A new approach of assessing patient safety aspects in routine practice using the example of "doctors handwritten prescriptions".
Gerald Sendlhofer, Gudrun Pregartner, Veronika Gombotz and 7 others
PMID 30554434WHAT IT FOUND
Doctor-nurse self-assessments overestimated prescription quality compared with independent nursing experts.
After training and feedback, some legibility and completeness items improved significantly, but overall change was only slight, especially in surgical wards.
Key findings
01Self-assessments by doctors and nurses overestimated prescription quality compared with external assessments.
02Mean scores improved only slightly over six months (surgical 1.91 to 1.76; non-surgical 1.77 to 1.50), with significant improvements for checklist items 1, 6 and 11-13.
03External assessors rated non-surgical wards more favourably than surgical wards for checklist items 6, 7, 13 and 14.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Nurses selected the five fever charts per ward, so the sample may not represent all prescriptions. Several charts came from the same ward, but the agreement analysis ignored those dependencies. The study tested many checklist items and used a 0.05 significance threshold for exploratory analysis, so some item-level improvements may be chance. All wards received the same assessment and training process, so there was no untreated comparison group. Self-assessment was done by a doctor and nurse together, but the paper suggests nurses may have been overruled by doctors.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not conclude that the feedback programme made all prescriptions safe. Overall improvement was only slight, self-assessments overestimated quality, and nurse-selected charts may have introduced bias.