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J Patient Saf. 2013 Mar;9(1):8-12. doi: 10.1097/PTS.0b013e318269992d.

Public perceptions and preferences for patient notification after an unsafe injection.

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  • 1Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, Georgia, USA.



Unsafe injection practices in health-care settings often result in notification of potentially affected patients, to disclose the error and recommend blood-borne pathogens testing. Few studies have assessed public perceptions and preferences for patient notification.


Six focus groups were conducted during Fall 2009, with residents of Atlanta, GA, and New York City, NY. Questions focused on preferences for receiving health information, knowledge of safe injection practices, and responses to and preferences for a patient notification letter. A mixed-method analysis was performed for qualitative themes and descriptive statistics.


A total of 53 individuals participated; only 2 had ever heard of the term safe injection practices. After identification of unsafe injection practices, participants preferred to be notified via telephone, letter/mailing, email, or face-to-face from the facility where the incident occurred. More than 25 different types of information were mentioned as elements to be placed in a patient notification letter including: corrective actions by the facility, course of action for the patient, assurance of medical coverage, and how it happened/reason for the incident. Participants preferred that the tone of the letter be empathetic; nearly all indicated it was "very likely" that they would seek testing if notified.


Facilities and health departments should strive to assure the notification process is conducted swiftly, clearly guiding affected patients to the necessary course of action. Notification letters are not "one size fits all," and some preferences expressed by patients may not be feasible in all situations. Prevention efforts should be complemented by research on improving effective patient communications when unsafe injection practices necessitate patient notification.

[PubMed - indexed for MEDLINE]
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