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At least 37 records · Page 2Linked to original sources
PubMed2005

Real time patient safety audits: improving safety every day.

BACKGROUND: Timely error detection including feedback to clinical staff is a prerequisite for focused improvement in patient safety. Real time auditing, the efficacy of which has been repeatedly demonstrated in industry, has not been used previously to evaluate patient safety. Methods successful at improving quality and safety in industry may provide avenues for improvement in patient safety. OBJECTIVE: Pilot study to determine the feasibility and utility of real time safety auditing during routine clinical work in an intensive care unit (ICU). METHODS: A 36 item patient safety checklist was developed via a modified Delphi technique. The checklist focused on errors associated with delays in care, equipment failure, diagnostic studies, information transfer and non-compliance with hospital policy. Safety audits were performed using the checklist during and after morning work rounds thrice weekly during the 5 week study period from January to March 2003. RESULTS: A total of 338 errors were detected; 27 (75%) of the 36 items on the checklist detected >or=1 error. Diverse error types were found including unlabeled medication at the bedside (n = 31), ID band missing or in an inappropriate location (n = 70), inappropriate pulse oximeter alarm setting (n = 22), and delay in communication/information transfer that led to a delay in appropriate care (n = 4). CONCLUSIONS: Real time safety audits performed during routine work can detect a broad range of errors. Significant safety problems were detected promptly, leading to rapid changes in policy and practice. Staff acceptance was facilitated by fostering a blame free "culture of patient safety" involving clinical personnel in detection of remediable gaps in performance, and limiting the burden of data collection.

Delphi Technique↗
PubMed1992

The influence of safety belt laws on self-reported safety belt use in the United States.

We assessed rates and trends in safety belt use by presence and type of safety belt law using data from states participating in the 1984-1989 Behavioral Risk Factor Surveillance System. State(s) with a safety belt law allowing law enforcement officers to stop vehicles for occupants' failure to use safety belts (primary enforcement law) had greater and more rapid increases in safety belt use rates than did states with laws requiring that vehicles must first be stopped for some other violation before a citation or fine for occupants' failure to use safety belts could be imposed (secondary enforcement law). Larger and sustained increases in safety belt use occurred when safety belt laws became effective or when fines were imposed for violations than when laws were first enacted. These data suggest that primary enforcement laws result in greater and more rapid increases in safety belt use than do secondary enforcement laws, and that initial increases in safety belt use following implementation of laws are sustained.

Humans↗
PubMed2004

Complying with the Occupational Safety and Health Administration's Bloodborne Pathogens Standard: implementing needleless systems and intravenous safety devices.

Preventing the transmission of bloodborne pathogens to healthcare workers has been a mission and a challenge of the healthcare industry for over 20 years. The development of the Occupational Safety and Health Administration Bloodborne Pathogens Standard in 1991 and the passing of the Needlestick Safety Act in 2000 mandated hospitals to develop an Exposure Control Plan to protect workers from these pathogens. Children's Hospital Boston began implementation of a needleless system in 1993. Employees readily accepted these systems into practice, because they were convenient and easy to use. A marked decrease in exposures to bloodborne pathogens naturally followed, which is consistent with the national data. The transition to intravenous (i.v.) safety devices at Children's Hospital began in 2000 and proved to be more of a challenge. First, the clinicians must choose a safety product, which requires developing and implementing a trial plan with potential catheters. This selection process is especially difficult in pediatrics where successful placement of the smallest-gauge catheter, no. 24, is imperative. After choosing an i.v. safety product, successful transition is dependent upon the thoroughness of i.v. safety device training and a commitment by the clinicians to the use of these products. Although the number of needlestick injuries and subsequent transmission of bloodborne pathogens have been further reduced with the use of i.v. safety devices, needlestick injuries still occur. This results from a lack of familiarity with the engineering of the device and therefore poor technique or a failure to activate the safety mechanism. Staff resistance due to loss of expertise with the new device and patient care concerns are additional barriers to the use of these new products. Addressing these obstacles and providing adequate training for all clinicians were required for successful implementation of these i.v. safety devices.

Attitude of Health Personnel↗
PubMed2006

Safety culture and accident analysis--a socio-management approach based on organizational safety social capital.

One of the biggest challenges for organizations in today's competitive business environment is to create and preserve a self-sustaining safety culture. Typically, the key drivers of safety culture in many organizations are regulation, audits, safety training, various types of employee exhortations to comply with safety norms, etc. However, less evident factors like networking relationships and social trust amongst employees, as also extended networking relationships and social trust of organizations with external stakeholders like government, suppliers, regulators, etc., which constitute the safety social capital in the Organization--seem to also influence the sustenance of organizational safety culture. Can erosion in safety social capital cause deterioration in safety culture and contribute to accidents? If so, how does it contribute? As existing accident analysis models do not provide answers to these questions, CAMSoC (Curtailing Accidents by Managing Social Capital), an accident analysis model, is proposed. As an illustration, five accidents: Bhopal (India), Hyatt Regency (USA), Tenerife (Canary Islands), Westray (Canada) and Exxon Valdez (USA) have been analyzed using CAMSoC. This limited cross-industry analysis provides two key socio-management insights: the biggest source of motivation that causes deviant behavior leading to accidents is 'Faulty Value Systems'. The second biggest source is 'Enforceable Trust'. From a management control perspective, deterioration in safety culture and resultant accidents is more due to the 'action controls' rather than explicit 'cultural controls'. Future research directions to enhance the model's utility through layering are addressed briefly.

Accidents, Occupational↗
PubMed2006

Production supervisor impacts on subordinates' safety outcomes: an investigation of leader-member exchange and safety communication.

PROBLEM: Supervisors are increasingly important to the functioning of manufacturing operations, in large part due to their role as leaders. While supervisors' relations and communication with their subordinates are known to be important in influencing subordinates' behavior, little is known about how these two factors will impact subordinates' safety. This study investigated how much each factor contributes to safety-related outcomes for blue-collar production employees. METHOD: Production employees at five Pennsylvania wood manufacturers completed a survey during their work shift. Five hundred and ninety eight employees provided data on leader-member exchange (LMX), safety communication, and safety-related events. Archival data on OSHA recordables were also obtained from the producers' human resources database. RESULTS: Analyses found that the influence of LMX was greater than that of safety communication in predicting safety-related events. Neither LMX nor safety communication was significantly related to OSHA recordables. Results also demonstrated that employee job satisfaction and demographic variables such as gender and age have safety implications. IMPACT ON INDUSTRY: Results from this study further emphasize the importance of production supervisors and illustrate the potential role of leader-member exchange in enhancing workplace safety. Specifically, organizations should foster positive social exchange between their employees and supervisors and enhance the leadership qualities of supervisors to help reduce workplace injuries.

Accidents, Occupational↗
PubMed1998

Safety instrumented functions and safety integrity levels (SIL).

This paper discusses two performance-based standards, ANSI/ISA S84.01 and IEC d61508, and the requirements they place upon user companies of electrical, electronic and programmable electronic safety related systems (E/E/PE SRS) or Safety Instrumented Systems (SIS). To comply to the requirements of the standards, a user company would have to: (a) identify the safety target level of the process; (b) evaluate the hazardous events that pose a risk higher than the safety target level; (c) determine the safety function(s) that must be implemented in an SIS to achieve the safety target level; (d) implement the safety functions in an SIS and evaluate its safety integrity level (SIL); (e) install, test and commission the SIS; and (f) verify that the installed SIS does in fact reduce the process risk to below the safety target level. Several risk analysis techniques that can be used to comply with the aforementioned requirements are discussed and a simple example is used to illustrate the use, advantages and disadvantages of the techniques. The evaluation of SIL of the SIS (probability to fail to respond to a process demand) is outside the scope of this paper.

Electronics↗
PubMed2003

Antecedents of injury among youth in agricultural settings: a longitudinal examination of safety consciousness, dangerous risk taking, and safety knowledge.

PROBLEM: Injuries are the leading cause of death for adolescents in the United States. METHODS: This study longitudinally examined three psychological mediators of injury among 3,081 youths in agricultural settings: (a) safety consciousness, (b) dangerous risk taking, and (c) safety knowledge. These variables are examined within a nomological network of contextual variables. RESULTS: Cross-sectional results revealed that safety consciousness and dangerous risk taking were the strongest predictors of reported injury at Time 1 and Time 2. Safety knowledge had an unexpected negative association with injury, albeit weak. As predicted, participating in safety activities was positively associated with safety consciousness, and time spent working was strongly associated with safety knowledge. Furthermore, self-esteem had both positive and negative safety outcomes, suggesting a more complex functioning. Males exhibited fewer safety cognitions than females as predicted. Longitudinal data also revealed that injury at Time 1 and dangerous risk taking were the strongest predictors of Time 2 injury. IMPACT ON INDUSTRY: Results from this study emphasize the importance of assessing dangerous risk-taking perceptions when attempting to predict future injuries.

Adolescent↗
PubMed2002

The safety checklist program: creating a culture of safety in intensive care units.

BACKGROUND: In 1999 the VA Ann Arbor Healthcare System began a safety checklist program to help build a culture of safety among nurses, respiratory therapists, and unit maintenance providers in the intensive care units (ICUs). Program objectives were to (a) create the opportunity for each participating staff member to view his or her work and unit environment in a broader safety context; (b) establish clear, concise, and measurable standards that staff would identify and value as important safety factors; (c) develop a data collection methodology that would minimize confirmation bias; and (d) correct safety deficits immediately. DATA MANAGEMENT: Staff measure compliance with safety standards twice daily and record results on a form specifically designed for the project. Data are transferred to a spreadsheet, and graphic presentations are posted in each ICU. Staff periodically adjust both standards and data collection procedures. SUMMARY: Staff can articulate how the program is making the ICU a safer environment. Nursing response to a recent major error reflects the growth that has occurred since the program's inception. Safety checks performed by ICU staff are critical in maintaining a constant level of safety. Although the effect on untoward events was not measured, the potential for incidents, including medication and intravenous errors, nosocomial infections, ventilator complications, and restraint complications may be reduced. The program invests bedside clinicians in writing safety standards, creates a partnership between staff and the clinical risk manager, and provides executive leaders an opportunity to demonstrate support of a culture beyond blame.

Data Collection↗
PubMed1996

A content analysis of safety behaviors of television characters: implications for children's safety and injury.

Examined frequency and characteristics of safety behaviors in television programs popular with child audiences. A sample of 52 programs was coded for safety event location, demographic characteristics of safety models, social and physical contexts of safety events, and successful or unsuccessful outcomes of safety behaviors. Results indicate an overall rate of 13 safety behaviors per hour, with hour half of all safety behaviors located in commercial advertisements. Most safety behaviors were performed by made adult characters, had limited relevance for children, and were not associated with either positive or negative outcomes. Findings are discussed in terms of their relevance for observational learning of safety behaviors by child viewers.

Adolescent↗
PubMed2001

Do safety practices differ between responders and non-responders to a safety questionnaire?

OBJECTIVE: To compare reported safety practices between responders and non-responders to a safety survey. DESIGN: Cross sectional survey at baseline compared with safety practices reported at subsequent child health surveillance checks. SUBJECTS: Parents of children aged 3-12 months registered with practices participating in a controlled trial of injury prevention in primary care that did, and did not, respond to the baseline survey and who subsequently attended child health surveillance checks. RESULTS: No difference in safety practices was found between responders and non-responders to the survey at the 6-9 month check. Responders were more likely to report owning a stair gate (odds ratio (OR) 2.75, 95% confidence interval (CI) 1.82 to 4.16) and socket covers (OR 2.16, 95% CI 1.53 to 3.04) at the 12-15 month check, and owning socket covers (OR 2.19, 95% CI 1.34 to 3.61) at the 18-24 month check. Responders were more likely to report greater than the median number of safety practices at the 18 month check. CONCLUSIONS: Non-responders to a safety survey appear to be less likely to report owning several items of safety equipment than responders. Further work is needed to confirm these findings. Extrapolating the results of safety surveys to the population as a whole may lead to over estimation of safety equipment possession.

Attitude to Health↗
PubMed2000

Patient safety in America: comparison and analysis of national and Texas patient safety research.

The Institute of Medicine (IOM) report on patient safety in late 1999, To Err is Human, attracted great national attention when it announced that 44,000 to 98,000 patients die each year in American hospitals because of patient safety problems and that a patient safety crisis exists in American health care and American hospitals. The report relied heavily on a Harvard group's study of hospital care in New York in 1984 and another Harvard group's study of hospital care in Utah and Colorado in 1992. This article reviews and compares American hospital inpatient safety research and corresponding Texas hospital patient safety research. It focuses on the major patient safety research of the last two decades that led to the IOM report, and compares information from the major studies with the work of the Texas Medical Foundation (TMF). The Harvard patient safety studies that have received great national attention are compared here with a stronger, broader, and more robust database from TMF, the peer review organization for Texas. The TMF studies of 300,000 patient admissions during 3 years in more than 400 hospitals are compared with the Harvard studies of 30,000 charts in 51 hospitals in New York in 1984 and 15,000 charts in 28 hospitals in Utah and Colorado in 1992. The TMF data and a close look at the Harvard data show a positive patient safety picture that has been ignored too often in the current debate, with low rates of significant injury and death caused by any medical care or hospital care safety or negligence problems.

Hospitals↗
PubMed2004

Effectiveness of primary enforcement safety belt laws and enhanced enforcement of safety belt laws: a summary of the Guide to Community Preventive Services systematic reviews.

BACKGROUND: The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor-vehicle crashes. This paper summarizes the systematic reviews of two interventions to increase safety belt use: primary enforcement safety belt laws and enhanced enforcement of safety belt laws. The reviews were previously published in the American Journal of Preventive Medicine. METHODS: We conducted the systematic reviews using the methodology developed for the Guide to Community Preventive Services. RESULTS: These reviews provide strong evidence that primary laws are more effective than secondary laws in increasing safety belt use and decreasing fatalities and that enhanced enforcement is effective in increasing safety belt use. Increases in belt use are generally highest in states with low baseline rates of belt use. DISCUSSION: Primary safety belt laws and enhanced enforcement programs tend to result in greater increases in usage rates for target groups with lower baseline rates. Concerns regarding public opposition to these interventions may impede their implementation in some jurisdictions. However, surveys indicate that a substantial majority of the public supports implementation of both primary laws and enhanced enforcement programs. CONCLUSION: Based on the strong evidence for effectiveness of primary safety belt laws and enhanced enforcement programs, the Task Force on Community Preventive Services recommended that all states enact primary safety belt laws and that communities implement enhanced enforcement programs.

Accidents, Traffic↗
PubMed2002

Development and test of a model linking safety-specific transformational leadership and occupational safety.

The authors developed, tested, and replicated a model in which safety-specific transformational leadership predicted occupational injuries in 2 separate studies. Data from 174 restaurant workers (M age = 26.75 years, range = 15-64) were analyzed using structural equation modeling (LISREL 8; K. G. Jöreskog & D. Sörbom, 1993) and provided strong support for a model whereby safety-specific transformational leadership predicted occupational injuries through the effects of perceived safety climate, safety consciousness, and safety-related events. Study 2 replicated and extended this model with data from 164 young workers from diverse jobs (M age = 19.54 years, range = 14-24). Safety-specific transformational leadership and role overload were related to occupational injuries through the effects of perceived safety climate, safety consciousness, and safety-related events.

Adult↗
PubMed2006

The role of leader influence tactics and safety climate in engaging employees' safety participation.

This study examines the effect of leader influence tactics on employee safety participation in a U.K.-based manufacturing organization, examining the role of safety climate as a mediator. Structural equation modeling showed that leader influence tactics associated with a transformational leadership style had significant relationships with safety participation that were partially mediated by the safety climate (consultation) or fully mediated by the safety climate (inspirational appeals). In addition, leader influence tactics associated with a transactional leadership style had significant relationships with safety participation: rational persuasion (partially mediated by safety climate) and coalition tactics (direct effect). Thus, leaders may encourage safety participation using a combination of influence tactics, based on rational arguments, involvement in decision making, and generating enthusiasm for safety. The influence of building trust in managers is discussed as an underlying mechanism in this relationship. Practical implications are highlighted, including the design of leadership development programs, which may be particularly suited to high-reliability organizations.

Journal Article↗
PubMed2005

The effect of safety initiatives on safety performance: a longitudinal study.

Construction industry is one of the most dangerous industries, not only in the USA, but worldwide. In this longitudinal study we examined the effects of safety initiatives on the safety performance of construction companies. One of the measures commonly used in the USA to track a company's safety performance is the experience modification rate (EMR). The EMR is based on the company's safety records (injury claims) from the past three full years and is used to calculate the workers' compensation insurance premiums. In a longitudinal study, we studied the effects of safety efforts and initiatives on the EMR. The results show that safety initiatives and money spent on safety do improve safety performance, but only over time.

Accident Prevention↗
PubMed1997

Safety climate and attitude as evaluation measures of organizational safety.

The main aim of this research is to develop a set of evaluation measures for safety attitudes and safety climate. Specifically it is intended: (a) to test the instruments; (b) to identify the essential dimensions of the safety climate in the airport ground handling companies; (c) to assess the quality of the differences in the safety climate for each company and its relation to the accident rate; (d) to analyse the relationship between attitudes and safety climate; and (e) to evaluate the influences of situational and personal factors on both safety climate and attitude. The study sample consisted of 166 subjects from three airport companies. Specifically, this research was centered on ground handling departments. The factor analysis of the safety climate instrument resulted in six factors which explained 69.8% of the total variance. We found significant differences in safety attitudes and climate in relation to type of enterprise.

Accidents, Occupational↗