A conceptual framework identifying sources of risk to patient safety in primary care

2012 ◽  
Vol 18 (3) ◽  
pp. 185 ◽  
Author(s):  
Logan McLeod ◽  
JoAnn Kingston-Riechers ◽  
Egon Jonsson
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Acute Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Delivery ◽  
Acute Care Setting ◽  
Primary Care Delivery ◽  
Potential Risks ◽  
Organisational Structures

The potential risks to patient safety in a primary care setting are different than the risks to patient safety in an acute care setting. The main differences arise from the organisational structures of primary care delivery and the greater involvement of patients in their care. To account for these differences, we present the Patient Safety in Primary Care Framework to conceptualise the sources of risk to patient safety.

Addressing the Health Care Delivery Needs in the Acute Care Setting by Developing a Postmaster’s Acute Care Certification Program

2016 ◽  
Vol 9 (1) ◽  
pp. 124-127
Author(s):  
Helen Miley ◽  
Courtney Reinisch
Keyword(s):  
Primary Care ◽  
New Jersey ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Care Setting ◽  
Care Delivery ◽  
The State ◽  
Inpatient Setting ◽  
Acute Care Setting ◽  
Term Care

The state of New Jersey certifies nurse practitioners and clinical nurse specialists from all specialties as advanced practice nurses (APNs). There are more than 4,000 certified APNs in the state in 17 specialty areas. APNs in the state have the privilege of practicing in various settings such as ambulatory, inpatient, and long-term care. The state does not limit the setting where an APN chooses to practice. A trend is emerging in the state to address the concern of primary care–educated APNs to prepare them for the delivery of care in the acute care setting. Some institutions within the state of New Jersey are requiring their primary care educated and certified adult primary care APNs working in an inpatient setting to obtain an acute care certification. Recognizing the needs of these adult primary care APNs, Dr. Helen Miley developed a postmaster’s certificate program which has been approved by Rutgers School of Nursing faculty. Although the first cohort has not yet been admitted to the program, it will be implemented in the near future. Because it is important to address the educational needs of adult primary care APNs, this article describes the needs assessment and development plan used for this program.

scholarly journals Primary Care and the Ethics of Integrating Genomic Medicine

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Vasiliki Rahimzadeh
Keyword(s):  
Primary Care ◽  
Care Setting ◽  
Primary Care Setting ◽  
Care Delivery ◽  
Genomic Medicine ◽  
Primary Care Providers ◽  
Care Providers ◽  
Care Clinic ◽  
Genomic Technologies ◽  
Primary Care Delivery

Objectives: To explore the practical barriers to, and implications of, incorporating genomic technologies in the primary care setting. In evaluating the primary care mission and anticipated role of genomic medicine in conversation with one another, I discuss the ways in which the primary care philosophy problematizes innovations afforded to clinical medicine through whole genome sequencing. I discuss these themes in relation to the evaluation frameworks that must precede full integration, specifically the Analytic validity, Clinical validity, Clinical Utility and Ethical, legal social considerations (ACCE) model. Finally, my analysis will consider the added ethical nuances for integrating genomic medicine in the wake of new standards for healthcare delivery in the U.S.Methods: I review the literature concerning 1) models for evaluating the applicability of emerging genomic technologies in the primary care setting, namely the ACCE model proposed by the Center for Disease Control, and 2) anticipated changes to primary care delivery through proposed healthcare legislation.Results: Three main facets of primary care delivery problematize full integration of genomic medicine in clinical practice. They include: primary care providers' propensity to maintain therapeutic relationships with patients over the lifecourse, acuity to community health patterns, and gaps in genetic/genomic-specific knowledge among practicing clinicians. Implementation of genomic medicine requires that technologies be adaptable to the heterogeneity of the primary care clinic, in both the diverse populations it serves and broad spectrum of resource availability.Conclusions: The rapid pace at which genomic technology has fundamentally altered the direction of medical research scene is extraordinary to say the least. The potential benefits for incorporating these innovations depict a clinical landscape that predicts and prevents disease before it manifests, and cares for patients using treatments that are tailored to their own genetic person. The primary care arena presents unique challenges to the evaluation, diffusion and translation of genomic technologies. Yet the same aspects that present limitations also reinforce the reasons why the primary care setting is a critical forum in which to operationalize genomic medicine in practice. With so much dialogue generated around ushering in a new era of medicine, it is unclear whether this is celebrating the novelty of the genomic revolution, or the reinvigoration of a longstanding clinical tradition in patient-centered primary care.

Addressing the Health Care Delivery Needs in the Acute Care Setting by Developing a Postmaster’s Acute Care Certification Program

2015 ◽  
Vol 8 (1) ◽  
pp. 39-42
Author(s):  
Helen Miley ◽  
Courtney Reinisch
Keyword(s):  
Primary Care ◽  
New Jersey ◽  
Acute Care ◽  
Nurse Practitioners ◽  
Care Setting ◽  
Care Delivery ◽  
The State ◽  
Inpatient Setting ◽  
Acute Care Setting ◽  
Term Care

The state of New Jersey certifies nurse practitioners and clinical nurse specialists from all specialties as advanced practice nurses (APNs). There are more than 4,000 certified APNs in the state in 17 specialty areas. APNs in the state have the privilege of practicing in various settings such as ambulatory, inpatient, and long-term care. The state does not limit the setting where an APN chooses to practice. A trend is emerging in the state to address the concern of primary care–educated APNs to prepare them for the delivery of care in the acute care setting. Some institutions within the state of New Jersey are requiring their primary care–educated and primary care–certified adult primary care APNs working in an inpatient setting obtain an acute care certification. Recognizing the needs of these adult primary care APNs, Dr. Helen Miley developed a postmaster’s certificate program which has been approved by Rutgers School of Nursing faculty. Although the first cohort has not yet been admitted to the program, it will be implemented in the near future. Because it is important to address the educational needs of adult primary care APNs, this article describes the needs assessment and development plan used for this program.

scholarly journals Assessment of patient safety culture in primary care setting, Al-Mukala, Yemen

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Hana H. Webair ◽  
Salwa S. Al-assani ◽  
Reema H. Al-haddad ◽  
Wafa H. Al-Shaeeb ◽  
Manal A. Bin Selm ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Safety Culture ◽  
Care Setting ◽  
Primary Care Setting ◽  
Patient Safety Culture

Care of the Acutely Ill Adult

2020 ◽  
Keyword(s):  
Acute Care ◽  
Care Setting ◽  
Care Delivery ◽  
Clinical Signs ◽  
Current Evidence ◽  
Evidence Based ◽  
Acute Care Setting ◽  
Dynamic Nature ◽  
Timely Manner ◽  
Systematic Assessment

The new edition of Care of the Acutely Ill Adult enables nursing staff to develop an in-depth understanding of the knowledge required to care for patients whose condition is deteriorating. The book emphasizes the importance of systematic assessment, interpretation of clinical signs of deterioration, and the need to escalate the patient in a timely manner. Current evidence-based practice and up-to-date guidelines are included in each systems-based chapter and case studies are used throughout the book to enable nurses to apply knowledge to patient scenarios. In recognition of the dynamic nature of acute care delivery, new chapters have been included that focus on pain management and planning for care when recovery is unlikely. This book remains an essential purchase for any nurse working in an acute care setting.

scholarly journals Identification of Barriers to SBARB at the Bedside in an Acute Care Setting

2018 ◽  
Author(s):  
Elizabeth Bryand
Keyword(s):  
Patient Safety ◽  
Acute Care ◽  
Care Setting ◽  
Healthcare Providers ◽  
Staff Nurses ◽  
Practice Change ◽  
Perceived Barriers ◽  
Sensitive Information ◽  
Acute Care Setting ◽  
Patient Privacy

Nurse to nurse handoff that occurs at the end of each shift is a known area of potential safety risk due to poor communication and inadequate safety checks. The Joint Commission (TJC) reported that communication between healthcare providers or between patient and healthcare providers was the leading root cause of sentinel events. Research supports the benefits of a structure handoff at the bedside to patient safety and satisfaction. Despite these proven benefits, staff nurses have not consistently embraced the practice. The purpose of this study was to identify nurses’ perceived barriers to performing SBARP (Situation, Background, Assessment, Recommendation and Patient) at the bedside in an acute care setting. Rogers Diffusion of Innovation Theory was used to guide the development and implementation of this project. A mixed qualitative and quantitative survey was utilized to assess the nurses’ perceived barriers to performing SBARP at the patient’s bedside. The survey was distributed to nurses employed on two medical-surgical floors at Newport Hospital. Responses (N = 19) showed that although staff nurses perceived that bedside handoff positively impacted patient satisfaction and patient safety, they did not routinely practice bedside handoff. Nurses cited lack of comfort with the practice, patient privacy, perception of time, and communication of sensitive information as barriers to performing bedside handoff. Sustaining practice change over time in an organization can be challenging. Leadership support and enforcement of bedside handoff in addition to targeted education to reduce perceived barriers to the practice may help to increase the practice of bedside handoff.

Examination of the Use of Healing Touch by Registered Nurses in the Acute Care Setting

2016 ◽  
Vol 35 (1) ◽  
pp. 97-107 ◽  
Author(s):  
Joel G. Anderson ◽  
Mary Ann Friesen ◽  
Diane Swengros ◽  
Anna Herbst ◽  
Lucrezia Mangione
Keyword(s):  
Patient Care ◽  
Registered Nurses ◽  
Acute Care ◽  
Care Setting ◽  
Care Delivery ◽  
Acute Care Setting ◽  
Healing Touch ◽  
The Impact ◽  
Acute Care Nursing ◽  
Care Nursing

Acute care nursing is currently undergoing unprecedented change, with health systems becoming more open to nonpharmacological approaches to patient care. Healing Touch (HT) may be a valuable intervention for acute care patients. Research has shown that HT helps both the patient and the caregiver; however, no study to date has examined the impact that the education of nurses in and their use of HT have on daily care delivery in the acute care setting. The purpose of the current qualitative study was to examine the use of HT by registered nurses in the acute care setting during their delivery of patient care, as well as the impact of education in and use of HT on the nurses themselves. Five themes were identified: (1) use of HT techniques, processes, and sequence; (2) outcomes related to HT; (3) integration of HT into acute care nursing practice; (4) perceptions of HT, from skepticism to openness; and (5) transformation through HT. Education in HT and delivery of this modality by nurses in the acute care setting provide nurses with a transformative tool to improve patient outcomes.

A qualitative study of nurses’ perspectives of caring for children with intellectual disability and their families in a paediatric acute care setting

2019 ◽  
Vol 23 (4) ◽  
pp. 639-651 ◽  
Author(s):  
Peter Lewis ◽  
Nathan J Wilson ◽  
Hayden Jaques ◽  
Kate O’Reilly ◽  
Michele Wiese
Keyword(s):  
Intellectual Disability ◽  
Acute Care ◽  
Care Setting ◽  
Adaptive Functioning ◽  
Care Delivery ◽  
Hospital Setting ◽  
Acute Care Setting ◽  
Additional Time ◽  
Paediatric Hospital ◽  
Children With Intellectual Disability

Children with intellectual disability (ID) experience chronic and pervasive limitations across intellectual and adaptive functioning. They are also at risk of developing co-morbidities. They are likely to be hospitalised more frequently and for longer periods of time than other children. The purpose of this study was to understand the experiences of nurses when caring for children and teenagers with ID in an acute paediatric hospital setting. The aim of the research was to inform future directions for the delivery of equitable and effective care for this vulnerable population. This study used a qualitative thematic analysis of individual interviews conducted with eight registered and enrolled nurses who provided care to children and adolescents with ID in an Australian paediatric acute hospital setting. Themes which emerged from this analysis were (1) Recognising similarities and managing differences; (2) Nurse–parent relationships; and (3) Caring for children with ID requires additional time. This study highlights that navigating care delivery and relationships when working with young people with ID and their caregivers in an acute care setting is complex. Nursing children with ID in hospital requires sophisticated skills. To ensure quality healthcare for patients with ID, a range of strategies are proposed.

scholarly journals Making care more patient centered; experiences of healthcare professionals and patients with multimorbidity in the primary care setting

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sanne Jannick Kuipers ◽  
Anna Petra Nieboer ◽  
Jane Murray Cramm
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Setting ◽  
Healthcare Professionals ◽  
Primary Care Setting ◽  
Care Delivery ◽  
Care Needs ◽  
Patient Centered ◽  
Improvement Program ◽  
Improvement Programs

Abstract Background The present study describes how primary care can be improved for patients with multimorbidity, based on the evaluation of a patient-centered care (PCC) improvement program designed to foster the eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, coordination of care, continuity and transition, emotional support, and family and friends). This study characterizes the interventions implemented in practice as part of the PCC improvement program and describes the experiences of healthcare professionals and patients with the resulting PCC delivery. Methods This study employed a mixed-methods design. Semi-structured interviews were conducted with nine general practitioners and nurse practitioners from seven primary care practices in Noord-Brabant, the Netherlands, that participated in the program (which included interventions and workshops). The qualitative interview data were examined using thematic analysis. A longitudinal survey was conducted with 138 patients with multimorbidity from these practices to assess perceived improvements in PCC and its underlying dimensions. Paired sample t tests were performed to compare survey responses obtained at a 1-year interval corresponding to program implementation. Results The PCC improvement program is described, and themes necessary for PCC improvement according to healthcare professionals were generated [e.g. Aligning information to patients’ needs and backgrounds, adapting a coaching role]. PCC experiences of patients with multimorbidity improved significantly during the year in which the PCC interventions were implemented (t = 2.66, p = 0.005). Conclusion This study revealed how primary PCC can be improved for patients with multimorbidity. It emphasizes the importance of investing in PCC improvement programs to tailor care delivery to heterogenous patients with multimorbidity with diverse care needs. This study generates new perspectives on care delivery and highlights opportunities for its improvement according to the eight dimensions of PCC for patients with multimorbidity in a primary care setting.

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