Road safety is an important public health issue; technology, policy, and educational interventions to prevent crashes are of significant interest to researchers and policymakers. In particular, there is significant ongoing research to proactively evaluate the safety of new technologies, including autonomous vehicles, before enough crashes occur to directly measure their impact. We analyze the distributional form of five diverse datasets that approximate motor vehicle safety incident severity, including one dataset of hard braking events that characterizes the severity of non-crash incidents. Our empirical analysis finds that all five datasets closely fit a lognormal distribution (Kolmogorov-Smirnov distance < 0.013; significance of loglikelihood ratio with other distributions < 0.000029). We demonstrate a linkage between two well-known but largely qualitative safety frameworks and the severity distributions observed in the data. We create a formal model of the Swiss Cheese Model (SCM) and show through analysis and simulations that this formalization leads to a lognormal distribution of the severity continuum of safety-critical incidents. This finding is not only consistent with the empirical data we examine, but represents a quantitative restatement of Heinrich\'s Triangle, another heretofore largely qualitative framework that hypothesizes that safety events of increasing severity have decreasing frequency. Our results support the use of more frequent, low-severity events to rapidly assess safety in the absence of less frequent, high-severity events for any system consistent with our formalization of SCM. This includes any complex system designed for robustness to single-point failures, including autonomous vehicles.

BACKGROUND: Filler injection is among the most popular nonsurgical aesthetic procedures worldwide. Though relatively noninvasive, filler injection can lead to severe vascular adverse events. Even though the incidence is rare, it may cause devastating and irreversible outcomes. A Swiss cheese model has been widely applied for risk analysis and management approach in medical field.
OBJECTIVE: In this review article, we adopt the Swiss cheese model and create a structured approach to prevent severe vascular complications caused by filler injections.
METHODS: We reviewed the current literature regarding the knowledge and techniques of preventing vascular adverse events in the filler injection.
RESULTS: We propose four structured strategies in this model to reduce the risk of severe vascular adverse events of filler injections, including clinical facial anatomy, safe filler injection principles, real time imaging and auxiliary instruments, and implication of checklist.
CONCLUSIONS: This review provides clinicians a structured approach before and during the filler injection procedure to reduce the risk of vascular adverse events and improve its safety and outcome.

Minor adverse airway events play a pivotal role in the safety of airway management. Changes in airway management strategies can reduce such events, but the broader impact on airway management remains unclear.
Minor, frequently occurring adverse airway events were audited before and after implementation of changes to airway management strategies. We used two Bayesian networks to examine conditional probabilities of subsequent airway events and to compute the likelihood of certain events given that certain previous events occurred.
Independent of sex, age, and American Society of Anesthesiologists physical status, targeted changes to airway management strategies reduced the risk of a first event. Obese patients were an exception, in whom no risk reduction was achieved. Frequently occurring event sequences were identified, for example the most likely event to follow difficult bag-mask ventilation was a Cormack-Lehane grade ≥3, with a risk of 14.3% (95% credible interval [CI], 11.4-17.2%). An impact of the targeted changes was detected on the likelihood of some event sequences, for example the likelihood of no consecutive event after a tracheal tube-related event increased from 43.3% (95% CI, 39.4-47.6%) to 56.4% (95% CI, 52.0-60.5%).
Identification of risk patterns and typical structures of event sequences provides a clinically relevant perspective on airway incidents. It further provides a means to quantify the impact of targeted airway management changes. These targeted changes can influence some event sequences, but overall, the benefit results from the cumulative effect of improvements in multiple events. Targeted airway management changes with knowledge of risk patterns and event sequences can potentially further improve patient safety in airway management.
NCT02743767.

This report describes a case of a 70-year-old male that underwent decompression laminectomy and internal fixation under general anaesthesia. After extubation, the patient gradually developed no response to instructions and the disturbance of consciousness persisted with unequal pupils in size, but clinical neurological findings and a brain computed tomography scan showed no organic abnormalities. A careful medical history undertaken by anaesthesiologists revealed that the patient had a history of trauma to his left eye, resulting in blindness in this eye, but the surgeons, anaesthesiologists and nurses did not find these problems before the operation. The diagnosis in this case was prolonged unconsciousness due to delayed recovery from anaesthesia. Careful titration of the dose based on individual response in order to reduce adverse effects of general anaesthetics is especially important in elderly patients. Multiple checks of the patient information, surgical safety checklist and medical history by anaesthesiologists, surgeons and nurses can minimize the chance of an adverse outcome.

Home ventilation involves the use of medical devices at patient\'s home by personnel who are not healthcare practitioners. This implies new potential risks not fully addressed by current standards and guidelines. A methodological approach to investigate potential failures and define improvement actions to address the dangerous potential situations in HV is required. A multidisciplinary team performed an extended version of Failure Mode, Effect and Criticality Analysis (FMECA) to analyse the home ventilation service provided by the Local Healthcare Unit of Naples (ASL NA1) that assisted 60 homebound ventilator dependent patients. The failures were identified in three risk areas: device, electrical system & fire hazard, and indoor air quality. The corrective actions were formulated with two extra steps: identification of critical failures with a threshold applied to the risk priority number and analysis of causes by means of contributory factors (Organization, Technology, Information, and Structure) based on Reason\'s theory of failures. 22 of 86 potential failures were identified as critical. Specific corrective actions were addressed and proposed through contributory factors to improve the overall quality of home ventilation service. The use of this systemic approach oriented the improvements to reduce the harms caused by vulnerabilities in high-risk care service as life support home ventilation.

OBJECTIVE: The aim of this study was to determine nurses\' perceptions of supports and barriers to high-alert medication (HAM) administration safety.
METHODS: A qualitative descriptive design was used.
METHODS: Eighteen acute care nurses were interviewed about HAM administration practices. Registered nurses (RNs) working with acutely ill adults in two hospitals participated in one-on-one interviews from July-September, 2017. Content analysis was conducted for data analysis.
RESULTS: Three themes contributed to HAM administration safety: Organizational Culture of Safety, Collaboration, and RN Competence and Engagement. Error factors included distractions, workload and acuity. Work arounds bypassing bar code scanning and independent double check procedures were common. Findings highlighted the importance of intra- and interprofessional collaboration, nurse engagement and incorporating the patient in HAM safety.
CONCLUSIONS: Current HAM safety strategies are not consistently used. An organizational culture that supports collaboration, education on safe HAM practices, pragmatic HAM policies and enhanced technology are recommended to prevent HAM errors.
CONCLUSIONS: Hospitals incorporating these findings could reduce HAM errors. Research on nurse engagement, intra- and interprofessional collaboration and inclusion of patients in HAM safety strategies is needed.
目的: 本研究的目的在于确定护士对高危药品(HAM)用药安全有利因素及障碍的看法。 设计: 采用了定性描述设计 方法: 就高危药品(HAM)用药实践采访了18名急症护理护士。2017年七月至九月,对两家医院护理重症成年患者的注册护士(RN)进行了一对一访问。内容分析用于数据分析。 结果: 三个有助于高危药品(HAM)用药安全的主题:组织安全教育、合作、注册护士能力以及参与度。过失原因包括各种干扰、工作量以及敏锐度。绕过条形码扫描和独立复查程序的行为十分常见。调查结果强调了专业内和跨专业合作、护士参与度、以及让患者加入高危药品(HAM)安全。 结论: 目前并未贯彻高危药品(HAM)安全策略。建议建立支持合作的组织教育、高危药品(HAM)安全实践教育、高危药品(HAM)实用政策并提高技术避免高危药品(HAM)过失。 影响: 采纳这些调查结果的医院能够减少高危药品(HAM)过失。需要对护士参与度、专业内和跨专业合作以及让患者加入高危药品(HAM)安全策略进行研究。.

METHODS: A 71-year-old female accidentally received thiothixene (Navane), an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc) for 3 months. She sustained physical and psychological harm including ambulatory dysfunction, tremors, mood swings, and personality changes. Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms.
CONCLUSIONS: Errors occurred at multiple care levels, including prescribing, initial pharmacy dispensation, hospitalization, and subsequent outpatient follow-up. This exemplifies the Swiss Cheese Model of how errors can occur within a system. Adverse drug events (ADEs) account for more than 3.5 million physician office visits and 1 million emergency department visits each year. It is believed that preventable medication errors impact more than 7 million patients and cost almost $21 billion annually across all care settings. About 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Medication errors and ADEs are an underreported burden that adversely affects patients, providers, and the economy.
CONCLUSIONS: Medication reconciliation including an \'indication review\' for each prescription is an important aspect of patient safety. The decreasing frequency of pill bottle reviews, suboptimal patient education, and poor communication between healthcare providers are factors that threaten patient safety. Medication error and ADEs cost billions of health care dollars and are detrimental to the provider-patient relationship.

Approximately 2,700 patients are harmed by wrong-site surgery each year. The World Health Organization created the surgical safety checklist to reduce the incidence of wrong-site surgery. A project team conducted a narrative review of the literature to determine the effectiveness of the surgical safety checklist in correcting and preventing errors in the OR. Team members used Swiss cheese model of error by Reason to analyze the findings. Analysis of results indicated the effectiveness of the surgical checklist in reducing the incidence of wrong-site surgeries and other medical errors; however, checklists alone will not prevent all errors. Successful implementation requires perioperative stakeholders to understand the nature of errors, recognize the complex dynamic between systems and individuals, and create a just culture that encourages a shared vision of patient safety.

The Swiss Cheese Model (SCM) is the most popular accident causation model and is widely used throughout various industries. A debate exists in the research literature over whether the SCM remains a viable tool for accident analysis. Critics of the model suggest that it provides a sequential, oversimplified view of accidents. Conversely, proponents suggest that it embodies the concepts of systems theory, as per the contemporary systemic analysis techniques. The aim of this paper was to consider whether the SCM can provide a systems thinking approach and remain a viable option for accident analysis. To achieve this, the train derailment at Grayrigg was analysed with an SCM-based model (the ATSB accident investigation model) and two systemic accident analysis methods (AcciMap and STAMP). The analysis outputs and usage of the techniques were compared. The findings of the study showed that each model applied the systems thinking approach. However, the ATSB model and AcciMap graphically presented their findings in a more succinct manner, whereas STAMP more clearly embodied the concepts of systems theory. The study suggests that, whilst the selection of an analysis method is subject to trade-offs that practitioners and researchers must make, the SCM remains a viable model for accident analysis.

OBJECTIVE: To provide a brief introduction into Critical Incident Reporting Systems (CIRS) as used in human medicine, and to report the discussion from a recent panel meeting discussion with 23 equine anaesthetists in preparation for a new CEPEF-4 (Confidential Enquiry into Perioperative Equine Fatalities) study.
METHODS: Moderated group discussions, and review of literature.
METHODS: The first group discussion focused on the definition of \'preventable critical incidents\' and/or \'near misses\' in the context of equine anaesthesia. The second group discussion focused on categorizing critical incidents according to an established framework for analysing risk and safety in clinical medicine.
RESULTS: While critical incidents do occur in equine anaesthesia, no critical incident reporting system including systematic collection and analysis of critical incidents is in place.
CONCLUSIONS: Critical incident reporting systems could be used to improve safety in equine anaesthesia - in addition to other study types such as mortality studies.