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

Objective. To 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. Methods. We 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. 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, 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. Conclusion. There 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. Keywords Patient safety, health care-associated infections, medication errors, surgical errors, diagnostic errors, pressure injuries, patient falls, COVID-19 ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded and commissioned by the World Health Organization's Patient Safety Flagship Unit. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript