Improving patient safety using the sterile cockpit principle during medication administration: a collaborative,unit-based project

Aim To implement the sterile cockpit principle to decrease interruptions and distractions during high volume medication administration and reduce the number of medication errors. Background While some studies have described the importance of reducing interruptions as a tactic to reduce medication errors, work is needed to assess the impact on patient outcomes. Methods Data regarding the type and frequency of distractions were collected during the first 11 weeks of implementation. Medication error rates were tracked 1 year before and after 1 year implementation. Results Simple regression analysis showed a decrease in the mean number of distractions, (β = −0.193, P = 0.02) over time. The medication error rate decreased by 42.78% (P = 0.04) after implementation of the sterile cockpit principle. Conclusions The use of crew resource management techniques, including the sterile cockpit principle, applied to medication administration has a significant impact on patient safety. Implications for nursing management Applying the sterile cockpit principle to inpatient medical units is a feasible approach to reduce the number of distractions during the administration of medication, thus, reducing the likelihood of medication error. ‘Do Not Disturb’ signs and vests are inexpensive, simple interventions that can be used as reminders to decrease distractions.     

RESNA Position on the Application of Tilt,Recline, and Elevating Legrests for Wheelchairs

ABSTRACT

This document, approved by the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) Board of Directors on April 23, 2008, describes typical clinical applications and provides evidence from the literature supporting the application of tilt, recline, and elevating legrests for wheelchairs.     

Riding a Bus While Seated in a Wheelchair: A Pilot Study of Attitudes and Behavior Regarding Safety Practices

A total of 283 wheelchair-seated bus riders responded to a 35-item Web-based survey investigating their experiences on public, fixed-route buses. The survey addressed the use of wheelchair tiedowns and occupant restraint systems (WTORS), the attitudes and behaviors of wheelchair users toward the use of this equipment, and the transit experience. Results indicate that consistent use of four-point tiedown and occupant restraint systems is fairly low. Only 33.2% of the participants reported always securing their wheelchair, and 62.2% reported using occupant restraints consistently. A preference for fixed-route over paratransit was related to larger city size. Implementation of transit agency policy regarding WTORS was found to be inconsistent. Easier-to-use WTORS and improved operator training in larger transit agencies would likely increase the correct use of safety equipment and improve wheelchair users' bus-riding experiences.     

RESNA Position on the Application of Seat-Elevating Devices for Wheelchair Users

ABSTRACT

This document, approved by the Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) Board of Directors in September 2005, shares typical clinical applications and provides evidence from the literature supporting the use of seat-elevating devices for wheelchair users.     

Activity-based Therapies in Spinal Cord Injury:: Clinical Focus and Empirical Evidence in Three Independent Programs

This article summarizes presentations of a symposium examining the potential impact of activity-based therapies (ABT) in promoting neurological and functional recovery after spinal cord injury (SCI). The symposium addressed 3 key questions concerning activity-based therapy in SCI: (1) What clinical approaches are used? (2) Is there empirical evidence supporting efficacy of ABT in promoting neurological recovery and improving overall function, health, and quality of life? (3) What are the issues related to long-term viability of ABT?     

Development and Testing of an Innovative User-Adjustable Support Surface for Wheelchair Seating Discomfort

ABSTRACT

Beginning in 2000, a study of discomfort experienced by wheelchair users and development of technology solutions were undertaken. This research culminated with the present study of a new technology targeting sitting discomfort. Support for development of the “Butt Scooter” prototype and its testing was provided through an NIH research grant. Investigators tested a prototype device, called the “Butt Scooter,” and conducted a focus group to obtain expert clinical opinions about the potential usefulness of the prototype. Subject testing of the prototype device followed a single subject design (ABABA). Subjects self-administered the Tool for Assessing Wheelchair disComfort (TAWC) to evaluate their discomfort levels. Results from three subjects are reported. All three expert therapists participating in the focus group responded favorably to the prototype. In summary, results from subject testing were somewhat mixed with regard to discomfort management, however all subjects commented positively on the features of the device.     

State of the Science Workshop on Wheelchair Transportation Safety

ABSTRACT

The Rehabilitation Engineering Research Center on Wheelchair Transportation Safety held a state-of-the-science workshop on wheelchair transportation. The workshop had three purposes: reviewing and documenting the status of wheelchair transportation safety, identifying deficiencies, and formulating, discussing, and prioritizing recommendations for future action. The final goal was to disseminate the workshop outcomes for utilization in formatting future research priorities. A nominal group technique was used to facilitate focused open discussion by knowledgeable persons, resulting in the identification and ranking of existing deficiencies according to priority. Participants then formulated potential short-term solutions and speculated what wheelchair transportation safety should be in the future. This document presents four white papers, prepared prior to the workshop and modified according to participant feedback, and summarizes the outcomes of the workshop. The results identify and prioritize recommendations for future action.     

Effective followership: A standardized algorithm to resolve clinical conflicts and improve teamwork

In healthcare, the sustained presence of hierarchy between team members has been cited as a common contributor to communication breakdowns. Hierarchy serves to accentuate either actual or perceived chains of command, which may result in team members failing to challenge decisions made by leaders, despite concerns about adverse patient outcomes. While other tools suggest improved communication, none focus specifically on communication skills for team followers, nor do they provide techniques to immediately challenge authority and escalate assertiveness at a given moment in real time. This article presents data that show one such strategy, called the Effective Followership Algorithm, offering statistically significant improvements in team communication across the professional continuum from students and residents to experienced clinicians.