Patient safety indicator
With patient safety indicators as measuring instruments, it is possible to recognize the current status of patient safety, assess the effectiveness of measures and increase patient safety. Patient safety indicators are used to predict adverse events that relate to the model factors. In this way, statements can be made about the level of security in an organization.
Patient safety focuses on the successful endeavor to provide error-free patient care . The strategies and measures developed are intended to ensure optimal patient care. Due to the increasingly complex examination and treatment processes in the healthcare system , the demands on staff are increasing. In order to protect patients from avoidable harm in connection with therapeutic treatment, patient safety is an important part of quality assurance. The avoidable damage can mostly be traced back to organizational and communication deficits, which have to be recognized, eliminated and prevented. To this end, patient safety indicators were developed through risk management .
Definitions
Quality assurance indicators
Quality indicators reflect the criteria of results and their structure and processes. The evaluation as well as the interpretation depend on the service providers. The quality is not measured directly, but is used as a "pointer" for special supply areas.
Patient safety (PS)
The goal of patient safety is to avoid incidents that could endanger patients. The processes can be measured which have a high probability of leading to an avoidable negative result. The security is directly related to the patient. It is important that the patient safety indicators continue to improve to ensure continued optimal patient safety.
Risk management
The task of risk management is to identify and reduce risks . This can be inferred from the details of patient care . The requirement for insurability also plays a role in the case of financial benefits that are often recognizable in the short term.
Indicators
Indicators are easily measurable parameters that define adverse events. Indicators also point to general quality problems. There is a demand for indicators that are meaningful for users and patients and that require little collection effort.
Requirements for an optimal indicator
- it is based on existing data
- it is relevant to patients
- it forms a relevant process from
- it is specific to an outcome
- it is repeatable
- it is easy to collect
- it is formulated in an understandable manner
- it is easy to influence (or the process associated with the indicator)
- it maps a process well
Areas of application for patient safety
Patient safety is important wherever medical work in facilities is intended to determine the state of health of the population , to treat it and to eliminate impending dangers.
Health care institutions:
- Outpatient facilities: doctor's offices, dental offices
- Care facilities: Outpatient care facilities, inpatient / semi-inpatient care facilities
- Other medical facilities : inpatient / semi-inpatient facilities, hospitals, prevention and rehabilitation facilities
- Other healthcare facilities: pharmacies , large medical and technical equipment
Model factors
The patient hazardous and preventable events relate to outcomes such as medication errors , falls, and hospitalized and acquired infections. The complaints of the patient and their relatives also apply here. One of the largest outcomes of patient safety is mortality during or shortly after hospitalization. This target value is particularly important and data can be provided for this purpose.
The model is based on ensuring better quality attention and professional observation for each patient through improved staffing. This can reduce deaths.
The model contains some influencing factors. One of the personnel factors. These are made up of experience, qualifications and employee satisfaction. The opponents of the personnel-side factors are the patient-side factors, which are made up of the respective indicators of the patient and the perception.
The influencing factors also include external conditions such as staffing levels and general care conditions.
The measure of the proportion of qualified personnel is also an influencing factor of the model.
In addition to these factors, there are other factors for which it cannot be determined with certainty whether they have a direct influence on the care capacity and the qualification of the staff. These include fluctuations, nursing management and general organizational aspects such as the use of resources, autonomy , control and the doctor / nursing relationship. The teamwork and burnout of care are also among these factors.
A process for improved patient observation and the initiation of necessary treatments is formed from these factors. If this process cannot be carried out reliably, the outcomes can occur. Good examples of failed patient safety are pressure ulcers or nosocomial infections, as well as urinary tract infections. This also includes postoperative infections, sepsis and pneumonia . Falls can also occur through careless observation of patients by employees. Delayed administration of medication leads to length of stay and it can also lead to mortality if help is delayed in an emergency.
The patient-endangering event that must be avoided is mortality . The mortality rate should not be influenced by reduced staff capacity or staff quality. It is therefore important to establish patient safety through indicators and give them a framework for maintaining it.
Indicators
Quality indicators (QI)
Structure indicators
Structural indicators help decision-makers and institutions with planning and controlling.
Process indicators
Process indicators are used for process planning and organizational development. They help with the interaction between patient and staff and help with compliance with supply and organizational processes. In order to be able to design a process, the requirements and the process characteristics must first be clarified. Process key figures or process indicators are important for this. These are based on the quality goals of the organization.
Result indicators
Result indicators are used for planning , control and quality management. Adverse events such as mortality are recorded and analyzed and assessed by quality management.
Patient Safety Indicators (PSI)
With the patient safety indicator system, the experts are in direct contact with the patient. These are involved through direct documentation and data acquisition. The indicators are designed in such a way that they are related to the internal self-assessment, especially by the employees. However, the external rankings should be noted. If the indicators are used continuously, they lead to an improvement in quality and increased patient safety .
The patient safety indicators are made up of a total of three indicators. On the one hand the structural indicators, the clinical / nursing process indicators and the clinical / nursing result indicators.
Structural indicators
Guidelines are formed from these indicators and clinical pathways emerge. Service providers are the target group here. The aim is to define activities, ensure those responsible and find coordination. The areas of application should be transparent both externally and internally.
The structural indicators relate to conditions that are influenced by the direct interaction of the patient, such as the hygiene guidelines.
Clinical / nursing process indicators
These indicators are diagnosis / intervention related and are also used for external and internal transparency. The target groups are service providers, patients and decision-makers. The quality of care is adapted to the recognized treatment criteria. Treatment criteria include surgical antibiotic prophylaxis or antibiotic management for certain diseases . The aim here is to provide information internally and externally.
These indicators can be compared externally and made public.
Clinical / nursing outcome indicators
These indicators relate to the adverse clinical / nursing events such as falls or wound infections. The target groups are the service providers, the management and the executive positions. The aim here is to assess and optimize the internal self-assessment. Suggestions for improvement are now exchanged. This serves to continuously improve patient safety. The transparency is only internal.
Differences between patient safety indicators and quality safety indicators
The patient safety indicators are implemented in "expert systems" and additional data is often required, which is not required for the quality safety indicators. The documentation of the indicators depends on the department. With the “expert systems” of patient safety , prompt feedback is required, which takes place every ¼ years.
A so-called "management system" is used for the quality assurance indicators; this is primarily used for planning and control. The " management system " uses routine data.
Elements of quality management in health care companies
The following components are indispensable for good quality management in health care operations.
- Quality management manual
- diagnosis
- New and further development
- Documents and patient data
- Traceability
- Process control
- Measuring devices
- exams
- Corrective / preventive actions
- Quality checks
- Initial and continuing education
- Aftercare
Criteria for the selection of patient safety indicators
Scientific criteria
In order to increase patient safety and to be able to use it for internal quality assurance measures, evidence must be provided. These evidence are divided into four types. The division is made into validity, reliability, sensitivity and feasibility.
validity
This is about the accuracy that the indicators represent. It is checked whether the indicators reflect exactly what they should reflect.
The validity is divided into 3 sub-items
a) Face Validity
This type of validity measures what the indicator shows to be measured.
b.) Content Validity
The exactness plays a big role. The content, definition and structure are reflected upon .
c.) Construct Validity
The indicators are now related to each other and this is expected. An example is unexpected mortality of a patient or a wound infection after an operation , which leads to another, unplanned, operation.
Reliability
The indicators must be measurable but also precise and reproducible.
sensitivity
The conditions in hospitals are continuously changing in the future. Therefore, the chosen patient safety indicators should be able to react to changes and have a certain leeway.
Feasibility
The patient safety indicators should be as easy as possible to integrate into the hospital information system.
Uniform methodology
In addition to the methodology , reference values should also be available:
- Comparisons should be available, both on a regional, national and international basis.
- In-house rules, such as trends from peer groups, should be queried for the first time.
- One of the most important methods is data collection. It should be recorded at the organizational level as well as at the department level. The data quality is continuously checked and optimized via the system used. It is important to always observe and comply with data protection and confidentiality. Data acquisition is not just about collecting data, but using it effectively and sensibly.
- The reference data should always be available and be able to be used frequently. At best, collection and feedback take place every quarter.
- A standardized methodology, such as the PDCA cycle, is used for feedback . All employees from all departments are included in the feedback . Not only the feedback is important, but also the regular training of the employees. This also results in feedback from employees. Potential for improvement can be identified and suggestions for improvement presented.
Individual evidence
- ↑ a b Introduction to patient safety. Retrieved June 9, 2018 .
- ↑ M. Rall, T. Manser, H. Guggenberger, DM Gaba, K. Unertl: Patient safety and errors in medicine . Thieme Verlag, 2001.
- ↑ a b c d e Klauber, Geraedts, Friedrich, Wasem: Patient safety and risk management . Springer Berlin Heidelberg, Berlin, Heidelberg.
- ↑ a b Berg, Ulsenheimer: patient safety, doctor liability, practice and hospital organization . Springer Verlag, 2006.
- ↑ Manfred Schröder, Tim Schröder: Risk management in hospitals . Springer Verlag, January 2000.
- ↑ a b c d e Austrian Platform for Patient Safety (ANetPAS): Selection and implementation of patient safety indicators in hospitals . Vienna January 2012.
- ↑ AHRQ Fact Sheet: Requirements for an Optimal Indicator. Retrieved June 9, 2018 .
- ↑ Areas of application of the PS. Retrieved June 9, 2018 .
- ↑ Peter Hensen: Quality Management in Health Care, Basics for Studies and Practice . Springer Gabler Verlag, January 2006.
- ^ Andreas Frodl: Logistics and quality management in health care companies . 1st edition. Springer Galber Verlag, January 2012.