Iran Journal of Nursing

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Kalroozi F, Joolaee S. Safety in Pediatric Intensive Care Units in Iran: An Integrative Review. IJN 2018; 31 (112) :6-19
URL: http://ijn.iums.ac.ir/article-1-2643-en.html

Background & Aims: One of the basic rights of patients in the health system of all countries in the world, including Iran, is receiving safe care based on up-to-date knowledge and the superiority of patient interests. The first book of national accreditation standards was published in Iran by the Ministry of Health in 2010 and has been officially used by hospitals and healthcare centers since 2012. Since then, healthcare centers have provided inpatient and hospitalization services based on the criteria introduced by the ministry of health. In this regard, the standards applied were revised five times up to 2016. The criteria exist for the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU) and are assessed every year in these wards. In Iran, findings from scattered studies have reported different percentages of errors, including drug error, in these areas. One of the defects of the studies has been the lack of actual statistics on errors due to lack of reports. In addition, there was a lack of a specific center to present statistics on this issue, which has led to a lack of accurate reports on safety and errors made in pediatrics care. Patient care error is an independent concept, meaning that medical errors are not just made by nurses in the pediatrics wards of Iran. However, it could be expressed that nurses in pediatrics wards have different perceptions of error, which can endanger the lives of children and hospitalized patients. In a qualitative research, the error concept was mentioned as injury, without care, wrong thinking and action, and being in a situation from the perspective of nurses. It seems that high workload, lack of drug resources, the inefficient performance of colleagues, and lack of experience and knowledge in prescribing drugs are the most important reasons for errors in hospital wards. In Iran, a limited number of studies have been performed on the safety culture in the pediatric wards and no research has been carried out on the safety culture in PICUs and NICUs. Factors affecting communication and cultural sensitivity in the pediatrics wards include organizational factors such as inefficient policy-making, lack of a specific definition of hospital culture, insufficient staff education about the topic, and human factors including communication between nurses and patients and cultural differences between nurses and families. Given the high cultural diversity in Iran, improvement of education, and changing cultural policies in hospitals will increase patient safety and quality and communications. Moreover, identifying cultural differences and the impact of culture on care, adaptation to different cultures, interpersonal communication, and recognizing the cultural values of the child and family are effective factors in pediatrics and family care. According to the results of previous studies, it seems that the level of safety culture is low and medium in the neonatal intensive care unit, and nurses believe that there is a shortage of staff in these sections, which has led to the occurrence of errors at a large scale. In addition, accurate and full education is not provided to promote the culture of safety. With this background in mind, this comprehensive review was performed to evaluate safety in pediatrics wards in Iran.
Materials & Methods: In this comprehensive review, we searched valid Persian databases, including Magiran, SID, and IranMedex, and English databases such as Elsevier, Scopus, Medline, Google Scholar, ScienceDirect, and PubMed using keywords of “patient safety” and “pediatric intensive care unit” and their Farsi equivalents without a time limitation.
Results: In total, 35 articles were selected from 61 papers found. However, only 10 articles that directly evaluated safety in PICUs in Iran and were published in domestic and foreign scientific-research journals and their full text was available were entered into the study based on the research objectives.
Conclusion: Given the lack of accurate information about the safety of PICUs in Iran, it seems that insufficient knowledge of nurses about how to give safe medicine, high workload, the existence of an incorrect safety culture in the wards and inappropriate policies in ensuring the safety of patients are important factors affecting the inadequate observance of safety in the PICUs. Moreover, research in PICUs has focused more on medication error, infection control, hospital culture, parenting experience, shift delivery, shifts, and nurses' knowledge of the concept of error. Relatively high prevalence of medication error due to lack of medication information of nurses, lack of infection control due to not using clinical guidelines and lack of nursing facilities, insufficient observance of professional communication and weakness in the safety culture of these sectors, non-delivery of work shifts according to the related standards, nurses’ attitude to the concept of safety and their information about the matter have necessitated accurate planning to eliminate these issues. The most important safety issue in the PICU seems to be the lack of accurate and dispersed statistics, which makes deciding about safety status difficult. Studies show that most researchers are interested in drug safety and other safety-related factors have received less attention. Furthermore, there is scarce research on inadvertent and intentional errors made in PICUs. It seems that work pressure and inappropriate policy-making about the provision of children’s safety have been among the factors affecting inadequate observance of safety in PICUs. Therefore, it is suggested that future studies be conducted on this topic.