Nursing News

10 Best Practices for Patient Safety


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By Susan Kreimer, MS, contributor

March 18, 2010 - Just before the new millennium, health care began building a foundation to advance patient safety. The catalyst: a 1999 landmark Institute of Medicine report that highlighted safety problems and paved the way for reducing medical errors. Since then, many evidence-based practices have evolved to offer effective solutions to common adverse events. 

Many are simple, common-sense practices that need to remain at the forefront of nurses’ work habits, including these 10 important safety measures.

10 Best Practices for Patient Safety:

1. Curb infection spread – Wash and sanitize hands before coming into direct contact with each patient. Data indicate that health care-associated infections are the most common serious hospital complication. Each year, they affect nearly two million patients, lead to an estimated 99,000 deaths, and cost the health care system as much as $20 billion, according to the Centers for Disease Control and Prevention. The most frequent infection of this type is methicillin-resistant Staphylococcus aureus, or MRSA.

2. Identify patients correctly – Rely on at least two pieces of information, such as name and date of birth. This helps ensure that patients receive the medicine or other treatment intended for them. Also, check for the appropriate blood type before a transfusion, according to The Joint Commission’s 2010 Hospital National Patient Safety Goals. (Editor’s Note: See related Devices & Technology column for the latest in patient identification technologies.)

3. Use medicines safely – Label all drugs, including those in syringes, cups and basins. Take extra precautions with patients on blood thinners. With the enormous number of prescription drugs on the market, there is significant potential for error due to confusing brand or generic names and packaging. The Joint Commission’s safety goals require finding out which medicines each patient is taking. Make sure that any additional medication doesn’t conflict with current ones.

4. Avoid surgical errors – Follow The Joint Commission’s “Universal Protocol” to prevent wrong-site or wrong-person surgery and performing the wrong procedure. One effective strategy is called “time-out.” This a specific period for all team members to independently verify an impending clinical action, according to the World Health Organization’s Collaborating Centre for Patient Safety Solutions, which consists of The Joint Commission and The Joint Commission International.

5. Prevent venous thromboembolism (VTE) – Eliminate hospital-acquired VTE, the most common cause of preventable hospital deaths. A free guide from the Agency for Healthcare Research and Quality spells out the essential first steps, presents evidence and identifies best practices, analyzes care delivery, and tracks performance with metrics and interventions.  “Included in the guide are examples of standard order sets that can help ensure patients receive evidence-based care shown to prevent these clots,” said Jeff Brady, MD, MPH, the agency’s lead for the patient safety portfolio. It also would help to classify patients based on risk, ranging from low to mid and high.

6. Customize hospital discharges – Create an easy-to-follow plan for each patient. It should include a medication routine, a record of all upcoming medical visits, and names and numbers of whom to call if problems arise. These steps can help decrease potentially preventable readmissions by 30 percent, according to the agency. Medications and follow-up care may have changed due to hospitalization, Brady said. “It’s not only telling the patient about any changes in medication regimens and what needs to happen after discharge, but also actually scheduling appointments for follow-up evaluation and care,” he added. Equally important is documenting vital information clearly so that a patient understands.

7. Use good hospital design principles -- Prevent patient falls with evidence-based design of patient rooms and bathrooms as well as decentralized nurses’ stations. This allows for easier observation and access to patients. Falls can result in serious injuries, extend a patient’s stay and dramatically drive up health care costs. For more information, nurses and administrators can download a free 50-minute DVD from the AHRQ, “Transforming Hospitals: Designing for Safety and Quality.”

8. Assemble better teams and rapid response systems – Encourage everyone on the team, including junior members, to speak up. “One thing that can be a barrier to effective communication is the hierarchy that exists on healthcare teams,” Brady said. A free toolkit called TeamSTEPPS™, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety, can be tailored to any health care setting, from emergency departments to ambulatory clinics.

9. Share data for quality improvement – Participate in The National Database of Nursing Quality Indicators (NDNQI)®. This proprietary database of the American Nurses Association (ANA) collects and evaluates unit-specific, nurse-sensitive data from more than 1,500 participating U.S. hospitals. The facilities receive unit-level data reports that they can compare to similar units regionally, statewide and nationwide. This gives nurses and their managers the opportunity to evaluate performance and staffing levels relative to patient outcomes and set organizational goals for improvement.

“The future of health care is evidence-based practice. To have the evidence, you need to collect the data and make apples-to-apples comparisons – your nursing unit’s performance versus similar hospitals’ performance for the same type of unit,” said Isis Montalvo, MBA, MS, RN, director of ANA’s National Center for Nursing Quality®, which oversees the NDNQI program. “The days are gone when nurses did what seemed right, or did things because that’s the way they had always been done. Our decisions today should be made based on a scientific foundation. Through NDNQI, we have data that allows us to make the best practice decisions possible. We know what practices lead to reduced fall rates, reduced hospital-acquired pressure ulcers and other adverse patient outcomes.”

10. Foster an open-communication culture – Minimize mistakes due to lack of communication between doctors, nurses and other health professionals. A similar strategy worked for the airline industry. About 30 years ago, it became obvious that better communication between a pilot and crew members reduced human-error-related accidents and fatalities. The Institute of Medicine in 2004 suggested emulating high-reliability industries such as the airlines to transform nursing. Since then, various “Crew Resource Management (CRM)” programs have been adopted in many U.S. hospitals. Through interactive sessions, nurses learn to maintain awareness in changing clinical situations, said Gary Sculli, RN, MSN, a former airline transport pilot who is now program manager at the VA National Center for Patient Safety in Ann Arbor, Mich. This approach “challenges nurses to think differently about their work and empowers them to transform their practice.”

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