Examining safety in PICUs
Observing safety in health services systems means to observe the principles that by embracing them, the patient’s safety is guaranteed or probability of damages is minimized [1]. The Institute of Medicine in America (IOM) defines safety as avoiding any accidental and intentional damages (e.g. death or injuries due to pharmaceutical side-effects, misidentification, and or hospital infections) by the health care team [2, 3].
Providing safety in medical centers and PICUs in particular is of dire importance as children are not capable of looking after themselves. They depend completely on health personnel for medical cares [1]. In addition, the immune system in children is weaker than that of adults so that mortality rate and injuries caused by medical errors in children are higher than adults [4, 5]. On the other hand, nurses in PICUs have to handle several tasks and deal with different diseases like seizure, poisoning, loss of consciousness, and many other problems. All these issues along with many other factors increase the risk of damage to children in hospitals [6-8].
The WHO introduces children’s safety in hospitals as one of the endemic and pandemic concerns and emphasizes that failure to observe children’s safety increases financial costs, tension in patients and families, hospitalization term, and health system costs [9, 10]. International bodies like the WHO, Patient Safety Foundation (PSF), American Society for Health Care Risk Management [11], and Iran Ministry of Health have tried to improve the safety of patients in PICUs in particular by introducing and implementing safety guidelines in heath centers. These guidelines include hand hygiene, surgical safety, patients identification, single use of injection devices, avoiding catheter and tubing misconnection, patient’s fall, bedsore prevention, informed consent for procedures, medication administration safety throughout hospitalization and transfer, communication during patient hand-over, performance of correct procedure at correct body site, and control of concentrated electrolyte solutions. Inspectors and supervisors are in charge of making sure that the guidelines introduced by the ministry of health about safety are observed. The inspections are periodical and once a year [12]. Notable is that there is no accurate statistics about occurrence of medical errors in Iran. Expectedly, the occurrence rate of these errors in Iran might not be better than that in the USA and Europe. Clearly, the rate of medical errors by physicians and nurses in health centers is relatively high and the personnel do not have a good performance in terms of observing safety standards of the WHO. There are a variety of reasons for the failure to implement the guidelines perfectly such as the ruling culture in wards, organizational management, resources, and reporting system [14-18].
Given the importance of the topic, this study tries to compare safety status in PICUs in comparison with the safety standards of WHO. The results can help us to solve probable problems and improve the safety of hospitalized children.
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