Safety Games: Nice Catch!

May 2015 - Vol.12 No. 5 - Page #22

Are you familiar with the game of Leela, played in 16th century India to teach moral values? It was the inspiration for the children’s game, Chutes and Ladders. How about Chaturanga, used to teach noblemen the strategies of war during the Middle Ages? It was the precursor to chess. Have you ever heard of Nice Catch, played by health care workers in this millennium? It’s an example of a “safety game!” 

Why play safety games in the hospital? Because patient safety is a top priority in health care. Each year, over 400,000 people die in the United States due to preventable medical errors,1 and over 1.5 million people are harmed by medication errors.2 Reducing those numbers requires a workforce knowledgeable about the causes and processes that contribute to error and harm and that is empowered to make improvements. A culture of safety is foundational to such improvement work, and the concept of safety games represents a creative way to help achieve such an environment. 

Games Improve Processes
Games have been used successfully in industry to support process improvement, as well as in health care in areas such as anesthesiology and pharmacy. Dimensions common to a safe culture include leadership commitment to safety and open communication based on trust. Organizational learning and teamwork also are important, as is a non-punitive approach to reporting; analysis; and discussion of safety concerns. The goal of safety games is to provide visual reminders that safety is a top priority. These games encourage sharing uncomfortable topics in a comfortable environment while promoting teamwork and collaboration. 

Games are effective teaching tools because they employ active learning strategies. They are consistent with adult learning theory, which reminds us that adults learn best by doing and not merely by listening. Safety games can be knowledge- or application-based, and can be tailored to almost any safety topic of interest. The games can be used to introduce information, heighten awareness, or to complement other teaching methodologies.

How It Works
Each game requires a champion, or coach, who is responsible for game design, kickoff, interim coaching, ending the game, and post-game follow-up. 

  • The kickoff should generate excitement and explain the goals and rules of play.
  • Interim coaching involves providing game reminders, recognition of players, and progress reports, especially if the game lasts over a month.
  • When the game ends, the coach is responsible for arranging for any rewards that were promised. 
  • Post-game follow-up, including communication of achievements and lessons learned, is essential. Positive reinforcement enhances a safe culture and sets the stage for the next game.

Potential coaches include the medication safety officer, a management or staff member, a resident, or a student. The coach begins by creating an educational plan tailored to a specific audience. One way to achieve this is to think about the objectives and content that would be used in a lecture or slide presentation. The next step is to add active learning strategies and determine how they can be achieved through a game. Pre-game huddles for group brainstorming can be helpful.

Features of Successful Safety Games
Effective games share common characteristics. By design, safety games should be:

  • Focused. Games should be goal-oriented, much like a lesson plan designed to impart knowledge, and should provide opportunities to apply lessons learned.
  • Fun! Creativity is a plus. Like a good advertisement, the concepts and message should be relatable and easy to remember.
  • Thematic. Sports, board games, and TV shows can serve as themes to engage participants.
  • Clearly defined. Keep it simple! The audience must be able to easily understand the rules of play. In addition, the end of the game must be clearly defined. The game’s completion can be triggered by reaching a certain pre-defined goal, completing a cycle, or by reaching the conclusion of a defined time period.

See CHECKLIST: How to Create a Safety Game.


Helpful Hints

  • Recognize players for their contributions. Keep incentives in line with the theme of the game. Low-cost or cost-free incentives can contribute to the success of your game.
  • Reward the team (eg, the department) when it reaches a pre-defined goal, such as percent staff participation or number of issues/suggestions identified. Rewards can be a shared meal, ice cream, or perhaps a drawing for a gift card or other incentive.
  • Be as inclusive as possible when considering your target audience (eg, both pharmacists and pharmacy technicians). If your topic dictates a specific audience, consider organizing two concurrent games or having two groups play on alternate months. 
  • Locate the game on a board or wall in a space that people frequent multiple times daily, such as near a break room, the restrooms, mailboxes, or entry to the department. Use a 3-x5-foot board or larger; visibility is critical to achieving goals.
  • Simplify the amount and type of supplies required. Inexpensive supplies can be found at craft and educational supply stores. 

An example of a successful safety game that took place at Valley Health/Valley Physician Enterprise in Winchester, Virginia, is discussed in the SIDEBAR. 

Capture the imagination of your staff and co-workers with safety games and watch them become your best safety champions while your safety culture flourishes.


  1. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122-128.
  2. Institute of Medicine Committee on Identifying and Preventing Medication Errors, Board on Health Care Services. Aspden P, Wolcott JA, Bootman JL, Cronenwett LR, eds. Preventing Medication Errors: Quality Chasm Series. Washington, DC: The National Academies Press; 2007.

Additional examples of safety games will be presented in future issues of PP&P. We hope you will play along, and welcome your safety game stories. If you are a game coach, and would like your game to be considered for publication in the magazine, please send it to Senior Editor Jennifer Karpinski at, or contact Jennifer at 201-670-0077 x340.


Deb Saine, MS, RPh, FASHP, FSMSO, is senior lean management engineer at Valley Health/Valley Physician Enterprise in Winchester, Virginia. She has authored numerous articles and has presented internationally on the topic of medication safety, and served in ASHP leadership positions. Deb received her BS in pharmacy from the University of Toledo and an MS in management from Antioch University.


Nice Catch!

Click here to view a larger version of this Table

It’s Time to Make a Nice Catch!
A Nice Catch is a circumstance or event that has the capacity to cause error; a near-miss is an error that occurs, but is caught before it reaches the patient. Sometimes a Nice Catch results from a conversation that starts with: Why don’t we do x-y-z this way? Some examples are listed below, but do not limit your thinking to just these:

  • Look-alike/sound-alike (LA/SA) drugs
  • Storage or labeling of a drug that contributes to a mix-up
  • Dispensing of a used multidose container, because we were unable to see it had been used (caught before administration)
  • A confusing set of orders in a pre-approved order set

Who Can Play?

  • Everyone!

What Do I Win? 

  • A Nice Catch pin (see PHOTO 1)
  • When 90% of staff participates, a pizza party for all
  • Entry into drawing for a prize at the end of the game
  • The satisfaction of knowing you played a part in making medication use safer

How Do I Join the Game?

    • Pick up a Nice Catch entry form (see Sample entry form) from the folder on the break room door 

  • Fill it out with your Nice Catch idea. Suggestions for how to solve the problem are welcome, but not required.
  • Include your name so you can be included in the prize drawing and the total participation rate for the pizza party.
  • Place the form in the entry folder on the break room door.
  • Play as many times as you want. Only one pin per player, but each Nice Catch earns another entry into the drawing.

Then What?

  • Visit the game board often, where all the Nice Catches will be shared on baseballs. 
  • If these new ideas generate more ideas of your own, enter again!
  • Follow the progress on the baseball bat. 
  • When the bat is completely colored in, the game is over. Time to celebrate!

Participate – Have Fun – Make an Impact on Safety!
90% participation is our goal. Encourage your coworkers to play!


After the Game Is Completed
Conduct a wrap-up meeting and share the results of the game.


Like what you've read? Please log in or create a free account to enjoy more of what has to offer.

Recent Popular Articles

December 2021 : USP 800
December 2021
December 2021 : USP 800
December 2021 : USP 800

Current Issue