TY - JOUR AU - Hanskamp-Sebregts, M.E.C. AU - Zegers, M. AU - Boeijen, W.M.J. AU - Wollersheim, H.C. AU - Gurp, P.J. van AU - Westert, G.P. PY - 2019 UR - https://hdl.handle.net/2066/209687 TI - Process evaluation of the effects of patient safety auditing in hospital care (part 2) EP - 441 SN - 1353-4505 IS - iss. 6 SP - 433 JF - International Journal for Quality in Health Care VL - vol. 31 DO - https://doi.org/10.1093/intqhc/mzy173 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/209687/209687.pdf?sequence=1 ER - TY - JOUR AU - Hanskamp-Sebregts, M.E. AU - Zegers, M. AU - Westert, G.P. AU - Boeijen, W.M.J. AU - Teerenstra, S. AU - Gurp, P.J.M. van AU - Wollersheim, H.C. PY - 2019 UR - https://hdl.handle.net/2066/215427 AB - OBJECTIVE: To evaluate the effectiveness of internal auditing in hospital care focussed on improving patient safety. DESIGN, SETTING AND PARTICIPANTS: A before-and-after mixed-method evaluation study was carried out in eight departments of a university medical center in the Netherlands. INTERVENTION(S): Internal auditing and feedback focussed on improving patient safety. MAIN OUTCOME MEASURE(S): The effect of internal auditing was assessed 15 months after the audit, using linear mixed models, on the patient, professional, team and departmental levels. The measurement methods were patient record review on adverse events (AEs), surveys regarding patient experiences, safety culture and team climate, analysis of administrative hospital data (standardized mortality rate, SMR) and safety walk rounds (SWRs) to observe frontline care processes on safety. RESULTS: The AE rate decreased from 36.1% to 31.3% and the preventable AE rate from 5.5% to 3.6%; however, the differences before and after auditing were not statistically significant. The patient-reported experience measures regarding patient safety improved slightly over time (P < 0.001). The SMR, patient safety culture and team climate remained unchanged after the internal audit. The SWRs showed that medication safety and information security were improved (P < 0.05). CONCLUSIONS: Internal auditing was associated with improved patient experiences and observed safety on wards. No effects were found on adverse outcomes, safety culture and team climate 15 months after the internal audit. TI - Effects of patient safety auditing in hospital care: results of a mixed-method evaluation (part 1) EP - 15 SN - 1353-4505 IS - iss. 7 SP - 8 JF - International Journal for Quality in Health Care VL - vol. 31 DO - https://doi.org/10.1093/intqhc/mzy134 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/215427/215427.pdf?sequence=1 ER - TY - JOUR AU - Hanskamp-Sebregts, M.E.C. AU - Zegers, M. AU - Vincent, C. AU - Gurp, P.J.M. van AU - Vet, H.C. de AU - Wollersheim, H.C. PY - 2016 UR - https://hdl.handle.net/2066/170948 AB - OBJECTIVES: Record review is the most used method to quantify patient safety. We systematically reviewed the reliability and validity of adverse event detection with record review. DESIGN: A systematic review of the literature. METHODS: We searched PubMed, EMBASE, CINAHL, PsycINFO and the Cochrane Library and from their inception through February 2015. We included all studies that aimed to describe the reliability and/or validity of record review. Two reviewers conducted data extraction. We pooled kappa values (kappa) and analysed the differences in subgroups according to number of reviewers, reviewer experience and training level, adjusted for the prevalence of adverse events. RESULTS: In 25 studies, the psychometric data of the Global Trigger Tool (GTT) and the Harvard Medical Practice Study (HMPS) were reported and 24 studies were included for statistical pooling. The inter-rater reliability of the GTT and HMPS showed a pooled kappa of 0.65 and 0.55, respectively. The inter-rater agreement was statistically significantly higher when the group of reviewers within a study consisted of a maximum five reviewers. We found no studies reporting on the validity of the GTT and HMPS. CONCLUSIONS: The reliability of record review is moderate to substantial and improved when a small group of reviewers carried out record review. The validity of the record review method has never been evaluated, while clinical data registries, autopsy or direct observations of patient care are potential reference methods that can be used to test concurrent validity. TI - Measurement of patient safety: a systematic review of the reliability and validity of adverse event detection with record review SN - 2044-6055 IS - iss. 8 SP - e011078 JF - BMJ Open VL - vol. 6 DO - https://doi.org/10.1136/bmjopen-2016-011078 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/170948/170948.pdf?sequence=1 ER - TY - JOUR AU - Hanskamp-Sebregts, M.E. AU - Zegers, M. AU - Boeijen, W.M.J. AU - Westert, G.P. AU - Gurp, P.J.M. van AU - Wollersheim, H.C. PY - 2013 UR - https://hdl.handle.net/2066/125391 AB - BACKGROUND: Auditing of patient safety aims at early detection of risks of adverse events and is intended to encourage the continuous improvement of patient safety. The auditing should be an independent, objective assurance and consulting system. Auditing helps an organisation accomplish its objectives by bringing a systematic, disciplined approach to evaluating and improving the effectiveness of risk management, control, and governance. Audits are broadly conducted in hospitals, but little is known about their effects on the behaviour of healthcare professionals and patient safety outcomes. This study was initiated to evaluate the effects of patient safety auditing in hospital care and to explore the processes and mechanisms underlying these effects.Methods and design: Our study aims to evaluate an audit system to monitor and improve patient safety in a hospital setting. We are using a mixed-method evaluation with a before-and-after study design in eight departments of one university hospital in the period October 2011--July 2014. We measure several outcomes 3 months before the audit and 15 months after the audit. The primary outcomes are adverse events and complications. The secondary outcomes are experiences of patients, the standardised mortality ratio, prolonged hospital stay, patient safety culture, and team climate. We use medical record reviews, questionnaires, hospital administrative data, and observations to assess the outcomes. A process evaluation will be used to find out which components of internal auditing determine the effects. DISCUSSION: We report a study protocol of an effect and process evaluation to determine whether auditing improves patient safety in hospital care. Because auditing is a complex intervention targeted on several levels, we are using a combination of methods to collect qualitative and quantitative data about patient safety at the patient, professional, and department levels. This study is relevant for hospitals that want to early detect unsafe care and improve patient safety continuously.Trial registration: Netherlands Trial Register (NTR): NTR3343. TI - Effects of auditing patient safety in hospital care: design of a mixed-method evaluation SN - 1472-6963 IS - iss. 1 SP - 226 JF - BMC Health Services Research VL - vol. 13 DO - https://doi.org/10.1186/1472-6963-13-226 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/125391/125391.pdf?sequence=1 ER - TY - JOUR AU - Sluisveld, P.H. van AU - Zegers, M. AU - Natsch, S.S. AU - Wollersheim, H.C. PY - 2012 UR - https://hdl.handle.net/2066/108640 AB - BACKGROUND: Medication errors are a leading cause of patient harm. Many of these errors result from an incomplete overview of medication either at a patient's referral to or at discharge from the hospital. One solution is medication reconciliation, a formal process in which health care professionals partner with patients to ensure an accurate and complete transfer of medication information at interfaces of care. In 2007, the Dutch government compelled hospitals to implement a bundle concerning medication reconciliation at hospital admission and discharge. But to date many hospitals have failed to implement this bundle fully. The aim of this study was to gain insight into the barriers and drivers of the implementation process. METHODS: We performed face to face, semi-structured interviews with twenty health care professionals and managers from several departments at a 953 bed university hospital in the Netherlands and also from the surrounding community health services. The interviews were analysed using a combined theoretical framework of Grol and Cabana to classify the drivers and barriers identified. RESULTS: There is lack of awareness and insufficient knowledge of health care professionals about the health care problem and the bundle medication reconciliation. These result in a lack of support for implementing the bundle. In addition clinicians are reluctant to reallocate tasks to nurses or pharmacy technicians. Another major barrier is a lack of communication, understanding and collaboration between hospital and community caregivers. The introduction of more competitive market forces has made matters worse. Major drivers are a good implementation plan, patient awareness, and obligation by the government. CONCLUSIONS: We identified a wide range of barriers and drivers which health care professionals believe influence the implementation of medication reconciliation. This reflects the complexity of implementation. Implementation can be improved if these factors are adequately addressed. The feasibility and effectiveness of these strategies should be tested in controlled trails. TI - Medication reconciliation at hospital admission and discharge: insufficient knowledge, unclear task reallocation and lack of collaboration as major barriers to medication safety EP - 170 SN - 1472-6963 SP - 170 JF - BMC Health Services Research VL - vol. 12 DO - https://doi.org/10.1186/1472-6963-12-170 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/108640/108640.pdf?sequence=1 ER -