Access to primary care is becoming more challenging, in part due to physicians leaving the field. Twenty-nine states have expanded nurse practitioner (NP) autonomy to increase access. This study compares potentially inappropriate prescribing practices between NPs and primary care physicians (PCP). In the study population, adults aged 65 and older, NPs and PCPs had nearly identical rates of potentially inappropriate prescribing. The authors encourage focusing on improving prescribing practices among all prescribers instead of working to limit prescribing to physicians.

Hand hygiene adherence is an essential component of patient safety. Using the SEIPS 2.0 model, this study explored clinician perspectives about high reliability in hand hygiene. The 61 respondents identified several barriers associated with aspects of organizational culture, environment, tasks and tools, including frequently empty alcohol-based hand rub dispensers and challenges with the layout of patient care areas.

The COVID-19 pandemic dramatically impacted the delivery of nursing care. This retrospective analysis examined the impact of a bedside checklist and nursing-led intervention bundle (“Nursing Back to Basics” or NB2B bundle) among patients hospitalized with COVID-19 at one academic hospital in New York City. The NB2B bundle, implemented with a bedside checklist, included five evidence-based interventions. Between March and April 2020, the NB2B intervention showed a 12% reduction in mortality due to COVID-19 compared with usual care.

Missed nursing care is a key indicator of patient safety and has been linked to safety climate. Survey responses from 3,429 labor and delivery nurses from 253 hospitals across the United States found an average of 11 of 25 aspects of essential nursing care were occasionally, frequently, or always missed. Higher perceived safety climate was associated with less missed care. The authors discuss the importance of strategies to reduce missed care, such as adequate nurse staffing, ensuring nonpunitive responses to errors, and promoting open communication.

Previous research has suggested that increases in physician workloads can threaten patient safety. This retrospective study found that medical errors are higher among emergency medicine physicians with lower productivity, as measured by the number of patients seen per hour.

… rates as much as earlier studies have reported. … Girotra S,  Jones PG, Peberdy MA, et al. Association of rapid …

Patient use of digital and online symptom checkers is increasing, but formal validation of these tools is lacking. This systematic review identified ten studies assessing symptom checkers evaluating a variety of conditions, including infectious diseases and ophthalmic conditions. The authors concluded that the diagnostic and triage accuracy of symptom checkers varies and has low accuracy.

… of which were preventable. … Plint AC, Newton AS, Stang A, et al. How safe are paediatric emergency departments? A national prospective cohort study. BMJ Qual Saf. Epub 2022 …

… association between burnout and RAR events. … Lou SS, Lew D, Harford DR, et al. Temporal associations between EHR-derived workload, burnout, and errors: a prospective cohort study. J Gen Intern Med. Epub 2022 June …

Effective handoff communication is a key indicator of safe patient care. These authors outline a new model for handoff communication, integrating three theoretical frameworks addressing relevant inputs (i.e., individual organizational, environmental factors), mediators (e.g., communication, leadership), outcomes (e.g., patient, provider, teamwork, and organizational outcomes), and adaptation loops.

… to potential patient deterioration. Twelve months after a new EWS was implemented in one hospital, nurses were … nursing skills, and opportunity cost. … Braun EJ, Singh S, Penlesky AC, et al. Nursing implications of an early warning system implemented to reduce adverse events: a qualitative study. BMJ Qual Saf. Epub 2022 Apr 15. …

Critical incident reporting is an important method to detect patient safety hazards and improve care. A research team in one large UK tertiary hospital reviewed cardiac arrest calls and cardiopulmonary resuscitation (CPR) events reported to the hospital incident reporting system; ten thematic areas for potential improvement were identified (e.g., failure to rescue, staffing concerns, equipment/drug concerns). Organizations could replicate this longitudinal process to improve high-risk patient safety event outcomes.

… the domains and priority areas laid out in the WHO’s Patient Safety Challenge. Although all areas were … transitions of care , and polypharmacy. … Garfield S, Teo V, Chan L, et al. To what extent is the World Health … being addressed in English hospital organizations? A descriptive study. J Patient Saf. 2022;18(1):e257-e261. …

Missed nursing care appears to be associated with higher rates of adverse events. More than 3,600 registered nurses (RNs) were surveyed about missed care during labor and birth in the United States. Three aspects of nursing care were reported missing by respondents: thorough review of prenatal records, missed timely documentation of maternal-fetal assessments, and failure to monitor input and output.

… field, researchers developed the Diagnosis Learning Cycle, a model intended to improve diagnosis through peer feedback . … Fernandez Branson C, Williams M, Chan TM, et al. Improving diagnostic performance through …

At the start of the COVID-19 pandemic, many elective surgical procedures were canceled or postponed due to limited resources (e.g., personal protective equipment, diagnostic tests, redeployment of healthcare personnel). This commentary discusses the implications of rationed non-urgent surgical care within the context of medical ethics: beneficence, non-maleficence, justice, and autonomy. The authors developed an algorithm to guide surgical teams through the decision-making process of delaying non-urgent surgical procedures, if necessary, in the future. 

… in healthcare workers during the Covid-19 pandemic: a multinational cross-sectional study. PLoS One. …

… of reducing diagnostic error . This article outlines a process for identifying pediatric inpatients with uncertain …

Overnight coverage creates opportunities for increasing resident autonomy but can carry risks for patient safety.  This study found that the presence of overnight hospitalists was associated with fewer resident barriers to contacting supervising physicians overnight but that other barriers during overnight coverage – such as technological barriers and organizational culture – influence residents seeking help from supervising physicians.