Evaluation of the Pedi-CSI (Clinical Safety Investigation) Video Vignettes

Saturday, 7 November 2015

Judith A. Vessey, PhD, MBA, RN, FAAN
Medicine Patient Services, Boston Children's Hospital, Boston, MA, USA
Amanda J. Lulloff, MS, RN
William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
Rachel DiFazio, PhD, RN, FAAN
Department of Orthopaedics - Hunnewell 2, Boston Children's Hospital, Boston, MA, USA

Patient safety is a major component of quality patient care (World Health Organization, 2006) and pediatric nurses are integral in assuring safe care to young, vulnerable patients (IOM, 2004). Comprehensive, formalized patient safety training is needed by pediatric nurses and nursing students because ill children often present with different and often more complex safety issues than their adult counterparts. Failing to provide specialized training can lead to safety failures; and although difficult to quantify, financial costs of safety errors resulting in adverse events are high. Although population-specific training is necessary, the majority of pedagogical patient safety activities are designed towards adult inpatient settings; valid patient safety training programs specific to pediatric nursing care could not be identified (Agency for Healthcare Research and Quality [AHRQ], n.d.).  

This project’s goal was to address this gap in pediatric patient safety clinical education; the evidence-based-practice paradigm (Schaffer, Sandau, & Diedrick, 2013) was used in its development. Initially, relevant research findings, professional guidelines, the National Patient Safety Goals, selected pediatric clinical literature, and clinical educational strategies were reviewed. Using these findings and in consultation with pediatric patient safety experts, a series of pediatric patient care video vignettes were created. The clinical video vignette format was chosen as it can convey didactic information, influence the learner’s  affective knowledge and attitudes (Robertson, Kaplan, Atallah, Higgins, Lewitt, & Ander, 2010) and improve the learner’s clinical judgment and critical thinking (Fero, Witsberger, Wesmiller, Zullo, & Hoffman, 2008; Lasater & Nielsen, 2009). Thus video vignettes are especially effective teaching tools as they help nurses identify breeches in patient safety, create a desire to adjust their care delivery accordingly, and influence others to adopt safe practices as well.

       A series of twelve brief pediatric patient safety vignettes were created. To ensure that the most common pediatric patient safety errors were included, a grid was created that incorporated patient safety information from the National Patient Safety Goals, the National Institute for Children’s Healthcare Quality  initiatives,  and the Agency for Healthcare Quality guidelines to common pediatric clinical situations. Scripts for each vignette were drafted that incorporated specific obvious and subtle patient safety errors and vulnerabilities. The vignettes were then filmed in acute care settings (with actors) to illustrate these elements. The central themes of the vignettes are: 1) skin breakdown, 2) handoffs, 3) IV site contamination, 4) cross contamination, 5) environmental services cleaning, 6) patient discharge, 7) mislabeled specimens, 8) medication administration, 9) oxygen administration, 10) alarm fatigue, 11) high alert medications, and 12) fall prevention.  Upon their completion, an expert panel of pediatric professionals determined the full range of safety violations in each vignette. Two copies of each vignette, one without and one with the violations clearly explicated, were then produced. Participants initially watch the unmarked video vignette and independently record patient safety errors. Upon completion, the vignette with the errors highlighted is then shown, allowing participants to compare their responses with those embedded in the scenario. Supportive materials including a patient safety goal briefing/de-briefing teaching materials and a training manual have been developed.

Further validation of the video vignettes has been accomplished by having pediatric inpatient nurses from all levels of clinical practice participate in their testing. The video vignettes, along with the teaching materials, are being prepared for inclusion in OPENPediatrics (openpediatrics.org). OPENPediatrics is a free online community that is peer-reviewed and academically rigorous, sharing best practices for pediatric patients globally. This will allow their use by pediatric nurses in pediatric clinical and academic settings worldwide. This presentation will present the project’s development, allow conference participants to test their patient safety knowledge with a sample vignette, and provide information regarding accessing the vignettes and supportive materials.