Comparing the Safety Action Feedback and Engagement (SAFE) Loop with an established incident reporting system: Study protocol for a pragmatic cluster randomized controlled trial.
Comparing the Safety Action Feedback and Engagement (SAFE) Loop with an established incident reporting system: Study protocol for a pragmatic cluster randomized controlled trial.
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DOI：
10.1016/j.conctc.2023.101192
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发表时间：
2023-10
影响因子：
1.5
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中科院分区：
文献类型：
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事故报告在医院中被广泛使用，以提高患者的安全，但当前的报告系统并不能发挥最优的作用。事件报告的效用是有限的，因为医院工作人员可能不知道要报告什么，可能害怕报复，可能会怀疑管理人员是否会审查报告并有效应对。这是一项安全行动反馈和参与(SAFE)循环的群集化随机对照试验，该循环旨在将医院事件报告系统转变为提高患者安全性的有效工具。安全循环有六个关键属性：获取护士关于优先处理其单位的哪些安全问题的输入；专注于了解选定的高优先级事件；培训护士撰写更具信息性的事件报告；促使护士报告高优先级事件；整合来自多个来源的事件信息；向护士提供关于调查结果和缓解计划的反馈。这项研究将专注于用药错误，并随机选择洛杉矶一家大型学术/社区医院的20个护理单元。结果包括：(1)事件报告实践(高优先级报告的比率，报告中描述的促成因素)，(2)护士对事件报告的态度，以及(3)高优先级事件的比率。定量分析将比较干预护理单元和对照护理单元实施前后结果的变化，而定性分析将探索护士实施的经验。如果有效，安全循环将有几个好处：增加护士对报告的参与度，生成更多信息量更大的报告，使安全领导者能够了解问题，更有效地设计基于系统的解决方案，并降低高优先级患者安全事件的发生率。
Incident reporting is widely used in hospitals to improve patient safety, but current reporting systems do not function optimally. The utility of incident reports is limited because hospital staff may not know what to report, may fear retaliation, and may doubt whether administrators will review reports and respond effectively. This is a clustered randomized controlled trial of the Safety Action Feedback and Engagement (SAFE) Loop, an intervention designed to transform hospital incident reporting systems into effective tools for improving patient safety. The SAFE Loop has six key attributes: obtaining nurses' input about which safety problems to prioritize on their unit; focusing on learning about selected high-priority events; training nurses to write more informative event reports; prompting nurses to report high-priority events; integrating information about events from multiple sources; and providing feedback to nurses on findings and mitigation plans. The study will focus on medication errors and randomize 20 nursing units at a large academic/community hospital in Los Angeles. Outcomes include: (1) incident reporting practices (rates of high-priority reports, contributing factors described in reports), (2) nurses' attitudes toward incident reporting, and (3) rates of high-priority events. Quantitative analyses will compare changes in outcomes pre- and post-implementation between the intervention and control nursing units, and qualitative analyses will explore nurses’ experiences with implementation. If effective, SAFE Loop will have several benefits: increasing nurses’ engagement with reporting, producing more informative reports, enabling safety leaders to understand problems, designing system-based solutions more effectively, and lowering rates of high-priority patient safety events.