Interprofessional Students Seek and Find Safety Hazards at the BedsideGretchen Gregory, MSN, RN, Carla Dyer, MD, Sue Boren, PhD; Doug Wakefield, PhD

Sinclair School of Nursing , University of Missouri School of Medicine and University Health Care

BackgroundThe University of Missouri offers a six-hour, four-week interprofessional curriculum in patient safety, quality improvement, and teamwork/communication. The course began in 2003 with an emphasis in patient safety and has gone through many revisions, including the addition of a large scale simulation involving 6 patients with safety issues integrated throughout scenarios in 2009. The Safety Seek And Find Exercise (SSAFE) was developed in 2010 to complement the simulation, heighten the students’ bedside safety awareness and facilitate interprofessional teamwork.

Conclusions and Implications•SSAFE provided an opportunity to improve students’ ability to recognize safety hazards while enhancing interprofessional collaboration and communication. •Students identified more safety hazards collaborating as an interprofessional team than working independently. •The number of times a student experienced SSAFE and its timing did not impact the students’ ability to identify safety hazards. •SSAFE served as a team building exercise and provided students with environmental safety knowledge. •Many students identified patient safety as a shared responsibility.

 

Purpose of Study 1)To evaluate the effects of SSAFE on the students’ ability to recognize potential safety hazards: a) individually and as a team; and b) within interprofessional groups. 2) To determine optimal frequency and timing of SSAFE in relationship to the existing curriculum.

Safety Seek and Find Exercise (SSAFE)

.

Each interprofessional group consisted of: 5 medical students 4 nursing students1 pharmacy student 1 respiratory therapy

student1 Health Administration graduate student

Staged room -29 safety hazards

Independently identifies safety hazards - SILENTLY

Group identification of safety hazards- COLLABORATIVELY

Debrief and short reflection

Results (continued)Nurses identified 3 more potential safety hazards than other professional groups (13±3; mean + SD) versus (10±3) (p<0.001).

 

Of 12 teams that completed SSAFE twice (Group A), there was no difference in the number of safety hazards identified between time 1 (range 16–23) and time 2 (range 16–24) using the signed ranked test (p=0.1270).

There was no significant difference between the mean number of items identified by Group B, completing SSAFE once (19±3: mean+SD), versus Group A, who experienced SSAFE twice (21±2) (p=0.1156). Exposure to SSAFE prior to the large scale simulation showed no advantage as a “primer” to increase students’ recognition of potential hazards in large scale simulation.

  Number of Students

Mean # of Safety Items Identified*

(Standard Deviation)

Health Administration

24 7.5 (3.3)

Medical 93 10.7 (2.8)

Nursing 104 13.2 (2.6)**

Pharmacy 27 9.3 (3.1)

Respiratory 12 11.4 (2.7)

All Professions 260 11.3 (3.3)

Acknowledgements: Statistical analysis provided by Bin Ge MD, MA and Youngju Pak, PhD. Additional

support provided by Dr. Leslie Hall, the Interprofessional Education Steering Committee, the University

of Missouri Center for Health Care Quality, and Dr. Linda Headrick, Senior Associate Dean School of

Medicine.

Safety Hazards

Individual Frequency

(N=260)

Group Frequency

(N=24)

Fall/Restraint Related Issues • Bed in high position 31.8% 91.7% • Bed unlocked 63.5% 91.7% • Call light out of reach of patient 51.2% 95.8%

Infection Control Issues • Bloody dressing on central line or IV line 6.2% 20.8% • Bedpan/urinal on bedside table with urine in it 81.5% 95.8%

Identification Issues • Allergies listed on chart but no bracelet 58.5% 91.7% • ID band does not match name on chart 43.5% 87.5%

Medication Management Issues • Order sheet with unapproved abbreviations 10.4% 25.0% • Patient allergic to medication ordered 4.6% 25.0% • Allergy band with unapproved abbreviation 6.2% 20.8%

General Patient Safety • Very cluttered room; trip hazard-cord laying in

walkway; chair with linens hanging off of it 83.5% 100.0%

• Nonskid socks absent 2.7% 25.0%

Equipment Safety • Portable O2 tank unsecured in corner of the

room. 39.6% 62.5%

• Cigarette in bed 63.5% 79.2%

Communication Issues • Nurse report sheet with other patients info at

bedside- confidentiality 55.0% 75.0%

MethodsParticipants included 260 students from 5 disciplines, divided into 24 groups.

Students identified safety issues in a staged hospital room containing 29 safety hazards. The students first identified hazards individually by listing items and then collaborated as an interprofessional team. The students had 20 minutes to complete responses. Twelve of 24 randomly assigned interprofessional small groups experienced SSAFE as a “primer” to increase their awareness of bedside safety hazards prior to their participation in the large scale simulation (Group A).

Then all 24 teams experienced SSAFE immediately following the simulation. The “primer’s” impact was evaluated by the students’ ability to recognize safety hazards during the large scale simulation. At course completion, faculty debriefed students on key safety hazards embedded in SSAFE.

ResultsIndividual participants (n=260) identified a range of 3-72% of potential hazards in the SSAFE. Students identified significantly more hazards collaborating as an interprofessional team (range 17-23 of 29) than working independently (mean range 9-13) (p=0.0005 using signed rank test).

NEW additionSSAFE “Primer”

to simulationGroup A

Large Scale Simulation5 disciplines, 6 patients

NEW addition SSAFEGroup AGroup B

Interprofessional discussionsQI & Safety

No PrimerGroup B

*Full list available upon request