Perceived risk: The impact of real and simulated exposure to adverse events

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DESCRIPTION (provided by applicant): More people die from preventable adverse events (AEs) than from breast cancer or AIDS. Technology and process-based solutions to this problem have had some success; however, humans remain at the sharp edge of care. There is a critical need to understand and improve human resilience to preventable AEs. It is not clear how providers perceive risks associated with preventable AEs or follow through with AE prevention strategies. Following personal experience with a preventable AE, providers anecdotally report a greater sensitivity to risks. Research has shown that the greater the perceived consequences associated with missing an event, the higher the likelihood that the event will be detected. Higher perceived consequences are also associated with greater adoption of prevention strategies. The goals of this research involve first determining whether or not individuals who perceive greater likelihood and consequences of AEs report higher levels of attention to possible AEs and greater adherence to AE prevention strategies. Secondly, we will determine whether or not reported attitudes and intended behaviors are influenced by prior exposure to AEs. Finally, we seek to determine whether we can manipulate attitudes and behaviors in a meaningful way through simulated exposure to preventable AEs. Can we, through simulated experiences designed to replicate critical contextual details of preventable AEs, create "seasoned" professionals with the value of personal AE experience, without having exposed a patient to harm? What are the critical contextual details that are required to create a meaningful simulated AE experience? How does such an experience compare to compelling third-party stories of true AEs and their consequences with respect to changing attitudes, behaviors, and detection performance over time? The long-term goal is to develop a feasible and effective program of education and/or exposure to simulated AEs for application in health care training and practice that provides a significant and lasting impact on attitudes and behaviors to decrease rates of preventable AEs. We will explore the relationship between prior preventable AE experience and AE prevention attitudes and intended behaviors through a large-scale survey of Trinity Health nurses. We will evaluate the feasibility and critical contextul details associated with simulating preventable AEs to impact attitudes through an iterative process of designing simulations and testing them in the laboratory and in situ. We will compare the impact of different approaches, including simulation of preventable AEs, to manipulating AE prevention attitudes through an experimental comparison involving nursing students at Boise State University. The expected outcomes of this project are to better understand the relationship between experience with real and simulated preventable AEs and attitudes associated with risks and consequences of AEs and AE prevention strategies. We will also gain understanding related to the feasibility and acceptance of in situ simulation of preventable AEs with the intention of increasing attention and compliance related to AE prevention strategies. PUBLIC HEALTH RELEVANCE: Despite efforts to reduce preventable adverse events since the IOM report in 2000, such events continue to have a significant impact on public health. This research proposes to study the relationship between providers' 1) prior exposure to adverse events, 2) perceived risk of adverse events, and 3) reported attitudes and behaviors associated with adverse event prevention. We also seek to determine whether exposure to simulated adverse events can impact attitudes and behaviors in a way that may ultimately lead to a significant reduction in patient and provider harm related to preventable adverse events.