Healthcare systems have begun to focus greater attention on patient safety as the result of recent studies that demonstrate inconsistency in the delivery of safe patient care.
The Institute of Medicine’s 1999 report, To Err is Human: Building a Safer Health System, concluded an estimated 98,000 patients die each year as a result of errors in the U.S. healthcare system.1
The U.S. Agency for Healthcare Research and Quality focuses a majority of its research on patient safety, and the Joint Commission focuses its standards on patient safety as well. Their studies and initiatives, as well as others, demonstrate patients are indeed at risk for serious harm due to lack of patient safety in nursing and healthcare practice.2
The gap between what nurses do and do not know about patient safety needs to be closed. There are many studies available on patient safety.
Research reveals, for example, that patient outcomes are at least 28% better when clinical care is based on evidence rather than tradition or “common sense.” Hospital administrators, meanwhile, are aware attention to patient safety is a priority and that error reduction is an area in which not enough is being done.3
While the concept of patient safety is commonplace in healthcare institutions, studies are needed that directly address how to teach nurses to incorporate patient safety practices into their daily nursing practice while completeing the myriad of tasks that inundate them.
Other studies are needed to help in the development a comprehensive tool to assist the nurse with maintaining patient safety.
Nursing-Sensitive Care Measures
In 2004, the National Quality Forum released 15 national voluntary consensus standards for nursing-sensitive care.
The National Voluntary Consensus Standards for Nursing-Sensitive Care: An Initial Performance Measure Set were the first national standardized performance measures for nurses.
Specifically, the NQF standards are designed to “assess the extent to which nursing personnel in acute care hospitals contribute to healthcare quality, patient safety, and a professional and safe work environment,” according to NQF.
The quality standards were endorsed by NQF’s 250-plus member organizations through its formal Consensus Development Process, which it says gives them “special legal standing as voluntary consensus standards.”4
According to NQF, the standards can be used by consumers to assess the quality of nursing care in hospitals and also by providers to identify opportunities for improvement of critical outcomes and processes of care.
The 15 NQF nursing-sensitive care standards include:4
Death among surgical inpatients with treatable serious complications (“failure to rescue”)
Pressure ulcer prevalence
Falls with injury
Restraint prevalence (vest and limb only)
Urinary catheter-associated urinary tract infection for intensive care unit (ICU) patients
Central line catheter-associated blood stream infection rate for ICU and high-risk nursery (HRN) patients
Ventilator-associated pneumonia for ICU and HRN patients
Smoking cessation counseling for acute myocardial infarction patients
Smoking cessation counseling for heart failure patients
Smoking cessation counseling for pneumonia patients
Nursing care hours per patient day
Practice Environment Scale-Nursing Work Index (composite+five subscales)
Transforming the Nursing Work Environment
The Institute of Medicine’s 2004 report, Keeping Patients Safe: Transforming the Work Environment of Nurses, identifies solutions to problems in hospital, nursing home and other healthcare organization work environments that threaten patient safety through their effect on nursing care.
According to the IOM, the report should be considered companion to its To Err is Human report and “puts forth a blueprint of actions that all healthcare organizations which rely on nurses should take.”5
The report presents evidence from health services, behavioral and organizational research, and human factors and engineering to address pressing public policy questions, including nurse staffing levels, nurse work hours, and mandatory overtime The report’s findings and recommendations address the interrelated issues of management practices, workforce capability, work design and organizational safety culture.5
Actions were needed from the federal and state governments, according to IOM, as well as from coalitions of parties involved in shaping the work environments of nurses.5
Nurses routinely depend on their nursing assessment and critical thinking when determining the skills required for addressing patient problems.
Today, the gap needs to be closed on empowering nurses through an identified process to help with delivering evidence-based and safe care practices for patients-in turn preventing errors.
Different healthcare systems use various approaches to accomplish this goal. A comprehensive patient safety tool to assist the nurse with maintaining patient safety may not seem feasible since the list continues to expand.
However, rallying all nurse leaders to teach right at the bedside to help nursing staff incorporate patient safety into their daily nursing practice is an innovative way to help accomplish this goal and to begin to make the two practices-patient safety practices and nursing practice-synonymous.
Nurse educators address the gap to some extent, but all nurse leaders need to assist with this paradigm shift. Might all nurse leaders embark on real-time education at the bedside to help nurses understand patient safety practices are not a separate area of practice from nursing practice today?
Kerfoot, et al. (2006) emphasized patient safety is essentially a new area of focus within hospitals.6
Nurses are the largest group of staff employed in healthcare across the continuum, and the era has already begun where nurses are helping to improve patient quality outcomes and enhance patient safety by collaborating with other healthcare professionals within hospital systems as valued team members.6
Regardless of specialization, patient safety needs to be maintained in all areas of nursing practice.
Providing nursing staff with information on patient safety through this on-the-spot approach will help foster new thought processes for nursing staff – to think of patient safety and nursing practice as one.
Still, there is much that can be done for improving patient safety practices within nursing’s own practice.
Nurse leaders in any sphere can help with this case by embarking on real-time education at the bedside to help emphasize the understanding that patient safety practices and nursing practice today are indeed synonymous.
References for this article can be accessed by clicking here.
Sandra Evans is clinical nurse specialist, acute care, patient care services, Detroit Medical Center, Detroit, Mich.