Four of the articles this month are about the important topic of patient safety. The movement of safety education for nurses began in earnest in 2005 with the Quality and Safety Education for Nurses (QSEN) project, funded by the Robert Wood Johnson Foundation. The ultimate goal was to reshape nursing education and training to create a culture of safety in nursing. Phases I and II resulted in the identification of the knowledge, skills, and attitudes needed by nurses to create a culture of safety. Six quality and safety competencies were proposed as a result of the first two phases: patient-centered care; teamwork and collaboration; evidence-based practice; quality improvement; safety; and informatics (QSEN, 2014). Phase III was announced in 2009 and focused on improving faculty knowledge and skills necessary to teach and assess achievement of these important competencies. Phase IV was launched in 2012 and focuses on a better-educated nurse workforce, with a goal of at least 80% of registered nurses having a bachelor's degree or higher. This initiative is based on results of several large research studies that have demonstrated lower mortality when hospitals have higher proportions of nurses prepared at that level or above (Aiken et al., 2003, 2008).
It's not that safety is a new concept in healthcare and nursing. After all, we learned the five rights of medication administration, the importance of bedrails, and to never leave the bed raised. But did we ever stop to analyze the causes of medication errors? Medication errors often resulted in reprimands and other forms of discipline rather than thoughtful analysis of the systematic factors that led to the error. For example, medications that are meant to be given orally were often drawn up in a syringe for measurement. A syringe is meant for intramuscular or intravenous administration. Oral or topical medications measured in a syringe have been mistakenly administered through an intravenous line with deadly consequences. Not too long ago, physicians' orders might indicate a dose of insulin in "u's" instead of "units." The "u" has been mistaken for a zero, increasing the dose by a factor of 10 and causing an overdose of insulin to be administered. Efforts in recent years have focused on identifying the systematic factors that led to the error and eliminating them. So in hospitals and pharmacies today, insulin is ordered in units, and oral medications are not drawn up in syringes.
Did we ever stop to think about the dangers inherent in restraints? When we found patients wedged between the mattress and the bed rail, or when we found confused patients trying to climb over side rails, why didn't we come to the logical conclusion that these devices, meant for patient safety, could actually cause injuries and death? Were we as concerned as we should have been about patient falls? I don't mean to imply that no one cared about patient falls, but it seems to me that we expected and were comfortable with some errors and some falls. They were not thought of as events that could be eliminated or at least greatly reduced. For whatever reason or reasons, we didn't consider patient safety in the same way that, thankfully, we do today.
The continuing education feature this month is by Beauvais and Frost. The topic is safe patient handling, a concept rapidly changing in hospital settings, but with its own unique problems and barriers in home care. Edwards and colleagues conducted a qualitative study on safety issues at end of life. The authors also identified considerations for home care clinicians that differ from those in inpatient settings. Simone and coauthors wrote about an important initiative by the Food and Drug Administration to collect information on adverse events related to home medical equipment, and Zidek and colleagues conducted a study on emergency preparedness of rural and urban residents. I hope after reading these articles you will be more aware of some of the safety issues unique to home care, and will be better prepared to contribute to a culture of safety.
In other articles this month, Dr. Luann Etcher of Yale University wrote about the topic of sleep disturbance among caregivers. She makes an important point that the typical caregiver is an older female, a group that is already at risk of sleep disturbances. The stress of caregiving and lack of sleep can lead to serious health consequences for these caregivers. Finally, Farris and coauthors wrote an interesting article about a little known phenomenon known as Takatsubo Cardiomyopathy, sometimes called broken heart syndrome. Enjoy your reading! As always, let us know how we're doing. Letters to the editor are welcome at [email protected].
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