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Participation of the Netherlands in the European Union Network for Patient Safety and Quality of Care (PaSQ).

Steeg, L. van de, Schoten, S. van, Loos, E. de, Wagner, C. Participation of the Netherlands in the European Union Network for Patient Safety and Quality of Care (PaSQ). Utrecht/La Plaine St Denis: NIVEL, CBO, PaSQ: European Union Network for Patient Safety and Quality of Care, 2015.
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This report aims to give insight into the Dutch participation in the European Union Network for Patient Safety and Quality of Care (PaSQ), and the extent to which this participation contributed to the overall goal of PaSQ: ‘to improve patient safety and quality of care in Europe by supporting the implementation of good organizational practices and safe clinical practices in health care organizations and through sharing of
information and experiences’. The general objective of PaSQ is to improve patient safety and quality of care in Europe by supporting the implementation of good organizational practices and safe clinical practices in health care organizations and through sharing of information and experience. Special attention is paid to patient involvement and to further implementation of existing tools for quality improvement, instead of developing new tools.

By participating in PaSQ Joint Action the Netherlands became part of a large European network, which offered the Netherlands access to information on patient safety and quality of care from other participating countries, as well as an opportunity to share Dutch information and experiences with others.
The participating Dutch hospitals had the chance to improve their care processes by further implementing three safe clinical practices, supported in this effort by CBO and NIVEL. They became part of a network at national level in which they could exchange knowledge on and experiences with these safe clinical practices and had access to the European PaSQ network and resources as well.

Seven Dutch hospitals participated in PaSQ, each working on the implementation or sustainability of one or more safe clinical practices: Medication Reconciliation, Paediatric Early Warning Scores (PEWS), and Hand Hygiene. The hospitals received implementation support in the form of national meetings, webinars, conference calls with project leaders, access to the PaSQ website and implementation toolboxes, and
access to PaSQ activities such as international webinars and exchange meetings. In order to provide the hospitals with insight into their performance on the relevant safe clinical practices and further stimulate implementation efforts, NIVEL conducted an implementation evaluation for each of the three safe clinical practices. Data was gathered in each hospital using patient record reviews, hospital guidelines and
interviews or observations, after which hospitals received a short report on their performance.

PEWS was used both for more patients and more often per patient in the five participating hospitals by the end of 2014. Many of the hospitals used the participation in PaSQ as an incentive to get the implementation of PEWS going and used the national network to exchange instruments and experiences.
All project leaders indicated that they were implementing PEWS mainly because it had become a mandatory aspect of a safety management system in the Netherlands. Nurses and physicians involved had doubts about the usefulness of existing PEWS for nonuniversity hospitals, because they felt these PEWS were originally developed for university hospitals.
Unlike the implementation of PEWS, Hand Hygiene did not involve a new subject for the participating hospitals and the PaSQ toolbox contained no new tools or ideas for Dutch hospitals. Due to the fact that only two hospitals participated, the opportunity for knowledge exchange within a national network was also limited. This might explain why Hand Hygiene compliance has not improved in the two PaSQ hospitals during the project.
Medication Reconciliation compliance did improve in the two participating hospitals, when compared to compliance in 2012. The largest improvement was seen in the number of patients where a medication overview was created before discharge. However, overall compliance at discharge remained relatively low.

Overall, the participation in PaSQ meant a new impulse for implementation efforts in the participating hospitals, supported by the knowledge exchange taking place within the national and international network. This lead to good results for especially PEWS, as well as the start of a more permanent national group of hospitals and experts working on further developing PEWS and its implementation in the Netherlands.
Future participation of Dutch healthcare organisations in an international network aimed at patient safety and quality of care would be most beneficial to these organisations if the network was aimed at safe clinical practices that are new to the Netherlands. This would ensure sufficient room for improvement, as well as access to new insights, methods and materials from other countries.
In order to make the most of a national network of healthcare organisations, either as part of a larger international network or separately, the number of participating organisations needs to be sufficiently large. Having at least five healthcare organisations in a network would ensure sufficient diversity between organisations and limit negative effects of drop outs on the network.

A proposal for a permanent network for patient safety and quality of care in the EU has been developed by PaSQ partners. The Dutch hospitals participating in PaSQ will individually keep working on the implementation and sustainability of safe clinical practices.