Patient Safety

A culture of safety means the entire team consistently and steadfastly works to minimize adverse events for our patients. To do this, we have instituted numerous safety protocols, such as:

• Providing a safe, confidential environment that encourages our clinicians and patient-facing staff to communicate concerns or errors to our leadership team, without fear of reprimand or punishment, for the sole purpose of improving patient safety.
• Instituting safety training across our entire organization so our clinicians and clinical staff are aligned with industry best practices relating to patient safety. Conducting safety culture surveys with our clinicians to identify current patient safety strengths and opportunities for improvement.
• Encouraging systemwide collaboration to introduce solutions to patient safety issues.

Our Center for Research, Education, Quality and Safety (CREQS) supports our commitment to improving patient care through evidence-based medicine, focusing on:

• Research — Comprising clinicians across the United States, our research advisory committee designs, implements and maintains a clinical research oversight and support program that enables our practices to conduct safe, effective, financially viable and legally compliant medical research. Our clinical research helps our clinicians determine the best options for successfully treating patients and leads to the development of new treatment options. Additionally, we produce more than 100 peer-reviewed manuscripts each year, some in collaboration with the nation's top medical universities.
• Education — We are passionate about clinical and research excellence; therefore, we have created comprehensive online and in-person educational and professional development opportunities. Thousands of health care professionals worldwide attend our accredited sessions each year to learn the latest medical advancements in maternal-fetal medicine, neonatology and numerous pediatric subspecialties.
• Quality and safety — Our unwavering mission to Take great care of the patient, every day and in every way™ can only be achieved through our continuous quality-improvement and safety programs. These initiatives enable our clinicians to provide the best possible patient outcomes.

We have a dedicated team of professionals focused on quality improvement. They teach and organize quality improvement and safety work for our network of clinicians. Examples include:

• Regular in-person and online meetings with our clinicians to teach quality-improvement methodologies and review our quality-improvement literature, ensuring we are aligned across the organization.
• Forums for local practices to present their quality-improvement and safety projects to a broad audience help educate health care professionals about effective implementation of quality-improvement and patient-safety methodologies.
• Our electronic note-writing system, BabySteps® Cloud, feeds one of the world's largest repositories of neonatal data. The Pediatrix® Clinical Data Warehouse (CDW) provides frontline clinicians with near real-time data, allowing NICU improvement teams to benchmark their performance internally and against a large national dataset. The data is also used to create more than 100 peer-reviewed publications and enables us to make meaningful observations that improve the care we provide.

Our extensive library of technical literature and the data collected from the CDW enables our physicians and advanced practice providers to make better-informed patient care decisions. We educate on how to effectively use the data to understand how patient outcomes are changing over time and how to apply the data and literature to their practices and hospital units for improved outcomes.

Collaboration and open communication across our entire company ensures we continually and consistently provide the best possible care to our patients. We encourage collaboration across ranks and disciplines to establish solutions to patient safety issues. Open communication allows our clinicians to freely address concerns so we can make immediate adjustments to our processes and continually enhance the quality of care our patients receive.

We want our teams to regularly evaluate their systems and microsystems of care and focus on system-based improvements rather than taking a "try harder" approach. Take a medication dosing error, for example. Telling the nurse that he or she should have double-checked is marginally helpful.

A more beneficial approach is to examine the entire process, asking questions, such as: Why did we decide to use this medicine? How is it ordered? How does the pharmacy receive and process the order? How does the medication get to the correct unit within a hospital? What happens when it arrives? How does the nurse assess the medicine and check it against the electronic health record? How is it administered? Are there forcing functions to prevent oral medicines from being given intravenously and vice versa?

Implementing evidence-based guidelines and finding systems-based solutions for use in quality and safety can reduce the risk of preventable adverse events by orders of magnitude.

Our No. 1 priority is to consider each patient as an individual and apply the best science/evidence to the patient's unique scenario. We collaborate with our patients, patient families or guardian(s), primary care physician and any relevant specialists to devise a sound treatment plan focused solely on the patient's needs. Forming this type of team is of utmost importance to the patient's short- and long-term outcomes.

Evidence-based clinical practices mean treatment choices (when applicable) are based on the best available published scientific evidence. Evidence-based guidelines need to be customized to the local NICU context. There are situations, of course, where it is appropriate to deviate from an evidence-based guideline, but in general:

• Deviation from a clinical guideline due to patient variation is good for patient outcomes.
• Deviation from a clinical guideline due to physician preference is not good for patient outcomes.

Virtually all clinicians come to work with the goal of caring for their patients safely and effectively. The NICU is an extremely complex environment with inherent risk for error. Therefore, we strive to create a blame-free environment, where staff feel safe reporting a medical error without the threat of being punished. This approach encourages error reporting, helping teams learn from their errors and finding weaknesses in their processes that can be addressed.