Interventions to improve patient safety during the COVID-19 pandemic: a systematic review

Abstract

Objective: To summarise the literature on healthcare interventions to reduce harm to patients caused by the COVID-19 pandemic across six domains: medication safety, diagnostic safety, surgical safety, healthcare-associated infections, pressure injuries and falls.

Methods: We performed a mixed-methods systematic review, with the intention to present results narratively. We combined parallel searches and expert input across each domain of interest, identifying 13 019 unique articles across the six domains. Of these, 590 full texts were assessed for eligibility. 7 were included for the medication safety domain; 7 for diagnostic safety; 32 for surgical safety; 11 for healthcare-associated infections; 5 for the pressure injuries and 2 for falls. Overall, a total of 61 unique articles were included-4 articles were represented across more than one domain.

Findings: There were few rigorous evaluations of specific interventions to reduce patient harm caused by the pandemic. Adjustments in treatments, triage and procedures, and use of risk stratification tools reduced delays and permitted more elective surgery and diagnostic testing to proceed. These changes also led to improvements in medication safety practices and prevention of healthcare-associated infections.

Conclusion: There has been little research on interventions to reduce patient harm caused in healthcare settings during the COVID-19 pandemic. Interventions focused on preventing nosocomial transmission of COVID-19 and on permitting access to urgent surgical and diagnostic needs. A few studies tested strategies to reduce new risks imposed by the pandemic for medication safety, healthcare-associated infections, pressure injuries and falls. Development of high-reliability health systems and healthcare organisations to protect patients and health workers from harm will be essential to mitigating the impact of future pandemics within the objectives of the Global Patient Safety Action Plan 2021-2030.

Keywords: COVID-19; Diagnostic errors; Health services research; Healthcare quality improvement; Medication safety.

Figure 1. Intervention themes appearing within each safety domain. Edu, Education; Mod Proc, Modified Procedures; Safety guide, Adapted Safety Guidelines; Triag, Triaging; IT, Information Technology; Telemed, Telemedicine; Team com, Team Communication.

Figure 2. Geographical distribution of studies, by safety domain and intervention theme. Med = Medication safety, Diag = Diagnostic safety, Surg = Surgical safety, HAI = Healthcare-associated infections, PI = Pressure injuries; Mod Proc = Modified Procedures, Safety guide = Adapted Safety Guidelines, Triag = Triaging, IT = Information Technology, Telemed = Telemedicine, Edu = Education, Team com = Team Communication Diag, Diagnostic safety; Edu, Education; HAI, Healthcare-associated infections; IT, Information Technology; Med, Medication safety; Mod Proc, Modified Procedures; PI, Pressure injuries; Surg, Surgical safety; Safety guide, Adapted Safety Guidelines; Triag, Triaging; Telemed, Telemedicine; Team com, Team Communication.