Awareness and consistent application of professional guidance can support safe, effective care delivery. This collection of articles presents short introductions to a range of guidelines that suggest actions that inform safe nursing activities. Topics covered include medication safety, retained surgical items, and safe patient handling. 

Quality improvement (QI) and patient safety initiatives can be challenging to implement and sustain. The article proposes incorporating behavioral insights (BI) into QI to enhance and reinforce behaviors to support positive change. The authors describe using BI in a QI program to increase actions and behaviors more aligned with safe use of intravenous antibiotics at one hospital in Denmark.

Digital maturity in healthcare refers to how well hospitals use digital systems to improve patient care processes, enhance patient safety, and provide quality health care. This study used the Electronic Medical Record Assessment Model (EMRAM) to examine the relationship between digital maturity and Leapfrog’s quality and safety scores. Among 1,026 hospitals, researchers found that higher digital maturity was associated with improved odds of achieving a higher Leapfrog hospital safety grade, indicating advanced patient safety outcomes.

Effective communication and coordination among care teams is essential to the delivery of high quality, safe health care. This article introduces the Multi-Team Shared Expectations Tool (MT-SET), which is used to improvement team communication, engage teams in eliciting needs and establishing shared expectations among teams and individuals. A pilot evaluation of the MT-SET in perioperative and inpatient care units at Johns Hopkins University School of Medicine found that the MT-SET tool fostered better cross-unit teamwork and coordination, but issues such as care delays and inconsistent communication persist.

Sleep deprivation or changes to circadian rhythm (such as those introduced by daylight savings time, or DST) can hinder the delivery of safe health care. In this analysis of 288,432 malpractice claims between January 1990 and September 2018, researchers found that the spring transition to DST was not associated with higher severity patient safety incidents, but that events occurring during the 7-8 months of DST were more severe compared to the 2-4 months of standard time.

Missed nursing care can lead to lower quality of care and threaten patient safety. This systematic review including 24 articles evaluated methods for measuring missed nursing care in long-term aged care (LTAC) settings. The authors concluded that existing tools are inconsistently applied and lack strong methodologic verification; additional research to develop standardized, validated tools is needed.

Polypharmacy in older adults, particularly those with dementia, can increase the risk of patient safety events. This qualitative study evaluated whether integrating pharmacists into care teams at special housing for older adults in Sweden improved medication safety. Findings from semi-structured interviews and content analysis revealed that pharmacists are perceived to be important members of the care team, but communication barriers within teams hinders medication safety.

High-reliability organizations are built on elements that reduce hierarchy, improve communication, and recognize expertise in team members during times of crisis. This summary of the literature explores evidence supporting the use of huddles to enhance transparency and information sharing. It provides a sample structure for HRO huddles at the unit level.

Transitions of care between the hospital and home can jeopardize patient safety for a myriad of reasons, such as communication gaps and poor care coordination. This article evaluates the implementation of hybrid “Your Care Needs You” (YCNY) intervention in the UK’s National Health Services (NHS), which aims to improve the safety of care transitions from hospital to home by supporting patients in (1) managing health and well-being, (2) medication management, (3) completing activities of daily living, and (4) anticipating needs and escalating care. Qualitative evaluations and observations found that YCNY goals resonated with patients, but that implementation was often hampered by time constraints and understaffing.

Retained surgical items (RSIs) remain a persistent patient safety problem. This review examined the use of machine learning (ML) and deep learning (DL) tools to support RSI prevention and detection and how these applications can be integrated with existing safety practices in perioperative care.

Open disclosure of errors is increasingly encouraged in health care and emphasized in health profession training. This randomized trial evaluated the effectiveness of video-based communication assessment (VCA) feedback in resident error disclosure skill training. The researchers found that internal medicine and family medicine residents who received individual feedback on simulated error disclosure performance scored significantly higher on subsequent error disclosure assessments, as compared to residents who did not receive feedback.

Patients with higher medication complexity, such as patients with cancer, are particularly vulnerable to medication safety events (MSEs). This qualitative study with patients with breast, prostate, lung, and colorectal cancer identified several barriers to the use of technology for MSE self-reporting, such as limited access to technology and low confidence in using technology.

Like many health care organizations, the Veterans Health Administration (VHA) is working towards becoming a high-reliability organization (HRO). In this qualitative study, researchers interviewed 14 current and past leaders involved in HRO transformation at the Harry S. Truman Memorial Veterans' Hospital. Leaders identified three key strategies for achieving high reliability: (1) consistent communication from leadership and modeling of HRO principles, (2) empowering frontline staff to make changes and fail, and (3) hiring and training team members in alignment with organizational culture and HRO values.

Delayed diagnosis and management of sepsis can lead to significant patient harm. This qualitative study explored patient perspectives about near-miss events and deaths due to maternal sepsis. The focus groups and interviews identified four key issues important for future quality improvement efforts: insufficient awareness of sepsis warning signs, atypical symptoms, dismissal of concerns leading to delayed diagnosis, and difficulty accessing follow-up care.

Health care leaders have a critical role in establishing and supporting a robust culture of safety. This report analyzed the environment of care at one Veterans’ Affairs hospital that perpetuated poor psychological safety, thereby reducing improvement opportunities. The examination concluded that the responsibility for the situation sat squarely with organizational leadership, who dismissed staff concerns, failed to examine factors contributing to problems, and fostered an unsafe deference to hierarchy. Recommendations for improvement focus on improving use of human resources strategies to generate needed change.

The fast-paced and complex environment of the emergency department (ED) can threaten patient safety. In this meta-analysis, the pooled prevalence of medication errors in the ED was 22%. The researchers estimated that 36% of patients experienced a medication error in the ED, with about 43% of these errors being potentially harmful but without leading to death.

Large electronic health record- or population-based datasets form the basis for many diagnostic error studies. This article raises the issue of data-driven feedback loop failures which occur when disease incidence, presentation, and risk factors are misunderstood in research and, therefore, future medical practice. For example, men presenting with "classic" symptoms of heart attack are more frequently targeted for evaluation than women with "atypical" symptoms, thereby resulting in underdiagnoses of heart attack in women and underrepresentation in the evidence base.

Patients and families can look at various rating systems to compare hospitals, nursing homes, and other healthcare providers. This study compared ratings of four national hospital rating organizations: Hospital Compare, Healthgrades, The Leapfrog Group, and US News and World Report. The results showed discordance between hospital ratings on several important overall and condition-specific measures, potentially causing confusion for patients seeking care.

Artificial intelligence (AI) is transforming the way researchers and clinicians seek to improve patient safety. This article provides a primer on AI terminology (e.g., generative AI, large language models), opportunities for it to improve patient safety, and challenges such as bias and hallucinations.