Publications scientifiques

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.

What do double-check routines actually detect?

Double checking is used in oncology to detect medication errors before administering chemotherapy. The objectives of the study were to determine the frequency of detected potential medication errors, i.e., mismatching information, and to better understand the nature of these inconsistencies.

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

Abstract


Quality and Safety in Health Care

A survey on what pharmacists and physicians caring for nursing home residents expect of user-friendly lists of potentially inappropriate prescribing (PIP lists).

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

Abstract
 


Guideline-based indicators for adult patients with myelodysplastic syndromes

Guideline-based indicators (GBI) are measurable elements for quality of care and are currently lacking for adult patients with Myelodysplastic syndromes (MDS). The authors developed a GBI consensus for the domains of diagnosis (n = 14), therapy (n = 8), and provider/infrastructural characteristics (n = 7).

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

Abstract
 


Impact of an evidence-based intervention on urinary catheter utilization

Catheter-associated urinary tract infections (CAUTI) are a well-known complication of urinary tract catheterization, with rates ranging from 0.2-4.8 per 1,000 catheter days. The aim of this study was to decrease urinary catheterization and consequently catheter-associated urinary tract infections (CAUTI) and non-infectious complications.

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

Abstract


Registration and Management of Never Events in Swiss Hospitals

In Switzerland, there is no mandatory reporting of never events. The aim of this study was to explore how hospitals outside mandatory never-event-regulations identify, register, and manage never events and whether practices are associated with hospital size.

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

Abstract


Patient Safety Threats in Information Management

Cancer care is complex, involving highly toxic drugs, critically ill patients, and various different care providers. Because it is important for clinicians to have the latest and complete information about the patient available, this study focused on patient safety issues in information management developing from health information technology (HIT) use in oncology ambulatory infusion centers.

 

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.

Abstract
 


What are we doing when we double check?

Double checking is often considered a useful strategy to detect and prevent medication errors, especially before the administration of high-risk drugs. From a safety research perspective, the effectiveness of double checking in preventing medication errors is limited by several factors, even if they are conducted independently.

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

Abstract
 

 


Change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals

Although indwelling urinary catheters (IUCs) are commonly used in acute care hospitals, an appropriate medical indication is often missing. IUCs are associated with urinary tract infections and non-infectious complications such as haematuria and urethral injury. The reduction of IUC use is therefore a key measure to increase patient safety. To promote safe urinary catheter use in Swiss hospitals, a national QI project was developed and conducted by the Swiss Patient Safety Foundation in partnership with Swissnoso, the National Center for Infection Control.

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

Abstract


Speaking up about patient safety in psychiatric hospitals

The aim of this study was to examine speak up‐related behaviour and climate for the first time in psychiatric hospitals. A cross‐sectional survey was conducted among healthcare workers (HCWs) in six psychiatric hospitals with nine sites in Switzerland.

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

Abstract

 

 


Case Study: More Patient Safety by Design–System

Many of the more recent initiatives to improve patient safety target the behavior of health care staff (e.g., training, double-checking procedures, and standard operating procedures). System-based interventions have so far received less attention, even though they produce more substantial improvements, being less dependent on individuals’ behavior. One type of system-based intervention that can benefit patient safety involves improvements to hospital design. Given that people’s working environments affect their behavior, good design at a systemic level not only enables staff to

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

Abstract

 


Speaking up culture: Need of faculty working in patient safety

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.

 

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

Abstract
 


Safety-relevant medication processes in Swiss nursing homes

Reducing adverse drug events in nursing homes is a central patient safety concern. The aim of this study was to assess how often selected medication processes to increase medication safety are already implemented in Swiss nursing homes and to examine how nursing homes that have not yet implemented these processes can be characterized based on their organizational features.

 

Results
420 of 1,525 invited individuals participated in the survey (response rate: 27.5 %). Of these, 65.0 % stated that regular systematic medication reviews have been provided in their institution. 9.5 % of the nursing homes use a list to identify potentially inappropriate medication, and 6.7 % of the nursing homes have a standardized process to monitor side effects of medications. 66.0 % of the participating nursing homes have implemented at least one of these three processes, 34.0 % of the participating nursing homes have not implemented any of the three processes. Statistically significant differences in process implementation were found according to the geographical location of the nursing home, the type of documentation used for medications, the physician model, the number of external general practitioners, as well as the medication supply channel and the legal obligation to cooperate with pharmacists. No differences were found with regard to the nursing home size.

Conclusion
In Swiss nursing homes, central safety-relevant medication processes have not yet been implemented nationwide. In particular, implementation is not widespread in nursing homes where medical care for their residents is provided by many different external general practitioners. The organizational features need to be taken into account to successfully implement quality improvement measures.

Source
The journal of evidence and quality in health care

Authors
Andrea Niederhauser, Dr. Lea Brühwiler, Dr. Liat Fishmann, Prof. Dr. David Schwappach der Stiftung Patientensicherheit Schweiz.

Abstract


Patient safety hazards resulting from information technology usage in outpatient oncology infusion centers

The aim of the present study from Dr. Yvonne Pfeiffer, Chantal Zimmrmann and Prof. Dr. David Schwappach from Patient Safety Switzerland was to identify patient safety hazards coming with the use of health information technology (HIT): patient safety hazards in three outpatient oncology infusion centers were assessed and priority topics identified.

Additionally, the number of information sources clinicians have to use in order to get an idea of the patient's situation was systematically assessed. Interviews and observations were conducted with one nurse and one doctor of each ambulatory infusion center.

Principal results
Information management-related patient safety hazards were omnipresent in daily care: eleven topics were identified from 125 assessed patient safety hazards. Three of them were particularly relevant to the clinicians’ development of an adequate mental model about the patient: patient-related information was not stored in one place but often fragmented in different HIT systems; despite the introduction of HIT, paper documentation remained in place for certain information, making access difficult and increasing the number of relevant sources; the lack of usability of the HIT systems made it difficult to retrieve patient information in a timely manner. Clinicians needed to use between 5 and 11 sources of information to get a more complete picture of a patient's situation.

Major conclusions
Overall, it has been shown that the design of the HIT systems is not sufficiently adapted to the work processes and does not support clinicians in being fully informed about a patient. The topics identified point to future system design and areas for improvement. In this process, it is very important to align the real work requirements with the design of the HIT and to evaluate and monitor the actual implementation and use of HIT.

Source: ZEFQ Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen

Authors: Dr. Yvonne Pfeiffer, Chantal Zimmermann, Prof. Dr. David Schwappach, Fondation sécurité des patients suisse

Abstract


Safe vincristine use in Switzerland: Still a long way to go?

Different international organizations recommend safety measures for the use of vincristine to prevent wrong route administrations. A central recommendation is to use infusion bags instead of syringes to prevent confusion with intrathecal chemotherapy. This study aimed to investigate the implementation of safety measures for vincristine and intrathecal chemotherapies in Switzerland.

Source:  Journal of Oncology Pharmacy Practice

Authors: Dr Lea Brühwiler et Prof. Dr David Schwappach, Fondation Sécurité des patients Suisse

Abstract


Patient Safety in Cancer Care

Cancer care has seen large successes in terms of increased survival rates and improvements in quality of life. However, despite these achievements, many patients suffer preventable harm from treatment. Studies of patient safety in cancer care have usually focused on chemotherapy safety and have been conducted in large centers. These studies reveal that errors are more frequent in more complex therapies and that about 1-3% of adult and pediatric patients are affected by chemotherapy errors 1.

Source: eonsmagazine Winter/Spring 2019

Author: Prof. Dr. David Schappach, Directeur recherche et développement, Directeur adjoint, Fondation sécurité des patients Suisse


Speaking Up about Patient Safety in Perioperative Care: Differences between Academic and Nonacademic Hospitals in Austria and Switzerland

Purpose of the Study: In perioperative care, communication about patient safety concerns is both difficult and valuable. Research into speaking up has mostly been conducted in single countries; the aim of this study was to compare speaking up-related climate and behaviors in academic and nonacademic hospitals.

Source: Journal of Investigative Surgery

 

Authors:
David Schwappach from Swiss Patient Safety Foundation, Zurich, Switzerland
Gerald Sendlhofer from Executive Department for Quality and Risk Management, Landeskrankenhaus-Universitatsklinikum Graz, Graz, Austria and Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Research Unit for Safety in Health, Medizinische Universitat Graz, Graz, Austria

Abstract


Assessment of the safety climate in outpatient diagnostic services: Development and psychometric evaluation of a questionnaire

Safe practice and safety culture are important issues in outpatient diagnostic imaging services. As questionnaires assessing safety culture through the measurement of safety climate in this setting are not yet available, the present study aimed to develop and validate such an instrument.

 

Conclusions

The final instrument presents a valid, consistent and reliable option to measure safety climate in outpatient diagnostic imaging services. Results can be used as a basis for quality improvement.

Key Points

• An adapted questionnaire that assesses safety climate in outpatient diagnostic imaging services was developed and tested in Switzerland.

• Psychometric evaluation showed the questionnaire to be a valid, consistent and reliable instrument.

• Results are of interest for imaging services as well as for stakeholders interested more globally in monitoring and quality improvement

Authors

Marianne Jossen, Fabio Valeri, Christina Heilmaier, David Schwappach

Source
Springer Link, European Radiology

Abstract


 


Medication safety in Switzerland: Where are we today?

Empirical research shows that medication safety is an urgent area of concern in the Swiss healthcare system. Adverse drug events and medication errors are common and risks such as polypharmacy are widespread.

 

Abstract
No comprehensive national strategy explicitly dedicated to medication safety exists in Switzerland. The federalist system of government with relative autonomy of the cantons relating to healthcare laws influences the implementation of national healthcare reforms, also to the disadvantage of medication safety. Direct dispensing of drugs by the prescribing physician is permitted in almost all German-speaking cantons. This special feature of the Swiss system implies specific challenges for medication safety. Nonetheless, there is an increasing number of national activities dealing with various aspects of medication safety, such as the “progress!” programmes within the National Quality Strategy. Within the National Research Programme “Smarter Health Care” (NRP 74) of the Swiss National Science Foundation, several research projects are currently focusing on medication safety. Clinical pharmacy activities in hospitals are relatively widespread. In the primary care sector, pharmaceutical care practice and the corresponding competencies for pharmacists are being further developed. However, a comprehensive strategy, priority-setting and effectiveness studies involving all stakeholders are required in order for the Swiss healthcare system, to meet the challenges facing medication safety in a forward-looking manner.

Auteures
Liat Fishman, Lea Brühwiler, David Schwappach

Source
Springer Link/Bundesgesunheitsblatt - Gesundheitsforschung - Gesundheitsschutz

 


Nurses’ and Physicians’ Perceptions of Indwelling Urinary Catheter Practices and Culture in Their Institutions

Objectives Indwelling urinary catheters (IUCs) are commonly used devices in acute care that may lead to catheter-associated urinary tract infections or noninfectious complications. Responsibilities for IUC are usually shared between nurses and physicians, and a common mental model among the two professional groups is thus essential for a successful reduction in catheter use. The aim of this study was to determine variation in the perceptions of current practices and culture regarding IUC use between these two groups.

Results

Nurses and physicians each have their own tasks but also share responsibilities for catheter placement, care, and removal. Overall, nurses were more positive than physicians about current practices and culture regarding IUC use within their institution (mean scale scores = 5.4 for nurses versus 5.1 for physicians, P < 0.001). Perceptions of the two professional groups diverged most strongly on practices to avoid unnecessary placement of IUCs, the presence of shared values and attitudes in support of restrictive catheter use, and the other group's leadership commitment.

 

Autors

Niederhauser, Andrea, MPH*; Züllig, Stephanie, PhD*; Marschall, Jonas, MD†‡; Schwappach, David LB, PhD*§ progress! Safe Urinary Catheterization Collaboration Group