Reeling from the deaths of two children due to medication errors, the staff of Seattle Children's Hospital devoted Saturday to special training designed to prevent a recurrence of the tragedies.
"It's so very important that we never forget that we harmed these children," said Pat Hagan, president of Children's Hospital. "We were all devastated by this when it happened. It struck us at our core."
Hagan said the patient deaths have been a "great, great tragedy for these families," and "a profound tragedy" for the hospital staff.
"We never want to forget how this feels. That feeling is going to be what drives us to continue to find ways to improve what we do here," he said.
Over 550 doctors, nurses, pharmacists and other staff members gathered at Children's for a special Patient Safety Day to address the medication errors that caused two deaths over the past 18 months.
More than 28 patient safety sessions were held, including 11 devoted to medication safety.
But first, participants gathered together in the morning to remember the two small patients who died.
"How we emerge from this situation today and over the coming months will be the real test of us as an organization," said Thomas Hansen, the hospital's CEO. "As I look around this room, I'm confident that we have the best and brightest people to rise to this challenge."
He told the staff "we must strive for zero errors, this must be our promise."
The day's sessions included topics such as decreasing verbal orders and increasing the safety of verbal orders when they are necessary, standardizing medications located on care units, ordering, dispensing and administration of high-risk medications, interruptions, provider-to-provider hand-offs and communication, ambulance transport and patient safety training using simulation.
Hospital spokesperson Louise Maxwell said Children's also is fully cooperating with state investigations of the recent medication errors and has made a number of improvements to decrease the chance of errors.
The hospital has also initiated a re-evaluation of the entire medication delivery system and launched a detailed analysis to determine why usual safety processes failed in each of the medication error cases.
Hospital officals said Saturday's special training did not affect care for patients or others needing urgent or emergency services.
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