Background: To use advanced medical technologies (AMTs) correctly and safely requires both specialist knowledgeand skills, and an awareness of risks and how those can be minimized. Reporting safety concerns aboutAMTs in home care can contribute to an improved quality of care. The extent to which a health care organizationhas integrated the reporting, evaluation and learning from incidents is a key element of that organization’spatient safety culture.Objectives: To explore nurses’ experiences regarding the education followed in the use of AMTs in the homesetting, and their organizations’ systems of reporting.Design: Descriptive cross-sectional design.Methods: 209 home care nurses from across the Netherlands who worked with infusion therapy, parenteralnutrition and/or morphine pumps responded to the online questionnaire between July 2018 and February 2019.The analysis of the data was mainly descriptive.Results: Educational interventions that are most often used to learn how to use AMTs were, as an average over thethree AMTs, instruction by a nurse (71%), practical training in the required skills (71%) and acquiring informationto increase theoretical knowledge (69%). Considerable attention is paid to patient safety (88%) and thehome setting (89%). However, a substantial proportion of the nurses (up to 29%) use AMTs even though they hadnot been tested on their skills. 95% of the respondents were well acquainted with the incident reporting protocolof their organization, but only 49% received structural or regular feedback on any actions taken as a result ofevent reporting.Conclusions: This study revealed aspects of nurses’ education that imply risk factors for patient safety. Practicaltraining is not always given, additional or retraining is often voluntary, and the required skills are not alwaystested. However, the results show that nurses do have a good awareness of patient safety. Incidents are mainlydiscussed within the team, but less at the organizational level.
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Purpose – In the domain of healthcare, both process efficiency and the quality of care can be improved through the use of dedicated pervasive technologies. Among these applications are so-called real-time location systems (RTLS). Such systems are designed to determine and monitor the location of assets and people in real time through the use of wireless sensor networks. Numerous commercially available RTLS are used in hospital settings. The nursing home is a relatively unexplored context for the application of RTLS and offers opportunities and challenges for future applications. The paper aims to discuss these issues. Design/methodology/approach – This paper sets out to provide an overview of general applications and technologies of RTLS. Thereafter, it describes the specific healthcare applications of RTLS, including asset tracking, patient tracking and personnel tracking. These overviews are followed by a forecast of the implementation of RTLS in nursing homes in terms of opportunities and challenges. Findings – By comparing the nursing home to the hospital, the RTLS applications for the nursing home context that are most promising are asset tracking of expensive goods owned by the nursing home in orderto facilitate workflow and maximise financial resources, and asset tracking of personal belongings that may get lost due to dementia. Originality/value – This paper is the first to provide an overview of potential application of RTLS technologies for nursing homes. The paper described a number of potential problem areas that can be addressed by RTLS. Published by Emerald Publishing Limited Original article: https://doi.org/10.1108/JET-11-2017-0046 For this paper Joost van Hoof received the Highly Recommended Award from Emerald Publishing Ltd. in October 2019: https://www.emeraldgrouppublishing.com/authors/literati/awards.htm?year=2019
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Background Advanced medical technologies (AMTs), such as respiratory support or suction devices, are increasingly used in home settings and incidents may well result in patient harm. Information about risks and incidents can contribute to improved patient safety, provided that those are reported and analysed systenaticaly. Objectives To identify the frequency of incidents when using AMTs in home settings, the effects on patient outcomes and the actions taken by nurses following identification of incidents. Methods A cross- sectional study of 209 home care nurses in the Netherlands working with infusion therapy, parenteral nutrition or morphine pumps, combining data from a questionnaire and registration forms covering more than 13 000 patient contacts. Descriptive statistics were used. Results We identified 140 incidents (57 adverse events; 83 near misses). The frequencies in relation to the number of patient contacts were 2.7% for infusion therapy, 1.3% for parenteral nutrition and 2.6% for morphine pumps. The main causes were identified as related to the product (43.6%), the organisation of care (27.9%), the nurse as a user (15.7%) and the environment (12.9%). 40% of all adverse events resulted in mild to severe harm to the patient. Incidents had been discussed in the team (70.7%), with the patient/informal caregiver(s) (50%), or other actions had been taken (40.5%). 15.5% of incidents had been formally reported according to the organisation’s protocol. Conclusions Most incidents are attributed to product failures. Although such events predominantly cause no harm, a significant proportion of patients do suffer some degree of harm. There is considerable underreporting of incidents with AMTs in home care. This study has identified a discrepancy in quality circles: learning takes place at the team level rather than at the organisational level.
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