1. Mee, Cheryl L. RN,BC, CMSRN, MSN

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Unlike most health care errors-even those that kill patients-airplane crashes always make headlines. Yet research shows that the airline passenger in seat 14C is safer than the hospital patient in bed 307A.

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This month's Issues in Nursing feature, "View from the Cockpit" (see page 50), explains why the airline industry can teach health care professionals something about safety. Consider, for example, the carefully scripted safety briefing passengers get before each flight. Standardized throughout the industry, it's designed for easy recall in an emergency, so you're likely to remember the basics, such as putting on your own oxygen mask before helping a child. No matter what airline you fly, you hear the same briefing and see the same demonstration.


These and other protocols are part of crew resource management (CRM), a key reason for the airline industry's remarkable safety record in the last 20 years. Simply stated, CRM is designed to use all resources-personnel, equipment, and information-to safeguard operations. Everyone from pilot to baggage handler is expected to speak up if something is amiss, even if that means challenging the judgment of someone in higher authority.


A key principle of CRM, situational awareness, means being aware of the big picture and trusting your instincts. Equally important, it means speaking up when your gut tells you something is wrong. Nurses have great instincts but may need encouragement and support to speak up to physicians and others in authority.


Another principle, cross-monitoring, involves double-checking high-risk work and verifying or correcting inaccurate or ambiguous information. You already apply this principle when you administer blood or high-alert medications. Imagine how much safer your environment would be if more cross-monitoring protocols were incorporated in your facility's standard operating procedures.


Could your facility benefit from CRM? Ask yourself these questions:


* Should medication double checks be more common?


* Are overwork and distractions threatening patient safety?


* Do nurses feel unsafe speaking out about safety concerns, errors, or near misses?


* Are nurses conditioned to wait in the background for orders?



When nurses speak up about concerns, are they seen as troublemakers?

If you answered yes to any of these questions, you'll find "View from the Cockpit" enlightening. I hope you'll enjoy this interesting look at airline safety and come away with ideas you can apply to your practice. Communicate them clearly to the policy makers in your facility-and please, don't hesitate to speak up.


Cheryl L. Mee, RN,BC, CMSRN, MSN


Editor-in-Chief, Nursing2006