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“It’s one of our primary responsibilities to ensure that patients are safe.” Perspectives and strategies of technical aid providers to establish and maintain patient safety in home mechanical ventilation

Authors:

Susanne Stark ,

Charité - Universitätsmedizin Berlin, Germany, DE
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Yvonne Lehmann

DE
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Abstract

Introduction

The complexity of home mechanical ventilation (HMV) requires integrated and co-ordinated services to ensure high-quality and safe healthcare. Technical aid providers in Germany are attributed legal responsibilities in establishing and maintaining application safety for ventilator-associated (life-sustaining) devices. However, whether and how this is achieved is largely unknown. As part of a larger study, we aimed to explore the providers’ perspectives on safety in ventilator-associated technical aid supply, focusing particularly on subjective safety concepts, perceived safety, roles and applied strategies in establishing and maintaining safety.

Theory/Methods

 An explorative qualitative design was applied. Episodic interviews with purposeful contrastively sampled experienced field representatives of German technical aid providers were planned. Interviews were conducted face-to-face or via videoconference between 8 and 10/2020 using a flexible interview guide. Conversations were audio-recorded, transcribed verbatim, and analysed using qualitative content analysis and MAXQDA software.

Results

Safety was predominantly defined in terms of technical aspects and evaluated as safe in eleven interviews with interviewees majorly qualified in intensive nursing care. Participants ascribe themselves a primary responsibility for establishing and maintaining safety but, simultaneously, experience relative isolation in the healthcare context. Besides aid supply and implementation, major tasks comprise contractually agreed instruction and training in aid application during regular home visits and 24/7 emergency services, involving supply monitoring and, to some extent, the adoption of healthcare services (e.g. tracheostomy tube change). Additionally, they adopt hospital discharge management tasks and support interprofessional communication. Their strategies are diverse, primarily intuitive and oriented to perceived user needs. Providers identify primary safety risks and challenges to their work in healthcare fragmentation and lacking accountability, coordination problems, structural (e.g. shortage/qualification deficits among nurses and prescribing physicians) and legal deficiencies (lacking mandates, insufficient reimbursement of services).

 

 

Discussion & lessons learned

Our results complement existing evidence on safety in a highly complex healthcare field. Contrasted with the patient and stakeholder perspective, they can contribute to developing recommendations for improved HMV technical aid supply, including discourse on whether and how assigned responsibilities can be adequately addressed by providers, carefully considering the accountabilities of other professionals and evidence from international approaches concerning technical aid supply. From a systems perspective, the need for improved co-ordination and collaboration in HMV becomes apparent. Accordingly, a conceptual understanding of safety can contribute to developing goal-oriented, evidence- and theory-based prevention and mitigation strategies.

Suggestions for future research

Future research should emphasise 1) advancing knowledge on safety in HMV technical aid supply and beyond, 2) developing theory- and evidence-based safety recommendations and strategies, and 3) answering how healthcare integration can contribute to safe and high-quality care for patients receiving HMV.

Limitations

 An interview-based approach can only approximate actual tasks and strategies. However, it enabled the study plan to be followed during the COVID-19 pandemic. Furthermore, selection bias is expectable due to participant self-selection whose perspectives represent the views of highly engaged providers.

Conclusion

Technical aid providers’ perspectives and views on systems, structural and legal challenges pose important suggestions for the future development of HMV and aid supply. 

How to Cite: Stark S, Lehmann Y. “It’s one of our primary responsibilities to ensure that patients are safe.” Perspectives and strategies of technical aid providers to establish and maintain patient safety in home mechanical ventilation. International Journal of Integrated Care. 2022;22(S1):22. DOI: http://doi.org/10.5334/ijic.ICIC21011
Published on 08 Apr 2022.

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