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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Patient safety | 7/10 | https://en.wikipedia.org/wiki/Patient_safety | reference | science, encyclopedia | 2026-05-05T04:26:13.019610+00:00 | kb-cron |
Possible additions to the dataset will address the patient's condition on admission and increase the understanding of how laboratory and pharmacy utilization impact patient outcomes. The goal of AHRQ is to refine the area-level indicators to improve outcomes for children receiving outpatient care and reduce the incidence of hospitalization for those defined conditions.
=== Collaborations for pediatric safety and quality === Numerous groups are engaged in improving pediatric care, quality, and safety. Each of these groups has a unique mission and membership. The following table details these groups' missions and websites.
=== Nurse staffing and pediatric outcomes === While the number of nurses providing patient care is recognized as an inadequate measure of nursing care quality, there is hard evidence that nurse staffing is directly related to patient outcomes. Studies by Aiken and Needleman have demonstrated that patient death, nosocomial infections, cardiac arrest, and pressure ulcers are linked to inadequate nurse-to-patient ratios. The presence or absence of registered nurses (RNs) impacts the outcome for pediatric patients requiring pain management and/or peripheral administration of intravenous fluids and/or medications. These two indicators of pediatric nursing care quality are sensitive measures of nursing care. Professional nurses play a key role in successful pain management, especially among pediatric patients unable to verbally describe pain. Astute assessment skills are required to intervene successfully and relieve discomfort.33 Maintenance of a patient's intravenous access is a clear nursing responsibility. Pediatric patients are at increased risk for intravenous infiltration and for significant complications of infiltration, should it occur. The characteristics of effective indicators of pediatric nursing care quality include the following:
Scalable: The indicators are applicable to pediatric patients across a broad range of units and hospitals, in both intensive care and general care settings. Feasible: Data collection does not pose undue burden on staff of participating units as the data is available from existing sources, such as the medical record or a quality improvement database and can be collected in real time. Valid and reliable: Indicator measurement within and across participating sites is accurate and consistent over time.
=== Conclusions === Pediatric care is complex due to developmental and dependency issues associated with children. How these factors impact the specific processes of care is an area of science in which little is known. Throughout health care, providing safe and high-quality patient care continues to provide significant challenges. Efforts to improve the safety and quality of care are resource-intensive and take continued commitment not only by those who deliver care but also by agencies and foundations that fund this work. Advocates for children's health care must be at the table when key policy and regulatory issues are discussed. Only then will the voices of our most vulnerable groups of healthcare consumers be heard.
== Working hours of nurses and patient safety == A recent increase in work hours and overtime shifts of nurses has been used to compensate for the decrease in a number of registered nurses (RNs). Logbooks completed by nearly 400 RNs have revealed that about "40 percent of the 5,317 work shifts they logged exceeded twelve hours." Errors by hospital staff nurses are more likely when work shifts extend beyond 12 hours, or they work over 40 hours in one week. Studies have shown that overtime shifts have harmful effects on the quality of care provided to patients, but some researchers "who evaluated the safety of 12-hour shifts did not find increases in medication errors." The errors which these researchers found were "lapses of attention to detail, errors of omission, compromised problem solving, reduced motivation" due to fatigue as well as "errors in grammatical reasoning and chart reviewing." Overworked nurses are a serious safety concern for their patients' well-being. Working back-to-back shifts, or night shifts, is a common cause of fatigue in hospital staff nurses. "Less sleep, or fatigue, may lead to increased likelihood of making an error, or even the decreased likelihood of catching someone else's error." Limiting working hours and shift rotations could "reduce the adverse effects of fatigue" and increase the quality of patient care.
== Health literacy == Health literacy is a common and serious safety concern. A study of 2,600 patients at two hospitals determined that between 26% and 60% of patients could not understand medication directions, a standard informed consent, or basic health care materials. This mismatch between a clinician's level of communication and a patient's ability to understand can lead to medication errors and adverse outcomes. The Institute of Medicine (2004) report found low health literacy levels negatively affect healthcare outcomes. In particular, these patients have a higher risk of hospitalization and longer hospital stays, are less likely to comply with treatment, are more likely to make errors with medication, and are more ill when they seek medical care.
== Pay for performance (P4P) ==
Pay for performance systems can improve patient safety by linking providers' compensation to measures of work quality or process goals. As of 2005, 75 percent of all U.S. companies connected at least part of an employee's pay to measures of performance, and in healthcare, over 100 private and federal pilot programs were underway. Methods of healthcare payment current at that time may actually have rewarded less-safe care, since some insurance companies will not pay for new practices to reduce errors, while physicians and hospitals can bill for additional services that are needed when patients are injured by mistakes. However, early studies showed little gain in quality for the money spent, as well as evidence suggesting unintended consequences, like the avoidance of high-risk patients, when payment was linked to outcome improvements. The 2006 Institute of Medicine report Preventing Medication Errors recommended "incentives...so that profitability of hospitals, clinics, pharmacies, insurance companies, and manufacturers (are) aligned with patient safety goals...(to) strengthen the business case for quality and safety." There is widespread international interest in health care pay-for-performance programs in a range of countries, including Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States.