Error Prevention Mechanisms Research Articles

Mindful Workarounds in Bar Code Medication Administration.

Bar-Coded Medication Administration systems (BCMA) are often used with workarounds. These workarounds are usually judged against standard operating procedures or the use of the technology as 'designers' intended'. However, some workarounds may be reasonable and justified to prevent safety errors. In this conceptual paper, we clarify BCMA safety mechanisms and provide a framework to identify workarounds with BCMA that nullify the error prevention mechanisms inherent in the technology design and process. We also highlight the importance of understanding the purpose behind a nurse's workaround in BCMA, focusing on the notion of mindful (thoughtful) workarounds that have the potential to improve patient safety.

Video-assisted surgery: suggestions for failure prevention in laparoscopic cholecystectomy

Surgery differs from other medical specialties in its execution. It is often complex and includes considerable individual variations. Observing problems in operating theatres (OT) allows for the identification of system failures, which should be defined for learning purposes to increase patient safety and enhance general safety culture within hospital organizations. This study evaluates a common video-assisted surgical procedure, laparoscopic cholecystectomy (LC) through failure analysis. The profile of the LC procedure and failure sources is presented. Data consisted of video observations and interviews concerning twelve LC operations performed at a day surgery unit. All operations were teaching sessions. Qualitative analysis was undertaken. Through task analysis, specialist interviews and failure identification, a failure profile of LC was produced. Twenty failure types were identified, and failures were, for example, remote attention towards ergonomics, novice's skill failures, inadequate supervision and unnecessary risk-taking caused by tight operating schedules. The results showed that the importance of working principles should be emphasized. The failure profile of LC revealed three phases featuring multiple failures: dissecting the peritoneal covering; identifying, sealing and cutting the cystic duct and cystic artery; and detaching the gallbladder from the hepatic bed and inspecting the hepatic bed. This study offers information for hospital organizations about the current state of surgical work and surgical skills learning. This information could be exploited in the development of system defences: error prevention mechanisms through investing in the redesign of work tasks and working methods; as well as reinforcing education and training for enhancing patient safety in OT.

Patient safety culture in acute care: A web‐based survey of nurse managers' and registered nurses' views in four Finnish hospitals

Nurse managers (NMs) and registered nurses (RNs) have key roles in developing the patient safety culture, as the nursing staff is the largest professional group in health-care services. We explored their views on the patient safety culture in four acute care hospitals in Finland. The data were collected from NMs (n = 109) and RNs (n = 723) by means of a Hospital Survey on Patient Safety Culture instrument and analyzed statistically. Both groups recognized patient safety problems and critically evaluated error-prevention mechanisms in the hospitals. RNs, in particular, estimated the situation more critically. There is a need to develop the patient safety culture of hospitals by discussing openly about them and learning from mistakes and by developing practices and mechanisms to prevent them. NMs have central roles in developing the safety culture at the system level in hospitals in order to ensure that nurses caring for patients do it safely.