الفهرس 
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Abstract
Patient’s safety has received increased attention in recent years, but mostly with the focus on the epidemiology of errors and adverse events rather than on practice that reduce such events. The National Forum for Quality Measurement and Reporting ( the National Quality Forum) define a patient safety practice as a type of process or structure whose application reduce the probability of adverse events resulting from exposure to the health care system a cross the range of disease or procedure.
Bronchoscopy procedures nowadays are considered the cornerstone of diagnosis and treatment in lung problems. The development of bronchoscopy has provided enormous benefits to patients by early and accurate diagnosis. Moreover, it identifies the patients with serious conditions, so can be treated more simply, safely, cheaply, and effectively. Bronchoscopy can be used to diagnose the causes of persistent cough, coughing up blood, spots seen on chest X-rays, vocal cord paralysis, interstitial pulmonary disease, inflammation and infections such as: tuberculosis (TB), pneumonia, and fungal or parasitic lung infections, narrowed areas in airways and airway blockage (obstruction). It also has been allowed for the detection of tumors or bronchial cancer. Similarly, it has an important therapeutic role in removal of secretions, blood, mucus plugs, or growths (polyps) to clear airways, control of bleeding in the bronchi, removing foreign objects or other blockages, radiation treatment for bronchial tumors, stent placement, drainage of abscess, collection of sputum and biopsy of tissue.
The technique of bronchoscopes is extremely safe, with very low rates of complications, when performed by both; a properly trained bronchoscopist and highly qualified bronchoscopy nursing staff. The quality of nursing care depends on comprehensive and intelligent determination of the impact of nursing interventions on the health status of the patient where the patients are the concern of this determination.
The architectural design of the bronchoscopy unit is considered as extensive infrastructure that fits the international standards of patient safety and infection control, in addition to instilling comfort and security for both the patients and the staff. The modern bronchoscopy unit has areas devoted to preparation, procedure, recovery, cleaning, maintenance and storage of equipment, reporting and archiving, as well as staff management.
The bronchoscopic nurse is responsible for providing a professional, holistic patient care in order to ensure patient’s physical safety and psychological well-being before, during and after bronchoscopy procedures to prevent any hazards or avoidable complications. Safety measures for each patient should be considered as this carried out in three time periods: ”The pre-procedure period” which includes all contacts between the bronchoscopist, bronchoscopy nurses, and unit staff with the patient before the administration of sedation or insertion of the bronchoscopy. ”The intraprocedure period” extends from the administration of sedation or insertion of the bronchoscopy to its removal. ”The postprocedure period” extends from the completion of the procedures to subsequent follow-up.
The aim of this study: was to assess the safety measures provided for patients undergoing bronchoscopy.
The study was conducted at the bronchoscopy unit at Smoha University Hospital (SUH). The hospital is affiliated to the Ministry of Higher Education and provides public non paid services. This unit is composed of seven rooms divided as follows; two procedure rooms; each room contains one bed, mobile carts to hold the necessary equipment and supplies for the procedure, connected with telescreen to display the procedure, each procedure room includes a reprocessing area. There are three additional rooms used as; recovery and preparation areas for bronchoscopy admitted patients, each room has three beds and a bathroom. The unit also contains one nursing room and one physician’s room.
A convenient sample of (80) adult patients underwent bronchoscopy, at the time of data collection at the above mentioned setting, were included.
To fulfill the objectives of the study, one tool was developed by the researcher after reviewing the current national and international related literature to collect the necessary data for this study. It was entitled as: ”Safety Measures Provided for Patients Undergoing Bronchoscopy Observational Checklist”.
The tool comprised of two parts:
Part one:
This part is a patient’s data sheet attached to the tool. It included items related to patient’s socio-demographic data such as: patient’s age, sex, marital status, level of education, occupation. Health relevant data included; diagnosis, date of admission, type of bronchoscopy, time of start the procedure, time of discharge from the procedure room, medical history which include presence of associated disease; arrhythmia, heart failure, hypertension, diabetes, asthma, COPD, tuberculosis , hepatitis C etc…These data also comprised: chief complaints, current medications and laboratory investigations as: International Normalized Ratio (INR), hemoglobin, prothrombin activity, prothrombin time, serum urea, serum creatinine and others. This part also contained assessment of vital signs (temperature, pulse, respiration, blood pressure and oxygen saturation).
Part two:
This part was used to assess the safety measures provided throughout the three phases of bronchoscopy procedure as well as complications penetrated to unsafe measures during and immediately after procedures, if any. It included three sections and each section contained items as follows:
Section (1): which, was developed to assess safety measures provided to patients prior to bronchoscopy procedure, it’s further subdivided as:
Section (1.a): Ideal physical setup of the bronchoscopy unit and facilities which included: reception and waiting area, preparation area, procedure room, recovery area, reprocessing/decontamination area, bronchoscope, equipment and supply storage area, nursing manager office and crush cart. Section (1.b): ”Safety measures provided to patient before the bronchoscopy”, which included items related to: physical, mechanical, thermal, electrical, bacteriological, chemical and psychological safety.
Section (2): ”Safety measures provided to patient during the bronchoscopy procedure”. It included items related to: physical, electrical, thermal, instrumental and mechanical, psychological and bacteriological safety.
Section (3): ”Safety measures provided to patient after the bronchoscopy procedure” comprised items allied to: physical, psychological safety and decontamination of bronchoscope and accessories equipment through; preliminary cleaning, manual cleaning, disinfection, automated bronchoscope reprocessing machines, storage and care of accessory.
Section (III): ”the complications related to unsafe measures during and immediately after the procedure” which entitled as follows: anesthesia complications which included: hypoxemia, hypercapnia, bradycardia, hypotension, vaso-vagal effect, respiratory depression, excitability, seizure, hemoptysis, nausea, vomiting, arrhythmia, gas embolism, cardio respiratory arrest and technical complications which included: hemorrhage, vocal cord injury, laryngospasm, bronchospasm, pneumothorax, damage to teeth, fever, chills, bacteremia, sinusitis, pneumonia and others.
Scoring of the tool:
The scores for safety measures provided to patients before the procedure were ranging from (0-82), safety measures provided to patients during the procedure were (0-76) and for safety measures provided to patients after the procedure were from (0-96).
The tool was revised by experts in the field of the study for content validity and the necessary modifications were done. A pilot study was done for the developed tool. Data were collected throughout a period of 6 months, from the beginning of April 2016, till end of September 2016.
The following were the most important results of the present study:
Sixty seven point five percent of patients were males while 32.5% were females. The mean patients’ age was (47.24 ± 11.88). Nearly two thirds of subjects (65.0%) were not working while the remaining subjects (35.0%) were working; more than one third of them (i.e 39.3%) had clerical works while 60.7% had manual work.
As regard to bronchoscopy unit’s physical structured set up and facilities the results revealed that:
The highest mean score was (100.0 ± 0.0) for reception and waiting areas, followed by preparation area, reprocessing/ decontamination area, procedure room, recovery area, equipment and supply storage area with (86.46 ± 5.15, 85.54 ± 1.12, 85.50 ± 1.82, 71.52 ± 0.80 and 70.25 ± 2.24), respectively and the lowest mean score was (17.19 ± 26.56) for crash carts.
Regarding safety measures provided for patients before the bronchoscopy procedure the results showed that:
The highest mean score was (100.0 ± 0.0) for mechanical safety, followed by electrical, chemical and thermal safety with (99.79 ±1.86, 98.13 ± 12.44 and 72.71 ± 13.32), respectively and the lowest mean score was (36.11 ± 6.73) for bacteriological safety.
Concerning safety measures provided for patients during the bronchoscopy procedure the results presented that:
The highest mean score was (100.0 ± 0.0) for thermal safety, followed by Instrumental and mechanical, electrical, physical, psychological safety with (99.43 ± 3.85, 99.37 ± 5.59, 88.13 ± 4.88 and 82.50 ± 23.67), respectively and the lowest mean score was (46.67 ± 12.12) for bacteriological safety.
Regarding safety measures provided for patients after the bronchoscopy procedure the results showed that:
The highest mean score was (70.42 ± 7.49) for psychological safety, followed by (67.48 ± 2.31) for decontamination of bronchoscope and accessory equipment and the lowest mean score was (49.73 ± 8.99) for physical safety.
In relation to patients’ complications related to unsafely measure during and immediately after the procedures.
It was noted that the only observed anesthesia complications throughout the study, during and immediately after the bronchoscopy procedures was hypoxemia, which represented 2.5% of the complications, encountered, and through to be anesthesia, related and none of the patients had any technical complications.
Regarding safety measures before, during and after bronchoscopy procedure to the assigned; healthcare providers. The results illustrated that:
The safety measures before bronchoscopy procedures to the assigned; healthcare providers
The highest percent measures ”done safely” by nurses were 100% for electrical and chemical safety measures while the least percent was 45.0% for bacteriological safety measures.
Concerning doctors’ safety measures; the highest percent ”done safely” was 6.3% for mechanical safety measures while the lowest percent was 1.3% for thermal safety measures. Other safety measures were ”not done” at all by all doctors.
None of the safety measures identified, were done, at all by neither workers nor anesthesiologist.
As regard safety measures during bronchoscopy procedure to the assigned; healthcare providers. The results demonstrated that:
Nurses’ safety measures during bronchoscopy procedures the table shows that; the highest percent measures ”done safely” was 100% for instrumental and mechanical safety measures while the lowest percent was 45.0% for bacteriological safety measures.
Doctors’ safety measures; the highest percent ”done safely” was 63.8% for psychological safety measures while the lowest percent was 1.3% for electrical safety measures. Other safety measures were ”not done” at all by all doctors.
None of the safety measures identified, were done, at all by neither workers nor anesthesiologist.
In relation to safety measures after bronchoscopy procedure to the assigned; healthcare providers. The results showed that:
Nurses’ safety measures after bronchoscopy procedures the table shows that; the highest percent measures ”done safely” was 98.8% for decontamination of bronchoscopes and accessory equipment, while the lowest percent was 95.0 % for physical safety measures.
Doctors’ safety measures; the highest percent ”done safely” was 1.3% for physical and psychological safety measures, while other safety measures were ”not done” at all by all doctors.
Anesthesiologist safety measures; the highest percent ”done safely” was 3.8% for physical safety measures, while other safety measures were ”not done” by at all anesthesiologist.
None of the safety measures identified were done, at all by workers.
There was a positive statistical significant correlation between the ideal physical setup and safety measures provided to patients before bronchoscopy. Statistical negative correlations were elicited between the physical setup and safety measures provided both during and after bronchoscopy where r= -0.475* &-0.433* respectively & where p were <0.001*.
Based on these results, the following recommendations were suggested:
o updated pre service and annual in-service training programs for healthcare providers working at bronchoscopy units are highly advocated with emphasis on the newly assigned staff. Recent infection control guidelines, have to be strictly advocated.
o Developing procedural manual and standards specific to bronchoscopy patient’s safety in Arabic is highly required.
o Regular annual self-appraisal for healthcare providers about patients’ safety measures.
o Replication of study on large probability samples is very important.
Recommendations for further researchers:-
o Developing standards of safe bronchoscopy nursing care.
o Developing manuals for safety measures provided for patients undergoing bronchoscopy procedures at varied Egyptian bronchoscopy units.
o Determine the effects of the safety measures application provided for patients undergoing bronchoscopy procedures on their clinical outcomes.
o Identifying local barriers hindering healthcare providers’ application of safety measures at the bronchoscopy unit.