الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 189 |  |  |
| | | from | 189 | | |
Abstract
Patient safety is prevention of health care associated errors and adverse events from happening to patients. Patient safety is a global public health concern affecting both developed and developing countries. Until now, only few organizations in Egypt have assessed how much their staff culture backs up patient safety. It is important for HCPs to have good knowledge and attitude about PS in order to minimize the incidence of adverse events that may lead to serious disabilities to the patients. The present study aimed to study the effect of an intervention program on patient safety knowledge and attitude of healthcare providers and assess patient safety standards at the selected intensive care units in Alexandria with the following specific objectives:
1. To assess patient safety at intensive care units in Alexandria.
2. To assess knowledge and attitude of health care providers regarding patient safety at intensive care units in Alexandria.
3. To plan, implement and evaluate the effect of an intervention program on health care providers’ knowledge and attitude regarding patient safety at intensive care units in Alexandria.
A cross-sectional study was conducted among 400 health care providers (61 physicians, 142 nursing supervisors and 197 nurses) worked at intensive care units in the Main university hospital and the Ministry of health hospitals, followed by an intervention study (one group pre/post-test design). On a subsample of 100 healthcare providers with the lowest score of knowledge and attitude was included in the intervention regardless of their occupation or place of work. The data collection tools and methods included: a pre-designed structured interviewing questionnaire, observational checklist and intervention program. The questionnaire comprised three sections to collect data from HCPs about: Socio-demographic data such as: (age, sex, education level, occupation, workplace, working hours, years of experience in ICUs and training on patient safety), knowledge regarding the procedures which contribute in patient safety measures, it was divided into three dimensions: dimensions for general patient safety issues, dimensions for medication management safety, operative and invasive procedure safety dimensions and safety attitude questionnaire to measure the attitude regarding patient safety that consists of six scales. Observational checklist was used to assess patient safety and the surrounding facility and environmental safety standards in the randomly selected units which were six ICUs from the Main University hospital and three ICUs from Ras el Teen hospital in Alexandria.
A health education program was designed and implemented among HCPs based on the results of the pre-intervention phase and consisted of three educational sessions with the following topics: Introduction to the concept of patient safety, WHO and the Egyptian patient safety standards and video demonstration session with discussion and recommendations for implementation of patient safety standards. Then, knowledge and attitude of participants were reassessed twice using the same questionnaire.
Data were coded, entered, and analyzed using the statistical package for social sciences (SPSS) version 20 software. Statistical analysis was performed and both descriptive and analytical statistics were calculated.
The current study revealed the following main results:
Socio-demographic data of the total healthcare providers:
The sample included 400 healthcare providers with the majority of the sample were females (69.5%) of the study sample. The participants’ age was ranged from 20-59 years old with mean age 32.3±9.32. The young age group < 30 years old was highest percentage among all participants groups. About two thirds (65.5%) HCPs were assigned from the Main University hospital and 34.5% were from the MOHP hospitals. More than one third of the total participants (35.5%) had university or post graduate of nursing, 25.5% had technical institute of nursing, 23.7% had secondary school of nursing and 15.3% had university or post graduate studies of medicine. The years of experience ranged from
0.0-41 years with the mean of 8.90±8.49 years. The majority of the healthcare providers got < 10years of experience. The mean of number of work hours/week was 46.82±14.14 hours/week, with the highest percent among nurses (49.2%) worked > 48 hours per week. The highest percentage (61%) of the providers obtained their patient safety experiences from practice and the least 4% from other activities like internet.
Assessment of Knowledge and attitude of health care providers regarding Patient Safety.
The majority of participants showed fair level of knowledge regarding the patient safety (68.8%), 25% showed poor knowledge and only 6.2% showed good knowledge level (mean percent score= 60.12 ± 19.76).
Regarding the overall attitude score, (65.5%) showed neutral total attitude score and (22.3%) showed negative total attitude score, while only (12.3%) showed positive total attitude scores (mean present score=60.15±16.56).
Determinants of knowledge and attitude scores of health care providers regarding patient safety
There were statistically significant differences between knowledge score and sex (p=0.007), occupation (p= 0.025), years of experience (p < 0.001), number of working hours/week (p=0.001) and source of patient safety experiences (Mcp<0.005).
There were statistically significant differences between attitude score and all determinants. sex(p=0.005), age (p< 0.001), work place (p< 0.001), education level (p< 0.001), occupation (p< 0.001), years of experience (p < 0.001), number of working hours/ week(p=0.001) and source of patient safety experiences (Mcp=0.001).
The overall mean attitude percent score was significantly the highest among physicians (67.94±21.09), followed by nurses (59.78±16.4) and it was the least among nursing supervisors (57.32±13.34). (p<0.001).
Multivariate logistic regression revealed that sex, education level, years of experience and source of PS experiences were the significant predictors of the knowledge score among HCPs (p≤0.05).
Regarding the attitude score the multivariate logistic regression illustrated that work place, age <30, secondary education level, the source of PS experiences (internet) were the significant predictors among HCPs (p≤0.05).
Impact of the intervention program on knowledge and attitude scores of HCPs regarding patient safety:
There was a significant increase in the mean total knowledge score from the pre-intervention phase (3.85±1.71) to (10.08±0.91), (10.27±1.08) in the post-1 and post-2 phases respectively. (p<0.001).
No one in the intervention group of HCPs had good knowledge level in the pre-intervention phase, while 24%, 29% of them had good knowledge level in the post-1 and post-2 intervention phases respectively. (p<0.001).
No one in the intervention group of HCPs had positive attitude level in the pre-intervention phase, while 31%, 40% of them had positive attitude level in the post-1 and post-2 intervention phases respectively. (p<0.001).
In the post-1 intervention phase, 33.3% of the females’ participants had good knowledge (p=0.012), those aged ≥40 years followed by those aged <30 years and aged 30-<40 years (25.0%, 8.0% respectively) (p<0.031). One third 33.3% of the participants worked in the Main University hospital had good knowledge compared to 8.1% of those worked in the MOHP hospitals. (p=0.004). Half (50%) of the participants who were secondary educated had good knowledge compared to 13.3% of those university or post graduated of medicine. (p=0.002).
In the post-2 intervention phase, it was found that 38.1% of the participants worked in the Main University hospital had good knowledge compared to 13.5% of those worked in the MOHP hospitals, (p=0.009). More than half (53.6%) of the participants who were secondary educated had good knowledge compared to 13.0% of those university or post graduated of nursing. (p=0.007). Moreover, 54.5% of the participants who had ≥15 years of experience got good level of knowledge compared to 13.6% of those who had 10-<15 years of experience. (p=0.049).
In the post-1intervention phase, 42.1% of the females participates had positive attitude (p=0.006). In addition, 52.6% of those aged ≥40 years had positive attitude compared to (32.1%, 12%) of those aged (<30 years and those aged 30-<40 years) respectively (p=0.015). Moreover, 42.9% of the participants worked in the Main University hospital had positive attitude compared to 10.8% of those worked in the MOHP hospitals (p=0.001). About two thirds (64.3%) of participants who were secondary educated had positive attitude compared to 13% of those university or post graduated of nursing (p<0.001). It was found that, 40.3% of nurses’ participants had positive attitude compared to 13% of nursing supervisors. (p=0.033).
In the post-2 intervention phase, 47.6% of the participants worked in the Main University hospital had positive attitude compared to 27% of those worked in the MOHP hospitals (p=0.042). Moreover, 40% of both university or post graduated of medicine and secondary educated nurses level participants had positive attitude compared to 21.7% of those university or post graduated of nursing. (p=0.003).
There was a significant strong positive correlation between the attitude and the knowledge scores in each phase of the intervention (r=0.679, 0.928, 0.677) respectively.
Assessment of scores of patient safety and surrounding facility and environmental safety standards:
ICU1 (Cardiac) at the MOHP hospitals the only unit which met the patient safety standards generally 81.54%. By each domain it met the medication management standards and operative invasive procedures with 93.06%, 81.48% respectively. While partially met the general safety standards with 72.92%. The total patient safety standards with respect to the other units were partially met the patient safety standards at ICU2, ICU3 of the MOHP hospital. The Main university hospital was partially met the patient safety standards the ICU4, ICU5, ICU6, ICU7, ICU8 and ICU9 with 79.49%, 79.49%, 74.87%, 73.85%, 67.18%, 74.36%, 69.23%, 69.74% respectively (p<0.001).
There was a significant difference in the mean scores of the total patient safety and the total facility and environmental safety standards and their domains among the selected ICUs affiliated to both the Main University hospital and MOHP hospital (p<0.001).
The ICUs affiliated to both the Main University hospital and MOHP hospital were partially met the total facility and environmental safety standards. And found that hazardous materials and waste, fire safety and utility systems domains had the lowest percent of met requirement of the standards for all the selected ICUs.
There was significant positive correlation of the HCPs’ patient safety Knowledge and attitude scores with the patient safety observational (p= 0.032, p=0.018, p=0.032) respectively but there was no significant correlation with the surrounding facility and the environmental safety observational score of the selected ICUs for the study in the three phases. (p=0.553, p=0.382, p=0.532) respectively.
As regards to the overall observational score, there was significant positive correlation with knowledge score in the three intervention phases. While there was significant positive correlation with attitude score in the post-1 (p=0.005) and the post-2 intervention phase (p=0.007) only.
6.2. Conclusions:
Based on the findings of the study, the following can be concluded:
One quarter 25% of healthcare providers had poor level of knowledge and 12.3% had positive attitude regarding patient safety. Logistic regression revealed that sex, education level, years of experience and the source of PS experiences were the significant predictors of the knowledge score among HCPs. In addition to work place, age, education level, the source of PS experiences were the significant predictors of the attitude score among HCPs.
After educational of intervention, there was a significant improvement in knowledge and attitude regarding patient safety. A tailored educational intervention program was beneficial to improve the healthcare provider’s knowledge and attitude scores regarding patient safety.
All the selected ICUs were partially met the overall patient safety and the surrounding facility and environmental safety standards. The ICUs of MOHP had higher compliance score to patient safety and environmental safety standards than the Main University hospital.
6.3. Recommendations:
The following recommendations are suggested based on the study results:
1- For higher administrations sectors:
Large scale raising awareness campaigns to highlight the importance of achieving patient safety in hospitals especially in intensive care units.
Promotion of strict adherence to existing regulations regarding the surrounding facility and environmental safety e.g environmental law number 4 (1994), ISO 14001 standards.
Continuous monitoring and follow-up for the constructed strategies and guidelines regarding patient safety and the surrounding facility and environmental safety standards in collaboration with different responsible authorities.
Emphasis on the importance of providing written policies and procedures, posters, leaflet and initiatives programs regarding patient safety and environmental safety for HCPs.
2- For health care settings:
Implementation of continuous educational programs and evaluation for health care providers about importance and application of patient safety and environmental safety standards in hospital on a regular basis.
Providing written, announced policies, procedures and posters in the hospitals’ departments regarding patient safety and the surrounding facility and environmental safety standards.
The importance to follow all the requirements of patient safety and the surrounding facility and environmental standards must be emphasized especially the fire safety, utility safety and hazardous and waste safety to achieve patient safety.
Implementation of reward and accountability policy and decrease work stress and work place violence for HCPs in the hospitals.
Enhance the importance of proper inspection for the equipment and implement preventive and curative maintenance plan on a regular basis.
3- For Healthcare Providers:
Improve knowledge and attitude of HCPs regarding patient safety should be emphasized through attending continuous educational programs, conferences, workshops or through e-learning programs.
Continuous motivation to the outstanding performance staff should be provided for better quality of care.
The providers responsible on patient safety and the environmental safety departments in hospital should be qualified and well trained.
4- For the Researchers
Further researches are needed to assess the effect of education program on the knowledge and attitude of HCPs in a separate group according to their educational level.
In Egypt, there is a widely needed researches to assess patient safety according to ISQUA standards in all health care settings and must be supported from relevant ministries. And also situation analysis of medical errors should be done.