Guidelines in Practice: A Safe Environment of Care.

Creating a safe environment for performing surgical procedures is essential to achieve successful patient outcomes and protect the perioperative personnel who are providing care. Numerous factors challenge the provision of a safe environment of care and create a complex setting for perioperative nurses to manage. The updated AORN "Guideline for a safe environment of care" provides perioperative nurses with recommendations for establishing a safe environment for both patients and personnel. This article provides an overview of the guideline and discusses recommendations for implementing fire safety protocols, using warming cabinets, and creating a latex-safe environment. It also includes a scenario describing the care of a patient with an unidentified latex allergy who is undergoing a laparoscopic sleeve gastrectomy and hiatal hernia repair. Perioperative nurses should review the guideline in its entirety and implement recommendations as applicable in operative and other procedural settings.

The application of systematic accident analysis tools to investigate food safety incidents.

Effective food safety (FS) management relies on the understanding of the factors that contribute to FS incidents (FSIs) and the means for their mitigation and control. This review aims to explore the application of systematic accident analysis tools to both design FS management systems (FSMSs) as well as to investigate FSI to identify contributive and causative factors associated with FSI and the means for their elimination or control. The study has compared and contrasted the diverse characteristics of linear, epidemiological, and systematic accident analysis tools and hazard analysis critical control point (HACCP) and the types and depth of qualitative and quantitative analysis they promote. Systematic accident analysis tools, such as the Accident Map Model, the Functional Resonance Accident Model, or the Systems Theoretical Accident Model and Processes, are flexible systematic approaches to analyzing FSI within a socio-technical food system which is complex and continually evolving. They can be applied at organizational, supply chain, or wider food system levels. As with the application of HACCP principles, the process is time-consuming and requires skilled users to achieve the level of systematic analysis required to ensure effective validation and verification of FSMS and revalidation and reverification following an FSI. Effective revalidation and reverification are essential to prevent recurrent FSI and to inform new practices and processes for emergent FS concerns and the means for their control.

A palpable sense of frustration with NHS patient safety culture development.

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses two recent reports on NHS patient safety.

Receptivity of providing firearm safety storage devices to parents along with firearms safety education.

Background: In the United States, 33% of households with children contain firearms, however only one-third reportedly store firearms securely. It's estimated that 31% of unintentional firearm injury deaths can be prevented with safety devices. Our objective was to distribute safe storage devices, provide safe storage education, evaluate receptivity, and assess impact of intervention at follow-up. Method: At five independent, community safety events, parents received a safe storage device after completing a survey that assessed firearms storage methods and parental comfort with discussions regarding firearm safety. Follow-up surveys collected 4 weeks later. Data were evaluated using descriptive analysis. Result: 320 participants completed the surveys, and 288 participants were gunowners living with children. Most participants were comfortable discussing safe storage with healthcare providers and were willing to talk with friends about firearm safety. 54% reported inquiring about firearm storage in homes their children visit, 39% stored all their firearms locked-up and unloaded, 32% stored firearms/ammunition separately. 121 (37%0.8) of participants completed the follow-up survey, 84% reported using the distributed safety device and 23% had purchased additional locks for other firearms. Conclusion: Participants were receptive to firearm safe storage education by a healthcare provider and distribution of a safe storage device. Our follow up survey results showed that pairing firearm safety education with device distribution increased overall use of safe storage devices which in turn has the potential to reduce the incidence of unintentional and intentional self-inflicted firearm injuries. Providing messaging to promote utilization of safe storage will impact a firearm safety culture change.

Enhancing intersection safety in autonomous traffic: A grid-based approach with risk quantification.

Existing studies on autonomous intersection management (AIM) primarily focus on traffic efficiency, often overlooking the overall intersection safety, where conflict separation is simplified and traffic conflicts are inadequately assessed. In this paper, we introduce a calculation method for the grid-based Post Encroachment Time (PET) and the total kinetic energy change before and after collisions. The improved grid-based PET metric provides a more accurate estimation of collision probability, and the total kinetic energy change serves as a precise measure of collision severity. Consequently, we establish the Grid-Based Conflict Index (GBCI) to systematically quantify collision risks between vehicles at an autonomous intersection. Then, we propose a traffic-safety-based AIM model aimed at minimizing the weighted sum of total delay and conflict risk at the intersection. This entails the optimization of entry time and trajectory for each vehicle within the intersection, achieving traffic control that prioritizes overall intersection safety. Our results demonstrate that GBCI effectively assesses conflict risks within the intersection, and the proposed AIM model significantly reduces conflict risks between vehicles and enhances traffic safety while ensuring intersection efficiency.

The factors influencing patient safety management as perceived by emergency department nurses: A qualitative study.

AIM: One of the most important, unpredictable and stressful areas in hospitals is the emergency department (ED) where seconds are crucial for providing immediate care and saving the patients' lives. Therefore, the present study aimed to identify the factors which impact the patient safety management as perceived by the ED nurses in Southern Iran. DESIGN: This is a qualitative, descriptive study. METHODS: The participants were 23 ED nurses selected via purposeful sampling who were asked to take part in an interview. Data were collected using semi-structured, individual, in-depth interviews and analysed via content analysis. RESULTS: Analysis of the qualitative data yielded 4 themes and 12 subthemes. The four main themes were: negligence of safety standards and standard precautions, disregard of ethical principles, professional challenges and inefficient organizational management.

Bibliometric analysis of safety management system research (2001-2021).

INTRODUCTION: Occupational health and safety (OHS) has become an integral part of human society, particularly considering the growing rates of injuries and deaths worldwide. Hence, numerous employers, governments, and stakeholders worldwide have established critical OHS measures to safeguard human health and occupational safety. Numerous studies have been conducted to identify and highlight risks and hazards, as well as to detect, monitor, minimize, and prevent workplace injuries and deaths. METHOD: This study presents the publication trends, research landscape, and scientific developments related to safety management systems (SMS) based on published documents from the Elsevier Scopus database. Published documents on SMS and indexed in Scopus are identified, screened, and analyzed to examine the publication trends, research developments, and scientific landscape. For this purpose, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), bibliometric analysis (B.A.), and systematic literature review (SLR) procedures are used. The results reveal that 799 related documents were published between 2001 and 2021. RESULTS: The most productive stakeholders, that is, top researchers, affiliations, and countries, include Liesbeth Jacxsens, Universiteit Gent (Belgium), and the United States. This study shows that the availability of research grants, incentives, or awards is critical to the productivity of top researchers, institutions, and nations actively researching SMS topics. The bibliometric analysis reveals that the topic is characterized by high productivity, co-authorships, keyword occurrence, and citations. CONCLUSION: The analysis shows that SMS research is a broad, multidimensional, and impactful area that has become essential for identifying, reducing, monitoring, and eliminating risks in many industries. It is concluded that the topic of the SMS remains relevant because of its impact on human health, occupational safety, and environmental well-being. PRACTICAL APPLICATIONS: This study provides in-depth insight into expanding the scope of SMS research. Moreover, research and policymakers can facilitate decision-making and collaboration based on this study's outtakes.

Risk self-perception and occupational accidents.

INTRODUCTION: This study analyzes the relationship between measures of occupational accidents and workers' perception of risk in the workplace using nationally representative data on workers' characteristics and a complete record of occupational accidents. METHODS: Regression analyzes addressing both the ordinal nature of the dependent variable and causality were conducted to control for different sociodemographic factors influencing workers' perceptions of occupational risks. Special attention was paid to the risk level of the worker's workgroup, existence of family responsibilities, organizational safety culture, and measures of accident rates. RESULTS: Individuals showed different perceptions of risk based on their personal and work characteristics. Significant associations were observed between each variable of interest and risk perception. Overall, the results remain robust across specifications addressing both simultaneity and ordinality. CONCLUSIONS: Employees' "reading" of hazards was not fully aligned with objective information on occupational accidents but depended on individual characteristics. Having family responsibilities or being unionized increased workers' risk perception, whereas belonging to a workgroup with higher accident rates reduced it. PRACTICAL APPLICATIONS: Knowing how workers perceive risk and how this perception deviates from statistical information on accidents are essential for management to accurately design safety measures. In this regard, specific characteristics such as age, having dependents in the family, or the typology of the workers' workgroup should be taken into account. Greater knowledge of preventive measures will improve the way workers perceive risk, and ultimately contribute to reducing the likelihood of occupational accidents.

Precursory elements of safety culture: Exploratory analyses of engineering students' safety attitudes.

INTRODUCTION: Safety culture as a concept has been well-researched in the literature. There is less work, however, on how individuals entering the workforce acquire and partake in safety culture over time and how they might be primed to partake in the positive elements of safety culture. METHOD: We begin this exploration by surveying engineering students' attitudes toward safety and experiences with safety education at the Georgia Institute of Technology (n = 316). RESULTS: We find disparities among engineering disciplines, where some majors have more negative views toward safety than others. This may point to the need for more [effective] safety education to prevent negative attitudes toward safety in the workplace. In addition to describing trends among engineering students' attitudes, this study also uses factor analysis to characterize the latent constructs of precursory safety culture: the safety-related attitudes that may direct how people engage with safety culture as early-career engineers. PRACTICAL APPLICATIONS: The analysis provides a conceptual construction of precursor safety culture attitudes, which can serve as a guide to future measurement efforts.

Investigating the dynamic nature of landslide susceptibility in the Indian Himalayan region.

Landslide susceptibility zonation (LSZ) mapping is used to delineate areas prone to landslides and is critical for effective landslide hazard management. The existing methodologies for generating such maps tend to neglect the influence of dynamic environmental variables on landslide occurrences, which may lead to obsolete and erroneous estimates of landslide susceptibility (LS) for a concerned area. Although recent studies have started to report the effects of Land Use/ Land Cover (LULC) variation on LSZ mapping, variations in other dynamic variables like rainfall, soil moisture, and evapotranspiration apart from LULC may also influence slope stability in mountainous regions. The present study investigates the impact of variations in these four variables on the LS distribution, of a selected Indian Himalayan region between 2017 and 2021. Random Forest (RF) susceptibility models are utilized for evaluating the LS for the selected years and geospatial technologies are employed for LS change detection. The results indicate up to 19% variations in the spatial extent for some of the zones of the generated LSZ maps. The research findings of this study are crucial since they reveal the impact of dynamic behavior on LS, which has not been previously documented in the literature.

Organizational Learning in the Morbidity and Mortality Conference.

INTRODUCTION: The focus of morbidity and mortality conferences (M&MCs) has shifted to emphasize quality improvement and systems-level care. However, quality improvement initiatives targeting systems-level errors are challenged by learning in M&MCs, which occurs at the individual attendee level and not at the organizational level. Here, we aimed to describe how organizational learning in M&MCs is optimized by particular organizational and team cultures. METHODS: A prospective, multiple-case study design was used. Using purposive sampling, three cases covering different medical/surgical specialties in North America were chosen. Data collection included direct observations of the M&MC, semistructured interviews with key M&MC members, and documentary information. RESULTS: The role of the M&MC in all cases integrated two key concepts: recognition of system-wide trends and learning from error, at an organizational and team level. All cases provided evidence of double-loop learning and used organizational memory strategies to ensure knowledge was retained within the organization. A patient safety culture was linked to the promotion of open communication, fostering learning from adverse events. CONCLUSION: This study describes three cases of systems-oriented M&MCs that reflected elements of organizational learning theory. The M&MC can therefore provide a context for organizational learning, allowing optimal learning from adverse events.

Maturity of Food Safety Management Systems in the Vietnamese Seafood Processing Industry.

Fifty-nine percent (59%) of the reported food safety issues in Vietnam are related to seafood products, mainly fish and fish products. The international export of seafood products continues to grow due to intensification of the production in the Vietnamese seafood processing industry. To ensure the production of safe food, a company-specific, effective food safety management system is essential. This research explores the maturity of food safety management systems in a convenience sample of the Vietnamese seafood processing industry to identify potential gaps and interventions for improvement. The food safety management system diagnostic instrument was used to assess the context riskiness, maturity of control and assurance activities and food safety performance of 11 companies. Maturity of their food safety management systems was further explored through hierarchical cluster analysis, and the differences in maturity between clusters were statistically tested through Mann-Whitney U tests (nonparametric). The influence of companies' organizational characteristics on the maturity of control and assurance activities was assessed through nonparametric K independent tests. A variability in the maturity of food safety management systems between the eleven Vietnamese companies was measured. Cluster analysis revealed two clusters, Cluster I (six companies) and Cluster II (five companies). The companies in both these clusters operate under a moderate level context riskiness and average to advanced level of food safety performance. However, control and assurance activities are at a lower maturity in Cluster I compared to Cluster II. None of the companies' organizational characteristics (i.e. certification level) have a statistically significant influence on the maturity of control and assurance activities. However, compliance with multiple food safety standards and the presence of physical intervention system(s) have a positive influence on food safety performance.

A novel framework for human factors analysis and classification system for medical errors (HFACS-MES)-A Delphi study and causality analysis.

The healthcare system (HCS) is one of the most crucial and essential systems for humanity. Currently, supplying the patients' safety and preventing the medical adverse events (MAEs) in HCS is a global issue. Human and organizational factors (HOFs) are the primary causes of MAEs. However, there are limited analytical methods to investigate the role of these factors in medical errors (MEs). The aim of present study was to introduce a new and applicable framework for the causation of MAEs based on the original HFACS. In this descriptive-analytical study, HOFs related to MEs were initially extracted through a comprehensive literature review. Subsequently, a Delphi study was employed to develop a new human factors analysis and classification system for medical errors (HFACS-MEs) framework. To validate this framework in the causation and analysis of MEs, 180 MAEs were analyzed by using HFACS-MEs. The results showed that the new HFACS-MEs model comprised 5 causal levels and 25 causal categories. The most significant changes in HFACS-MEs compared to the original HFACS included adding a fifth causal level, named "extra-organizational issues", adding the causal categories "management of change" (MOC) and "patient safety culture" (PSC) to fourth causal level", adding "patient-related factors (PRF)" and "task elements" to second causal level and finally, appending "situational violations" to first causal level. Causality analyses among categories in the HFACS-MEs framework showed that the new added causal level (extra-organizational issues) have statistically significant relationships with causal factors of lower levels (Φc≤0.41, p-value≤0.038). Other new causal category including MOC, PSC, PRF and situational violations significantly influenced by the causal categories of higher levels and had an statistically significant effect on the lower-level causal categories (Φc>0.2, p-value<0.05). The framework developed in this study serves as a valuable tool in identifying the causes and causal pathways of MAEs, facilitating a comprehensive analysis of the human factors that significantly impact patient safety within HCS.

When tomorrow comes: A prospective risk assessment of a future artificial general intelligence-based uncrewed combat aerial vehicle system.

There are concerns that Artificial General Intelligence (AGI) could pose an existential threat to humanity; however, as AGI does not yet exist it is difficult to prospectively identify risks and develop requisite controls. We applied the Work Domain Analysis Broken Nodes (WDA-BN) and Event Analysis of Systemic Teamwork-Broken Links (EAST-BL) methods to identify potential risks in a future 'envisioned world' AGI-based uncrewed combat aerial vehicle system. The findings suggest five main categories of risk in this context: sub-optimal performance risks, goal alignment risks, super-intelligence risks, over-control risks, and enfeeblement risks. Two of these categories, goal alignment risks and super-intelligence risks, have not previously been encountered or dealt with in conventional safety management systems. Whereas most of the identified sub-optimal performance risks can be managed through existing defence design lifecycle processes, we propose that work is required to develop controls to manage the other risks identified. These include controls on AGI developers, controls within the AGI itself, and broader sociotechnical system controls.

Intern nursing students' perceptions of patient safety culture and their experiences with factors affecting the safety of care in hospital settings: A mixed method study.

BACKGROUND: Patient safety culture is a globally studied subject as it plays a significant role in preventing and reducing errors. There is limited mixed-method research into the in-depth investigation of intern nurses' views on patient safety in hospital settings and the factors affecting it. OBJECTIVE: This study was conducted to determine intern nursing students' perceptions of patient safety culture and their experiences with exploring factors affecting the safety of care in hospital settings. DESIGN AND METHODS: A convergent mixed-method design was used. The study group was selected using the purposive sampling method. STROBE and COREQ checklists were followed. The quantitative phase was descriptive and correlational, and the qualitative phase was phenomenological. Quantitative data were collected using a "Personal Information Form" and "Patient Safety Culture Scale" and qualitative data using a "Semi-Structured Interview Form." Mean ± standard deviation, median (min-max), frequency, percentage values, Shapiro-Wilk, and Mann-Whitney U tests were employed to evaluate quantitative data. The inductive content analysis method was used to analyze qualitative data. SETTING AND PARTICIPANTS: The study consisted of intern nursing students from a university in the 2020-2021 academic year. The quantitative phase of the research was conducted with 38 and the qualitative phase with nine intern nursing students. In the qualitative phase, the saturation point was taken as a basis. RESULTS: In the study, nursing students' perceptions of patient safety culture were high (3.24 ± 0.49; min = 1.88 and max = 4). The results of the qualitative data analysis indicated that the factors affecting patient safety in hospital settings consisted of three themes, namely "health professionals, care environment, and patients and caregivers" and nine subthemes. CONCLUSIONS: Intern nursing students had high perceptions of patient safety culture and had highly significant experiences with the factors affecting safe care in hospital settings.

Have our backs-medical-surgical nurses' safety culture experiences: An inductive qualitative descriptive study.

AIM: This study aims to describe medical-surgical registered nurses' experiences with safety culture. DESIGN: Qualitative, Inductive descriptive. METHODS: Registered nurses were recruited from a Midwestern community hospital in the United States using purposive sampling. The participants were interviewed using semi-structured interview questions from February 6, 2020-April 9, 2020. Safety huddles were observed and key documents were collected. The interviews were transcribed and analyzed using inductive qualitative content analysis. The COREQ checklist was followed. RESULTS: A total of 16 registered nurses were interviewed. Six themes emerged: Time to know my patient to keep them safe, using my gut and nursing interventions, getting extra eyes on the patient, not always having what is needed to provide safe care, organization prioritizes patient safety, and learning: have our backs. No Patient or Public Contribution.

Psychometric evaluation of the Persian version of Emergency Medical Services- Safety Attitudes Questionnaire (EMS-SAQ).

AIM: This study aimed to conduct a psychometric evaluation of the Persian adaptation of the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ). METHODS: In this cross-sectional study, the validity and reliability of the EMS-SAQ were assessed among 484 Iranian pre-hospital emergency department employees between February and June 2023. RESULTS: Five factors were extracted namely safety climate, teamwork, job satisfaction, stress management, and working conditions with explained 38.75% of the total variance. The goodness of fit indexes confirmed the model (χ2 = 409.031, DF = 196, χ2 /df = 2.087, CFI = 0.900, IFI = 0.901, PCFI = 0.763 and PNFI = 0.701, and RMSEA = 0.069 [CI90% 0.059-0.078]). CONCLUSION: The Persian version of the SAQ-EMS, comprising 22 items across five factors, demonstrated good validity and reliability. It is recommended to undertake qualitative studies focusing on the concept of patient safety in pre-hospital settings, considering diverse contexts and cultural nuances to develop more robust assessment tools.