Patient safety ethics and human error management in ED contexts part I : development of the global patient safety movement

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end patient safety has become the focus of a world-wide endeavour aimed at reducing the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments. In this article (the first of a two-part discussion on the subject) an overview of the incidence and impact of preventable adverse events in ED contexts is explored. The development of a ‘culture of safety’ in other hazardous industries and the ‘lessons learned’ and applied to the health care industry are also briefly examined. In a second article (to be presented as Part II), some of the ethical tensions that have arisen in the context of implementing patient safety processes and their possible implications for ED contexts are explored.

Patient safety ethics and human error management in ED contexts Part II : Accountability and the challenge to change

In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end, patient safety has become the focus of a world-wide endeavour – endorsed by the World Health Organisation – to reduce the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments, of which the Emergency Department is a prime example. In Part I of this article series, an overview of the incidence and impact of preventable adverse events in Emergency Department contexts and the development of the global patient safety movement was presented. In this second article brief attention is given to examining some of the ethical tensions that have arisen in response to the patient safety movement and their possible implications for Emergency Department contexts and staff.

Clinical risk management and patient safety education for nurses : a critique

Nurses have a pivotal role to play in clinical risk management (CRM) and promoting patient safety in health care domains. Accordingly, nurses need to be prepared educationally to manage clinical risk effectively when delivering patient care. Just what form the CRM and safety education of nurses should take, however, remains an open question. A recent search of the literature has revealed a surprising lack of evidence substantiating models of effective CRM and safety education for nurses. In this paper, a critical discussion is advanced on the question of CRM and safety education for nurses and the need for nurse education in this area to be reviewed and systematically researched as a strategic priority, nationally and internationally. It is a key contention of this paper that without ‘good’ safety education research it will not be possible to ensure that the educational programs that are being offered to nurses in this area are evidence-based and designed in a manner that will enable nurses to develop the capabilities they need to respond effectively to the multifaceted and complex demands that are inherent in their ethical and professional responsibilities to promote and protect patient safety and quality care in health care domains.

How general practitioners determine young people's rights

To explore how Victorian general practitioners understand and apply relevant legal authority when faced with a. young person who requests the oral contraceptive pill, over 300 doctors were asked to make decisions about a hypothetical patient's competence and confidentiality. Respondents presented a range of philosophical perspectives about young people's entitlements, and operationalised legal authority in a variety of ways. The data indicate that the assumptions embedded in relevant law, the vague nature of existing legal criteria and the evident diversity in assessment practices all have the potential to act as obstacles to young people's claim to rights in the medical context.

Complexity, age and motor competence effects on fine motor kinematics

Prehension is a fundamental skill usually performed as part of a complex action sequence in everyday tasks. Using an information processing framework, these studies examined the effects of task complexity, defined by the number of component movement elements (MEs), on performance of prehension tasks. Of interest was how motor control and organisation might be influenced by age and/or motor competence. Three studies and two longitudinal case studies examined kinematic characteristics of prehension tasks involving one-, two- and three-MEs: reach and grasp (low-complexity); reach, grasp and object placement (moderate-complexity); and reach, grasp and double placement of object (high-complexity). A pilot study established the suitability of tasks and procedures for children aged 5-, 8- and 11-years and showed that responses to task complexity and object size manipulations were sensitive to developmental changes, with increasing age associated with faster movements. Study 2 explored complexity and age effects further for children aged 6- and 11-years and adults. Increasing age was associated with shorter and less variable movement times (MTs) and proportional deceleration phases (%DTs) across all MEs. Task complexity had no effect on simple reaction time (SRT), suggesting that there may be little preprogramming of movements beyond the first ME. In addition, MT was longer and more on-line corrections were evident for the high- compared to the moderate-complexity task for ME1. Task complexity had a greater influence on movements in ME2 and ME3 than ME1. Adults, but not children, showed task specific adaptations in ME2. Study 3 examined performance of children with different levels of motor competence aged between 5- and 10-years. Increasing age was associated with shorter SRTs, and MTs for ME1 only. A decrease in motor competence was associated with greater difficulty in planning and controlling movements as indicated by longer SRTs, higher %DTs and more on-line corrections, especially in ME2. Task complexity affected movements in all MEs, with a greater influence on ME1 compared to Study 2. Findings also indicated that performance in MEs following prehension may be especially sensitive to motor competence effects on movement characteristics. Case studies for two children at risk of Developmental Coordination Disorder (DCD) revealed two different patterns of performance change over a 16-17 month period, highlighting the heterogeneous nature of DCD. Overall, findings highlighted age-related differences, and the role of motor competence, in the ability to adapt movements to task specific requirements. Results are useful in guiding movement education programmes for children with both age-appropriate and lower levels of motor competence.

Patient assessment of medication information leaflets and validation of the Evaluative Linguistic Framework (ELF)

Objective : To obtain patient feedback about the structure and quality of medication information leaflets and validate the usefulness of the Evaluative Linguistic Framework (ELF) for improving written communication with patients.
Methods : Triangulated feedback about a set of rheumatoid arthritis (RA) medication leaflets, some developed with knowledge of the ELF, was obtained from 27 people with RA from interviews, focus group discussion and self-administered questionnaires. The principal elements of the framework were investigated: overall generic structure and functions of each stage, interpersonal relationship between writer and reader, technicality of language and density of information.
Results : Participant assessments of the leaflets aligned with the framework in terms of what constituted a good leaflet. While the main purpose of the leaflets was identified as being information provision, participants also wanted clear instructions, benefits to be highlighted and side effects to be comprehensively listed. For comprehensiveness and user-friendliness, leaflets developed with guidance of the ELF were consistently preferred.
Conclusion : According to people with RA, leaflets generated from a linguistic framework are clearer and more effective in communicating information about medications.
Practice Implications : The ELF is a user-friendly, structured analytic system that can assist with the development of effective high quality patient information materials.

Perspectives of a nurse, a social-worker and a psychiatrist, regarding patient assessment in acute inpatient psychiatry settings : a case study approach

This case study explores what informs and organizes the assessment of patients, as undertaken by a nurse, a social worker and a psychiatrist in public, metropolitan, acute mental health service settings. The research data are the transcripts of in-depth interviews with three experienced practitioners, one from each of the three disciplines. The analysis draws on Foucauldian concepts: discourse as constructed through practices of discipline and the gaze. We explored examples of taken-for-granted assessment practices and their interplay with discourse. The findings suggest that participating practitioners use language in assessment in ways that support the powerful discourses of the professional disciplines. The competing discourse of management, associated with industry and economics, is evident in hospital admission processes, dictating the times and places of assessment. Professional and management discourses both effectively marginalize the perspective of another player in assessment, the patient.