The Effects of Safety Discrimination Training and Frequent Safety Observations on Safety-Related Behavior

Perioperative Delirium/Agitation Associated With the Use of Anesthetics and/or Adjunct Agents: A Study of Patient Behaviors, Injuries, and Interventions to Mitigate Risk

Anesthetics and adjunct agents have a long history of being associated with patients engaging in delirious or agitated behavior in a perioperative setting. Prior to this study, few have explored the topic with a focus on safety for both the patient and staff. We explored the Pennsylvania Patient Safety Reporting System (PA-PSRS) database for event reports to identify bouts of delirium/ agitation associated with anesthetics and/or adjunct agents that occurred during the pre-, intra-, or postoperative period. We identified 97 event reports from 63 healthcare facilities over a two-year period. Patients’ ages ranged from 1 to 91 years and 66% of the patients were reported as male. Also, 8% of the delirium/agitation occurred preoperatively, 8% intraoperatively, and 84% postoperatively. Across all three operative periods, 62% of the reports described dangerous/nonviolent behavior and 26% described dangerous/violent behavior. Additionally, 40% of the event reports described one or more patient injuries (e.g., cardiopulmonary arrest, asphyxiation, hematoma, prolapse/dehiscence, progressive ischemia) and 36% of the patients required additional healthcare services or monitoring (e.g., intra- or interfacility transfer, additional surgical procedure). Finally, 54% of the event reports described patient behavior that created an immediate and high risk of staff harm. Overall, the current study provides novel insight into how delirium/agitation has varying safety implications depending on the operative period. We encourage readers to review Table 5, which proposes a four-phase intervention package to prevent, treat, and de-escalate bouts of delirium/agitation.

Reopening the Doors to Center-Based ABA Services: Clinical and Safety Protocols During COVID-19

In the wake of the coronavirus (COVID-19) pandemic, U.S. organizations that provide applied behavior analysis (ABA) programs to individuals with autism spectrum disorder have implemented a variety of safety precautions to minimize the spread of the virus, often shifting center-based services to the home or telehealth. Considered essential workers, ABA providers are exempt from government directives to close, so they have both the freedom and the great responsibility to make their own decisions about how best to keep their clients safe while continuing to provide medically necessary services. In the coming weeks and months, ABA providers will be faced with the decision about whether to reopen centers. This article does not address that decision, except to acknowledge the urgency to reopen, both to help clients and to remain solvent. Political rhetoric and contradictory public information further complicate this daunting decision. Because ABA providers do not have legal guidance to shift the burden of such decisions to local and state regulators, the burden is theirs alone. The unprecedented nature of the COVID-19 pandemic means that no decision is clearly wrong or right, and every decision has consequences. Although ABA providers do not have their own state guidance, many states have issued guidelines for childcare providers whose operations have continued throughout the pandemic. This article analyzes that guidance, identifies common variables potentially relevant to ABA organizations, highlights clinical considerations and procedural compliance, and provides ABA organizations with the tools to make the best decision for their clients, in their community, and on their timeline.

Experimental analysis of using examples and non-examples in safety training

INTRODUCTION

The effects of training content consisting of examples and/or non-examples was studied on the acquisition of safety-related skills.

METHOD

Participants (N=160) were randomly assigned to first receive computer-based training on office ergonomics that included either no examples of safe or at-risk postures, safe examples only, at-risk examples only, or both safe and at-risk examples. Participants then attempted to classify as safe or at-risk various postures depicted in short video clips and demonstrate with their own posture the range of safe postures.

RESULTS

Groups that were trained with both safe and at-risk examples showed greater classification accuracy and less error in their demonstration of safe postures. Training with only safe or at-risk examples resulted in a moderate amount of error and a consistent underestimation of risk.

CONCLUSION

Training content consisting of both examples and non-examples improved acquisition of safety-related skills.

PRACTICAL APPLICATIONS

The strategic selection of training content may improve identification of risks and safe work practices.

Effects of conducting peer behavioral observations on the observer's correct use of discrete trial teaching procedures

A procedure consisting of peer observation and evaluation termed behavioral observations was used to improve educational staff's correct use of discrete trial teaching procedures (DTT). All participants had been previously trained and proficient in using DTT procedures; however, during baseline, showed a low level of correct demonstration of DTT procedures (mean scores: 38.3%, 43.3%, and 35.0%). Participants were then taught use a checklist to observe and score a peer's performance during DTT sessions in a classroom setting. After conducting behavioral observations, staff increased their correct usage of DTT procedures to 85.1%, 88.3%, and 81.1% respectively. These data indicate that conducting behavioral observations can lead to large and rapid improvements in educational staff's correct use of DTT procedures with a large effect size (d=4.19).