Note UCSF-CTSI supported study: Audrey Lyndon, PhD, RN, FAAN, former CTSI K Scholar, is best known for her work demonstrating how communication failures contribute to preventable adverse events in perinatal care – and for developing strategies to improve safety on labor and delivery units.
Read full paper in BMJ Quality & Safety: "Parents’ perspectives on safety in neonatal intensive care: a mixed-methods study."
ABSTRACT
Background & objectives
Little is known about
how parents think about neonatal intensive care
unit (NICU) safety. Due to their physiologic
immaturity and small size, infants in NICUs are
especially vulnerable to injury from their medical
care. Campaigns are underway to integrate
patients and family members into patient safety.
This study aimed to describe how parents of infants
in the NICU conceptualise patient safety and what
kinds of concerns they have about safety.
Methods
This mixed-methods study employed
questionnaires, interviews and observation with
parents of infant patients in an academic medical
centre NICU. Measures included parent stress,
family-centredness and types of safety concerns.
Results
46 parents completed questionnaires and
14 of these parents also participated in 10
interviews (including 4 couple interviews). Infants
had a range of medical and surgical problems,
including prematurity, congenital diaphragmatic
hernia and congenital cardiac disease. Parents were
positive about their infants’
care and had low levels
of concern about the safety of procedures. Parents
reporting more stress had more concerns. We
identified three overlapping domains in parents’
conceptualisations of safety in the NICU, including
physical, developmental and emotional safety.
Parents demonstrated sophisticated understanding
of how environmental, treatment and personnel
factors could potentially influence their infants’
developmental and emotional health.
Conclusions
Parents have safety concerns that
cannot be addressed solely by reducing errors in
the NICU. Parent engagement strategies that
respect parents as partners in safety and address
how clinical treatment articulates with physical,
developmental and emotional safety domains may
result in safety improvements.