Background: As many as 3.7% of patients experience preventable adverse events in health care facilities nationwide. Patient safety requires both effective training methods and an interprofessional culture of safety. The “Room of Hazards” is a simulation developed to assess skills in identification of safety hazards amongst staff of different health care disciplines.
Methods: In our simulation, a room in the hospital was set up to display a clinical scenario simulating an inpatient hospital room and a patient mannequin with multiple safety hazards. Participants were anonymously asked to participate in the simulation by silently writing down all safety hazards they observed. Answer sheets were analyzed, transcribed and responses were grouped into five hazard categories (patient, medications, equipment, environment, and care processes). Results were analyzed using ANOVA analysis with a Tukey post hoc test if they achieved homogeneity of variance and a Games-Howell test if homogeneity was not achieved.
Results: Nursing staff (n=70), nursing students (n=5), medical students (n=3), physicians (n=11), social workers (n=5), pharmacists (n=6), Certified Nursing assistants (CNAs) (n=9), psychologists (n=4), and others (n=2) participated in the simulation. Overall, participants identified an average of 20.8 out of 34 possible hazards: 2.9/6 in for the patient category, 3.4/5 in medications, 5.8/9 in equipment, 6.0/8 in environment, and 2.7/6 in care processes. There was a significant difference among professions in hazards identified in each category: environment (p=0.020), equipment (<0.001), medications (p=0.003), patient (p=0.041), and total hazards identified (p<0.001). Within the medications category, nurses and pharmacists identified more hazards than CNAs (3.86 vs. 1.67, p=0.018 and 4.83 vs. 1.67, p = 0.025, respectively). In the equipment category, nurses identified more hazard than social workers (7.01 vs. 1.80, p = 0.002), pharmacists (7.01 vs. 1.17 p < 0.001), or physicians (7.01 vs. 4.00, p = 0.019), and CNAs identified more hazards than pharmacists (5.67 vs. 1.17; p = 0.044). In the environment category, nurses identified more hazards than medical students (6.31 vs. 3.67, p = 0.018). Nurses found more total hazards than medical students (23.30 vs. 12.67; p <0.001) or pharmacists (23.30 vs. 14.33, p = 0.045). Nursing students also identified more total hazards than medical students (21.00 vs. 12.67, p = 0.042).
Conclusions: While all participants identified hazards in all categories, there were significant differences amongst different health care professions in their ability to identifying safety hazards from different categories. This finding suggests that each professional’s unique training and responsibilities results in variable degrees of appreciation in identifying different types of safety hazards. In order to maximize identification and correction of patient safety hazards, interdisciplinary teaching and collaboration is crucial. Our study provides a starting point to include a diverse group hospital staff members in safety training with simulation techniques.