It is known from research that there is a gap in professionals’ adherence to safe practices6. Some authors highlight that a video could be an important educational tool for increasing patients’ knowledge of the role they can play during hospitalization16.
Walsh et al. estimated the rate of error in the administration of chemotherapy as 8.2 per 1000 orders in oncology adult patients in the outpatient setting, causing damage in one error for every 1000 orders.17 A considerable fraction of these occur in the phase of administration, which is observable by patients. Qualitative studies have shown that patients are aware of the medication errors that are occurring and are prepared to participate actively in their prevention.18,19 Also, some works suggests that healthcare professionals, like patients, generally view patient involvement positively.20
The National Haemovigilance Report published in Spain, in 2016, recorded 332 errors in the administration of blood products, and 32% of them happened at “the bedside of the patient.”21 However, studies on patients’ involvement in transfusion safety are scarce.22
Between 5% and 10%, patients admitted to a hospital will develop at least one nosocomial infection. Hand hygiene is one of the main measures to prevent these infections2. However, according to international studies, the adherence of professionals to hand hygiene is less than 50%.15 Multimodal strategies are being implemented to improve their adherence. These strategies have had a variable effectiveness (51–83%) and there is some evidence that patients can play an important role in improving the compliance.23
Proper patient identification at every step of clinical care is vital to ensure patient safety. However, despite the priority placed on addressing this issue, significant problems persist. “Wrong patient,” “wrong site,” and “wrong procedures” continue to be among the most frequently submitted sentinel events reported to The Joint Commission in the USA.24
These data suggest that new methods are needed to assess professionals’ adherence to safe practices. Such data has the potential to allow clinical teams and services to consider the reasons for non-adherence and to make changes to improve patient safety.
Our research showed that more than 3 out of 4 participants were willing to play the role of the safety auditor. Several reasons can explain this finding, some of which are related to the process of reporting data to healthcare organizations. In the first place, we proposed that the assessment must be done anonymously so the participants would not have to confront healthcare professionals. Second, the participants received a training inducing more confidence in their skills. In fact, 89% participants answered that they knew how to assess safe practices after the training offered. Other reasons are related to the participants’ characteristics. Oncology patients may perceive a high risk of an error and thus be more willing to play an active role in patient safety. All these are enablers of patient involvement in patient safety14,25−29. In the study P&Fs’ participation was intended to simulate a continuous assessment during their process of care. Their willingness here may be different to a more conventional audit team, in which the P&F is a member along with healthcare professionals.
On the other hand, our research showed that the willingness to audit safe practices was different depending on the safe practice and whilst these differences did not reach statistical significance, it is interesting to note which practices were selected. Transfusion or chemotherapy identification were the safe practices that P&Fs were more willing to audit while hand hygiene was the least selected practice. Somehow there many reasons that could influence P&Fs preference and willingness to engage in their healthcare. Some studies revealed that there is a general expectation that healthcare professionals, “know what they are supposed to be doing” and a common assumption that they always did what they were supposed to do, specially the most basic duties as washing their hands properly or administering the correct medications. Also, some studies suggest that checking to ensure that healthcare professionals were doing their job correctly could be embarrassing and damage relationship with them.
Participants were offered training before assessing their observation skills to increasing their health literacy. After the training, almost half of participants were considered to have the skills to be an auditor. It means that not every P&F willing to be auditor could or should be. Younger participants with high education level who have experienced an adverse event or who did not rate “totally safe” in the item General perception of hospital’s safety made the best auditors. Our study showed that P&Fs with higher education status, a proxy for health literacy,30 were better equipped to identify non-compliance with safe protocols. In this study, relatives had better skills to play the role of the auditor in the bivariate analysis and they improved after the training more than patients did but the result did not reach statistically significant differences in the regression model, probably due to the relatives’ sample size.
Here we recommend that organizations develop methods to assess the skills of P&Fs before they are fully engaged in this audit process. Further research is also needed to assess and develop training programmes for patients and family members as auditors.
P&Fs’ assessment of gaps in safe practices gives the organization real-time data in order to engage them in the plan-do-check-act cycle. Furthermore, the fact that professionals may feel observed could encourage their adherence to safe practices.
LIMITATIONS
Although P&Fs as well as the environmental frame are real-world entities, the evaluation of the professionals’ safe practice adherence was undertaken by watching videos. To know the validity of involving P&Fs as auditors, it is necessary to compare the observations of P&Fs against a gold standard. The research project required an evaluation under controlled conditions because it is not possible to add additional observers to the P&Fs themselves in order to avoid the Hawthorne effect.
The evaluation of the role of the P&Fs as auditors of safe practices is an innovative approach. Therefore, from an ethical point of view, it seems more reasonable to assess safe practice under real conditions only if minimum guarantees of success are met. Further, the acceptance of the role of P&Fs as auditors implies, not only that the P&Fs themselves have accepted this function, but also that the healthcare professionals and the management team also accept it. Using data to demonstrate that P&Fs are able to audit correctly facilitates the acceptance of this new role by health professionals and P&Fs.