Today, 17 September, is World Patient Safety Day. In view of the major strains and risks that the global health workforce has confronted as a result of the COVID-19 pandemic, the World Health Organisation has chosen “Health Worker Safety: A Priority for Patient Safety” as this year’s theme.
Here at the PCHSS, patient safety is also regarded as a central concern for both patients and the systems and workforces that deliver care. As patient harm is not only antithetical to the very purpose of healthcare but also results in billions of dollars lost each year, we see improving patient safety as a cornerstone of achieving health system sustainability. Because of this, it is a subject that cuts across the PCHSS’s research. To commemorate World Patient Safety Day, we have compiled a sampling of our recent contributions to the subject.
August 2020 – Associations between double-checking and medication administration errors: a direct observational study of paediatric inpatients – BMJ Quality & Safety
For decades, nurses around the world have double checked the administration of medications in paediatric hospitals as part of standard practice. But research has continued to show high rates of medication errors in such settings and there is little evidence of double-checking’s effectiveness in reducing them. In this study, the PCHSS’s Johanna Westbrook and colleagues pointed to some of the shortcomings of double-checking as a strategy to combat the problem.
May 2020 – It’s time to step it up. Why safety investigations in healthcare should look more to safety science – International Journal for Quality in Health Care
PCHSS investigator Professor Jeffrey Braithwaite and colleagues Professor Siri Wiig and Dr Robyn Clay-Williams described how healthcare would do well to look to safety science to expand its capabilities for understanding accidents. The article identifies limitations in the way that mishaps are typically understood within healthcare and encourages the integration of insights from safety science to “provide new lenses to investigatory bodies.”
February 2020 – Enhancing patient outcomes through evaluation of the appropriateness and quality use of pathology in general practice – Report to the Department of Health Quality Use of Pathology Program
Appropriate use of pathology testing by general practitioners represents a key part of clinical decision-making, including diagnosing, screening, treating, and monitoring diseases. This report prepared by Dr Rae-Anne Hardie, PCHSS investigator Johanna Westbrook and colleagues documents a quantitative observational study to investigate how specific pathology tests are used in general practices in Australia. The study sought to monitor the degree to which test ordering practices align with evidence-based pathology guidelines. The results of this study can be used by Primary Health Networks seeking to undertake quality improvement activities for both test result management activities and patient outcomes.
November 2019 – Quality of care for acute abdominal pain in children – BMJ Quality & Safety
This study by PCHSS investigators Yvonne Zurynski, Jeffrey Braithwaite and colleagues found that children suffering from acute abdominal pain may receive notably different care based on where they are taken for medical attention. A CareTrack Kids project, the study examined the visits to general practitioners, emergency departments, and hospitals of 514 children experiencing acute abdominal pain. About 70% of visits were found to adhere to evidence- or consensus-based clinical practice guidelines across 21 care quality indicators. Care in general practice settings had significantly lower rates of adherence (~63%) than in emergency departments (86%) and in hospital inpatient settings (~88%). To improve adherence rates in general practices and all healthcare settings, the authors suggest increased use of electronic decision support tools to embed clinical recommendations into everyday practice.
The expert testimony of PCHSS’s Johanna Westbrook featured prominently in the Royal Commission’s report on aged care quality and safety. Her research revealed the prevalence of errors in the records of aged care facility residents (averaging 10 discrepancies between general practice records and aged care facility records). Professor Westbrook highlighted how “data analytics of medication information could support better care and help identify anomalous prescribing practices.”
October 2019 – Duration of Antipsychotic Medication Use by Aged Care Facility Residents With Dementia – Alzheimer Disease and Associated Disorders
This study, carried out by Dr Kimberly Lind, PCHSS investigator Johanna Westbrook and colleagues found that people with dementia in Australian aged care facilities were being unnecessarily sedated with antipsychotic drugs for more than 200 days at a time, twice as long as the maximum time recommended in guidelines.
August 2019 – NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high‐risk conditions – Pharmacoepidemiology & Drug Safety
Adverse events from nonsteroidal anti‐inflammatory drugs (NSAIDs) are a greater risk to people in residential aged care facilities because of their age and health status. The research team composed of Dr Kimberly Lind, PCHSS investigator Johanna Westbrook and colleagues sought to discover contemporary trends in NSAID use in this population. Among 10,367 older adults in Australian residential aged care facilities, they found that 2,414 (23.3%) used at least one NSAID, with 756 (7.3%) using only oral, 1,326 (12.8%) using only topical, and 332 (3.2%) using both topical and oral NSAIDs. Researchers found the prevalence of the “triple whammy” NSAID combination (oral, diuretic, and angiotensin‐converting‐enzyme inhibitor or angiotensin receptor antagonist) to be less than 1.8% of residents overall, but that for a quarter of these residents use of the triple whammy combination was for more than one in every five days.
May 2019 – Safety and effectiveness of stoss therapy in children with vitamin D deficiency – Journal of Paediatrics and Child Health
Compliance with daily therapies can be difficult. For children with vitamin D (250HD) deficiency, might high‐dose, short‐term (stoss) therapy be a better option than standard, daily therapy? This randomised study of 151 children carried out by Dr Paul Tannous, PCHSS investigator Yvonne Zurynski and colleagues sought to answer that question. The researchers found that, while over 80% of both those receiving the standard treatment regimen and those receiving the stoss treatment achieved vitamin D sufficiency, 25OHD levels tended to be significantly greater among those receiving the standard treatment and that simplifying the treatment regimen did not improve compliance. Nevertheless, the researchers concluded, the results “support stoss therapy as an effective and safe alternative therapy for the treatment of paediatric vitamin D deficiency.”
In 2017 the World Health Organisation a global challenge to “reduce the level of severe, avoidable harm related to medication by 50% over 5 years”. Classifying harm associated with medication errors can be challenging and tools used to do so vary widely across studies. In this paper, Dr Peter Gates, PCHSS investigator Johanna Westbrook and colleagues describe the systematic process by which they developed the Harm Associated with Medication Error Classification (HAMEC) tool, which provides clear definitions of levels of medication-related harm.
Dose errors pose a risk across care settings, and paediatric inpatient settings are no exception. Computerized provider order entry (CPOE) systems with clinical decision support (CDS) promise to assist in reducing the risk of dosing errors, but do they work? Through a systematic review that included the assessment of 39 relevant studies, Dr Peter Gates, PCHSS investigator Johanna Westbrook and colleagues found that hospitals using CPOE (with or without CDS) had a lower rate of dose errors compared with those using paper charts. However, in light of the dearth of pre/post studies on the subject, they noted that future research employing controlled designs is needed to understand the true impact of CPOE on paediatric dosing errors.
November 2018 – Safety of patient-facing digital symptom checkers – The Lancet
A paper by a team including PCHSS investigator Enrico Coiera team examined how apps designed to help patients decide if their symptoms are serious or not are evaluated. Their work uncovered significant issues with evaluation methods and program performance, which underscored the urgent need for new guidelines to evaluate the safety, effectiveness, and cost of these systems.
November 2018 – Aged care: no need to wait for Royal Commission – MJA Insight+
As the Royal Commission into Aged Care Quality and Safety began, PCHSS investigator Johanna Westbrook wrote an editorial in MJA InSight+ on aged care. She wrote, “there’s a wealth of information already available that could, and should, be telling us what is going wrong, where and why” without waiting for outcomes from the Royal Commission. She highlighted her team’s research into the over-administration of antipsychotic drugs administered in residential aged care as an example of the need for better information technology systems to continuously track medication management. Professor Westbrook noted that these should supersede “conventional ad hoc audits of patient records” that result in out-of-date information that is “virtually meaningless in informing improvements.”