The COVID-19 pandemic had wide-ranging impacts on care delivery and patient safety. This study examined the relationship between critical care clinician experiences related to patient safety during the pandemic and COVID-19 caseloads during the pandemic. Findings suggest that as COVID-19 caseloads increased, clinicians were more likely to perceive care as less safe.

Antimicrobial stewardship is an important element of patient safety. This scoping review explored how antimicrobial indication documentation can impact antibiotic use and clinical outcomes. The authors conclude that this is a growing area of research interest and note that emerging evidence indicates that appropriate antimicrobial indication documentation can improve prescribing and patient outcomes but that larger trials are needed to provide more robust evidence.

Electronic health records (EHR) can improve patient care and safety but are not without potential risks. A cyberattack led to a 25-day shutdown of a hospital’s EHR that necessitated a rapid shift to manual processes. This article outlines the laboratory service’s processes during the shutdown, including patient safety and error reduction, billing, and maintaining compliance with regulatory policies.

This article summarizes the principles of high reliability organizations (HROs) and how one healthcare organization sought to become an HRO by emphasizing a culture of safety and the learning healthcare system. The authors discuss how the principles of high-reliability were successfully leveraged during the COVID-19 pandemic.

Using data reported to the National Healthcare Safety Network, this study identified significant increases in the incidence of healthcare-associated infections from 2019 to 2020. The authors conclude that these findings suggest a need to return to conventional infection control and prevention practices and prepare for future pandemics.

Overtreatment and overuse of healthcare services have been identified as potential sources of patient harm. Using Medicare fee-for-services claims, this study sought to describe hospital characteristics associated with 12 low-value services. Results showed the highest levels of overuse were associated with nonteaching and for-profit hospitals, particularly in the American South. The authors suggest interventions to decrease overuse and overtreatment could be targeted based on hospital characteristics and region.

Harm from opioids is a widely recognized patient safety issue, and potential harm associated with short-term use is a growing area of concern. This analysis of a previously opioid-free surgical population identified a high rate of potential opioid-related adverse drug events (ORADEs); risk was strongly associated with route and duration of post-operative opioid administration. The presence of an ORADE was associated with longer postoperative length of stay, higher hospitalization costs, lower odds of discharge home, and higher odds of death.

Resolving medication errors often requires coordination between different care providers. This qualitative study examined medication safety incidents at one VA hospital and found that health care providers rely on cognitive decentering, collaborative decision-making, back-up behaviors, and contingency planning to coordinate care during medication safety incidents. The primary barriers to care coordination identified were role ambiguity, breakdowns in care, and electronic health record-related challenges.

… attributed to healthcare professionals or occurring in a healthcare facility. Antibiotics, pain medicines, and … errors reported to United States poison centers: a retrospective observational study. Drug Therap Perspect. …

… more frequently up to one-year postintervention. … Schwartz A,  Peskin S, Spiro A, et al. Direct observation of depression …

Physician burnout has been associated with increased patient safety incidents. A recent national survey of pediatric residents found burnout rates exceeded 50%. The survey found that risk of burnout was associated with reported stress, sleepiness, dissatisfaction with work-life balance and recent medical error. Burnout rates were lowest among residents reporting empathy, self-compassion, quality of life, and confidence in providing compassionate care.

Cognitive task analysis is a human factors engineering method used to evaluate individuals' thinking to better understand safety. This study examined medication safety through the lens of cognitive task analysis and concluded that the method identifies actionable safety gaps and should be more widely used in health care.

… where patients combine their daily medicines into a spare vial. However, patients are at risk for mistakenly taking a vial of a single medication instead of their pill-dump vial and …

This observation and interview study examined instances of surgical trainees hesitating in the operating room. Both trainees and attending physicians interpreted hesitation as incompetence. The authors suggest that this interpretation of hesitation does not support progressive autonomy for trainees and must be addressed in order to promote surgical safety.

… BMJ Qual Saf … BMJ Qual Saf … Burnout is a highly prevalent patient safety issue. This survey study … work–life balance and burnout. Researchers validated a novel survey measure for work–life balance by asking … as a shared experience within health care settings. … Schwartz SP, Adair KC, Bae J, et al. Work-life balance …

Multidisciplinary organizational efforts are necessary to reduce inappropriate prescribing of opioids. This commentary describes the design and implementation of an opioid stewardship program that combined the use of technology, education, and clinical strategies under strong leadership guidance as a cross-disciplinary strategy to address opioid misuse.

Aviation safety relies on systems improvement rather than individual blame to understand and mitigate failure. This commentary applies principles key to that philosophy from commercial aviation to medicine. The authors highlight vigilance, team performance, and nontechnical skill development as strategies to improve reliability in critical care and surgery.

… Ann Emerg Med … This pre–post study examined the effect of a change in emergency department opioid prescribing …