A 2-tier study of direct care providers assessing the effectiveness of the red rule education project and precipitating factors surrounding red rule violations.

As a safety initiative, Inova Loudoun Hospital implemented a Red Rule policy and educated 100% of its staff. The policy consisted of 2 Red Rules: critical requirements for safety associated with an activity or a procedure. The purpose of tier 1 of this 2-tier survey research project was to determine the effectiveness of the educational effort in 13 departments of the hospital. Of the 128 participants, 61% provided a correct or partially correct definition for Red Rule 1 and 12% for Red Rule 2. From an evidence-based practice viewpoint, study results concluded that the Red Rule Education Project required reinforcement. The purpose of tier 2 was to quantify factors that contributed to safety events in the departments of the hospital. Employees violating a Red Rule were asked to complete a survey identifying the factors influencing their behavior. Of the 13 participants (RNs = 100%), the order of frequency of factors influencing errors was interruptions (77%), rushing (69%), inadequate staffing (39%), fatigue (31%), and poor communication (38%). Respondents did not report an awareness of committing an error during the time of the error occurrence. Awareness of specific factors contributing to an error can facilitate process improvement and future counseling and educational efforts.