عنوان

ارتقاء فرآیند ایمنی بیمار در بخش آسیب طناب نخاعی)SCI )بیمارستان توانبخشی رفیده : یک مطالعه اقدام پژوهشی مشارکتی

Introduction: Despite advancements in medical science and rehabilitation care, the provision of unsafe care and occurrence of adverse events have had a significant impact on the functioning of individuals requiring rehabilitation services. Currently, the main patient safety policies in patients with spinal cord injury (SCI) implemented in rehabilitation hospitals are based on guidelines similar to general hospitals and community-based initiatives. However, the application of these guidelines may not be highly effective in rehabilitation settings due to different care goals and increased vulnerability of the patient population. Therefore, the aim of this study was to improve the patient safety process in the SCI department of a rehabilitation hospital.Methods: This study employed a qualitative research design using an action research approach,conducted in two phases (preliminary and exploratory phase, and first and second cycle) over a period of two years (2020-2022) in a rehabilitation hospital. In the first phase of the study, after introducing the research objectives to the participants and obtaining their consent, the status of patient safety in the SCI department was assessed and the priority areas for patient safety were determined through collaboration with the staff and departmental officials. Both qualitative methods (semi-structured interviews, observations, group discussions) and quantitative methods (validated safety checklists and health ministry patient safety indicators)were used to identify the main challenges and priorities for patient safety in the SCI department. Qualitative content analysis (Granheim and Lundman, 2004) was utilized to analyze the qualitative data collected, while descriptive statistics tests (frequency, mean, and standard deviation) were used to analyze the quantitative data. The significance level was set at less than 0.05. The analysis was conducted using SPSS version 20. Based on the qualitative and quantitative data collected through a collaborative process and based on the department's needs, fall prevention emerged as a priority for the SCI department. Therefore, in the second phase of the study, the focus shifted towards implementing activities to improve the fall prevention program. Two cycles were carried out, following Cohen's model (2007), which involved action planning, changing performance, observation and evaluation, and feedback. Adherence to fall prevention measures, incidence of falls, and patient satisfaction with care were assessed. Participants were also asked to identify challenges and suggest solutions to reduce falls in patients. Based on their input and available resources, a fall prevention promotion program was formulated by the research team with active involvement from the medical care team. The operational plan designed by the medical care team was then implemented for three months.In the monitoring and observation phase after the implementation of the operational program, an evaluation was conducted through qualitative analysis of the therapeutic care team's opinions and a satisfaction questionnaire, as well as a checklist of fall prevention measures and the incidence of falls. For quantitative evaluation, paired t-tests were used to analyze pre- and post-program scores. Data were presented using means and standard deviations, with asignificance level of less than 0.05. Analysis was performed using SPSS version 20. In the feedback phase, issues and problems with program implementation were identified based on the effectiveness of the program, as perceived by the participants. Improvement strategies and methods were then determined for the next cycle based on the knowledge and experiencegained from previous stages. Subsequently, a new action plan was developed to address the identified problems, and the operational program was implemented for a period of three months with the inclusion of new changes. Finally, after discussing and reviewing the obtained results, new suggestions and solutions were proposed to advance the program.Results: This study revealed that among the patient safety guidelines, fall prevention emerged as the main priority in the SCI department of the rehabilitation hospital. Challenges in the fall prevention program included inadequate working conditions, professional competency gaps, lack of patient and caregiver awareness and involvement, and deficiencies in fall prevention policies/procedures. Through both quantitative and qualitative stages and in accordance with an action research approach, a fall prevention program was designed and developed throughfour main strategies and ten activities. The activities were organized to enhance professional competency, increase patient and caregiver knowledge and involvement, improve fall prevention policies/procedures, and effectively manage the work environment. The mean and standard deviation of adherence to fall prevention measures, patient satisfaction with care, and the percentage of falls (based on occupied bed days) in the study were 3.81 ± 9.66, 81.18 ± 40.75, and 5, respectively, before the changes, and 13.4 ± 13.18, 10.48 ± 50.90, and 3.6, respectively, after the changes (p < 0.001).Conclusion: This study demonstrated that the designed program, through the development of professional competency, improvement of interdisciplinary interactions, provision of motivational mechanisms, and implementation of educational courses for patients and their companions, as well as environmental changes, led to the execution of necessary and appropriate fall prevention measures in the SCI department. The sustainability of this program requires effective health system policies and planning, which will undoubtedly enhance patient safety and improve the quality of care. Further studies using quantitative and qualitative methods are recommended to test this program in other rehabilitation hospitals and care centersfor vulnerable populations.Key words: Patient safety, fall, hospital, rehabilitation, spinal cord injury patients, participatory action research