Table 2

Safer systems: illustrative strategies and interventions for a low-resource NBU

System componentExample interventions
Support of familiesProvide organised training, with initial supervision and support, so that families can carry out essential caring tasks on the ward and at home.
Enhance communication between health professionals and families throughout the care pathway.
Task and technologyStandardise assessment of all patients on admission using structured forms. This can direct staff with limited experience to key issues such as ascertaining the HIV status of a mother.
Standardise drug prescription charts. Provide easily read checklists and tables that enable checking of prescriptions.
StaffMaintain training logs of key competencies such as resuscitation and immediate care of a preterm baby.
Explore formal task-sharing with auxiliary staff or other health professional groups such as nutritionists.
Teamwork and cultureIntroduce tools such as whiteboards to facilitate team communication, define essential tasks and who is responsible for each task.
Establish joint medical and nursing handovers. Use shared medical and nursing records.
Work to build a culture that supports everyone to express safety concerns and immediately communicate possible errors while providing clear guidance to junior team members on when and how to escalate a problem to a senior.
Working conditionsEngage with management to improve hand washing facilities and space for staff breaks.
Agree with hospital management and NBU team the minimum requirements for ward supplies of disinfectant and cleaning utensils, the cleaning programme and training of staff.
Organisation and governanceEstablish and implement clear policies on the qualifications/training required for administering intravenous drugs.
Plan staff rotations to avoid sudden relocation of multiple skilled staff or a deluge of students.
Agree minimum safety criteria and provide regular reports to hospital management on how often these are breached as part of a case for improved resources/support.