Nama : Noviana Mulianingsih

Nim : 04143865
Tugas : Evidance Basic Nursing

Focus on Patient Safety: Patient Safety in Nursing Practice

Carolyn M. Clancy MD Journal of Nursing Care Quality
Mary Beth Farquhar MSN, RN September 2005
Beth A. Collins Sharp PhD, RN Volume 20 Number 3
Pages 193 - 197
HEALTHCARE experts have long known about patient safety problems in the
American healthcare system, but the issue has only recently moved to the center of the
national healthcare agenda. Florence Nightingale warned in the late 1800s to "do the sick no
harm," but it took the Institute of Medicine's (IOM's) landmark report To Err Is Human:
Building a Safer Health System1 to create momentum for the patient safety movement of
today.
The IOM report caused headlines worldwide when it was released, and now 5 years
later, patient safety has become an increasingly important public concern. For example, in a
recent survey by the Kaiser Family Foundation (KFF), the Agency for Healthcare Research
and Quality (AHRQ), and the Harvard School of Public Health, 1 in 3 respondents reported
that they or a family member had experienced a medical error at some point in their life; one
fifth of all respondents said it had caused serious health consequences such as death, long-
term disability, or pain.2 Moreover, 5 years after the publication of the IOM report,
Americans say that they do not believe the nation's quality of care has improved. Forty
percent of the people surveyed said the quality of healthcare has gotten worse in the past 5
years, while 17% said the quality of care has gotten better, and nearly 38% said it has stayed
the same.3
There is progress still to be made, but the survey did offer some good news. It is a
positive sign that consumers are more sensitive overall to issues of quality and safety of care.
Seven in 10 people surveyed said that they checked a medication against their written
prescription when picking it up at the pharmacy; another 7 in 10 said they called to check on
test results; and 2 in 3 reported talking with their surgeon about the details of an upcoming
procedure, including what will take place during the procedure, how long will it take, and the
recovery process.
We need to use such positive news to continue the momentum of improvement. We
also must recognize that improvement and transformation of the healthcare system is a team
effort, and that each team member in the system has a significant role to play.
Nurses are the largest group of healthcare providers in the nation offering direct
patient care. We commend the Journal of Nursing Care Quality for making a significant
contribution to the national dialogue by calling attention to both the problems and the cutting-
edge solutions that have been seen to help improve safety and quality. The journal clearly
recognizes the significant role that nurses have in making care as safe as possible. Because of
nurses' broad, yet intimate, perspective on the causes of errors and their prevention, they are
an indispensable part of the multidisciplinary teams that are finding innovative solutions to
improve safety and ultimately benefit patients.
The statement defining the mission of the AHRQ, "to improve the quality, safety,
efficiency, and effectiveness of health care for all Americans," reflects the need to do more
than only fund research. We need to make sure that the findings, knowledge, and tools that
result from research are put immediately to work to improve health and healthcare.
The AHRQ has long been a leader in funding research on patient safety and making
its findings applicable to the everyday care of patients. The US Congress has supported this
effort by appropriating more than $165 million for AHRQ's patient safety research initiative.
Most recently, Congress appropriated $139 million for AHRQ's new multiyear health
information technology initiative, which will help harness the power of technology to
improve safety. The more than 100 grants and contracts funded under this initiative will help
providers improve patient safety by reducing medication errors through eliminating
handwritten prescriptions, helping to ensure that important information follows patients as
they move among healthcare settings, and reducing duplicative and unnecessary testing.
The AHRQ is committed to improving patient safety, not only through funding
research on patient safety, but also by commissioning such groundbreaking reports as the
IOM report Keeping Patients Safe: Transforming the Work Environment of Nurses. This
report provides guidance on how to design a work environment, in which nurses can provide
safer patient care.4
According to The Effect of Health Care Working Conditions on Patient Safety, a
systematic review,5 strong evidence exists that workforce staffing and workflow design affect
medical errors and patients' safety outcomes. The AHRQ funded a special program of
research on working conditions, with the majority of the projects focusing on nursing. Results
from these studies will be released in the coming year. In the meantime, the existing body of
AHRQ research on the nursing workforce has been summarized in Research in Action:
Hospital Nurse Staffing and Quality of Care.6 The current research supports the existing
reports that nurse staffing is integral to patient safety.
We must continue working to apply the knowledge gained from our research to
clinical practice. For the momentum of change to continue, all stakeholders must be on
board7 from researchers and caregivers to educators and policymakers. To transform our
healthcare system, it is also essential to have the support of leaders and managers at all levels
in a variety of organizations.
Chief among the factors that will help transform the healthcare system is our
knowledge that patient safety problems are more the result of system design flaws than they
are of "bad" providers. By blaming and punishing providers, we have only created a "culture
of shame" and driven problems underground rather than solving the problems that would
enhance patient safety.
A systems approach takes a broader perspective by seeking solutions in the physical
and cultural environment. For example, the way nursing units are arranged, healthcare
procedures, organizational knowledge transfer, technical failures, inadequate policies and
procedures, communication among healthcare teams, and staffing issues are all significant
factors that may dramatically affect the individual caregiver's ability to deliver safe, high-
quality care. These issues, left unaddressed, may result in additional errors.7
How is patient safety defined, and what is the extent of medical errors? The IOM
defines patient safety as "freedom from accidental injury; ensuring patient safety involves the
establishment of operational systems and processes that minimize the likelihood of errors and
maximize the likelihood of intercepting them when they occur."1
Estimates are that preventable medical errors are responsible for between 44,000 and
98,000 patient deaths in hospitals per year.1 The cost of errors ranges from $17 million up to
$29 million annually,1 and the related emotional costs for patients and their families, as well
as caregivers, are incalculable.
One of the serious issues we face in the healthcare industry is the long hours
demanded of nurses and other healthcare providers. Healthcare lags behind other sectors of
the economy such as aviation, nuclear power, and manufacturing that prevent unsafe service
systems from proliferating.8 Long hours pose a threat to patient safety because caregivers
display slower reaction time, decreased energy, and reduced attention to detail.3
Our research is confirming the fact that we must seek solutions in the larger
healthcare system if we are going to reduce unnecessary deaths and injuries. In one AHRQ-
funded research study, nurses who work shifts longer than 12 hours or who work unplanned
overtime were found to be 3 times more likely than other nurses to make errors such as
giving patients incorrect medications or dosages or administering medications late.9 Another
study showed that the odds of a nurse making an error were twice as high among nurses who
rotated shifts as that among nurses working straight days or evenings.10
Another concern is nurse staffing levels. Research has shown that higher rates of poor
patient outcomes, including pneumonia, shock, upper gastrointestinal bleeding, cardiac arrest,
urinary tract infections, and longer hospital stays, are more likely in hospitals that have lower
nurse staffing levels. This is particularly pertinent when there are fewer registered nurses on
duty, as compared with licensed practical nurses or nurses' aides, and when nurses spend less
than optimal time with patients. As the IOM has noted, direct-care nursing staff must be
involved in determining and evaluating the approaches used to decide staffing levels for each
shift to improve quality and enhance patient safety.4
These and other studies are providing the momentum to shift away from blaming
individuals when errors are made to a more balanced approach that focuses on the healthcare
systems and work environments. Yet all of our research and work on improving patient safety
will not have an impact unless the healthcare system creates a "culture of safety." In this
culture, nurses and other caregivers are encouraged to report medical errors, "near misses," or
adverse events, where they can be discussed in an atmosphere of trust and mutual respect
without fear of blame or retribution.7 Mistakes or near mistakes are used as opportunities for
learning. A culture of safety focuses on analyzing why and how problems occur rather than
the person who might have been responsible.10 In this type of environment, innovation and
positive changes are possible4 that would ultimately benefit both patients and caregivers.
An important part of this culture is talking to patients. In the KFF/AHRQ/Harvard
survey, only 30% of respondents who reported medical errors said that the doctor or
healthcare professional told them or their family member that an error had been made. In
addition, just over 50% thought it was likely that the doctor would tell them if they
experienced a preventable medical error. Since these are baseline data, we do not know if
these percentages have increased over the last 5 years. However, the central issue is that
caregivers should be expected to inform patients when they make a medical error. Telling a
patient about a medical error and what can be done to prevent future errors should be the rule,
not the exception.
An increasing number of tools are available to support nurses in their efforts to help
create a culture of safety. For example, the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO) uses a voluntary reporting system to capture serious adverse events.
JCAHO also began requiring organizations seeking accreditation to comply with its National
Patient Safety Goals, which ensure a greater focus on patient safety. Its 2005 goals include
improving the accuracy of patient identification, improving caregiver communication,
reducing the risk for healthcare-associated infections, and improving the safety of medication
use.12
The AHRQ has also funded the Hospital Survey on Patient Safety Culture. This
survey can help diagnose the safety culture of an organization, raise safety awareness, and
identify opportunities for improvement.13 It measures both hospital- and unit-level aspects of
the culture such as supervisor/manager expectations and actions, nonpunitive response to
error, and continuous learning.14 Readers can go to http://www.ahrq.gov/qual/hospculture for
details of the survey and instructions.
The AHRQ's health information technology initiative mentioned earlier is an
important component of this culture change, but is a means to an end, not an end in itself. As
the IOM said in 2003, "Americans should be able to count on receiving healthcare that is
safe[horizontal ellipsis]this requires, first, a commitment by all stakeholders to a culture of
safety, and, second, improved information systems."15
Our agency has a number of studies underway that encompass a wide variety of issues
such as
1. nurse workload and working conditions, including the effects of fatigue and stress,
2. sleep deprivation and shift work,
3. organizational climate and culture, including written and oral communication, and
information flow,
4. human problems such as failure to follow policy and procedures,
5. lack of appropriate patient education,
6. staff development, and
7. technical failures.
We will continue to share the findings from these studies and help others to translate these
into changes at the service delivery level.
As we hope you have gathered from this commentary, AHRQ (http://www.ahrq.gov) is an
excellent resource for nurses. Together, we have a tremendous opportunity and responsibility
to make a difference in helping to safeguard the patients we care for every day.
Helpful AHRQ Resources
1. AHRQ's Patient Safety E-Newsletter: http://www.ahrq.gov/qual/ptsflist.htm
2. AHRQ Nursing Web site: http://www.ahrq.gov/about/nursing
3. AHRQ Medical Errors and Patient Safety Web
site: http://www.ahrq.gov/qual/errorsix.htm
4. AHRQ WebM&M: http://www.webmm.ahrq.gov (This is an online forum that focuses
on patient safety cases. Nurses are encouraged to share the nurse perspective by
authoring case studies. It offers nursing CEUs.)

Nama : Mia Listyaningrum

Nim : 04143858
Kelas : A/KP/II
Patient Safety in the NICU: A Comprehensive Review
Haifa A. Samra PhD, RN-NIC Journal of Perinatal and Neonatal
Jacqueline M. McGrath PhD, RN, FNAP, FAAN Nursing
Whitney Rollins BS, RN June 2011
Volume 25 Number 2
Pages 123 - 132

Abstract
Patient safety is a worldwide priority aimed at preventing medical errors before they
cause death, harm, or injury. Medical errors impact 1 in 10 patients worldwide (WHO), and
their implications may include death, permanent, or temporary harm, financial loss, and
psychosocial harm to the patient and in some cases to the caregiver. The unique aspects and
the complexity of the neonatal intensive (NICU) environment, in addition to the vulnerability
of the neonatal population increase the risk for medical errors. The following article offers an
overview of safety issues specific to neonatal intensive care and provides strategies and
examples on how to ensure safe practice. In particular, the authors focus on strategies to
improve the team process. Practice recommendations and research implications are presented.
Patient safety is a worldwide priority aimed at preventing medical errors before they
cause death, harm, or injury. Medical errors impact 1 in 10 patients worldwide,1 and their
implications may include death, permanent or temporary harm, financial loss, and
psychosocial harm to the patient and in some cases to the caregiver. The purposes of this
article are to (1) provide an overview of medical errors, (2) discuss factors leading to medical
errors and, (3) discuss evidence-based strategies aimed at improving patient safety in the
neonatal intensive care unit (NICU). In particular, improving the team process is a pivotal
focus in this review as well as practice and research implications related to patient safety.
SCOPE OF THE PROBLEM
Medication errors occur more frequently in premature neonates especially those born
less than 30 weeks gestation and weighing less than 1500 gm. These infants are at great risk
because of their severity of illness and the need for more medical support including
pharmacologic measures, cardiovascular monitoring, and support and nutritional measures.
Recent reports show that 57% of medical errors occur in 24 to 27 weeks gestation infants
compared with only 3% in hospitalized full-term newborns.2 Adverse drug events occur at a
rate of 13 to 91 events/100 neonatal intensive care admissions.2,3 Using the trigger method
or an "occurrence" to prompt a focused chart review, high rates of medical errors are often
revealed in hospitalized adults and children. A review of 749 randomly selected charts from
15 NICUs (14 in the United States and 1 in Canada) showed that adverse events (AE) (for
definitions) occur at a rate of 74 events per every 100 patients (0-11 AE/patient).4,5 Of the
reported events, 10% resulted in death, 23% resulted in permanent harm, 40% resulted in
temporary harm, and 7% required life-saving interventions. Overall, the report stated that
56% of the events could have been prevented.4 Reports of AE in the NICU include, but are
not limited to, nosocomial infection (28%), intravenous catheter infiltrates (16%), accidental
extubations (8%), and intracranial hemorrhage and ischemia (10.5%). Misidentification errors
are also common in the NICU. For example, 11% of all errors submitted to the Vermont
Oxford Network (VON) are classified as misidentification errors. One study showed that only
9% of NICU patients wear identification bands as specified by the Joint Commission
(formerly Joint Commission on Accreditation of Healthcare Organization: JCAHO) unit
policy.6 This policy infraction has implications for diagnostic, medication, treatment, and
documentation errors. Other countries such as Switzerland, England, the Netherlands,
Canada, and Australia report similar error rates.3

BACKGROUND AND SIGNIFICANCE

In 1999, the Institute of Medicine (IOM) released its landmark report, To Err is
Human: Building a Safer Health System, which stated that up to 98 000 deaths/year are
attributable to medical errors with an estimated cost of $17 to $29 billion. In addition to its
call on healthcare professionals to adopt evidence-based strategies to improve teamwork and
communication, the report heightened the awareness of the public, as well as policy makers,
to patient safety issues. Although it diminished consumer confidence in the healthcare
industry, the IOM report called for Congress to investigate medical errors and improve
patient safety.7 During the last decade and since the release of the IOM report, patient safety
has become the focus of several professional organizations and regulatory and accrediting
agencies, as evidenced by the release of several patient safety initiatives, statements, goals,
and campaigns. The Joint Commission National Safety Goals, the Institute of Health
Improvement 100 k lives Campaign, and the Safety and Quality Improvement Act of 2005
are among those initiatives. In 2001, the IOM released another report Crossing the Quality
Chasm: A New Health System for the 21st Century that highlighted 6 safety and quality aims
for the 21st Century.8 According to the report, healthcare providers should offer effective,
evidenced-based, patient centered, timely, efficient, and equitable care and patients should not
be harmed by the care that they receive.8 A third report by the IOM in 2003 Keeping Patients
Safe: Transforming the Work Environment of Nurses, called on nurses to create a culture of
safety and to construct safe workplace environments. Fatigue and quality of staffing were
highlighted as factors affecting patient safety.9 This priority for nursing is congruent with the
Nurses' Code of Ethics that holds nurses accountable for participating in the creation of work
environments that are conducive to safe and quality care.

FACTORS LEADING TO MEDICAL ERRORS AND REASON'S "SWISS CHEESE"

MODEL
Reliable work processes and constant vigilance by healthcare professionals are crucial
for safe provision of care in any NICU. Despite best efforts, an error can still occur and error
prevention requires more than just good intentions. Medical errors in the workplace leading
to adverse events in the NICU are rarely intentional or the result of one single factor. System
structure and processes that are not well designed and that do not take into account human
factors and workplace hazards are prone to fail and therefore, leave people vulnerable to
committing errors. Multiple factors at several levels including point of care, organization,
patient, individual, or team levels exist in patient care and management. Because of the
interconnectedness of these factors, failure at one level of the system may affect reliability
and performance at other levels.10 Factors at the point of care may include equipment and
medical device poor design or malfunction. At the organization level, inadequate staffing,
look alike and sound alike drug names, inadequate information sharing, cost-cutting
measures, poor climate and environmental design, and management practices contribute to
medical error.
The unique aspects and the complexity of the NICU environment, in addition to the
vulnerability of the neonatal population increase the risk for medical errors. Medication
errors pose a significant risk to the neonatal patient for a number of reasons. Fragile neonates
have limited capacity in buffering the unintended consequences of their medical treatment
and therefore can be easily harmed. Prolonged lengths of hospital stay (ie, sicker and more
complicated patients) means longer exposure to potential harm. The neonate's rapidly
changing body size and the use of off-label medications pose challenges to healthcare
professionals on a daily basis. In addition, the neonate's inability to communicate what he or
she is experiencing adds to the risk of suffering from a severe adverse effect of a drug that
has been administered. Finally, premature and underdeveloped body systems of the neonate
who is admitted to the NICU interfere with drug absorption, distribution, metabolism, and
excretion, making the risk of being exposed to toxic drug levels exponential compared to an
adult patient.11 Results from 20 community hospitals participating in the Healthcare
Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ)
showed that risk for medical error is higher with longer length of stay, emergency type
admissions, and for publically insured pediatric patients.12
Human factors at an individual level include fatigue, burnout, lack of expertise and
false sense of security with technology, complacency, and lack of cultural competence.
Human factors at the team level are related to team performance and to lack of effective
leadership and team focus, failure to share information and provide task assistance and
breakdown in communication, which is believed to be the most significant barrier to patient
safety. According to the Joint Commission, 70% to 80% of medical errors are due to
dysfunctional interactions.13 Cultural and sex differences may exacerbate communication
problems and lead to a greater potential for breakdowns in communication. Certain behaviors
that are displayed by individuals and by groups lead to communication breakdown,
compromise the team process, and therefore weaken the system defenses against medical
errors. Such behaviors include "excessive professional courtesy" (when team members are
reluctant to challenge someone of higher status), "hidden agendas", "halo effect", and
"passenger syndrome" ("just along for the ride"), and "task fixation" or failure to see the big
picture.14 In a large study of healthcare providers, 7% of study participants reported making
a medication error in the last year with intimidation by a coworker being the contributing
factor.15
To sum it up, work environments are complex and so is how and why medical errors
occur. Reason's Swiss Cheese Model is the most widely used model to explain system failure
and to analyze medical errors.16 Every system has hazards that are inherent in its structure.
Every system also has defenses or barriers that prevent harm from a hazard reaching the
patient. Hazards are conditions or events that are not related to the patient's course of illness
and have the potential to cause harm if there is a failure in the system defenses. System
defenses or barriers, like Swiss cheese slices, have holes in them and if due to some random
event those holes align, they form an open path for harm from a workplace hazard or a
medical error to reach the patient. Medical errors or unsafe acts can be seen as holes in the
system defenses. Humans are fallible and medical errors are inevitable. However by adding
layers of defense and by plugging the holes and preventing them from aligning to form a
path, harm can be stopped from reaching the patient.

STRATEGIES TO IMPROVE PATIENT SAFETY

Patient safety is a comprehensive approach that uses human factors science to
improve system processes and structure and to ensure patient safety. Several strategies have
been developed and adopted by healthcare organizations to strengthen barriers to medical
error and to eliminate workplace hazards. for a list of such strategies.17-29 Among those
strategies, Electronic Medication Ordering or Computerized Provider Order Entry and Safety
Medication Systems (Bar Coding) have made the most significant impact on reducing the rate
of AE. It is believed that 93% of adverse drug events are prevented due to the implementation
of Computerized Provider Order Entry. For example, barcode medication administration has
led to a 47% reduction in the rate of preventable adverse drug events.20
Technology alone cannot rectify all of the problems leading to medical errors. Error
management that includes reporting, monitoring, tracking, and prevention is the cornerstone
for building safe patient environments. Error reporting and tracking is an effective strategy in
identifying trends and patterns of harmful events and "near misses." In addition to providing
information on how effective certain strategies are in improving patient safety, error reporting
creates opportunities for the staff and administration to learn from mistakes and to improve
existing practices or create new strategies for decreasing the probability of harm. Several
systems for error reporting exist. Voluntary reporting whether external or internal generates
most of the existing information on factors leading to error. Anonymous and specialty-based
external reporting systems such as the Neonatal Intensive Care Quality (NICQ) Collaborative
sponsored by the Vermont Oxford Network (web-based) provides opportunities for incident
monitoring and generates a significant amount of important information on trends and
contributing factors. Internal reporting systems increase awareness and create learning
opportunities within the healthcare organization. Some states require healthcare organizations
to have patient safety plans in place and report serious events and incidents to state safety
authorities. The majority of states prohibit punitive actions against healthcare workers
reporting such events. Despite the availability of multiple reporting systems, existing data
show that the majority of incidents or events are not reported and patient safety remains of
great concern. Barriers to error reporting include cost, access to databases and lack of
standardized terminology, and fear of punitive actions. Building work cultures that support
information sharing, encourage and promote transparency, and acknowledge human fallibility
requires commitment, trust, and resources.
A common understanding on how and why medical errors occur is needed. Safety
interventions should not be perceived as additional work or external mandates. Instead,
individuals must feel empowered to identify hazards in the work place and to implement
strategies that would eliminate or minimize those hazards. This can be best achieved by
building high performance teams and maximizing the team process.14,31-33
TEAMWORK, LEADERSHIP, WORK CULTURE AND PATIENT SAFETY
Team Strategies and Tools to Enhance Performance and Patient Safety
(TeamSTEPPS) is an evidence-based program developed by the Department of Defense
(DoD) in collaboration with the Agency of Health Research and Quality (AHRQ) to improve
patient safety and build high efficiency reliable teams. Implementation of this program has
gained some momentum in the past few years, is built on over 3 decades of research in the
military and offers a comprehensive approach to effective teamwork.14,33 The TeamSTEPPS
program is based on both the "Just Culture Model" and the Crew Resources Management
(CRM) concepts. Just Culture encourages everyone who is involved in patient care to voice
his or her safety concerns regardless of his or her position or status. The CRM has been used
in the aviation industry for more than 2 decades. The aim is to improve teamwork knowledge,
skills, and attitudes of the crew; and to promote effective use of resources through the use of
checklists, structured briefs or team events, advocacy and assertion. Even though the use of
CRM in the healthcare industry is still in its infancy, promising results in improving patient
safety has been reported.14 TeamSTEPPs emphasizes 4 core competencies with tools and
scripts specific to each competency that are essential for reliable and high level team
performance. The competencies are leadership, situation awareness (mutual performance
monitoring), mutual support (back-up behavior), and communication. A paradigm shift from
individual focus to team focus is believed to occur with TeamSTEPPS training. The outcomes
include focus on team competencies, information sharing, and task assistance.14 Various
teams exist in a healthcare organization with different professional backgrounds,
responsibilities, and clinical focus. Patient safety requires that teams and individuals within
an organization be committed to coordination, collaboration, mutual accountability,
acknowledgment, recognition, mutual respect, and partnership with the patient and the
family. Partnering with the NICU family is crucial for patient safety. The family needs to be
asked about their desire to be involved in their infant's care, and their preferences must be
respected. Families need to have access to relevant information about their infants, and their
feedback should be solicited. Leaving the family out may leave out valuable information that
is crucial for providing safe care.34

PRACTICE RECOMMENDATIONS
Work culture is the sum of individual values, behaviors, and beliefs that are constantly
displayed by the team. Communication and behavior patterns exhibited by healthcare teams
determine the workplace culture. One of the initial steps toward building a culture of patient
safety is to create a vision that strives to achieve the highest level of team competence.
Buying into such a vision, implementing it, and sustaining the changes can be challenging
and requires resources and organizational commitment. However, physicians and nurses have
the obligation to provide the highest level of care possible, do no harm, and maximize patient
benefits. By adopting the strategies that are shown in, physicians and nurses can take the
initiative to improve teamwork and ensure patient safety.

RESEARCH IMPLICATIONS
Even though during the last decade technological advances and evidence-based
practices have made positive impact on patient safety, the goal to build a safer healthcare
system has yet to be realized. The AHRQ's 2010 National Quality Report showed
improvement in patient safety over the last 6 years, however, gaps in how medical errors,
handoffs and patient care transitions are managed exist.35 A great need remains in
understanding what contributes to such gaps and what the best strategies are to remove the
barriers to safe care. There is also the need to translate science and existing evidence into
practice. Future research needs to focus on implementing and evaluating new evidence-based
interventions and practices that promote patient safety and this includes improving workload
under severe nursing shortage, designing valid and reliable measures of safety and quality
and sustaining improvements in culture change and teamwork. Finally, the need for
comparative effectiveness research with cost-benefit analysis of safety practices and
programs is critical.
CONCLUSION
The influence of work culture on patient safety cannot be underestimated. Many
elements that constitute what we call work culture directly affect how healthcare
professionals perform their jobs and how patient safety is perceived and achieved. Beliefs,
norms, and attitudes exhibited by healthcare professionals are expressed through the way in
which team members interact with one another and perform patient care. Therefore, creating
a culture of safety through evidenced-based team training and enabling healthcare
professionals to discuss, analyze, and report medical errors and "near misses" is a major step
in the right direction. Working together to improve care for infants and their families must be
a priority not just a slogan!

References
1. World Health Organization. WHO launches 'Nine patient safety solutions.
2007http://www.who.int/mediacentre/news/releases/2007/pr22/en/index.html.
Accessed October 3, 2010. [Context Link]
2. Kugelman A, Inbar-Sanado E, Shinwell E Iatrogensis in neonatal intensive care units:
Observational and interventional, prospective, multicenter study. Pediatr.
2008;122:550-555.
3. http://www.nursingcenter.com/lnc/journalarticleprint?Article_ID=1165782