Instruments for Patient Safety Assessment: a scoping review

Instruments for Patient Safety Assessment: a scoping review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Instruments for Patient Safety Assessment: a scoping review Elisabete Maria Garcia Teles Nunes, Fernanda Sirtoli, Eliane Lima, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3797000/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To perform a systematic review of the existing literature to map instruments/scales for assessing patient safety in healthcare services. Method: scoping review. The protocol was registered on the Open Science Framework (https://osf.io/p329w). Eligibility criteria were defined based on the mnemonic P (patients), C (instruments/scales for assessing safety), C (healthcare services), in any language, and without temporal restriction. The study search was conducted in the MEDLINE, EMBASE, LILACS, and Scopus databases, and the repository of the Brazilian Digital Library of Theses and Dissertations. Two independent reviewers performed selection and data extraction. Results: 63 articles were selected, identifying 48 instruments/scales and 71 dimensions for patient safety assessment, with a predominance of dimensions such as teamwork, professional satisfaction, safety climate, communication, and working conditions. Conclusion: The diversity of instruments and dimensions for patient safety assessment characterizes the multidimensionality and scope of patient safety. However, it hinders benchmarking between institutions and healthcare units. Safety Management Patient Safety Quality Management in Healthcare Evaluation of Research Programs and Tools Nursing Management Review Figures Figure 1 INTRODUCTION Patient safety is fundamental to healthcare delivery in all settings. However, in the 21st century, adverse events, avoidable errors and risks associated with healthcare continue to pose significant challenges to patient safety worldwide. Studies indicate that an average of one in ten patients is subject to an adverse event while receiving hospital care in high-income countries. In contrast, in low- and middle-income countries, this estimate is one in four patients, with 134 million adverse events occurring annually because of unsafe care in hospitals, which contributes to about 2.6 million deaths. Overall, 60% of deaths in low- and middle-income countries are due to unsafe and low-quality care ( 1 – 2 ) . Patient safety is a crucial component of healthcare service quality, universally defined as patient care free from harm resulting from complications caused by or stemming from that care. While people typically associate patient safety with hospital care, unsafe care is a problem that spans the entire healthcare system, including primary and ambulatory care ( 3 – 4 ) . It is essential to assess real issues related to safe practices in healthcare settings. Patient safety and safety culture are integral components of quality indicators in healthcare services, and identifying strengths and weaknesses aims to guide the institution's strategic plan for improvement and control of healthcare services offered to patients ( 5 – 6 ) . Numerous instruments scattered in the literature measure patient safety and safety culture, varying considerably in terms of general characteristics, assessed dimensions, conducted psychometrics, and applicability ( 3 , 6 – 7 ) . Our objective was to perform a systematic review of the existing literature to map instruments/scales for evaluating patient safety in healthcare services. METHOD Scope review. Scope review is a type of evidence synthesis that systematically identifies and maps studies available in the literature on a specific theme or question, allowing the identification of gaps and simultaneously assessing the quality of existing studies ( 8 – 9 ) . Protocol and registration Following the Joanna Briggs methodology ( 8 ) , a review protocol was developed and published on the Open Science Framework ( https://osf.io/p329w ) before initiating the literature search. In this review, the researchers adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist ( 10 ) . Search strategy Following JBI guidelines, the search strategy occurred in three stages ( 8 ) . In the first stage, a limited search was conducted on the PubMed electronic database and the Mesh platform on the topic to identify the most commonly used descriptors in the literature. Descriptors for the search were selected with the guidance of a librarian experienced in medical literature research and reviews. In the second stage, the search was conducted in the databases: MEDLINE, EMBASE, LILACS, and Scopus. Grey literature was also consulted using the repository of the Brazilian Digital Library of Theses and Dissertations (BDTD), provided by the Ministry of Science, Technology, and Innovation of Brazil. In the third stage, the bibliographic references of selected records were analyzed to retrieve potential new records that addressed the research question. Identification of the research question The research question and eligibility criteria were defined based on the PCC mnemonic suggested by JBI ( 8 ) . PCC stands for Population (patients), Concept (instruments/scales for assessing patient safety), and Context (healthcare services). Thus, the research question was defined as follows: "What are the instruments/scales for assessing patient safety in healthcare services?" Study selection To address the research question, eligibility criteria were established for study selection following the PCC (Table 1 ). Table 1 – Eligibility criteria for the scope review studies - Brazil, 2023 Inclusion criteria* Population Patients Concept Concept instruments/scales for assessing patient safety Context Healthcare services Search sources MEDLINE (OVID), EMBASE, LILACS, Scopus, Brazilian Digital Library of Theses and Dissertations (BDTD) Study designs Studies that include instruments or scales for assessing patient safety in healthcare services. Period No time restriction Language All Availability Full text available Descriptors Safety Management; Patient Safety; Total Quality Management; Process Assessment, Health Care; Evaluation of Research Programs and Tools; Surveys and Questionnaires Descriptor crossings Process Assessment, Health Care AND Patient Safety AND Safety Management Safety Management AND Patient Safety AND Evaluation of Research Programs and Tools Patient Safety AND Evaluation of Research Programs and Tools Total Quality Management AND Evaluation of Research Programs and Tools AND Patient safety Process Assessment And Patient Safety AND Health Care AND Evaluation of Research Programs and Tools Surveys and Questionnaires AND Evaluation of Research Programs and Tools Study in the format of a scientific article, guideline, doctoral thesis, master's dissertation, or complete abstract published in proceedings or scientific journals. Exclusion Criteria** Studies that do not distinguish instruments/scales for assessing patient safety in healthcare services. Studies with restricted access and whose request for availability to the authors was not met. * For study selection, all inclusion criteria must be present. ** The study will be excluded if at least one of the exclusion criteria is present. Source: Authors (2023). For the literature search in the review, the Rayyan QCRI® platform (web app Scoping Reviews) was employed. The Rayyan program allows the removal of duplicates and blinded the two researchers (Sirtoli, FC and Minarini, GPSS), who independently conducted the initial study selection, enabling a comparison of agreements and disagreements. A third researcher (Lima EFA) assessed these. The results were evaluated and selected for inclusion based on the information provided in the title and abstract. The screening was conducted blindly by two authors simultaneously (Sirtoli, FC and Minarini, GPSS), and disagreements regarding the inclusion of studies were resolved through discussion with a third investigator (Lima EFA). Subsequently, the selected articles were read in full, and their integration into the final selection was defined. Data extraction and synthesis For data extraction, a form was developed based on the template provided by JBI ( 8 ) , containing key information from the sources, such as author, reference, results, and findings relevant to the scope review question. The data were synthesized, and the results were summarized to present an overview of the studies found on the topic. RESULTS In total, 4,019 articles were identified, with 1,462 in the Scopus database, 1,892 in LILACS, 89 in PubMed/MEDLINE, 575 in EMBASE, 01 in the Brazilian Digital Library of Theses and Dissertations (BDTD), and 1,014 duplicated articles. As recommended by JBI, the PRISMA-ScR flowchart model was used ( 10 ) . Figure 1 provides a detailed overview of the study selection process. The sample consisted of 63 articles, with publications starting in 2007 and most occurring between 2017 and 2021. English was the predominant language in the publications. Of the studies, 19 instruments were applied in a research setting in the United States of America, and five were applied in Canada, both countries in North America. Fifteen studies were conducted in other countries in Europe, seven in countries belonging to Oceania, six in the Asian continent, six in the Middle East, and five in countries across Asia and South America, such as Brazil. Forty-eight instruments were identified, with 27 applicable to intra-hospital care, covering emergency services, and the others were tailored for intra-hospital emergencies (n = 4), pre-hospital care by surface or air (n = 4), family members in the emergency department (n = 1), primary health care (n = 4), and any health area (n = 8). Most articles used instruments to assess the patient safety culture, while others assessed patient safety y focusing on a specific aspect, with closed-ended questions predominating. The Likert scale was commonly used to measure agreement levels, ranging from three to five points. In each instrument, the number of questions varied from 3 to 67, incorporated into 71 dimensions. The instrument Safety Attitude Questionnaire (SAQ) (n = 22) and the Hospital Survey on Patient Safety (HSOPS) (n = 17) were frequently used, as presented in Table 2 , while Table 3 describes the distribution of dimensions/domains according to the patient safety assessment instruments included in this review. Table 2 Distribution of studies according to patient safety assessment instruments, by country, number of questions, dimensions, and context of application - Vitória, ES, Brazil, 2023 Instrument Country Nº of questions Nº of dimensions Context 1 RPPE ( 67 ) Chipre 39 8 α 2 ED Survey Colorado ( 67 ) USA 55 9 β 3 ED Survey Indianapolis ( 67 ) USA 67 10 β 4 Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association ( 67 ) USA 15 4 Ω 5 EMS Safety Climate Scale ( 67 ) USA 20 6 Ω 6 EMS-SI ( 67 ) USA 44 6 Ω 7 Alberta Registered Nurse Survey ( 67 ) Canada 20 12 α 8 Institute for Healthcare Improvement ( 67 ) USA 19 4 β 9 EMS-SAQ ( 67 ) USA 30 6 Ω 10 PCQ-F ( 67 ) Sweden 17 3 δ 11 SAQ (7,11–13,15,24,26,28,30,38–40,42,48,51–52,54,65–67,70−71) USA ( 11 ) , UK ( 15 ) , New Zealand ( 7 ) , England ( 65 ) 41 5 ỵ Brazil ( 28 , 42 , 66 ) 41 6 α USA ( 51 – 52 ) 56 6 α Iran ( 67 ) 60 NF α USA ( 12 , 13 , 39 – 40 , 52 , 54 ) 30 6 α Taiwan ( 24 , 71 ) Palestine ( 30 ) Denmark ( 70 ) 32 6 α Korea ( 26 ) 35 7 α Saudi Arabia, Australia ( 38 ) 36 6 α USA ( 48 ) 57 7 α 12 SAQ-OR ( 31 ) Portugal 59 6 α 13 SAQ-AV ( 37 , 45 , 57 ) Netherlands ( 37 ) Norway ( 45 ) Italia ( 57 ) 62 5 ỵ 14 TSCS ( 42 ) USA 27 3 ⥀ 15 EPA ( 42 ) USA 45 5 ỵ 16 MaPSaF ( 42 ) USA NF 1 ⥀ 17 PC-SafeQuest ( 41 , 52 , 54 ) USA 30 4 α 18 MOSPSC ( 3 , 42 ) USA ( 42 ) 54 12 α Saudi Arabia ( 3 ) 44 12 ỵ 19 HSOPSC (7,14,17,23–25,33−35,42,46,53–54,58,60–61,68) Netherlands ( 15 ) 56 11 ỵ Portugal ( 67 ) , Korea ( 7 ) , South Korea ( 33 ) , Saudi Arabia ( 54 ) Spain ( 23 , 33 ) Netherlands, USA, Taiwan ( 25 ) Japan ( 46 ) 42 12 α Kuwait ( 7 ) 22 8 α Iran ( 14 ) 42 12 β USA ( 14 ) 39 6 α Sweden ( 35 ) 51 14 α Belgium ( 17 ) 42 12 α China ( 24 ) 29 10 α China ( 53 , 68 ) 42 12 β Tunisia ( 60 – 61 ) 45 10 β Bulgaria ( 58 ) 37 11 β 20 AACN HWEAT e HSOPSC ( 23 ) USA 20 6 α 21 SCOPE ( 42 ) USA 46 3 ỵ 22 PMOS ( 22 , 27 , 32 , 59 ) UK ( 32 ) Australia ( 59 ) 43 9 α England ( 22 ) 42 12 α England ( 27 ) 44 9 α 23 NOTECHS ( 64 ) Canada 4 NF α 24 TEAMS ( 64 ) Canada 11 3 α 25 SEIPS too ( 64 ) Canada 6 NF α 30 PSCHO ( 7 , 16 ) UK 45 12 α 31 SOS ( 7 ) UK NF NF α 32 Can-PSC ( 7 ) UK NF NF α 33 OCSFS ( 11 , 33 ) USA 30 6 α 34 MSSAPS ( 47 ) France 28 5 α 35 Trigger Tool ( 41 , 54 ) NH NF NF α 36 IPCAF ( 49 ) Brazil NF 5 α 37 HHSAF ( 49 ) Brazil NF 5 α 38 MAPSAF ( 50 ) UK NF 9 α 39 HCAHPS ( 50 ) USA 32 8 α 40 Health Professional Education in Patient Safety Survey (H-PEPSS) ( 21 ) Canada 23 6 α 41 WHO’s Surgical Safety Checklist ( 35 ) Sweden NF NF α 42 Patient Safety Culture Questionnaire in Acute Geriatric Units ( 19 ) Austria 7 7 ỵ 43 Specific Questionnaire on Patient Safety in the Laboratory ( 20 ) Spain 62 6 ⥀ 44 NHSOPSC ( 29 ) Norway 43 12 ỵ 45 ASCN ( 36 ) Iran 32 4 ⥀ 46 Patient Participation Questionnaire (PPQ) ( 55 ) Nh 17 4 α 47 Medical Office Survey on Patient Safety Culture (SOPS) ( 62 ) USA 38 10 α 48 Influences on Patient Safety Behaviors Questionnaire (IPSBQ) ( 69 ) Australia NF 11 α Legend: NF – Not found; TeamS - Team Strategies and Tools to Enhance Performance and Patient Safety; SAQ - Safety Attitudes Questionnaire; SAQ-AV - Safety Attitudes Questionnaire - Ambulatory Version; SAQ-OR - Safety Attitudes Questionnaire/Operating Room; SAQ-EMS - Safety Atittudes Questionnaire - Emergency Medical Service; RPPE - Revised Professional Practice Environment; PSCS - Patient Safety Culture Survey; ED - Emergency Department; EMS - Emergency Medical Services; EMS-SI - Emergency Medical Services – Safety Inventory; PCQ-F - Person-centered Climate Questionnaire – Family; PMOS - Patient Measure of Safety; EPA – European Practice Assessment; TSCS - Teamwork and Safety Climate Survey; MaPSaF - Manchester Patient Safety Framework; PSCHO – Patient Safety Climate in Healthcare Organizations; MOSPSC - Medical Office Survey on Patient Safety Culture; HSOPS - Hospital Survey on Patient Safety Culture; SCOPE - Safety Culture Questionnaire for General Practice; QSEN-SES- Quality and Safety Education for Nurses Student Evaluation Survey; PC-SafeQuest - Primary Care Safety Questionnaire; OCSFS - Organizational Climate Safety Factors; HHSAF - Hand Hygiene Self-Assessment Framework by WHO; MAPSAF - Manchester Patient Safety Framework; HCAHPS - Hospital Consumer Assessment of Healthcare Providers and Systems; H-PEPSS - Health Professional Education in Patient Safety Survey; NHSOPSC - Nursing Home Survey on Patient Safety Culture; PPQ - Patient Participation Questionnaire; SOPS - Medical Office Survey on Patient Safety Culture; IPSBQ - Influences on Patient Safety Behaviors Questionnaire; TeamS - Team Strategies and Tools to Enhance Performance and Patient Safety; IPCAF - Infection Prevention and Control Assessment Framework by WHO; ASCN - Instrument for the Assessment of Safe Nursing Care; AACN HWEAT - American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool; MSSAPS - Medical Student Safety Attitudes and Professionalism Survey; Can-PSC - Canadian Patient Safety Climate Scale, SOS - Safety Organizing Scale; NOTECHS - Operating Theatre Team Non-Technical Skills Assessment Tool; SEIPS - Systems Engineering Initiative for Patient Safety; α - intra-hospital encompassing emergency service; β - exclusive for intra-hospital emergency; Ω - pre-hospital care, both by surface and/or air; δ - family members in the emergency service; ỵ - primary health care; ⥀ - any health care area. Table 3 Distribution of dimensions/domains according to patient safety assessment instruments included in this review - Vitória, ES, Brazil, 2023 Dimensions/Domains Instruments 1 Expectations and actions of unit/service leadership/supervision that favor safety HSOPSC; PSCS, SAQ, NHSOPSC 2 Teamwork SAQ, EPA, TSCS, PC-SafeQuest, MaPSaF, MOSPSC, SCOPE, PMOS, HSOPSC; PSCS; SAQ-EMS; RPPE; ED; EMS-SI, MSSAPS, PSCHO, QSEN-SES, SAQ-OR, NHSOPSC, ASCN, SAQ-AV 3 Training PMOS, EMS, PSCHO, NHSOPSC 4 Team structure PMOS, NHSOPSC 5 Communication SAQ, EPA, TSCS, PC-SafeQuest, MOSPSC, ESCOPO, PMOS, HSOPSC; PSCS, RPPE, Institute for Healthcare Improvement, PMOS, PSCHO, Safety Culture Survey, HCAHPS, Patient Safety Culture Questionnaire in Acute Geriatric Units, Specific questionnaire on patient safety in the laboratory, NHSOPSC 6 Leadership RPPE, PMOS 7 Situation monitoring ED, Safety Culture Survey 8 Safety perceptions HSOPSC; PSCS; SAQ-EMS; SAQ; EMS-SI, PSCHO, Safety Culture Survey, NHSOPSC 9 Safety reports (including incident and near-miss notification) Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association, MAPSAF 10 Frequency of notified adverse events HSOPSC; PSCS, Alberta Registered Nurse Survey 11 Organizational learning - continuous improvement PMOS, HSOPSC; PSCS, Safety Culture Survey, Patient Safety Culture Questionnaire in Acute Geriatric Units 12 Feedback and communication about error MSSAPS, MAPSAF, Safety Culture Survey, HCAHPS, NHSOPSC 13 Non-punitive response to error HSOPSC; PSCS, Safety Culture Survey, NHSOPSC 14 Staffing levels HSOPSC; PSCS, ED 15 Hospital management support for patient safety HSOPSC; PSCS, Safety Culture Survey, NHSOPSC 16 Management perception SAQ, EPA, TSCS, PC-SafeQuest, MOSPSC, SCOPE NHSOPSC, SAQ-AV 17 Stress/workload perception SAQ, EPA, PC-SafeQuest 18 Job satisfaction SAQ, EPA, SAQ-EMS; SAQ; EMS-SI; Alberta Registered Nurse Survey, OCSFS, PSCHO, SAQ-AV 19 Access to resources PMOS 20 Equipment design and operation PMOS 21 Roles and responsibilities PMOS 22 Information flow PMOS 23 Ward type and layout PMOS 24 Issues in handoffs and transitions between units/services HSOPSC; PSCS 25 Safety climate SAQ-EMS; SAQ; PCQ-F; EMS-SI; Institute for Healthcare Improvement, The Safety Attitudes Questionnaire, OCSFS, MSSAPS, PSCHO, MAPSAF, HCAHPS, Specific questionnaire on patient safety in the laboratory, SAQ-OR,SAQ-AV 26 Stress SAQ-EMS; SAQ; EMS-SI, Patient Safety Culture Questionnaire in Acute Geriatric Units, SAQ-OR, SAQ-AV 27 Working conditions SAQ-EMS; SAQ; EMS-SI, The Safety Attitudes Questionnaire, OCSFS, PSCHO, Patient Safety Culture Questionnaire in Acute Geriatric Units, Specific Questionnaire on Patient Safety in the Laboratory, SAQ-OR, SAQ-AV 28 True collaboration AACN HWEAT 29 Skilled communication AACN HWEAT 30 Effective decision-making AACN HWEAT 31 Meaningful recognition AACN HWEAT 32 Authentic leadership AACN HWEAT 33 Climate of everydayness PCQ-F 34 Climate of hospitality PCQ-F 35 Internal work motivation RPPE 36 Control over practice RPPE 37 Staff relationships with physicians RPPE, MSSAPS 38 Physical environment ED, PMOS 39 Nursing ED 40 Culture ED 41 Coordination ED, Patient Safety Culture Questionnaire in Acute Geriatric Units 42 Availability of personal protective equipment EMS, PMOS 43 Management support EMS 44 Absence of job hindrances EMS 45 Cleanliness of workspace EMS 46 Minimal conflict/good communication EMS 47 Crowding Institute for Healthcare Improvement 48 Medication safety Institute for Healthcare Improvement 49 Quality of care Alberta Registered Nurse Survey 50 Adverse patient events Alberta Registered Nurse Survey, Patient Safety Culture Questionnaire in Acute Geriatric Units 51 Full-time/part-time work Alberta Registered Nurse Survey 52 Salary Alberta Registered Nurse Survey 53 Continuing education Alberta Registered Nurse Survey, MAPSAF, Specific Questionnaire on Patient Safety in the Laboratory 54 Quality assurance program Alberta Registered Nurse Survey 55 Preceptorship Alberta Registered Nurse Survey 56 Autonomy Alberta Registered Nurse Survey 57 Control over clinical practice Alberta Registered Nurse Survey 58 Relationship between nurses and doctors (RN–MD relationships) Alberta Registered Nurse Survey 59 Emotional exhaustion Alberta Registered Nurse Survey 60 Flying status (Condition of flight) Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association 61 Staff crew safety Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association 62 Patient safety Safety beliefs and practices conducted by the Air and Surface Transport Nurses Association, SAQ, PSCHO 63 Scheduling and bed management PMOS 64 Dignity and respect PMOS 65 Core function support PMOS 66 Burnout OCSFS 67 Processes and equipment/resources Patient Safety Culture Questionnaire in Acute Geriatric Units, Specific Questionnaire on Patient Safety in the Laboratory 68 Handoff NHSOPSC 69 Nursing skills ASCN 70 Psychological needs of patients ASCN 71 Physical needs of patients ASCN Note: The instruments and their acronyms are described in the legend of Table 2 . Table 2 - Distribution of studies according to patient safety assessment instruments, by country, number of questions, dimensions, and application context - Vitória, ES, Brazil, 2023 Table 3 - Distribution of dimensions/domains according to patient safety assessment instruments included in this review - Vitória, ES, Brazil, 2023 DISCUSSION Regarding the composition of dimensions and questions, a variety of dimensions were identified in the instruments. Those with the highest number of dimensions were the Hospital Survey on Patient Safety, with 14 dimensions, and the instruments Alberta Registered Nurse Survey, Medical Office Survey on Patient Safety Culture, Patient Measure of Safety, and Patient Safety Climate in Healthcare Organizations (PSCHO), with 12 dimensions each, respectively. The Swedish version of the Hospital Survey on Patient Safety includes 51 items covering 14 dimensions of patient safety culture and three single outcome questions with a 5-point Likert scale ( 35 ) . Different instruments comprised 12 dimensions, among them is the questionnaire named Alberta Registered Nurse Survey, applied to nurses working in various intra-hospital sectors, including emergency services, in Canada, with responses given on a Likert scale, yes or no, or multiple choices ( 67 ) . The Medical Office Survey on Patient Safety Culture has 54 questions, with six specific to primary care among the 12 domains. It is available in English and Spanish and has a reliability of 0.77–0.90 ( 42 ) . The Patient Measure of Safety is another example of a tool that encompasses 12 domains, including communication, individual factors, physical environment, bed management, staff management/workload, dignity and respect, training and education, lines of responsibility, equipment and supplies, supervision and leadership, team factors, and support from central functions ( 22 ) . The instrument Patient Safety Climate in Healthcare Organizations has 45 items using a 5-point Likert scale ranging from "strongly agree" to "strongly disagree." Based on the principal component analysis, the research evaluates 12 dimensions reflecting general safety climate components, such as top management involvement in patient safety, the existence of a blame culture, and responsiveness of the unit manager to identified safety issues. PSCHO used the High Reliability Organizations Theory (HROT) to guide its tool development process ( 7 ) . A safety climate survey containing 15 to 20 items based on the PSCHO instrument was applied to managers, physicians, and healthcare professionals in hospital settings, including organizational, unit-based, and interpersonal domains ( 72 ) . In the instruments, there was a predominance of dimensions such as teamwork, job satisfaction, safety climate, communication, and working conditions. Some dimensions were less prominent, manifesting in a single instrument with specific characteristics, such as “burnout” in the OCSFS – Organizational Climate Safety Factors instrument (Table 3 ). Forty-eight instruments were identified, of which 27 apply for intra-hospital care, covering emergency services, and the remaining instruments were created for intra-hospital emergency (n = 4), surface or air prehospital care (n = 4), family members in emergency services (n = 1), primary healthcare (n = 4), and any healthcare area (n = 8). Focused on intra-hospital care, covering emergency services, the Manchester Patient Safety Framework (MAPSAF) was developed to support healthcare teams and organizations in developing a safety culture in emergency services ( 50 ) . MAPSAF has ten dimensions and aims to encourage proactive behavior, increase awareness of patient safety, identify improvements, assess interventions, and monitor changes ( 41 ) . The dimensions include: continuous improvement; priority given to safety; system errors and individual responsibility; incident recording; incident assessment; learning and making changes; communication; staff management; staff education; and teamwork ( 50 ) . Another tool, the Patient Measure of Safety (PMOS), used in three articles in this review, provides a systematic way to assess patient safety. It is considered a tool applied to healthcare professionals and patients capable of proactively identifying evidence-based contributing factors to safe patient care and signaling areas for hospitals to direct improvements ( 22 , 32 ) . PMOS is a 44-item questionnaire with nine domains ( 27 ) . Regarding the assessment of patient safety culture in intra-hospital emergency services, this review found the Revised Professional Practice Environment (RPPE) instrument. The applicability of RPPE involved physicians and nurses to evaluate professionals' perceptions of their work environment and professional practice. The scale was designed with 39 questions distributed across eight dimensions, with responses scored on a 5-point Likert scale ( 67 ) . Studies using the Safety Attitudes Questionnaire (SAQ) in healthcare settings were identified, based on two conceptual models: Vincent's model for risk and safety analysis and Donabedian's conceptual model for quality assessment ( 7 ) . This instrument underwent variations and adaptations to fit the specific reality of each country, setting, and study objects. Therefore, depending on the country where it was applied, this scale ranged from 30 to 60 questions, and responses to each question followed a Likert-type scale of five points for the degree of agreement ( 7 , 13 , 24 , 28 , 30 , 42 , 48 , 65 , 71 ) . The Health Professional Education in Patient Safety Survey (H-PEPSS) focuses mainly on the socio-cultural aspects of patient safety, including culture, teamwork, communication, managing risk, and understanding human factors. The study results indicate that H-PEPSS is an instrument capable of measuring knowledge, skills, and attitudes in patient safety and is largely useful for examining the impact of specific patient safety curriculum initiatives ( 21 ) . There is also the Hand Hygiene Self-Assessment Framework (HHSAF), which is a systematic self-assessment tool from the World Health Organization aimed at obtaining a situational analysis of hand hygiene promotion and practices in healthcare facilities ( 49 ) . Another assessment tool supporting the implementation of World Health Organization guidelines is the Infection Prevention and Control Assessment Framework (IPCAF), published in 2018. It focuses on key components of effective infection prevention and control programs in acute healthcare, aiming to identify relevant problems or deficiencies requiring improvement through regular form reapplication to document progress over time and identify strengths and gaps that provide future policy ( 49 ) . Addressing the family context of the emergency service, the Person-Centred Climate Questionnaire – Family (PCQ-F) consists of 17 items in three dimensions of psychosocial climate. It aims to analyze aspects of the safety climate of the intra-hospital emergency service perceived by patients' families and evaluate the centrality of the person in the climate, as perceived by family members. The tool can guide health managers, workers, and stakeholders in the analysis and intervention of the psychosocial climate in long-term care institutions ( 67 ) . Among the forty-one instruments identified in the research, three were specifically constructed for primary care (SCOPE, PC-Safe Quest, and EPA). The Short Child Occupational Profile (SCOPE) is the Dutch version of the Hospital Survey on Patient Safety Culture (HSOPS) from the US Agency for Healthcare Research and Quality (AHRQ), validated and adapted for use in primary care in the Netherlands ( 16 ) . The Dutch HSOPS consists of 56 questions assessing 11 dimensions of patient safety culture: teamwork across hospital units, teamwork within units, hospital handoffs and transitions, event notification frequency, non-punitive response to error, communication openness, feedback and communication about error, managerial actions promoting patient safety, hospital management support for patient safety, adequate staff, and general safety perceptions ( 64 ) . Concerning the PC-Safe Quest, Safe Quest Safety Climate Survey, it is an instrument intended for all members of the primary health care team, based on the practice of professionals in the community, containing 30 items grouped into five dimensions: communication, leadership, teamwork, safety systems, and workload ( 11 ) . The European Practical Assessment (EPA) was built from an observational study in nine European countries with diverse healthcare systems as a viable and valid educational technology to measure the organization and management of primary care practices, within or between countries or to seek trends over time. The instrument can also provide personalized feedback, including minimum standards (summative), benchmark parameters, and suggestions for practice improvement (formative), either at the initiative of the practice itself or as a part of accreditation. In this context, each country can choose to use the EPA for a summative or formative assessment or a combination of both ( 42 ) . This questionnaire (EPA) has 45 items related to patient safety management divided into ten patient safety domains that assess users' and professionals' perceptions of the institution's infrastructure, quality, and safety ( 42 ) . The instruments identified in this review contribute to monitoring patient safety in healthcare services, which is essential in the management work process, as the adoption of safe practices directly influences the quality of care provided, the work process of the healthcare team, and the financial costs related to care. This review is valuable for healthcare management, as managers can select instruments that best fit their contexts and objectives for improving patient safety. Our study has some limitations. The scoping review methodology does not imply quality assessment; therefore, our review did not analyze the quality of the included studies. There is a risk of selection and publication bias due to the wide variety of methodological approaches and instruments related to patient safety, and our search strategy may not have fully covered this. Additionally, our search strategy used only one base for gray literature research (BDTD). We acknowledge that more databases could have been searched, including those cataloging gray literature. Another limitation was the difficulty in capturing three studies with restricted access. This study has several strengths. Firstly, a librarian with experience in medical literature research and reviews conducted and guided a comprehensive search strategy. The search used broad concepts, proximity operators, and various relevant databases. The selected databases were multidisciplinary to identify such studies. Secondly, a blind screening process ensured eligibility, and a detailed form ensured that included studies were mapped and summarized. Thirdly, the PRISMA-ScR checklist was used throughout the search process, and as a result, we conducted a critical assessment to address the objective of this scoping review. CONCLUSION This study identified 48 instruments/scales to assess patient safety in healthcare services. Within these instruments, 71 dimensions of patient safety assessment were identified. The instruments with the highest number of dimensions were the Hospital Survey on Patient Safety, Alberta Registered Nurse Survey, Medical Office Survey on Patient Safety Culture, Patient Measure of Safety, Patient Safety Climate in Healthcare Organizations, and Team Strategies and Tools to Enhance Performance and Patient Safety. The predominant dimensions across the instruments were teamwork, professional satisfaction, safety climate, communication, and working conditions. This review allowed for the identification of instruments that are adapted and validated for each culture, context, and language. The diversity of patient safety assessment instruments with various dimensions found well characterizes the multidimensionality and scope of patient safety. However, it poses some challenges for benchmarking between institutions/healthcare units. Declarations Ethics approval and consent to participate Not applicable Consent for publication Not applicable Availability of data and materials All data analyzed during this study are included in this published article. Competing interests The authors declare that they have no competing interests. Funding This paper was supported by the Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Lisbon, Portugal (81/2023). Author contributions Conceptualization: E.N., F.S., E.L., G.M., F.G., C.P; methodology: E.N., F.S., E.L., G.M., F.G., C.P; analysis, investigation, visualization, writing – original draft preparation: F.S., E.L., G.M., C.P.; C.P.; supervision: E.L., C.P.; writing-review and editing: E.N., P.L., F.G.; funding: E.N., P.L. All authors have read and agreed to the published version of the manuscript. Acknowledgements Not applicable Author details 1,5,6 Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Lisbon, Portugal; [email protected] (E.N.); [email protected] (F.G.); [email protected] (P.L.) 2,4 Universidade Federal do Espírito Santo, Vitória, ES, Brasil; [email protected] (F.S.); [email protected] (G.M.) 3,7 Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Universidade Federal do Espírito Santo, Vitória, ES, Brasil; [email protected] (E.L.); [email protected] (C.P.) 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3797000","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":265564865,"identity":"294f93f0-e11b-44e7-b572-a2e8b6a81efc","order_by":0,"name":"Elisabete Maria Garcia Teles Nunes","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArUlEQVRIiWNgGAWjYPACGyBmbiBJSxoQMwK1JBCv5TAJWvile8wefPhzXk6+vbGBufAHEVok55wxN5zZdtvY4MzBBuYZxNhicCPHTJq34XbiBonEBmYeYrTYg7T8+XOufv78h0RqMZAAamFgO5DAcIORSC0SN9LKJHvbkg03nElsODwjjQgt/DOSt0n8+GMnL99++ODjAhsitKCAw6RqACYZ0rWMglEwCkbBSAAA14c0w03hHOkAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-7598-0670","institution":"Escola Superior de Enfermagem de Lisboa","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Elisabete","middleName":"Maria Garcia Teles","lastName":"Nunes","suffix":""},{"id":265564866,"identity":"f921387e-5994-494e-94e6-bfe436dccf50","order_by":1,"name":"Fernanda Sirtoli","email":"","orcid":"","institution":"Universidade Federal do Espírito Santo: Universidade Federal do Espirito Santo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fernanda","middleName":"","lastName":"Sirtoli","suffix":""},{"id":265564867,"identity":"ed63b096-ecbc-4c82-b1df-ef588bdbc0df","order_by":2,"name":"Eliane Lima","email":"","orcid":"","institution":"Universidade Federal do Espírito Santo: Universidade Federal do Espirito Santo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Eliane","middleName":"","lastName":"Lima","suffix":""},{"id":265564868,"identity":"856cdfa1-245d-405b-a829-ef9ed6fb5925","order_by":3,"name":"Greyce Minarini","email":"","orcid":"","institution":"Universidade Federal do Espírito Santo: Universidade Federal do Espirito Santo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Greyce","middleName":"","lastName":"Minarini","suffix":""},{"id":265564869,"identity":"e55bd874-831d-4411-ab08-78741673fadc","order_by":4,"name":"Filomena Gaspar","email":"","orcid":"","institution":"Escola Superior de Enfermagem de Lisboa","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Filomena","middleName":"","lastName":"Gaspar","suffix":""},{"id":265564870,"identity":"4c5480bc-62c0-4210-bfd0-ccdaa66af9b5","order_by":5,"name":"Pedro Lucas","email":"","orcid":"","institution":"Escola Superior de Enfermagem de Lisboa","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Pedro","middleName":"","lastName":"Lucas","suffix":""},{"id":265564871,"identity":"0398b282-83ae-4327-9587-fd320251ee21","order_by":6,"name":"Cândida Primo","email":"","orcid":"","institution":"Universidade Federal do Espírito Santo: Universidade Federal do Espirito Santo","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cândida","middleName":"","lastName":"Primo","suffix":""}],"badges":[],"createdAt":"2023-12-23 15:38:51","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3797000/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3797000/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49382445,"identity":"d67a7d6a-bc31-475b-9e1b-1dcca9d27338","added_by":"auto","created_at":"2024-01-09 19:21:49","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":518624,"visible":true,"origin":"","legend":"\u003cp\u003eStudy Selection Flowchart – Prisma-SCR\u003c/p\u003e\n\u003cp\u003eSource: Adapted from Peters et al (2020)\u003csup\u003e(10)\u003c/sup\u003e.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-3797000/v1/3a3e518d3f93ba8fea6c9450.jpeg"},{"id":52592759,"identity":"98f031a1-45bc-45d8-93a5-62e5d962490f","added_by":"auto","created_at":"2024-03-13 11:11:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":501448,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3797000/v1/63e956cc-1a4a-49a1-8c9f-88260c6719aa.pdf"}],"financialInterests":"","formattedTitle":"Instruments for Patient Safety Assessment: a scoping review","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePatient safety is fundamental to healthcare delivery in all settings. However, in the 21st century, adverse events, avoidable errors and risks associated with healthcare continue to pose significant challenges to patient safety worldwide. Studies indicate that an average of one in ten patients is subject to an adverse event while receiving hospital care in high-income countries. In contrast, in low- and middle-income countries, this estimate is one in four patients, with 134\u0026nbsp;million adverse events occurring annually because of unsafe care in hospitals, which contributes to about 2.6\u0026nbsp;million deaths. Overall, 60% of deaths in low- and middle-income countries are due to unsafe and low-quality care\u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePatient safety is a crucial component of healthcare service quality, universally defined as patient care free from harm resulting from complications caused by or stemming from that care. While people typically associate patient safety with hospital care, unsafe care is a problem that spans the entire healthcare system, including primary and ambulatory care\u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIt is essential to assess real issues related to safe practices in healthcare settings. Patient safety and safety culture are integral components of quality indicators in healthcare services, and identifying strengths and weaknesses aims to guide the institution's strategic plan for improvement and control of healthcare services offered to patients\u003csup\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eNumerous instruments scattered in the literature measure patient safety and safety culture, varying considerably in terms of general characteristics, assessed dimensions, conducted psychometrics, and applicability\u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. Our objective was to perform a systematic review of the existing literature to map instruments/scales for evaluating patient safety in healthcare services.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003eScope review. Scope review is a type of evidence synthesis that systematically identifies and maps studies available in the literature on a specific theme or question, allowing the identification of gaps and simultaneously assessing the quality of existing studies\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eProtocol and registration\u003c/p\u003e \u003cp\u003eFollowing the Joanna Briggs methodology\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e, a review protocol was developed and published on the Open Science Framework (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/p329w\u003c/span\u003e\u003cspan address=\"https://osf.io/p329w\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) before initiating the literature search. In this review, the researchers adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist\u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSearch strategy\u003c/p\u003e \u003cp\u003eFollowing JBI guidelines, the search strategy occurred in three stages\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. In the first stage, a limited search was conducted on the PubMed electronic database and the Mesh platform on the topic to identify the most commonly used descriptors in the literature. Descriptors for the search were selected with the guidance of a librarian experienced in medical literature research and reviews. In the second stage, the search was conducted in the databases: MEDLINE, EMBASE, LILACS, and Scopus. Grey literature was also consulted using the repository of the Brazilian Digital Library of Theses and Dissertations (BDTD), provided by the Ministry of Science, Technology, and Innovation of Brazil. In the third stage, the bibliographic references of selected records were analyzed to retrieve potential new records that addressed the research question.\u003c/p\u003e \u003cp\u003eIdentification of the research question\u003c/p\u003e \u003cp\u003eThe research question and eligibility criteria were defined based on the PCC mnemonic suggested by JBI\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e. PCC stands for Population (patients), Concept (instruments/scales for assessing patient safety), and Context (healthcare services). Thus, the research question was defined as follows: \"What are the instruments/scales for assessing patient safety in healthcare services?\"\u003c/p\u003e \u003cp\u003eStudy selection\u003c/p\u003e \u003cp\u003eTo address the research question, eligibility criteria were established for study selection following the PCC (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u0026ndash; Eligibility criteria for the scope review studies - Brazil, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eInclusion criteria*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConcept\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConcept instruments/scales for assessing patient safety\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eContext\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthcare services\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSearch sources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMEDLINE (OVID), EMBASE, LILACS, Scopus, Brazilian Digital Library of Theses and Dissertations (BDTD)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudy designs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudies that include instruments or scales for assessing patient safety in healthcare services.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeriod\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo time restriction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLanguage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAvailability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFull text available\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDescriptors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSafety Management; Patient Safety; Total Quality Management; Process Assessment, Health Care; Evaluation of Research Programs and Tools; Surveys and Questionnaires\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDescriptor crossings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProcess Assessment, Health Care AND Patient Safety AND Safety Management\u003c/p\u003e \u003cp\u003eSafety Management AND Patient Safety AND Evaluation of Research Programs and Tools\u003c/p\u003e \u003cp\u003ePatient Safety AND Evaluation of Research Programs and Tools\u003c/p\u003e \u003cp\u003eTotal Quality Management AND Evaluation of Research Programs and Tools AND Patient safety\u003c/p\u003e \u003cp\u003eProcess Assessment And Patient Safety AND Health Care AND Evaluation of Research Programs and Tools\u003c/p\u003e \u003cp\u003eSurveys and Questionnaires AND Evaluation of Research Programs and Tools\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStudy in the format of a scientific article, guideline, doctoral thesis, master's dissertation, or complete abstract published in proceedings or scientific journals.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eExclusion Criteria**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStudies that do not distinguish instruments/scales for assessing patient safety in healthcare services.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eStudies with restricted access and whose request for availability to the authors was not met.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e* For study selection, \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eall\u003c/span\u003e inclusion criteria must be present.\u003c/p\u003e \u003cp\u003e** The study will be excluded if at least one of the exclusion criteria is present.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSource: Authors (2023).\u003c/p\u003e \u003cp\u003eFor the literature search in the review, the Rayyan QCRI\u0026reg; platform (web app Scoping Reviews) was employed. The Rayyan program allows the removal of duplicates and blinded the two researchers (Sirtoli, FC and Minarini, GPSS), who independently conducted the initial study selection, enabling a comparison of agreements and disagreements. A third researcher (Lima EFA) assessed these.\u003c/p\u003e \u003cp\u003eThe results were evaluated and selected for inclusion based on the information provided in the title and abstract. The screening was conducted blindly by two authors simultaneously (Sirtoli, FC and Minarini, GPSS), and disagreements regarding the inclusion of studies were resolved through discussion with a third investigator (Lima EFA). Subsequently, the selected articles were read in full, and their integration into the final selection was defined.\u003c/p\u003e \u003cp\u003eData extraction and synthesis\u003c/p\u003e \u003cp\u003eFor data extraction, a form was developed based on the template provided by JBI\u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/sup\u003e, containing key information from the sources, such as author, reference, results, and findings relevant to the scope review question. The data were synthesized, and the results were summarized to present an overview of the studies found on the topic.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eIn total, 4,019 articles were identified, with 1,462 in the Scopus database, 1,892 in LILACS, 89 in PubMed/MEDLINE, 575 in EMBASE, 01 in the Brazilian Digital Library of Theses and Dissertations (BDTD), and 1,014 duplicated articles. As recommended by JBI, the PRISMA-ScR flowchart model was used\u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides a detailed overview of the study selection process.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe sample consisted of 63 articles, with publications starting in 2007 and most occurring between 2017 and 2021. English was the predominant language in the publications. Of the studies, 19 instruments were applied in a research setting in the United States of America, and five were applied in Canada, both countries in North America. Fifteen studies were conducted in other countries in Europe, seven in countries belonging to Oceania, six in the Asian continent, six in the Middle East, and five in countries across Asia and South America, such as Brazil.\u003c/p\u003e \u003cp\u003eForty-eight instruments were identified, with 27 applicable to intra-hospital care, covering emergency services, and the others were tailored for intra-hospital emergencies (n\u0026thinsp;=\u0026thinsp;4), pre-hospital care by surface or air (n\u0026thinsp;=\u0026thinsp;4), family members in the emergency department (n\u0026thinsp;=\u0026thinsp;1), primary health care (n\u0026thinsp;=\u0026thinsp;4), and any health area (n\u0026thinsp;=\u0026thinsp;8).\u003c/p\u003e \u003cp\u003eMost articles used instruments to assess the patient safety culture, while others assessed patient safety y focusing on a specific aspect, with closed-ended questions predominating. The Likert scale was commonly used to measure agreement levels, ranging from three to five points. In each instrument, the number of questions varied from 3 to 67, incorporated into 71 dimensions. The instrument Safety Attitude Questionnaire (SAQ) (n\u0026thinsp;=\u0026thinsp;22) and the Hospital Survey on Patient Safety (HSOPS) (n\u0026thinsp;=\u0026thinsp;17) were frequently used, as presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, while Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e describes the distribution of dimensions/domains according to the patient safety assessment instruments included in this review.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of studies according to patient safety assessment instruments, by country, number of questions, dimensions, and context of application - Vit\u0026oacute;ria, ES, Brazil, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstrument\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026ordm; of questions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u0026ordm; of dimensions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eContext\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRPPE\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChipre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eED Survey Colorado\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eED Survey Indianapolis\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSafety beliefs and practices\u003c/p\u003e \u003cp\u003econducted by the Air and Surface Transport Nurses Association\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eΩ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEMS Safety Climate Scale\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eΩ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEMS-SI\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eΩ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstitute for Healthcare Improvement\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEMS-SAQ\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eΩ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePCQ-F\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSweden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eδ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003eSAQ\u003csup\u003e(7,11\u0026ndash;13,15,24,26,28,30,38\u0026ndash;40,42,48,51\u0026ndash;52,54,65\u0026ndash;67,70\u0026minus;71)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e, UK\u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/sup\u003e, New Zealand\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e, England \u003csup\u003e(\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eỵ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003csup\u003e(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003csup\u003e(\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTaiwan\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePalestine\u003csup\u003e(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDenmark \u003csup\u003e(\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKorea\u003csup\u003e(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSaudi Arabia,\u003c/p\u003e \u003cp\u003eAustralia\u003csup\u003e(\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003csup\u003e(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSAQ-OR\u003csup\u003e(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePortugal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSAQ-AV\u003csup\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNetherlands\u003csup\u003e(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNorway\u003csup\u003e(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eItalia\u003csup\u003e(\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eỵ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTSCS\u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e⥀\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEPA\u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eỵ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaPSaF\u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e⥀\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePC-SafeQuest\u003csup\u003e(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMOSPSC\u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSaudi Arabia\u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eỵ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"10\" rowspan=\"11\"\u003e \u003cp\u003eHSOPSC\u003csup\u003e(7,14,17,23\u0026ndash;25,33\u0026minus;35,42,46,53\u0026ndash;54,58,60\u0026ndash;61,68)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNetherlands\u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eỵ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePortugal\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e, Korea\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e,\u003c/p\u003e \u003cp\u003eSouth Korea\u003csup\u003e(\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/sup\u003e,\u003c/p\u003e \u003cp\u003eSaudi Arabia\u003csup\u003e(\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSpain\u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNetherlands, USA, Taiwan\u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eJapan\u003csup\u003e(\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKuwait\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSweden\u003csup\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBelgium\u003csup\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChina\u003csup\u003e(\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTunisia\u003csup\u003e(\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBulgaria\u003csup\u003e(\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAACN HWEAT e HSOPSC\u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSCOPE\u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eỵ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePMOS \u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUK\u003csup\u003e(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAustralia\u003csup\u003e(\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEngland\u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEngland\u003csup\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNOTECHS\u003csup\u003e(\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTEAMS\u003csup\u003e(\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSEIPS too\u003csup\u003e(\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePSCHO\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSOS\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCan-PSC\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOCSFS\u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMSSAPS\u003csup\u003e(\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrigger Tool\u003csup\u003e(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIPCAF\u003csup\u003e(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHHSAF\u003csup\u003e(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMAPSAF\u003csup\u003e(\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHCAHPS\u003csup\u003e(\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Professional Education in Patient Safety Survey (H-PEPSS)\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWHO\u0026rsquo;s Surgical Safety Checklist\u003csup\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSweden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient Safety Culture Questionnaire in Acute Geriatric Units\u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAustria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eỵ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecific Questionnaire on Patient Safety in the Laboratory\u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e⥀\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNHSOPSC\u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNorway\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eỵ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eASCN\u003csup\u003e(\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e⥀\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient Participation Questionnaire (PPQ)\u003csup\u003e(\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical Office Survey on Patient Safety Culture (SOPS)\u003csup\u003e(\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfluences on Patient Safety Behaviors Questionnaire (IPSBQ)\u003csup\u003e(\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eα\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eLegend: NF \u0026ndash; Not found; TeamS - Team Strategies and Tools to Enhance Performance and Patient Safety; SAQ - Safety Attitudes Questionnaire; SAQ-AV - Safety Attitudes Questionnaire - Ambulatory Version; SAQ-OR - Safety Attitudes Questionnaire/Operating Room; SAQ-EMS - Safety Atittudes Questionnaire - Emergency Medical Service; RPPE - Revised Professional Practice Environment; PSCS - Patient Safety Culture Survey; ED - Emergency Department; EMS - Emergency Medical Services; EMS-SI - Emergency Medical Services \u0026ndash; Safety Inventory; PCQ-F - Person-centered Climate Questionnaire \u0026ndash; Family; PMOS - Patient Measure of Safety; EPA \u0026ndash; European Practice Assessment; TSCS - Teamwork and Safety Climate Survey; MaPSaF - Manchester Patient Safety Framework; PSCHO \u0026ndash; Patient Safety Climate in Healthcare Organizations; MOSPSC - Medical Office Survey on Patient Safety Culture; HSOPS - Hospital Survey on Patient Safety Culture; SCOPE - Safety Culture Questionnaire for General Practice; QSEN-SES- Quality and Safety Education for Nurses Student Evaluation Survey; PC-SafeQuest - Primary Care Safety Questionnaire; OCSFS - Organizational Climate Safety Factors; HHSAF - Hand Hygiene Self-Assessment Framework by WHO; MAPSAF - Manchester Patient Safety Framework; HCAHPS - Hospital Consumer Assessment of Healthcare Providers and Systems; H-PEPSS - Health Professional Education in Patient Safety Survey; NHSOPSC - Nursing Home Survey on Patient Safety Culture; PPQ - Patient Participation Questionnaire; SOPS - Medical Office Survey on Patient Safety Culture; IPSBQ - Influences on Patient Safety Behaviors Questionnaire; TeamS - Team Strategies and Tools to Enhance Performance and Patient Safety; IPCAF - Infection Prevention and Control Assessment Framework by WHO; ASCN - Instrument for the Assessment of Safe Nursing Care; AACN HWEAT - American Association of Critical-Care Nurses Healthy Work Environment Assessment Tool; MSSAPS - Medical Student Safety Attitudes and Professionalism Survey; Can-PSC - Canadian Patient Safety Climate Scale, SOS - Safety Organizing Scale; NOTECHS - Operating Theatre Team Non-Technical Skills Assessment Tool; SEIPS - Systems Engineering Initiative for Patient Safety; α - intra-hospital encompassing emergency service; β - exclusive for intra-hospital emergency; Ω - pre-hospital care, both by surface and/or air; δ - family members in the emergency service; ỵ - primary health care; ⥀ - any health care area.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of dimensions/domains according to patient safety assessment instruments included in this review - Vit\u0026oacute;ria, ES, Brazil, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDimensions/Domains\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstruments\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExpectations and actions of unit/service leadership/supervision that favor safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHSOPSC; PSCS, SAQ, NHSOPSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeamwork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSAQ, EPA, TSCS, PC-SafeQuest, MaPSaF, MOSPSC, SCOPE, PMOS, HSOPSC; PSCS; SAQ-EMS; RPPE; ED; EMS-SI, MSSAPS, PSCHO, QSEN-SES, SAQ-OR, NHSOPSC, ASCN, SAQ-AV\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraining\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS, EMS, PSCHO, NHSOPSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeam structure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS, NHSOPSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSAQ, EPA, TSCS, PC-SafeQuest, MOSPSC, ESCOPO, PMOS, HSOPSC; PSCS, RPPE, Institute for Healthcare Improvement, PMOS, PSCHO, Safety Culture Survey, HCAHPS, Patient Safety Culture Questionnaire in Acute Geriatric Units, Specific questionnaire on patient safety in the laboratory, NHSOPSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRPPE, PMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSituation monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eED, Safety Culture Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSafety perceptions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHSOPSC; PSCS; SAQ-EMS; SAQ; EMS-SI, PSCHO, Safety Culture Survey, NHSOPSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSafety reports (including incident and near-miss notification)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSafety beliefs and practices conducted by the Air and Surface Transport Nurses Association, MAPSAF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency of notified adverse events\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHSOPSC; PSCS, Alberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrganizational learning - continuous improvement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS, HSOPSC; PSCS, Safety Culture Survey, Patient Safety Culture Questionnaire in Acute Geriatric Units\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFeedback and communication about error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMSSAPS, MAPSAF, Safety Culture Survey, HCAHPS, NHSOPSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-punitive response to error\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHSOPSC; PSCS, Safety Culture Survey, NHSOPSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaffing levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHSOPSC; PSCS, ED\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospital management support for patient safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHSOPSC; PSCS, Safety Culture Survey, NHSOPSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSAQ, EPA, TSCS, PC-SafeQuest, MOSPSC, SCOPE NHSOPSC, SAQ-AV\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStress/workload perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSAQ, EPA, PC-SafeQuest\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJob satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSAQ, EPA, SAQ-EMS; SAQ; EMS-SI; Alberta Registered Nurse Survey, OCSFS, PSCHO, SAQ-AV\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAccess to resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEquipment design and operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoles and responsibilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInformation flow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWard type and layout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIssues in handoffs and transitions between units/services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHSOPSC; PSCS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSafety climate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSAQ-EMS; SAQ; PCQ-F; EMS-SI; Institute for Healthcare Improvement, The Safety Attitudes Questionnaire, OCSFS, MSSAPS, PSCHO, MAPSAF, HCAHPS, Specific questionnaire on patient safety in the laboratory, SAQ-OR,SAQ-AV\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSAQ-EMS; SAQ; EMS-SI, Patient Safety Culture Questionnaire in Acute Geriatric Units, SAQ-OR, SAQ-AV\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorking conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSAQ-EMS; SAQ; EMS-SI, The Safety Attitudes Questionnaire, OCSFS, PSCHO, Patient Safety Culture Questionnaire in Acute Geriatric Units, Specific Questionnaire on Patient Safety in the Laboratory, SAQ-OR, SAQ-AV\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrue collaboration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAACN HWEAT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSkilled communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAACN HWEAT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffective decision-making\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAACN HWEAT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeaningful recognition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAACN HWEAT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAuthentic leadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAACN HWEAT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClimate of everydayness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCQ-F\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClimate of hospitality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePCQ-F\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal work motivation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRPPE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl over practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRPPE\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff relationships with physicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRPPE, MSSAPS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eED, PMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCulture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoordination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eED, Patient Safety Culture Questionnaire in Acute Geriatric Units\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAvailability of personal protective equipment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEMS, PMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagement support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEMS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsence of job hindrances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEMS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCleanliness of workspace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEMS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimal conflict/good communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEMS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCrowding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstitute for Healthcare Improvement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedication safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstitute for Healthcare Improvement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuality of care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdverse patient events\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey, Patient Safety Culture Questionnaire in Acute Geriatric Units\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFull-time/part-time work\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSalary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContinuing education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey, MAPSAF, Specific Questionnaire on Patient Safety in the Laboratory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuality assurance program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreceptorship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAutonomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eControl over clinical practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelationship between nurses and doctors (RN\u0026ndash;MD relationships)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmotional exhaustion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlberta Registered Nurse Survey\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFlying status (Condition of flight)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSafety beliefs and practices conducted by the Air and Surface Transport Nurses Association\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStaff crew safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSafety beliefs and practices conducted by the Air and Surface Transport Nurses Association\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatient safety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSafety beliefs and practices conducted by the Air and Surface Transport Nurses Association, SAQ, PSCHO\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScheduling and bed management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDignity and respect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCore function support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePMOS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurnout\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOCSFS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProcesses and equipment/resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePatient Safety Culture Questionnaire in Acute Geriatric Units, Specific Questionnaire on Patient Safety in the Laboratory\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHandoff\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNHSOPSC\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eASCN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological needs of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eASCN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical needs of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eASCN\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote: The instruments and their acronyms are described in the legend of Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e - Distribution of studies according to patient safety assessment instruments, by country, number of questions, dimensions, and application context - Vit\u0026oacute;ria, ES, Brazil, 2023\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e - Distribution of dimensions/domains according to patient safety assessment instruments included in this review - Vit\u0026oacute;ria, ES, Brazil, 2023\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eRegarding the composition of dimensions and questions, a variety of dimensions were identified in the instruments. Those with the highest number of dimensions were the Hospital Survey on Patient Safety, with 14 dimensions, and the instruments Alberta Registered Nurse Survey, Medical Office Survey on Patient Safety Culture, Patient Measure of Safety, and Patient Safety Climate in Healthcare Organizations (PSCHO), with 12 dimensions each, respectively.\u003c/p\u003e \u003cp\u003eThe Swedish version of the Hospital Survey on Patient Safety includes 51 items covering 14 dimensions of patient safety culture and three single outcome questions with a 5-point Likert scale\u003csup\u003e(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDifferent instruments comprised 12 dimensions, among them is the questionnaire named Alberta Registered Nurse Survey, applied to nurses working in various intra-hospital sectors, including emergency services, in Canada, with responses given on a Likert scale, yes or no, or multiple choices\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e. The Medical Office Survey on Patient Safety Culture has 54 questions, with six specific to primary care among the 12 domains. It is available in English and Spanish and has a reliability of 0.77\u0026ndash;0.90\u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe Patient Measure of Safety is another example of a tool that encompasses 12 domains, including communication, individual factors, physical environment, bed management, staff management/workload, dignity and respect, training and education, lines of responsibility, equipment and supplies, supervision and leadership, team factors, and support from central functions\u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe instrument Patient Safety Climate in Healthcare Organizations has 45 items using a 5-point Likert scale ranging from \"strongly agree\" to \"strongly disagree.\" Based on the principal component analysis, the research evaluates 12 dimensions reflecting general safety climate components, such as top management involvement in patient safety, the existence of a blame culture, and responsiveness of the unit manager to identified safety issues. PSCHO used the High Reliability Organizations Theory (HROT) to guide its tool development process\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. A safety climate survey containing 15 to 20 items based on the PSCHO instrument was applied to managers, physicians, and healthcare professionals in hospital settings, including organizational, unit-based, and interpersonal domains\u003csup\u003e(\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the instruments, there was a predominance of dimensions such as teamwork, job satisfaction, safety climate, communication, and working conditions. Some dimensions were less prominent, manifesting in a single instrument with specific characteristics, such as \u0026ldquo;burnout\u0026rdquo; in the OCSFS \u0026ndash; Organizational Climate Safety Factors instrument (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eForty-eight instruments were identified, of which 27 apply for intra-hospital care, covering emergency services, and the remaining instruments were created for intra-hospital emergency (n\u0026thinsp;=\u0026thinsp;4), surface or air prehospital care (n\u0026thinsp;=\u0026thinsp;4), family members in emergency services (n\u0026thinsp;=\u0026thinsp;1), primary healthcare (n\u0026thinsp;=\u0026thinsp;4), and any healthcare area (n\u0026thinsp;=\u0026thinsp;8).\u003c/p\u003e \u003cp\u003eFocused on intra-hospital care, covering emergency services, the Manchester Patient Safety Framework (MAPSAF) was developed to support healthcare teams and organizations in developing a safety culture in emergency services\u003csup\u003e(\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMAPSAF has ten dimensions and aims to encourage proactive behavior, increase awareness of patient safety, identify improvements, assess interventions, and monitor changes\u003csup\u003e(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e)\u003c/sup\u003e. The dimensions include: continuous improvement; priority given to safety; system errors and individual responsibility; incident recording; incident assessment; learning and making changes; communication; staff management; staff education; and teamwork\u003csup\u003e(\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAnother tool, the Patient Measure of Safety (PMOS), used in three articles in this review, provides a systematic way to assess patient safety. It is considered a tool applied to healthcare professionals and patients capable of proactively identifying evidence-based contributing factors to safe patient care and signaling areas for hospitals to direct improvements\u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u003c/sup\u003e. PMOS is a 44-item questionnaire with nine domains\u003csup\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eRegarding the assessment of patient safety culture in intra-hospital emergency services, this review found the Revised Professional Practice Environment (RPPE) instrument. The applicability of RPPE involved physicians and nurses to evaluate professionals' perceptions of their work environment and professional practice. The scale was designed with 39 questions distributed across eight dimensions, with responses scored on a 5-point Likert scale\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStudies using the Safety Attitudes Questionnaire (SAQ) in healthcare settings were identified, based on two conceptual models: Vincent's model for risk and safety analysis and Donabedian's conceptual model for quality assessment\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. This instrument underwent variations and adaptations to fit the specific reality of each country, setting, and study objects. Therefore, depending on the country where it was applied, this scale ranged from 30 to 60 questions, and responses to each question followed a Likert-type scale of five points for the degree of agreement\u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe Health Professional Education in Patient Safety Survey (H-PEPSS) focuses mainly on the socio-cultural aspects of patient safety, including culture, teamwork, communication, managing risk, and understanding human factors. The study results indicate that H-PEPSS is an instrument capable of measuring knowledge, skills, and attitudes in patient safety and is largely useful for examining the impact of specific patient safety curriculum initiatives\u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThere is also the Hand Hygiene Self-Assessment Framework (HHSAF), which is a systematic self-assessment tool from the World Health Organization aimed at obtaining a situational analysis of hand hygiene promotion and practices in healthcare facilities\u003csup\u003e(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAnother assessment tool supporting the implementation of World Health Organization guidelines is the Infection Prevention and Control Assessment Framework (IPCAF), published in 2018. It focuses on key components of effective infection prevention and control programs in acute healthcare, aiming to identify relevant problems or deficiencies requiring improvement through regular form reapplication to document progress over time and identify strengths and gaps that provide future policy\u003csup\u003e(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAddressing the family context of the emergency service, the Person-Centred Climate Questionnaire \u0026ndash; Family (PCQ-F) consists of 17 items in three dimensions of psychosocial climate. It aims to analyze aspects of the safety climate of the intra-hospital emergency service perceived by patients' families and evaluate the centrality of the person in the climate, as perceived by family members. The tool can guide health managers, workers, and stakeholders in the analysis and intervention of the psychosocial climate in long-term care institutions\u003csup\u003e(\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAmong the forty-one instruments identified in the research, three were specifically constructed for primary care (SCOPE, PC-Safe Quest, and EPA). The Short Child Occupational Profile (SCOPE) is the Dutch version of the Hospital Survey on Patient Safety Culture (HSOPS) from the US Agency for Healthcare Research and Quality (AHRQ), validated and adapted for use in primary care in the Netherlands\u003csup\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe Dutch HSOPS consists of 56 questions assessing 11 dimensions of patient safety culture: teamwork across hospital units, teamwork within units, hospital handoffs and transitions, event notification frequency, non-punitive response to error, communication openness, feedback and communication about error, managerial actions promoting patient safety, hospital management support for patient safety, adequate staff, and general safety perceptions\u003csup\u003e(\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eConcerning the PC-Safe Quest, Safe Quest Safety Climate Survey, it is an instrument intended for all members of the primary health care team, based on the practice of professionals in the community, containing 30 items grouped into five dimensions: communication, leadership, teamwork, safety systems, and workload\u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe European Practical Assessment (EPA) was built from an observational study in nine European countries with diverse healthcare systems as a viable and valid educational technology to measure the organization and management of primary care practices, within or between countries or to seek trends over time. The instrument can also provide personalized feedback, including minimum standards (summative), benchmark parameters, and suggestions for practice improvement (formative), either at the initiative of the practice itself or as a part of accreditation. In this context, each country can choose to use the EPA for a summative or formative assessment or a combination of both\u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis questionnaire (EPA) has 45 items related to patient safety management divided into ten patient safety domains that assess users' and professionals' perceptions of the institution's infrastructure, quality, and safety\u003csup\u003e(\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe instruments identified in this review contribute to monitoring patient safety in healthcare services, which is essential in the management work process, as the adoption of safe practices directly influences the quality of care provided, the work process of the healthcare team, and the financial costs related to care.\u003c/p\u003e \u003cp\u003eThis review is valuable for healthcare management, as managers can select instruments that best fit their contexts and objectives for improving patient safety.\u003c/p\u003e \u003cp\u003eOur study has some limitations. The scoping review methodology does not imply quality assessment; therefore, our review did not analyze the quality of the included studies. There is a risk of selection and publication bias due to the wide variety of methodological approaches and instruments related to patient safety, and our search strategy may not have fully covered this. Additionally, our search strategy used only one base for gray literature research (BDTD). We acknowledge that more databases could have been searched, including those cataloging gray literature. Another limitation was the difficulty in capturing three studies with restricted access.\u003c/p\u003e \u003cp\u003eThis study has several strengths. Firstly, a librarian with experience in medical literature research and reviews conducted and guided a comprehensive search strategy. The search used broad concepts, proximity operators, and various relevant databases. The selected databases were multidisciplinary to identify such studies. Secondly, a blind screening process ensured eligibility, and a detailed form ensured that included studies were mapped and summarized. Thirdly, the PRISMA-ScR checklist was used throughout the search process, and as a result, we conducted a critical assessment to address the objective of this scoping review.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study identified 48 instruments/scales to assess patient safety in healthcare services. Within these instruments, 71 dimensions of patient safety assessment were identified. The instruments with the highest number of dimensions were the Hospital Survey on Patient Safety, Alberta Registered Nurse Survey, Medical Office Survey on Patient Safety Culture, Patient Measure of Safety, Patient Safety Climate in Healthcare Organizations, and Team Strategies and Tools to Enhance Performance and Patient Safety. The predominant dimensions across the instruments were teamwork, professional satisfaction, safety climate, communication, and working conditions.\u003c/p\u003e \u003cp\u003eThis review allowed for the identification of instruments that are adapted and validated for each culture, context, and language. The diversity of patient safety assessment instruments with various dimensions found well characterizes the multidimensionality and scope of patient safety. However, it poses some challenges for benchmarking between institutions/healthcare units.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis paper was supported by the Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Lisbon, Portugal (81/2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: E.N., F.S., E.L., G.M., F.G., C.P; methodology: E.N., F.S., E.L., G.M., F.G., C.P; analysis, investigation, visualization, writing \u0026ndash; original draft preparation: F.S., E.L., G.M., C.P.; C.P.; supervision: E.L., C.P.; writing-review and editing: E.N., P.L., F.G.; funding: E.N., P.L. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1,5,6\u0026nbsp;\u003c/sup\u003e Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Escola Superior de Enfermagem de Lisboa, Lisbon, Portugal;\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e (E.N.);\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e (F.G.);\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e (P.L.)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2,4\u003c/sup\u003e Universidade Federal do Esp\u0026iacute;rito Santo, Vit\u0026oacute;ria, ES, Brasil;\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e (F.S.);\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e (G.M.)\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3,7\u0026nbsp;\u003c/sup\u003eNursing Research, Innovation and Development Centre of Lisbon (CIDNUR),\u0026nbsp;Universidade Federal do Esp\u0026iacute;rito Santo, Vit\u0026oacute;ria, ES, Brasil;\u0026nbsp;\u003ca href=\"mailto:[email protected]\" target=\"_blank\"\[email protected]\u003c/a\u003e (E.L.);\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e (C.P.)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. 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Dispon\u0026iacute;vel em: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jep.12731\u003c/span\u003e\u003cspan address=\"10.1111/jep.12731\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Safety Management, Patient Safety, Quality Management in Healthcare, Evaluation of Research Programs and Tools, Nursing Management, Review","lastPublishedDoi":"10.21203/rs.3.rs-3797000/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3797000/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To perform a systematic review of the existing literature to map instruments/scales for assessing patient safety in healthcare services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e scoping review. The protocol was registered on the Open Science Framework (https://osf.io/p329w). Eligibility criteria were defined based on the mnemonic P (patients), C (instruments/scales for assessing safety), C (healthcare services), in any language, and without temporal restriction. The study search was conducted in the MEDLINE, EMBASE, LILACS, and Scopus databases, and the repository of the Brazilian Digital Library of Theses and Dissertations. Two independent reviewers performed selection and data extraction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 63 articles were selected, identifying 48 instruments/scales and 71 dimensions for patient safety assessment, with a predominance of dimensions such as teamwork, professional satisfaction, safety climate, communication, and working conditions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The diversity of instruments and dimensions for patient safety assessment characterizes the multidimensionality and scope of patient safety. However, it hinders benchmarking between institutions and healthcare units.\u003c/p\u003e","manuscriptTitle":"Instruments for Patient Safety Assessment: a scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-09 19:21:44","doi":"10.21203/rs.3.rs-3797000/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"84323e0f-8da7-4df6-a01a-cf71f8470746","owner":[],"postedDate":"January 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-13T11:03:01+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-09 19:21:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3797000","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3797000","identity":"rs-3797000","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}