Visitor Behaviors Can Influence the Risk of Patient Harm: An Analysis of Patient Safety Reports From 92 Hospitals

Authors

DOI:

https://doi.org/10.33940/data/2022.6.7

Keywords:

visitors, family, patient safety, hospital, behavior, intervention, risk mitigation, signage, warning sign, instructional sign

Abstract

Visual Abstract

Background: Previous research has shown that visitors can decrease the risk of patient harm; however, the potential to increase the risk of patient harm has been understudied.

Methods: We queried the Pennsylvania Patient Safety Reporting System database to identify event reports that described visitor behaviors contributing to either a decreased or increased risk of patient harm. Event reports from January 1 to June 30, 2019, were searched for keywords and reviewed for inclusion criteria. Event reports were manually coded to identify visitor influence on risk of patient harm (e.g., increase or decrease), visitor behavior, and event type.

Results: A total of 427 event reports were analyzed and we identified five categories of visitor behavior that influenced patient safety by either decreasing or increasing the risk of patient harm. We found that 63.7% (272 of 427) of event reports described a visitor behavior that decreased the risk of patient harm and the remaining 36.3% (155 of 427) of reports described behavior that increased the risk of harm. There was a greater variety of visitor behaviors that contributed to an increased risk of patient harm, as opposed to a decreased risk of harm. The visitor behavior most frequently associated with a decreased risk of patient harm was communicating with staff (91.2%, 248 of 272); for example, to inform staff of deterioration of a patient’s condition. The visitor behavior most frequently associated with an increased risk of patient harm was moving a patient (63.2%, 98 of 155). Across the 427 event reports, we found that visitor behavior was associated with seven event types; the falls event type (61.6%, 263 of 427) and medication-related event type (14.8%, 63 of 427) occurred most frequently.

Conclusion: The current study provides insight into which visitor behaviors are contributing to a decreased risk of patient harm and adds to the literature by identifying behaviors that can increase the risk of patient harm, across multiple event types. Table 6 and Table 7 outline potential safety strategies that staff and facilities may consider using to target visitor behavior. As outlined in Table 6, the use of warning and instructional signage can be a relatively low-effort and effective strategy to influence visitor behavior and address multiple behavior categories and event types.

Author Biographies

Christine E. Sanchez, MPH, Patient Safety Authority

Christine E. Sanchez (chrsanchez@pa.gov) is a patient safety analyst on the Data Science and Research team at the Patient Safety Authority (PSA). She is responsible for utilizing patient safety data, combined with relevant literature, to develop strategies aimed at improving patient safety in Pennsylvania.

Matthew A. Taylor, PhD, Patient Safety Authority

Matthew A. Taylor is a patient safety analyst for the Patient Safety Authority (PSA), where he conducts research, uses data to identify patient safety concerns and trends, and develops tools and materials to help facilities and clinicians improve patient safety.

Rebecca Jones, MBA, RN, Patient Safety Authority

Rebecca Jones is director of Data Science and Research at the Patient Safety Authority (PSA) and founder and director of the PSA’s Center of Excellence for Improving Diagnosis.

References

Berwick DM. Don Berwick’s Challenge: Eliminate Restrictions on Visiting Hours in the Intensive Care Unit. Institute for Healthcare Improvement website. http://www.ihi.org/resources/Pages/ImprovementStories/DonBerwicksChallengeEliminateRestrictionsonVisitingHoursintheIntensiveCareUnit.aspx. Accessed May 6, 2022.

Berwick DM, Kotagal M. Restricted Visiting Hours in ICU Time to Change. JAMA. 2004;292(6):736-7.

Junior APJ, Besen BAMP, Robinson CC, Falavigna M, Teixeira C, Rosa RG. Flexible Versus Restrictive Visiting Policies in ICUs: A Systematic Review and Meta-Analysis. Crit Care Med. 2018;46(7):1175-80. Epub 2018/04/12. doi: 10.1097/CCM.0000000000003155. PMID: 29642108.

Levers CM, Farshait N. Engaging Patient’s Family and Visitors in Patient Safety by Providing Education About Additional Precautions(Isolation) and Routine Practices (Standard Precautions). Am J Infect Control. 2014;42(6). doi: 10.1016/j.ajic.2014.03.177.

Merner B, Hill S, Taylor M. “I’m Trying to Stop Things Before They Happen”: Carers’ Contributions to Patient Safety in Hospitals. Qual Health Res. 2019;29(10):1508-18. Epub 2019/04/20. doi: 10.1177/1049732319841021. PMID: 30999812; PMCID: PMCPMC7322936.

Olding M, McMillan SE, Reeves S, Schmitt MH, Puntillo K, Kitto S. Patient and Family Involvement in Adult Critical and Intensive Care Settings: A Scoping Review. Health Expect. 2016;19(6):1183-202. Epub 2016/11/24. doi: 10.1111/hex.12402. PMID: 27878937; PMCID: PMCPMC5139045.

Oyesanya TO, Bowers B. “I’m Trying To Be the Safety Net”: Family Protection of Patients With Moderate-To-Severe TBI During the Hospital Stay. Qual Health Res. 2017;27(12):1804-15. Epub 2017/09/25. doi: 10.1177/1049732317697098. PMID: 28936928; PMCID: PMCPMC6281395.

Smith L, Medves J, Harrison MB, Tranmer J, Waytuck B. The Impact of Hospital Visiting Hour Policies on Pediatric and Adult Patients and their Visitors. JBI Libr Syst Rev. 2009;7(2):38-79. doi: 10.11124/01938924-200907020-00001.

Vorwerk J, King L. Consumer Participation in Early Detection of the Deteriorating Patient and Call Activation to Rapid Response Systems: A Literature Review. J Clin Nurs. 2016;25(1-2):38-52. Epub 2015/09/17. doi: 10.1111/jocn.12977. PMID: 26373438.

Bostwick AD, Beesley SJ. Family Role in Patient Safety in the Intensive Care Unit. Families in the Intensive Care Unit. Springer; 2018. p. 277-87.

Giap T-T-T, Park M. Implementing Patient and Family Involvement Interventions for Promoting Patient Safety: A Systematic Review and Meta-Analysis. J Patient Saf. 2021;17(2):131-40.

Kim YS, Kim HS, Kim HA, Chun J, Kwak MJ, Kim MS, et al. Can Patient and Family Education Prevent Medical Errors? A Descriptive Study. BMC Health Serv Res. 2020;20(1):269-75. Epub 2020/04/03. doi: 10.1186/s12913-020-05083-y. PMID: 32234042; PMCID: PMCPMC7106564.

Mackie BR, Mitchell M, Marshall PA. The Impact of Interventions That Promote Family Involvement in Care on Adult Acute-Care Wards: An Integrative Review. Collegian. 2018;25(1):131-40. doi: 10.1016/j.colegn.2017.01.006.

Xyrichis A, Fletcher S, Philippou J, Brearley S, Terblanche M, Rafferty AM. Interventions to Promote Family Member Involvement in Adult Critical Care Settings: A Systematic Review. BMJ Open. 2021;11(4):e042556. Epub 2021/04/09. doi: 10.1136/bmjopen-2020-042556. PMID: 33827833; PMCID: PMCPMC8031009.

Ryu YM, Roche JP, Brunton M. Patient and Family Education for Fall Prevention Involving Patients and Families in a Fall Prevention Program on a Neuroscience Unit. J Nurs Care Qual. 2009;24(3):243-9.

Jeske L, Kolmer V, Muth M, Cerns S, Moldenbaur S, Hook M. Partnering With Patients and Families in Designing Visual Cues to Prevent Falls in Hospitalized Elders. J Nurs Care Qual. 2005;21(3):236-41.

Prates DdO, Silva AEBdC. Interruptions of Activities Experienced by Nursing Professionals in an Intensive Care Unit. Rev Latino-Am Enfermagem. 2016;24. doi: http://dx.doi.org/10.1590/1518-8345.0997.2802.

Johnson KD, Motavalli M, Gray D, Kuehn C. Causes and Occurrences of Interruptions During ED Triage. J Emerg Nurs. 2014;40(5):434-9. Epub 2013/11/26. doi: 10.1016/j.jen.2013.06.019. PMID: 24269063.

Altamimi M, Alfuqaha O, Baniissa A, AL-Maqbeh W. Visitors and Equipment Failure as Predictors of Interruptions Among Nurses. Cent Eur J Nurs Midwifery. 2022;13(2). doi: 10.15452/CEJNM.2021.12.0039.

Relihan E, O’Brien V, O’Hara S, Silke B. The Impact of a Set of Interventions to Reduce Interruptions and Distractions to Nurses During Medication Administration. Qual Saf Health Care. 2010;19(5):e52. Epub 2010/06/01. doi: 10.1136/qshc.2009.036871. PMID: 20511596.

Pape T. Applying Airline Safety Practices to Medication Administration. Medsurg Nurs. 2003;12(2):77-93.

Jaswaney R, Davis A, Cadigan RJ, Waltz M, Brassfield ER, Forcier B, et al. Hospital Policies During COVID-19: An Analysis of Visitor Restrictions. J Public Health Manag Pract. 2022;28(1):E299-E306.

Taylor MA, Nowalk A, Falk A. In-Hospital Substance Use and Possession: A Study of Events From 38 Acute Care Hospitals in Pennsylvania. Patient Saf. 2020;2(2):57-68. Epub 2020/06/06. doi: 10.7573/dic.2020-6-6. PubMed PMID: 32821263; PubMed Central PMCID: PMCPMC7413591.

United States Food and Drug Administration. Infusion Pump Risk Reduction Strategies for Home Health Nurses.

Grissinger M. A Patient’s Wandering Eye and the Internet Can Lead to Pump Tampering. Pharm Ther. 2009;34(6):283-328.

Laughery KR, Wogalter MS. A Three-Stage Model Summarizes Product Warning and Environmental Sign Research. Saf Sci. 2014;61:3-10. doi: 10.1016/j.ssci.2011.02.012.

Meis J, Kashima Y. Signage as a Tool for Behavioral Change: Direct and Indirect Routes to Understanding the Meaning of a Sign. PLoS One. 2017;12(8):e0182975. Epub 2017/08/31. doi: 10.1371/journal.pone.0182975. PMID: 28854203; PMCID: PMCPMC5576639.

Graphic Products. Best Practice Guide to OSHA Safety Signs. Graphic Products website. https://www.graphicproducts.com/resources/guides/. Published December 2020. Accessed May 6, 2022.

Strawderman L, Huang Y, Garrison T. The Effect of Design and Placement of Work-Zone Warning Signs on Driver Speed Compliance: A Simulator-Based Study. IISE Trans Occup Ergon Hum Factors. 2013;1(1):66-75. doi: 10.1080/21577323.2012.714839.

Young SL. Increasing the Noticeability of Warnings: Effects of Pictorial, Color, Signal Icon and Border. Proc Hum Factors Ergon Soc Annu Conf; 1991;35(9):580-584.

Shaver EF, Braun CC. CAUTION: How to Develop an Effective Product Warning. Risk Manag. 2008;55(6):46-51.

Smith-Jackson T, Druak T, editors. Posted Warnings, Compliance, Behavioral Intent. IEA 2000/HFES 2000 Congress; 2000.

Plimpton S, Root J. Materials and Strategies That Work in Low Literacy Health Communication. Public Health Rep. 1994:86-92.

Weiss BD. Health Literacy and Patient Safety: Help Patients Understand. Manual for Clinicians. Second Edition. American Medical Association Foundation. 2007.

Dunham S, Lee E, Persky A. The Psychology of Following Instructions and Its Implications. Am J Pharm Educ. 2020;84(8):1052-6.

Stableford S, Mettger W. Plain Language: A Strategic Response to the Health Literacy Challenge. J Public Health Policy. 2007;28(1):71-93.

Geller E, Farris J, Post D. Prompting a Consumer Behavior for Pollution Control. J Appl Behav Anal. 1973;6(3):367-76.

Austin J, Hatfield D, Grindle A, Bailey J. Increasing Recycling in Office Environments: The Effects of Specific, Informative Cues. J Appl Behav Anal. 1993;26(2):247-53.

Kurz T, Donaghue N, Walker I. Utilizing a Social-Ecological Framework to Promote Water and Energy Conservation: A Field Experiment. J Appl Soc Psychol. 2005;36(6):1281-300.

Taylor MA, Li A, Estock JL, Boudreaux-Kelly MY, Pham IT, Casey MC. Preferred Terms and Icons for Labels on Electrosurgical Units: Survey of VA Nurses. Biomed Instrum Technol. 2019;53(2):102-9.

Sigurdsson SO, Taylor MA, Wirth O. Discounting the Value of Safety: Effects of Perceived Risk and Effort. J Safety Res. 2013;46:127-34. doi: 10.1016/j.jsr.2013.04.006.

Pennsylvania Department of Health. Medical Care Availability and Reduction of Error (MCARE) Act, Pub. L. No. 154 Stat. 13 (2002). DOH website. https://www.health.pa.gov/topics/Documents/Laws%20and%20Regulations/Act%2013%20of%202002.pdf. Published 2002. Accessed April 28, 2022.

Article title and abstract on blue abstract background.

Published

2022-06-17

How to Cite

Sanchez, C. E., Taylor, M. A., & Jones, R. (2022). Visitor Behaviors Can Influence the Risk of Patient Harm: An Analysis of Patient Safety Reports From 92 Hospitals. Patient Safety, 4(2), 70–79. https://doi.org/10.33940/data/2022.6.7

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Section

Original Research and Articles
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