Table 2

Qualitative analysis of transcripts from 24 rounding sessions for patient safety themes and codes applied for identification of PS educational messages

Themes
Representative examples
Total PS messages
N (%)
Major codes*
N (%)
 Medication safety
 ‘What is the spironolactone dose for heart failure because it’s different than cirrhosis? …that is a mistake people make’.
 ‘You throw in hypnotics, opioids and Benzos on these (elderly) people. You are asking for a recipe for a disaster’.
116 (31.8%)Rationale for drug usage 21 (18%)
Preventing complications 19 (16%)
Discontinuation of drugs 19 (16%)
Pain management 13 (11%)
 Discharge safety
 ‘If he’s got some support, we can discharge him. He looks like he’s not going to be okay by himself…. Find some support. He needs follow’.
 ‘If you plan to discharge tomorrow, get the patient up, move around, remove Foleys, iv lines need to be removed, stop iv fluids’.
72 (19.7%)Continuity of care 37 (51%)
Discharge readiness 12 (17%)
Safe placement 8 (11%)
 Preventing diagnostic errors
 ‘When we don’t have diagnosis, we end up over treating or not treating’.
 ‘You find yourselves swimming in a sea of nothingness until you have your diagnosis’.
51 (14.0%)Clinical reasoning/dx 19 (37%)
Rationale for tests 11 (21%)
 Procedural safety
 ‘The (rectal) cuff …applies pressure to the mucosa and sometimes you end up being with pressure necrosis. We want to keep the tube in as short (a time) as possible’.
37 (10.1%)Aspiration precautions 9 (24%)
Preoperative, perioperative and postoperative 6 (16%)
 Communication
 ‘I tell my patients you should keep all your medication list in your pocket or wallet’.
29 (7.9%)Educating the patient 13 (44%)
Medication reconciliation 6 (20%)
Inpatient safety
‘Did we address all patient safety things … Is (he) on DVT precautions?’
25 (6.8%) Restraint safety 7 (28%)
 Preventing complications 7 (28%)
 Comfort measures 5 (20%)
 Healthcare-associated infections
 ‘Once you leave the room, you have to wash your hands with soap and water. The alcohol doesn’t stop (C. difficile). We don’t want to spread (an) epidemic’.
18 (4.9%)Contact precautions 6 (33%)
Intravenous catheters 6 (33%)
Hand hygiene 4 (22%)
Patient safety culture
‘She is transferred to you guys with severe Cor Pulmonale. Appropriately she is DNR … She needs morphine for her dyspnoea. LOW DOSE of morphine’.
16 (4.3%)Code status 5 (31%)
End of life issues 4 (25%)
  • *Codes with >10% of the frequency of messages. They accounted for >60% of total messages.

  • dx, diagnosis; PS, patient safety.