patient measurement of safety –patients’
TRANSCRIPT
Outline
• Introduction:
• What is PMOS?
• Why is PMOS a studied topic?
• Previous studies on PMOS
• Objective of Study
• Study Methodology and design
• Results
• Conclusion
• Q & A
Why PMOS?
•At CMC the measurement of safety has been restricted to extracting information from staff, using AHRQ patient safety culture questionnaire, incident reports etc…
•Recent literature highlighted the importance of patients as the ‘smoke detectors’ for safety
PMOS questionnaire was developed to study patient safety culture from patients’ perspective
We need new safety detectors!
Introduction on PMOS
• Patient Measurement of Safety (PMOS) is studied using YCFF factors
• YCFF being the Yorkshire Contributory Factors Framework - a comprehensive taxonomy of the factors contributing to patient safety incidents
• Patients expect safety to be a priority within health services
May provide insightful feedback regarding their safety thus reducing avoidable harm and improving health care
A validation study conducted by Rosemary McEachan et. al compared the PMOS results completed by patients with the AHRQ patient safety staff questionnaire completed by hospital staff
Factor analysis of PMOS developed by Gilles Lawton et. Al. revealed 8 key domains of safety from the 20 YCFF key contributory factors
Communication & Teamwork
Organization & Care Planning
Access to Resources
Physical Environment (Ward
Type & Layout)
Information Flow
Staff Roles & Responsibilities
Staff Training & Equipment (design &
functioning)
Overall Safety Outcome
Study Objective
• Develop a PMOS questionnaire that can be used in Clemenceau Medical Center hospital to promote organizational learning about safety
• Explore the extent to which patients are able to identify factors related to the safety of their care
• Use patients’ perspective as a tool for the measurement of their safety at CMC and to describe opportunities for safety improvement
Study Design & Methodology
• Patients were recruited from Clemenceau Medical Center from 3 medical
surgical units
• The study was approved by the hospital’s IRB
• Patients were approached and explained the study synopsis.
• Patients were given a choice to fill the questionnaire privately or fill the
survey with the help of the study coordinator
Inclusion Criteria Exclusion Criteria
Patients admitted to medical/surgical wardsPatients admitted in critical care units or outside the
medical/surgical wards
Patients are 18 years and abovePediatric patients and patients under the age of 18
years
Patients provide verbal consent to complete the questionnaire
Patients who do not agree to consent to the survey
Date of admission to date of survey = 2 days or more Patients unable to provide feedback
Study Sample
• Based on the following formula a planned sample size of 46 is needed to reach a precision level of +/- 10%:
n = N / [1 + N (e)^ 2]
n is the sample size ; N is the population size
e is the level of precision
Assuming a 95% confidence level
• A total of 46 patients were recruited
Study Tool
• The PMOS questionnaire was developed based on the 8 key domains and translated to Arabic (Arabic translation was validated twice by 2 separate readers)
• Patients were asked to answer the questions based on a five-point Likert scale (Strongly Agree, Agree, Neither, Disagree, Strongly Disagree)
Domains Number of QuestionsCommunication & Team work 6
Organization & Care Planning 7
Access to Resources 2
Physical Environment 6
Information Flow 3
Staff Roles & Responsibilities 6
Equipment (functioning & design)
2
Overall Safety Outcome 1
Open Ended Questions 2
Total Number of Questions 35
55%45%
Demographic Distribution by Gender
Male
Female50%
27%
23%
Demographic Distribution by Med/Surg Floor
5th Med/SurgFloor
6th Med/SurgFloor
7th Med/SurgFloor
9.10%
31.80%29.50% 29.50%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
18-29 30-50 51-70 >70
Percentage
Age Groups
Demographic Distribution by Age
Demographic Distribution of Participants
Data Analysis
• A ‘positive index’ was constructed by summing the number of questions that patients responded to by using one of the two positive response options (strongly agree, or agree for positively worded questions and strongly disagree and disagree for negatively worded questions).
• Thus, patients had a score out of 33 (excluding open-ended questions) where higher responses equated to better safety.
• The mean PMOS index score for the entire sample was 28.35 (SD = 5.92).
on average patients responded positively to around 28 questions out of 33 questions in the PMOS questionnaire.
Domains with highest scorings were:
» Information flow
» Staff roles and responsibilities
» Communication
» Equipment
The domain with the least score was “delays” with 3.63 mean positive score
Positive Index Score
Variables Mean Positive Index Score SD
PMOS Positive Index 28.35 5.92
Domain 1:
Communication & Team Work
Most of the people who work in this team seem to enjoy their work
4.55 0.96
All information about my care is conveyed and shared between staff and between shifts
Staff listen to my concerns
Staff understand what I say when I share a concern
Staff communicate with me in a proper manner
Medical staff provide me with explanation of my clinical tests results
Domain 2:
Organization & Planning
I am involved in decision-making in relation to treatment
4.33 0.94
I am aware who is involved in my care
I know what to expect from those providing care
I am actively engaged in the planning of my care
I feel comfortable asking questions when something doesn’t seem right
Domain 3:
Access to Resources
In my opinion all services needed for my recovery and safety are available4.38 0.44
Services are provided within an acceptable time frame
Domain 4:
Physical Environment
Signs are available to easily navigate the hospital
4.49 1.02
Precautions are available to prevent me from falling
The physical environment of my room helps and does not hinder safe practice
Room setup is convenient; items needed during hospitalization are within my reach
My transfer and movement within the hospital setting was safe and smooth
Hand sanitizer bottles are available at reach
Domain 5:
Information Flow
All staff caring for me know about my medical history
4.7 0.58Information about my status and wellbeing is known by all staff caring for me
Everyone speaks using language I can understand
Domain 6:
Staff Roles & Responsibilities
There is enough staff to handle the workload
4.58 1.07
Staff are well trained to perform their tasks
Doctors and staff clearly understand each other’s roles and responsibilities
The responsibility of each staff that enters my room is clear to me
This team and its clinicians give the attention that patients feel they need
I have felt valued and respected by the staff caring for me
Domain 7: EquipmentEquipment/ devices used during my stay were all properly functioning
4.55 0.5All staff are well trained to use and handle equipment
Domain 8: DelaysI was prepped for my procedure to have it done on time
3.63 0.85I was informed of my imaging and/or lab test schedule and they were done within expected
time
Patients Identification of Improvements Needed for Enhanced Patient Safety
DomainTimes Domain was
IdentifiedIllustrative Statements Written by Patients
Physical Environment 6
Need to have a more quiet environment at night for patients to rest
improve cleanliness of the room
Patient transfer from department to department should be more medically safe
The automatic entrance doors of the floor open too fast that can cause patients and visitors
to fall
improve cleanliness of the bathroom in the patient's room
Patients under isolation precautions should all have their room doors closed. I stopped
walking in the floor corridor after realizing that this is not applicable for all isolation patients.
Staff Attitude & Behavior 4
Improve nurses' attitude with patients
nurses need to show more care
Staff should apply hand hygiene gel before touching anything in the patient's room and after
completing the activities inside the room
Staff should apply hand hygiene gel
Management of staff and staffing levels
/Staff workload3
The floor is understaffed with nurses
Nurses were very busy, their response to my calls were late
Need to recruit more practical nurses during the night shift
Communication and Team work 1 Need to improve communication between staff at the emergency unit
Equipment and supplies 1Some personal hygiene items needed for patients during admissions are missing such as
toothbrush and toothpaste
Scheduling and bed management 1 Decrease patients' waiting time from emergency department to the admission unit
Patients Identification of Aspects of Patient Safety that are Key for their Safety &Available
DomainTimes Domain was
IdentifiedIllustrative Statements Written by Patients
Organization & Care Planning 4
Having well developed and implemented infection control processes to prevent
hospital acquired infections
Patients receive the proper medical treatment
The availability of good medical treatment
Patients receive the proper medical treatment
Communication and Team work 2
Cooperation between staff is available
Overall the medical and nursing teams collaborate together to provide patients
with the proper medical care and a safe environment
Staff Attitude & Behavior 2
Medical and nursing staff provide patients with emotional support due to good
communication with patients
Friendly staff providing chronic patients like myself emotional support to pass
through the hardships of the disease
Physical Environment 1Good room cleanliness
Staff Training1
At the unit, nurses are well aware of patient safety measurements
Correlations Indicator Questions Vs Patient Safety
Variables Odds Ratio P-Value
All information about my care is conveyed and shared between staff and between shifts 39 0
I Was Prepped on Time 32.416 0
There is enough staff to handle the work load 24.514 0
The responsibility of each staff that enters my room is clear to me 24.514 0
I am actively engaged in the planning of my care 24.514 0
I Was Informed of My Imaging Result 18.05 0
Hand sanitizer bottles are available at reach 11.428 0.001
Medical staff provide me with explanation of my clinical tests results 9.264 0.002
I am involved in decision making in relation to treatment 9.264 0.002
Services are provided within an acceptable timeframe 7.59 0.006
• 10 questions under 6 domains were significantly correlated with patients’ perception of safety
• 2 domains did not show significant correlation to patients’ perception of safety within the hospital:
• Information flow
• Equipment (use and design)
• Within the domain “Physical Environment” the only aspect that was significantly correlated with safety was hand hygiene
patients gave clear weight on proper hand hygiene when considering what environment is safe for them.
This is also supported by patients’ responses to the two open ended questions
Conclusion
• Patients provided an overall positive feedback on their safety at CMC
• Patients did not weigh and correlate all 8 domains of PMOS questions with their safety
Patients correlated 6 domains with with their safety:
» Communication & teamwork
» Organization & Planning
» Access to Resources
» Physical Environment
» Staff Roles & Responsibilities
» Delays
• 2 additional domains were identified, but were not part of the 8 key domains:
» Staff Attitude & behavior
» Scheduling & Bed Management
“nurses perform their tasks like robots, they need to show more care”
“gap in bed management from admission to the ER department to the unit”
Where Do We Go from here?
• This pilot study is a stepping-stone to conduct a hospital-wide measurement of patient safety at CMC using PMOS
• The overall hospital-wide study shall be conducted using an updated PMOS questionnaire which shall include the following changes:
• Add questions for 2 new domains (Staff attitude and Bed management)
• Remove questions that showed no correlation with patients’ perception of safety, instead the questionnaire shall be shortened to include significant questions