Patient and Staff Safety
Across the country, studies indicate that patients need an advocate to have a safe care environment when entering hospitals. This came so true for me when a neighbor had a roll over car accident and was transported from the scene of the accident via helicopter to a major trauma center. His wife was in another state attending a terminally ill mother so I was the friend who came to take him home from the trauma emergency room several hours after the accident. He was sitting in a wheel chair unattended and said, "Let's go." I asked if I needed to talk with anyone to release him. He had the papers and said he was ready to go home. He was ashen, he had a fractured sternum, staples in his head and severe contusions, but I did as he wished and wheeled him to my car, bundling him to keep warm. We stopped at a 24-hour drug store to get pain medicines. It was late, he had nothing to eat, he needed soup so he could take his medications and he was not in a condition to stay alone. I spent the night so I could observe him and be available if he had an emergency. His wife returned the next day and then took him back to the hospital two days later due to his experiencing severe abdominal discomfort, only to be discharged home within a few hours and called back to return the same day, when the MRI revealed a suspicious area in his abdomen. Then he was hospitalized for two more days. He had circulatory collapse in his intestines due to the seat belt compression, which saved his life and now he is eventually healing. But, where are the safety rules that indicate a patient in a wheelchair is to be accompanied by staff to the automobile when discharged? Where is the total concern for safety and well being of a severe trauma accident patient?
Patient safety is the most essential ingredient of quality healthcare as is the safety of the staff. A vital lifeline to our nation's healthcare is patient and staff safety. We are fortunate to have two nurse leaders in the field of patient and staff safety giving editorial direction to this most timely issue of Nursing Administration Quarterly. Ann E. Kobs, MS, RN, President/CEO, Ann Kobs & Associates, Wheaton, Ill, provides compliance consultation for hospitals and long-term care, home, ambulatory care, and behavioral healthcare organizations. Ms. Kobs' experience includes nearly ten years at the Joint Commission on Accreditation of Healthcare Organizations, where she opened the Sentinel Event Unit and was the Associate Director of the Department of Standards Interpretation. She has published extensively on standards, patient safety, and infection control, as well as speaking nationally and internationally.
Cathy Rick, RN, MSN, CNAA, FACHE, is the Chief Nursing Officer/Headquarters, Department of Veteran Affairs, Washington, DC. Ms Rick provides leadership and guidance to the Veteran's Administrations 58,000 nursing personnel, who care for 6 million veterans each year. As the Chief Nurse Executive for VA, she is responsible for the development, implementation and evaluation of national policy and strategic planning activities that support the missions of the Veterans Health Administration: clinical care, education, research, backup to the Department of Defense and emergency preparedness. She is a well-published nurse leader and frequently speaks on topics related to advancing nursing practice, patient care delivery models and leadership principles for all nursing roles.
There is a growing body of empirical research, which relates to patient and staff safety, such as data from the Center for American Nurses suggesting that nurse fatigue threaten patient safety. The fatigue brought on by too much overtime in caring for too many patients for too many hours is a definite threat to patient safety. As I started my 4-year tenure as CNO at the King Faisal Hospital and Research Centre in Riyadh, Saudi Arabia, in 1987, I noted a high frequency of medication errors, especially where nurses worked as much overtime as they wanted to. I knew this was unsafe for patients and unhealthy for nurses so a limitation of hours worked was placed on all staff, and there was a significant reduction in medication errors. More important are the studies from the Institute of Medicine (IOM) and the Agency for Healthcare Research and Quality, which calls for limiting nurses' work hours supported by evidence from nursing and other professions. The recommendation from the IOM report is that nurses in direct patient care be limited to 12 hours per day and 60 hours per week. While nursing fatigue is a major factor in both patient and staff safety, no one can really determine the level of sustainability an individual nurse may have while working and be safe in providing care. Each person has different work tolerance ability and when emergencies require more work time as in a disaster, nurses are usually able to sustain their professional patient safe care ability. It is important to have uninterrupted breaks and use evidence-based safety practices. Learning to take care of ourselves with good nutrition and sufficient time for exercise, rest, relaxation and good sleep habits is an essential component for the nurse executive and staff in order to provide safe patient care.
As studies uncover various causes of medical errors and trends in staff safety issues, such as needle stick protection and back injuries, we are challenged to develop system and technology changes, which correct these serious hazards to safe care. We know that as many as 98,000 patients die as the result of medical errors in hospitals each year, according to the IOM report in November 1999, titled To Err Is Human: Building a Safer Health System. Technology can and does reduce significantly the errors being made with bar coding, pen tablets, mobile devices, wireless networks, touch screens and browser-based solutions. It is essential to implement such technology now, because the Food and Drug Administration's new patient safety initiative will require hospitals to use bar coding on medications within the next three years. Electronic order entry systems have proven to lessen medical errors.
Can we create blame-free environment, and monitor practices with best practices as our foremost concern? There are many innovative approaches to ensure safety for surgical procedures as marking the right leg with the patient alert before doing a surgical procedure as was done to me recently. One leg had NO in large black marks so the correct knee was operated on, which had YES. Safe patient care is possible and communication in all forms effects the outcome. Should discharge be done without communicating to whomever is taking the patient home as well as the patient? How can we create a safer working environment for staff if we don't track data and develop creative solutions?
The IOM estimates that preventable healthcare-related injuries cost from $17 billion to $29 billion each year. It is no wonder that patient safety is such a high priority. But let us always enable a safe environment for staff as well because we are the caretakers of the caregivers. Collectively, we have the ability and creativity to find a better way to provide safe patient care and create the safest possible environment for staff.
Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP
Editor-in-Chief, Nursing Administration Quarterly