Brief report: Hospitalized patients’ attitudes about and participation in error prevention

Waterman, Amy D.; Gallagher, Thomas H.; Garbutt, Jane; Waterman, Brian; Fraser, Victoria J.; Burroughs, Thomas E.

doi:10.1111/j.1525-1497.2005.00385.x

Cited by 114 publications

(119 citation statements)

References 10 publications

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“…Other clinical interventions that could potentially reduce the incidence and burden of ADRs include using a preferred prescriber and medication reconciliation interventions that include patient education regarding their medications. [39–42]…”

Section: Discussionmentioning

confidence: 99%

Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments

2012

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Background: The rapid rise in the availability and use of pharmaceutical agents, and particularly polypharmacy, directly increases the risk for patients to experience adverse drug reactions (ADRs). There are few studies on the overall incidence and costs of ADRs.Objective: The aim of this study was to estimate the incidence and costs of emergency department (ED) visits related to ADRs for patients greater than 65 years of age using administrative data, and to describe risk factors for experiencing severe ADRs.Methods: We employed a retrospective cohort design based on population-based healthcare administrative clinical databases. Identification of ADR-related ED visits from the administrative database was based on International Classification of Diseases, 10th Revision-Canadian Enhancement (ICD-10-CA) codes for each ED visit. The incidence and costs of ADR-related ED visits and subsequent hospital admissions were estimated for all adults aged 66 years and above for the period April 2003–March 2008. Costs were standardized and reported in 2008 Canadian dollars. Logistic regression was used to detect risk factors for severe ADRs.Results: Approximately 0.75% of total annual ED visits among adults aged 66 years and above were found to be ADR-related, and among these patients 21.6% were hospitalized. In 2007, the cost of ADR-related visits was $333 per ED visit and $7528 per hospitalization for a total annual cost of $13.6 million in Ontario, or an estimated $35.7 million in Canada. Severe ADRs were associated with sex, age, comorbid disease burden, multiple drugs, multiple pharmacies, newly prescribed drugs, recent ED visit, recent hospitalization and long-term care (LTC) residence.Conclusions: ADRs are an important public health issue that threaten the safety of drug therapy and results in significant economic burden to the healthcare system. ED visits related to ADRs may be underestimated in retrospective studies using administrative data compared with prospective studies. Further research is needed to better understand the risk of experiencing severe ADRs among LTC residents.

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Section: Discussionmentioning

confidence: 99%

Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments

2012

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“…Additionally, studies showed that the extent to which patients believed that their participation would prevent infections increased their intention to ask clinicians to wash their hands (Abbate et al, 2008;Longtin et al, 2009;Luszczynska & Gunson, 2007). Similarly, feeling more comfortable with error prevention increased willingness to act (Waterman et al, 2006). Extraversion was associated with patients" willingness to ask clinicians, including doctors, to wash their hands (Duncanson & Pearson, 2005;Longtin et al, 2009).…”

Section: Cognitive Factorsmentioning

confidence: 99%

“…The review found evidence that patients were generally willing and able to report formally incidents such as drug complications and medication errors as this did not require the overt questioning of clinicians (Jarernsiripornkul et al, 2002(Jarernsiripornkul et al, , 2003van den Bemt et al, 1999;Waterman et al, 2006;Weingart et al, 2004). However, an important barrier is that generally patients were not made aware of the incident reporting system (Frey et al, 2009;Watt et al, 2009 (Coulter & Ellins, 2006).…”

Section: Organisational Aspectsmentioning

confidence: 99%

“…One study found that patients did not read medication instructions (Brown et al, 2006) and others found that patients were reluctant to mark their body to indicate the site of surgery (DiGiovanni et al, 2003;Waterman, 2006) suggesting a submissive attitude towards safety.…”

Section: Cognitive Factorsmentioning

confidence: 99%

“…It was seen as inappropriate to challenge clinicians (Ballinger & Payne, 2000); some patients were fearful of questioning medical authority (Schwappach, 2008;Smythe, 2010) while others were afraid of being rude to or offending the doctor (Brown et al, 2006;Davis, et al, 2008;Randle et al, 2006;Schwappach & Wernli, 2010b;Waterman et al, 2006;Quinn, 2003). Other studies demonstrated patients" perceptions of doctors" as holding an elite position in the healthcare context for example patients were more willing to ask nurses than doctors to wash their hands (McGuckin et al, 1999(McGuckin et al, , 2001NPSA, 2004) and might ask challenging questions of the nurses while they left factual questions for the doctors (Davis et al, 2008).…”

Section: Clinician-patient Relationshipsmentioning

confidence: 99%

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Patients' willingness and ability to participate actively in the reduction of clinical errors: A systematic literature review

Doherty

Stavropoulou

2012

Social Science & Medicine

148

149

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This systematic review identifies the factors that both support and deter patients from being willing and able to participate actively in reducing clinical errors. Specifically, we add to our understanding of the safety culture in healthcare by engaging with the call for more focus on the relational and subjective factors which enable patients' participation (Iedema, Jorm & Lum, 2009; Ovretveit, 2009). A systematic search of six databases, ten journals and seven healthcare organisations' web sites resulted in the identification of 2714 studies of which 68 were included in the review. These studies investigated initiatives involving patients in safety or studies of patients' perspectives of being actively involved in the safety of their care. The factors explored varied considerably depending on the scope, setting and context of the study. Using thematic analysis we synthesized the data to build an explanation of why, when and how patients are likely to engage actively in helping to reduce clinical errors. The findings show that the main factors for engaging patients in their own safety can be summarised in four categories: illness; individual cognitive characteristics; the clinician-patient relationship; and organisational factors. We conclude that illness and patients' perceptions of their role and status as subordinate to that of clinicians are the most important barriers to their involvement in error reduction. In sum, patients' fear of being labelled 'difficult' and a consequent desire for clinicians' approbation may cause them to assume a passive role as a means of actively protecting their personal safety. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63

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A 62-Year-Old Woman With Skin Cancer Who Experienced Wrong-Site Surgery

Gallagher

2009

JAMA

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Ms W is a 62-year-old woman who experienced wrong-site surgery when a lesion was removed from her face.Several months ago, a pink, scaly plaque on her face was biopsied and diagnosed as a 0.5-cm 2 squamous cell carcinoma. Threemonthslater,MsWenteredanoperatingroominaBoston, Massachusetts, hospital for surgery to remove the skin cancer.The morning after her surgery, Ms W removed her bandages and discovered that the surgery had been performed on an area to the right of the lesion. Ms W feels that the surgery team marked an area of skin incorrectly before the surgery was performed and believes she would have identified the mistake if she had been given a mirror in the operating room to check where the lesion was marked.After the initial surgery, Ms W began to experience shooting pain that spread from her nose to the left side of her forehead. The pain would surface 5 to 6 times per day, and she gained some relief by rubbing the area. She tried gabapentin but did not find it helpful. In addition, Ms W experienced significant swelling and bruising around her eyes and felt unable to work for a period of several weeks.Several weeks later, Ms W underwent a second procedure to remove the correct lesion.This was the second time Ms W experienced an untoward event following an elective procedure. Ten years earlier, Ms W had a pneumothorax after a trigger point injection into the trapezius muscle. Initially unrecognized by her surgeon, this led to a 2-week hospital stay, eventually requiring thoracic surgery. Ms W contacted an attorney at the time, and she was compensated by the hospital for the event.No formal legal proceedings were required.Ms W is generally healthy. She drinks socially, exercises regularly, and does not smoke. She has private health insurance. With respect to medical history, Ms W reports having viral meningitis followed by what was termed postmeningitic fibromyalgia and tinnitus. She has had a hysterectomy and breast biopsies for benign disease and is thought by a neurologist to have cervical radiculopathy, with tingling in both forearms and hands and, occasionally, in her feet.On physical examination, she looks well and has tanned skin from sun exposure. Physical findings are otherwise unremarkable. The surgical scars on her face are not readily visible.Laboratory findings are unremarkable. Medications include an estradiol patch, alprazolam as needed for anxiety, multivitamins, calcium supplements, and daily aspirin.CME available online at www.jamaarchivescme.com and questions on p 697.

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Brief report: Hospitalized patients’ attitudes about and participation in error prevention

Cited by 114 publications

References 10 publications

Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments

Incidence and Economic Burden of Adverse Drug Reactions among Elderly Patients in Ontario Emergency Departments

Patients' willingness and ability to participate actively in the reduction of clinical errors: A systematic literature review

A 62-Year-Old Woman With Skin Cancer Who Experienced Wrong-Site Surgery

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