La création, la diffusion et l’utilisation des savoirs constitue par conséquent une mission clé de la fondation. Vous trouverez ici un aperçu des publications scientifiques.
Le programme COM-Check montre comment la compliance peut être mesurée et améliorée avec la check-list chirurgicale. Pour une application durable et correcte de la check-list, Sécurité des patients Suisse recommande un contrôle régulier de la compliance grâce à l’observation et au feedback. Ces instruments sont présentés dans la série de publications 5+ COM-Check – Sécurité chirurgicale à partir de la mi-janvier 2022.
Un CIRS (Critical Incident Reporting System) est un système de déclaration et d’apprentissage permettant de répertorier les «erreurs évitées», dites «near misses». Il est frappant de constater que les évènements signalés portent dans la plupart des cas sur des actes erronés. Il en va de même pour les incidents graves, dont les causes identifiées sont souvent comparables.
Dans le secteur de la santé, les systèmes d’informations numériques peuvent améliorer l’efficacité et la sécurité des soins. Si leur conception, leur implémentation ou leur utilisation s’avèrent toutefois inadéquates, leur potentiel n’est pas pleinement exploité et des erreurs peuvent être commises. Ceci peut porter préjudice aux patients, affecter l’efficacité et susciter la frustration du personnel de santé.
The aim of the study was to develop quality standards reflecting minimal requirements for safe medication processes in nursing homes.
In a first step, relevant key topics for safe medication processes were deducted from a systematic search for similar guidelines, prior work and discussions with experts. In a second step, the essential requirements for each key topic were specified and substantiated with a literature-based rationale. Subsequently, the requirements were evaluated with a piloted, two-round Delphi study.
We developed normative quality standards for a safer and resident-oriented medication in Swiss nursing homes. Altogether, 85 requirements define the medication processes and the behaviour of healthcare professionals. A rigorous implementation may support nursing homes in taking a step towards safer and resident-oriented medication.
Ce rapport donne un aperçu des domaines d'action potentiellement pertinents et des interventions efficaces en matière de sécurité des patients pour les projets nationaux d'amélioration de la qualité, décrit les pratiques de mise en œuvre prometteuses, évalue les «progrès ! des programmes pilotes», définit les méthodes et le contenu des futurs programmes d'intervention, et identifie les domaines d'action prioritaires.
Un résumé, qui donne un aperçu des principales conclusions, est disponible en anglais, allemand, italien et français. Le rapport complet en anglais est disponible gratuitement.
Results
Data of 959 health care professionals were included in the analysis. Single participants identified on average 4.7 of the 10 errors and additional 10 errors and hazards that were not part of the official scenario. However, they also overestimated their performance, with 58% feeling the errors to be easy to find. Group observations indicated that participants rarely reflected on possible consequences of the hazards for the patient or their daily work. Participants feedback to the method was very positive.
Conclusions
Our findings suggest that the Room of Horrors is a popular and effective method to raise situational awareness for patient safety issues among health care staff. More attention should be given to debriefing after the experience and to benefits of interprofessional trainings.
Source
Journal of Patient Safety
Authors
Chantal Zimmermann, Annemarie Fridrich, David Schwappach
Results
In 22 (3.2%) of 690 observed double checks, 28 chemotherapy-related inconsistencies were detected. Half of them related to non-matching information between order and drug label, while the other half was identified because the nurses used their own knowledge. 75% of the inconsistencies could be traced back to inappropriate orders, and the inconsistencies led to 33 subsequent or corrective actions.
Conclusions
In double check situations, the plausibility of the medication is often reviewed. Additionally, they serve as a correction for errors and that are made much earlier in the medication process, during order. Both results open up new opportunities for improving the medication process.
Source
BMJ open
Authors
Dre Yvonne Pfeiffer, Chantal Zimmermann, Prof. Dr David Schwappach, Sécurité des patients Suisse
Potentially inappropriate prescribing (PIP, including potentially inappropriate medication, PIM) is frequent. In research and practice, the use of PIP lists could optimize a patient's medication. However, they are barely used, possibly because of their limited user-friendliness. This study aimed at evaluating the opinions of pharmacists and physicians caring for nursing home residents on user-friendliness as well as knowledge and current use of PIP lists.
Results
A total of 30 practitioners participated in the survey, eight of whom were interviewed by phone. 43 % (13/30) of the participants had already heard of PIP lists, and 46 % (6/13) of them made use of a PIP list. Less experienced professionals had more often heard of PIP lists than more experienced ones. The most important aspects of user-friendliness were: time required to use the list, electronic availability, clear structure and provision of reasons, why a medication is potentially inappropriate. Physicians more often than pharmacists preferred a PIP list adapted to the Swiss drug market.
Conclusion
In order for PIP lists to be used more frequently, the aspects of user-friendliness should be taken into account. Personalizable PIP lists could be an interesting development.
Source
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
Authors
Simone C.Lüscher, Kurt E.Hersbergera, Lea D.Brühwiler
Results
We screened relevant G/Rs published between 1999 and 2018 and aggregated all available information as candidate GBIs into a formalized handbook as the basis for the subsequent consensus rating procedure. An international multidisciplinary expert panel group (EPG) of acknowledged MDS experts (n = 17), health professionals (n = 7), and patient advocates (n = 5) was appointed. The EPG feedback rates for the first and second round were 82% (23 of 28) and 96% (26 of 27), respectively. A final set of 29 GBIs for the 3 domains of diagnosis (n = 14), therapy (n = 8), and provider/infrastructural characteristics (n = 7) achieved the predefined agreement score for selection (>70%).
Conclusion
We identified shortcomings in standardization of patient-reported outcomes, toxicity, and geriatric assessments that need to be optimized in the future. Our GBIs represent the first comprehensive consensus on measurable elements addressing best practice performance, outcomes, and structural resources. They can be used as a standardized instrument with the goal of assessing, comparing, and fostering good quality of care within clinical development cycles in the daily care of adult MDS patients.
Source
Blood advances
Authors
Kristina Stojkov, Tobias Silzle, Georg Stussi, David Schwappach, Juerg Bernhard, David Bowen et al
Findings
We included 25,880 patients [13,171 before the intervention (August-October 2016) and 12,709 after the intervention (August-October 2017)]. Catheter utilization dropped from 23.7% to 21.0% (p=0.001), and catheter-days per 100 patient-days from 17.4 to 13.5 (p=0.167). CAUTI remained stable on a low level with 0.02 infections per 100 patient-days (before) and 0.02 infections (after), (p=0.98). Measuring infections per 1,000 catheter-days, the rate was 1.02 (before) and 1.33 (after), (p=0.60). Non-infectious complications dropped significantly, from 0.79 to 0.56 events per 100 patient-days (p<0.001), and from 39.4 to 35.4 events per 1,000 catheter-days (p=0.23). Indicated catheters increased from 74.5% to 90.0% (p<0.001). Reevaluations increased from 168 to 624 per 1,000 catheter-days (p<0.001).
Conclusion
In this before/after intervention study of urinary catheter utilization, a straightforward bundle of three evidence-based measures (providing a catheter indication list, promoting daily catheter evaluation, and teaching state-of-the-art catheter insertion) reduced catheter utilization and led to increases in indicated urinary catheters and daily evaluations. The intervention had an impact on non-infectious complications, whereas the CAUTI rate remained on a low level.The next step is planning the national roll-out of both the surveillance module and the intervention bundle, the components of which have been made available to the public (surveillance module, intervention bundle)
Source
The Journal of Hospital Infection
Authors
Dr. Alexander Schweiger, Prof. Dr. med. Jonas Marschall, PD Dr. med. Stefan P. Kuster, Judith Maag, Prof. Hugo Sax, Swissnoso
Andrew Atkinson, Inselspital Bern
Dr. med. Sonja Bertschy, Kantonsspital Luzern
Emmanuelle Bortolin, Ente Ospidaliero Cantonale Bellinzona
Dr. Gregor John, Hôpital Neuchâtelois
PhD Andreas Limacher, Universität Bern
Prof. Dr. David Schwappach und Dr. Stephanie Züllig, Patientensicherheit Schweiz
Results
Clinical risk managers representing 95 hospitals completed the survey (55% response rate). Among responding risk and quality managers, only 45% would be formally notified through a designated reporting channel if a never event has happened in their hospital. Averaged over a list of 8 specified events, only half of hospitals could report a systematic count of the number of events. Hospital size was not associated with never- event-management. Respondents reported that their hospital pays “too little attention” to the recording (46%), the analysis (34%), and the prevention (40%) of never events. All respondents rated the systematic registration and analysis of never events as very (81%) or rather important (19%) for the improvement of patient safety.
Conclusions
A substantial fraction of Swiss hospitals do not have valid data on the occurrence of never events available and do not have reliable processes installed for the registration and exam of these events. Surprisingly, larger hospitals do not seem to be better prepared for never events management.
Source
Journal of Patient Safety
Authors
Prof. Dr. David Schwappach and Dr. Yvonne Pfeiffer from Swiss Patient Safety Foundation
Objective
The aim was to exploratively and prospectively assess patient safety risks from an expert perspective: instead of retrospectively analyzing safety events, we assessed the information management hazards inherent to the daily work processes; instead of asking healthcare workers at the front line, we used them as information sources to construct our patient safety expert view on the hazards.
Methods
The work processes of clinicians in three ambulatory infusion centers were assessed and evaluated based on interviews and observations with a nurse and a physician of each unit. The 125 identified patient safety issues were described and sorted into thematic groups.
Results
A broad range of patient safety issues was identified, such as data fragmentation, or information islands, meaning that patient data are stored across different cases or software and that different professional groups do not use the same set of information.
Conclusions
The current design and implementation of HIT systems do not support adequate information management: clinicians needed to play very close attention and improvise to avoid errors in using HIT and treat cancer patients safely. It is important to take the clinical front-end practice into account when evaluating or planning further HIT improvements.
Source
Journal of Patient Safety
Authors
Dre Yvonne Pfeiffer; Chantal Zimmermann; Prof. Dr David Schwappach de Sécurité des patients Suisse.
As double checking uses considerable resources of nurses’ time and cognitive capacity, there is a pressing need to know whether existing empirical evidence supports using double checking despite its mentioned shortcomings.
We present a framework for classifying checking procedures and differentiating them from other medication-related safety behaviours in order to structure future research and practice. In addition, the concept of independence is discussed.
Source
BMJ Quality and Safety
Authors
Dre Yvonne Pfeiffer, Chantal Zimmermann, Prof. Dr David Schwappach de Sécurité des patients Suisse
The QI project was modelled after other successful QI initiatives in the USA. The overall project goal was to reduce IUC use and to promote safe catheter insertion and maintenance by implementing an evidence-based intervention bundle in seven Swiss acute care hospitals.With the present study, we aimed to assess the changes in staff perspectives in the participating hospitals using survey data collected before and after implementation of the intervention bundle.
Conclusion
Changing staff attitudes, knowledge and behaviour are important prerequisites for an effective reduction of catheter use and catheter-associated complications. We found small but significant changes in staff perceptions after implementation of an evidence-based intervention bundle. The positive trends were present in all subgroups, indicating that regardless of responsibilities and practice of catheter placement, perspectives on urinary catheter use changed over time. Efforts now need to be targeted at reinforcing and sustaining these changes, so that restrictive use of IUCs becomes an integral part of the hospital culture.
Source
BMJ Open
Authors
Andrea Niederhauser, Stephanie Züllig, Jonas Marschall, Alexander Schweiger, Gregor John, Stefan P Kuster, David LB Schwappach on behalf of the progress! Safe Urinary Catheterization Collaboration Group
Conclusions
Speaking up for patient safety is an important topic in the psychiatric healthcare setting. Speaking up to prevent harm to patients should be further promoted in psychiatric clinics as an important safety measure. In order to fully enact their role as advocates for patient safety, nurses should be empowered to voice concerns even in difficult situations. Further research is needed to gain more insights into the complex trade‐offs and considerations that influence decisions to speak up or withholding voice in the psychiatric healthcare setting.
Source
International Journal of Mental Health Nursing
Authors
David L. B. Schwappach PhD, MPH; Andrea Niederhauser MPH
work more efficiently; it can also prevent errors and mishaps, which can have serious consequences for patients.While an increasing number of studies have demonstrated the effect of hospital design on patient safety, this knowledge is not easily accessible to clinicians, practitioners, risk managers, and other decision-makers, such as designers and architects of health care facilities. This is why the Swiss Patient Safety Foundation launched its project, «More Patient Safety by Design: Systemic Approaches for Hospitals», which is presented in this chapter.
Source
Advances in Health Care Management
Authors
Irene Kobler, Prof. Dr. Alfred Angerer, Prof. Dr. David Schwappach, MPH
Results
326 individuals completed the questionnaire (response rate 24%). 37% of responders were in their 5th- 6th clinical term, 32% were in their 7th-8th term and 31% were in the 9th-12th term. 69% of students had a specific safety concern in the past four weeks, 48% had observed an error and 68% noticed the violation of a patient safety rule. Though students perceived specific patient safety concerns, 56% did not speak up in a critical situation. All predefined barriers seemed to play an important role in inhibiting students’ voicing concerns. The scores on the psychological safety scale were overall moderately favourable. Students felt little encouraged by colleagues and, in particular, by supervisors to speak up.
Conclusion
Speaking up behaviour of students was assessed for the first time in an Austrian academic teaching hospital. The higher the term the more frequent students reported perceived patient safety concerns or rule violations and withholding voice. These results suggest the need to adapt the curriculum concept of the faculty in order to address patient safety as a relevant topic.
Source
PLOS ONE
Authors
David Schwappach, Gerald Sendlhofer, Lars-Peter Kamolz, Wolfgang Köle, Gernot Brunner