What are the safety incidents identified by family
members of hospitalized children?
In decreasing order of reports frequency, the following
safety incidents were identified: those related to medication
administration (24% of the studies)15,23,31,32,38,40,42, patient
identification, hospital infection control through hand
hygiene, and the use of Personal Protective Equipment
(PPE) (14%)15,38,40,42, falls (14%)15,23,38,40, procedure
performance (10%)15,32,38, communication (10%)15,38,42, diet
supply (7%)15,38, phlebitis, and skin injuries (7%)23,40,
multiple needle pricks (3%)31, diagnosis (3%)32, delays in
treatment (3%)31, and child surveillance and visit
control (3%).38
What are the factors contributing to unsafe care
identified by family members of hospitalized children?
The factors contributing to unsafe care identified by family
members of hospitalized children were grouped into two
categories: factors related to professionals and factors
related to the organization.
Regarding the former, the majority of family members of
hospitalized children identify communication failures
among the professionals and between the team and the
family as one of the contributing factors to unsafe care,
with this being the most reported main cause in the
included studies (31%)15,33,34,36,39,41,42,44,45.
They expressed feeling insecure when excluded from
care41,42 and when nurses' behavior was perceived as
careless and non-protective28. Concerns were raised about
the lack of knowledge, skills, experience, or competencies
of some professionals34,40, lack of professional rigor, and
insufficient time spent with the child34. Concerns were also
described for not "knowing the baby"35. They mentioned
some professionals dismissed their concerns and did not
seek advice from colleagues34. They reported providing
care that they believed was the responsibility of
professionals36. They recognized, in turn, that errors can
occur because of the involvement of many professionals33.
Weaknesses were also mentioned regarding medication
administration33,36,37,40, use of equipment, baby positioning,
warming after bathing, skincare, and hand hygiene as
contributing factors to unsafe care37. Some family members
reported feeling abandoned when the children's condition
worsened28. They mentioned not receiving education about
falls and being unaware of risk assessment22.
As for factors contributing to unsafe care related to
organizations, family members reported significant delays
in hospitalization, in care provision44, and an inadequate
ratio of professionals36. They reported concerns about
controlling strangers' access to units39,40 and the cleanliness
and hygiene conditions of the units due to the risk of
infection.36,39,40,44
What are the suggestions mentioned by the family
members to promote the safety of care provided to
hospitalized children?
Suggestions for improvement to promote safety were also
grouped into two categories: those directed toward
healthcare professionals and those directed toward the
organization.
Regarding the former, family members suggested
professionals observe hospitalized children more
frequently,26 and reinforced the need for greater attention
from healthcare professionals28 and the importance of
open communication.25,36,38
They valued and encouraged a child and family-centered
approach, considering the partnership of care as an
opportunity to promote safety.9
Still regarding communication, the majority of companions
understood that being informed about the medications and
procedures performed allows a closer look, increasing the
child's safety.19 They would like to be informed of the
names of medications, not just the types of medications,
that all professionals perform procedures in a standardized
manner, and that information is provided equally to
different family members.33
They mentioned that communication with professionals
enables them to be guided on the best way to participate in
care, avoiding risks to the child's health,19 and reinforced
the importance of the team reflecting on its role in
conveying information and guidance to family
members.38,42
Family members also suggested improvements directed
toward healthcare professionals: fall risk assessment,
greater attention to patient identification, implementation
and compliance with measures for the correct
prescription/administration of medications,39 increased
teamwork, handwashing, equipment sterilization,36
individualized care36,41, and care with affection and
empathy.39,41
In regard to suggestions for organizational improvement to
promote safety, family members recommend: greater
control and restriction of visits, increased attention to
infection control,4 greater guidance and supervision of
care,38 use of advanced technologies38,43 and an increase in
professional qualifications.43,44
They also suggest posting safety recommendations in
public areas of the units, such as proper hand hygiene
practices, increasing adherence among family members,
visits, and greater openness to dialogue with professionals
on this aspect.29
Conclusion
Through the results extracted from the included studies, it
was possible to address the scoping review questions. There
is little divergence in the perception of safety among
families of hospitalized children. Families can report safety
incidents in various aspects of care, with medication
administration being the incident with the highest number
of reports. They understand that patient safety goes beyond