Nurses’ Use and Understanding of the Letter 'A' in the S.A.F.E. Error Prevention Tool

88 Pages Posted: 24 Apr 2018

Date Written: April 3, 2018


In 1999 the Institute of Medicine (IOM) published its landmark report named “To Err is Human: Building a Safer Health Care System.” The report called for an extensive improvement in order to reduce medical errors which have resulted in permanent injury, even deaths. There are approximately 268 preventable deaths each day in hospitals across this country. On March 1, 2017, the Joint Commission issues a Sentinel Event Alert highlighting the industries and its leader’s failure to implement a culture of safety designed to reduces preventable error. Since the IOM report, some facilities have adopted Safety Science, High-Reliability, and behavior modifying error prevention tools to help change traditional practices. The problem: to date, there is no formal study or tool to measure nurses’ use and understanding of high-reliability Error Prevention Tools (EPT). The purpose of the quasi-experimental, quantitative, comparative study is to measure and compare (ED Nurses and ICU nurses) use and understanding of the S.A.F.E. EPT adopted by the clinical site three years prior to the study. The significance of the study is to inform the healthcare industry and the clinical site of nurses’ use and understanding of the EPT. The study was conducted using a 51 question M-HSOPSC. The nature, scope and limitations of the project focused on the letter “A” of the S.A.F.E. EPT. Of the respondents who participated in the study, the majority indicated they used and understood the (EPT). Using SPSS, Pearson correlation was used to determine directional relationship, Mann-Whitney was used as a non-parametric statistical analysis to compare ED & ICU nurses use of the Error Prevention Tool. Due to confounding variables, the sample effect size to detect a power of .80 was not met. The analysis did produce statistically significant results using a Sig .05.

Keywords: Patient Safety, Safety Science, High-Reliability, Error Prevention, Preventible Medical Errors

Suggested Citation

Flores, Gerardo, Nurses’ Use and Understanding of the Letter 'A' in the S.A.F.E. Error Prevention Tool (April 3, 2018). Available at SSRN: or
No contact information is available for Gerardo Flores

Register to save articles to
your library


Paper statistics

Abstract Views
PlumX Metrics