Evidence-based Safety Practices Research Articles

Validation of system safety hazard analysis in safety-critical industries: An interview study with industry practitioners

While many hazard analysis techniques exist, little empirical research has been dedicated to their use in industrial contexts, in particular concerning how practitioners validate hazard analyses. This raises questions about the accuracy, comprehensiveness, and credibility of safety analyses, and how practitioners consider this issue in relation to the overall system safety work. Acquiring qualitative evidence regarding the validation of hazard analysis among practitioners is important to support evidence-based safety practices. This paper qualitatively investigates the state of practice in hazard analysis and its validation for system safety among practitioners. Twenty semi-structured interviews were conducted with practitioners in safety–critical industries in North America. Feedback from practitioners indicates that only a limited number of hazard analysis methods are applied in industry, which are mainly based upon linear accident theory. It is also found that almost all practitioners perform some form of validation as they believe this type of safety work improves safety. Experts Reviews and benchmark exercises are the only methods reported for validating hazard analysis. In addition, practitioners highlighted several weaknesses of the current hazard analysis and hazard analysis validation practices, of which subjectivity is seen as the most important one. The authors discuss this in context of the emerging academic consensus that hazard analysis is inherently subjective, but that it can nevertheless be very useful especially when it relies on strong evidence. Also, several opportunities for organizations, regulatory bodies, and academic institutions are identified to improve the current state of the practice in both hazard analysis and hazard analysis validation.

Knowledge, attitudes and practices regarding patient safety among surgical trainees in Sri Lanka

IntroductionSurgical trainees play an integral role in the perioperative workup and safety of patients undergoing surgery. This study was aimed to assess surgical trainees’ knowledge, attitudes and practices on perioperative surgical patient safety. MethodsA descriptive cross-sectional study among 105 surgical trainees (males 96%, mean age 33 years, range 30-40 years) was performed using self-administered validated questionnaires on knowledge, attitudes (Safety Attitude Questionnaire-SAQ) and practices (Questionnaire on evidence-based safety practices and reporting of medical errors). Responses were marked on a 5-point Likert scale and were analysed.ResultsApproximately two thirds (n=72, 69%) were junior registrars and the rest (n=33, 31%) were senior registrars. The median knowledge score was 60 (range 10-90). The Median SAQ score was 74 (151/205, range 57-95). Approximately 65% (n=68) claimed they were aware of the protocols of marking the surgical site. Nearly three quarters (n=78, 74%) have read the WHO safe surgery guidelines. Eighty-seven participants (84%) had not attended a formal risk management course/ teaching activity. Only 53% (n=56) believed that medical errors were handled appropriately and less than a third (31%, n=33) believed that the work environment was favourable to discuss errors. Only 54% (n=57) had received appropriate feedback about their performances. ConclusionOverall, the patient safety culture among surgical trainees was found to be suboptimal. Formal teaching sessions, workshops and local guidelines may help improve knowledge and attitudes on patient safety among surgical trainees. Furthermore, working conditions need to be improved to encourage discussion of medical errors and allow frequent feedback.

The State of the Practice in Validation of Model-Based Safety Analysis in Socio-Technical Systems: An Empirical Study

Even though validation is an important concept in safety research, there is comparatively little empirical research on validating specific safety assessment, assurance, and ensurance activities. Focusing on model-based safety analysis, scant work exists to define approaches to assess a model’s adequacy for its intended use. Rooted in a wider concern for evidence-based safety practices, this paper intends to provide an understanding of the extent of this problem of lack of validation to establish a baseline for future developments. The state of the practice in validation of model-based safety analysis in socio-technical systems is analyzed through an empirical study of relevant published articles in the Safety Science journal spanning a decade (2010–2019). A representative sample is first selected using the PRISMA protocol. Subsequently, various questions concerning validation are answered to gain empirical insights into the extent, trends, and patterns of validation in this literature on model-based safety analysis. The results indicate that no temporal trends are detected in the ratio of articles in which models are validated compared to the total number of papers published. Furthermore, validation has no clear correlation with the specific model type, safety-related concept, different system life cycle stages, industries, or with the countries from which articles originate. Furthermore, a wide variety of terminology for validation is observed in the studied articles. The results suggest that the safety science field concerned with developing and applying models in safety analyses would benefit from an increased focus on validation. Several directions for future work are discussed.

Safety Champions: An Innovative Role During an Evolving Pandemic.

Safety Champions: An Innovative Role During an Evolving Pandemic.

Surgical Teams' Attitudes About Surgical Safety and the Surgical Safety Checklist at 10 Years: A Multinational Survey.

In use for over a decade, the Checklist is a safety instrument aimed at improving operating room communication, teamwork, and evidence-based safety practices. An online survey was sent to surgeons, nurses, and anesthesiologists in 5 high-income countries (Canada, the United States, the United Kingdom, Australia, and New Zealand). Survey results were analyzed using SPSS. A total of 2032 health care professionals completed the survey. Of these respondents, 47.6% were nurses, 70.5% were women, 65.1% were from the United States, and 50.0% had 20 years of experience or more in their role. Most respondents felt the Checklist positively impacted patient safety (70.9%), team communication (73.1%), and teamwork (58.9%). Only 50.3% of respondents were satisfied their team's use of the Checklist, and only 47.5% reported team members stopping to fully participate in the process. More nurses lacked confidence regarding their role in the Checklist process than surgeons and anesthesiologists combined (8.9% vs 4.3%). Fewer surgeons and anesthesiologists than nurses felt they received adequate training on the Checklist's use (57.8% vs 76.7%). While most respondents perceive the Checklist as enhancing patient safety, not all surgical team members are actively engaging with its use. To enhance buy-in and meaningful use of the Checklist, health systems should provide more training on the Checklist with respect to its purpose and strengthening teamwork.

Pivoting Dental Practice Management during the COVID-19 Pandemic-A Systematic Review.

Background and Objectives: The aims of this systematic review were to identify additional infection control measures implemented in dental practice globally to prevent cross-infection and evaluate the psychological impacts of the pandemic among dental professionals. Materials and Methods: A sequential systematic literature search was conducted from December 2019 to 30 April 2020 through PubMed, CINAHL, Scopus, Google Scholar, Embase, and Web of Science databases. The search yielded the following results: “COVID-19” (n = 12,137), “Novel corona virus” (n = 63), “COVID-19 and dentistry” (n = 46), “COVID-19 and oral health” (n = 41), “Novel Corona virus and Dentistry” (n = 0), “dental health and Novel Coronavirus” (n = 26), and “dental practice and Novel Coronavirus” (n = 6). Results: After a careful review and eliminating articles based on inclusion and exclusion criteria, the final review included 13 articles. Management of infection control is discussed extensively in the literature and remains the main theme of many Coronavirus Disease 2019 (COVID-19) articles on dentistry. Telephone triage using a questionnaire, hand hygiene, personal protective equipment (PPE) for clinical and nonclinical staff, a preprocedural mouth rinse, and aerosol management have been discussed and implemented in few countries. Three studies recommended that elective treatments for patients with a temperature of >100.4 F or 38 °C should be postponed or performed in an airborne infection isolation room (AIIR) or negative-pressure room. Limiting the number of patients in the waiting area, the removal of shared objects, proper ventilation, and physical distancing were highly recommended. Psychological distress among dental professionals in relation to existing medical conditions and self-efficacy has been discussed. Conclusions: Although the COVID-19 pandemic has had a substantial impact on the dental profession worldwide, our review highlights many practice management approaches to adopt the new norm. More research highlighting evidence-based safety practices and multisectoral collaboration is required to help dental professionals make informed decisions and make the profession safe, both for the patient and dental professionals.

Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR.

Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health record (EHR) systems. This study was aimed to describe providers' use and perceived usability of the Patient Safety Dashboard and discuss barriers and facilitators to implementation. The Patient Safety Dashboard was implemented in a cluster-randomized stepped wedge trial on 12 units in neurology, oncology, and general medicine services over an 18-month period. Use of the Dashboard was tracked during the implementation period and analyzed in-depth for two 1-week periods to gather a detailed representation of use. Providers' perceptions of tool usability were measured using the Health Information Technology Usability Evaluation Scale (rated 1-5). Research assistants conducted field observations throughout the duration of the study to describe use and provide insight into tool adoption. The Dashboard was used 70% of days the tool was available, with use varying by role, service, and time of day. On general medicine units, nurses logged in throughout the day, with many logins occurring during morning rounds, when not rounding with the care team. Prescribers logged in typically before and after morning rounds. On neurology units, physician assistants accounted for most logins, accessing the Dashboard during daily brief interdisciplinary rounding sessions. Use on oncology units was rare. Satisfaction with the tool was highest for perceived ease of use, with attendings giving the highest rating (4.23). The overall lowest rating was for quality of work life, with nurses rating the tool lowest (2.88). This mixed methods analysis provides insight into the use and usability of a dashboard tool integrated within a vendor EHR and can guide future improvements and more successful implementation of these types of tools.

Leadership, safety culture and patient safety in hospitals: in search of evidence

Background At least since the publication of “To Err is Human” in the year 2000 we all know that hospitals could be safer than they are [1]. In the meantime the knowledge about patient safety and evidence based safety practices grew substantially but too often these practices do not reach the patients [2]. Evidence based medicine, nursing and therapy are advancing but the implementation gap seems also to be growing [3]. Are evidence based leadership and an appropriate safety culture the solution to this implementation gap since “more than enough evidence exists to prompt decisive action” [4]? Do we suffer blind spots on the roles of leadership and safety culture? The first objective of this study was to review theories, models and empirical evidence of the functions, roles and interdependences of leadership practices, safety cultures and patient safety outcomes in hospitals. Secondly, empirical studies will be conducted to test and validate the framework.

The Top Patient Safety Strategies That Can Be Encouraged for Adoption Now

Over the past 12 years, since the publication of the Institute of Medicine's report, “To Err is Human: Building a Safer Health System,” improving patient safety has been the focus of considerable public and professional interest. Although such efforts required changes in policies; education; workforce; and health care financing, organization, and delivery, the most important gap has arguably been in research. Specifically, to improve patient safety we needed to identify hazards, determine how to measure them accurately, and identify solutions that work to reduce patient harm. A 2001 report commissioned by the Agency for Healthcare Research and Quality, “Making Health Care Safer: A Critical Analysis of Patient Safety Practices” (1), helped identify some early evidence-based safety practices, but it also highlighted an enormous gap between what was known and what needed to be known.

Patient safety and medical errors: knowledge, attitudes and behavior among Italian hospital physicians

To investigate physicians' knowledge about evidence-based patient safety practices, their attitudes on preventing and managing medical errors and to explore physicians' behavior when facing medical errors. A nationwide cross-sectional survey. We first stratified our population by the 20 Italian regions. Then, within each stratum, we selected by simple random sampling, for each region, one regional general hospital and one district general hospital to yield a sample of 40 hospitals overall. Twelve hundred physicians involved in direct patient care (30 per hospital) were sent a survey by mail and 696 responded. Knowledge on patient safety practices, attitudes and practices toward the prevention of medical errors. Physicians' knowledge of evidence-based safety practices was inconsistent. More than 90% of physicians reported that counting surgical items during an invasive surgical procedure represented a patient safety practice. Positive attitudes about patient safety were revealed by responses, but 44.5 and 44.1%, respectively, agreed or were uncertain about the disclosure of errors to the patients. The pattern of behavior showed that 7.6% of physicians reported to have never been involved in medical errors, and among system failures, 'overwork, stress or fatigue of health professionals' was the most highly rated item. The results from our study highlight that greater efforts are needed to facilitate the translation of positive attitudes towards patient safety into appropriate practices that have proven to be effective in the reduction of medical errors.