BACKGROUND AND OBJECTIVE

Proper documentation of patient safety events is important to be able to provide changes that can prevent events from occurring again. The Philippine General Hospital launched an online platform for reporting patient safety events in 2017. This paper aimed to describe the patient safety events, initial response to the event, and preventive actions done in the institution.

This is a retrospective descriptive study of patient safety event records from August 2017 to April 2022. General data of the patients, details surrounding the events, response to the event, and preventive measures done after the event were documented. Descriptive analysis was performed.

There was a total of 625 events reported with 525 total unique reports. There was an increased rate of patient safety event reports from 2021 to 2022. The average rate was 23.8 and 25.7 reports per month, respectively. Most reports were for in-patient cases and were type 3 preventable adverse events. The general initial response of healthcare personnel to the adverse events is to provide the appropriate clinical care. Preventive measures include re-orientation and event specific actions.

Documentation is crucial for patient safety events to provide solutions and prevent reoccurrence of these events that can cause harm to patients.

BACKGROUND AND OBJECTIVES

This study at a national tertiary hospital in Manila, Philippines investigated the use of the "Copy and Paste" Function (CPF) within their Electronic Medical Record (EMR). While CPF has benefits and risks, little is known about its usage patterns and impact on patient safety at the institution. This study explores nurses' perceptions and recommendations on CPF use in this hospital’s EMR, assessing its prevalence, impact on patient safety, associations between prevalence and impact, and providing usage recommendations.

A sequential explanatory research design was employed using surveys and semi-structured interviews. Ethical clearance was obtained before data collection. Instruments were adapted from similar studies and have undergone expert validation. Content validity was confirmed, and internal consistency was acceptable (Cronbach’s Alpha = 0.77). Stratified random sampling determined the respondents per area. Data analysis included descriptive statistics, Spearman’s rho, and thematic analysis.

The survey (n = 256) showed CPF use by nurses and doctors, and was confirmed by semi-structured interviews (n = 9). Nurses generally perceived CPF's impact on documentation as neutral (40.17%), leaning towards positive impact. Interviews supported this, revealing both “challenges” and “benefits” of CPF use as themes after thematic analysis. There was no statistically significant association between perceived CPF prevalence and its perceived impact on patient safety (p = 0.164). The theme “considerations for safe CPF use” also emerged from the analysis.

This study found mixed perceptions on CPF’s impact in healthcare. There is a call to continue its use, but safety measures must be implemented first. Recommendations include order verification, caution, practice standardization, selective CPF usage, additional technological features, and alternative documentation methods. A governance structure to manage EMR-related issues, such as unsafe CPF practices, is also recommended to ensure proper monitoring and response.

BACKGROUND AND OBJECTIVE

Medication errors pose substantial risks in hospitals, particularly concerning patient safety. These errors, occurring throughout the medication use process, are one of the most common causes of morbidity and mortality in clinical practice. In the Philippines, there is a lack of evidence on the prevalence and effects of medication errors, emphasizing the need for further investigation. This study evaluated the prescribing, transcribing, and monitoring errors among inpatients under the Pulmonary Medicine Service of the Department of Medicine in the Philippine General Hospital.

This cross-sectional retrospective records review used the total population purposive sampling technique to examine eligible charts of inpatients with asthma and/or COPD from August 1 to December 31, 2022. The frequency, type, and severity of medication errors were determined. Linear regression and Cox proportional hazards models were used to examine the relationship between patient-related factors and medication errors, and length of hospital stay and mortality.

Fifty (50) out of 226 medical records were processed and analyzed. Included patients were predominantly older male adults. More than two-thirds of the patients were diagnosed with COPD while approximately one-fourth suffered from asthma. All patients were practicing polypharmacy and the vast majority presented with comorbidities. A total of 6,517 medication errors, predominantly prescribing errors (99.1%), were identified. Despite the high prevalence of medication errors, the majority were classified as “error, no harm” (98.8%), while only 1.17% were deemed as “error, harm.” As the frequency of prescribing errors increases in the power of three (rough approximation of e), from 1 to 3 to 9 to 27, etc., the expected hospital stay increases by 2.078 days (pCONCLUSION

All eligible patient charts had at least one medication error, with the majority being prescribing errors. Among the variables, prescribing errors significantly affected the length of stay, while severity of transcribing errors had a marginally significant effect. It is essential to develop comprehensive education and training initiatives and adopt a systematic approach to mitigate medication errors and promote patient safety.

There is limited evidence to substantially describe the state of Patient Safety (PS) in the Philippines.1,2 With most publications reflecting respondent-based assessments of institutional patient safety culture, patient-sensitive and records-based indicators are scarce.3 Despite the Institute of Medicine’s4 call to action to address preventable errors and the publication of patient safety indicators5, there has been slow progress in patient safety in the country.
Patient Safety

Background: In 2008, the Department of Health (DOH) issued Administrative Order 2008-0023 that called for an “effective and efficient monitoring system that will link all patient safety initiatives”. However, there are still no explicit and harmonized targets to measure effectiveness and to provide benchmarks that assess whether previous efforts were helpful. Objective: The study aimed to describe the status of patient safety performance measures and indicators on the international patient safety goals (IPSGs) in select hospitals in the Philippines. Methods: Descriptive, cross-sectional design was used to investigate currently used performance measures and indicators. Data collection included administration of a Hospital Patient Safety Indicators Questionnaire (HPSIQ) that summarized the currently used patient safety measures and indicators in the sampled Level 2 and level 3 hospitals and triangulation by review of documents such as hospital databases, protocols on reporting, and manuals for information gathering regarding patient safety. Performance measures were categorized using the Donabedian framework. Core indicators were identified through review of standards that cut across the six IPSGs and evaluation of overarching processes and concepts in patient safety. Results: Forty-one level 2 and 3 hospitals participated in the study. Most performance indicators were process measures (52%), while structure (31%) and outcome measures (17%) accounted for the rest. There is an obvious lack of structural requirements for patient safety in the hospitals included in this study. Less than half the hospitals surveyed implement risk assessment and management consistently. Reporting of events, near- misses, and patient safety data are widely varied among hospitals. Data utilization for quality improvement is not fully established in many of the hospitals. Patient engagement is not integrated in service delivery and performance measurement but is crucial in promoting patient safety. Conclusion Mechanisms to improve hospitals’ capacity to monitor, anticipate, and reduce risk of patient harm during the provision of healthcare should be provided. Having a unified set of definitions and protocols for measurement will facilitate reliable monitoring and improvement. Leadership and governance, both internal (e.g., hospital administrators) and external (e.g., DOH) that recognize a data-driven approach to policymaking and improvement of service delivery are crucial in promoting patient safety
Patient Safety ; Outcome and Process Assessment, Health Care

Background and Objectives: This study at a national tertiary hospital in Manila, Philippines investigated the use of the "Copy and Paste" Function (CPF) within their Electronic Medical Record (EMR). While CPF has benefits and risks, little is known about its usage patterns and impact on patient safety at the institution. This study explores nurses' perceptions and recommendations on CPF use in this hospital’s EMR, assessing its prevalence, impact on patient safety, associations between prevalence and impact, and providing usage recommendations. Methods: A sequential explanatory research design was employed using surveys and semi-structured interviews. Ethical clearance was obtained before data collection. Instruments were adapted from similar studies and have undergone expert validation. Content validity was confirmed, and internal consistency was acceptable (Cronbach’s Alpha = 0.77). Stratified random sampling determined the respondents per area. Data analysis included descriptive statistics, Spearman’s rho, and thematic analysis. Results: The survey (n = 256) showed CPF use by nurses and doctors, and was confirmed by semi-structured interviews (n = 9). Nurses generally perceived CPF's impact on documentation as neutral (40.17%), leaning towards positive impact. Interviews supported this, revealing both “challenges” and “benefits” of CPF use as themes after thematic analysis. There was no statistically significant association between perceived CPF prevalence and its perceived impact on patient safety (p = 0.164). The theme “considerations for safe CPF use” also emerged from the analysis. Conclusion This study found mixed perceptions on CPF’s impact in healthcare. There is a call to continue its use, but safety measures must be implemented first. Recommendations include order verification, caution, practice standardization, selective CPF usage, additional technological features, and alternative documentation methods. A governance structure to manage EMR-related issues, such as unsafe CPF practices, is also recommended to ensure proper monitoring and response.
patient safety ; nurses ; Philippines

Background and Objective: Medication errors pose substantial risks in hospitals, particularly concerning patient safety. These errors, occurring throughout the medication use process, are one of the most common causes of morbidity and mortality in clinical practice. In the Philippines, there is a lack of evidence on the prevalence and effects of medication errors, emphasizing the need for further investigation. This study evaluated the prescribing, transcribing, and monitoring errors among inpatients under the Pulmonary Medicine Service of the Department of Medicine in the Philippine General Hospital. Methods: This cross-sectional retrospective records review used the total population purposive sampling technique to examine eligible charts of inpatients with asthma and/or COPD from August 1 to December 31, 2022. The frequency, type, and severity of medication errors were determined. Linear regression and Cox proportional hazards models were used to examine the relationship between patient-related factors and medication errors, and length of hospital stay and mortality. Results: Fifty (50) out of 226 medical records were processed and analyzed. Included patients were predominantly older male adults. More than two-thirds of the patients were diagnosed with COPD while approximately one-fourth suffered from asthma. All patients were practicing polypharmacy and the vast majority presented with comorbidities. A total of 6,517 medication errors, predominantly prescribing errors (99.1%), were identified. Despite the high prevalence of medication errors, the majority were classified as “error, no harm” (98.8%), while only 1.17% were deemed as “error, harm.” As the frequency of prescribing errors increases in the power of three (rough approximation of e), from 1 to 3 to 9 to 27, etc., the expected hospital stay increases by 2.078 days (p <0.001) (e.g., 32 = 9 errors with LOS of around 4 days); meanwhile, more severe transcribing errors increase the length of stay by 4.609 days (p = 0.034) All independent variables were noted to have a lack of significance and thus no meaningful patterns in the data related to patient mortality were identified, primarily due to the insufficient amount of observed mortality in the included sample. Conclusion All eligible patient charts had at least one medication error, with the majority being prescribing errors. Among the variables, prescribing errors significantly affected the length of stay, while severity of transcribing errors had a marginally significant effect. It is essential to develop comprehensive education and training initiatives and adopt a systematic approach to mitigate medication errors and promote patient safety.
medication errors ; patient safety ; pulmonary medicine

Objectives: Majority of the existing patient safety culture tools are designed for healthcare workers. Despite the claims that this patient safety tools are patient-centered, limited attention was given to the patients’ perspectives and cultural considerations in the development. Local studies are not available in extant literature that capture patient perspectives on being safe during hospitalization. The goal of the study was to develop and provide preliminary psychometric analysis on a tool that measures patients’ perception of safety culture in a hospital setting. Methods: The study was a quantitative methodological study. The instrument was developed in three phases, conceptualization and item generation through literature review, clinical observation, and focus group discussion, two rounds of expert panel review, and pilot testing. The tool was tested on 122 eligible patients admitted in a tertiary hospital. Factor analysis of the items was done to determine the underlying factor under each item. Cronbach’s alpha was used to test the degree of internal consistency of the scale. Results: The Patient Perceptions on Safety Culture in Hospital Setting Scale consists of 25 items. The analysis yielded four factors explaining a total of 69.23% of the variance in the data. Items were grouped in four dimensions: Hospital workforce (4 items), Hospital Environment (5 items), Heath Management and Care Delivery (7 items), and Information Exchange (9 items). Each factor registered a Cronbach’s alpha of 0.81, 0.78, 0.91, 0.94, respectively. The overall Cronbach’s alpha of the scale is 0.95. Conclusion The study offers preliminary evidence on the psychometric properties of a newly developed tool that measures patient perceptions on hospital safety culture. Subsequent studies on larger samples need to be conducted to determine the reliability and validity of the tool when applied to different population and contexts as well as determining valid cut-off points in scoring and interpretation.
Patient Safety ; Patient Participation

Anesthesiologists have been at the forefront of initiatives addressing perioperative patient safety. As anesthesia has no direct therapeutic benefit, its risk must be minimized. At times the surgery is simple but the patient’s condition complicates anesthetic management, increasing the risk for complications. This report describes the anesthetic management of an adult patient diagnosed with inclusion body myositis (IBM), a rare inflammatory degenerative myopathy, who initially presented with decreased motor function in both lower and upper extremities causing him to be bedbound for two years. Due to the progression of his disease, he eventually developed dysphagia, hence he was scheduled for esophagoscopy, cricopharyngeal Botox injection, and percutaneous endoscopic gastrostomy. As patients with IBM are at risk for exaggerated sensitivity to neuromuscular blockers and respiratory compromise, anesthesia was at the helm of a multidisciplinary team approach. The perioperative management centered on preoperative optimization, prevention of aspiration, avoidance of anesthetics that may trigger malignant hyperthermia, and prevention of postoperative pulmonary complication. The hospital course was uncomplicated and the patient was discharged well after one day. This report emphasizes how improvements in resources, technology, and healthcare delivery, especially in anesthesia, help prevent perioperative adverse events.
Patient Safety ; Myositis, Inclusion Body ; Malignant Hyperthermia

INTRODUCTION: The number of injuries and expenses from unsafe delivery of health care has heeded the call for a greater patient safety advocacy. The development of an effective reporting system contributes towards this cause. The study aimed to explore the perceptions of nurses regarding critical incidents and investigate the factors affecting their decision to report a certain event. METHODS: Focus group discussions including 28 nurses working in the service wards of a tertiary hospital, and the data gathered were analyzed using descriptive qualitative approach. RESULTS: Three key themes emerged from the discussions: (1) perceptions of an incident, (2) attitudes, norms, and culture of incident reporting in the workplace, and (3) perceptions and suggestions for management actions and improving the reporting system. The study showed that various factors tend to interplay in the identification of an incident as well as the consideration to perform the behavior. DISCUSSION The primary practice and education implications focus on changing the workplace culture and proper orientation of the staff, while further research regarding the role of reporting, and appropriate analysis of error reporting among other health care professionals would be recommended.
hospital communication systems ; nursing education ; critical incidents ; patient safety