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Bakgrund: Årligen drabbas miljoner patienter världen över av vårdrelaterade infektioner, vilket representerar ett folkhälsoproblem och ett hotmot patientsäkerheten. Enligt WHO måste varje land därför vidta och fokusera på åtgärder som att förbättra hygienrutiner hos vårdpersonalen, för att minska andelen vårdrelaterade infektioner. Syfte: Att få insyn, förståelse och fördjupad kunskap i hur chefer på ett akutsjukhus i Stockholm arbetar för patientsäkerhet genom följsamhet till hand-, kläd-och hygienrutiner. Hur upplevsföljsamhet till hygienrutinerna vara, ses svårigheter, hur ser praxis för ansvar och uppföljning av följsamheten till hygienrutinernaut?Målet är att kunna ge förslag och inspiration till hur följsamhet till hygienrutiner kan optimeras på det sjukhus där studien utförts, även som inspiration till andra vårdgivare. Metod: 41 chefer på olika nivåer intervjuades. Kvalitativ forskningsansats valdes och manifest kvalitativ innehållsanalys användes som analysmetod. Resultat: Chefer upplever att följsamheten till hygienrutiner generellt är god, men kan skilja sig åt mellan yrkeskategorier. Det finns individer med upprepad icke-följsamhet, trots påpekanden.Det arbetas med följsamhet på den egna enheten, medan det är liten koordinering mellan enheterna. Varje chef bestämmer själv hur arbetet skall läggas upp för sin personal, det finns ingen klar sjukhusgemensam strategi. Önskemål uttrycks om att få tid med sin verksamhetschef att diskutera hur enhetens följsamhet ser ut och behov av åtgärder för förbättring samt åtgärd för de med lägre följsamhet. Konklusion: Följsamheten till hygienrutiner skulle sannolikt kunna öka genom att chefer samverkar, samordnaroch haren mer enad strategi och sjukhusövergripande fokusering på hygienrutiner.

Patient Safety.

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The global medical process is a chain of different medical multidisciplinary procedures. The success in global Patient Safety will depend on the Safety of the consecutive medical processes that intervene in this complex system. Laboratory data is an essential part of health care, indeed it is used in 70% of clinical decisions. Inappropriate laboratory test over requesting is extremely frequent. The prevalence of under requesting has been less studied. The consequences of under requesting are clear, we are missing a diagnosis. Inappropriate over requesting can result not only in a problem of cost but also in a problem regarding patient safety. Additionally, another important consequence of inappropriate tests over requesting is that such amount of unnecessary tests has probably contributed to a significant increase in the volume of those over the last years. In all, there is general consensus that the inadequacy of test requesting must be corrected through strategies and monitored over time through indicators to assure the optimal laboratory contribution to clinical decision-making and patient safety.

Hospitals --- Patient safety. --- Safety measures.

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Making Healthcare Safer reports I, II, and III have shown a positive impact of patient safety practices on the reduction of medical errors. However, threats to patient safety are still emerging and evolving in a dynamic world. Patient safety research is growing, spanning across more healthcare settings, and considers a wide array of contextual factors. The combination of emerging patient safety threats and the growing amount of published patient safety research, patient safety resources, and accrediting body standards makes it increasingly difficult to prioritize adoption and implementation of evidence-based practices. AHRQ's fourth iteration of Making Healthcare Safer intends to address this issue by publishing evidence-based reviews of patient safety practices and topics as they are completed. This intentional release of updated reviews will aid healthcare organization leaders in prioritizing implementation of evidence-based practices in a timelier way. The report also will help researchers identify where more research is needed in a timelier way and assist policymakers in understanding which patient safety practices have the supporting evidence for promotion. Reviews will be posted below as they are completed. Making Healthcare Safer IV was commissioned in 2022. To kick off the report, AHRQ explored the potential harms that may be associated with telehealth, which has grown exponentially during the wake of the COVID-19 pandemic to facilitate healthcare during a time when in-person clinical encounters between a patient and clinician was significantly reduced to help slow the spread of the virus. Because the benefits of telehealth became evident during the pandemic, the harms and patient safety practices to reduce the risk for medical errors, misdiagnosis, and privacy concerns are still being assessed. This review will serve as a baseline for the evidence of harms and patient safety practices to prevent or mitigate harms associated with the use of telehealth. Making Healthcare Safer IV began with a horizon scan to identify emerging trends and needs in the patient safety field. A technical expert panel (TEP) was convened to prioritize which topics and patient safety practices, including updates to the ones covered in the previous Making Healthcare Safer reports, would be most beneficial to the field if addressed throughout the years of the fourth report. These discussions are summarized in the the Prioritization Report. AHRQ determined that the first rapid review would be on the potential harms that may be associated with telehealth, which has grown exponentially during the wake of the COVID-19 pandemic to facilitate healthcare during a time when in-person clinical encounters between a patient and clinician was significantly reduced to help slow the spread of the virus. Because the benefits of telehealth became evident during the pandemic, the harms and patient safety practices to reduce the risk for medical errors, misdiagnosis, and privacy concerns are still being assessed. This review will serve as a baseline for the evidence of harms and patient safety practices to prevent or mitigate harms associated with the use of telehealth. Since AHRQ asked for this topic to be explored first, it was not discussed during the TEP convening. The first three Making Healthcare Safer reports, published in 2001, 2013, and 2020, have each served as a consolidated source of information for healthcare providers, health system administrators, researchers, and government agencies. A set of tables compares the patient safety practices among the reports.

Evidence-based medicine. --- Patient safety.

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Patient Safety --- Professional-Patient Relations --- Hospitals

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Patient Safety --- Stress, Psychological --- Burnout, Professional --- Patient Care Team