Variations in risk perceptions: a qualitative study of why unnecessary urinary catheter use continues to be problematic.
Variations in risk perceptions: a qualitative study of why unnecessary urinary catheter use continues to be problematic.
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DOI：
10.1186/1472-6963-13-151
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发表时间：
2013-04-26
影响因子：
2.8
通讯作者：
Krein SL
中科院分区：
文献类型：
--
作者：
Harrod M;Kowalski CP;Saint S;Forman J;Krein SL
导尿管相关性尿路感染（CAUTI）是美国最常见的获得性卫生保健相关感染之一。我们检查了预防CAUTI倡议的实施情况，以更好地了解卫生保健提供者对风险的感知如何影响他们使用预防措施，以及这些风险感知对患者护理决策的潜在影响。了解这种看法对于制定更有效的方法至关重要，以确保成功采用关键的患者安全做法，从而为住院患者提供更安全的护理。我们对12家医院的工作人员进行了半结构化的电话和面对面访谈。使用开放编码和持续比较方法对总共42个访谈进行分析。该分析将“风险”确定为中心主题，并确定了一个“风险解释框架”，因为它的敏感结构可以组织和解释我们的发现。我们发现，医疗保健提供者使用多种风险感知，一些无证据基础，来确定是否有必要使用留置导尿管。这些风险包括规范性工作，工作人员处理相互竞争的优先事项，必须决定哪些优先事项也要参加；松散耦合的错误，阴性结果和导尿管的使用没有明确的联系；过程弱点，其中风险似乎与现有的组织过程和正在实施的新计划有关；解决方案由医护人员开发的解决方案组成，以绕过为劝阻导管使用而创建的一些组织流程。正在实施旨在减少留置导尿管的患者安全举措的医院应该意识到，对患者的风险并不是唯一被认为重要的风险；应制定相应的实施计划。
Catheter associated urinary tract infection (CAUTI) is one of the most commonly acquired health care associated infections within the United States. We examined the implementation of an initiative to prevent CAUTI, to better understand how health care providers’ perceptions of risk influenced their use of prevention practices and the potential impact these risk perceptions have on patient care decisions. Understanding such perceptions are critical for developing more effective approaches to ensure the successful uptake of key patient safety practices and thus safer care for hospitalized patients. We conducted semi-structured phone and in-person interviews with staff from 12 hospitals. A total of 42 interviews were analyzed using open coding and a constant comparative approach. This analysis identified “risk” as a central theme and a “risk explanatory framework” was identified for its sensitizing constructs to organize and explain our findings. We found that multiple perceptions of risk, some non-evidence based, were used by healthcare providers to determine if use of the indwelling urethral catheter was necessary. These risks included normative work where staff deal with competing priorities and must decide which ones to attend too; loosely coupled errors where negative outcomes and the use of urinary catheters were not clearly linked; process weaknesses where risk seemed to be related to both the existing organizational processes and the new initiative being implemented and; workarounds that consisted of health care workers developing workarounds in order to bypass some of the organizational processes created to dissuade catheter use. Hospitals that are implementing patient safety initiatives aimed at reducing indwelling urethral catheters should be aware that the risk to the patient is not the only risk of perceived importance; implementation plans should be formulated accordingly.
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影响因子：
5.7
作者：
Krein, Sarah L.;Kowalski, Christine P.;Saint, Sanjay
通讯作者：
Saint, Sanjay
影响因子：
5.4
作者：
Dixon-Woods, Mary;Suokas, Anu;Tarrant, Carolyn
通讯作者：
Tarrant, Carolyn
影响因子：
7.2
作者：
Laws, Rachel A.;Kemp, Lynn A.;Eames-Brown, Rosslyn
通讯作者：
Eames-Brown, Rosslyn
DOI：
10.1197/jamia.m2378
发表时间：
2008-01-01
影响因子：
6.4
作者：
Vogelsmeier, Amy A.;Halbesleben, Jonathon R. B.;Scott-Cawiezell, Jill R.
通讯作者：
Scott-Cawiezell, Jill R.
影响因子：
2.5
作者：
Halbesleben, Jonathon R. B.;Savage, Grant T.;Wakefield, Bonnie J.
通讯作者：
Wakefield, Bonnie J.