Ohlsen Jonas Torp, Søfteland Eirik, Akselsen Per Espen, Assmus Jörg, Harthug Stig, Lein Regina Küfner, Sevdalis Nick, Wæhle Hilde Valen, Øvretveit John, Hartveit Miriam
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
BMJ Qual Saf. 2025 Mar 19;34(4):257-268. doi: 10.1136/bmjqs-2024-017185.
Many patient safety practices are only partly established in routine clinical care, despite extensive quality improvement efforts. Implementation science can offer insights into how patient safety practices can be successfully adopted.
The objective was to examine the literature on implementation of three internationally used safety practices: medication reconciliation, antibiotic stewardship programmes and rapid response systems. We sought to identify the implementation activities, factors and outcomes reported; the combinations of factors and activities supporting successful implementation; and the implications of the current evidence base for future implementation and research.
We searched Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Education Resources Information Center from January 2011 to March 2023. We included original peer-reviewed research studies or quality improvement reports. We used an iterative, inductive approach to thematically categorise data. Descriptive statistics and hierarchical cluster analyses were performed.
From the 159 included studies, eight categories of implementation activities were identified: and . Most studies reported activities from multiple categories. Implementation factors included: c and . Factors were often suggested post hoc and seldom used to guide the selection of implementation strategies. Implementation outcomes were reported as: and . Most studies reported implementation improvement, hindering discrimination between more or less important factors and activities.
The multiple activities employed to implement patient safety practices reflect mainly method-based improvement science, and to a lesser degree determinant frameworks from implementation science. There seems to be an unexploited potential for continuous adaptation of implementation activities to address changing contexts. Research-informed guidance on how to make such adaptations could advance implementation in practice.
尽管进行了广泛的质量改进工作，但许多患者安全措施在常规临床护理中仅部分得以确立。实施科学可以为如何成功采用患者安全措施提供见解。
目的是研究关于三种国际通用安全措施实施情况的文献：用药核对、抗生素管理计划和快速反应系统。我们试图确定所报告的实施活动、因素和结果；支持成功实施的因素和活动的组合；以及当前证据基础对未来实施和研究的影响。
我们检索了2011年1月至2023年3月期间的Medline、Embase、科学网、护理及相关健康文献累积索引、PsycINFO和教育资源信息中心。我们纳入了经同行评审的原创研究或质量改进报告。我们采用迭代归纳法对数据进行主题分类。进行了描述性统计和层次聚类分析。
从纳入的159项研究中，确定了八类实施活动：以及。大多数研究报告了多个类别的活动。实施因素包括：c和。因素通常是事后提出的，很少用于指导实施策略的选择。实施结果报告为：以及。大多数研究报告了实施方面的改进，这妨碍了区分更重要或不太重要的因素和活动。
用于实施患者安全措施的多种活动主要反映了基于方法的改进科学，在较小程度上反映了实施科学的决定因素框架。似乎存在持续调整实施活动以适应不断变化的环境的未开发潜力。关于如何进行这种调整的基于研究的指导可以推动实践中的实施。
