Background: The objective of this study was to develop a Paediatric Oncology Trigger Tool aimed at facilitating the detection of adverse events and no-harm incidents in the patient process from specialised hospital care to home healthcare in paediatric oncology. The development of the trigger tool addresses the need for enhanced safety knowledge in paediatric oncology, particularly as the field has increasingly transitioned from inpatient admissions to day care and home healthcare settings. Existing trigger tools do not fully meet the specific requirements of paediatric oncology, where care is collaboratively provided by patients, parents and healthcare professionals.

Materials and methods: The study employed a multi-step process, including a literature search, a three-phase modified Delphi process, and the practical application of the trigger tool. All six Swedish paediatric oncology centres were represented in the Delphi process. Medical records were reviewed as part of the national multicentre study Patient Safety in Paediatric Oncology, which included participation from four out of six paediatric oncology centres, covering 64% of the population in Sweden. Data were collected from stakeholders representing the patient process from specialised hospital care to home healthcare in paediatric oncology, as well as from reviewers of medical records, and representatives with patient safety and trigger tool methodology expertise. Data were gathered through virtual meetings and web-based surveys, where the triggers were discussed and rated in terms of clinical relevance, comprehensibility and usefulness. Ratings were made using a four-point Likert scale. A dichotomisation process was used to assess consensus, defined as the proportion of respondents giving the same dichotomised rating.

Result: The key outcome was the development of a Paediatric Oncology Trigger Tool. The final tool consisted of 22 triggers with definitions and decision support information, designed to enhance understanding of patient safety in paediatric oncology.

Conclusions: The application of a multi-step development process resulted in a final context-specific trigger tool, the Paediatric Oncology Trigger Tool, addressing unique patient safety needs. The tool can be used in local safety initiatives aiming to improve safety for children with cancer. Additionally, this paper provides a transparent description of a systematic development process.

Background The WHO calls for integrating patient safety curricula in healthcare education globally, but the limited contextual applicability of existing frameworks constrains national implementation. This work aims to describe the development of Swedish national competence goals in patient safety to establish patient safety as a distinct field summarised within a comprehensive framework of competency areas.Method The national competence goals were developed in a project initiated by the Swedish National Board of Health and Welfare that commissioned a group of academics with expertise in patient safety to work on the project. The development entailed an iterative process involving both physical and digital meetings, individual work and two rounds of questionnaires. Initially, drawing on expert knowledge and international literature, a set of competence areas based on key concepts in patient safety was proposed and defined. Within each competence area, several competence goals were developed. A modified Delphi process was then employed to collect insights from two multidisciplinary panels of experts (n=23). Finally, competence areas, key concepts and competence goals were refined based on feedback from the two Delphi panels.Results The project resulted in a national framework comprising 15 competence areas and 113 competence goals, highlighting key dimensions of patient safety such as foundational concepts, professional roles, systems thinking, patient involvement, human factors, communication and teamwork, organisational culture, risk awareness, learning from adverse events, evaluation, safe practices, technology, leadership, emergency preparedness and high-risk care situations.Conclusions The development of national competence areas and goals marks an advancement in establishing patient safety as a distinct scientific discipline, where they collectively provide a broad and structured set of educational goals and standards. This initiative provides a foundation for integrating patient safety curricula into national healthcare education and strengthening patient safety practices, which can serve as an inspiration to others.

Background

To promote patient safety, international guidelines highlight the importance of a joint plan for continued treatment in older persons. Accordingly, in a co-design initiative involving older persons and healthcare professionals, a medication plan was developed. This study aimed to assess the feasibility of applying the medication plan for older persons in primary care. The objectives were to examine the feasibility of the medication plan in clinical practice and to examine the feasibility of methods that could be used to study a broader implementation.

Methods

A prospective study design, using both qualitative and quantitative methods, was employed. During appointments at primary care centres, physicians (n = 6), persons aged 75 or older (n = 21), and, when applicable, their next of kin (n = 2) collaboratively agreed on a medication plan, which was documented in the electronic health record. Over a 3-month follow-up period, data regarding the feasibility of the medication plan (usability and fidelity) and the feasibility of the research methods (recruitment and retention rates, data collection, and outcome measures) were collected.

Results

Usability assessed by the System Usability Scale scored a median of 51.3 out of 100 for physicians. The participants’ experiences of the medication plan’s usability addressed functionalities, individualisation for relevance, resources, and a de-prioritised medication plan. Fidelity was assessed based on 8 out of 15 older persons reporting that they had received a medication plan, and 59% of all prescribed medications had documented goals and/or comments. The recruitment rate was 75% for physicians and 70% for older persons. There were no changes in polypharmacy and no contact with healthcare due to suspected adverse drug events. The participants’ perceptions of the medication plan’s ability to promote patient safety addressed awareness and information, challenges beyond the medication plan, and patient involvement.

Conclusions

The implementation of the co-designed medication plan encountered challenges related to usability and fidelity, requiring collaborative refinements of the prototype. Additional difficulties arose from using a low-fidelity prototype in clinical practice. Our results emphasise the strength of combining qualitative and quantitative methods to capture participants’ perspectives on the medication plan’s ability to promote patient safety. Before conducting a larger study, the evaluation methods require further refinement.

Trial registration.

ClinicalTrials.gov NCT06016140 (retrospectively registered).

BACKGROUND: Trigger tools are widely used for detecting adverse events. Within the multicentre study Patient Safety in Paediatric Oncology, a trigger tool was created to address the unique needs of paediatric oncology. Although trigger tools are highly valued for detecting adverse events, concerns about their usability and reliability persist. Understanding the perspectives of medical record reviewers using these tools may provide valuable insights for improving their usability and reliability. This study aimed to explore the experiences of medical record reviewers involved in the development and use of a Paediatric Oncology Trigger Tool.

METHODS: A descriptive qualitative case study was conducted to investigate the experiences of medical record reviewers participating in the development and use of the Paediatric Oncology Trigger Tool. Data were collected through a semi-structured focus group interview conducted via Zoom, involving six reviewers with varying levels of experience in paediatric oncology and trigger tool methodology. The interview was audio-recorded and transcribed verbatim. The written text was analysed in its entirety using reflexive thematic analysis.

RESULTS: The analysis revealed an overarching theme of knowledge building with three themes: competencies, resources and usefulness. The findings highlight the importance of collaborative learning, expert support and adequate resources, while also noting challenges such as time consumption and the emotional impact of reviewing medical records of critically ill children.

CONCLUSIONS: This study offers a comprehensive examination and clarity regarding the development and use of a patient safety instrument, a process marked by both challenges and facilitators from the perspective of medical record reviewers. The study underscores the need for resources, training and support during the review process to ensure the reliability and usefulness of the trigger tool.

BACKGROUND: Health care organisations have a long history of dividing work and tasks into decentralised functions and units by forming divisions and departments with delegated power. New ways of working, such as process-oriented approaches, have been called for to address challenges such as staffing shortages and resource constraints. There is limited understanding of the interplays that will occur in health care organisations during a shift from a traditional decentralised structure to a process-oriented approach. This study aims to explore the perceptions of health care staff and leaders when introducing a process-oriented routine. METHOD: We conducted interviews and focus groups with 29 participants in specialised and primary care in order to explore their experiences of a newly introduced routine regarding on-demand consultation, aimed at enhancing communication and patient coordination in a Swedish health care region. The participants included operating managers, schedulers and physicians. Data were analysed using reflexive thematic analysis in accordance with Braun & Clark's guidance. RESULTS: The findings encompass three main themes when introducing a process-oriented routine: Creates a readiness to act, The critical role of trust for adopting on-demand consultation in everyday practice and Challenges associated with transformation. The results show that health care staff and leaders are positive about the new way of working, but the readiness to act is challenged by issues of trust, as well as cultural components and structural factors such as experienced resource constraints. CONCLUSION: Our results underscore the need to consider not only organisational aspects but also social and individual relational factors when introducing a process-oriented way of work into a decentralised and complex health care system.

Objective

This study aims to provide a deeper understanding of what persons with lived experience and professionals with experience of patient safety, suicide research, and investigations consider to be most important in investigations of healthcare before suicide to learn and improve the care of suicidal patients.

Method

This is a qualitative study based on 15 semistructured interviews with persons with lived experience of suicidality and professionals. Thematic analysis was used.

Results

The persons with lived experience and the professionals agreed that a holistic approach to the investigations is crucial. They should embrace a longer period of time, involve family and significant others, integrate the perspective and expectations of the patient, and analyze factors of significance for suicidality, suicide prevention, and safety. There is a need to improve the investigations through the involvement of all stakeholders and actors, securing competence in the investigation team and prioritizing cases to investigate.

Conclusions

Substantial changes in the approach and performance of investigations of suicide in healthcare are needed to make these investigations valuable for increasing the safety of the care of suicidal patients. A holistic perspective during the analysis is crucial for understanding the suicidal process, the interacting factors, and the care process preceding suicide. Competencies in suicidality, suicide prevention, and patient safety must be included in the analysis team to ensure high quality and relevance. To improve the value of these investigations, we suggest establishing a template based on current knowledge to ensure attention to variables of significance for a safe care of suicidal patients.

English summary:

Swedish surgical care shows high quality and patient safety. The reasons for this are several; among the most important are a generally well-educated staff and nation-wide quality registers. Areas in need of development are improved risk assessment and risk management, both for individual patients and for specific types of operations. The ability of the surgical team to synthesize information on what has been done and what should be done postoperatively and communicate this to the teams that take care of the patients after surgery needs further honing. This could result in decreased failure-to-rescue in the postoperative period. Also, strengthening of teamwork and team performance is needed. As new knowledge on the detrimental effects of rude behaviour emerges, it becomes obvious that further work to diminish this is needed. Research is under way of identifying the possibility to identify good and safe surgeons already at the start of their education.

Svensk sammanfattning:

Svensk operationssjukvård är i grunden bra och säker, även om undvikbara skador fortsatt förekommer i för hög utsträckning.

Framtida arbete behöver riktas in på bland annat preoperativ identifiering och hantering av patient- och ingreppsspecifika risker samt ett förbättrat teamarbete och arbetsklimat under hela den perioperativa perioden.

Bättre förmåga att fånga och vidta åtgärder mot avvikelser från det förväntade förloppet, det vill säga minskad »failure to rescue«, har visats vara ett effektivt sätt att reducera förekomsten av undvikbara skador.

Forskning pågår om hur man kan identifiera och träna dem med bäst förutsättningar att bli bra och säkra operatörer.

OBJECTIVE: The decline in suicide rates has leveled off in many countries during the last decade, suggesting that new interventions are needed in the work with suicide prevention. Learnings from investigations of suicide should contribute to the development of these new interventions. However, reviews of investigations have indicated that few new lessons have been learned. To be an effective tool, revisions of the current investigation methods are required. This review aimed to describe the problems with the current approaches to investigations of suicide as patient harm and to propose ways to move forward.

METHODS: Narrative literature review.

RESULTS: Several weaknesses in the current approaches to investigations were identified. These include failures in embracing patient and system perspectives, not addressing relevant factors, and insufficient competence of the investigation teams. Investigation methods need to encompass the progress of knowledge about suicidal behavior, suicide prevention, and patient safety.

CONCLUSIONS: There is a need for a paradigm shift in the approaches to investigations of suicide as potential patient harm to enable learning and insights valuable for healthcare improvement. Actions to support this paradigm shift include involvement of patients and families, education for investigators, multidisciplinary analysis teams with competence in and access to relevant parts across organizations, and triage of cases for extensive analyses. A new model for the investigation of suicide that support these actions should facilitate this paradigm shift.

HIGHLIGHTS

• There are weaknesses in the current approaches to investigations of suicide.
• A paradigm shift in investigations is needed to contribute to a better understanding of suicide.
• New knowledge of suicidal behavior, prevention, and patient safety must be applied.

BACKGROUND: Occupational Health Service (OHS) is a service that should support employers and employees with their work environment. Previous research indicates the need for deeper knowledge about the effect of workplace interventions with a focus on planning, organizing and designing the workplace to improve work conditions in hospital settings.

OBJECTIVE: The aim was to evaluate the outcomes, workplace interventions and intervention strategies in hospital settings.

METHODS: A systematic literature review was conducted. CINAHL, MEDLINE, PsycInfo, Scopus, and Web of Science Core Collection were searched in September 2021. The Mixed Methods Appraisal Tool was used to evaluate the quality of the included studies. Study results are presented through a narrative synthesis. A protocol for this study was registered on the Open Science Framework.

RESULTS: Twenty-six studies, published between 2010 and 2021, were included. These included randomized controlled trials (RCTs), non-RCTs, and mixed methods reports with moderate to good quality. The results support the use of workplace interventions to improve work conditions, health, and well-being in hospital settings. Combinations of different interventions, tailored to the specific organization, were used. Important intervention strategies commonly used in the start-up, evaluation, and intervention of successful workplace interventions, were identified. Using a pragmatist complexity approach in workplace interventions can improve outcomes by providing clear intervention strategies and combinations of tailored interventions, related to context specific problems.

CONCLUSION: OHS support in workplace interventions with clear intervention strategies will contribute to improve work conditions, health and well-being in hospital settings.

In a recently published thesis, we propose a cultural shift in the assessment of suicide as an incident of severe patient harm, from a focus on errors and an often speculative avoidability, to healthcare's ability of risk management over time. Patient safety work needs to change in line with the development of knowledge in patient safety. This means a cultural change in the view of patient safety, with a clearer focus on healthcare's abilities in risk management and learning. Legislation and regulations regarding healthcare and the supervisory authority need to support this cultural change in assessment and investigations of patient harm.  A shift from a focus on errors and deviations to quality and positive outcomes of care, proactive patient safety work, risk management, patient safety culture and management commitment is needed.