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Building safer systems by ecological design: using restoration science to develop a medication safety intervention
  1. P B Marck1,2,3,
  2. J A Kwan1,
  3. B Preville2,
  4. M Reynes2,
  5. W Morgan-Eckley2,
  6. R Versluys2,
  7. L Chivers2,
  8. B O’Brien2,
  9. J Van der Zalm2,
  10. M Swankhuizen2,
  11. S R Majumdar4
  1. 1Faculty of Nursing, University of Alberta, Edmonton, Canada
  2. 2Royal Alexandra Hospital, Capital Health, Edmonton, Canada
  3. 3John Dossetor Health Ethics Centre, University of Alberta, Edmonton, Canada
  4. 4Faculty of Medicine, University of Alberta, Edmonton, Canada
  1. Correspondence to:
 P B Marck RN
 PhD, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada T6G 2T4; patricia.marck{at}ualberta.ca

Abstract

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.

  • DIC, digital image catalogue
  • LPN, licensed practical nurse
  • MSI, medication safety inventory
  • RN, registered nurse
  • ecological design
  • repeat photography
  • medication safety
  • restoration science
  • safety culture
  • DIC, digital image catalogue
  • LPN, licensed practical nurse
  • MSI, medication safety inventory
  • RN, registered nurse
  • ecological design
  • repeat photography
  • medication safety
  • restoration science
  • safety culture

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Footnotes

  • Portions of this work were supported by the Faculty of Nursing, University of Alberta; the Royal Alexandra Hospital Clinical Research Unit, Capital Health; the Canadian Nurses Foundation Nursing Care Partnership Program; Dr J Lander’s Canadian Health Services Research Foundation Chair for Better Care Summer Studentship Program; the Alberta Heritage Foundation for Medical Research Summer Studentship Program; and Dr Nancy Edwards’ Canadian Institutes for Health Research/Canadian Health Services Research Foundation Nursing Chair (Multiple Interventions for Community Health Nursing) at the University of Ottawa. Dr Majumdar is a Population Health Investigator of the Alberta Heritage Foundation for Medical Research and a New Investigator of the Canadian Institutes of Health Research.

  • The authors have no competing interests to declare.

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