Blame-free Culture Research Articles

Shaping Safety: Unveiling the Dynamics of Incident Reporting and Safety Culture in Saudi Arabian Healthcare.

Patient safety is a critical concern in healthcare systems worldwide. Understanding the interplay between safety culture and incident reporting behaviors among healthcare professionals is essential for improving patient outcomes. To examine the perception of patient safety culture among healthcare professionals in Saudi Arabia and its impact on their attitudes toward incident reporting, considering variables such as level of care, ownership, and professional background. A cross-sectional survey was distributed both online and onsite to 453 healthcare professionals, with 402 completing it. The survey assessed various dimensions of safety culture and incident reporting behaviors. Statistical analysis included correlation matrices, regression models, and comparative assessments across different types of hospital settings. The study revealed significant associations between perceived safety culture and incident reporting behaviors (p < 0.01). Specifically, management (B = 0.64, p < 0.01), working conditions (r = 0.51, p < 0.01), and job satisfaction (r = 0.52, p < 0.01) were identified as crucial for improvement. The study highlighted the importance of fostering a blame-free culture and establishing clear reporting guidelines to enhance reporting frequencies. Enhancing the perception of patient safety within healthcare settings positively influences the likelihood of incident reporting. Strategic interventions aimed at improving safety culture could significantly advance patient care quality.

A potentially lifesaving error: unintentional high-dose adrenaline administration in anaphylaxis-induced cardiac arrest; a case report

BackgroundCardiopulmonary resuscitation is a crucial skill for emergency medical services. As high-risk-low-frequency events pose an immense mental load to providers, concepts of crew resource management, non-technical skills and the science of human errors are intended to prepare healthcare providers for high-pressure situations. However, medical errors occur, and organizations and institutions face the challenge of providing a blame-free error culture to achieve continuous improvement by avoiding similar errors in the future. In this case, we report a critical medical error during an anaphylaxis-associated cardiac arrest, its handling and the unexpected yet favourable outcome for the patient.Case presentationDuring an out-of-hospital cardiac arrest due to chemotherapy-induced anaphylaxis, a patient received a 10-fold dose of epinephrine due to shortcomings in communication and standardization via a central venous port catheter. The patient converted from a non-shockable rhythm into a pulseless ventricular tachycardia and subsequently into ventricular fibrillation. The patient was cardioverted and defibrillated and had a return of spontaneous circulation with profound hypotension only 6 min after the administration of 10 mg epinephrine. The patient survived without any residues or neurological impairment.ConclusionsThis case demonstrates the potential deleterious effects of shortcomings in communication and deviation from standard protocols, especially in emergencies. Here, precise instructions, closed-loop communication and unambiguous labelling of syringes would probably have avoided the epinephrine overdose central to this case. Interestingly, this serious error may have saved the patient’s life, as it led to the development of a shockable rhythm. Furthermore, as the patient was still in profound hypotension after administering 10 mg of epinephrine, this high dose might have counteracted the severe vasoplegic state in anaphylaxis-associated cardiac arrest. Lastly, as the patient was receiving care for advanced malignancy, the likelihood of termination of resuscitation in the initial non-shockable cardiac arrest was significant and possibly averted by the medication error.

Registered nurses' emotional responses to medication errors and perceived need for support: A qualitative descriptive analysis.

To identify the contributing factors behind the second victim phenomenon, describe the emotional responses of nurses after medication errors, assess the support received by them after errors and recognize the need for a suitable support program for second victims. Qualitative descriptive design. Eleven in-depth semi-structured interviews were conducted among registered nurses studying advanced degrees at a University in Finland during November 2021-April 2022. Data were analysed using thematic analysis. The study results revealed four themes with various sub-themes which included: contributing factors behind the second victim phenomenon; emotional responses of nurses after error; support received by nurses; and the desired need for a support program for second victims. The severity of the error and the negative work environment acted as catalysts for the second victim phenomenon among nurses. A "bitter aftermath" of emotions and a sense of insufficient support added further risk to already stressed and anxious nurses. This study identifies the early exploratory and enduring impact of memories associated with medication errors, some of them haunting nurses for long periods of time. Further, the need for support at different levels is highlighted to reduce the impact of negative emotions generated among nurses after medication errors. Through the lens of this study, it has been possible to identify contributing factors behind the second-victim phenomenon and enduring symptoms that make nurses vulnerable to becoming second victims of medication incidents. This study addresses the aftermath effect of medication errors from the perspective of nurses involved with such incidents. It provides valuable insights for healthcare managers and nurse leaders to establish a just and blame-free culture in healthcare organizations and help emotionally traumatized nurses cope effectively after error. The research adheres to Consolidated criteria for reporting qualitative research (COREQ) guidelines. No patient or public contribution.

Examining Barriers and Perceptions in Reporting Medication Administration Errors among Nurses at the Tertiary Care Hospitals in Peshawar Pakistan

Medication administration is vital for patient safety, yet medication errors can lead to life-threatening situations and increased mortality rates. Nurses, being essential members of the healthcare team, are constantly present with patients and regularly tasked with drug administration, facing a significant burden of medication errors compared to other healthcare providers. Objectives: To explore the barriers and perceptions of nurses' regarding medication errors reporting in public sector tertiary care hospitals. Methods: A convenient sample of 209 staff nurses participated in this cross-sectional survey from June to October 2022. A three-part questionnaire was used to gather information on the general characteristics of nurses, the causes of medication errors, and the justifications for not reporting them. Results: The Pharmacy supplies inappropriate doses to this unit with a mean of (2.53 ± 1.28) and an insufficient number of staff nurses in each working shift (4.23 ± 0.76) were the two least and most significant contributing factors to medication errors. Additionally, the two most and least significant factors for not reporting medication errors were that nurses may be held accountable if the patient suffered harm (3.94 ± 1.16) and that nurses did not agree with the hospital's definition of a medication error (2.33 ± 1.26) on average. Conclusions: The main causes of drug mistakes and failure to reveal them were nursing and management issues. Moreover, attempt to establish a blame-free culture to motivate reporting errors.

Nurses' perception of medication administration errors and factors associated with their reporting in the neonatal intensive care unit.

Medication administration is a complex process, and nurses play a central role in this process. Errors during administration are associated with severe patient harm and significant economic burden. However, the prevalence of under-reporting makes it challenging when analysing the current landscape of medication administration error (MAE) and hinders the implementation of improvements to the existing system. The aim of this study is to describe the reasons for the occurrence of MAEs and the reasons behind the under-reporting of MAEs, to determine the estimated percentage of MAE reporting and to identify factors associated with them from the nurses' perspective. This cross-sectional study was conducted using a validated self-administered questionnaire. The questionnaire contained 65 questions which were divided into three sections: (i) reasons for the occurrence of MAEs, which consisted of 29 items; (ii) reasons for not reporting MAEs, which consisted of 16 items; and (iii) percentage of MAEs actually reported, which consisted of 20 items. It was distributed to 143 nurses in the neonatal intensive care units of five public hospitals in Malaysia. Multivariable logistic regression was used to identify the factors associated with MAE reporting. The estimated percentage of MAE reporting was 30.6%. The most common reasons for MAEs were inadequate nursing staff (5.14 [SD 1.25]), followed by drugs which look alike (4.65 [SD 1.06]) and similar drug packaging (4.41 [SD 1.18]). The most common reasons for not reporting MAEs were that nursing administration focuses on the individual rather than looking at the systems as a potential cause of the error (4.56 [SD 1.32]) and that too much emphasis is placed on MAEs as a measure of the quality of nursing care (4.31 [SD 1.23]). Factors statistically significant with MAE reporting were administration response (adjusted odds ratio [AOR] = 6.90; 95% confidence interval (CI) = 2.01-23.67; P = 0.002), reporting effort (AOR = 3.67; 95% CI = 1.68-8.01; P = 0.001), and nurses with advanced diploma (AOR = 0.29; 95% CI = 0.13-0.65; P = 0.003). Our findings show that under-reporting of MAEs is still common and less than a third of the respondents reported MAEs. Therefore, to encourage error reporting, emphasis should be placed on the benefits of reporting, adopting a non-punitive approach, and creating a blame-free culture.

The relationships between patient safety culture and sentinel events among hospitals in Saudi Arabia: a national descriptive study

BackgroundSentinel events (SEs) can result in severe and unwanted outcomes. To minimize the fear of sentinel events reporting and the occurrence of sentinel events, patient safety culture improvements within healthcare organizations is needed. To our knowledge, limited studies explored the relationships between patient safety culture and sentinel events on a local level and no research has been conducted at the national level in Saudi Arabia.ObjectivesThis study aimed to explore the relationships between the patient safety culture and the reported-SEs on a national level during the year 2020 in Saudi hospitals.MethodsThis was a descriptive study. We utilized two data sources (the reported-SEs and the patient safety culture survey) that were linked using hospitals information. To explore the relationships between patient safety culture and reported-SEs rates, we performed descriptive statistics, a test of independence, post-hoc analysis, correlation analysis, and multivariate regression and stepwise analyses.ResultsThe highest positive domain scores in patient safety culture domains in the Saudi hospitals (n = 366) were “Teamwork Within Units” (80.65%) and “Organizational learning-continuous improvement” (80.33%), and the lowest were “Staffing” (32.10%) and “Nonpunitive Response to Error” (26.19%). The highest numbers of reported-SEs in 103 hospitals were related to the contributory factors of “Communication and Information” (63.20%) and “Staff Competency and Performance” (61.04%). The correlation analysis performed on 89 Saudi hospitals showed that higher positive patient safety culture scores were significantly associated with lower rates of reported-SEs in 3 out of the 12 domains, which are “Teamwork Within Units”, “Communication Openness”, and “Handoffs and Transitions”. Multivariate analyses showed that “Handoffs and Transitions”, “Nonpunitive Response to Error”, and “Teamwork Within Units” domains were significant predictors of the number of SEs. The "Staff Competency and Performance" and "Environmental Factors" were the most contributory factors of SEs in the number of significant correlations with the patient safety culture domains.ConclusionThis study identified patient safety culture areas of improvement where hospitals in Saudi Arabia need actions. Our study confirms that a more positive patient safety culture is associated with lower occurrence of sentinel events. To minimize the fear of sentinel events reporting and to improve overall patient safety a culture change is needed by promoting a blame-free culture and improving teamwork, handoffs, and communication openness.

Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety.

IntroductionRecognizing the values and norms significant to healthcare organizations (Safety Culture) are the prerequisites for safety and quality care. Understanding the safety culture is essential for improving undesirable workforce attitudes and behaviours such as lack of adverse event reporting. The study assessed the frequency of adverse event reporting, the patient safety culture determinants of the adverse event reporting, and the implications for Ghanaian healthcare facilities.MethodsThe study employed a multi-centre cross-sectional survey on 1651 health professionals in 13 healthcare facilities in Ghana using the Survey on Patient Safety (SOPS) Culture, Hospital Survey questionnaire. Analyses included descriptive, Spearman Rho correlation, one-way ANOVA, and a Binary logistic regression model.ResultsThe majority of health professionals had at least reported adverse events in the past 12 months across all 13 healthcare facilities. Teamwork (Mean: 4.18, SD: 0.566) and response to errors (Mean: 3.40, SD: 0.742) were the satisfactory patient safety culture. The patient safety culture dimensions were statistically significant (χ2 (9, N = 1642) = 69.28, p < .001) in distinguishing between participants who frequently reported adverse events and otherwise.ConclusionPromoting an effective patient safety culture is the ultimate way to overcome the challenges of adverse event reporting, and this can effectively be dealt with by developing policies to regulate the incidence and reporting of adverse events. The quality of healthcare and patient safety can also be enhanced when healthcare managers dedicate adequate support and resources to ensure teamwork, effective communication, and blame-free culture.

The influence of physician-nurse collaboration on patient safety culture

BackgroundMany factors in health care organizations affect patients' safety, such as; multi-professional teamwork and collaboration. Physician-Nurse collaboration is the most crucial inter-professional collaboration in the health care system. Because these professionals are the closest to the patient and make most decisions related to patients' conditions, Physician-Nurse collaboration affects patients' health condition consequences, length of stay in health care facilities, patients' mortality, and the existence of medical errors. Aim of the studyThis study explores the relationship between physician-nurse collaboration and patient safety culture and compares patient safety culture levels between Jordanian hospitals from different sectors. In addition, examine differences in patient safety culture levels according to the position of health care providers (i.e., nurse managers, RN, and physicians). MethodsA descriptive, cross-sectional design using a self-administered questionnaire was used for the current study. Data were collected between February and May of 2019. Four different hospital settings in Jordan (University, not-for-profit, private and governmental hospitals) were selected. In addition, we recruited a convenience sample representing registered nurses, nurse managers, and physicians at the selected hospitals. MeasurementsThree self-administered questionnaires were used to collect data for the current study: Demographic Data, Collaboration and Satisfaction About Care Decisions (CSACD), and Hospital Survey on Patient Safety Culture version 1.0 (HSOPS). Data analysisData were screened for errors in data entry, outliers, or missing values. Data were normally distributed without extreme outliers. This study used descriptive statistics, the Pearson product-moment correlation, one-way ANOVA, and the Chi-square tests were used in this study. The level of significance (alpha value) is set at 0.05. Resultsshowed that physician-nurse collaboration had a significant positive relationship with all patient safety culture levels (P < 0.01). In addition, the Pearson's product-moment correlation coefficient results indicated that all patient safety culture scores and subscales were positively and significantly correlated with physician-nurse collaboration (P < 0.01). Furthermore, the results of one-way ANOVA showed a statistically significant difference in the overall perception of patient safety culture according to the position of participants (P < 0.01). Moreover, Participants in Not-for-Profit Hospitals were more likely to report an ‘excellent/very good’ patient safety grade (P < 0.001) than in other hospitals. ConclusionPhysician-nurse collaboration positively impacts overall patient safety culture grades. Health care organization in Jordan has the potential to increase levels of patient safety cultures; however, to achieve this aim, there should be a stronger focus on building effective inter-professional collaboration and building a blame-free culture among healthcare providers, and these organizations should receive the needed support from health care leaders in the country. To help strengthen the health care system, raise patient safety culture levels, and improve quality.

Perceived Patient Safety Culture among Healthcare Providers in Southern Jordanian Hospitals during COVID-19 Pandemic

Background: The first step towards creating safe circumstances for patient care is to conduct thorough and ongoing assessments of the safety culture in the healthcare sector. Purpose: The purpose of this study was to assess healthcare professionals’ perceived culture of patient safety during the 2019 corona virus disease (COVID-19) outbreak in southern Jordanian hospitals. Methods: A descriptive, cross-sectional research of healthcare professionals (physicians, nurses and their administrators) was carried out. An Arabic translation of the Hospital Survey of Patient Safety Culture (HSPSC) questionnaire was used to collect information from 531 healthcare providers between July and November 2021 in four hospitals in Southern Jordan. Results: Nurses perceived ‘staffing’ as the highest dimension of the twelve dimensions of safety culture. However, they perceived ‘reporting patient safety events’ as the lowest dimension. The results show that healthcare providers perceived the twelve dimensions of patient safety culture as weakness areas that need improvement. The number of patient safety events reported by respondents in public hospitals was significantly (p&lt;0.05) higher than the number of those reported by respondents in private ones (2.4±0.71 vs. 2.8±0.98, respectively). Conclusions: Hospitals in southern Jordan need to improve their patient safety culture procedures as well as patient safety aspects, such as personnel, handoffs and reporting-related components. Implications for Nursing: Hospital policies need to be adopted in a way that enhances a blame-free culture and an organized safety education program for all healthcare providers, especially new staff. Healthcare providers should be motivated to work as a team through a more reasonable allocation of authority and commission of work. Keywords: Patient safety, Safety culture, Southern Jordan, COVID-19 pandemic

Exploring healthcare workers\u2019 perceptions on the use of morbidity and mortality audits as an avenue for learning and care improvement in Kenyan hospitals\u2019 newborn units

BackgroundIn many sub-Saharan African countries, including Kenya, the use of mortality and morbidity audits in maternal and perinatal/neonatal care as an avenue for learning and improving care delivery is sub-optimal due to structural, organizational, and human barriers. While attempts to address these barriers have been reported, lots of emphasis has been paid to addressing the role of tangible inputs (e.g., availing guidelines and training staff in the success of mortality and morbidity audits), while process-related factors (i.e., the role of the people, their experiences, relationships, and motivations) remain inadequately explored. We examined the processes of neonatal audits, their potential in promoting learning from gaps in care and improving care delivery, with a deliberate focus on process-related factors that generally influence mortality and morbidity (M&M) audits.MethodsThis was an exploratory qualitative study, conducted in three hospitals, in Nairobi and Muranga counties. We employed a mix of in-depth interviews (17) and observation of 12 mortality and morbidity audit meetings. Our study participants included: nurses, doctors, trainee clinicians (i.e., junior doctors on internships), and nursing students involved in providing newborn care. These data were coded using NVivo12 employing a thematic content analysis approach.ResultsPerceived shortcomings in the conduct of M&M audits such as unclear structure was reported to have contributed to its sub-optimal nature in promoting learning. These shortcomings, in addition to hierarchy and power dynamics, poor implementation of audit recommendations, and negative experiences, (e.g., blame) also demotivated health workers from attendance and participation in audits. Despite these, positive outcomes linked to audit recommendations, such as revision of care protocols, were reported. Overall, leadership and a blame-free culture enabled positive changes and promoted learning from audit-identified modifiable factors.ConclusionOur findings indicate that M&M audits provide a space for meaningful discussions, which may lead to learning and improvement in care delivery processes. However, a lack of participation, lack of observed positive outcomes, and negative experiences may reduce their usefulness. An enabling environment characterized by minimized effects of hierarchy and positive use of power and a blame-free culture may promote active participation, enhancing positive relationships and interactions thus promoting team learning.

"So hard not to feel blamed!": Assessment of implementation of Benin's Maternal and Perinatal Death Surveillance and Response strategy from 2016-2018.

To assess the implementation of the Maternal and Perinatal Death Surveillance and Response (MPDSR) strategy institutionalized in Benin in 2013 to address the alarmingly high maternal and neonatal death rates. A retrospective, mixed-methods study was performed. We used all maternal and neonatal death notifications and reviews from 2016 to 2018, reviewed the reports of 63MPDSR working groups, and held two online group discussions. Descriptive quantitative analysis was performed, and content analysis was applied to qualitative data. Deaths were under-notified, with estimated notification rates at 46%-48% for maternal and 16%-21% for neonatal deaths over the 3years. Review completion rates were low, corresponding to 50%-56% of maternal and 8%-17% of neonatal deaths. Causes of undernotification included very low notification of community-based and private health facility deaths, and fear of blame. Low review completion rates were due to heavy workload, staffing shortages, fear of blame, and weak leadership. Moreover, reviews were of poor quality and the response was weak. Maternal and Perinatal Death Surveillance and Response is operational in Benin. However, this assessment highlights the need to strengthen the notification strategy, continuously build MPDSR committee members' capacities, engage decision-makers for an effective response, and create a better blame-free, accountable, and learning culture.

Readers’ panel: Inappropriate use of Datix: how can nurses help create a blame-free culture?

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Understanding reporting practices and perceptions of barriers in adverse events following immunisation surveillance: A cross–sectional survey of paediatricians in Kerala, India

PurposeThe role of health care professionals (HCPs) is central to adverse event following immunisation (AEFI) surveillance. A cross–sectional survey was conducted among paediatricians practising in Kerala, India, to assess their knowledge and reporting behaviour in AEFI surveillance as well as to identify barriers to reporting. ResultsA random sample of 380 paediatricians were contacted of whom, 243 (63.9%) participated in the survey. The understanding scores were distributed as follows: 30.9% very high or high, 40.3% moderate, and 28.8% low. Formal training was significantly associated with higher understanding scores, and increased AEFI detection and reporting. Only 42.0% of respondents had formal training; paediatricians in the public sector had higher access to training than those in the private sector. There were 141 respondents (58.0%) who identified an AEFI in the previous year, of whom 66 (46.8%) reported it. The main barriers to AEFI reporting were: difficulties with reporting process (28.9%); fear of raising public alarm (28.1%); time constraints (22.3%); fear of personal consequences (15.7%); and belief that health authorities rarely take useful action (11.6%). ConclusionTraining in AEFI surveillance should be prioritised for HCPs with greater emphasis in medical education programmes. Study showed that a user–friendly reporting mechanism and a blame–free culture are crucial to improve AEFI reporting practices.

Epidemiology of patient safety incidents in a long-term rehabilitative hospital in KwaZulu-Natal, South Africa (April 2011 to March 2016).

BackgroundPatient safety is a key priority of the National Department of Health. Despite the publication of legislation and other measures to address patient safety incidents (PSIs) there are a paucity of studies relating to patient safety at the different levels of hospitals.ObjectivesTo determine the epidemiology (incidence, nature and root causes) of PSIs at a long-term rehabilitative hospital between April 2011 and March 2016.MethodData were collected through a review and analysis of routinely collected hospital information on patient records and from the PSI register, as well as minutes of adverse health events meetings, quality assurance reports and patient complaints register.ResultsA total or 4.12 PSIs per 10 000 inpatient days were reported. Approximately 52% of the adverse health events occurred in females with most of the adverse health events occurring in the 50–59 years category: 96% being reported during the day and 33% within the shift change. Pressure ulcers, falls, injury, hospital acquired infections and medication error were the most commonly reported PSIs. Patient factors were listed as the most common root cause for the PSIs.ConclusionThe study shows a low reporting rate of PSIs whilst showing a diverse pattern of PSIs over a period of 5 years. There is a need for active change management in order to establish a blame-free culture and learning environment to improve reporting of PSI. A comprehensive quality improvement intervention addressing patients, their families and staff is essential to minimise PSI and its consequences.

Factors Influencing Patient Safety Culture in Saudi Arabia: A Systematic Review

ABSTRACT&#x0D; Context: Patient safety, which is concerned with preventing harm to patients, has already become a vital element of the global healthcare system. The evidence relating to the status of the patient safety culture in Arab countries suggests that it is at a sub-optimal level because of a punitive approach to errors and deficits in communications openness.&#x0D; Aim: The given review aimed to identify the relevant evidence related to factors influencing patient safety culture in Saudi Arabia hospitals from patients and health care provider perspectives.&#x0D; Methods: A systematic search was conducted in five electronic databases—MEDLINE, CINAHL, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews. Related papers and reference lists of included studies were also hand-searched. One reviewer verified that the research met the inclusion criteria, assessed the research quality, and extracted their relevant features. The Yorkshire Contributory Factors Model (YCFF) was used to categorize factors influencing safety culture in the included documents.&#x0D; Results: 14 documents were included, and most research was appraised as being satisfactory to high quality. Strength and weakness factors that are influencing patient safety culture have been identified. In Saudi Arabia, ineffective leadership, a blame culture, workload/inadequate staffing, and poor communication are key factors hindering a positive patient safety culture. Conversely, 'strength' factors influencing a positive patient safety culture included good teamwork within units, realistic manager expectations and supportive actions promoting patient safety, and organizational attitudes to learning/continuous improvement. There is an absence of patient perspectives about patient safety culture in Saudi Arabian studies.&#x0D; Conclusion: In the Saudi healthcare system, policymakers should pay attention to factors that may influence a positive patient safety culture, particularly the development of a blame-free culture, improving communications and leadership ability, learning from mistakes, and involving patient perspectives in safety initiatives. Further study must understand the barriers and facilitators in Saudi Arabia Hospitals to implement a positive patient safety culture.

Strategies to Increase Resilience, Team Building, and Productivity Among Radiologists During the COVID-19 Era.

Well-being can be defined as feeling connected through mutually supportive relationships and productivity in the workplace [1,2]. An extended response to the coronavirus disease 2019 (COVID-19) pandemic will likely lead to a magnification of stress and burnout, with negative consequences in the workplace in terms of engagement and productivity. A positive and proactive approach to radiologist well-being is necessary now more than ever. Acknowledging that there are many strategies for increasing physician well-being, such as better communication, self-check-ins, and a supportive, blame-free work culture [3], in this opinion piece we focus on potential measures to foster engagement and nurture professional connections among radiologists at a time when the unpredictable demands and stressors of the COVID-19 pandemic continue to evolve.

Factors contributing to the patient safety culture in Saudi Arabia: a systematic review

BackgroundPatient safety, concerned with the prevention of harm to patients, has become a fundamental component of the global healthcare system. The evidence regarding the status of the patient safety culture...

Assessment of patient safety culture perception among healthcare workers in intensive care units of Alexandria Main University Hospital, Egypt

ABSTRACT Background Patient safety culture (PSC) is a vital feature to assess the ability of any healthcare setting in addressing and reducing patients harm. This study attempted to assess the PSC in Intensive Care Units (ICUs) at Alexandria Main University Hospital (AMUH) from the point of view of physicians and nurses. Methods A cross-sectional study was implemented in two ICUs at AMUH over period of six months. Seventy-two participants were interviewed using the Hospital Patient Safety Scale, customized by the Agency for Healthcare Research and Quality (AHRQ). Results The average positive response to individual items in the patient safety scale ranged from 2.7% to 79.2%. The “Teamwork within Units” dimension had the utmost average percentage positive score (63.5%) amongst all participants, on the other hand, the “Non-Punitive Response to Errors” dimension had the lowest one (12.0%). Less than half (45.8%) of the interviewed participants rated patient’s safety at the hospital as accepted. Conclusions PSC is friable in targeted ICUs, much of work is needed to raise the responsiveness of health care givers regarding this issue. Executives and supervisors need to encourage the practices of PS through a blame free culture.

Second victims need emotional support after adverse events: even in a just safety culture.

Second victims need emotional support after adverse events: even in a just safety culture.

Nature of Blame in Patient Safety Incident Reports: Mixed Methods Analysis of a National Database.

A culture of blame and fear of retribution are recognized barriers to reporting patient safety incidents. The extent of blame attribution in safety incident reports, which may reflect the underlying safety culture of health care systems, is unknown. This study set out to explore the nature of blame in family practice safety incident reports. We characterized a random sample of family practice patient safety incident reports from the England and Wales National Reporting and Learning System. Reports were analyzed according to prespecified classification systems to describe the incident type, contributory factors, outcomes, and severity of harm. We developed a taxonomy of blame attribution, and we then used descriptive statistical analyses to identify the proportions of blame types and to explore associations between incident characteristics and one type of blame. Health care professionals making family practice incident reports attributed blame to a person in 45% of cases (n = 975 of 2,148; 95% CI, 43%-47%). In 36% of cases, those who reported the incidents attributed fault to another person, whereas 2% of those reporting acknowledged personal responsibility. Blame was commonly associated with incidents where a complaint was anticipated. The high frequency of blame in these safety, incident reports may reflect a health care culture that leads to blame and retribution, rather than to identifying areas for learning and improvement, and a failure to appreciate the contribution of system factors in others' behavior. Successful improvement in patient safety through the analysis of incident reports is unlikely without achieving a blame-free culture.