DOI: 10.12775/MBS.2014.007

DOI: 10.12775/MBS.2014.007
Medical and Biological Sciences, 2014, 28/1, 39-44
ORIGINAL ARTICLE / PRACA ORYGINALNA
Lidia Sierpińska 1, 2, Anna Ksykiewicz – Dorota 2 Marian Jędrych 3
PROVISION OF PATIENT SAFETY DURING HOSPITALIZATION
AS A MEASURE OF QUALITY OF CARE
ZAPEWNIENIE BEZPIECZEŃSTWA CHOREMU W TRAKCIE HOSPITALIZACJI
JAKO WYMIAR JAKOŚCI OPIEKI
1
Chair and Department of Management in Nursing, Faculty of Nursing and Health Sciences, Medical University, Lublin
Head: Prof. Anna Ksykiewicz – Dorota
2
2
Military Clinical Hospital No.1 with Polyclinic, Independent Public Health Unit, Lublin
Commander: Colonel Prof. Zbigniew Kędzierski
Chair and Department of Management in Nursing, Faculty of Nursing and Health Sciences, Medical University, Lublin
Head: Prof. Anna Ksykiewicz – Dorota
3
Chair and Department of Mathematics and Medical Biostatics, Medical University, Lublin
Head: Prof. Marian Jędrych
Summary
Introduction: The maintenance and development of
hospitals in a market-based health care system is associated
with an improvement in the quality of medical services. At
the same time, there is a need for an objective evaluation
of the level of nursing using various research methods and
instruments. Among these instruments is a questionnaire for
the assessment of the level of nursing care -BOHIPSZO.
Material and methods: The evaluation covered
640 patients, who constituted 19.2% of those who received
treatment in 143 wards in 45 hospitals in Poland, where
the studies were conducted during the period 2009 – 2012.
The research instrument was a questionnaire form for the
assessment of the level of nursing care BOHIPSZO according
to H. Lenartowicz.
Results: Based on the analysis of the study material
it was found that the quality of nursing care from the aspect of
provision of patient safety during hospitalization is on a higher
level in hospitals with accreditation or the ISO certificate,
compared to those which do not possess quality certificates
(p<0.001).
Conclusions: The preparation of a hospital for
accreditation in accordance with the accreditation criteria, and
for the certification audit according to the requirements of the
standard PN EN ISO 9001:2009 has a motivating effect on the
employees with respect to the provision of adequate conditions
of the environment of patient care during hospitalization,
which is a precondition for a higher level of patient care in
hospitals with the quality certificate.
Streszczenie
Wstęp: Utrzymanie i rozwój szpitali w rynkowym
systemie ochrony zdrowia wiąże się z doskonaleniem jakości
świadczeń medycznych. Jednocześnie istnieje potrzeba
obiektywnej oceny poziomu pielęgnowania przy pomocy
różnych metod i narzędzi badawczych. Jednym z narzędzi jest
arkusz oceny poziomu pielęgnowania – BOHIPSZO.
40
Lidia Sierpińska et al.
Materiał i metody: Ocenie poddano 640 pacjentów,
co stanowiło 19,2% z tych, którzy byli leczeni w 143
oddziałach, w 45 szpitalach w Polsce, gdzie były prowadzone
badania w latach 2009 - 2012. Narzędziem badawczym był
kwestionariusz oceny poziomu pielęgnowania BOHIPSZO
według H. Lenartowicz.
Wyniki: Na podstawie analizy materiału badawczego
stwierdzono, że jakość opieki pielęgniarskiej w aspekcie
zapewnienia bezpieczeństwa pacjenta podczas hospitalizacji
jest na wyższym poziomie w szpitalach z akredytacją lub
certyfikatem ISO, w porównaniu do tych, które nie posiadają
certyfikatów jakości (p <0,001).
Wnioski: Przygotowanie szpitala do akredytacji
zgodnie z kryteriami akredytacyjnymi oraz do audytu
certyfikującego zgodnie z wymaganiami normy PN-EN ISO
9001:2009 ma wpływ na motywację pracowników w zakresie
zapewnienia prawidłowych warunków środowiska opieki
nad pacjentem podczas hospitalizacji, co determinuje wyższy
poziomu opieki nad chorym w szpitalach z certyfikatem
jakości.
Key words: quality of care, BOHIPSZO questionnaire, patient safety
Słowa kluczowe: jakość opieki, kwestionariusz BOHIPSZO, bezpieczeństwo pacjenta
INTRODUCTION:
search for methods and instruments for the evaluation of the
quality of medical services provided in various areas. One
of the instruments for the assessment of the level of patient
nursing in hospital wards is the BOHIPSZO questionnaire
(acc. to H. Lenartowicz) which covers the criteria concerning
safe hospital environment presented in Polish literature [4,5,6].
Considering the fact that the scope of problems
pertaining to the provision of the quality of patient care,
including the provision of safety during hospitalization, is
important in the management of the nursing care subsystem,
the following research problem was posed: Does the quality
certificate differentiate from the aspect of safety of the
patients hospitalized?
Concern about the quality of nursing care is
among the essential preconditions of successful treatment,
improvement of the bio – psycho – social status of a patient,
and is an evidence of good management of a health care
facility.
An improvement of the quality of medical care
results, among others, from the Ljubljana Charter on Reforming
Health Care, adopted by all Member States in Ljubljana in
1996. In the Charter it was emphasized that the system of
health care should ‘aim at continuous improvements in the
quality of care’ [1]. An improvement of medical services in
Polish hospital wards is associated with a constant monitoring,
analysing, and improving clinical processes and the processes
MATERIAL AND METHODS:
of management of the environment of care.
The managerial staff is responsible for the
The study was conducted during the period from
improvement of the quality of patient care by the provision
September 2009 - June 2012 in 143 wards in 45 hospitals in
of safety during hospitalization, implementation of the quality
the territory of Poland. It covered 85 wards from 24 hospitals
management systems and carrying out an objective evaluation
possessing the quality certificate (accreditation or ISO) in the
of the services provided by means of standardized instruments
regions of: Katowice, Lublin, Łodź, Warsaw, Opole, Rzeszów,
with criteria for the evaluation of the quality of care. The
Gdańsk, Kielce, and Olsztyn – Group A, and 58 wards in 21
implementation of the process of accreditation fulfils this
hospitals which did not possess the quality certificate (Group
condition because the accreditation criteria for Polish hospitals
B) in the regions of: Wrocław, Bydgoszcz, Lublin, Łódź,
consider the provision of patient safety in hospital conditions.
Cracow, Warsaw, and Szczecin. A total number of 640 patients
The Programme for Accreditation of Hospitals developed by
participated in the study which was 19.2% of the total number
the Centre for Quality Monitoring in Health Care includes the
of patients treated in the wards covered by the study. In both
Table I. Structure of the patients in the study (Groups A and B)
group of standards concerning ‘Patient Safety’. The authors
groups patients were selected at random (Tab. I).
of accreditation standards emphasize that patient safety is a
Group A
Group B
TOTAL
key measure of the quality of care and constitutes an integral
No.
Respondents
No.
%
No.
%
No.
%
element of the system of improvement of care. The institution
should implement a system which would allow regular
Patients treated in hospital
346
54.1
294
45.9
640
100.0
1.
wards
evaluation of patient safety and drawing conclusions from this
evaluation [2].
The second system of improvement of the quality
Table I. Structure of the patients in the study (Groups A and
Table II.B)
Limitation of patients’ access to the medicine cabinet in the ward and to
of health services, which is increasingly more common in
disinfectants; storage of drugs and infusion liquids in original packages and in a
Polish health care facilities, is the quality management system
specified place (Group A and B)
implemented according to the Polish standard PN – EN ISO
The study was conducted by the method of
9001:2009. This system consists of the fulfilment of specified
a diagnostic
survey,
whereas
was
Group
Procedure
compatibilitythe study technique
TOTAL
examined
standards and procedures, and an objective assessment by
observation,
interview,
analysisNoof documentation and a
Yes
Group A
100.00%
an external organization [3]. The criteria of internal and
questionnaire.
research instrument
a questionnaire
1007The 97.77%
23
2.23% was1030
882
100.00%
825
93.54%
57
external audits refer also to the observance of specified
forGroup
the Bassessment
of
the quality
of 6.46%
nursing BOHIPSZO
acc.
TOTAL
1912
100.00%
1832
95.82%
80
4.18%
procedures handled in the Quality Book, and up-to-date
to H. Lenartowicz,
consisting
of
8
groups
of
standards
which
Chi-square (df=1); 21.20, p<0.001
regulations concerning the provision of patient safety during
are considered the most important in patient nursing. The
hospitalization.
main standards consists of 71 detailed criteria (each of them
Literature review concerning the assessment of the
ascribedofasafe
score
value in
from
1 –room,
3 scores).
of rooms
the in the
Table III.isProvision
conditions
patient
surgery,The
hall name
and other
level of patient care, including the provision of patient safety
questionnaire
ward (Groups Acomes
and B) from the Polish acronym (BOHIPSZO),
during hospital treatment, shows that there is a continuous
which means: Patient safety; Protection against infection;
Group
examined
Group A
Group B
TOTAL
Procedure compatibility
Yes
No
1382
1088
2470
93.95%
89
6.05%
80.89%
257
19.11%
87.71%
346
12.29%
Chi-square (df=1);111.15, p<0.001
TOTAL
1471
1345
2816
100.00%
100.00%
100.00%
No.
1.
Respondents
Patients treated in hospital
wards
Group A
No.
346
%
54.1
Group B
No.
294
TOTAL
%
No.
%
45.9
640
100.0
Provision of patient safety during Table
hospitalization
measure
of (Groups
care A and B)
I. Structureasofathe
patientsofinquality
the study
41
Table II. Limitation of patients’ access to the medicine cabinet in the ward and to
disinfectants;
of drugs
and
infusion
liquids
in original
packages and in a
Hotel services together with the fulfilment of existential needs;
In storage
hospitals
with the
certificate
the vast
majority
Group
A
Group
B
TOTALof
specified place
(Group A and B)
No.
Respondents
Informing; Subjectivity; Self-care; and Therapeutic-nursing
nurses (97.77%) ensured that the patients had no access to the
No.
%
No.
%
%
procedures.
medicine cabinet and disinfectants
in the
ward.
At No.
the same
Group
Procedure
compatibility
TOTAL
Bearing in mind the evaluation of the quality of
time,
the same
of nurses in this group store drugs
Patients
treated percentage
in hospital
1. examined
346
54.1
45.9
640
100.0
Yes
No 294
patient care from the aspect of prevention of undesirable
and wards
infusion liquids
in original packages
and in specified places
Group A
1030
100.00%
1007
97.77%
23
2.23%
events, the results concerning main criterion No. 1 ‘Patient
(the places correctly labelled), while in hospitals without the
Group B
882
100.00%
825
93.54%
57
6.46%
safety’ were analyzed.
certificate
a higher percentage of patients (6,46%)
were
not
TOTAL
1912
100.00%
1832
95.82%
80
4.18%
The material obtained was subjected to statistical
provided the safe hospital
environment
in
this
respect.
21.20, p<0.001
Table II. Limitation of patients’Chi-square
access to(df=1);
the medicine
cabinet in the ward and to
analysis. The results of statistical calculations were compiled
Instorage
the of
study
analyzed,
a significant
disinfectants;
drugsmaterial
and infusion
liquids in original
packages and in a
in Tables 2-8 (in percentages). Statistical hypotheses were
relationship
was observed
specified
place (Group
A and B)between the type of hospital (with
verified based on the non-parametric chi-square test [7,8].Table
The III. Provision
or without
the conditions
certificate)
and safe
conditions
in and
the other
wardrooms in the
of safe
in patient
room,
surgery, hall
p values p<0.05 were considered statistically significant. The
rooms,
such Aas:
patients’
room, surgery, hall and other rooms
ward
(Groups
and
B)
Group
Procedure compatibility
TOTAL
results of the study were elaborated on the IBM PC computer,
in
the ward (p<0.001)
(Tab. III).
examined
Yes
No
using the ‘STATISTICA 10.0’ software.
Group
Group
A
examined
Group
B
Group A
TOTAL
RESULTS:
Group B
Procedure
1007
97.77% compatibility
23
2.23%
No 6.46%
825 Yes93.54%
57
1382
93.95%
89
6.05%
1832
95.82%
80
4.18%
1088 Chi-square
80.89% (df=1);
25721.20, p<0.001
19.11%
1030 TOTAL
100.00%
882
100.00%
1471
100.00%
1912
100.00%
1345
100.00%
Based on analysis of the research material
TOTAL
2816
100.00%
2470
87.71%
346
12.29%
Chi-square (df=1);111.15, p<0.001
concerning the observance of the standard for the provision
of patients’ safety in Polish hospital wards, it was found that
Table III. Provision
safe conditions
in conditions
patient room,
andsurgery,
other rooms in the
in both research groups the patients were provided relatively
Table III.ofProvision
of safe
insurgery,
patient hall
room,
ward
A and
B) in the ward (Groups A and B)
good conditions with relation to the safe environment of care.
hall(Groups
and other
rooms
However, it was evaluated that the global patient protection
Table IV. Effective
signalling within reach, proper handles and rails installed, as well as efficient
on wheelchairs
(Groups
Acompatibility
and B)of the study, it was
rate was higher in hospitals with the quality certificate (Group brakes
Group
Based on
the results
indicated
Procedure
TOTAL
A – 97.0%), compared to the facilities without the certificate
that
patients from
hospitals
with
the
quality
certificate
- Group
examined
Yes
No
Group
Procedure
compatibility
TOTAL
(Group B – 87.6%) (Fig.1).
A
(93.95%)
were 93.95%
provided
safe
conditions
in the
patients’
Group
A
1471
100.00%
1382
89
6.05%
examined
Yes
No
room,
and other
in the1345
hospital
ward
Group A
Group B
Group B surgery,
100.00%
1088 hall,
80.89%
257 rooms
19.11%
Group A
1252
100.00%
1141
91.13%
111
8.87%
3,0%
12,4%
(tidy
rooms,2470
proper87.71%
lighting at346night,12.29%
dry
and properly
cleaned
TOTAL
2816
100.00%
Group B
981
100.00%
715
72.88%
266
27.12%
floors,
beds secured
to side
walls or p<0.001
in another2233
way, secured
Chi-square
(df=1);111.15,
TOTAL
100.00%
1856
83.12%
377
16.88%
windows and doors,
when(df=1);
needed).
Group B, the aboveChi-square
130.54,In
p<0.001
mentioned procedures were observed in 80.89%.
87,6%
97,0%
Subsequent analysis also showed a significant
relationship between the type of hospital (with or without the
Table IV. Effective signalling within reach, proper handles and rails installed, as well as efficient
certificate) and effective signalling within a patient’s grasp
deficit of care
nursing care provided
deficit of care
nursing care provided
brakes on wheelchairs (Groups A and B)
(p<0.001) (Tab. IV).
Figure 1.Figure
Global1.
indicator
ofindicator
patient safety
providedsafety
in hospital
(Groups
Ahospital
and B)
Global
of
patient
provided
in
Table I. Structure of the patients in the study (Groups A and B)
Group
Procedure compatibility
TOTAL
(Groups A and B)
examined
Yes
No
Group A
1252
100.00%
1141
91.13%
111
8.87%
During the subsequent
of Bthe results
of
Group Aanalysis
Group
TOTAL
Group B
981
100.00%
715
72.88%
266
27.12%
No.
study, theRespondents
percentage values were calculated for the level of
TOTAL
2233
100.00%
1856
83.12%
377
16.88%
No. of% care No.
%
No.criteria
%
care provided as well as deficit
in individual
Chi-square (df=1); 130.54, p<0.001
of provision of patient safety in a hospital. It is noteworthy
Patients treated in hospital
that
the provision
Table IV. Effective signalling within reach, proper handles
1. in all criteria for the assessment
346
54.1 of294
45.9
640of safe
100.0
hospital
and rails installed, as well as efficient brakes on wheelchairs
wards environment, the level of care provided was higher
in all hospitals possessing the quality certificate, compared to
(Groups A and B)
hospitals in Group B.
A significant relationship was observed between the
Based on analysis of the study material, it was found
Table II. Limitation
of patients’
access
to the medicine
in the
ward and to that in hospital wards with the quality certificate 91.13% of
type of the
examined
hospital
(with andcabinet
without
certificate)
disinfectants;
storage
of drugs
and infusion
in original
packages
in a had an effective signalling within their reach (in
and the limited
access
of patients
to theliquids
medicine
cabinet
in and
patients
specified
place
(Group A and
B) of drugs and infusion liquids in
the ward,
disinfectants,
storage
patients’ room, bathroom, toilet). Apart from this, in the rooms
original packages, and in a specified place (p<0.001) (Tab. II).
of the ward proper handles and rails were fixed and efficient
brakes on the beds and wheelchairs, while a large group of
Group
Procedure compatibility
TOTAL
patients in hospitals without the quality certificate (27.12%)
examined
Yes
No
did not have the above-mentioned standards fulfilled.
Group A
1030
100.00%
1007
97.77%
23
2.23%
One of the detailed criteria of the provision of safe conditions
Group B
882
100.00%
825
93.54%
57
6.46%
for a patient in hospital is the knowledge of the procedures
TOTAL
1912
100.00%
1832
95.82%
80
4.18%
by nurses and auxiliary staff in the case of fire, the method of
Chi-square (df=1); 21.20, p<0.001
evacuation of patients, and placing fire equipment in a proper
place.
While analyzing the research material collected in
Table II. Limitation of patients’ access to the medicine cabinet
this
respect,
a significant relationship was also found between
in the ward and to disinfectants; storage of drugs and infusion
Table III. Provision of safe conditions in patient room, surgery, hall and other rooms the
in the
type of hospital (with or without certificate) and the aboveliquids in original packages and in a specified place (Group
ward
(Groups A and B)
mentioned procedures (p<0.001) (Tab. V).
A and B)
Group
examined
Group A
Group B
Procedure compatibility
Yes
No
1382
1088
93.95%
80.89%
89
257
TOTAL
6.05%
19.11%
1471
1345
100.00%
100.00%
examined
Group A
Group B
TOTAL
Yes
1774
1248
3022
No
89.69%
204
10.31%
73.07%
460
26.93%
81.99%
664
18.01%
Chi-square (df=1); 171.39, p<0.001
1978
1708
3686
100.00%
100.00%
100.00%
Table V. Fire emergency procedures and methods of evacuation of patients are known to
Sierpińska
42 and auxiliary staff; fire equipment is placed in a properLidia
Table
VII. Electrical,
nurses
place
(Groups
A et al.gas, oxygen installations, and medical equipment do not create risk
for patients (Groups A and B)
and B)
patients
were not
assured safe conditions
Group (19.29%)Procedure
compatibility
TOTALin this
examined
Yes
No
respect.
Group A
1863
100.00%
Group A
1362
100.00%
88.46% of further
215
11.54%
1241
91.12%
121
8.88%
In1648
the course
analysis
of the research
Group B
1607
100.00%
1297
80.71%
310
19.29%
Group B
1178
100.00%
899
76.32%
279
23.68%
material,
a significant
relationship
was
observed
the
TOTAL
3470between
100.00%
2945
84.87%
525
15.13%
TOTAL
2540
100.00%
2140
84.25%
400
15.75%
Chi-square
(df=1); 40.36,
p<0.001 and the provision
type of hospital (with
or without
certificate)
Chi-square (df=1); 104.28, p<0.001
of identification bracelet wristbands for patients, information
Table VIII.on
Provision
of identification
patients,
information
on the
Table V. Fire emergency procedures and methods of evacuation
the front
page of the bracelet
nursingwristbands
records toforwhat
agents
the
Table VI. Standards for calling resuscitation team and emergency procedures are
front page of the nursing records to what agents the patient is allergic; and
of patients
known
nursesand and
auxiliary
fire
patient
allergic;
placing
the patient’s
and surname
developed
andare
known
to thetonurses,
proper
equipmentstaff;
and pharmacological
placingisthe
patient’sand
name
and surname
on thename
bed (Groups
A and B)
equipment
is placed
in Aa and
proper
agents
prepared
(Groups
B) place (Groups A and B)
on the bed (p<0.001) (Tab.VIII).
Table V. Fire
to
emergency procedures and methods of evacuation of patients are knownGroup
TOTAL
Procedure compatibility
nurses and auxiliary staff; fire equipment is placed in a proper place (Groups
A
examined
It
is
noteworthy
that
91.12%
of
nurses
and
auxiliary
Yes
No
Procedure compatibility
TOTAL
andGroup
B)
Group A
1488
100.00%
examined staff from
hospital
quality certificate declared
961
64.58%
527
35.42%
Yes hospitals with No
Group
Procedure compatibility
Group B
1403
100.00%
634
45.19%
769
54.81%
the
observance
in the 10.31%
case of fire.
Apart
from
Group
A
1978TOTAL
100.00%
1774 of procedures
89.69%
204
examined
Yes
No
TOTAL
2891
100.00%
1595
55.17%
1296
44.83%
Group fire
B
1708 places.
100.00%In
this,
equipment
was placed
in26.93%
appropriate
1248
73.07%
460
Group A
1362
100.00%
Chi-square (df=1); 109.82, p<0.001
1241
91.12%
121
8.88%
TOTAL of3022
3686 the100.00%
81.99%
664
18.01%
hospitals
Group B
it was reported
that
in 23.68%
aboveGroup B
1178
100.00%
899
76.32% (df=1);
279171.39,23.68%
Chi-square
p<0.001
mentioned
procedures
are
not
observed
in
patient
care.
Table VIII. Provision of identification bracelet wristbands for
TOTAL
2540
100.00%
2140
84.25%
400
15.75%
While considering
the criterion
‘Standards for calling
Chi-square (df=1);
104.28, p<0.001
patients, information on the front page of the nursing records
a resuscitation team and emergency procedures are developed
what agents the patient is allergic; and placing the patient’s
Table VII. Electrical, gas, oxygen installations, and medical equipment do not create to
risk
and
known
to
the
nurses
and
pharmacological
agents
prepared’
name
and surname on the bed (Groups A and B)
for patientsfor
(Groups
and B)
Table VI. Standards
callingAresuscitation
team and emergency procedures are
a significant
was also
developed
and relationship
known to the nurses,
andnoted
proper(p<0.001)
equipment between
and pharmacological
Procedure
compatibility
thisGroup
criterion
type
of
hospital
(with or withoutTOTAL
certificate)
agents
preparedand
(Groups
A and
B)
Results of the analysis showed that 64.58% of
examined
Yes
No
(Tab.VI).
patients
who
received treatment in hospitals with the quality
Group A
1863
100.00%
1648
88.46%
215
11.54%
certificate had the identification bracelet wristbands provided.
Group
Procedure compatibility
TOTAL
Group
B
100.00%
Table V. Fireexamined
emergency
procedures
and methods
of19.29%
evacuation1607
of patients
are knownIntoaddition, in this group of patients, information is provided
1297
80.71%
310
Yes
No
TOTAL
3470
100.00%
2945
84.87%
525
15.13%
nurses
and
auxiliary
staff;
fire
equipment
is
placed
in
a
proper
place
A
Group A
1978
100.00% (Groups
1774
89.69%
204
10.31%
on the front page of nursing records about which agents the
Chi-square (df=1); 40.36, p<0.001
andGroup
B) B
1708
100.00%
1248
73.07%
460
26.93%
patient is allergic to, and the patient’s name and surname
TOTAL
3686
100.00%
3022
81.99%
664
18.01%
placed on the hospital bed. In hospitals without the certificate
Group
Procedure
compatibility
TOTAL
Chi-square bracelet
(df=1); 171.39,
p<0.001for patients, information on the
Table VIII. Provision of identification
wristbands
examined
these procedures of patient identification were observed only
front page of theYes
nursing records toNo
what agents the patient is allergic; and
Table
Standards
for
calling
resuscitation
team
and
in 45.19% of patients.
placing
the1241
patient’s
name
and
surname
on
the
bed
(Groups
A
and
B)
Group
A VI.
1362
100.00%
91.12%
121
8.88%
Table VII. emergency
Electrical,
gas,
installations,
medical
equipment
do not create risk
procedures
are developed
and
known
to the100.00%
nurses,
Group
B
1178
899 oxygen
76.32%
279 and23.68%
for patients
(Groups
A and
B) pharmacological agents
and
proper2140
equipment
and
prepared
DISCUSSION:
TOTAL
2540 TOTAL
100.00%
Group
84.25%
400
15.75%
Procedure
compatibility
examined A and B)Yes
(Groups
Chi-square
(df=1);
104.28,
p<0.001
No
Group
Procedure compatibility
TOTAL
A
1488
100.00%
Group
examined
Patient safety during hospitalization is an important
961 Yes 64.58%
527 No 35.42%
Group A
B The
1403 the 100.00%
100.00%
634nurses
45.19%
769
54.81%
1863
element of the quality of nursing care. Analysis of the literature
Group
employed
quality
1648
88.46%
215in hospitals
11.54% with
TOTAL
2891
100.00%
1595
55.17%
44.83%
Group B for 1297
1607procedures
100.00% are
Table VI. Standards
calling resuscitation
team and
emergency
80.71%
310
19.29%
shows that in health care it is possible to prevent as many as
certificate
considerably
more 1296
frequently
(89.69%)
worked
in
(df=1);
p<0.001
TOTAL and2945
3470 and
100.00%
developed
knownChi-square
to the nurses,
and proper
equipment
pharmacological
84.87%
525109.82,
15.13%
42.0% of undesirable, patient life-threatening events [9].
the wards where the
standards
for calling a resuscitation team
Chi-square
agents prepared (Groups
A and(df=1);
B) 40.36, p<0.001
The American Nurses Association indicates that injuries and
and emergency procedures were developed and, at the same
medical errors result from shortages of personnel, including
Table VIII.time,
known
to them. Apart
fromwristbands
this, the proper
equipment
Provision
of identification
bracelet
for patients,
information on the
the nursing staff [10].
Group
Procedure
compatibility
TOTAL
front
page of the nursing
records
to what
agentsinthe
is allergic;
and
and
pharmacological
agents
were
prepared
thepatient
case of
life
examined
Based on the studies conducted in Brazil among
placing the patient’s
on the bed (Groups A and B) Yes name and surname
No
threatening states. In the group of hospitals without certificate
patients treated in intensive care wards, it was found that
Group A
1978
100.00%
1774
89.69%
204
10.31%
these
principles were
observed in patient care in
73.07%.
the most frequent undesirable events were those concerning
GroupB
TOTAL
Group
1708
100.00%
1248 Procedure
73.07% compatibility
460
26.93%
examined While analysing
No
TOTAL
subsequent
criterion,
the erroneous administration of a drug (51.4%), which was
3686 a significant
100.00%
3022 Yes81.99% the664
18.01%
Group A
1488
100.00%
961
64.58%
527
35.42%
related with the method of administration, inappropriate
relationship
was Chi-square
noted
between
the type
of hospital
(with
or
(df=1);
171.39,
p<0.001
Group B
1403
100.00%
634
45.19%
769
54.81%
documentation of orders, infusion pump system failure or lack
without
certificate)
and
the
maintenance
of
patient
safety
from
TOTAL
2891
100.00%
1595
55.17%
1296
44.83%
of observance of nursing procedures [11].
the aspect of electric,
gas, and
oxygen
installations, as well as
Chi-square
(df=1);
109.82, p<0.001
The principles of management of drugs, including
Table VII. Electrical,
gas,
oxygen
installations,
and
medical
equipment
do
not
create
risk
safety on the part of the medical equipment (p<0.001) (Tab.
for patients (Groups A and B)
the conditions of their storage in Polish hospital wards, have
VII).
been dealt with in the accreditation criteria for Polish hospitals.
Group
Procedure compatibility
TOTAL
The Programme of Hospitals Accreditation imposes on medical
examined
Yes
No
entities the obligation in the area of the development and
Group A
1863
100.00%
1648
88.46%
215
11.54%
implementation of the procedure of surveillance over drugs
Group B
1607
100.00%
1297
80.71%
310
19.29%
stored in the wards, development of the system of labelling
TOTAL
3470
100.00%
2945
84.87%
525
15.13%
of the prepared drugs, elaboration and application of the
Chi-square (df=1); 40.36, p<0.001
preparation procedure, storage and administration, as well as
transport of drugs which are related with a specified risk [12].
Table VII. Electrical, gas, oxygen installations, and medical
Table VIII.equipment
Provision of
identification
bracelet
wristbands
for
patients,
information
on
theresults of own studies confirm that in the facilities with
The
do not create risk for patients (Groups A and B)
front page of the nursing records to what agents the patient is allergic; and
the quality certificate the principles of storage of drugs and
placing the patient’s name and surname on the bed (Groups A and B) disinfectants were significantly more frequently perceived in
In hospitals with the quality certificate, in 88.46% of
hospital wards, confirmed for hospitals without the certificate.
electric,
gas,
and oxygen installations, and medicalTOTAL
equipment
While analyzing the research material, it was
Group
Procedure compatibility
did
not create a Yes
risk for patients. NoIn addition, patients were
examined
observed that the provision of safe conditions in the
instructed
about
behaviour,
warning1488
labels 100.00%
placed,
patients’ room, surgery, hall, and other rooms in the ward
Group A
961 safe
64.58%
527 and35.42%
was significantly more often consistent with the principles
whereas
without 769
the certificate
large group
Group B in hospitals
100.00%of
634
45.19%
54.81% a 1403
Group
examined
TOTAL
Procedure compatibility
Yes
No
1595
55.17%
1296
44.83%
Chi-square (df=1); 109.82, p<0.001
TOTAL
2891
100.00%
Provision of patient safety during hospitalization as a measure of quality of care
in hospitals with accreditation of the ISO certificate than in
facilities without the certificate.
In the relevant literature, there are reports stating
that the technology in medicine exerts an effect on the
improvement of the quality of care, and simultaneously, brings
about the risk of threat to patient safety. The abundance and
complexity of new appliances at a patient’s bed may be the
cause of undesirable events [13].
Bearing in mind patients’ protection in association
with the use of electrical appliances and electro-medical
devices, standards have been designed by the International
Electrotechnical Commission (IEC 60601 -1), standards by
the manufacturers of equipment and national standards. In
Poland, the standard is PN – EN 60601 – 1:2011. This standard
concerns safety and basic technical requirements with respect
to medical-electrical appliances and medical- electrical
systems. It specifies general requirements and serves as a basis
for the development of detailed standards [14].
Own studies show that the electric, gas, and oxygen
installations as well as medical-electrical appliances did not
threaten a patient’s safety significantly more often in hospitals
with the certificate, compared to medical facilities which did
not possess the certificate. At the same time, nurses in this
group of hospitals significantly more often instructed patients
concerning safe behaviour, and warning labels in place.
According to Jardin, health care facilities should
possess an efficient alarm system in the case of fire risk, in
order to quickly detect fire and provide instant assistance
to extinguish the fire. In opinion of this author, a special
exception in the alarm requirements for health care facilities
should be the placing of instructions for using the alarm box
in the nurses’ stations. The alarm boxes should be visible and
easily accessible. Apart from this, within the emergency first
aid in case of fire, hospitals should be equipped with portable
fire extinguishers of a proper size and type, located at sites,
which are available for the staff at any time [15].
Fire protection in national hospital wards has also
found its proper dimension in accreditation criteria for Polish
hospitals. The Fire Brigade should confirm the fulfilment of
fire protection requirements. While evaluating the fulfilment
of the fire protection requirements, attention is also paid to the
distribution and efficient function of fire hydrants, presence of
smoke detectors, unblocked evacuation routes and emergency
exits, and an appropriate labelling of evacuation routes [16].
Analysis of the research material showed that in
hospitals with the quality certificate the nurses and auxiliary
staff knew the procedures in case of fire and ways of evacuation
of patients, also on a higher level compared to the facilities
without the certificate. In addition, it was found that the fire
equipment was located in the proper place, compared to the
hospitals without accreditation, which was also statistically
significant.
Based on the results of studies, it was also found that
there was an effective signalling within reach, proper handles
and rails installed as well as efficient brakes on wheelchairs
were significantly more frequent in hospitals with the quality
certificate, compared to those without the certificate.
Analysis of the relevant literature indicates that the
medical staff should know the latest guidelines with respect to
cardiopulmonary resuscitation [17].
According to the opinion of Baksh, all hospital
staff who have contact with patients should undergo regular
training in resuscitation [18]. The trainings should be in
accordance with the programme of the European Resuscitation
43
Council. Unified educational programmes will be a basis for
the courses organized in basic and advanced cardiopulmonary
resuscitation in adults and children/newborns [19, 20].
Own studies show that nurses in hospitals with the
quality certificate significantly more often work in the wards
where the standards for calling the resuscitation team and
procedures in emergency states are known to them. Also, the
proper equipment and pharmacological agents are prepared in
case of life-threatening emergencies. In the group of hospitals
without the certificate these principles were observed to a
lesser extent.
Studies conducted in the United States showed that
approximately 60% of medical errors are associated with
an incorrect identification of a patient [21]. According to
the researchers from New York employed in palliative care,
hospital procedures for the identification of patients should be
developed in order to improve the quality of care of severely
ill patients [22].
Considering the fact that the lack of correct
identification of a patient may result in unnecessary
examinations and medical procedures, creates the risk of errors
in medical records, and may even lead to death – in Poland, on
1 July 2011, by virtue of an Act, an obligation was imposed on
hospital to implement coded identification cards for patients.
The objective of the above-mentioned Act, among other things,
is a quicker and error-free identification of patients, increase in
safety, and facilitation of the work of medical staff [23].
The results of own studies carried out in the
Polish hospital wards confirmed that nurses employed in
hospitals with the quality certificate, while performing their
occupational tasks, significantly more frequently provided
the correct identification of patients. Based on the estimation
data, it was indicated that approximately 70% of the material
collected came from the period when in Poland there was no
legal obligation in the area of identification of patients with
coded identification cards, and the nurses, mainly in hospitals
of Group A observed this principle.
CONCLUSIONS:
1. The global rate concerning the provision of patient safety
in a hospital was higher in hospitals with accreditation
certificate and the ISO certificate, compared to facilities
without certificates, which indicates that the preparation
of a hospital for the accreditation visit and certification
audit mobilises the hospital staff to the implementation and
observance of procedures preventing undesirable events.
2. In hospitals with the quality certificate the provision of
patient safety during hospitalization was statistically more
frequent (p<0.001) in all the criteria of Standard I: Patient
safety – handled in the BOHIPSZO questionnaire.
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Address for correspondence:
Lidia Sierpińska
Military Clinical Hospital No.1 with Polyclinic,
Independent Public Health Unit,
Al. Racławickie 23, 20 - 049 Lublin
Tel. +48 (81) 718 32 97; 507 810 339;
fax: +48 (81) 718 32 77;
e- mail: [email protected]
Received: 17.09.2013
Acceoted for publication: 07.01.2014