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User instructions
This presentation is provided to assist with introducing the study to key stakeholders of the health facility in which harmful incidents will be assessed (facility managers, ethics council, etc.)
The slides can be used to animate a face-to-face meeting (projected with a beamer or used as talking points), serve as talking points for a telephone conversation or, less ideally, be sent by email or distributed in hard-copy
Deliver this introduction well in advance of the planned date of the study and start preparing early (thoroughly read the slides, rehearse, etc.)
Adapt the slides to local requirements and delete non-applicable slides Allow time to establish a relationship of trust with key stakeholders Clearly explain the need to tackle patient harm, but do not force anybody to
participate in the study Recommend a method, approach and time plan for the study, but be receptive
to input
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User instructions (continued)
If you plan on using record review but are not sure whether the facility keeps records, or if you are not very familiar with the quality of the facility’s records and filing system (for retrospective record review), plan an alternative method for if minimal criteria for record review are not met.
Once at the facility, clarify whether the facility keeps records of current hospital admissions (for record review of current in-patients) or whether the records of last year’s hospital admissions are available (for retrospective record review). If so, check a sample and, if records are sufficient, proceed with the presentation. Otherwise, suggest the second most appropriate method and proceed with the presentation of that.
Provide further information if necessary and agree to a second meeting, or a meeting with additional key stakeholders, if needed
To allow thorough preparation, the study should be conducted no less than two weeks after management have approved the initiative
Ask for contact details and provide yours
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Why and how to study and improve patient safety at your health facility
<insert your name, title and affiliation here>
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The need to tackle patient harm
Every year tens of millions of patients throughout the world suffer disabling injuries or death, due to unsafe medical care
The consequences are millions of devastated lives and billions of dollars unnecessarily spent on prolonged hospitalization, loss of income, disability and litigation
I am certain that you do all you can to ensure patient safety, but there is always room for improvement
I therefore wish to assist you in improving patient safety in your facility
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Be assured that...
there is no risk in participating in the study you have the right to refuse participation (although
this would be a missed opportunity for improving patient safety in your facility)
you will not lose any state subsidies or other benefits if you do not want to take part
if you do participate in the study but later change your mind, you can terminate the study at any time
the objective is to evaluate practices and challenges at the level of a ward, unit or facility rather than to assess individuals: names of individuals will not be recorded
we keep patient data or other sensitive information (availability of equipment, quality of practices, medical records, etc.) strictly confidential
investigators will be happy to answer any questions you might have at any stage of the process
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Objective of the study and recommended method
If you agree to participate in the study, I would like to assist you with [delete objectives that do not apply]: counting patient harm, and/or identifying causes of patient harm, and/or developing an action plan, and/or monitoring & improving patient safety achievements
I recommend employing [delete non-applicable method]: record review of current in-patients and/or retrospective record review, and/or staff interviews on current in-patients, and/or nominal group meetings, and/or direct observation
In the following I wish to give you a short overview of the recommended method [delete non-applicable slides]
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Method overview: record review of current in-patients
reviewing medical records of all patients who are hospitalized on the data collection day, from all types of wards and in-patient settings
records of all current in-patients of x departments of a health facility on a given day, a quiet room equipped with a table
availability for a couple of hours of the doctor in charge of the selected wards to clarify potential questions (if available, not necessarily required)
Method process Requires from you
prevalence incidence of harmful incidents calculated
contributing factors identified
preventability determined, among other results
Results
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Method overview: retrospective record review
reviewing the facility’s in-patient medical records from the last year, including all types of wards and in-patient settings
facility’s in-patient medical records from the last year, a quiet room equipped with a table
Method process Requires from you
incidence of harmful incidents calculated
contributing factors identified
preventability determined, among other results
Results
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Method overview: staff interview on current in-patients
interviewing ward nurse/nurse supervisor and physician/doctor in charge of in-patients on day of data collection (a given day)
availability of the ward nurse/nurse supervisor (~ half a day) and the physician/doctor in charge of in-patients (~ half a day)
a quiet room equipped with a table and records of current in-patients (if available, not necessarily required)
Method process Requires from you
prevalence incidence of harmful incidents calculated
contributing factors identified
preventability determined, among other results
Results
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Method overview: direct observation and interviews
observation of facilities and injection supply stock
observation of injection practices
interviews with injection providers
interviews with department supervisors of injection providers
availability of x ward/outpatient nurses for observation and interviews
availability of x department supervisors/ward sisters/charge nurses for interviews
permission to observe facilities and injection supply (half a day for data collection from five wards/departments of a district hospital)
Method process Requires from you
causes of harmful incidents occurring during specific procedures as well as problems relating to injection facilities/supply stock are identified
Results
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Method overview: nominal group meeting
one or several brainstorming sessions with staff representing all hospital activities
five to twelve staff from this facility participate at each session
availability of staff for approximately two hours
a quiet meeting room equipped with tables and a blackboard/
whiteboard/flipchart
Method process Requires from you
causes of harmful incidents are identified
Results
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How you can contribute to the success of the study
be committed to the study and demonstrate to staff that you support it instruct participating staff to co-operate with investigators assist with providing the necessary materials and meeting the
requirements avoid controlling or obstructing the data collection process explain the study to the staff from your facility who will participate in it
(templates will be provided) reassure your staff that they will not be punished if the study reveals
shortcomings be available to be presented with the results at the end and to
communicate these to staff be willing to improve patient safety to the best of your ability
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The benefits for your health care facility
The work in your facility will be thoroughly assessed by trained and motivated investigators
You will receive evidence-based external recommendations to improve patient safety in your health facility
You will benefit from a constructive exchange of experiences and good practices among investigators, your staff and yourself
Relationships that can be leveraged for future initiatives will be established
Your staff will be sensitized to patient safety issues
[delete those of the following slides that do not apply]
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Your next steps forrecord review of current in-patients
* more comprehensive guidance is provided in the method protocol
we agree when the record review will be held
you arrange that a room equipped with a table and the records will be available
you introduce us to staff from selected wards and medical records department, we reassure them that the record review is confidential and explain their role
we select an appropriate sample, gather these records and note missing records
we screen and review medical records for harmful incidents, contributing factors and preventability and calculate the prevalence of harmful incidents
for monitoring and improvement only: we discuss the results with the doctor in charge to compare the results of the current study to those of past studies
we immediately present the results to you if possible or, if not, do so at a later stage
Preparation* Conduct*
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Your next steps forretrospective record review
* more comprehensive guidance is provided in the method protocol
we agree when the record review will be held
you arrange that a room equipped with a table and the records will be available
you introduce us to the medical records department, we reassure them that the record review is confidential and explain their role, the process and its objectives
we select an appropriate sample, gather these records and note missing records
we screen and review medical records for harmful incidents, contributing factors and preventability and calculate the incidence of harmful incidents
for monitoring and improvement only: we discuss the results with the doctor in charge to compare results of the current study to those of past studies
we immediately present the results to you if possible or, if not, do so at a later stage
Preparation* Conduct*
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Your next steps forstaff interviews on current in-patients
* more comprehensive guidance is provided in the method protocol
we agree when the staff interviews will be held and which wards will be studied
you arrange that a meeting room and the medical records (if existing) will be available
you introduce us to the nurse and doctor/physician and we explain their role
we gather records (if available) and list names of selected in-patients
we determine for each patient whether harmful incidents are present or not through interviewing the nurse and consulting relevant documents
we study positively screened cases more in depth through interviewing the doctor in charge and consulting relevant documents
for monitoring and improvement only: we compare the results of the current study to those of past studies through discussion with the department supervisor
we immediately present the results to you if possible or, if not, do so at a later stage
Preparation* Conduct*
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Your next steps for anominal group meeting
* more comprehensive guidance is provided in the method protocol
we decide upon the number of nominal group meetings and agree when these will be held
you select and invite participants
you arrange for a meeting room equipped with tables and a blackboard/whiteboard/flipchart
we conduct one or several nominal group meetings (depending on the size of the facility) with 5 to 12 staff members participating at each
Preparation* Conduct*
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Your next steps fordirect observation and related interviews
* more comprehensive guidance is provided in the method protocol
we jointly select wards/units and agree when the study will be conducted
you ensure that ward/outpatient nurses and department supervisors, ward sisters or charge nurses will be available for observation and related interviews
we present the study to the matron and explain his/her role in the data collection
the matron introduces us to the charge nurses/sisters of participating clinical areas and informs them of the observation and interviews
we observe injection facilities/stock, observe injection practices and conduct interviews with injection providers and department supervisors
we immediately present the results to you if possible or, if not, do so at a later stage
Preparation* Conduct*
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Questions? Comments?
Thank you for participating!
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Further information
For further information, questions or comments contact
<insert your name and telephone number or email> Visit the Patient Safety Programme (Research) website at: http://www.who.int/patientsafety/research/en/
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