Backman Chantal, Hebert Paul C, Jennings Alison, Neilipovitz David, Choudhri Omar, Iyengar Akshai, Rigal Romain, Forster Alan J
University of Ottawa , Ottawa, Canada.
University of Montreal , Montreal, Canada.
Int J Health Care Qual Assur. 2018 Mar 12;31(2):140-149. doi: 10.1108/IJHCQA-04-2017-0067.
Purpose Patient safety remains a top priority in healthcare. Many organizations have developed systems to monitor and prevent harm, and have invested in different approaches to quality improvement. Despite these organizational efforts to better detect adverse events, efficient resolution of safety problems remains a significant challenge. The authors developed and implemented a comprehensive multimodal patient safety improvement program called SafetyLEAP. The term "LEAP" is an acronym that highlights the three facets of the program including: a Leadership and Engagement approach; Audit and feedback; and a Planned improvement intervention. The purpose of this paper is to evaluate the implementation of the SafetyLEAP program in the intensive care units (ICUs) of three large hospitals. Design/methodology/approach A comparative case study approach was used to compare and contrast the adherence to each component of the SafetyLEAP program. The study was conducted using a convenience sample of three ( n=3) ICUs from two provinces. Two reviewers independently evaluated major adherence metrics of the SafetyLEAP program for their completeness. Analysis was performed for each individual case, and across cases. Findings A total of 257 patients were included in the study. Overall, the proportion of the SafetyLEAP tasks completed was 64.47, 100, and 26.32 percent, respectively. ICU nos 1 and 2 were able to identify opportunities for improvement, follow a quality improvement process and demonstrate positive changes in patient safety. The main factors influencing adherence were the engagement of a local champion, competing priorities, and the identification of appropriate resources. Practical implications The SafetyLEAP program allowed for the identification of processes that could result in patient harm in the ICUs. However, the success in improving patient safety was dependent on the engagement of the care teams. Originality/value The authors developed an evidence-based approach to systematically and prospectively detect, improve, and evaluate actions related to patient safety.
目的 患者安全仍是医疗保健领域的首要任务。许多组织已开发出监测和预防伤害的系统,并在不同的质量改进方法上进行了投资。尽管组织为更好地发现不良事件做出了这些努力,但安全问题的有效解决仍然是一项重大挑战。作者开发并实施了一个名为SafetyLEAP的全面多模式患者安全改进计划。术语“LEAP”是一个首字母缩写词,突出了该计划的三个方面,包括:领导与参与方法;审核与反馈;以及计划好的改进干预措施。本文的目的是评估SafetyLEAP计划在三家大型医院的重症监护病房(ICU)中的实施情况。
设计/方法/途径 采用比较案例研究方法来比较和对比对SafetyLEAP计划各组成部分的遵守情况。该研究使用了来自两个省份的三个(n = 3)ICU的便利样本。两名评审员独立评估SafetyLEAP计划的主要遵守指标的完整性。对每个单独案例以及跨案例进行了分析。
结果 该研究共纳入257名患者。总体而言,完成的SafetyLEAP任务比例分别为64.47%、100%和26.32%。ICU 1号和2号能够识别改进机会,遵循质量改进流程,并在患者安全方面表现出积极变化。影响遵守情况的主要因素是当地倡导者的参与、相互竞争的优先事项以及适当资源的识别。
实际意义 SafetyLEAP计划有助于识别ICU中可能导致患者伤害的流程。然而,提高患者安全的成功取决于护理团队的参与。
原创性/价值 作者开发了一种基于证据的方法,用于系统地、前瞻性地检测、改进和评估与患者安全相关的行动。