Since we were kids and began to explore our homes and the world around us, we would often be given a caution: safety first.
As nurses, it’s important to do everything possible to keep yourself as well as your patients safe. Patricia McGaffigan, RN, MS, chief operating officer and senior vice president of programs for the National Patient Safety Foundation (NPSF), took time to answer some questions about safety. What follows is an edited version of the transcript.
What are some of the most important tips that nurses need to know regarding patient safety?
Nurses must know that their safety is essential for patient safety. They should engage in and communicate worries on leadership walk rounds. There are many ways nurses can be involved in safety at their own level. For example, they can look for ways to champion care. Substandard care is not acceptable, and understanding reporting mechanisms for any related concerns is important. Understanding that error/harm is nearly always the result of systems issues.
What should nurses do if they make a mistake that results in possible patient harm/injury?
Typically, it is a chain of events that leads to an error, so the concept of a single person making a mistake is not really how we look at it at NPSF. In my talks, I usually ask folks if they have been involved in the care of a patient where a medical error has occurred, especially at the proximal, sharp end.
The first thing they should do is to ensure that the patient is receiving any immediate care that they need, which may range from observation to serious, high-level interventions necessary to stabilize or save the patient. And they should be honest in reporting all details of what happened to ensure that patients are receiving the most appropriate and comprehensive care. Nurses should understand how to report error, the process for RCAs, and asking for feedback on any outcomes and recommendations from those processes. Then there’s the issue of how to provide accurate and timely communication to patients and families.
Nurses should get help for any emotional distress they may be having, which includes immediate distress, and recognizing that their distress may be long term and require ongoing support to maintain their emotional health.
What are the most common tips that brand new nurses should know so that they can keep their patients safe? What about keeping themselves safe?
All nurses should be aware of practice policies and guidelines of their organization related to all aspects of patient care. They should immediately question anything if they are not informed or are concerned about risk—speak up and don’t be ashamed if you’re worried. They can learn how to appropriately express their concerns using a methodical approach to communications, such as SBAR [Situation, Background, Assessment, Recommendation].
They should include any patient/family reported concerns, because often they are an important barometer of whether a patient may be “different.” This is especially true, for example, in pediatric patients, where parents are often the best early warning system. They should ask more senior nurses or others on the care team for their advice and support. They should complete a foundational safety science course if they have not had one in their training, and look with enthusiasm to education/training/simulation exercises offered by their organization.
All nurses should be trained in ergonomics, safe patient handling, proper use of PPE [Personal Protective Equipment], and disposal of contaminated materials (including needles/sharps). They should come to work well rested, ensure they have time for breaks and nutrition, and that they understand the limits of human fatigue. They should look for and take advantage of peer support programs and training. They should know how to report any harm to themselves.
Some people tend to get scared in the hospital, rehab center, or any place they would be treated by nurses. What can nurses do to alleviate their fears?
Again, communication is important and can help allay fears. We recommend that health professionals get educated about the prevalence of low health literacy and tools and tactics they can use to improve communication with patients/families. Nurses—and all clinicians and staff in a health facility—should be sensitive to cultural issues, language differences, use of translators, and the like.
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