Interventions to Improve Patient Safety During the Covid-19 Pandemic: A Systematic Review

Abstract

ObjectiveTo summarize the literature on health care interventions to reduce harm to patients caused by the COVID-19 pandemic across six domains: medication errors, diagnostic errors, surgical errors, health care-associated infections, pressure injuries, and falls.MethodsWe performed a mixed methods systematic review, with the intention to present results narratively. We combined parallel searches and experiential evidence across each domain of interest. We included studies published between 11 March 2020 and 28 August 2023 that reported an intervention in response to an identified patient safety issue. We identified 13,019 unique articles across the six domains. Of these, 590 full texts were assessed for eligibility. Seven were included for the medication safety domain; seven for diagnostic safety; 32 for surgical safety; 11 for health care-associated infections; six for the pressure injuries; and two for falls (Annex C). Overall, a total of 61 unique articles were included – four articles were represented across more than one domain.FindingsThere 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, improvements in medication safety practices, and prevention of health care-associated infections. Publications emphasized the importance of implementing existing practices and following the latest guidelines to prevent health care-associated infections, medication errors, pressure injuries and falls.ConclusionThere is little research on interventions to reduce patient harm caused in health care 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 errors, health care-associated infections, pressure injuries, and falls. They also urged extra efforts to implement existing practices and following the latest guidelines already known to be effective. Development of high-reliability health systems and health care organizations 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.