FACTORS AFFECTING PATIENT SAFETY AS PERCEIVED BY STAFF NURSES IN SELECTED HOSPITALS IN METRO MANILA I. INTRODUCTION A)BACKGROUND “The biggest challenge to moving toward a safer health system is changing the culture from one of blaming individuals for errors to one in which errors are treated not as personal failures, but as opportunities to improve the system and prevent harm. ” – Institute of Medicine ‘99 Issues related to a lack of patient safety have been reported for decades. During the first decade of the 21st century, there has been a national focus on improving patient safety.
Patient safety is a global issue, affecting countries at all levels of development and is one of the nation’s most pressing health care challenges. According to the Institute of Medicine (1999), they have estimated that as many as 44,000 to 98,000 people die in U. S. hospitals each year as the result of lapses in patient safety. Estimates of the size of the problem on this are scarce particularly in developing countries; it is likely that millions of patients worldwide could suffer disabling injuries or death every year due to unsafe medical care.
Healthcare institutions are becoming more aware of the importance of transforming organizational culture in order to improve patient safety. Growing interest in a culture of safety has been accompanied by the need for perception of health care workers on the aspects of patient safety improvement efforts. International accrediting bodies such as the Joint Commission International (2009) stated that almost 50 percent of their standards are directly related to safety.
Beforehand, they have already established National Patient Safety Goals (NPSG) in 2002 to help organizations address specific areas of concern in regards to patient safety. In the Philippines, we have the Philippine Health Insurance Corporation or better known as PhilHealth that accredits hospitals. Since the start of 2010, all institutions shall be re-accredited to determine whether they shall be awarded either as Center for Safety, Center for Quality or Center for Excellence. To aid them in this process, they have come up with the bench book for hospitals which contains seven performance areas.
Among these areas is “Safe Practice and Environment” which contains many core indicators. The National Core Competency Standards for Filipino Nurses (Board of Nursing, 2005) identified 11 key areas of responsibility, one of which is “Safe and Quality Nursing Care”. A core competency on this area focuses on the promotion safety and comfort and privacy of clients. Since nurses are known to be the front liners in any health care setting, they share several values, beliefs and experiences towards patient safety.
There is a need to better understand how nurses perceive the factors affecting patient safety because such findings can be translated into practice, especially in developing and transitional countries like ours. There is no doubt that patient safety has always and will continue to be an integral part of the delivery of quality patient care, and achieving an acceptable standard of patient safety requires that all healthcare settings develop patient safety systems including both a positive culture of safety and an organizational support for safety processes.
The researcher believes that this will not be possible unless the perceptions of the front-line healthcare providers and management are positively managed and directed, this is the main reason why the researcher decided to focus on the said to topic to shed some light in the attempt to know the implications of the identified factors affecting patient safety to the delivery of quality health care. B)STATEMENT OF THE PROBLEM: The study sought to identify the factors affecting patient safety as perceived by staff nurses.
Specifically, the researcher attempts to answer the following questions regarding the perceived factors affecting patient safety: 1)What is the demographic profile of the respondents in terms of their: A. Age B. Gender C. Primary work area or unit D. Number of years in service 2)What are the factors affecting patient safety as perceived by nurses in terms of: A. Teamwork within units B. Supervisor/Manager expectations C. Management support for patient safety D. Frequency of events reported E.
Overall perceptions of patient safety 3)Is there a significant relationship between the demographic profile of the respondents and the perceived factors affecting patient safety? C)STATEMENT OF THE HYPOTHESIS: Ho: There is no significant relationship between the profile of the respondents and the perceived factors affecting patient safety. D)SIGNIFICANCE OF THE STUDY The researcher assumes the vital role of this study within the following dimensions: ON NURSING SERVICE ADMINISTRATORS AND POLICY MAKERS: To reveal the nurses’ erceived factors on patient safety, so this may help in the development and implementation of protocols since healthcare organizations are beginning to be motivated to undertake safety culture assessments. Other institutions are already undertaking safety culture assessments to provide regulatory agencies with evidence of their patient safety activities. ON NURSING PRACTICE: Provide insights into the perceived factors on patient safety by nurses. Based on the findings to be culled from this study, implications on nursing care on patients may be derived.
Having this knowledge may help nurse practitioners to cultivate a culture of effective and safe healthcare delivery. ON NURSING EDUCATION: To help facilitate the understanding of the different factors affecting patient safety. Such awareness in essential for students in order for them to be trained in providing holistic care. For the faculty, this will aid them in preparing their students in utilizing the appropriate nursing process in helping them focus on the aspect of patient safety. ON FUTURE RESEARCHERS: To date, there has been limited data regarding the patient safety in our country.
This study may provide the needed drive for further inquiry by providing related facts and data necessary for researches of the similar context. E)SCOPE AND DELIMITATIONS The scope of this study is to identify the perception of nurses on the factors affecting patient safety. It shall focus on the demographic profile of the respondents and its relationship on the perceived factors. It shall be conducted in a selected hospital in Metro Manila from . For the purpose of this study, the following delimitations shall been noted: 1.
Due to time constraints on the part of the researcher, he decided to focus only on the following factors affecting patient safety as perceived by nurses: a. Teamwork within units b. Supervisor/Manager expectations c. Management support for patient safety d. Frequency of events reported e. Overall perceptions of patient safety 2. The study will only cover 80 Staff Nurse of the said institution. F)DEFINITION OF TERMS The terms used in the study is defined operationally by the researcher as follows: Gender Male or female Primary work area or unit
Area in which the respondent is currently working, either in a General Nursing Unit (GNU) or in Special Areas (DR, OR, ER, IMU, NICU, ER, ACC, Hemodialysis Unit) Number of years in service The respondents’ length of stay in his/her work Patient Safety: Avoidance and prevention of patient injuries or adverse events resulting from the process of health care delivery Teamwork within units: The extent to which staff support each other, treat each other with respect, and work together as a team. Supervisor/Manager expectations:
The extent to which supervisors/managers consider staff suggestions for improving patient safety. Management support for patient safety: Hospital management provides a work climate that promotes patient safety and shows that patient safety is a top priority Frequency of events reported: Numbers of mistakes of the following types are reported: (1) Mistakes caught and corrected before affecting the patient, (2) mistakes with no potential to harm the patient, and (3) mistakes that could harm the patient but do not occur
Overall perceptions of patient safety: Procedures and systems are good at preventing errors and there is a lack of patient safety problems II. REVIEW OF LITERATURE AND RELATED STUDIES: Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical error that often lead to adverse healthcare events. The frequency and magnitude of avoidable adverse patient events was not well known until the 1990s, when multiple countries reported staggering numbers of patients harmed and killed by medical errors.
Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization calls patient safety an endemic concern. (WHO, 2008) Recent reports by the Institute of Medicine (IOM) signal a substantial yet unrealized deficit in patient safety innovation and improvement. With the aim of reducing this dilemma, we provide an introductory account of clinical error resulting from poorly designed systems by reviewing the relevant health care, management, psychology, and organizational accident sciences literature. Palmieri, et. al. , 2008) A preventable adverse event does not necessarily mean a preventable death, since many of these patients would have died even if the adverse event had not occurred. (Leape, 1993) They estimate that about one-half of the deaths caused by iatrogenic AEs (adverse events) were preventable, by which they appear to mean deaths that would not have occurred without the adverse event. This statement is the clearest description of how the authors of these studies decided that an adverse event caused a death.
Although progress since then has been slow, the IOM report truly changed the conversation to a focus on changing systems, stimulated a broad array of stakeholders to engage in patient safety, and motivated hospitals to adopt new safe practices. (Leape, 2005) The pace of change is likely to accelerate, particularly in implementation of electronic health records, diffusion of safe practices, team training, and full disclosure to patients following injury. If directed toward hospitals that actually achieve high levels of safety, pay for performance could provide additional incentives.
When being treated, patients hope and trust that their health-related problems will be appropriately handled and that they will be well looked after. However, it is estimated that in EU Member States between 8% and 12% of patients admitted to hospitals suffer from adverse events while receiving health care. (http://ec. europa. eu/health/ph_systems/patient_safety_en. htm) CONCEPTUAL FRAMEWORK The study rooted on the concept of Maslow’s hierarchy of needs. It is a theory in psychology, proposed by Abraham Maslow in his 1943 paper “A Theory of Human Motivation”.
Maslow subsequently extended the idea to include his observations of humans’ innate curiosity. His theories parallel many other theories of human Developmental psychology, all of which focus on describing the stages of growth in humans. The lower four layers of the pyramid contain what Maslow called “deficiency needs” or “d-needs”: physiological (including sexuality), security of position, friendship and love, and esteem. With the exception of the lowest (physiological) needs, if these “deficiency needs” are not met, the body gives no physical indication but the individual feels anxious and tense.
With their physical needs relatively satisfied, the individual’s safety needs take precedence and dominate behavior. These needs have to do with people’s yearning for a predictable, orderly world in which injustice and inconsistency are under control, the familiar frequent and the unfamiliar rare. In the world of work, these safety needs manifest themselves in such things as a preference for job security, grievance procedures for protecting the individual from unilateral authority, savings accounts, insurance policies, reasonable disability accommodations, and the like.
For most of human history many individuals have found their safety needs unmet, but as of 2009 “First World” societies provide most with their satisfaction, although the poor must often still address these needs. III. RESEARCH METHODOLOGY A)RESEARCH DESIGN This study shall utilize a descriptive-comparative design since the purpose of this study is to identify the perceived factors affecting patient safety and its relationship with the demographic profile of the respondents. (Polit & Beck, 2008) B)LOCALE OF THE STUDY
X hospital is a private, tertiary, training hospital with 250 bed capacity licensed by the Department of Health. Its Nursing Service Department is composed of six medical-surgical units and eight special areas that cater a variety of medical, surgical, obstetric-gynecological and pediatric patients and cases. C)POPULATION AND SAMPLING TECHNIQUE Out of the one hundred (100) staff nurses of x hospital, eighty (80) or eighty per cent (80%) of the total population, shall be the respondents of the study. Based on the Slovin’s Formula with a 5% margin of error. D)RESEARCH INSTRUMENT
The study shall utilize an adapted and modified questionnaire based on the Hospital Survey on Patient Safety by the Agency for Health Care Research and Quality (AHRQ). The AHRQ, is a part of the United States Department of Health and Human Services which supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services. (www. ahrq. gov) They sponsors, conducts, and disseminates research to help people make more informed decisions and improve the quality of health care services.
It also acts as the regulator for Patient Safety Organizations that are certified under the Patient Safety and Quality Improvement Act. The AHRQ funded and supervised development of the Hospital Survey on Patient Safety Culture (hospital survey). Developers reviewed research pertaining to safety, patient safety, error and accidents, and error reporting. They also examined existing published and unpublished safety culture assessment tools. In addition, hospital employees and administrators were interviewed to identify key patient safety and error-reporting issues.
According to the AHRQ, Health care organizations can use these survey assessment tools to: •Raise staff awareness about patient safety. •Diagnose and assess the current status of patient safety culture. •Identify strengths and areas for patient safety culture improvement. •Examine trends in patient safety culture change over time. •Evaluate the cultural impact of patient safety initiatives and interventions. •Conduct internal and external comparisons. The survey was pilot tested and revised and then released by AHRQ in November 2004.
It was designed to assess hospital staff opinions about patient safety issues, medical error, and event reporting. The modified questionnaire shall consist of the demographic data of the respondents and clustered areas or composites that focus on the following: a. Teamwork within units b. Supervisor/Manager expectations c. Management support for patient safety d. Frequency of events reported e. Overall perceptions of patient safety A 5 point rating scale (Likert scale) shall be used with the following descriptive values: NUMERICAL SCOREDESCRIPTIVE VALUE 5Strongly Agree 4Agree Neither 2Disagree 1Strongly Disagree BIBLIOGRAPHY: A. BOOKS: Polit and Beck. (2008). Nursing Research. Principles and Methods 7th Ed. Lippincott Williams and Wilkins. Treece and Treece (1986). Elements of Nursing Research. St. Loui: The CV Mosby Company. Downie, N. (1984). Basic Statistical Methods 5th Ed. Harper & Row Publishers Inc. B. FOREIGN LITERATURE WHO (2008). Patient Safety research. Sorra, J. (2003). Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Health Care 2003;12(Suppl II):ii17–ii23 Institute of Medicine (2001).
Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press. Institute of Medicine (1999). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press Church A, Waclawski J. (1998) Designing and using organizational surveys: a Seven step process. San Francisco: Jossey-Bass. Kraut AI, ed. (1996) Organizational surveys: tools for assessment and change. San Francisco: Jossey-Bass. C. FOREIGN STUDIES: Donelly, L. (2008). Improving Patient Safety: Effects of a Safety Program on Performance and Culture in a Department of Radiology.
AJR:193, July 2009 165 Bodur, S. (2009). A survey on patient safety culture in primary healthcare services in Turkey. International Journal for Quality in Health Care Advance Access (originally published online on August 22, 2009) Smits, M. (2008). Measuring patient safety culture: an assessment of the clustering of responses at unit level and hospital level. Qual Saf Health Care 2009;18:292-296 doi:10. 1136/qshc. 2007. 025965 D. ELECTRONIC/ INTERNET RESOURCES: www. ahrq. gov www. jointcommission. org/patientsafety www. google. com
