Threats to patient safety in the primary care office: concerns of physicians and nurses.

BACKGROUND

Little is known about primary care professionals' concerns about risks to patient safety.

AIM

To identify threats to patient safety in the primary care office from the perspective of physicians and nurses.

DESIGN

Cross-sectional survey; participants were asked to name and rank threats to safety they personally were most concerned about.

SETTING

Physicians and nurses working in primary care offices in Switzerland.

METHODS

Verbatim reports were analysed under an inductive content-analysis framework. Coded threats were quantitatively analysed in terms of frequency and prioritisation. Differences between physicians and nurses were analysed.

RESULTS

Of 1260 invited individuals, 630 responded to the survey and 391 (31%) described 936 threats to patient safety. The coding system included 29 categories organised in 5 themes. Agreement of coders was good (kappa = 0.87, CI = 0.86-0.87). Safety of medication (8.8%), triage by nurses (7.2%) and drug interactions (6.8%) were the threats cited most frequently. Errors in diagnosis (OR = 0.21, CI 0.09-0.47, p <0.001), drug interactions (OR = 0.10, CI 0.04-0.25, p <0.001) and compliance of patients (OR = 0.28, CI 0.08-0.96, p = 0.044) were more likely to be cited by physicians. X-rays (OR = 3.34, CI 1.04-10.71, p = 0.043), confusion of patients or records (OR = 3.28, CI 1.55-6.94, p = 0.002), hygiene (OR = 3.21, CI1.12-9.19, p = 0.030), safety of office rooms (OR = 6.70, CI 1.46-30.73, p = 0.014), and confidentiality (OR = 7.38, CI 1.63-33.50, p = 0.010) were more likely to be described by nurses.

CONCLUSION

Physicians and nurses are concerned about diverse threats to patient safety in primary care. Involving both groups in detection and analysis of risks in medical offices seems a valuable strategy to improve collaboration and safety.