الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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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.