Online RN to MSN
Clinical Systems Leadership

6 Ways to Improve Patient Safety

The scope of patient care extends well beyond diagnosis and treatment. Patient safety is a primary concern, and with nurses at the center of care delivery, it’s important to note that they have an outsized effect on the level of safety in their respective health-care settings—even travel nurses. Most nurses take the responsibility of patient safety very seriously and frequently further their education to ensure, and continually improve on, safety.

While there are many different situations in which this might be experienced while completing an online Master of Science in Nursing, the knowledge and years of experience nurses have play a central role in helping them identify problems, develop solutions and positively impact patient safety.

Nurse on tablet.

Here are six ways nurses can improve safety:

Checklists

The use of checklists is among the most proven methods of securing and improving patient safety. Particularly in surgery and operating room settings, the checklist has helped reinforce patient safety to a marked degree. A study published in 2013 in the journal Patient Safety in Surgery cited other research that found mortality in major surgeries fell 47 percent, and morbidity decreased 36 percent, after the introduction of surgical checklists by the World Health Organization (WHO) in 2009.

In the same study, which focused on staff attitudes toward checklists, the authors noted nurse reactions to checklist use were especially positive. When asked to agree with statements on a scale of 1 to 5—with 5 being “strongly agree”—the most frequent response given by nurses to “I believe using the checklist improves patient safety” and “The use of the checklist should be mandatory for every case” was 5.

Although they have a distinct advantage in surgery, checklists can be applied across all types of care. Hospitals in Pursuit of Excellence, an arm of the American Hospital Association, has a few examples, including checklists for:

• Adverse drug reactions
• Central line-associated blood flow infections
• Preventable readmissions
• Injuries from fall or immobility

Fall prevention

That last checklist in the above section addresses an ever-present and ever-dangerous risk in health-care settings: injuries sustained due to a fall. For nurses in areas like home health, gerontology or assisted living, taking action to prevent falls takes on increased importance. The Centers for Disease Control and Prevention recognizes falls as the leading cause of injury and death in older Americans.

Nurses can make a big impact in reducing the risk of falls. A 2012 study by the Erlanger Health System observed that a pilot program—which consisted of updating best practices and using new technology—spearheaded by nursing leadership led to a 43 percent decrease in falls at one clinic.

There are several problem areas in facilities to consider when strategizing fall prevention. Examples identified by nurses in a 2011 study published in the journal BMC Nursing included:

• Unsurveyable local and long distances
• Colors and materials on floors
• Carpets, furniture, equipment
• Lighting
• Wet floors

Targeting Health-care Associated Infections

It is ideal that health-care settings be sterile, but the realities and challenges of care force open breaks in safeguards. Health-care-associated infections (HAIs) are preventable for the most part, yet the CDC’s data from its most recent year studied found 722,000 instances of HAIs in U.S. acute care hospitals; 75,100 patients died as a result of complications stemming from an HAI.

Intentional negligence is not often at fault for environments that lead to contraction of HAIs, but conditions can arise that may contribute to an unsafe medium for care delivery. WHO identified some of those factors outside of hygiene or lack of resources as:

• Prolonged and inappropriate use of invasive devices and antibiotics
• High-risk and sophisticated procedures
• Immuno-suppression and other severe underlying patient conditions
• Insufficient application of standard and isolation precautions

Specific precautions to take with HAIs include giving particular attention to procedures involving central bloodstream lines or catheters; instituting the mandatory use of checklists to ensure facility and equipment cleanliness; promoting hand hygiene, as transmittable diseases between health-care professionals and patients are hard to tamp down.

Communication

As important as the hard skills of nursing (medical- or clinical-specific training, education and skills) are, the soft skills like bedside manner, rapport and, most importantly, communication, are effective tools at a nurse’s disposal for improving patient safety. Communication is vital in health-care relationships. Open, continuous and honest conversations ensure patient safety, but lacking interaction between team members across the care continuum can be a detriment. The Institute for Healthcare Communication said 66 percent of medical errors researched during a 10-year period had a root cause of insufficient team communication.

Communication is effectively behavior based, meaning it can be hard to change. However, certain methodologies and structures exist to help guide health-care teams toward more effective communication. Consider SBAR (Situation, Background, Assessment, Recommendation), which is a structure used in health care to help shape informative and productive conversations:

• Stating the patient’s problem or condition
• Putting it into context of the patient’s medical background and history
• Evaluating what the issue may be
• Making a recommendation for a course of treatment

Another effective use of communication is a shift huddle where information can be shared, tasks can be assigned and concerns can be raised. The more structured the meeting, the more constructive and productive it will be to improving patient safety.

Technology

Advances in medical technology have not only spurred progress in care quality and delivery, but they have also benefitted efforts to improve patient safety.

Of these breakthroughs in modern health care, electronic health records (EHRs) stand out as a particularly useful tool. In a 2014 study from Health.it.gov, 73 percent of responding health-care professionals said they had an at least positive view of the impact of EHRs on care, safety and efficiency. Forty-five percent said an EHR had alerted them to a potential error in the last 30 days, and 70 percent cited EHRs as having a positive communicative effect.

EHRs give users advantages in a number of areas: Using patient data to analyze outcomes, normalizing fields of patient information for consistency, creating comprehensive records of patient history (allergies, medications, dosage) and supporting diagnostic decision-making all stand out.

One explicit situation where EHRs are critically valuable is transitions of care. When such transitions occur, it’s easy for important information to slip through the cracks. Patient safety is vulnerable at these points, and having secure, standardized and collaborative patient histories and instructions is necessary for successful transitions.

Nursing leader communicating.

Leadership and a culture of safety

Another integral nursing soft skill is leadership. Nurses observe and contribute to patient safety conditions on a daily basis, putting them in a direct position to influence and advocate improvements in patient safety. Just as important as those high-level ambitions is setting an example. Being looked to by staff means leaders have the opportunity to employ and publicize best practices. It can be monotonous to follow checklists and enter information in the correct fields of EHRs, but accurately completing these tasks may have effects on the safety of the patient, and nurses that hold themselves and others accountable also motivate improved patient safety.

This type of leadership fosters a culture of patient safety as a foreground issue and has measurable effects on safety. A 2015 study published in the journal Safety and Health found that hospitals that scored high on characteristics of settings with a strong patient safety culture were associated with a lower number of adverse events. Traits that were tied to improved safety conditions included:

• Supervisor expectations (i.e. Leadership setting the example)
• Organizational learning
• Open communication
• Teamwork within units
• Nonpunitive responses to errors
• Hospital management support

Patient safety is a core measure of quality, and health-care settings and professionals need to do all they can to ensure that it is looked after. As discussed, there are multiple pitfalls along the care continuum that may result in lapses or errors that could endanger the patient. These problems can be addressed on institutional and personal levels, such as dedication to mandating and using checklists, investing and training in technology, and through identifying problems and communicating about them.

Continued education is also a means to supplement these goals to improve patient safety. Completing an online Master of Science in Nursing at the University of Arizona may open students to new ways of thinking about patient safety.

Sources

https://pssjournal.biomedcentral.com/articles/10.1186/1754-9493-7-14

https://www.cdc.gov/media/releases/2016/p0922-older-adult-falls.html

https://patientcare.stryker.com/~/media/patientcare/doc/case%20studies/erlanger%20fall%20prevention.ashx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142214/

https://www.cdc.gov/hai/surveillance/

http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf

https://www.ncbi.nlm.nih.gov/books/NBK2683/

http://healthcarecomm.org/about-us/impact-of-communication-in-healthcare/

https://www.ncbi.nlm.nih.gov/books/NBK43663/

https://www.healthit.gov/sites/default/files/ONC_HIT_SafetyHealthITWeekWebinar_2014_09_12.pdf

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