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ResMed Notifies Customers About Updated Instructions and Labeling for Masks with Magnets Due to Potential Interference with Certain Medical Devices

FDA MedWatch -

ResMed (NYSE: RMD, ASX: RMD) is conducting a voluntary global field action to update its guides for all masks with magnets to inform users about potential magnetic interference when magnets are near certain implants and medical devices in the body. This voluntary field correction does not require a

Contextualising opioid-related risk factors before an initial opioid prescription

Quality and Safety in Health Care Journal -

When asked about the similarities between the region of Valencia, Spain and the State of Oregon in the USA, an artificial-intelligence (AI)-driven chatbot poetically listed several common features, such as natural beauty, strong focus on agricultural industries including wine production, extensive outdoor activities and a shared commitment to sustainable practices. But are there similarities in healthcare delivery, considering vastly different systems and significant practice variability, particularly regarding the management of pain and the role of opioid analgesics?

Here, the differences emerge. Oxycodone and hydrocodone are commonly prescribed opioids in Oregon,1 whereas prescribers in Valencia typically use tramadol and codeine.2 While Oregon has experienced a rapid increase in opioid-related deaths, reaching a record 548 (13.0 per 100 000 population) in 2021,3 Valencia had 88 (1.8 per 100 000 population) drug-related deaths during the same period.4 Unfortunately, these gaps have begun to narrow: the annual...

Work addiction and quality of care in healthcare: Working long hours should not be confused with addiction to work

Quality and Safety in Health Care Journal -

Behavioural addictions are addictions that do not involve the ingestion of psychoactive substances and yet feature all the core features found in more traditional substance-based addictions (eg, withdrawal symptoms, mood modification, tolerance, salience, conflict and relapse).1 Although a couple of behavioural addictions have now been formally recognised in major psychiatric and medical diagnostic manuals such as the Diagnostic and Statistical Manual for Mental Disorders and the International Classification of Diseases (ie, addictions to gambling and gaming), all other types of behavioural addiction have not been formally recognised (eg, addictions to sex, social media, exercise, work, etc).

Work addiction is a controversial topic, even though the concept of ‘work addiction’ in the form of ‘workaholism’ was first reported in the late 1960s.2 Work addiction (like exercise addiction) has been viewed by some as a ‘socially respectable addiction’3 or a ‘mixed blessings addiction’4...

Medical safety huddles to engage frontline physicians in patient safety: calling physicians back to the table

Quality and Safety in Health Care Journal -

It is broadly recognised that everyone has a role in making healthcare safe,1 yet hospitals continue to struggle with incorporating frontline physicians in quality improvement and patient safety work.2 One cornerstone of hospital-based quality improvement and patient safety work is multidisciplinary huddling. Multidisciplinary huddles—brief, focused, stand up meetings involving physicians, nurses, administrators, laboratory workers and other staff—can improve medical care by enabling collaborative and efficient information exchange and fostering a shared view of current clinical conditions.3 Huddles operationalise healthcare as a cooperative science: all team members work together to deliver more patient-centred, coordinated and effective healthcare,4 promoting stronger teamwork, communication and situational awareness on the unit floor.5 This increased communication among members of the team theoretically leads to a better understanding of the daily work of frontline staff, potentially a key to sustaining quality improvement.6 But huddles’...

Education and educational interventions: moving beyond information provision

Quality and Safety in Health Care Journal -

Many of us will be familiar with educational outreach visits (EVs), which according to the Effective Practice and Organisation of Care taxonomy are defined as ‘personal visits by a trained person to health workers in their own settings, to provide information with the aim of changing practice’. But is merely providing information enough to achieve a change in practice, and through which mechanisms? In this issue of BMJ Quality & Safety, Luetsch and colleagues1 undertook a rigorous, transparent realist synthesis exploring how EVs work to influence prescribing behaviour in ambulatory care settings. Based on a synthesis of 43 papers, Luetsch and colleagues explain how the quality of clinician–education visitor interactions is pivotal, with sustained relationships and evidence-based open dialogue leading to reflection on practice and changes to prescribing. In this editorial, we explore the strong parallels between this study and wider health professions education (HPE) research, and...

Initial opioid prescription characteristics and risk of opioid misuse, poisoning and dependence: retrospective cohort study

Quality and Safety in Health Care Journal -

Objective

To identify individual and initial prescription-related factors associated with an increased risk for opioid-related misuse, poisoning and dependence (MPD) in patients with non-cancer pain.

Methods

Cohort study linking several databases covering 5 million inhabitants of the region of Valencia, Spain, including all adults initiating prescription opioids in the period 2012–2018. To ascertain the association between the characteristics of the initial prescription choice and the risk of opioid MPD, we used shared frailty Cox regression models. We additionally considered death as a competing risk in sensitivity analyses.

Results

958 019 patients initiated opioid prescription from 2012 to 2018, of which 0.13% experienced MPD. Most patients were prescribed tramadol as initial opioid (76.7%) followed by codeine (16.3%), long-acting opioids (6.7%), short-acting opioids (0.2%) and ultrafast opioids (0.1%). Initiation with ultrafast (HR 7.2; 95% CI 4.1 to 12.6), short-acting (HR 4.8; 95% CI 2.3 to 10.2) and long-acting opioids (HR 1.5; 95% CI 1.2 to 1.9) were associated with a higher risk of MPD when compared with tramadol. Initial prescriptions covering 4–7 days (HR 1.3; 95% CI 1.0 to 1.8), 8–14 days (HR 1.4; 95% CI 1.0 to 1.9), 15–30 days (HR 1.7; 95% CI 1.2 to 2.3) and more than one a month (HR 1.8; 95% CI 1.3 to 2.5) were associated with more MPD risk than initial prescriptions for 1–3 days. Treatments with >120 daily morphine milligram equivalents (MME) increased MPD risk (vs <50 MME, HR 1.6; 95% CI 1.1 to 2.2). Main individual factors associated with increased risk of MPD risk were male sex (HR 2.4; 95% CI 2.1 to 2.7), younger age (when compared with patients aged 18–44 years, patients aged 45–64 years, HR 0.4; 95% CI 0.4 to 0.5; patients aged 65–74 years, HR 0.4; 95% CI 0.3 to 0.5 and patients aged 75 years old and over, HR 0.7; 95% CI 0.6 to 0.8), lack of economic resources (2.1; 95% CI 1.8 to 2.5) and registered misuse of alcohol (2.9; 95% CI 2.4 to 3.5). Sensitivity analyses yielded overall comparable results.

Conclusions

Our study identifies riskier patterns of opioid prescription initiation for non-cancer indications, as well as patient subgroups with higher risk of misuse, poisoning and dependence.

Effects of ethical climate in association with tenure on work addiction, quality of care and staff retention: a cross-sectional study

Quality and Safety in Health Care Journal -

Objectives

Work addiction is not contingent on personality alone; it is also impacted by social contextual factors. Work addiction influences the perceived quality of care and intention to remain in healthcare sector. The current study seeks to understand the role of ethical climate as a potential organisational lever to reduce such addiction, especially among newcomers.

Design

We contacted a sample of Canadian healthcare organisations to collect quantitative data using an online questionnaire from November 2021 to February 2022. All constructs (ethical climate, work addiction, perceived quality of care, intention to quit the profession) were measured using validated psychometric scales. 860 respondents provided complete questionnaires. We analysed the data using structural equation modelling and regression analysis.

Results

Work addiction mediated the indirect relationship between ethical climate and the intention to quit the profession (β=–0.053; 95% CI (–0.083 to –0.029); p<0.001) and with quality of care (β=0.049; 95% CI (0.028, 0.077); p<0.001). For each increase of 1 SD of ethical climate, the total effects regarding the variations in the outcomes were more important at low rather than high levels of tenure for work addiction (–11%, –2%), perceived quality of care (23%, 11%) and intention to quit the profession (–30%, –23%), respectively.

Conclusion

Ethical climate in healthcare organisations has a significant and beneficial relationship with healthcare workers’ (HCWs) work addiction behaviours. In turn, this relationship is related to greater perceived quality of care and higher intention to remain, especially for HCWs with lower tenure.

Physician engagement in organisational patient safety through the implementation of a Medical Safety Huddle initiative: a qualitative study

Quality and Safety in Health Care Journal -

Background

Efforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians’ strong professional identification, physician-led strategies may offer a novel strategic approach to enhancing physician engagement. It remains unclear what role medical leadership can play in leading programmes to enhance physician engagement. In this study, we explore physicians’ experience of participating in a Medical Safety Huddle initiative and how participation influences engagement with organisational quality and safety efforts.

Methods

We conducted a qualitative study of the Medical Safety Huddle initiative implemented across six sites. The initiative consisted of short, physician focused and led, weekly meetings aimed at reviewing, anticipating and addressing patient safety issues. We conducted 29 semistructured interviews with leaders and participants. We applied an interpretive thematic analysis to the data using self-determination theory as an analytic lens.

Results

The results of the thematic analysis are organised in two themes, (1) relatedness and meaningfulness, and (2) progress and autonomy, representing two forms of intrinsic motivation for engagement that we found were leveraged through participation in the initiative. First, participation enabled a sense of community and a ‘safe space’ in which professionally relevant safety issues are discussed. Second, participation in the initiative created a growing sense of ability to have input in one’s work environment. However, limited collaboration with other professional groups around patient safety and the ability to consistently address reported concerns highlights the need for leadership and organisational support for physician engagement.

Conclusion

The Medical Safety Huddle initiative supports physician engagement in quality and safety through intrinsic motivation. However, the huddles’ implementation must align with the organisation’s multipronged patient safety agenda to support multidisciplinary collaborative quality and safety efforts and leaders must ensure mechanisms to consistently address reported safety concerns for sustained physician engagement.

A realist synthesis of educational outreach visiting and integrated academic detailing to influence prescribing in ambulatory care: why relationships and dialogue matter

Quality and Safety in Health Care Journal -

Background

Many quality improvement initiatives in healthcare employ educational outreach visits, integrating academic detailing to bridge evidence-practice gaps and accelerate knowledge translation. Replicability of their outcomes in different contexts varies, and what makes some visiting programmes more successful than others is unclear.

Objective

We conducted a realist synthesis to develop theories of what makes educational outreach visiting integrating academic detailing work, for whom, under which circumstances and why, focusing on the clinician-visitor interaction when influencing prescribing of medicines in ambulatory care settings.

Methods

The realist review was performed in accordance with RAMESES standards. An initial programme theory was generated, academic databases and grey literature were screened for documents with detail on contexts, intervention and outcomes. Using realist logic of analysis, data from 43 documents were synthesised in the generation of a refined programme theory, supported by additional theoretical frameworks of learning and communication.

Results

Twenty-seven interdependent context-mechanism-outcome configurations explain how clinicians engage with educational outreach visits integrating academic detailing through programme design, what matters in programme design and the educational visitor-clinician interaction and how influence extends beyond the visit. They suggest that in addition to relevance, credibility and trustworthiness of a visit’s contents, communication and clinical skills of educational visitors, the relationship between the educational visitor and clinician, built on a dialogue of learning from and sense-making with each other, creates conditions of critical thinking which are conducive to facilitating prescribing practice change when necessary.

Conclusion

This realist synthesis elucidates that the quality of clinician-educational visitor interactions is pivotal to educational outreach visiting programmes. Building and sustaining relationships, and establishing an open dialogue are important; neglecting these undermines the impact of visits. Educational visitors can facilitate clinicians’ reflection on practice and influence their prescribing. Clinicians value the discussion of individualised, tailored information and advice they can translate into their practice.

PROSPERO registration number

CRD42021258199.

Effect of implementing a heart failure admission care bundle on hospital readmission and mortality rates: interrupted time series study

Quality and Safety in Health Care Journal -

This study aimed to evaluate the impact of developing and implementing a care bundle intervention to improve care for patients with acute heart failure admitted to a large London hospital. The intervention comprised three elements, targeted within 24 hours of admission: N-terminal pro-B-type natriuretic peptide (NT-proBNP) test, transthoracic Doppler two-dimensional echocardiography and specialist review by cardiology team. The SHIFT-Evidence approach to quality improvement was used. During implementation, July 2015–July 2017, 1169 patients received the intervention. An interrupted time series design was used to evaluate impact on patient outcomes, including 15 618 admissions for 8951 patients. Mixed-effects multiple Poisson and log-linear regression models were fitted for count and continuous outcomes, respectively. Effect sizes are slope change ratios pre-intervention and post-intervention. The intervention was associated with reductions in emergency readmissions between 7 and 90 days (0.98, 95% CI 0.97 to 1.00), although not readmissions between 0 and 7 days post-discharge. Improvements were seen in in-hospital mortality (0.96, 95% CI 0.95 to 0.98), and there was no change in trend for hospital length of stay. Care process changes were also evaluated. Compliance with NT-proBNP testing was already high in 2014/2015 (162 of 163, 99.4%) and decreased slightly, with increased numbers audited, to 2016/2017 (1082 of 1101, 98.2%). Over this period, rates of echocardiography (84.7–98.9%) and specialist input (51.6–90.4%) improved. Care quality and outcomes can be improved for patients with acute heart failure using a care bundle approach. A systematic approach to quality improvement, and robust evaluation design, can be beneficial in supporting successful improvement and learning.

Quality and safety in the literature: January 2024

Quality and Safety in Health Care Journal -

Healthcare quality and safety span multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last several months. Some articles will focus on a particular theme, whereas others will highlight unique publications from high-impact medical journals.

Key points

  • Among 210 132 pregnant or birthing persons from 78 hospitals across 4 African countries, use of a bundled care intervention (massage, uterotonic, tranexamic acid, IV fluids and examination) and a calibrated drape to estimate blood loss led to a lower risk of severe postpartum haemorrhage, laparotomy for bleeding or death from bleeding. N Engl J Med. 6 July 2023.

  • Quantitative assessment of National Action Plans developed by 114 countries as a measure of the global response to antimicrobial resistance demonstrated...

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