Managing Diabetes and Hyperglycemia in the Hospital Setting. Boris Draznin

are to create an environment that will always protect the patient from harm and also reduce the number of noninjurious and latent errors. Cognitive psychology helps us better understand the different ways in which our cognitive processes make us vulnerable to error and to help us avoid our own diagnostic errors—the kinds of errors most difficult for the individual to discover and most likely to cause an injurious error. One of the strengths of a culture-of-safety approach is the constant back-up checks and feedback provided to the clinicians, which greatly reduces the risk that a diagnostic error will go undetected. Involvement of the patient and their family in their care is crucial in reducing insulin errors. A culture of safety should strive to always include an informed patient and their family as a central aspect of a team approach in the provision of insulin therapy in the inpatient setting.

      Human factors are important to consider in the effort to reduce errors in insulin therapy. Even a highly skilled and knowledgeable provider of care may make a serious error if their sequence of steps during clinical care is interrupted, and these errors often are not noticed when rushed. Yet, along with a propensity for cognitive errors, humans have remarkable cognitive flexibility. A successful culture of safety must include back-up checks to discover these human errors and use the cognitive flexibility of the team members to create an environment that has patient safety as the highest priority.

      Finally, the best institutions will need to consider the danger of burdening the clinical team with nonclinical priorities. The more the clinical team is rewarded primarily for nonclinical priorities, the harder the task becomes for making insulin therapy safe for every patient.

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