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Safety II: A Focus on Prevention

Clinical researchers at Nationwide Children’s Hospital have published one of the first health care studies to examine how behavior aligned with Safety II concepts impacts patient safety.

Safety II is a novel approach to patient safety that focuses on why processes perform correctly in high-performing units.

The study, in Pediatrics, analyzed the Pediatric Intensive Care Unit (PICU) at Nationwide Children’s.

“High-complexity, high-risk environments demand flexibility and resilience among their individuals to avoid errors, and our PICU exemplifies that,” said Jenna Merandi, PharmD, MS, CPPS, medication safety officer at Nationwide Children’s and study author. “We wanted to understand how the PICU used Safety II concepts to achieve its remarkably low adverse drug event (ADE) rate.”

The researchers conducted multidisciplinary focus groups with PICU staff to identify factors that led to more reliable performance and increased the unit’s ability to handle unusual or unexpected situations. They identified key themes that appeared to be uniquely applicable to Safety II: relying on teamwork if something novel is considered; team response to challenging circumstances; skepticism; and bringing atypical approaches from other microenvironments.

Most institutions rely on the Safety I approach, which focuses on why processes fail then correcting them. The authors believe this is one of the first studies to outline how Safety II principles can be implemented in a pediatric hospital setting.

Left to right: Richard J. Brilli, MD, FAAP, MCCM, Jenna Merandi, PharmD, MS, CPPS, and Thomas Bartman, MD, PhD

“Moving forward, we want to use Safety II to understand how to apply resilience engineering into a health care system, and more testing needs to be done by implementing Safety II in other hospital units in order to achieve that understanding and broaden our program,” said Thomas Bartman, MD, PhD, associate medical director of quality improvement at Nationwide Children’s and co-author of the study.

Richard J. Brilli, MD, FAAP, MCCM, chief medical officer at Nationwide Children’s, says, “Safety II does not replace Safety I, but it is a new approach in addition to the old ‘finding and fixing’ model of addressing patient safety concerns. Optimistically, it has the potential to take patient safety to a whole new level.”

Merandi J, Vannatta K, Davis JT, McClead RE Jr, Brilli R, Bartman T. Safety II Behavior in a Pediatric Intensive Care Unit. Pediatrics. 2018 Jun:141(6).

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