***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Involvement of patients in the detection and prevention of safety related events and medical errors have been widely recommended . However , it has also been question ed whether patients at large are willing and able to identify safety-related events in their care . The aim of this study was to develop and pilot test a brief patient safety survey applicable to inpatient care in Swiss hospitals . Methods A survey instrument was developed in an iterative procedure . The instrument asks patients to report whether they have experienced specific undesirable events during their hospital stay . The preliminary version was developed together with experts and tested in focus groups with patients . The adapted survey instrument was pilot-tested in r and om sample s of patients of two Swiss hospitals ( n = 400 ) . Responders to the survey that had reported experience of any incident were sample d for qualitative interviews ( n = 18 ) . Based on the interview , the research er classified the reported incidents as confirmed or discarded . Results The survey was generally well accepted in the focus groups and interviews . In the quantitative pilot test , 125 patients returned the survey ( response rate : 31 % ) . The mean age of responders was 55 years ( range 17–91 , SD 18 years ) and 62.5 % were female . The 125 participating patients reported 94 " definitive " and 34 " uncertain " events . 14 % of the patients rated any of the experienced events as " serious " . The definitive and uncertain events reported with highest frequency were phlebitis , missing h and hygiene , allergic drug reaction , unavailability of documents , and infection . 23 % of patients reported some or serious concerns about their safety . The qualitative interviews indicate that both , the extent of patients ' uncertainty in the classification of events and the likelihood of confirmation by the interviewer vary very much by type of incident . Unexpectedly , many patients reported problems and incidents related to food and dietary intake . Overall , the in-depth interviews confirmed experiences from the focus groups that many patients feel reluctant to report undesirable events without acknowledging the presence or absence of individual responsibility or failure . Many patients reported that they did not ask or communicate about errors or near misses with staff and some patients even develop strategies to improve their safety but do not disclose these to staff . Conclusion Many patients experience undesirable events during hospitalization and a significant number of patients is seriously concerned about their safety . Surveying patients about experiences with safety-related events in hospital seems a valuable tool for identifying and monitoring problematic areas of care and undesirable events . Evidence from the qualitative interviews indicates that safety remains an unsaid word between patients and their care providers PURPOSE : Little is known about how well hospitalized patients can identify errors or injuries in their care . Accordingly , the purpose of this study was to elicit incident reports from hospital in patients in order to identify and characterize adverse events and near-miss errors . SUBJECTS : We conducted a prospect i ve cohort study of 228 adult in patients on a medicine unit of a Boston teaching hospital . METHODS : Investigators review ed medical records  and interviewed  patients during the hospitalization and by telephone 10 days after discharge about “ problems , ” “ mistakes , ” and “ injuries ” that occurred . Physician investigators classified patients ’ reports . We calculated event rates and used multivariable Poisson regression models to examine the factors associated with patient-reported events . RESULTS : Of 264 eligible patients , 228 ( 86 % ) agreed to participate and completed 528 interviews . Seventeen patients ( 8 % ) experienced 20 adverse events ; 1 was serious . Eight patients ( 4 % ) experienced 13 near misses ; 5 were serious or life threatening . Eleven ( 55 % ) of 20 adverse events and 4 ( 31 % ) of 13 near misses were documented in the medical record , but none were found in the hospital incident reporting system . Patients with 3 or more drug allergies were more likely to report errors compared with patients without drug allergies ( incidence rate ratio 4.7 , 95 % CI 1.7 , 13.4 ) . CONCLUSIONS : In patients can identify adverse events affecting their care . Many patient-identified events are not captured by the hospital incident reporting system or recorded in the medical record . Engaging hospitalized patients as partners in identifying medical errors and injuries is a potentially promising approach for enhancing patient safety Self management of warfarin treatment by patients , using a point of care coagulometer for testing international normalised ratios , is comparable to home glucose monitoring and may provide a robust model of service provision.1 2 Self management can lead to improvements in patients ' self efficacy , closer adherence to treatment , and increased control of treatment with oral anticoagulants.3 We report data on the effectiveness of the training programme used for a clinical trial ( self management of anticoagulation : a r and omised trial , SMART ) which aim ed to evaluate clinical and cost effectiveness of self management compared with routine care . UK guidelines indicated that training to a st and ard acceptable is essential , although the nature of the training was not clearly defined.2 Patients aged over 18 with a long term indication for warfarin , from 48 general practice s in the West Midl and s , were eligible . After giving consent patients were r and omly allocated to either self management or routine care . Data BACKGROUND Vitamin K antagonist treatment is effective for prevention and treatment of thromboembolic events but frequent laboratory control and dose-adjustment are essential . Small portable devices have enabled patient self-monitoring of anticoagulation and self-adjustment of the dose . We compared this self-management of oral anticoagulant therapy with conventional management by a specialist anticoagulation clinic in a r and omised cross-over study . METHODS 50 patients on long-term oral anticoagulant treatment were included in a r and omised controlled crossover study . Patients were self-managed or were managed by the anticoagulation clinic for a period of 3 months . After this period the alternative strategy was followed for each patient . Prothrombin time ( expressed as international normalised ratio [ INR ] ) were measured at intervals of 1 - 2 weeks in both periods without knowledge of type of management . The primary endpoint was the number of measurements within the therapeutic range ( therapeutic target value + /-50.5 INR units ) . FINDINGS There was no significant difference in the overall quality of control of anticoagulation between the two study periods . Patients were for 55 % and for 49 % of the treatment period within a range of + /-0.5 from the therapeutic target INR during self-management and anticoagulation clinic management , respectively ( p=0.06 ) . The proportion of patients who spent most time in the therapeutic target range was larger during self-management than during anticoagulation clinic-guided management . The odds ratio for a better control of anticoagulation ( defined as the period of time in the therapeutic target range ) during self-management compared with anticoagulation clinic-guided management was 4.6 ( 95 % CI 2.1 - 10.2 ) . A patient-satisfaction assessment showed superiority of self-management over conventional care . INTERPRETATION Self-management of INR in the population in this study is feasible and appears to result in control of anticoagulation that is at least equivalent to management by a specialist anticoagulation clinic . It is also better appreciated by patients . Larger studies are required to assess the effect of this novel management strategy on the incidence of thromboembolic or bleeding complications The purpose of this study was to explore patient opinion about asking healthcare professionals to wash their h and s prior to a clinical procedure and to explore if MRSA status and access to patient information about infection control would influence anxiety about asking . A descriptive survey was undertaken using a semi-structured question naire . The question naire was distributed to a r and omised convenience sample of 185 in- patients across all departments of an acute NHS Trust hospital ( response rate 59.4 % ) . Spearman 's rank order and Kendall Tau-b tests were used to analyse specific correlations . Respondents were more confident than anxious to be involved in a campaign that asked patients to ask staff to wash their h and s. Patients were more anxious to ask if previous admission episodes were fewer , if their knowledge of MRSA was high and if there was less information about infection control available . Less anxiety was associated with patients who had MRSA in the past and the suggestion that staff wore badges saying ' It 's OK to ask ' BACKGROUND Patient safety ' best practice s ' that call for patient participation to prevent adverse drug events have not been rigorously evaluated . OBJECTIVE To consider lessons learned from a patient partnership intervention to prevent adverse drug events among medical in- patients . DESIGN Prospect i ve r and omized , controlled pilot trial . SETTING Boston teaching hospital . Patients . Two hundred and nine adult in- patients on a general medicine unit . INTERVENTION Intervention  patients ( n = 107 ) received drug safety information and their medication list ; controls ( n = 102 ) received drug safety information only .  Measurements . Adverse drug events and close-call drug errors were identified using chart review and incident reports from nurses , pharmacists , and physicians . Patients and clinicians were surveyed about the intervention . RESULTS In 1053 patient-days at risk , 11 patients experienced 12 adverse drug events and 16 patients experienced 18 close calls . There was a non-significant difference between intervention patients and controls in survey responses and in the adverse drug event rate ( 8.4 % versus 2.9 % , P = 0.12 ) and close-call rate ( 7.5 % versus 9.8 % , P = 0.57 ) . Eleven percent of patients were aware of drug-related mistakes during the hospitalization . Among nurse respondents , 29 % indicated that at least one medication error was prevented when a patient or family member identified a problem . CONCLUSION Partnering with in- patients to prevent adverse drug events is a promising strategy but requires further study to document its efficacy OBJECTIVE To determine the effect of an  inpatient self-medication program ( SMP )  on the ability to self-medicate , patient medication knowledge , compliance , and patient morale . DESIGN R and omized controlled clinical trial . POPULATION One hundred seven consecutive patients admitted to a geriatric assessment and rehabilitation program were r and omized to either participate in the SMP or to receive st and ard care . INTERVENTION The SMP was a three-stage program in which patients were given increasing responsibility for the administration of their own medications . MEASUREMENTS Ability to self-medicate on discharge from hospital ; medication compliance at 1 month ; patient medication knowledge ; Philadelphia Morale Scale . MAIN RESULTS Participation in the self-medication program did not increase the proportion of  patients who were able to self-medicate on discharge from hospital . Compliance was improved by the program . On a proportional basis , the self-medication group made significantly fewer medication errors than the control group at 1-month follow-up ( 0.045 vs 0.086 , P < .001 ) . There were no significant differences in morale or medication knowledge between the SMP and control groups , although both groups made significant gains in knowledge about the names , administration times , and purpose s of their medications from admission to follow-up ( P < .001 ) . CONCLUSIONS A SMP can improve compliance in geriatric patients who are discharged to the community . Participation in a SMP does not improve patients ' morale nor does it improve their medication knowledge more than pharmacy counselling alone . Participation in a SMP is unlikely to increase the probability that patients will be able to self-medicate on discharge . Cognitive factors limit patients ' ability to self-medicate BACKGROUND A review of the literature on h and washing has documented the absence of research on the education of the patient as an intervention model for changing staff behavior regarding h and washing compliance . The primary objective of this project was to conduct a prospect i ve control study of the effect of  patient h and washing education  on staff  compliance with h and washing . METHOD A prospect i ve , controlled , 6-week intervention/control study was performed in 4 community hospitals in South Jersey . Each hospital served as its own control . Patients were educated within 24 hours of admission about the importance of asking their health care workers to wash their h and s.  Soap usage and h and washing was calculated by bed-days . Patient follow-up was conducted through telephone interviews 2 weeks after discharge . RESULTS The patient h and washing education model increased soap usage by health care workers an average of 34 % ( P = .021 ) ; this increase was consistent across hospitals regardless of the initial soap usage rates . Of the patients interviewed , 81 % read the material s provided , 57 % asked health care workers whether they had washed their h and s , and 81 % of this 57 % said they received positive responses . CONCLUSIONS For the first time , our findings document that education of patients regarding their role in monitoring h and washing compliance among health care workers can increase soap usage and h and washing and provide sustainable reinforcement of h and washing principles for health care workers BACKGROUND Several studies have demonstrated that patient self-management of oral anticoagulant therapy ( OAT )  can improve treatment quality . However , most of these studies were not conducted within a specialized anticoagulation care system . The objective of the present study was to determine whether patient self-management of OAT improves the quality of care delivered by anticoagulation clinics . METHODS In this r and omized study by 2 Dutch anticoagulation clinics 341 patients aged between 18 and 75 years and receiving long-term OAT were divided into 4 groups : an existing routine care group of patients untrained in self-management ; a routine care group of trained patients ; a group managed weekly at an anticoagulation clinic where international normalized ratios were measured by trained patients ; and weekly patient self-management . A 2-step r and omization procedure was followed : first , a Zelen- design r and omization was performed to distribute patients ( without informing them ) to the existing care group or to receive training in self-management ; second , trained patients were r and omized to the 3 other study groups . RESULTS Only 25.6 % of invited patients agreed to participate in the training program . Patients who remained in the existing care 
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The findings show that the main factors for engaging patients in their own safety can be summarised in four categories : illness ; individual cognitive characteristics ; the clinician-patient relationship ; and organisational factors .
We conclude that illness and patients ' perceptions of their role and status as subordinate to that of clinicians are the most important barriers to their involvement in error reduction .
In sum , patients ' fear of being labelled " difficult " and a consequent desire for clinicians ' approbation may cause them to assume a passive role as a means of actively protecting their personal safety