The Institute of Medicine’s landmark report To Err Is Human revealed that tens of thousands of patient safety errors occur in hospitals across the United States every year.1 Canadian studies in both adult and pediatric hospitals corroborated these findings, revealing that 1 in 13 patients are victims of medical errors.2 To reduce these errors, it is important to have a culture where adverse events can be openly discussed and learned from in the hopes of preventing recurrences.3,4 In the pediatric setting, an open culture is one where everyone involved in the care of children, including the children themselves and their families, can speak up and be heard.
The Montreal Children’s Hospital is an academic pediatric hospital that provides medical and surgical care to children 0 to 18 years of age. Results from patient and staff satisfaction surveys and from first-hand experience of front-line staff indicated that the safety culture could be improved at the hospital. Therefore, 3 physicians founded an interest group called “Champions for Patient Safety” to facilitate discussions and learning opportunities pertaining to patient safety, and broad participation is encouraged (ie, from health care professionals, hospital employees, patients, and their families). The founders come from 3 different core areas within the hospital: the pediatric emergency department, the pediatric intensive care unit, and the medical clinical teaching unit. Furthermore, many hospital executives, including the hospital chief executive officer and the pediatrician-in-chief, endorsed this group and its activities.
The Canadian Patient Safety Institute, a not-for-profit organization established by Health Canada in 2003 to promote safe care for all Canadians, established a national annual campaign to inspire extraordinary improvements in patient safety and quality.5 Although many hospitals participate by setting up kiosks to distribute information, the Montreal Children’s Hospital Champions for Patient Safety launched an innovative and interactive activity titled the “Crib of Horrors,” intended to align with the timing of Canadian Patient Safety Week around Halloween. The Crib of Horrors is a mobile setup of an infant or child mannequin in a crib with a long list of hazards and safety errors surrounding the infant (Fig 1). For example, there were used uncapped needles in the bed, the orogastric feeding tube was taped over the infant’s eye, excessive tubing was present that could strangle the infant, the wrong patient chart was in the crib, and there were multiple medication errors (eg, the use of trailing zeroes, or mL used for calculations instead of mg). This crib traveled around all areas of the hospital, including inpatient, outpatient, and waiting areas. Participants were invited to play the Crib of Horrors game by listing all errors they detected. A few contestants could participate at a time to allow adequate viewing, and it took about 20 minutes to complete. This activity attracted >80 participants from various professional backgrounds, including physicians, nurses, students, patient care attendants, and patients and family members. Families often used the Crib of Horrors as a teaching opportunity for their children and engaged them in the game too. A lot of positive feedback came from this activity, and the staff at the Montreal Children’s Hospital now look forward to this activity each year.
There are several benefits with this type of activity. First, the crib’s mobility makes it easy to reach a large and varied audience. Teams that work together can participate together, opening up dialogue about safety in their particular context. The activity is easy, quick, and cost-effective to set up, requiring 1 low-fidelity mannequin, a variety of medical supplies available on any inpatient unit, and some imaginative health care providers. Within an hour, our team created the Crib of Horrors that was used every day, for about 2 hours a day, for a whole week. Last, it addresses most of the Canadian Patient Safety Institute’s Patient Safety Competencies, a framework that acts as a benchmark for training, educating, and assessing health care professionals in patient safety.6 The competencies highlighted by the Crib of Horrors are Contribute to a Culture of Patient Safety, Work in Teams for Patient Safety, Communicate Effectively for Patient Safety, Manage Safety Risks, and Optimize Human and Environmental Factors. The only barrier identified was that someone had to stay with the crib to describe the rules and answer questions for it to work effectively.
Children cannot advocate for their own safe care; therefore, it is imperative that pediatric health care workers do so by focusing attention and resources toward the necessary system improvements.7 Though easy and inexpensive to set up, the Crib of Horrors had an impact on promoting a culture of safety in our organization, as indicated by the raised recognition and discussion of patient safety throughout the hospital that entire week. By sharing this innovative activity that promoted awareness of common patient hazards and the need to openly discuss lessons learned from adverse events, we hope to inspire others to recreate such mobile cribs (or beds) of horrors as part of their own safety campaigns.
The authors thank Dr Caroline Quach for her valuable comments on this manuscript.
- Accepted April 6, 2015.
- Address correspondence to Nadine Korah, MDCM, MSc, FRCPC, The Montreal Children’s Hospital, 1001 Decarie Blvd. Montreal, QC, Canada H4A 3J1. E-mail:
Dr Korah conceptualized and designed the patient safety initiative and drafted the initial manuscript; Drs Zavalkoff and Dubrovsky participated in conceptualizing and designing the patient safety initiative and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
- 1.↵Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press
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- 5.↵Canadian Patient Safety Institute. Available at: www.patientsafetyinstitute.ca/English/Pages/default.aspx
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- Copyright © 2015 by the American Academy of Pediatrics