Safety culture in the organ donation process: a literature review

An integrative literature review was conducted in the CINAHL, LILACS, PubMed, Scopus, and Web of Science databases, and the electronic library, SciELO, from 2012 to 2016, using a syntax of keywords and descriptors for each database; fourteen articles were selected for analysis.

Results

One thousand six hundred and fifty nine studies were found, 33 complete articles were read, and 14 studies were selected for analysis. The information obtained was analyzed critically and grouped into two categories. Category 1 – patient safety culture for the use of medications in the post-transplant period: the involvement of the multidisciplinary team is essential in the orientation process for hospital discharge, and the main factors related to errors in the use of medicines. Category 2 - safety culture in the transplant units: issues related to patient safety of those undergoing transplantation in the pre- and intra-operative periods.

Conclusion

This study showed that the issue of a culture of safety in the donation and organ transplantation process is incipient in the literature; well-designed studies related to the culture of patient safety are necessary for all the stages of the donation and transplant process.

Organizational culture; Patient safety; Tissue and organ procurement; Transplantation

Author/Year/Country/Level of evidence	Outcomes
Haipeng Meng, Jiayin Yang, Lunan Yan (2016)⁽¹¹11. Meng H, Yang J, Yan L. Donor safety in adult-adult living donor liver transplantation: A single-center experience of 356 cases. Med Sci Monit. 2016;22:1623-9.⁾ China. Level IV evidence	With measures used to improve the preoperative assessment and liver surgery, the risk for liver donors is controllable and acceptable.
Lima et al. (2016)⁽¹²12. Lima LF, Martins BC, Oliveira FR, Cavalcante RM, Magalhães VP, Firmino PY, et al. Pharmaceutical orientation at hospital discharge of transplant patients: strategy for patient safety. einstein (São Paulo). 2016;3(14):359-65.⁾ Brazil. Level IV evidence	The clinical pharmacist should be part of the multiprofessional team for education of the transplant patient at the time of hospital discharge, to prevent negative results associated with pharmacotherapy, and to guarantee medication reconciliation and patient safety.
McElroy LM, et al. (2016)⁽¹³13. McElroy LM, Woods DM, Yanes AF, Skaro AI, Daud A, Curtis T, et al. Applying the WHO conceptual framework for the International Classification for Patient Safety to a surgical population. Int J Qual Health Care. 2016;28(2):166-74.⁾ USA. Level IV evidence	A structure for patient safety can be applied to facilitate the organization and analysis of surgical safety data. Classification instruments can be easily and consistently applied for surgeries, in a standardized manner
Fermo et al. (2015)⁽¹⁴14. Fermo VC, Radünz V, Rosa LM, Marinho MM. Patient safety culture in a bone marrow transplantation unit. Rev Bras Enferm. 2015; 68(6):827-34.⁾ Brazil. Level IV evidence	The safety culture needs to be valued by professionals and managers aiming to achieve safe care by the professionals who work in the transplant unit. It is recommended that staff and managers discuss actions to be implemented in order to strengthen patient safety culture.
Kucirka LM, et al. (2015)⁽¹⁵15. Kucirka LM, Bowring MG, Massie AB, Luo X, Nicholas LH, Segev DL. Landscape of deceased donors labeled increased risk for disease transmission under new guidelines. Am J Transplant. 2015;15(12):3115-23.⁾ USA. Level IV evidence	It is critical to understand the mechanism and consequences of increased use of borderline organ donors in order to ensure a balance between patient safety and organ use.
Bonkowski et al. (2014)⁽¹⁶16. Bonkowski J, Weber RJ, Melucci J, Pesavento T, Henry M, Moffat-Bruce S. Improving medication administration safety in solid organ transplant patients through barcode-assisted medication administration. Am J Med Qual. 2014;29(3):236-41.⁾ USA. Level IV evidence	Routine adaptation of a barcode-based medicine delivery method has the potential to reduce medication administration errors in transplant patients.
Hsu et al. (2014)⁽¹⁷17. Hsu YC, Jerng JS, Chang CW, Chen LC, Hsieh MY, Huang SF, et al. Integrating team resource management program into staff training improves staff’s perception and patient safety in organ procurement and transplantation: the experience in a university-affiliated medical center in Taiwan. BMC Surg. 2014;14(51):1-8.⁾ Taiwan. Level III evidence	Implementing a team resource management program on patient safety and team member behaviors improves the culture of teamwork as well as patient safety in organ procurement and transplantation.
McElroy LM, et al. (2014)⁽¹⁸18. McElroy LM, Daud A, Lapin B, Ross O, Woods DM, Skaro A, et al. Detection of medical errors in kidney transplantation: a pilot study comparing proactive clinician debriefings to a hospital-wide incident reporting system. Surgery. 2014;156(5):1106-15.⁾ USA. Level IV evidence	The use of a web-based questionnaire to increase use of an incident reporting system for assessing safety risks in renal transplants demonstrated increased information, more prospects for a single safety issue, and an increased range of participants.
Torres-Rodríguez et al.(2014)⁽¹⁹19. Torres-Rodriguez IB, Fierro EC, Creixans XS, Allende MS, Rivero MA, Carrascosa MP, et al. Safety and efficacy of outpatient biopsy in renal transplantation. Nefrologia. 2014;34(6):749-55.⁾ Spain. Level IV evidence	Outpatient renal allograft biopsy is a safe and efficient procedure, allowing lower incidence of complications.
Gala-Lopez et al. (2013)⁽²⁰20. Gala-Lopez B, Kin T, O’Gorman D, Pepper AR, Senior P, Humar A, et al. Microbial contamination of clinical islet transplant preparations is associated with very low risk of infection. Diabetes Technol Ther. 2013; 15(4):323-7.⁾ Canada. Level IV evidence	The preparation of islets prior to implantation and the administration of appropriate antibiotics prevent contamination of the patient, promote safety, and decrease possible complications in immunosuppressed patients.
Martins et al. (2013)⁽²¹21. Martins BC, Souza TR, Luna AM, Fonteles MM, Firmino PY, Fernandes PF, et al. Pharmaceutical care in transplant patients in a university hospital: pharmaceutical interventions. Braz J Pharm. 2013; 49(4):659-68.⁾ Brazil. Level IV evidence	A pharmaceutical care service enables monitoring of pharmacotherapeutic treatment and intervention in a manner that provides greater team and patient safety.
Musgrave et al. (2013)⁽²²22. Musgrave CR, Pilch NA, Taber DJ, Meadows HB, McGilicuddy JW, Chavin KD, et al. Improving transplant patient safety through pharmacist discharge medication reconciliation. Am J Transplant. 2013;3(13):796-801.⁾ USA. Level IV evidence	The involvement of pharmacists, particularly at hospital discharge, leads to improved medication safety. Future studies are needed to evaluate other possible consequences of the pharmacist’s involvement
Taber et al. (2013)⁽²³23. Taber DJ, Plich NA, McGilicuddy JM, Bratton CF, Chavin KD, Balinga PK. Improved patient safety and outcomes with a comprehensive interdisciplinary improvement initiative in kidney transplant recipients. Am J Med Qual. 2013; 28(2):103-12.⁾ USA. Level IV evidence	Improved safety, and reduced rates of acute rejection and infection were noted after a multidisciplinary quality improvement initiative on medication distribution.
Muñoz et al. (2012)⁽²⁴24. Muñoz P, Rojas R, Cervera C, Garrido G, Fariñas MC, Valerio M, et al. Poor compliance with antifungal drug use guidelines by transplant physicians: a framework for educational guidelines and an international consensus on patient safety. Clin Transplant. 2012;26(1):87-96.⁾ Spain. Level IV evidence	The adherence of transplant physicians to the current recommendations on antifungal and prophylaxis treatment is weak. Thus, there is a clear need for an international consensus that emphasizes patient safety in this regard.

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[1] Corresponding author. Neide da Silva Knihs https://orcid.org/0000-0003-0846-5227 E-mail: neide.knihs@ufsc.br