How Nationwide Children's Hospital researchers are working to rethink patient safety

Researchers at Columbus, Ohio-based Nationwide Children's Hospital are analyzing how behavior aligned with Safety II, a revised approach to patient safety, affects safety in the pediatric intensive care unit, according to a study published in Pediatrics.

The researchers analyzed Nationwide Children's pediatric intensive care unit to identify what factors led to more reliable performance as well as staff's increased ability to manage unexpected situations during patient care.

The majority of hospitals use Safety I, which evaluates errors after they occur. In units that operate using Safety II behaviors, staff members proactively work to prevent future errors. This study marks one of the first to outline how Safety II principles can be implemented across pediatric hospitals.

"High-complexity, high-risk environments demand flexibility and resilience among their individuals to avoid errors, and our PICU exemplifies that," said study co-author Jenna Merandi, PharmD, in a press release. "We wanted to understand how the PICU used Safety II concepts to achieve its remarkably low adverse drug event rate."

The researchers held focus groups with PICU staff, asking open-ended questions to identify their strategies for establishing safety in their unit. The researchers then conducted a qualitative analysis of the focus group data and found hospital factors and behaviors that contributed to low adverse drug event rates in the PICU. The analysis revealed 19 common themes within four key domains.

The key domains consisted of individual characteristics, relationships and interactions, structural and environmental characteristics and innovative approaches. The themes identified in the first three domains are usually found in the Safety I approach and can be adapted to use in Safety II.

For the domain that focused on innovative approaches, the researchers found these themes were uniquely applicable to the Safety II approach —  relying on teamwork if something novel is considered, team response to challenging circumstances, skepticism and bringing "out-of-box" approaches to patient care.

"Safety II does not replace Safety I, but it is a new approach in addition to the old 'finding and fixing' model of addressing patient safety concerns," said Richard Brilli, MD, CMO at Nationwide Children's. "Optimistically, it has the potential to take patient safety to a whole new level."

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