Adverse events are common in healthcare. Three types of victims of patient-related adverse events can be identified. The first type includes patients and their families, the second type includes healthcare professionals involved in an adverse event and the third type includes healthcare organisations in which an adverse event occurs. The purpose of this integrative review is to synthesise knowledge, theory and evidence regarding action after adverse events, based on literature published in the last ten years (2009–2018). In the studies critically evaluated (n = 25), key themes emerged relating to the first, second and third victim elements. The first victim elements comprise attention to revealing an adverse event, communication after an event, first victim support and complete apology. The second victim elements include second victim support types and services, coping strategies, professional changes after adverse events and learning about adverse event phenomena. The third victim elements consist of organisational action after adverse events, strategy, infrastructure and training and open communication about adverse events. There is a lack of comprehensive models for action after adverse events. This requires understanding of the phenomenon along with ambition to manage adverse events as a whole. When an adverse event is identified and a concern expressed, systematic damage preventing and ameliorating actions should be immediately launched. System-wide development is needed.

Purpose: This paper aims to assess how patient safety culture and incident reporting differs across different professional groups and between long-term and acute care. The Hospital Survey On Patient Safety Culture (HSPOSC) questionnaire was used to assess patient safety culture. Data from the organizations’ incident reporting system was also used to determine the number of reported patient safety incidents. Design/methodology/approach: Patient safety culture is part of the organizational culture and is associated for example to rate of pressure ulcers, hospital-acquired infections and falls. Managers in health-care organizations have the important and challenging responsibility of promoting patient safety culture. Managers generally think that patient safety culture is better than it is. Findings: Based on statistical analysis, acute care professionals’ views were significantly positive in 8 out of 12 composites. Managers assessed patient safety culture at a higher level than other professional groups. There were statistically significant differences (p = 0.021) in frequency of events reported between professional groups and between long-term and acute care (p = 0.050). Staff felt they did not get enough feedback about reported incidents. Originality/value: The study reveals differences in safety culture between acute care and long-term care settings, and between professionals and managers. The staff felt that they did not get enough feedback about reported incidents. In the future, education should take these factors into consideration.

Background: Increasing number of nurse prescribers could be part of a solution to the shortage of physicians, improve access to treatment and curb the rise in healthcare costs; however, readmissions after nurse prescribers' appointments are under‐researched.Aims: To describe and compare clients' initial appointments with nurse prescribers and physicians. In addition, client readmissions within 60 days in the target organisation after nurse prescribers' and physicians' appointments were investigated.Design: Retrospective register‐based follow‐up study.Methods: Data included client appointments (n = 3986) with nurse prescribers and physicians, and clients' readmissions (n = 9038) from 1 January 2018 to 31 December 2019 from one hospital district in Finland. Data were analysed statistically using frequencies, percentages, rate ratios and cross‐tabulation. STROBE checklist was used.Results: Initial appointments including trimethoprim, pivmecillinam, phenoxymethyl penicillin, chloramphenicol, fusidic acid and cephalexin prescriptions with nurse prescribers (n = 36) were 2131, and physicians (n = 140) 1855. On average, client readmissions (within 60 days) per initial appointment were 2.10 after appointments with nurse prescribers and 2.46 after physicians. After initial appointments, including phenoxymethyl penicillin prescriptions, with nurse prescribers, clients had more readmissions in all age groups than after initial appointments with physicians. However, in all, after initial appointments with physicians, clients had a higher proportion of readmissions.Conclusion: Clients have fewer readmissions after appointments with nurse prescribers than physicians, including the same prescriptions. Nurse prescribers' skills may not have been fully utilised. Physicians treated many patients whose diseases nurse prescribers might have been able to treat based on the nurse prescribers' rights. However, physician clients may have more demanding service requirements.

Background: Despite two decades of promoting systems-based approaches, healthcare safety investigations often fail to produce system-level changes. This study analyzed the quality of recommendations from serious incident investigations conducted by multidisciplinary teams in Finland. Methods: Serious incident investigation reports (n = 169) from 2018 to 2023 were collected from 11 well-being services counties, with a total of 525 recommendations being extracted and classified as weak, intermediate, or strong according to the US Department of Veterans Affairs’ National Center for Patient Safety criteria. Each recommendation was assigned only to one strength category. Results: More than half of all recommendations were weak (56%) and focused mainly on staff training (43%) and new procedures or policies (39%). Intermediate recommendations comprised 37%, primarily targeting documentation and communication (63%), while only 7% were strong. Approximately one in four investigations (24%) included at least one strong recommendation. Mentions of recommendations being implemented were rare (20%), and only 7% included follow-up notes. None of the reports specified the analytical method used. Conclusions: Finnish healthcare's serious incident investigations produce predominantly weak, behavior-focused recommendations that are seldom followed-up or implemented. The absence of standardized reporting formats and limited documentation of follow-up hinder the evaluation of impact. To strengthen patient safety, investigations should yield fewer, but stronger, system-oriented recommendations developed using structured analytical methods and evaluated through consistent national guidance and monitoring mechanisms.