To evaluate the effect of attending neonatologist presence on first attempt neonatal intubation success and adverse events. Retrospective review of National Emergency Airway Registry for Neonates (NEAR4NEOS) intubations October 2014–December 2022. Univariate and multivariate analyses were performed to estimate associations between attending presence and outcomes. Among 12,652 intubation encounters, attendings were present for 8391 (66%) intubations by more junior operators. On univariate analysis, attending presence was associated with higher first attempt intubation success (OR 1.11, 95% CI 1.04–1.2). However, on multivariate analysis, attending presence was associated with lower first attempt success (aOR 0.78, 95% CI 0.70–0.86) and intubation requiring ≥3 intubation attempts (aOR 1.39, 95% CI 1.21–1.60). After adjustment, attending presence was associated with lower odds of first attempt intubation success. Reasons for this may include appropriate anticipation of high-risk intubations, altered team dynamics or unmeasured confounding biases.

Background: Implementing recommendations to improve in-hospital resuscitation is a complex process. The extent to which an advisory statement formulating ten theses to improve resuscitation quality in paediatrics is applied in clinical practice across Germany, Austria, and Switzerland (D-A-CH-region) remains unclear. Methods: A web-based cross-sectional survey was conducted among paediatric physicians in the D-A-CH region between November 2022 and May 2023, comprising 50 questions focusing on experience and safety in paediatric emergency management and on the structural conditions at hospitals required to implement the ten theses. Ethics approval was obtained from the Ethics Committee Leipzig, Germany (218/19-ek). Results: Structural recommendations were implemented to varying and often limited degrees: An emergency telephone chain was available in 91% of workplaces, 19% had a Paediatric Early Warning System, and 38% had a designated resuscitation supervisor. Although in-house training was available to 89% of respondents, 31% had not participated in in-house training in the preceding 12 months, and 37% had not attended a certified resuscitation course in the last five years. A total of 48% of respondents reported that structured debriefings following emergency events were rarely or never conducted. Internal guidelines for post-resuscitation care were available in 26% of institutions. Only seven respondents (less than 1%) worked in a setting where all the recommendations surveyed were in place. No significant differences were observed according to hospital size or type. Conclusions: Structural implementation of paediatric resuscitation recommendations remains markedly inadequate across the D-A-CH region, with likely multifactorial causes that are not yet fully understood.

Der frühe Beginn von Reanimationsmaßnahmen ist entscheidend für das Überleben und das neurologische Outcome eines Kindes nach einem Atem-Kreislauf-Stillstand. Für professionelle Ersthelfende ist es essenziell, einen leblosen Patienten früh zu erkennen, rasch zu reagieren sowie Basismaßnahmen konsequent und qualitativ hochwertig durchzuführen: Sicherstellen eines freien Atemwegs, effektive Beatmung und Thoraxkompressionen in hoher Qualität (Frequenz 100–120/min, ausreichende Tiefe mit mindestens einem Dittel des Thoraxdurchmessers, vollständige Entlastung des Thorax, Minimierung von Unterbrechungen). Nach Überprüfung von Bewusstsein und Öffnen der Atemwege wird als Nächstes die Atmung kontrolliert. Wenn keine oder nur insuffiziente Atmung vorliegt, sollen initial 5 Beatmungen erfolgen. Thoraxkompressionen mit Beatmungen im Verhältnis 15:2 schließen sich an. Kann ein Beatmungsbeutel nicht sofort eingesetzt werden, ist unverzüglich mit kontinuierlichen Thoraxkompressionen zu beginnen. Die Beatmungen werden ergänzt, sobald Beutel und passende Beatmungsmaske verfügbar sind. Die erweiterten Reanimationsmaßnahmen umfassen die Analyse des Herzrhythmus, ggf. eine Defibrillation bei pulsloser ventrikulärer Tachykardie oder Kammerflimmern sowie die Medikamentenverabreichung. Da Reanimationen von Kindern und Jugendlichen insgesamt selten sowie mit hoher kognitiver und emotionaler Belastung verbunden sind, ist regelmäßiges Training unerlässlich. Unbedingt sollten auch nichttechnische Fertigkeiten wie Kommunikation, Teamführung und Rollenzuweisung in die Ausbildung integriert werden. Besonders effektiv sind teamorientierte Trainings an Patientensimulatoren, wie sie z. B. in Reanimationskursen des European Resuscitation Council (EPALS/European Paediatric Life Support) angeboten werden.

OBJECTIVES:To compare procedural safety and success outcomes between catheter placement for minimally invasive surfactant therapy (MIST) and tracheal intubation (TI) for surfactant, and to identify characteristics associated with improved procedural outcomes among patients treated with MIST. STUDY DESIGN:We conducted a retrospective, multicenter, observational, matched cohort study from an international airway registry from 2016 to 2024. Patients treated with MIST and patients who received TI for surfactant without paralytic premedication, were matched 1:1 on gestational age, procedure location, and laryngoscope type. The primary outcome was severe oxygen desaturation (≥20% SpO2 decrease). Secondary outcomes included SpO2 <80%, any adverse event, and first attempt success. Using conditional logistic regression, the association between procedure type and outcomes was assessed. Among patients who received MIST, a multiple logistic regression model assessed the association between procedural characteristics and outcomes. RESULTS:There were 383 patients treated with MIST matched to 383 patients who underwent TI for surfactant. Compared with TI, MIST procedures were associated with lower adjusted odds of severe oxygen desaturation (aOR 0.66, 95% CI 0.45-0.97) and SpO2 <80% (aOR 0.59 95% CI: 0.40-0.85) and higher odds of first attempt success (aOR 2.93 95% CI 1.94-4.43). Odds of adverse events did not differ (aOR 0.88 95% CI 0.50-1.56). Factors associated with improved MIST outcomes included video laryngoscopy, first airway provider, commercial catheter type, and patient weight. CONCLUSIONS:MIST is associated with improved procedural safety and success compared with TI for surfactant. Several factors are associated with improved MIST procedural outcomes.

Objectives: Tracheal intubation (TI) is a critical skill for PICU attending physicians to maintain. We hypothesize that attendings perform fewer TIs and have lower success rate in PICU programs with a Pediatric Critical Care Medicine (PCCM) fellowship. Design: Retrospective study using the National Emergency Airway Registry for Children (NEAR4KIDS) from July 2016 to June 2020. Exposures were presence of PCCM fellowship and attending TI skill maintenance program (SMP). The primary outcome was attending's first attempt success and the secondary outcome was adverse airway outcome in the first attempt. Setting: Thirty-three PICUs in North America. Patients: Children receiving TI. Interventions: None. Measurements and Main Results: Overall, 23 of 33 PICUs had a PCCM fellowship with three of 23 having an attending TI SMP. Attendings performed TI in 24.1% (2,728/11,323): 13.9% (13.8 TI/yr per PICU) in PICUs with a fellowship vs. 66.0% (36.6 TI/yr per PICU) without a fellowship (p < 0.001). Attending first attempt success in PICUs with vs. without fellowships was 70.5% vs. 81.3% (difference, 10.8% [95% CI, 7.6-14.0%]; p < 0.0001). After controlling for confounders, attendings in a PICU with a fellowship had lower odds for first attempt success (adjusted odds ratio [aOR], 0.65 [95% CI, 0.47-0.90]). We failed to find an association between attending first attempt success and PICU program type, with vs. without a TI SMP (74.0% vs. 69.5%; p = 0.146). The adverse airway outcome rate of the TI with attending's first attempt was lower in PICU programs with vs. without a TI SMP (32.8% vs. 40.3%; p = 0.020). However, after adjusting for confounders, we failed to exclude the possibility of near halving of odds of adverse outcome (aOR, 0.75 [95% CI, 0.55-1.01]; p = 0.058). Conclusions: Attendings in PICU programs with a fellowship have fewer opportunities to perform TI and lower first attempt success rates. Opportunities exist for attending TI skill maintenance, especially in PICUs with a PCCM fellowship.

Objectives To compare success and safety of endotracheal tube (ETT) exchanges with primary intubations and identify factors associated with ETT exchange outcomes. Design Retrospective observational study of prospectively collected National Emergency Airway Registry for Neonates data. ETT exchanges are the placement of a new ETT when one is already in place, whereas primary intubations do not have a pre-existing ETT. The primary outcome was first-attempt success. Secondary outcomes included number of attempts, adverse tracheal intubation-associated events (TIAEs), severe TIAEs, desaturation and bradycardia. Descriptive statistics compared characteristics for ETT exchanges and primary intubations. Univariable and multivariable analyses compared primary and secondary outcomes and identified factors independently associated with ETT exchange outcomes. Results A total of 1572 ETT exchanges and 9999 primary intubations across 21 sites were included from October 2014 to September 2022. ETT exchanges represented 2.3%–31.2% (mean 13.6%) of intubations across sites. Patient, provider and practice characteristics varied significantly between ETT exchanges and primary intubations. In univariable analyses, ETT exchanges were associated with higher first-attempt success (70.5% vs 53.6%; p<0.001) and fewer safety events. In multivariable analyses, ETT exchanges were associated with an increased adjusted OR (aOR) of first-attempt success (1.71; 95% CI 1.57 to 1.86; p<0.001). ETT exchanges were associated with lower aOR of all safety outcomes except severe TIAEs. Factors independently associated with ETT exchange first-attempt success included video laryngoscopy and paralytic premedication. Conclusion Compared with primary intubations, ETT exchanges were associated with higher first-attempt success and fewer safety events. Video laryngoscope and paralytic premedication were associated with improved ETT exchange outcomes.

Background: Tracheal intubation in critically ill children is a life-saving, but high-risk procedure that involves multiple team members with diverse clinical skills. We aim to examine the association between the provider-reported teamwork rating and the occurrence of adverse tracheal intubation-associated events (TIAEs). Methods: A retrospective analysis of prospectively collected data from 45 pediatric intensive care units (PICUs) in the National Emergency Airway Registry for Children (NEAR4KIDS) database from January 2013 to March 2018 was performed. A composite teamwork score was generated using the average of each of five (7-point Likert scale) domains in the teamwork assessment tool. Poor teamwork was defined as an average score of 4 or lower. Team provider stress data were also recorded with each intubation. Results: 12,536 tracheal intubations (TIs) were reported from 2013 to 2018. Approximately 4.1% (n=520) rated a poor teamwork score. TIs indicated for shock were more commonly associated with a poor teamwork score, while those indicated for procedures and those utilizing neuromuscular blockade were less commonly associated with a poor teamwork score. TIs with poor teamwork were associated with a higher occurrence of adverse TIAE (24.4% vs. 14.4%, p<0.001), severe TIAE (13.7% vs. 5.9%, p<0.001), and peri-intubation hypoxemia < 80% (26.4% vs. 17.9%, p<0.001). After adjusting for indication, provider type, and neuromuscular blockade use, poor teamwork was associated with higher odds of adverse TIAEs (OR 1.77, 95% CI 1.35-2.34), severe TIAEs (OR 2.23, 95% CI 1.47-3.37) and hypoxemia (OR 1.63, 95% CI 1.25-2.03). Conclusion: TIs with poor teamwork were independently associated with a higher occurrence of TIAEs, severe TIAEs, and hypoxemia.

Background Nasal tracheal intubation (TI) represents a minority of all TI in the pediatric intensive care unit (PICU). The risks and benefits of nasal TI are not well quantified. As such, safety and descriptive data regarding this practice are warranted. Methods We evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation (SpO 2 > 20% from baseline) and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. To balance patient, provider, and practice covariates, we utilized propensity score (PS) matching to compare the outcomes of nasal vs. oral TI. Results A total of 22,741 TIs [nasal 870 (3.8%), oral 21,871 (96.2%)] were reported from 60 PICUs. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%), both p < 0.001. Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI (non-adjusted p = 0.408). With PS matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%, 95% confidence interval (CI): − 0.07, 7.7%), p = 0.055. First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI, p = 0.072. With PS matching, the success rate was not different between two groups (nasal 72.2% vs. oral 71.5%, p = 0.759). Conclusion In this large international prospective cohort study, the risk of severe peri-intubation complications was not significantly higher. Nasal TI is used in a minority of TI in PICUs, with substantial differences in patient, provider, and practice compared to oral TI. A prospective multicenter trial may be warranted to address the potential selection bias and to confirm the safety of nasal TI.

OBJECTIVES: Extremes of patient body mass index are associated with difficult intubation and increased morbidity in adults. We aimed to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe peri-intubation hypoxemia (pulse oximetry oxygen saturation < 80%) in critically ill children. DESIGN/SETTING: Retrospective cohort using the National Emergency Airway for Children registry dataset of 2013–2020. PATIENTS: Critically ill children, 0 to 17 years old, undergoing TI in PICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Registry data from 24,342 patients who underwent TI between 2013 and 2020 were analyzed. Patients were categorized using the Centers for Disease Control and Prevention weight-for-age chart: normal weight (5th–84th percentile) 57.1%, underweight (< 5th percentile) 27.5%, overweight (85th to < 95th percentile) 7.2%, and obese (≥ 95th percentile) 8.2%. Underweight was most common in infants (34%); obesity was most common in children older than 8 years old (15.1%). Underweight patients more often had oxygenation and ventilation failure (34.0%, 36.2%, respectively) as the indication for TI and a history of difficult airway (16.7%). Apneic oxygenation was used more often in overweight and obese patients (19.1%, 19.6%) than in underweight or normal weight patients (14.1%, 17.1%; p < 0.001). TIAEs and/or hypoxemia occurred more often in underweight (27.1%) and obese (24.3%) patients ( p < 0.001). TI in underweight children was associated with greater odds of adverse airway outcome compared with normal weight children after adjusting for potential confounders (underweight: adjusted odds ratio [aOR], 1.09; 95% CI, 1.01–1.18; p = 0.016). Both underweight and obesity were associated with hypoxemia after adjusting for covariates and site clustering (underweight: aOR, 1.11; 95% CI, 1.02–1.21; p = 0.01 and obesity: aOR, 1.22; 95% CI, 1.07–1.39; p = 0.002). CONCLUSIONS: In underweight and obese children compared with normal weight children, procedures around the timing of TI are associated with greater odds of adverse airway events.

BACKGROUND AND OBJECTIVES:Neonatal endotracheal tube (ETT) size recommendations are based on limited evidence. We sought to determine data-driven weight-based ETT sizes for infants undergoing tracheal intubation and to compare these with Neonatal Resuscitation Program (NRP) recommendations.METHODS:Retrospective multicenter cohort study from an international airway registry. We evaluated ETT size changes (downsizing to a smaller ETT during the procedure or upsizing to a larger ETT within 7 days) and risk of procedural adverse outcomes associated with first-attempt ETT size selection when stratifying the cohort into 200 g subgroups.RESULTS:Of 7293 intubations assessed, the initial ETT was downsized in 5.0% of encounters and upsized within 7 days in 1.5%. ETT downsizing was most common when NRP-recommended sizes were attempted in the following weight subgroups: 1000 to 1199 g with a 3.0 mm (12.6%) and 2000 to 2199 g with a 3.5 mm (17.1%). For infants in these 2 weight subgroups, selection of ETTs 0.5 mm smaller than NRP recommendations was independently associated with lower odds of adverse outcomes compared with NRP-recommended sizes. Among infants weighing 1000 to 1199 g: any tracheal intubation associated event, 20.8% with 2.5 mm versus 21.9% with 3.0 mm (adjusted OR [aOR] 0.62, 95% confidence interval [CI] 0.41-0.94); severe oxygen desaturation, 35.2% with 2.5 mm vs 52.9% with 3.0 mm (aOR 0.53, 95% CI 0.38-0.75). Among infants weighing 2000 to 2199 g: severe oxygen desaturation, 41% with 3.0 mm versus 56% with 3.5mm (aOR 0.55, 95% CI 0.34-0.89).CONCLUSIONS:For infants weighing 1000 to 1199 g and 2000 to 2199 g, the recommended ETT size was frequently downsized during the procedure, whereas 0.5 mm smaller ETT sizes were associated with fewer adverse events and were rarely upsized.

Objective To determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation. Design Retrospective analysis of prospectively collected data on intubations performed in the neonatal intensive care unit (NICU) and delivery room from the National Emergency Airway Registry for Neonates (NEAR4NEOS). Setting Eighteen academic NICUs in NEAR4NEOS. Patients Neonates requiring two or more attempts at intubation between October 2014 and December 2021. Main outcome measures The primary outcome was successful intubation on the second attempt, with severe tracheal intubation-associated events (TIAEs) or severe desaturation (≥20% decline in oxygen saturation) being secondary outcomes. Multivariate regression examined the associations between these outcomes and patient characteristics and changes in intubation practice. Results 5805 of 13 126 (44%) encounters required two or more intubation attempts, with 3156 (54%) successful on the second attempt. Second attempt success was more likely with changes in any of the following: intubator (OR 1.80, 95% CI 1.56 to 2.07), stylet use (OR 1.65, 95% CI 1.36 to 2.01) or endotracheal tube (ETT) size (OR 2.11, 95% CI 1.74 to 2.56). Changes in stylet use were associated with a reduced chance of severe desaturation (OR 0.74, 95% CI 0.61 to 0.90), but changes in intubator, laryngoscope type or ETT size were not; no changes in intubator or equipment were associated with severe TIAEs. Conclusions Successful neonatal intubation on a second attempt was more likely with a change in intubator, stylet use or ETT size.

Objective This study evaluates the clinical harm associated with tracheal intubation (TI) after unplanned extubation (UE) in the pediatric intensive care unit (ICU). We hypothesized that TI after UE is associated with a higher risk of adverse airway outcomes (AAOs), including peri-intubation hypoxia. Methods A total of 23,320 TIs from 59 ICUs in patients aged 0 to 17 years from 2014 to 2020 from the National Emergency Airway Registry for Children (NEAR4KIDS) database were evaluated. AAO was defined as any adverse TI-associated event and/or peri-intubation hypoxia (SpO2 < 80%). UE trends were assessed over time. A multivariable logistic regression model was developed to evaluate the association between UE and AAO, while controlling for patient, provider, and practice confounders. Results UE was reported as TI indication in 373 (1.6%) patients, with the proportion increasing over time: 0.1% in 2014 to 2.8% in 2020 (p < 0.001). TIs after UE versus TIs without preceding UE were more common in infants (62 vs. 48%, p < 0.001), males (63 vs. 56%, p = 0.003), and children with a history of difficult airway (17 vs. 13%, p = 0.03). After controlling for potential confounders, TI after UE was not significantly associated with AAO (adjusted odds ratio [aOR]: 1.26, 95% confidence interval [CI]: 0.99–1.62, p = 0.06). However, TI after UE was significantly associated with peri-intubation hypoxia (aOR: 1.35, 95% CI: 1.02–1.79, p = 0.03). Conclusions UE is increasing as an indication for TI, and is more common in infants and children with a history of difficult airway. As TI after UE was associated with increased peri-intubation hypoxia, future study should focus on identifying causality and mitigating peri-intubation risk.

Physical and mental disabilities resulting froma child's cardiac arrest are of exceptional family and social concern. Recent studies showed that the quality of pediatric resuscitation often does not meet recommended standards. Implementation of these 10 evidence-based measures published here can help improve survival rates and morbidity in resuscitated children. These 10 theses are intended to focus on the broad range of issues surrounding resuscitation of children and adolescents. It begins with improved prevention and recognition of life-threatening events in children to prevent respiratory and circulatory arrest. In the case of resuscitation, it can only be effective if consistent and sustained training is provided. Learning from each patient is the most important thing. The quality of resuscitation and the postresuscitation phase must be measured and evaluated to identify aspects for optimization. Structured collection of treatment and outcome data in a centralized, mandatory registry offers the opportunity to identify strengths of in-hospital and out-of-hospital care and to develop concepts for quality improvement. These theses and basic principles are also supported by the Austrian, German, and Swiss Resuscitation Councils and have already been published in Frontiers in Pediatrics.

Ketamine has traditionally been avoided for tracheal intubations (TIs) in patients with acute neurological conditions. We evaluate its current usage pattern in these patients and any associated adverse events. We conducted a retrospective observational cohort study of critically ill children undergoing TI for neurological indications in 53 international pediatric intensive care units and emergency departments. We screened all intubations from 2014 to 2020 entered into the multicenter National Emergency Airway Registry for Children (NEAR4KIDS) registry database. Patients were included if they were under the age of 18 years and underwent TI for a primary neurological indication. Usage patterns and reported periprocedural composite adverse outcomes (hypoxemia < 80

Tracheal intubation (TI) in critically ill children is a life-saving but high-risk procedure that involves multiple team members with diverse clinical skills. We aim to examine the association between the provider-reported teamwork rating and the occurrence of adverse TI-associated events (TIAEs). A retrospective analysis of prospectively collected data from 45 pediatric intensive care units in the National Emergency Airway Registry for Children (NEAR4KIDS) database from January 2013 to March 2018 was performed. A composite teamwork score was generated using the average of each of five (7-point Likert scale) domains in the teamwork assessment tool. Poor teamwork was defined as an average score of 4 or lower. Team provider stress data were also recorded with each intubation. A total of 12,536 TIs were reported from 2013 to 2018. Approximately 4.1% ( n = 520) rated a poor teamwork score. TIs indicated for shock were more commonly associated with a poor teamwork score, while those indicated for procedures and those utilizing neuromuscular blockade were less commonly associated with a poor teamwork score. TIs with poor teamwork were associated with a higher occurrence of adverse TIAE (24.4% vs 14.4%, p < 0.001), severe TIAE (13.7% vs 5.9%, p < 0.001), and peri-intubation hypoxemia < 80% (26.4% vs 17.9%, p < 0.001). After adjusting for indication, provider type, and neuromuscular blockade use, poor teamwork was associated with higher odds of adverse TIAEs (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.35-2.34), severe TIAEs (OR, 2.23; 95% CI, 1.47-3.37), and hypoxemia (OR, 1.63; 95% CI, 1.25-2.03). TIs with poor teamwork were independently associated with a higher occurrence of TIAEs, severe TIAEs, and hypoxemia.

Early initiation of resuscitation measures is of enormous importance for the outcome of a child after respiratory failure and cardiac arrest. Therefore, the timely recognition of a critically ill patient, early initiation and effective performance of basic measures, such as securing an open airway, effective ventilation and high-quality thorax compressions (frequency 100-120/min, depth 4-5 cm, full chest recoil, minimization of interruptions) are essential. After assessing consciousness, the airway should be opened and in the case of insufficient or lack of breathing five initial rescue breaths should be given. Subsequently, effective chest compressions should be performed in conjunction with assisted ventilation in a ratio of 15:2. If a bag valve mask is not immediately available, continuous chest compressions should be started immediately and ventilation added as soon as a bag valve mask becomes available. The extended resuscitation measures include the administration of medicaments, heart rhythm analysis and possibly defibrillation. Resuscitation situations in pediatrics are overall rare events and represent a great cognitive challenge and a significant emotional burden for all those involved. Therefore, continuous training measures to learn and refresh basic life support (BLS) and advanced life support (ALS) measures are essential. To this end, special pediatric resuscitation courses of the European Resuscitation Council (European pediatric life support, EPLS; ) are provided. So-called nontechnical skills, such as communication, team leadership and task distribution within the team are becoming increasingly more important and should be integrated into training concepts. In this context, team-oriented training concepts on state-of-the-art patient simulators are increasing in popularity.

Die Versorgung kritisch kranker Kinder ist eine zeitkritische Aufgabe, die eine effektive Zusammenarbeit unterschiedlicher Berufsgruppen und Fachdisziplinen erfordert. Rasches Erkennen des medizinischen Problems, Festlegen einer gemeinsamen Arbeitshypothese, die koordinierte Durchführung und regelmäßige Reevaluierung der Behandlung sind für die Sicherheit der Patienten essenziell. Um die Versorgung sicher zu gestalten, gibt es verschiedene Instrumente. Hierzu zählen eine standardisierte Notfallausrüstung, die alle anwenden können, kognitive Hilfsmittel zur sicheren Medikamentenapplikation sowie Checklisten zur Vorbereitung bzw. zur Durchführung von kritischen Prozeduren. Des Weiteren sind eine Standardisierung der Kommunikation, klare Rollen- und Aufgabenverteilungen sowie regelmäßige Nachbesprechungen hilfreich. Die Etablierung einer Sicherheitskultur („safety culture“) und regelmäßige Trainings sind für die Umsetzung der Maßnahmen unerlässlich.