1 User instructions This presentation is provided to assist with introducing the study to key stakeholders of the health facility in which harmful incidents

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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


incidence of harmful incidents calculated



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)


prevalence incidence of harmful incidents calculated



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)


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


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


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



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Your next steps forstaff interviews on current in-patients


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



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Your next steps for anominal group meeting


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


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Your next steps fordirect observation and related interviews


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



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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/

Documents

1 User instructions This presentation is provided to assist with introducing the study to key stakeholders of the health facility in which harmful incidents