Patient safety practices have been defined as those activities that reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions. This definition is concrete but quite incomplete, because so many practices have not been well studied with respect to their effectiveness in preventing harm. Practices considered to have sufficient evidence to include in the category of:
Improving Patient Safety Measures are as follows:
- Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk
- Use of perioperative beta-blockers in appropriate patients to prevent perioperative morbidity and mortality
- Use of maximal sterile barriers while placing central intravenous catheters to prevent infections
- Appropriate use of antibiotic prophylaxis in surgical patients to prevent postoperative infections
- Asking that patients recall and restate what they have been told during the informed-consent process to verify their understanding
- Continuous aspiration of subglottic secretions to prevent ventilator-associated pneumonia
- Use of pressure-relieving bedding materials to prevent pressure ulcers
- Use of real-time ultrasound guidance during central line insertion to prevent complications
- Patient self-management for warfarin (Coumadin®) to achieve appropriate outpatient anticoagulation and prevent complications
- Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition in critically ill and surgical patients, to prevent complications
- Use of antibiotic-impregnated central venous catheters to prevent catheter-related infections
- Many places lack robust reporting and learning systems which effectively capture events and dissect learning opportunities. The World Health Organization came up with a minimal Information Model for Patient Safety (MIM PS) has been developed to provide a simple tool to start collecting data on patient safety incidents. The user guide explains each of the categories and how to implement MIM PS.
If your healthcare organization doesn’t have a culture that values teamwork, accountability, and an environment that encourages speaking up, then you’re more likely to experience quality issues. Conference speaker Dr. Woods effectively illustrated the importance of culture using statistics on wrong site surgeries: 20 percent of healthcare professionals said they would not speak up if they witnessed an issue. In retrospective wrong site surgery reviews, 60-80 percent of people interviewed said they knew the incision was being made in the wrong place, but did not speak up.
According to Dr. Woods, the one word that best describes a culture of safety is civility. Civility, illustrated in the diagram below, facilitates a safe environment in which people feel comfortable speaking up and changes are implemented and communicated.
Many patient safety practices, such as the use of simulators, bar coding, computerized physician order entry, and crew resource management, have been considered as possible strategies to avoid patient safety errors and improve healthcare processes; research has been exploring these areas, but their remains innumerable opportunities for further research.12 Review of evidence to date critical for the practice of nursing can be found in later chapters of this Handbook.
Nursing As the Key to Improving Quality Through Patient Safety. Nursing has clearly been concerned with defining and measuring quality long before the current national and State-level emphasis on quality improvement. Florence Nightingale analyzed mortality data among British troops in 1855 and accomplished significant reduction in mortality through organizational and hygienic practices. She is also credited with creating the world’s first performance measures of hospitals in 1859. In the 1970s, Wandelt reminded us of the fundamental definitions of quality as characteristics and degrees of excellence, with standards referring to a general agreement of how things should be (to be considered of high quality). About the same time, Lang16 proposed a quality assurance model that has endured with its foundation of societal and professional values as well as the most current scientific knowledge.