Threats to patient safety in the primary care office: concerns of physicians and nurses.
BACKGROUND
Little is known about primary care professionals' concerns about risks to patient safety.


OBJECTIVE
To identify threats to patient safety in the primary care office from the perspective of physicians and nurses.


METHODS
Cross-sectional survey; participants were asked to name and rank threats to safety they personally were most concerned about.


METHODS
Physicians and nurses working in primary care offices in Switzerland.


METHODS
Verbatim reports were analysed under an inductive content-analysis framework. Coded threats were quantitatively analysed in terms of frequency and prioritisation. Differences between physicians and nurses were analysed.


RESULTS
Of 1260 invited individuals, 630 responded to the survey and 391 (31%) described 936 threats to patient safety. The coding system included 29 categories organised in 5 themes. Agreement of coders was good (kappa = 0.87, CI = 0.86-0.87). Safety of medication (8.8%), triage by nurses (7.2%) and drug interactions (6.8%) were the threats cited most frequently. Errors in diagnosis (OR = 0.21, CI 0.09-0.47, p <0.001), drug interactions (OR = 0.10, CI 0.04-0.25, p <0.001) and compliance of patients (OR = 0.28, CI 0.08-0.96, p = 0.044) were more likely to be cited by physicians. X-rays (OR = 3.34, CI 1.04-10.71, p = 0.043), confusion of patients or records (OR = 3.28, CI 1.55-6.94, p = 0.002), hygiene (OR = 3.21, CI1.12-9.19, p = 0.030), safety of office rooms (OR = 6.70, CI 1.46-30.73, p = 0.014), and confidentiality (OR = 7.38, CI 1.63-33.50, p = 0.010) were more likely to be described by nurses.


CONCLUSIONS
Physicians and nurses are concerned about diverse threats to patient safety in primary care. Involving both groups in detection and analysis of risks in medical offices seems a valuable strategy to improve collaboration and safety.
Swiss Patient Safety Foundation, Zuerich, Switzerland. schwappach@patientensicherheit.ch
David L B
DL
Schwappach
Katrin
K
Gehring
Markus
M
Battaglia
Roman
R
Buff
Felix
F
Huber
Peter
P
Sauter
Markus
M
Wieser
D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D009726:Nurses / Q000523:psychology*; D061214:Patient Safety; D010820:Physicians / Q000523:psychology*; D011320:Primary Health Care; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013557:Switzerland