Examining the views and performance of operating room personnel regarding patient safety in medical education centers affiliated to Tabriz University of Medical Sciences, 2013

Dissertation for Master's Degree in Nursing, Internal Medicine - Surgery

Research Introduction

Problem Statement

Definition of Words

Research Objectives and Questions

Limitations Research

Introduction of the research

Research title: Investigation of the views and performance of operating room personnel regarding patient safety in educational-therapeutic centers affiliated to Tabriz University of Medical Sciences, 1392.

Introduction of the problem

Familiarization with the rules And the rules and regulations governing nursing are among the priorities of nursing programs. Therefore, it is necessary for nurses to take the lead in maintaining and improving health, as well as promoting the safety of patients, preventing diseases, relieving the pain and suffering of patients, and considering the content of nursing laws as a guide while performing their assigned responsibilities (1). Today, in all aspects of the nursing profession, understanding the legal concepts helps the nurse to acquire professional knowledge so that she can protect herself in fulfilling her responsibilities and protect the patient's rights as well (2). All nurses are responsible for their decisions and actions in maintaining their job efficiency and are responsible for achieving the best possible outcome for the client, who do not face any risk factors and must continuously improve their legal knowledge through education and experience. Therefore, a nurse must make sufficient efforts in complying with the standards of care and matters related to the safety of patients and, finally, have an obligation to the people and communities in which they live (2,3). Medical errors are very high all over the world and are one of the 5 most important causes of death (4). Patient safety is one of the most important components of the quality of health care (5).

According to the statistics of the World Health Organization, information extracted from 56 countries of the world confirms that 87 million to 281 million surgeries were performed (one surgery per 25 people of the world's population) in 2002 in the world

It has been estimated that every year in the world at least 7 million people are injured as a result of surgery, and at least one million people die during surgery or immediately after surgery. The rate of unwanted events caused by surgery in the world is over 25% and the raw mortality rate after major surgery is 5-15%. In developed countries, approximately half of all unwanted complications of hospitalization are related to surgery, while half of these cases are preventable. The rate of reported major disabilities caused by surgeries in developed countries is 3-16%, of which 4-8% lead to permanent disability or death(6).

Research studies have shown that on average, in about 10% of all hospitalized cases, patients are injured to various degrees and it is estimated that up to 75% of these errors can be prevented(7). The World Health Organization has prioritized patient safety as a public health concern, statistics show that the error of employees working in healthcare systems affects one out of every 10 patients admitted to hospitals in the world (8). According to the estimate of the World Health Organization, every year tens of millions of people die or become disabled due to medical errors and unsafe treatment processes (9). In addition to inflicting suffering on humans, unsafe medical care and services also bring heavy economic costs to the health system and cause psychological pressure on health system workers and community members (10). Experts are of the opinion that in order to improve quality and improve patient safety, organizations should spread the culture of patient safety among their employees in addition to various structural interventions (11).And one of the factors that plays an effective role in improving the level of patient safety in hospitals is the existence of patient safety culture in these centers (12). In fact, it is estimated that between 5% and 10% of health-related costs are caused by unsafe clinical services, which lead to the harm of patients, and in this, the contribution of the failure of systems and methods is more than the role of people. is (13). Safety can be defined as avoidance, prevention and reduction of unfortunate and unwanted results or reduction of damage caused by medical processes to the patient, as well as protecting the patient from accidental injuries due to medical care or due to medical mistakes (14). As another definition, patient safety is the avoidance, prevention, and amelioration of adverse outcomes or harm from the health care process. So, in other words, patient safety is protecting the patient from accidental harm due to medical reasons or due to medical errors. The Patient Safety Agency[1][2] (2003) considers patient safety as a process during which an organization or institution makes patient care safer, which includes risk assessment, determination and management of risk related to the patient, reporting and analysis of incidents, and minimizing risk and preventing the recurrence of risk (15). formed that patient safety is one of the most important of them (16). The culture of patient safety shows the level of priority of patient safety from the point of view of employees in the department and their workplace organization(17). Considering the prevalence of medical errors, it is important to be aware of the patient safety culture in the health sector in order to change this culture and make it compatible with the progress made in the field of quality of care (18). Improving patient safety is not only a clinical issue and is also related to organizational dimensions (19). If there is no suitable platform for dealing with patient safety in the organization, and in other words, patient safety culture is not institutionalized, it is futile to hope for the successful implementation of patient safety programs (16). This culture should be present in all parts of the organization, including management and employees, and when it can be said that in an organization, this culture is present, so that people are not blamed unnecessarily and unfairly for the occurrence of unwanted medical incidents. Considering the fact that in health care systems, the vast majority of errors have a systemic background and a small amount directly go back to the individual, in this culture the approach to errors is a systemic approach, not an individual treatment and punishment of individuals. As long as there is a platform for the occurrence of errors, it is also possible to occur (19). The person should not be punished for sliding on the slippery surface, the slippery surface should be removed. It should always be kept in mind that every person who made an error as the last link in the error chain and its sharp edge is not necessarily a "bad person" (20). We must know that medical errors occur due to the existence of inappropriate systems and not because of the existence of people. In other words, improperly designed systems pave the way for errors to occur (21). Therefore, we must design the systems in such a way as to facilitate the correct execution of things and prevent risky actions. (19) We must distinguish between blame and the need to be accountable for our behavior (22). All people in the organization are responsible for maintaining the health and safety of their patients (23). It is unforgivable to make a mistake again (22).

Experts believe that in order to improve the quality and safety in health care, hospitals should establish a culture of patient safety among their employees along with structural interventions (16). It can be said that the culture of patient safety is one of the main elements of promoting safety and improving the quality of patient care and is the most important concern of people (21). There is a direct relationship between culture and organizational performance, although the nature and mechanisms hidden in this relationship have not yet been determined (20).