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Abstract Today, attention to patient safety and its effect on both individual patient outcomes and the healthcare industry as a whole are rendered as one of the most important organizational successes in achieving the set goals. So, developing and retaining patient safety policies and procedures is one of the biggest challenges facing healthcare organizations. Moreover, patient safety depends on a combination of dimensions in the health care facilities; general patient safety standards, medication management safety standards, surgical procedures safety standards, and environmental safety standards. Therefore, comparing patient safety in accredited and non-accredited PHC units is important for all healthcare providers and patients/ clients of healthcare organizations, especially staff nurses, where job performance is affected by them. Aim of the study: Compare patient safety in accredited and non-accredited primary healthcare units, in Housh Isa City, El Beheira Governorate. Design of the study: A Descriptive comparative Research Design was used to conduct this study. The setting of the study: This study was conducted in all accredited and non-accredited PHC units in Housh Isa City, El Beheira Governorate. It includes 25 units divided into 18 Accredited PHC units namely; Okasha, Harara, Frhash, Elganbiehy, Abo El Shoqaf, El Abqaen, El Kom El Akhader, El Rozimat, Kafr Elwaq, ElQaza, ElQony, Emara, Kobry Abd, Nagieb Mahfoze, Mohamed Refat, Abass El Aqad, Abd Elmonaem Riad, and Maternal and Child Health Center (MCH). And, 7 Non-accredited PHC units namely; ELhadad Elbahary, Abo Fereen, Tawfik Elhakeem, Ali Ben Aby Talb, El Sheashaay, Abd Elmegeed Seleem, and El Stomaa. All PHC units are governmental units affiliated with the Ministry of Health and Population to provide primary health care services such as maternal and child health, immunizations, public education, environmental sanitation, dental care, treatment of chronic diseases… etc. Subjects of the study: The subject of the study was divided into two groups as follows: 1. The health care providers in the previously mentioned settings were 225 out of 428. It was divided as 162 healthcare providers from accredited PHC units, and 63 from non- accredited PHC units. The chosen healthcare providers were selected using the bowl technique. Accordingly, from each PHC unit, two nurses, one physician, one dentist, one pharmacist, one paramedical staff, one housekeeper, one health educator, and one maintenance staff were chosen. Summary 59 2. Patients/ clients sample size was 400 out of 42708. It was divided as 288 patients/ clients from accredited PHC units, and 112 from non-accredited PHC units, by equal allocation 16 patients/ clients from each of 25 PHC units based on the patients/ clients visited in the previous 3 months. For both subject groups, the sample size estimated using Epi Info software program with expected frequency =50%, margin of error 5%, and confidence coefficient level 95%. Tool of the study: One tool was used to conduct this study: The National Safety Requirements (NSR) for PHC Units, It was developed by General Authority for Healthcare Accreditation and Regulation (GAHAR) (2018)(120) to assess safety in the PHC setting. The tool was classified into four groups (A General Patient Safety Standards, B Medication Management Safety Standards, C Surgical Procedure Safety Standards, and D Environmental Safety Standards) with a total of 24 main standards, and 40 sub-standards with 57 items; as follow: group (A): General Patient Safety Standards, it includes 6 main standards, and 5 sub-standards with 10 items. group (B): Medication Management Safety Standards, it includes 6 main standards, and 5 sub-standards with 10 items. group (C): Surgical Procedure Safety Standards, it includes 4 main standards, and 3 sub-standards with 6 items. group (D): Environmental Safety Standards, it includes 8 main standards, and 27 sub-standards with 31 items. The response was measured on met, partially met, or unmet the higher score was indicate higher patient safety. The score ranges from met =2 to unmet = zero. A unit had to score 80% or more in each group separately and a total of 90% or more in all groups to pass the NSR evaluation.(120) In addition, a demographic characteristics data sheet of the study subjects was developed, it was include questions related to age, gender, marital status, educational qualifications, years of experience in the working unit, and years of experience since graduation. Methods: 1- Official written permission was obtained from the Dean of the Faculty of Nursing, Damanhour University, and the responsible authorities of the study settings, at the Housh Isa PHC units, after an explanation of the study’s aim to facilitate the collection of the necessary data. 2- The tool was in Arabic and English language by the organization that developed it, General Authority for Healthcare Accreditation and Regulation (GAHAR).(120) 3- The tool was tested for its validity by five experts in the field of the study, and the necessary modifications were done accordingly. Summary 60 4- The reliability of the tool was tested statistically using Cronbach’s Alpha Coefficient test to measure the internal consistency of the items composing each dimension of the tool. The results of Cronbach’s Alpha Coefficient test were (0.790); it was reliable. 5- A Pilot study was carried out on 10% of the total sample size from the health care providers and patients/ clients in accredited and non-accredited PHC units, that equal (n=23) healthcare providers and were classified as the following: two physicians, five nurses, three dentists, three pharmacists, two paramedical staff, three housekeepers, two health educators, three maintenance staff, as well as an equal (n=40) patients/clients too, to check and ensure the clarity of the study’s tool and to identify obstacles and problems that may be encountered during data collection and any necessary modifications were done. The pilot sample was not included in the study sample. 6- The concurrent audit was utilized for data collection through; reviewing documents, observation, and structured interviews according to the standard form. Reviewing documents to assess for example; patient safety policy and procedure, observation for example; hand hygiene facilities, supplies, and a structured interview with healthcare providers and patients/clients for example; to assess the healthcare providers’ awareness of policies and procedures, fire safety plan and interview patients/clients, for example, to ask them if they asked by physicians about current medication. 7. The collected data were tabulated and analyzed using the appropriate statistical analysis. The main results of the present study were as follows: 1. There is a statistically significant difference between the accredited and non- accredited PHC units concerning the total patient safety standards mean scores. 2- The accredited PHC units had a higher total domain (A) the general patient safety standards and domain (D) the environmental safety standards mean scores than those of the non-accredited PHC units with a statistically significant difference between them. 3- A higher total domain (B) medication management safety mean scores were found in the accredited PHC units compared to the non-accredited PHC units. 4- There was no difference between the accredited and the non-accredited PHC units in domain (C) the surgical safety procedures standards mean scores. 5. All accredited primary healthcare units were fully met in domain D the environmental safety standards, while all non- accredited primary healthcare units were partially met. Summary 61 In light of the results of the current study, the following recommendations can be suggested: I. The PHC unit managers should: Unit mangers have to develop strategies to improve general patient safety standards through: 1- Empower and motivate healthcare providers by increasing financial benefits, rewards, and recognition of their work. 2- Contribute to change by creating increased awareness for all healthcare providers to ensure appropriate error-preventing procedures and systems in the healthcare environment. 3- Create an environment that addresses and prevents potential or actual safety problems that can help to reduce the incidence of medical errors by healthcare providers in the workplace. II. The healthcare providers’ Managers should: 1- Obtain feedback from healthcare providers and patients/ clients will allow gaining insight into process improvement techniques, improved learning, teamwork, and communication skills in the healthcare system. 2- Enhance the healthcare providers’ participation in the assessment and evaluation of their PHC unit to identify their defects and to be able to pinpoint issues or concerns to create an action plan for improvement. 3- Provide opportunities for growth and development of the healthcare providers’ abilities, through attaining training programs for general patient safety standards and encouraging self-learning and updating of their knowledge. III. The healthcare providers should: 1- Attend specific meetings, workshops, training programs, and seminars held that will help in improving their performance. 2- Follow organizational policies, rules, and regulations regarding patient safety standards . 3- Cooperate and communicate openly with each other and with their managers to discuss obstacles that are facing them when applying their work and ways for improvement to achieve a high level of patient safety. IV. Future/ Further studies should be conducted: • Assessment of obstacles that affect healthcare providers’ compliance with patient safety standards. • Assessment of Key Performance Indicators (KPI) in accredited and non-accredited primary healthcare units: A comparative study. |