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A bundle is a set of evidence-based interventions that, when performed consistently and reliably, has been shown to improve outcomes and safety in health care. A bundle is typically comprised of a small number of clinical practices (usually 3-5) which are supported by scientifically robust clinical evidence that are all performed cohesively for maximal impact. Examples include bundles to improve maternal care and timing identification and treatment of sepsis.

Best practices in health care as considered the ‘best way’ to identify, collect, evaluate, and disseminate information; implement practices; and/or and monitor the outcomes of health care interventions for patients or population groups with defined indications or conditions. The term “best practices” is somewhat controversial, as some “best practices” may not be supported by rigorous evidence. Therefore, there has been a transition to using “evidence-based practice” or the “best available evidence” to demonstrate that the practice is grounded in empirical research. Examples of evidence-based best practices include surgical pre-op checklists, sepsis bundles, and reducing the use of indwelling catheters.

Accountability in healthcare represents the procedures and processes by which one party justifies and takes responsibility for its activities. This can be both at an individual and organizational level. Individuals must be held accountable for their actions, but organizations also play a role and must also be accountable for their structures and systems.

 

Organizational accountability is dependent upon a safety culture that accepts that adverse events and medical errors should lead to organizational learning (as opposed to a punitive culture in which an organization places blame on individuals rather than making systematic changes based on learning from the errors). When individual errors are made, it is important that organizations separate human behaviors that fall into the reckless (conscious disregard) and intentional categories versus behaviors that reflect human error (e.g., should have done something different) or negligence (failure to exercise expected care). Human error and negligent errors are typically the result of lack of knowledge, misremembering, or misplaced priorities.

Blijleven V, Hoxha F, Jaspers MWM. J Med Internet Res. 2022;24:e33046.
Electronic health record (EHR) workarounds arise when users bypass safety features to increase efficiency. This scoping review aimed to validate, refine, and enrich the Sociotechnical EHR Workaround Analysis (SEWA) framework. Multidisciplinary teams (e.g. leadership, providers, EHR developers) can now use the refined SEWA framework to identify, analyze and resolve unsafe workarounds, leading to improved quality and efficiency of care.
Nether KG, Thomas EJ, Khan A, et al. J Healthc Qual. 2022;44:23-30.
Medical errors in the neonatal intensive care unit threaten patient safety. This children’s hospital implemented a robust process improvement program (RPI, which refers to widespread dissemination of process improvement tools to support staff skill development and identify sustainable improvements) to reduce harm in the neonatal intensive care unit. The program resulted in significant and sustainable improvements to staff confidence and knowledge related to RPI tools. It also contributed to improvements in health outcomes, including healthcare-acquired infection.
Tee QX, Nambiar M, Stuckey S. J Med Imaging Radiat Oncol. 2022;66:202-207.
Diagnostic errors in radiology can result in treatment delays and contribute to patient harm. This article provides an overview of the common cognitive biases encountered in diagnostic radiology that can contribute to diagnostic error, and strategies to avoid these biases, such as the use of a cognitive bias mitigation strategy checklist, peer feedback, promoting a just culture, and technology approaches including artificial intelligence (AI).
Brunelli L, Cristofori V, Battistella C, et al. Int J Integr Care. 2022;22:19.
Accreditation programs are intended to improve patient safety and quality of care. Researchers in Italy aimed to develop and validate an accreditation tool for home care. The tool, validated by 21 experts, is divided into six domains: 1) Organization and governance; 2) Patient safety and risk management; 3) Professionals’ knowledge, skills, and competencies; 4) Information and communication; 5) Care integration, and 6) Improvement and innovation.
Derksen C, Kötting L, Keller FM, et al. Front Psychol. 2022;13:771626.
Effective communication and teamwork are fundamental to ensure safe patient care. Building on their earlier systematic review of communication interventions in obstetric care, researchers developed and implemented a training to improve communication at two obstetric hospitals. While results did not show a change in communication behavior, perceived patient safety did improve. Additional resources are available in the curated library on maternal safety.
Howlett O, Gleeson R, Jackson L, et al. JBI Evid Synth. 2022;Epub Mar 4.
Rapid response teams are designed to provide emergency medical support to deteriorating hospitalized patients. This review examines the role of a family support person (FSP) as part of the rapid response team. The FSP supported the family during the resuscitation in numerous ways, such as explaining jargon and medical procedures and attending to the practical needs of the family.
Giardina TD, Choi DT, Upadhyay DK, et al. J Am Med Inform Assoc. 2022;29:1091-1100.
Most patients can now access their provider visit notes via online portals and many have reported mistakes such as diagnostic errors or missed allergies. This study asked patients who may be “at-risk” for diagnostic error about perceived concerns in their visit notes. Patients were more likely to report having concerns if they did not trust their provider and did not have a good feeling about the visit. Soliciting patient concerns may be one way to improve transparency regarding diagnostic errors and trust in providers.
Hall N, Bullen K, Sherwood J, et al. BMJ Open. 2022;12:e050283.
Reporting errors is a key component of improving patient safety and patient care. Primary care prescribers and community pharmacists in Northeast England were interviewed about perceived barriers and enablers to reporting medication prescribing errors, either internally or externally. Motivation, capability, and opportunity influenced reporting behaviors. 
Heed J, Klein S, Slee A, et al. Br J Clin Pharmacol. 2022;Epub Feb 16.
Hospitals in the US can evaluate the safety of their computerized provider order entry using a simulation tool such as the one provided by the Leapfrog Group. This study developed a similar simulation tool for use in the UK. Study participants rated 178 clinical scenarios for likelihood of occurrence, level of associated harm, and likelihood of harm. One hundred and thirty-one extreme or high-risk prescribing scenarios were developed and will be used to create the evaluation tool.
Muchiri S, Azadeh-Fard N, Pakdil F. J Patient Saf. 2022;18:237-244.
The Hospital Readmissions Reduction Program (HRRP), implemented by the Centers for Medicare & Medicaid Services (CMS), imposes a financial penalty on hospitals with higher than average readmission rates for certain conditions. Six years of readmission rates for four conditions included in the HRRP (acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure, and pneumonia) and two conditions not included (septicemia and mood disorders) were analyzed to assess the impact of the HRRP. The researchers conclude the HRRP reduced readmission rates for the four targeted conditions, but reductions were not consistent across all categories of patients.
Paulik O, Hallen J, Lapkin S, et al. J Patient Saf. 2022;18:e613-e619.
Patient falls are considered a never event and can result in serious injury. This study retrospectively reviewed inpatient falls resulting in injury and the strength of the improvement recommendations proposed after investigation of the event. The researchers classified 8.5% of recommendations as ‘strong’ (i.e., environmental modifications, equipment/process redesign), 35.7% as ‘medium’ (i.e., changing documentation process and/or skill mix, providing education) and 55.8% as ‘weak’ (i.e., alerts or warnings).
Van De Sijpe G, Quintens C, Walgraeve K, et al. BMC Med Inform Decis Mak. 2022;22:48.
Clinical decision support systems (CDSS) can help identify potential drug-drug interactions (DDI), but they can lead to alert fatigue and threaten patient safety. Based on an analysis of DDI alerts and survey data regarding physician experience using the DDI module in the CDSS, researchers identified barriers (i.e., lack of patient-specific characteristics and DDI-specific screening intervals) that contribute to false-positive alerts and alert fatigue.
Verhagen MJ, de Vos MS, Sujan M, et al. BMJ Qual Saf. 2022;31:402-408.
The Safety-II framework uses a proactive approach to improving patient safety by learning form what goes right in healthcare. This article summarizes the attributes of the Safety-II framework and outlines the challenges and opportunities related to integrating Safety-II within healthcare settings.
Wade C, Malhotra AM, McGuire P, et al. BMJ. 2022;376:e067090.
The role of healthcare disparities in patient safety is an emerging priority. This article summarizes disparities in preventable harm and outlines solutions to reducing inequalities in patient safety at the individual-, leadership-, and system-levels, such as identifying clear chains of accountability for adverse events and improving incident measurement and analysis specific to marginalized patient groups.
Willis E, Brady C. Nurs Open. 2022;9:862-871.
Incomplete nursing care can negatively affect care quality and safety. This rapid review found that missed or omitted nursing care in adults contributes to increased mortality, adverse events, and clinical deterioration. Included studies cited several causes (e.g., environmental factors, staffing levels and skill mix) as well as solutions (e.g., education, process redesign).

Institute for Safe Medication Practices.

Workplace bullying and disrespectful behavior have been shown to negatively affect fall rates, medication errors, and other adverse events. The Institute for Safe Medication Practices is seeking clinician input on and experiences with disrespectful behaviors in the ambulatory care setting (e.g., community, specialty, and long-term care pharmacies, physician practices, and outpatient visits) and how organizations have been working to improve the culture of respect. The survey will be open until May 27, 2022.

J Med Imaging Radiat Oncol. 2022;66(2):165-309.

Improving patient safety related to radiology and radiation oncology is an ongoing priority. This special issue explores themes related to radiology and radiation oncology, including monitoring and improving quality of care, promoting a culture of safety, and measuring, reporting, and learning from errors.