The association between event learning and continuous quality improvement programs and culture of patient safety.

PURPOSE: To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety. METHODS AND MATERIALS: We created an event learning system (termed a "good catch" program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers. A formal continuous quality improvement program was created to address these reported events and make improvements. Data on perceptions of the culture of patient safety were collected using the Agency for Health Care Research and Quality survey administered before, during, and after the initiatives. RESULTS: Of 560 good catches reported, 367 could be ascribed to a specific step on our process map. The calculated utility of safety barriers was highest for those embedded into the pretreatment quality assurance checks performed by physicists and dosimetrists (utility score 0.53; 93 of 174) and routine checks done by therapists on the initial day of therapy. Therapists and physicists reported the highest number of good catches (24% each). Sixty-four percent of events were caused by performance issues (eg, not following standardized processes, including suboptimal communications). Of 31 initiated formal improvement events, 26 were successfully implemented and sustained, 4 were discontinued, and 1 was not implemented. Most of the continuous quality improvement program was conducted by nurses (14) and therapists (7). Percentages of positive responses in the patient safety culture survey appear to have increased on all dimensions (p < .05). CONCLUSIONS: Results suggest that event learning and continuous quality improvement programs can be successfully implemented and that there are contemporaneous improvements in the culture of safety.

Comparison of Infant Car Seat grip orientations and lift strategies.

The rear-facing Infant Car Seat (ICS) is designed to meet federal requirements for transporting children less than 1 year old. Typical use includes transfer in and out of a vehicle, which is shown to be a difficult lift. Despite the frequency of this lift, manufacturers provide little guidance for users. Review of relevant literature suggested an ICS featuring an angled handle, promoting a neutral wrist posture, would increase grip stability and decrease lifting effort. Popular press suggested a foot-in-car stance for the ICS lift would do the same. An experiment was conducted in which wrist deviations from neutral posture were recorded along with lifting muscle activation levels (multiple flexor muscles and biceps brachii) and overall perceived exertion for straight versus a new bent handle design and conventional stance versus foot-in-car. Foot position was examined to test the recommendations in the popular press. Surprisingly, wrist deviation was not significantly affected by the new bent handle design (due to compensatory behavior with the straight handle) but was related to foot placement (p=0.04). Results revealed the bent handle to significantly reduce flexor activation compared with the straight handle (p=0.0003); however, the level of biceps activation increased. Biceps activation also significantly increased for foot-in-car stance (p=0.035) but not flexor activation. In general, the bent handle enabled the user to lift the ICS with a steadier grip and less effort.