Principles of Patient Safety

Patient safety focuses on reducing risk of accidental injury from healthcare delivery. Despite decades of attention, medical errors still harm hundreds of thousands of patients annually. Most errors are attributable to a combination of human factorsHuman factors with failure points of complex systems, rather than individual lapses. Safe systems aim to improve by fostering a culture of psychological safety that supports worker willingness to openly report errors and near-miss events without fearing retribution. Medication errors are frequent and often preventable. Direct observation of anesthesia professionals in the operating room has shown an error reaching one in 20 medication administrations, such as wrong dose or swapping syringes. Recommended prevention methods include eliminating look-alike vials, using pre-filled syringes, standardizing labeling and color coding, bar code administration, and smart infusion pumps. When errors occur, patients expect timely and honest disclosure. In response to fear that disclosure increases risk of a liability judgment, many U.S. states have enacted apology laws to protect certain elements of disclosure from being used as evidence in litigation. Some evidence suggests that health systems that support early disclosure, sometimes with offers of compensation, may have lower incidence of malpractice claims. Anesthesiologists should be familiar with local risk managementRisk management expectations and should have an active role in disclosure of perioperative adverse events. Awareness of general disclosure principles and practice in simulated patient scenarios is helpful preparation for real-life disclosure conversations.