this essay is described as the study of safety culture based on specific survey conducted by exploring the impact of Commission accreditation on the nursing homes on the perception considering the senior and experienced managers in every nursing home.
Next session focuses on a modified version of the survey for hospital specifically on patient safety culture and response of nursing homes about the administration– HSOPSC survey. The purpose of this research is to mainly identify safety culture issues those concerning nursing homes and view a comparative review by comparing existing available results with the hospitals. This usually involves usage of instruments for purpose of analyzing the existing data from the hospital.
The last section describes about adaptation of transdisciplinary healthcare model that mainly deals with improvement in research and network which in turn has huge influence on the collaborations conducted for the national improvement studies.
REFERENCES
[1] International Nuclear Safety Advisory Group (1986), Summary Report on the Post-Accident Review Meeting on the Chernobyl Accident. Geneva: International Atomic Energy Commission.
[2] Laura M. et al. (May 2012, vol.38 No.5) Relationship between Nursing Home Safety Culture and Joint Commission Accreditation.
[3] Reiman T, et al. (2010, vol 19(5), e20) Multilayered approach to patient safety culture. Qual Saf Health Care.
[4] Pronovost P, et al.( 2005, vol:1 iss:1 p:33–40) Implementing and validating a comprehensive unit-based safety program. J Patient Saf.
[5]. Huang DT, et al. (2010 vol: 22(3) ,p: 151–161) Intensive care unit safety culture and outcomes: A US multicenter study. Int J Qual Health Care.
[6]. Castle NG, et al. (2007, vol: 32(1), p: 66–76) Nursing home administrators’ opinions of the resident safety culture in nursing homes. Health Care Manage Rev.
[7]. Wagner LM, et al. (2009; vol: 41(2), p:184–192) Nurses’ perceptions of safety culture in long-term care settings. J Nurs Scholarsh.
[8] Cooper JB, (2003, vol.37, p: 212–14) Developing a culture of safety. Biomed Instr Technol.
[9] P. Aspden, (2007). Institute of Medicine, Committee on, and E. Preventing Medication, Preventing Medication Errors, National Academies Press.
[10] D. W. Bates, et al, (1995, vol. 274, no. 1, pp. 29–34) “Incidence of adverse drug events and potential adverse drug events: implications for prevention,” Journal of the American Medical Association.
[11] D. W. Bates, et al. (1993, vol. 8, no. 6, pp. 289 -294) “Incidence and preventability of adverse drug events in hospitalized adults,” Journal of General Internal Medicine.
[12] D. W. Bates, et al., (1999, vol. 159, no. 21, pp. 2553–2560). “Patient risk factors for adverse drug events in hospitalized patients. ADE Prevention Study Group,” Archives of Internal Medicine.
[13] L. L. Leape, (1995, vol. 52, no. 4, pp. 379–382). “Preventing adverse drug events,” American Journal of Health-System Pharmacy.
[14] L. L. Leape, et al.,(1991, vol. 324, no. 6, pp. 377–384) “The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II,” The New England Journal of Medicine.
[15] M. Lisby, et al. (2010, vol. 22, no. 6, pp. 507–518) “How are medication errors defined? A systematic literature review of definitions and characteristics,” International Journal forQuality in Health Care.
[16] NCCMERP, (2012) National Coordinating Council for Medication Error Reporting and Prevention, About Medication Errors: What is a Medication Error? http://www.nccmerp.org/ aboutMedErrors.html.
[17] J. A. Cafazzo, et al.,( vol. 12, pp. 70–74, 2009) “Human factors perspectives on a systemic approach to ensuring a safer medication delivery process,” Healthcare Quarterly.
[18] L. L. Leape, et al., (1995, vol. 274, no. 1, pp. 35–43)“Systems analysis of adverse drug events. ADE Prevention Study Group,” Journal of the American Medical Association.
[19] K. N. Barker, et al (2002, vol. 162, no. 16, pp. 1897–1903) “Medication errors observed in 36 health care facilities,” Archives of Internal Medicine.
