1. Enhancing the Culture of Safety in the NICU by Improving Safety Reporting Doernbecher Children’s Hospital, Oregon Health & Science University Safety Pins Homeroom Nikki Wiggins RN BSN, CCRN; Cindy Bell RNC; April Castaldi RN BSN; Dmitry Dukhovny MD MPH; Shelbe Sundeen RN BSN Aim By December 2014, staff will use standardized processes for identifying, reporting, and evaluating safety concerns. Patient safety report submission will increase by 25% over a 6 month period, when compared to data prior to March 2014. Setting 46 bed, Level IV, Academic Medical Center, Regional Referral and Surgical Center, Magnet Recognized Background Developing a reliable ongoing method of tracking patient safety events can help a unit determine if efforts to promote patient safety are effective. Safety event reporting was inconsistent and underutilized. Barriers : concern about punitive consequences, vehicle for practice change, value of reporting, retaliation from peers, reporting structures, expectations for what to report and how to report. Methods Completed safety surveys every six months, including baseline survey to assess perceptions about Culture of Safety in the DNCC, and to specifically analyze perceptions about reporting. Created and introduced improvement opportunity tool as a means for staff to report and problem solve concerns via the safety huddle. Incorporated safety reporting education into staff evaluations, huddles, and weekly newsletter to communicate the importance of reporting and provide instruction about how to report. Established Standards and Advocacy Committee to review reporting trends and address practice changes. Implemented Culture of Unit Safety Program (CUSP) rounds to encourage transparent conversations with staff and families about safety concerns. DNCC Safety Event Reporting Measures Outcome: Culture of Safety Survey data will show overall improvement in culture of safety. Process: Number of Patient Safety Event reports. Balancing: Encouragement by colleagues to report patient safety concerns. Perception about difficulty of speaking up. Lessons Learned Safety reporting is greatly affected by culture and vice-a-versa. Increasing awareness and ownership through transparency improves safety reporting and the culture of safety. Increased safety reporting can also increase moral distress. Comparative Safety Survey Data Next Steps Increase visualization of data via safety dashboard Peer to peer feedback training. Difficult conversation training. Addressing moral distress and moral courage regarding reporting. Interdisciplinary improvement rounds. Challenges Despite an improvement in reporting; it is still evident that speaking up remains a challenge in the culture of safety in the DNCC and a relevant contributing factor in safety events that occur. Contact: Nikki Wiggins RN BSN CCRN wigginsn@ohsu.edu