Samenvatting

Introduction A quality management system (QMS) in
healthcare organisations encompasses not only policies,
processes and necessary procedures but also the quality,
safety and risk management of medical technology.
Tactical and operational decision-making levels should be
closely interconnected. Previous studies have shown that
nurses at the operational level do have good awareness of
patient safety, but especially in teams with a strong degree
of self-organisation, interaction with tactical levels is an
issue. The tactical level is regarded as crucial for linking
top-down policy with bottom-up experiences.
Objectives To explore the perspectives of homecare
employees working at a tactical level regarding (1)
the quality frameworks used within their organisation
according to these employees, (2) the extent to which
these employees are aware of the procedures for the
safe use of advanced medical technologies (AMTs), such
as infusion pumps, within their organisation and (3) how
these employees perceive the patient safety culture
related to the use of AMTs within their organisation.
Design A qualitative descriptive research design was
employed.
Setting and participants 15 semistructured interviews
were conducted online with purposively sampled
participants from homecare organisations across the
Netherlands that had previously participated in related
studies. The participants were employees at the tactical
level within these homecare organisations, responsible for
the quality and safety of AMTs.
Results All participating organisations possess a QMS;
however, only seven indicated that there is a dedicated
plan for ensuring the quality and safety of AMTs.
National protocols for the use of AMTs and the supplier’s
maintenance protocols are commonly followed. Although
some participants say that their organisation has no
formal procedure for resolving malfunctions with AMTs, all
participants know pathways for solving problems. Tailored
training programmes for nurses on AMTs are provided,
but often without testing knowledge and skills or formal
registration of nurses’ competence. Professionals report
an incident on a separate form in the electronic client file
or via a separate reporting system. However, there is no
uniformity within organisations about handling incidents.
Most interviewees state that, in any case, incidents are
discussed within the team. On the dimension ‘reporting,
evaluating and learning from incidents’ of the ‘Instrument
for Self-Evaluation of Patient Safety Culture’, the prevailing
patient safety culture is, on average, characterised as
‘proactive’.
Conclusions There is a lack of uniformity regarding
quality and safety procedures for the use of AMTs in
homecare organisations, and structured policies for
the implementation, use and maintenance of AMTs
are needed. This study identified additional risk factors
regarding individual competencies in the use of AMTs at
home.