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Nilsson, L., Lindblad, M., Johansson, N., Säfström, L., Schildmeijer, K., Ekstedt, M. & Unbeck, M. (2023). Exploring nursing-sensitive events in home healthcare: A national multicenter cohort study using a trigger tool. International Journal of Nursing Studies, 138, Article ID 104434.
Open this publication in new window or tab >>Exploring nursing-sensitive events in home healthcare: A national multicenter cohort study using a trigger tool
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2023 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 138, article id 104434Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The provision of home healthcare is increasing in response to the growing aging population with the need for chronic disease management in their homes. Safety work differs from hospital care. The incidence of adverse events in home healthcare is sparsely studied but is estimated to occur in-one third of patients, and most are deemed preventable. Although nursing care is crucial for risk assessment and preventive work in the home environment, the role of registered nurses in the prevention of no-harm incidents and adverse events has not received sufficient scientific attention.

OBJECTIVES: To explore nursing-sensitive events in patients receiving home healthcare.

DESIGN, SETTING AND PARTICIPANTS: A Swedish national multicenter study based on a structured record review of 600 randomly chosen healthcare records from 10 organizations in different regions of the country.

METHODS: Ten trained teams, each including physician(s) and registered nurses, undertook a review based on the Global Trigger Tool method. The review covered a maximum of 90 days from admission to home healthcare. First, each record was screened for the presence of 38 predefined triggers. In the second step, every potential event was assessed according to preventability, types of events, severity, time of occurrence, consequences of the event, and potential contributing causes.

RESULTS: In total, 699 events were identified in the study. Of these, 495 (74.0%) were classified as nursing-sensitive (227 no-harm incidents and 268 adverse events) and affected 267 (44.5%) patients, with a mean of 1.9 events per patient. The majority (n = 367, 73.1%) were considered preventable. The most prominent types of nursing-sensitive event were falls (n = 138, 27.9%), pressure ulcers (n = 62, 12.5%), healthcare-associated infections (n = 58, 11.7%) and medication management (n = 50, 10.1%). Concerning severity, 45.9% were classified as no-harm incidents and another 36.6% resulted in temporary harm that required extra healthcare resources: 226 hospital days, 66 physician visits in outpatient care, and 99 in home healthcare. All severity types occurred from day 1, except death, which included only one patient. The most frequent contributing factors were deficiencies in nursing care, treatment & diagnosis, with the subgroups nursing care, observation, treatment & follow-up, followed by deficiencies in the organization.

CONCLUSIONS: Nursing-sensitive events in home healthcare are common, often preventable, and occur from the start of the care period. This study contributes to increased knowledge of patient safety shortcomings and points to the important role that registered nurses play in patient safety work.

Keywords
Adverse event, Home healthcare, No-harm incident, Nursing care, Record review
National Category
Nursing
Identifiers
urn:nbn:se:du-45142 (URN)10.1016/j.ijnurstu.2022.104434 (DOI)000922600600001 ()36630873 (PubMedID)2-s2.0-85146060264 (Scopus ID)
Funder
Medical Research Council of Southeast Sweden (FORSS), 470161Region Östergötland, LiO-53721
Available from: 2023-01-17 Created: 2023-01-17 Last updated: 2023-03-02Bibliographically approved
Dillner, P., Unbeck, M., Norman, M., Nydert, P., Härenstam, K. P., Lindemalm, S., . . . Förberg, U. (2023). Identifying neonatal adverse events in preterm and term infants using a Paediatric Trigger Tool. Acta Paediatrica, 112(8), 1670-1682
Open this publication in new window or tab >>Identifying neonatal adverse events in preterm and term infants using a Paediatric Trigger Tool
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2023 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 112, no 8, p. 1670-1682Article in journal (Refereed) Published
Abstract [en]

AIM: To explore the incidence and characteristics of inpatient neonatal adverse events in a Swedish setting.

METHODS: A retrospective record review, using a trigger tool, performed by registered nurses and a neonatologist, at a University Hospital. The identified adverse events were categorised by, for example, preventability, severity and time of occurrence.

RESULTS: A random selection of 150 admissions representing 3531 patient days were reviewed (mean [SD] birthweight 2620 [1120]g). Three hundred sixty adverse events were identified in 78(52.0%) infants and 305(84.7%) of these were assessed as being preventable. The overall adverse event rate was 240 per 100 admissions and 102.0 per 1000 patient days. Preterm infants had a higher rate than term infants (353 versus 79 per 100 admissions, p=0.001), however with regard to the length of stay, the rates were similar. Most adverse events were temporary and less severe (n=338/360, 93.9%) and the most common type involved harm to skin, tissue or blood vessels (n=163/360, 45.3%). Forty percent (n=145) of adverse events occurred within the first week of admission.

CONCLUSION: Adverse events were common in neonatal care and many occurred during the first days of treatment. Characterisation of adverse events may provide focus areas for improvements in patient safety.

Keywords
Adverse event, Neonatal care, Patient safety, Retrospective record review, Trigger tool
National Category
Pediatrics
Identifiers
urn:nbn:se:du-46008 (URN)10.1111/apa.16814 (DOI)000993401200001 ()37151117 (PubMedID)2-s2.0-85159923406 (Scopus ID)
Available from: 2023-05-11 Created: 2023-05-11 Last updated: 2023-07-17Bibliographically approved
Dillner, P., Eggenschwiler, L. C., Rutjes, A. W., Berg, L. M., Musy, S. N., Simon, M., . . . Unbeck, M. (2023). Incidence and characteristics of adverse events in paediatric inpatient care: a systematic review and meta-analysis. BMJ Quality and Safety (3), 133-149
Open this publication in new window or tab >>Incidence and characteristics of adverse events in paediatric inpatient care: a systematic review and meta-analysis
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2023 (English)In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, no 3, p. 133-149Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Adverse events (AEs) cause suffering for hospitalised children, a fragile patient group where the delivery of adequate timely care is of great importance.

OBJECTIVE: To report the incidence and characteristics of AEs, in paediatric inpatient care, as detected with the Global Trigger Tool (GTT), the Trigger Tool (TT) or the Harvard Medical Practice Study (HMPS) method.

METHOD: MEDLINE, Embase, Web of Science and Google Scholar were searched from inception to June 2021, without language restrictions. Studies using manual record review were included if paediatric data were reported separately. We excluded studies reporting: AEs for a specific disease/diagnosis/treatment/procedure, or deceased patients; study protocols with no AE outcomes; conference abstracts, editorials and systematic reviews; clinical incident reports as the primary data source; and studies focusing on specific AEs only. Methodological risk of bias was assessed using a tool based on the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Primary outcome was the percentage of admissions with ≥1 AEs. All statistical analyses were stratified by record review methodology (GTT/TT or HMPS) and by type of population. Meta-analyses, applying random-effects models, were carried out. The variability of the pooled estimates was characterised by 95% prediction intervals (PIs).

RESULTS: We included 32 studies from 44 publications, conducted in 15 countries totalling 33 873 paediatric admissions. The total number of AEs identified was 8577. The most common types of AEs were nosocomial infections (range, 6.8%-59.6%) for the general care population and pulmonary-related (10.5%-36.7%) for intensive care. The reported incidence rates were highly heterogeneous. The PIs for the primary outcome were 3.8%-53.8% and 6.9%-91.6% for GTT/TT studies (general and intensive care population). The equivalent PI was 0.3%-33.7% for HMPS studies (general care). The PIs for preventable AEs were 7.4%-96.2% and 4.5%-98.9% for GTT/TT studies (general and intensive care population) and 10.4%-91.8% for HMPS studies (general care). The quality assessment indicated several methodological concerns regarding the included studies.

CONCLUSION: The reported incidence of AEs is highly variable in paediatric inpatient care research, and it is not possible to estimate a reliable single rate. Poor reporting standards and methodological differences hinder the comparison of study results.

Keywords
Adverse events, epidemiology and detection, Chart review methodologies, Paediatrics, Trigger tools
National Category
Nursing
Identifiers
urn:nbn:se:du-44953 (URN)10.1136/bmjqs-2022-015298 (DOI)000906028000001 ()36572528 (PubMedID)2-s2.0-85149154002 (Scopus ID)
Note

Funding This study was funded by grants from a regional agreement on clinical research (ALF) between Region Stockholm and Karolinska Institutet (2020- 0443), Childhood Foundation of the Swedish Order of Freemasons (no award/ grant number).

Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-03-23Bibliographically approved
Unbeck, M., Lidgren, F., Tabbakh, E. & Nymark, C. (2023). The patient's experience of participation when admitted for elective surgical procedures: an interview study. International Journal of Qualitative Studies on Health and Well-being, 18(1), Article ID 2163958.
Open this publication in new window or tab >>The patient's experience of participation when admitted for elective surgical procedures: an interview study
2023 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 18, no 1, article id 2163958Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To describe the patient's experience of participation in their care when admitted for elective surgical procedures.

MATERIALS AND METHODS: A purposive sample of 14 patients who had undergone elective surgery was included in semi-structured individual interviews at a university hospital. The data was analysed using qualitative content analysis.

RESULTS: One theme was identified: Creating a meaningful relationship to enable participation in the care, based on three categories; Abilities, willingness, and a lack of experience affect participation, A professional approach with an open communication and individualized information, and The importance of structural factors.

CONCLUSIONS: To meet the patient's individual needs and wishes regarding participation, meaningful relationships need to be created between patient and healthcare personnel. The results also indicate that the patients have insufficient knowledge about their role regarding participation. To improve patient participation, its meaning needs to be clarified individually to the patient, emphasizing the importance to be active involved in his or her own care.

Keywords
Content analysis, interviews, patient participation, person-centred care, surgery
National Category
Nursing
Identifiers
urn:nbn:se:du-45106 (URN)10.1080/17482631.2022.2163958 (DOI)000909468800001 ()36617889 (PubMedID)2-s2.0-85145979138 (Scopus ID)
Available from: 2023-01-17 Created: 2023-01-17 Last updated: 2023-02-06Bibliographically approved
Magnéli, M., Kelly-Pettersson, P., Rogmark, C., Gordon, M., Sköldenberg, O. & Unbeck, M. (2023). Timing of adverse events in patients undergoing acute and elective hip arthroplasty surgery: A multicentre cohort study using the Global Trigger Tool. BMJ Open, 13(6), Article ID e064794.
Open this publication in new window or tab >>Timing of adverse events in patients undergoing acute and elective hip arthroplasty surgery: A multicentre cohort study using the Global Trigger Tool
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 6, article id e064794Article in journal (Refereed) Published
Abstract [en]

Objective To explore timing in relation to all types of adverse events (AEs), severity and preventability for patients undergoing acute and elective hip arthroplasty. Design A multicentre cohort study using retrospective record review with Global Trigger Tool methodology in combination with data from several registers. Setting 24 hospitals in 4 major regions of Sweden. Participants Patients ≥18 years, undergoing acute or elective total or hemiarthroplasty of the hip, were eligible for inclusion. Reviews of weighted samples of 1998 randomly selected patient records were carried out using Global Trigger Tool methodology. The patients were followed for readmissions up to 90 days postoperatively throughout the whole country. Results The cohort consisted of 667 acute and 1331 elective patients. Most AEs occurred perioperatively and postoperatively (n=2093, 99.1%) and after discharge (n=1142, 54.1%). The median time from the day of surgery to the occurrence of AE was 8 days. The median days for different AE types ranged from 0 to 24.5 for acute and 0 to 71 for elective patients and peaked during different time periods. 40.2% of the AEs, both major and minor, occurred within postoperative days 0-5 and 86.9% of the AEs occurred within 30 days. Most of the AEs were deemed to be of major severity (n=1370, 65.5%) or preventable (n=1591, 76%). Conclusions A wide variability was found regarding the timing of different AEs with the majority occurring within 30 days. The timing and preventability varied regarding the severity. Most of the AEs were deemed to be preventable and/or of major severity. To increase patient safety for patients undergoing hip arthroplasty surgery, a better understanding of the multifaceted nature of the timing of AEs in relation to the occurrence of differing AEs is needed. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords
Adult orthopaedics, Hip, Orthopaedic & trauma surgery, Arthroplasty, Replacement, Hip, Cohort Studies, Humans, Joints, Patient Safety, Retrospective Studies, adult, ambulatory surgery, article, cohort analysis, controlled study, drug safety, female, hemiarthroplasty, hip arthroplasty, hospital readmission, human, major clinical study, male, medical record review, multicenter study, orthopedics, randomized controlled trial, retrospective study, surgery, Sweden, traumatology, clinical trial, hip replacement, joint
National Category
Nursing
Identifiers
urn:nbn:se:du-46579 (URN)10.1136/bmjopen-2022-064794 (DOI)001014750700005 ()37295831 (PubMedID)2-s2.0-85162854662 (Scopus ID)
Available from: 2023-08-02 Created: 2023-08-02 Last updated: 2023-08-28
Tistad, M., Bergström, A., Elf, M., Eriksson, L., Gustavsson, C., Göras, C., . . . Wallin, L. (2023). Training and support for the role of facilitator in implementation of innovations in health and community care: a scoping review protocol.. Systematic Reviews, 12(1), Article ID 15.
Open this publication in new window or tab >>Training and support for the role of facilitator in implementation of innovations in health and community care: a scoping review protocol.
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2023 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 12, no 1, article id 15Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Implementing and sustaining innovations in clinical practice, such as evidence-based practices, programmes, and policies, is frequently described as challenging. Facilitation as a strategy for supporting implementation requires a facilitator, i.e. an individual with a designated role to support the implementation process. A growing number of studies report that facilitation can help tackle the challenges in implementation efforts. To optimise the potential contribution of facilitation as a strategy to improve the implementation of new practices, there is a need to enhance understanding about what training and support is required for individuals in the facilitator role. The objective of this scoping review is to map how facilitators have been trained for, and supported in, the facilitator role in implementation studies in health and community care. Specifically, the review aims to examine what is reported on training and support of facilitators in terms of learning outcomes, content, dose, mode of delivery, learning activities, and qualifications of the trainers and how the facilitators perceive training and support.

METHODS: This scoping review will follow the guidance of the Joanna Briggs Institute and the PRISMA Extension for Scoping Review checklist. We will include articles in which (a) facilitation is deployed as an implementation strategy, with identified facilitator roles targeting staff and managers, to support the implementation of specified innovations in health or community care, and (b) training and/or support of facilitators is reported. We will exclude articles where facilitation is directed to education or training in specific clinical procedures or if facilitation supports the implementation of general quality improvement systems. All types of peer-reviewed studies and study protocols published in English will be included. A systematic search will be performed in MEDLINE (Ovid), Embase (embase.com), Web of Science Core Collection, and CINAHL (Ebsco).

DISCUSSION: The proposed scoping review will provide a systematic mapping of the literature on the training and support of implementation facilitators and contribute useful knowledge within the field of implementation science to inform future facilitation initiatives.

SYSTEMATIC REVIEW REGISTRATION: Registered at Open Science Framework (registration https://doi.org/10.17605/OSF.IO/M6NPQ ).

Keywords
Community care, Evidence-based practice, Facilitation, Facilitator, Healthcare services, Implementation science, Supervision, Support, Training, i-PARIHS
National Category
Nursing
Identifiers
urn:nbn:se:du-45393 (URN)10.1186/s13643-023-02172-x (DOI)000924318500001 ()36721192 (PubMedID)2-s2.0-85147186976 (Scopus ID)
Available from: 2023-02-07 Created: 2023-02-07 Last updated: 2023-03-02Bibliographically approved
Olin, K., Göras, C., Nilsson, U., Unbeck, M., Ehrenberg, A., Pukk-Härenstam, K. & Ekstedt, M. (2022). Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study. BMJ Open, 12(1), Article ID e052283.
Open this publication in new window or tab >>Mapping registered nurse anaesthetists' intraoperative work: tasks, multitasking, interruptions and their causes, and interactions: a prospective observational study
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 1, article id e052283Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Safe anaesthesia care is a fundamental part of healthcare. In a previous study, registered nurse anaesthetists (RNAs) had the highest task frequency, with the largest amount of multitasking and interruptions among all professionals working in a surgical team. There is a lack of knowledge on how these factors are distributed during the intraoperative anaesthesia care process, and what implications they might have on safety and quality of care.

OBJECTIVE: To map the RNAs' work as done in practice, including tasks, multitasking, interruptions and their causes, and interactions, during all phases of the intraoperative anaesthesia work process.

METHODS: Structured observations of RNAs (n=8) conducted during 30 procedures lasting a total of 73 hours in an operating department at a county hospital in Sweden, using the Work Observation Method By Activity Timing tool.

RESULTS: High task intensity and multitasking were revealed during preparation for anaesthesia induction (79 tasks/hour, 61.9% of task time spent multitasking), anaesthesia induction (98 tasks/hour, 50.7%) and preparation for anaesthesia maintenance (86 tasks/hour, 80.2%). Frequent interruptions took place during preoperative preparation (4.7 /hour), anaesthesia induction (6.2 /hour) and preparation for anaesthesia maintenance (4.3 /hour). The interruptions were most often related to medication care (n=54, 19.8%), equipment issues (n=40, 14.7%) or the procedure itself (n=39, 14.3%). RNAs' work was conducted mostly independently (58.4%), but RNAs interacted with multiple professionals in and outside the operating room during anaesthesia.

CONCLUSION: The tasks, multitasking, interruptions and their causes, and interactions during different phases illustrated the RNAs' work as done, as part of a complex adaptive system. Management of safety in the most intense phases-preparing for anaesthesia induction, induction and preparing for anaesthesia maintenance-should be investigated further. The complexity and adaptivity of the nature of RNAs' work should be taken into consideration in future management, development, research and education.

Keywords
anaesthetics, organisation of health services, quality in health care
National Category
Nursing
Identifiers
urn:nbn:se:du-39370 (URN)10.1136/bmjopen-2021-052283 (DOI)000745075200004 ()35045998 (PubMedID)2-s2.0-85123626816 (Scopus ID)
Available from: 2022-02-02 Created: 2022-02-02 Last updated: 2023-08-28Bibliographically approved
Nowak, B., Schwendimann, R., Lyrer, P., Bonati, L. H., De Marchis, G. M., Peters, N., . . . Simon, M. (2022). Occurrence of No-Harm Incidents and Adverse Events in Hospitalized Patients with Ischemic Stroke or TIA: A Cohort Study Using Trigger Tool Methodology. International Journal of Environmental Research and Public Health, 19(5), Article ID 2796.
Open this publication in new window or tab >>Occurrence of No-Harm Incidents and Adverse Events in Hospitalized Patients with Ischemic Stroke or TIA: A Cohort Study Using Trigger Tool Methodology
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2022 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 5, article id 2796Article in journal (Refereed) Published
Abstract [en]

Adverse events (AEs)-healthcare caused events leading to patient harm or even death-are common in healthcare. Although it is a frequently investigated topic, systematic knowledge on this phenomenon in stroke patients is limited. To determine cumulative incidence of no-harm incidents and AEs, including their severity and preventability, a cohort study using trigger tool methodology for retrospective record review was designed. The study was carried out in a stroke center at a university hospital in the German speaking part of Switzerland. Electronic records from 150 randomly selected patient admissions for transient ischemic attack (TIA) or ischemic stroke, with or without acute recanalization therapy, were used. In total, 170 events (108 AEs and 62 no-harm incidents) were identified, affecting 83 patients (55.3%; 95% CI 47 to 63.4), corresponding to an event rate of 113 events/100 admissions or 142 events/1000 patient days. The three most frequent AEs were ischemic strokes (n = 12, 7.1%), urinary tract infections (n = 11, 6.5%) and phlebitis (n = 10, 5.9%). The most frequent no-harm incidents were medication events (n = 37, 21.8%). Preventability ranged from 12.5% for allergic reactions to 100% for medication events and pressure ulcers. Most of the events found (142; 83.5%; 95% CI 76.9 to 88.6) occurred throughout the whole stroke care. The remaining 28 events (16.5%; 95% CI 11.4 to 23.1) were detected during stroke care but were related to care outside the stroke pathway. Trigger tool methodology allows detection of AEs and no-harm incidents, showing a frequent occurrence of both event types in stroke and TIA patients. Further investigations into events' relationships with organizational systems and processes will be needed, first to achieve a better understanding of these events' underlying mechanisms and risk factors, then to determine efforts needed to improve patient safety.

Keywords
adverse events, no-harm incidents, retrospective record review, stroke, trigger tool methodology
National Category
Nursing
Identifiers
urn:nbn:se:du-39846 (URN)10.3390/ijerph19052796 (DOI)000769438400001 ()35270487 (PubMedID)2-s2.0-85126398800 (Scopus ID)
Available from: 2022-03-15 Created: 2022-03-15 Last updated: 2023-04-14Bibliographically approved
Eggenschwiler, L. C., Rutjes, A. W., Musy, S. N., Ausserhofer, D., Nielen, N. M., Schwendimann, R., . . . Simon, M. (2022). Variation in detected adverse events using trigger tools: A systematic review and meta-analysis. PLOS ONE, 17(9), Article ID e0273800.
Open this publication in new window or tab >>Variation in detected adverse events using trigger tools: A systematic review and meta-analysis
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2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 9, article id e0273800Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Adverse event (AE) detection is a major patient safety priority. However, despite extensive research on AEs, reported incidence rates vary widely.

OBJECTIVE: This study aimed: (1) to synthesize available evidence on AE incidence in acute care inpatient settings using Trigger Tool methodology; and (2) to explore whether study characteristics and study quality explain variations in reported AE incidence.

DESIGN: Systematic review and meta-analysis.

METHODS: To identify relevant studies, we queried PubMed, EMBASE, CINAHL, Cochrane Library and three journals in the patient safety field (last update search 25.05.2022). Eligible publications fulfilled the following criteria: adult inpatient samples; acute care hospital settings; Trigger Tool methodology; focus on specialty of internal medicine, surgery or oncology; published in English, French, German, Italian or Spanish. Systematic reviews and studies addressing adverse drug events or exclusively deceased patients were excluded. Risk of bias was assessed using an adapted version of the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Our main outcome of interest was AEs per 100 admissions. We assessed nine study characteristics plus study quality as potential sources of variation using random regression models. We received no funding and did not register this review.

RESULTS: Screening 6,685 publications yielded 54 eligible studies covering 194,470 admissions. The cumulative AE incidence was 30.0 per 100 admissions (95% CI 23.9-37.5; I2 = 99.7%) and between study heterogeneity was high with a prediction interval of 5.4-164.7. Overall studies' risk of bias and applicability-related concerns were rated as low. Eight out of nine methodological study characteristics did explain some variation of reported AE rates, such as patient age and type of hospital. Also, study quality did explain variation.

CONCLUSION: Estimates of AE studies using trigger tool methodology vary while explaining variation is seriously hampered by the low standards of reporting such as the timeframe of AE detection. Specific reporting guidelines for studies using retrospective medical record review methodology are necessary to strengthen the current evidence base and to help explain between study variation.

National Category
Health Sciences
Identifiers
urn:nbn:se:du-42519 (URN)10.1371/journal.pone.0273800 (DOI)000892263300068 ()36048863 (PubMedID)2-s2.0-85137138481 (Scopus ID)
Available from: 2022-09-07 Created: 2022-09-07 Last updated: 2023-03-17Bibliographically approved
Saar, L., Unbeck, M., Bachnick, S., Gehri, B. & Simon, M. (2021). Exploring omissions in nursing care using retrospective chart review: An observational study.. International Journal of Nursing Studies, 122, Article ID 104009.
Open this publication in new window or tab >>Exploring omissions in nursing care using retrospective chart review: An observational study.
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2021 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 122, article id 104009Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Omissions in nursing care can compromise patient safety. To date, this phenomenon has been investigated almost exclusively via nurse surveys. However, such surveys restrict the range of activities which can be assessed for omissions, and patient level analysis. As an alternative, retrospective chart review methodology has been used successfully in other research fields, but not yet for omitted nursing care.

OBJECTIVES: To describe characteristics and frequency of omitted nursing care using a retrospective chart review methodology.

DESIGN, SETTING AND PARTICIPANTS: Observational single center study in two German neurological inpatient units. A random sample of 100 patient admissions was used.

METHODS: A structured chart review protocol to detect nursing omissions was developed and applied. The full range of expected nursing care activities were assessed regarding the importance of documenting them and whether they had been fully or partially omitted. Vital sign measurements were assessed regarding both the measurement target number and the number of measurements recorded.

RESULTS: In total, 1885 activities-a mean of 19 per patient-were identified. Of the reviewed activities, 52% (n = 971) were fully or partially omitted. Patients experienced between one and 22 omitted nursing care activities during their hospital stay (8-84% of expected care activities). Ranging from 6% to 100% some activities were more commonly omitted than others during admission. The most frequently omitted nursing activity was giving emotional care (88%, n = 66); the least frequently omitted was teaching (10%, n = 29). Vital signs were recorded only 50% (n = 141) of the targeted number of times.

CONCLUSIONS: Using a retrospective chart review protocol to identify omissions in nursing care allows the assessment of a broad range of nursing activities. Additionally, this is the first-time patient-level data on a broad range of activities have been analyzed. The newly developed chart review methodology can complement established survey methods and provide a new perspective on the phenomenon of omitted nursing care.

Keywords
Care left undone, Delivery of health care, Electronic health record, Missed care, Nursing care, Omissions in nursing care, Quality of health care, Rationing of care, Retrospective chart reviews, Unfinished care
National Category
Nursing
Identifiers
urn:nbn:se:du-37832 (URN)10.1016/j.ijnurstu.2021.104009 (DOI)000696931100020 ()34298321 (PubMedID)2-s2.0-85110661786 (Scopus ID)
Available from: 2021-08-04 Created: 2021-08-04 Last updated: 2023-04-14Bibliographically approved
Projects
Kartläggning av förutsättningarna för patienter med traumatiska bröstkorgsskador – fokus på epidemiologi och patientsäkerhet; Publications
Lundin, A., Akram, S. K., Berg, L. M., Göransson, K. E. & Enocson, A. (2022). Thoracic injuries in trauma patients: epidemiology and its influence on mortality. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 30(1), Article ID 69.
Patientsäkerhet och resiliens vid vård av barn och unga med onkologisk sjukdomBrytpunkter för säker vård – samband mellan patientutfall och bemanning inom omvårdnadMarkörbaserad journalgranskning inom hemsjukvård – säker vård i hemmet; Publications
Nilsson, L., Lindblad, M., Johansson, N., Säfström, L., Schildmeijer, K., Ekstedt, M. & Unbeck, M. (2023). Exploring nursing-sensitive events in home healthcare: A national multicenter cohort study using a trigger tool. International Journal of Nursing Studies, 138, Article ID 104434. Lindblad, M., Unbeck, M., Nilsson, L., Schildmeijer, K. & Ekstedt, M. (2020). Identifying no-harm incidents in home healthcare: a cohort study using trigger tool methodology.. BMC Health Services Research, 20(1), Article ID 289. Lindblad, M., Schildmeijer, K., Nilsson, L., Ekstedt, M. & Unbeck, M. (2018). Development of a trigger tool to identify adverse events and no-harm incidents that affect patients admitted to home healthcare.. BMJ Quality and Safety, 27(7), 502-511Rutberg, H., Borgstedt-Risberg, M., Gustafson, P. & Unbeck, M. (2016). Adverse events in orthopedic care identified via the Global Trigger Tool in Sweden - implications on preventable prolonged hospitalizations.. Patient Safety in Surgery, 10, Article ID 23.
Validering av registerdata för utvärdering av oönskade händelser efter höftproteskirurgi; Publications
Hommel, A., Magnéli, M., Samuelsson, B., Schildmeijer, K., Sjöstrand, D., Göransson, K. & Unbeck, M. (2020). Exploring the incidence and nature of nursing-sensitive orthopaedic adverse events: A multicenter cohort study using Global Trigger Tool.. International Journal of Nursing Studies, 102, Article ID 103473. Magnéli, M., Unbeck, M., Rogmark, C., Sköldenberg, O. & Gordon, M. (2020). Measuring adverse events following hip arthroplasty surgery using administrative data without relying on ICD-codes.. PLOS ONE, 15(11), Article ID e0242008. Magnéli, M., Unbeck, M., Samuelsson, B., Rogmark, C., Rolfson, O., Gordon, M. & Sköldenberg, O. (2020). Only 8% of major preventable adverse events after hip arthroplasty are filed as claims: a Swedish multi-center cohort study on 1,998 patients.. Acta Orthopaedica, 91(1), 20-25Magnéli, M., Unbeck, M., Rogmark, C., Rolfson, O., Hommel, A., Samuelsson, B., . . . Sköldenberg, O. (2019). Validation of adverse events after hip arthroplasty: a Swedish multi-centre cohort study.. BMJ Open, 9(3), Article ID e023773.
Incidens och karaktäristika av skador inom pediatrisk slutenvård – en systematisk översikt och metaanalys; Publications
Dillner, P., Eggenschwiler, L. C., Rutjes, A. W., Berg, L. M., Musy, S. N., Simon, M., . . . Unbeck, M. (2023). Incidence and characteristics of adverse events in paediatric inpatient care: a systematic review and meta-analysis. BMJ Quality and Safety (3), 133-149
Identifiering av skador inom neonatalvårdKartläggning av inträffade fall och risker samt följsamhet till dokumentationsriktlinjer avseende fallförekomst under slutenvårdsperiod; Publications
Krakau, K., Andersson, H., Dahlin, Å., Egberg, L., Sterner, E. & Unbeck, M. (2021). Validation of nursing documentation regarding in-hospital falls: a cohort study. BMC Nursing, 20(1), Article ID 58.
Patientsäkerhet inom barnsjukvård; Publications
Nydert, P., Unbeck, M., Pukk Härenstam, K., Norman, M. & Lindemalm, S. (2020). Drug Use and Type of Adverse Drug Events-Identified by a Trigger Tool in Different Units in a Swedish Pediatric Hospital.. Drug, Healthcare and Patient Safety, 12, 31-40Unbeck, M., Lindemalm, S., Nydert, P., Ygge, B.-M., Nylén, U., Berglund, C. & Härenstam, K. P. (2014). Validation of triggers and development of a pediatric trigger tool to identify adverse events.. BMC Health Services Research, 14, Article ID 655.
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