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Charlotte Thomas-Hawkins, PhD, RN Linda Flynn, RN, PhD, FAAN

Patient Safety Culture and Nurse-Reported Adverse Patient Events in Outpatient Hemodialysis Facilities . Charlotte Thomas-Hawkins, PhD, RN Linda Flynn, RN, PhD, FAAN. Adverse Events in Outpatient Dialysis Facilities. Common occurrence (Holly, 2006)

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Charlotte Thomas-Hawkins, PhD, RN Linda Flynn, RN, PhD, FAAN

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  1. Patient Safety Culture and Nurse-Reported Adverse Patient Events in Outpatient Hemodialysis Facilities Charlotte Thomas-Hawkins, PhD, RN Linda Flynn, RN, PhD, FAAN

  2. Adverse Events in Outpatient Dialysis Facilities • Common occurrence (Holly, 2006) • 88 adverse events in 4 month period in 4 HD units • Falls • Infiltration of vascular access • Medication errors • International variations (Saran et al., 2003) • Increased skipped and shortened dialysis treatments in U.S. • Daily to weekly occurrences (Thomas-Hawkins et al., 2008) • Skipped and shortened dialysis treatments • Dialysis hypotension • Patient and family complaints

  3. Nursing Organization and Outcomes Model Aiken et al., 2002 Work Environment Support for Nursing Practice Nursing Structures RN-to-pt ratios Workload Patient Outcomes Process of Care Care Left Undone

  4. Effects of nursing variables on odds of weekly to daily occurrences of adverse events

  5. Patient Safety Culture Product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management. Sorra & Dyer, 2010

  6. Dimensions of patient safety cultureSorra & Nieva, 2004 • Supervisor/manager expectations & actions promoting safety • Hospital management support for patient safety • Organizational learning, continuous improvement • Teamwork within and across units • Communication openness • Feedback and communication about error • Nonpunitive response to error • Staffing • Handoffs and transitions • Patient safety grade • Event reporting

  7. Patient Safety Culture • Negative assessments of patient safety culture is associated with higher adverse patient events in hospital settings • Poor to failing safety grade • Iatrogenic pneumothorax, post-op infections, medication errors • Handoffs and transitions • AHRQ patient safety indicators, medication errors

  8. Handoffs and Transitions Safety • Transfer process of essential information and responsibility for patient care • Effective handoff supports exchange of critical information and continuity of care and treatment • Ineffective handoffs and transitions associated with adverse patient events

  9. Handoffs and Transitions in Dialysis Units

  10. Nursing Organization and Outcomes Model Aiken et al., 2002 Work Environment Patient Safety Culture Support for Nursing Practice Nursing Structures RN-to-pt ratios Workload Patient Outcomes Process of Care Handoffs and Transitions Safety Care left undone

  11. Study Purpose • What percentage of nurses positively endorse handoffs and transition safety and overall patient safety in outpatient hemodialysis units? • What are the unadjusted and adjusted effects of staff nurse perceptions of handoffs and transitions safety and overall patient safety on nurse-reported adverse patient events hemodialysis units?

  12. Methods • Sampling Frame • ANNA members who identified themselves as staff nurses • Mail survey – Modified Dillman method • Data analysis • Multiple Regression • Logistic Regression

  13. Measures • Series of questions to capture frequency of adverse events • Hospital Survey on Patient Safety Culture • Handoffs and Transitions Scale • Patient Safety Grade • Aiken staffing and process of care items • Practice Environment Scale • Individual Workload Perception Scale

  14. Sample (n = 422)

  15. Percent of respondents reporting at least monthly to daily occurrences

  16. Handoffs and Transitions Safety

  17. Handoffs and Transitions Safety

  18. Relationship between safety variables and adverse events *p<.05; **p<.01; p<.001

  19. Impact of negative nursing factors on odds of adverse events*p<.05; **p<.01; p<.001

  20. Unadjusted effects of negative patient safety ratings on odds of adverse events*p<.05; **p<.01; p<.001

  21. Adjusted effects of negative safety ratings on odds of adverse event occurrences

  22. Conclusions • Adverse events, as reported by nurses, occur frequently in outpatient hemodialysis facilities • Only 39% of nurses agree that patient handoffs and transitions during patient shift change are safe • 86% of nurses grade overall patient safety in hemodialysis units as good to excellent

  23. Conclusions • Negative ratings of handoffs and transitions was independently associated with higher odds of vascular access thrombosis and patient complaints • Poor to failing safety grade was independently associated with higher odds of patient and family complaints, medication errors, vascular access infection, and hospital admissions

  24. Conclusion • Phenomenon of patient safety culture is complex, abstract, and inferred by perceptions of individuals • Patient safety culture may be a meaningful indicator of patient safety and risk for adverse events in outpatient dialysis settings • Ongoing, standardized assessments of patient safety culture dimensions can help to identify problem areas that may lead to adverse events

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