Patient safety is a global health concern. For this study, representatives from 27 countries reported on rules, laws, and policies in their country related to adverse events and medical errors. As expected, laws varied widely between countries regarding issues such as apology laws, patient compensation schemes, and legal and emotional support for clinicians involved in adverse events.

Clinicians who are involved in a patient safety incident can experience psychological harm. This literature review of 104 studies identified five levels of support that can be provided to healthcare workers after a patient safety incident – (1) prevention, (2) self-care of individuals and/or teams, (3) support by peers and triage, (4) structured professional support, and (5) structured clinical support.

Usability concerns continue to affect the safe use of electronic health information systems. This commentary describes the role of vendors in improving usability, how regular testing can ensure safety, and the impact of organizational culture on the safe use of information technology over time.

Retained surgical items (RSIs) can lead to serious patient harm. Survey findings from 21 clinicians and stakeholders in Switzerland emphasized the importance of addressing production pressures, encouraging a culture of safety and teamwork, and implementation of effective counting procedures to reduce the incidence of retained surgical items.

Surgical site infections (SSI) are a common, but preventable, complication following surgery. This study sought to determine the association of commitment to, knowledge of, and social norms surrounding SSI prevention efforts and safety climate strength and level. Based on responses from nearly 2,800 operating room personnel in Sweden, only commitment and social norms were associated with safety climate level. None were associated with safety climate strength.

… and proposed a new consensus-based definition. … Vanhaecht K, Seys D, Russotto S, et al. An evidence and …

Anesthesia medications prepared in the operating room are vulnerable to errors at all stages of medication administration, including preparation and dilution. In this study, anesthesiologists were asked to prepare the mixture of three drugs used for spinal anesthesia for cesarean section. Results show deviation from the expected concentration and variability between providers. The authors recommend all medications be prepared in the hospital pharmacy or purchased pre-mixed from the manufacturer to prevent these errors. 

Burnout and stress among healthcare workers can adversely impact patient safety. Using data from two cross-sectional surveys, this study found the COVID-19 pandemic had a larger impact on the mental health and well-being of healthcare workers compared to involvement in a patient safety incident. Negative psychological symptoms such as anxiety, sleep deprivation, and wanting to leave the profession were all significantly higher in COVID-19-related groups. 

Effective patient safety improvement efforts address safety threats at the individual, interpersonal, and organizational levels. This study characterizes safety measures described in incident reports from German outpatient care settings. Of the 243 preventative measures identified across 160 reports, 83% of preventative measures were classified by the research team as “weak,” meaning that they focus on influencing human behavior rather than on treating underlying problems (e.g., alerts, trainings, double checks).

… on speaking up behaviors. … Walther F, Schick C, Schwappach D, et al. The impact of a 22-month multistep …

The World Health Organization (WHO) surgical safety checklist (SSC) can improve perioperative outcomes but implementation challenges persist. This study found that peer observation and immediate peer feedback improved SSC compliance and identified primary areas for future efforts to further improve compliance (i.e., reducing interruptions and improving sign outs).

… reactions from involved individuals. … Niederhauser A, Schwappach DLB. Speaking up or remaining silent about patient …

Tall Man lettering (TML) is a recommended strategy to reduce look-alike or sound-alike medication errors. This simulation study used eye tracking to investigate how of ‘tall man lettering’ impacts medication administration tasks. The researchers found that TML of prelabeled syringes led to a significant decrease in misidentified syringes and improved visual attention.

Polypharmacy and potentially inappropriate medications continue to pose health risks in older adults. Using a Delphi approach, experts identified 85 minimal requirements for safe medication prescribing in nursing homes. The five key topics recommend structured, regular review and monitoring, interprofessional collaboration, and involving the resident.

… involved in patient safety incidents. … Van Slambrouck L, Verschueren R, Seys D, et al. Second victims among …

Peer support programs can help clinicians cope with the emotional consequences of involvement in an adverse event. This cross-sectional survey of Dutch nurses and doctors found that most respondents (86%) had been involved in a patient safety incident at some point during their career but only a small proportion sought out support in the aftermath of the incident.

… of surgical safety checklists.  … Fridrich A,  Imhof A, Schwappach DLB. How much and what local adaptation is …

This study examined patient safety issues stemming from health information technology (HIT)-related information management hazards. The authors identified eleven thematic groups describing such hazards occurring at a systemic level, such as fragmentation of patient information, “information islands” (e.g., nurses and physicians have separate information sets despite the same HIT system), and inadequate information structures (e.g., no drug interaction warning integrated in the chemotherapy prescribing tool).

Double checking is one strategy for detecting and preventing medication errors; however, its effectiveness is unclear. This editorial presents a framework intended to further research and clinical practice by defining and classifying checking procedures and differentiating them from other medication-related safety behaviors.

This study focused on healthcare workers speaking-up behavior in six psychiatric hospitals in Switzerland. The authors found significant differences in speaking-up despite having moderate to high scores on items that were associated with psychological safety. Although nurses reported patient safety concerns more frequently, they also remained silent more often compared with psychologists and physicians, indicating they may feel less psychological safety.