Errors continue to put millions of patients at risk annually, but nurses are in a position to prevent many mistakes and improve patient outcomes.
“Nurses can make a substantial impact on safety,” said Patricia McGaffigan, RN, MSN, former chief operating officer of the National Patient Safety Foundation and now vice president of safety programs at the Institute for Healthcare Improvement in Boston.
Common nurse-associated patient safety concerns include medication errors, falls, infections, patient handoffs and missed care.“Making an error is not necessarily a professional, individual issue but in many cases is a reflection of teams and systems that are breaking down,” McGaffigan said.
Top 6 Things to Improve Patient Safety
1. Support a culture of safety
“The cultures of safety are essential in order for us to correct the issue of frequent error and harm,” McGaffigan said. “We cannot eliminate error totally. It’s a human function, and we are all fallible but not intentionally so.”
A culture of safety’s core values and behaviors demonstrate a collective and sustained commitment to emphasize safety over competing goals, according to the American Nurses Association. These cultures are open, support trust, provide appropriate resources for safe staffing, learn from errors and display transparency.
Jennifer Kadis, RN, MSN, CPAN, administrative director of clinical effectiveness and medical affairs for Memorial Healthcare System in Hollywood, Florida, credits the health system embracing a culture of safety and transparency with its success in reducing errors.
“Everyone on the team is responsible for safety,” Kadis said.
When nurses apply for a position with a new organization, McGaffigan recommends asking the employer about the unit’s safety scores and workplace safety.
2. Communicate well
“It’s all about communication and collaboration,” said Lydia L. Forsythe, PhD, MA, MSN, RN, CNOR, an Oklahoma-based adjunct faculty member at Kaplan University School of Nursing for the MSN and DNP programs.
Nurses should speak up if they observe something unsafe about to happen, equipment does not work or they need assistance moving a patient. Sometimes, nurses can bring these issues forward through shared governance, when management rounds on units or by meeting with a nurse leader.
Communication between shifts and settings can be fraught with missed information.
“Handoffs are definitely an area where risks are high,” McGaffigan said.
Memorial has implemented walking rounds and shift reports to address this risk by making sure “everyone is on the same page.”
3. Perform basic care and follow checklists
Fairly simple things, like providing oral care and turning patients, are very important and should not be skipped.
“There is an association between missed care and increased error and harm,” McGaffigan said. “Most people say it happens because they don’t have time to do everything.”
For instance, studies show good oral care can reduce the risk of pneumonia. And a patient not turned can develop a decubitus ulcer.
Memorial Healthcare uses crew resource management techniques, such as checklists and time-outs before procedures and has found they cut down on medical errors. And it has implemented hourly rounding, with nurses checking on patients and their need to use the restroom, be repositioned or need for pain relief.
4. Engage your patients
“There is no question, better patient engagement improves the safety of care,” McGaffigan said.
That includes asking the patient about his or her goals and listening when the patient questions the care being given. For instance, double-check if a patient says, “I’ve never taken that drug,” or “It doesn’t look familiar,” Kadis recommended.
Memorial has taken this a step further, creating a patient-friendly medication administration record and giving it to the patient each day.
“That has served well as a cross-check,” Kadis said. “And it prompts discussion and teaching.”
Patients and families at Memorial hospitals are empowered to call a “help alert” system if they feel caregivers are not addressing their current needs. The calls are triaged and assigned to the appropriate person.
“It makes the patients and families feel safe,” Kadis said. “One of the biggest things to avoid mistakes is to make the patient your ally.”
5. Learn from incidents and near misses
“To prevent errors, we need to understand what causes them,” said Rosemary Gibson, MS, senior advisor to The Hastings Center in Garrison, New York, and principal author of Wall of Silence: The Untold Story of the Medical Mistakes That Kill and Injure Millions of Americans.
Gibson recommends a system-based approach, using a fishbone diagram for root cause analysis, methodically looking at all of the facts. Nurses can obtain training to learn more about the process.
Kadis added that the debriefing about a fall or other incident needs to happen immediately, so details are not forgotten.
6. Take care of yourself
Fatigue and burnout can lead to mistakes and negatively affect patient safety. The COVID-19 pandemic has left nurses overwhelmed, tired, depressed, anxious and burned out. Many have left the bedside. Others are still struggling to provide care under difficult circumstances.
A study from The Ohio State University College of Nursing found alarmingly high levels of stress and depression, which correlates with more self-reported medical errors.
“These errors are made by very dedicated, caring, committed nurses who are experiencing their own symptoms of depression, anxiety or poor physical health,” said Bernadette Melnyk, chief wellness officer and dean of the College of Nursing at Ohio State in Columbus, in a statement. Nurses “cannot pour from an empty cup.”
Nurses can take advantage of employee assistance programs or other professional counseling, get enough sleep, eat healthy foods, socialize with friends, express grief and invest in their mental wellness.
