The ethics of neonatal research: An ethicist's and a parents' perspective.

The ethics of neonatal research are complex because vulnerable new parents are asked to provide consent on behalf of their fragile baby. Whereas clinical neonatal care has evolved to value personalized and shared decision-making, the goal of research ethics is still to standardize the informed consent process and make it as complete and thorough as possible. Ethicists, lawyers and physicians have shaped the field of research ethics and consent for research.

The owners have a right to be heard: Patient voice in design and performance improvement.

The Canadian taxpayer is an owner of the healthcare system and the owners have a right to be heard. This article encourages leaders both formal and informal to create cultures that promote ASKing questions to test assumptions held, LISTENing to hear the patient voice, and TALKing with patients and families to create new conversations and narratives. Looking at the label, "healthcare system" what's your contribution to creating health, how will you dedicate yourself to caring about the healthcare consumer and care provider, and what will be your role in creating a new and improved system? An implied question at the foundation of the article is this: Is the difference between managing and leading a difference of empathy?

Improving safety: engaging with patients and families makes a difference!

Following a brief review of the history and context for patient and family member involvement in healthcare safety improvements, a variety of tools and mechanisms for patient engagement will be offered along with specific examples from Patients for Patient Safety Canada (a patient-led program of the Canadian Patient Safety Institute) to illustrate the impact of involving patients and family members in safety work. Barriers and facilitators to patient engagement in safety will also be examined.

Medication reconciliation: the priority that isn't.

Medication reconciliation is a crucial step in safe care, but it is often done inconsistently or inadequately, or missed altogether. This can be dangerous and even deadly for patients, and expensive for the system. In this article, the authors discuss the current status of medication reconciliation in Canada, barriers to its implementation and steps healthcare organizations across the country are taking to introduce medication reconciliation.

Medication reconciliation: a prescription for safer care.

Four national healthcare organizations - Accreditation Canada, the Canadian Institute for Health Information, the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada - recently collaborated to better understand and share comprehensive information about medication reconciliation in Canada. This article summarizes the key findings of their joint report titled Medication Reconciliation in Canada: Raising the Bar and profiles innovative approaches and tools for healthcare organizations across Canada.

Utilizing quality improvement methods to prevent falls and injury from falls: enhancing resident safety in long-term care.

Introduction: Internationally, the growing evidence related to preventable adverse events within healthcare settings has resulted in the creation of numerous patient safety and quality improvement initiatives. In Canada, Safer Healthcare Now!, a national patient safety initiative of the Canadian Patient Safety Institute, and the Registered Nurses' Association of Ontario, the professional association representing registered nurses in Ontario, have partnered to combine quality improvement expertise with evidence-based practice expertise to accelerate improvement in the area of falls prevention and injury reduction. The synergistic relationship between Safer Healthcare Now! and the Registered Nurses' Association of Ontario has resulted in the evolution of the Safer Healthcare Now! national Falls Prevention intervention.

We have a perfect storm - let's use it.

The lead paper, "Responsibility for Canada's Healthcare Quality Agenda: Interviews with Canadian Health Leaders," is a valuable contribution to the quality and safety improvement conversations taking place across the country. My commentary suggests a dramatic convergence of social, economic, demographic and technological forces has brought healthcare to a threshold of a perfect storm. To brace ourselves against this storm, I have suggested that we need to understand the system not as a structure but as relationships.

Responsibility for Canada's healthcare quality agenda: the home and community sector.

In their study on the current state of the quality agenda in the Canadian healthcare system, Sullivan and colleagues interviewed healthcare leaders across Canada who predominantly represent the hospital care sector. The home and community sector is under-represented in research and discussions about quality and patient safety, despite the fact that it is the fastest-growing sector in healthcare. Patient safety research in home care has been spearheaded by VON Canada and the Canadian Patient Safety Institute since 2005.

A call for a new connectivity.

"Twisting the Lion's Tail" is a valuable and timely contribution to the literature on the need to break down silo thinking and acting. If we stay within a narrow silo by suggesting that researchers generate knowledge, practitioners use the knowledge and then researchers evaluate the results, we will not get to the system thinking view articulated in the lead paper. The author hopes his observations presented in this commentary add to the conversation.

What are you prepared to see?

A hospital system is made up of interconnecting circles of complex activity; however, we are conditioned to see and think in straight lines. What we see depends on what we are prepared to see. This article asks the question: What do you see in terms of patient safety and quality of care?

Establishing a provincial patient safety and learning system: pilot project results and lessons learned.

An effective safety event reporting system is an essential part of a comprehensive patient safety program. In British Columbia, we are implementing a provincial web-based event reporting tool and learning system called the BC Patient Safety and Learning System (PSLS). In this paper, we describe and report the results of our pilot study in a neonatal intensive care unit at BC Women's Hospital in Vancouver.

Potentially inappropriate prescribing of benzodiazepines for older adults and risk of falls during a hospital stay: a descriptive study.

Background: Falls have been identified as a potential adverse event associated with the administration of psychotropic medications to older patients.

Objective: The objective of this exploratory study was to examine the association between potentially inappropriate prescribing of benzodiazepines, as defined by the Beers criteria, by older adults (at least 65 years of age) and the risk of having a fall during acute inpatient care.

Methods: This 1-year retrospective cross-sectional study of discharges from a tertiary care hospital in Halifax, Nova Scotia, used pharmacy data to identify the prescription of benzodiazepines listed in the updated Beers criteria as being associated with an increased risk of falls.

An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections.

Background: The objectives of this integrative review were to critically examine the overall state of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections (HCAIs) in acute care and long-term care settings, and offer recommendations for future directions in the field based on our findings.

Methods: We searched for original research and reviews of research published between January 1, 1996, and July 31, 2006. Studies were identified through the electronic databases Medline, CINAHL, EMBASE, PUBMED, the Cochrane Library, and through expert consultation.

Reporting for learning and improvement: the Manitoba and Saskatchewan experience.

Both Saskatchewan and Manitoba have embarked on major provincial quality improvement endeavours that include a mandatory reporting and learning process aimed at enhancing patient safety by reducing the potential for recurrence of critical incidents. This move from a voluntary, less comprehensive process signals a commitment from policy makers that substantial improvements to safety will occur only when adverse events are addressed systemically within the healthcare system. Saskatchewan took the lead with the passage of legislative requirements to report, investigate and share learnings arising from critical incidents as of September 15, 2004.

Implementing a Good Catch program in an integrated health system.

In 2004, the Canadian Adverse Events Study (Baker et al. 2004) determined the incidence rate of adverse events (AE) in Canada to be 7.5%.