Building safer systems by ecological design: using restoration science to develop a medication safety intervention.
BACKGROUND
Experts call for stronger safety cultures and transparent reporting practices to increase medication safety in today's strained healthcare environments. The field of ecological restoration is concerned with the effective, efficient, and sustainable repair and recovery of ecosystems that have been degraded, damaged, or destroyed. A study was undertaken to determine whether the lessons of restoration science can be adapted to the study of medication safety issues.


METHODS
Working with 26 practitioners, the principles of good restoration were used to design and pilot an innovative multifaceted medication safety intervention. The intervention included focus groups with practitioners, the construction and administration of a research based medication safety inventory, repeat digital photography of environmental safety issues, and targeted environmental modifications.


RESULTS
Participants were most concerned about staff education and the physical environment for medication administration. Ward staff used the research to build a healthy reporting culture, introduce regular discussions of near misses, develop education strategies, redesign delivery and storage processes, and renovate the environment.


CONCLUSIONS
Members of a busy hospital ward successfully adapted methods of restoration science to study, redesign, and strengthen medication safety practices and ward safety culture within existing resources. Further research will be conducted to test the merits of restoration science for health care.
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada T6G 2T4. patricia.marck@ualberta.ca
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Marck
J A
JA
Kwan
B
B
Preville
M
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Reynes
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Morgan-Eckley
R
R
Versluys
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Chivers
B
B
O'Brien
J
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Van der Zalm
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Swankhuizen
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Majumdar
D000416:Alberta; D017753:Ecosystem; D006272:Health Facility Environment; D006302:Health Services Research / Q000379:methods; D006757:Hospital Units / Q000458:organization & administration* / Q000592:standards; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007318:Inservice Training; D008508:Medication Errors / Q000517:prevention & control*; D008510:Medication Systems, Hospital / Q000458:organization & administration* / Q000592:standards; D009741:Nursing Staff, Hospital / Q000193:education*; D015279:Organizational Culture; D009936:Organizational Innovation; D017751:Safety Management / Q000458:organization & administration*; D013597:Systems Analysis