It’s no secret that there are some difficult systemic challenges to address in medicine. A recent survey revealed that addressing issues with the quality of patient care is a priority for many nursing staff members. The fact that this is a forefront issue when many nurses face challenging conditions speaks volumes about the empathy of healthcare staff.
One element nurses and administrators can collaborate on to serve this priority for improving patient care is reducing the potential for medical errors and adverse events. Unfortunately, mistakes can seriously impact patient outcomes, affecting the efficacy of their treatment and overall experience. The good news is that there are practical ways to enhance patient safety, some of which we’re going to explore.
Designing Tailored Safety Protocols
It’s difficult to reduce medical errors and adverse events when there’s an unclear approach to safety. A solid structural framework helps ensure the consistency of measures and supports a culture of risk management. While there are general safety measures for all medical facilities, each space will have its challenges. Therefore, it’s best to take a tailored approach to designing effective safety protocols.
What do we mean by safety protocols? In essence, they are step-by-step plans that guide staff in performing each task safely and with minimal risk of error. Plans should prioritize clarity, communicate the high attention to detail required, and highlight the resources available for staff to complete these tasks. Certainly, nurses have the expertise to safeguard the well-being of everyone involved. Nevertheless, when administrators create solid protocols, most of the ambiguity is removed from operations.
Nursing and other staff should be involved in designing these protocols. Their daily interactions with the nuances of tasks tend to mean nurses have a better understanding of the hazards and how to address them practically. This doesn’t just pertain to patient care, but also the hazards staff face in the workplace, such as violence. One recent report found that 55% of healthcare professionals felt that violence policies are inadequate or ineffective. Involving nurses more meaningfully in policy design can be a route to mitigating these types of adverse events.
Prioritizing Staff Wellness
Facilities and their administrators have a duty to staff welfare. In a job as stressful as nursing, one recent study found that healthcare workers highlighted workplace stressors represented 49% of total work-life stressors. Issues like overwork and exhaustion are not just toxic to employees. They can also lead to errors, overlooked actions, and disrupted patient outcomes.
When focusing on staff well-being, one area leaders and nurses should collaborate on is gaining a better understanding of the potential reasons behind fatigue. Getting insufficient sleep due to late or unpredictable work schedules is a common factor, as is poor diet among professionals who feel they need to rush meals at work. Stress and anxiety may also put the body in an extended flight or fight mode that disrupts sleep, triggers insomnia, and affects exhaustion.
Alongside holding regular meetings to seek feedback, facilities need to change on a systemic level. This might include adapting scheduling approaches to ensure that nurses aren’t risking exhaustion with overlong shifts. It can also involve providing relevant resources that help address staff’s specific challenges.
For instance, those exposed to stressful conditions may benefit from access to subsidized therapy sessions or tools for relaxation, like guided meditation. Even making healthy snacks per the staff’s dietary requirements can boost energy, support efficiency, and minimize errors.
Streamlining with Technology
Some issues that influence medical errors and adverse events are related to inefficient administration. This includes mistakes with medical records and paperwork that put additional time stress on nursing staff. By adopting technological solutions that help streamline these tasks, medical facilities can provide nurses with accurate data and efficient operations that help safeguard patient well-being.
Some examples of these tools include the following.
Records Management Platforms
Effective medical records management involves maintaining the integrity of patients’ medical histories while safeguarding the privacy of that data. Software platforms that enable this provide nursing staff with centralized access to electronic records that are not only easy to search but also automatically updated across the system as changes occur.
In many cases, these tools feature robust counter-intrusion measures that prevent both unauthorized access and tampering with records. The result is that nurses can provide improved quality of care with reduced bandwidth for the errors poor records management can cause.
Artificial Intelligence Software
AI has an increasing presence in healthcare spaces. While these tools certainly can’t replace the expertise or empathy of nursing staff, they can help to streamline some tasks. For instance, AI data entry tools can handle unnecessarily repetitive administration that diverts attention from direct patient care. Not to mention that it can minimize human error. Some platforms can also analyze patient data to make tailored treatment plans. Nevertheless, in using AI to reduce errors, nursing staff needs to be vigilant of the results of these tools, reviewing for accuracy and potential bias.
Conclusion
Reducing medical errors and adverse events helps enhance safety and improve patient outcomes. Some ways to approach this require attention on systemic levels, including developing tailored safety protocols and leveraging streamlining technology. When administrators and nurses meaningfully collaborate on finding and implementing solutions, everyone involved benefits.
Deborah Dolan Hunt, PhD, RN, is an experienced nurse, educator, writer, scholar, full professor at the Dr. Betty L. Forest Dean of the College of Nursing and Public Health at Adelphi University, and author of Springer Publishing’s Fast Facts for Patient Safety in Nursing.
Hunt’s book is a practical resource for common preventable issues and their causes, including medication errors, patient falls, pressure ulcers, infections, and surgical errors. It focuses on strategies for becoming a safe practitioner through education and competency development while highlighting major national safety initiatives with improved outcomes.
Daily Nurse spoke with Hunt about Fast Facts for Patient Safety in Nursing and the impact of this incredible resource. What follows is our interview, edited for length and clarity.
What brings passion to your work?
Many things bring passion to my work. Writing and nursing have always been my passion. Throughout my nursing career, I have had various roles that were all fulfilling. As dean of the College of Nursing and Public Health, I collaborate with my colleagues to prepare our future nurses, advanced practice nurses, and healthcare professionals for their professional practice roles.
I have always been a patient advocate and have focused on patient safety. When To Err is Human was published, the Joint Commission and several organizations developed quality and safety initiatives. I was a hospital-based nurse educator at the time, and a major focus was on patient outcomes. When the QSEN competencies were developed, I was an assistant professor, attended faculty development sessions, and became the QSEN advocate for my peers. Although patient outcomes improved in recent years, the situation worsened. Several years ago, I attended a conference, and the keynote was given by Linda Caputi, who discussed the current state of affairs and the alarming statistics related to quality and safety. This prompted me to research patient safety and outcomes, and since I have published several books with Springer Publishing, I submitted a proposal, which was accepted. Due to the pandemic and my role as interim dean at the College of New Rochelle, the book took longer to write.
What is your role in helping decrease medical errors and improve patient outcomes?
As an educator, scholar, and author, I see my role as a content expert who can bring attention to the issues in a wide area through my articles, books, and presentations. As a professor and dean, I collaborate with my faculty colleagues within the College of Nursing and Public Health and the greater academic and clinical partners community.
Do you have any advice for avoiding medical errors?
Yes, and my books include many strategies based on my experience and literature review. There are several ways to avoid errors. Knowing the issues and statistics broadly and in one’s healthcare setting is important.
One of the important ones is for everyone to become a patient safety ambassador with a commitment to a culture of safety. Written and verbal communication has been identified as a frequent cause of errors, requiring education and policies to address these issues. Policies and procedures should be based on current evidence and reinforced at least annually. Nurses and other healthcare practitioners must develop critical thinking and clinical judgment skills. They must commit to lifelong learning, self-care, and patient advocacy. Engaging in self-care and truly being present with the patient is vitally important.
Hospital administrators must commit to quality and safety and maintain staffing ratios and mix. Patients and families need to take an active role in their care plan, as studies show that when patients are engaged, there are better outcomes. Medication errors and infections are some of the most common and require hypervigilance. Each healthcare organization must identify its strengths and weaknesses and develop approaches to improve quality and safety and prevent adverse outcomes.
The last chapter addresses patient safety using a holistic approach of cultural humility and artificial intelligence. Can you talk about that?
This chapter covers topics that are related to patient safety. First and foremost, in most situations, a holistic approach is warranted, mainly when focused on patient outcomes, as patient safety and quality are complex. However, it means that one should apply only some of the strategies at the same time. Cultural humility allows one to be open to others’ beliefs and attitudes. Some posit a correlation between cultural humility and perceptions of patient safety (Handtke et al., 2019; Hook et al., 2016). Artificial intelligence and technology are not new but are constantly changing and being reimagined and are correlated with improvements in patient outcomes. Still, there is a certain amount of risk, such as security breaches, that must always be considered.
Meet the Author
Deborah Dolan Hunt, PhD, RN, is an experienced nurse, educator, writer, and scholar. She is a full professor and the Dr. Betty L. Forest Dean of the College of Nursing and Public Health at Adelphi University. She is a Professor Emerita from The College of New Rochelle, past Associate Dean at Mercy College, and a New York Academy of Medicine Fellow.
Hunt is on the editorial board of DailyNurse.com and serves on the Personalized Medicine Coalition Advisory Panel, and is a guest editor for Frontiers. She is an Ambassador and Reviewer with PCORI (Patient-Centered Outcomes Research Institute). She serves as Co-Chair of the Health and Human Services Committee at Community Board #10, spearheading a healthy lifestyle initiative. She is a member of the Talent Acquisition Committee at the Westchester County Association and the Nassau Suffolk Executive Council. She was the PI of the HRSA grant at CNR and facilitated its transfer to Mercy College and is currently one of the Activity Directors for the Title V Access grants. Her research interests include leadership, patient outcomes, new nurse transition, and mentoring.
In addition to academic writing, Deborah also publishes children’s books, and the 2nd edition of her self-care book “Essential Oils, Teas, and Self-Care” will be released by Clear Fork Publishers.
In the Covid era, we often hear (and can’t help but understand) that older nurses, resources exhausted by their pandemic ordeal, are retiring early. Nurse of the Week Mercedes “Mercy” Kallal, RN, however, has been a nurse for over half a century now and at 83 years old she just isn’t ready to hand in her stethoscope. She tried once, about a dozen years ago, but even after working the Covid-19 frontlines—in her 80s, mind—there’s no evidence that Kallal might be running out of steam.
By now, it’s hard to imagine the post-anesthesia care unit (PACU) at New Jersey’s Jefferson Washington Township without the diminutive RN (Mercy is barely five feet tall). Fortunately, Kallal finds her work so meaningful that she’s in no hurry to hang a “Gone Fishing” sign on her door. “As long as I am mentally and physically able, I would love to dedicate my remaining life to taking care of patients … and help[ing] people,” she told the Philadelphia Inquirer. The Daisy Award winning RN seems to thrive on helping staff as well as patients; she’s the first person they call when someone needs a holiday or evening off, and the hospital even lauds her willingness to “help… younger co-workers balance life and work.” Jefferson Washington VP of Operations Autum Shingler-Nace happily describes Mercy as “A nurse’s nurse.”.
“What the heck is this? I was supposed to become a nun.”
This does not mean that Kallal is an ascetic lady-with-a-lamp who lives only for her patients. She has been a widow for years, but always has plenty to do. When off duty, she loves to travel, hit some casinos, and watch horse races. To wind down, she works in her garden.
Nonetheless, nursing truly is the life calling of this small gambler. In fact, Mercy’s husband entered her life as one of her patients.
After Arthur Kallan was discharged from the hospital, the feisty little nurse who had cared for him loomed large in his mind. Initially, when her former patient began to call and said that he missed her, Mercy was nonplussed, to say the least. The devout Roman Catholic recalled, “I thought, ‘What the heck is this? I’m supposed to become a nun.’ But we started dating.” In fact, the match worked out so well that she acquired her fondness for horse races from her patient-turned-spouse.
Kallal’s nursing career began in the Philippines, where she graduated from nursing school, and ventured to the United States in 1969. When she and a few fellow grads landed in Philadelphia, the newly arrived nurse says, “They put me in charge of 32 patients, and when I asked why, they said it was because I had a big mouth… I didn’t know the idiomatic expression, so I took it literally.”
After that, the nurse gravitated to Newark. Apparently, her mouth was not quite the right size yet for New Jersey (there is a checkpoint when one enters the state), so before long Mercy returned to Philly and picked up a range of nursing experience, including a VA hospital, a nun-managed nursing home, and finally, the heart transplant unit at Temple University, where she settled for two and a half decades.
“We keep thinking she’ll slow down a bit, but she keeps picking up more shifts.”
As she completed her 25th year at Temple, though, Mercy decided that she had had enough and DID retire… for a bit less than a year.
It was a delight to indulge in nearly 11 months of travel, but her savings began to dwindle, and now in her 50s, she still had an overabundance of energy and nursing beckoned to her once more. Widowed and living alone with no immediate family in the US, she took stock and thought it was time to work again “before I become a pauper,” and besides, “I live[d] by myself now. How much can you clean?”
By this point in her life, Kallal’s mouth must have been just the right size for NJ and the hospital now operating as Jefferson Washington Township was a mere 5-minute drive from her home (another reason she’s everyone’s go-to when someone needs to be covered). Into her 70s by then, Mercy began by taking things slowly and worked part-time, but that didn’t last for long. As a PACU co-worker told the Inquirer, “We keep thinking she’ll slow down a bit, but she keeps picking up more shifts.”
Patients, Mercy is not here for your careless risks
Since then, in addition to becoming known for her willingness to cover shifts whenever possible, Kallal is the unofficial PACU Health Martinet. She does not hold back when patients are disruptive, abusive, or take dangerous risks, and co-workers have been known to shamelessly throw particularly difficult charges on their Mercy. Her view: “I’m very strict and I explain to the patient that this is the way it has to be. You have to listen to your nurse.” But she adds, “And before they leave, they give me a hug and a kiss.” The kind-but-firm Philippine-born RN also meets any misguided obstinacy over masking or vaccination head-on—or something like that: ”I tried to explain getting vaccinated to one patient and she just looked at me like I had two heads. But at least I did my job as a nurse.”
To read the full story—and see more pithy Mercy quotes—click here.
Well, things are changing quite drastically in the U.S. due to the ongoing pandemic. While first writing this article, things were actually looking good for the U.S. We thought we were seeing light at the end of the tunnel due to the numerous vaccines and a large number of Americans being vaccinated. COVID-19 cases were decreasing, many states were confident and had thus eased restrictions and regulations surrounding social distancing, allowing businesses to open up. Healthcare providers who have been ensuring patient care via virtual means were also opening up for in-person visits. Unfortunately, things did not remain positive for long – the pandemic is far from over.
COVID-19 cases in certain states are once again rising with increasing the pressure on healthcare providers. Once again, some hospitals are choosing to postpone elective procedures, whereas others are updating visitation policies for the patients. Moreover, hospitals are now getting filled with regular patients as well as COVID-19 patients. Thus, healthcare providers must focus on enhancing patient safety and risk management to reduce unwanted incidents and enhance healthcare outcomes.
COVID-19 has changed everything
The pandemic has changed everything for the entire world – one can say that it has shaken the word’s core, figuratively. For instance, many of us are still working remotely and practicing social distancing. However, the biggest changes, arguably, occurred in hospitals and health systems – telehealth became one of the only ways to ensure patient care during the pandemic and it looks like telehealth will become a permanent part of healthcare. Before diving into patient safety and risk management in the post-pandemic era, let’s see how it was before the pandemic.
1. In patient safety and risk management, patient misidentification is a common theme
Quite simply, patient safety focuses on preventing patient harm during the treatment process so that unwanted incidents don’t hamper healthcare outcomes.
Now patient safety incidents occur because several reasons, such as diagnostic testing errors, medication errors, patient falls, among other issues. While these topics have been widely discussed by experts, let’s take a look at a less discussed but crucial problem that causes patient safety incidents in many ways – patient misidentification.
Patient misidentification isn’t anything new – in fact, it has existed for decades due to a variety of reasons. However, a lot of patient safety incidents can be traced back to patient misidentification.
2. Patient misidentification causes patient record mix-ups
This one’s quite simple – when a patient comes for an in-person visit, s/he is assigned the wrong medical record due to misidentification. As a result, any subsequent action will most definitely lead to a patient safety incident as the patient will receive wrong treatment, medication, and so on.
However, if by some miracle, the patient who came in doesn’t face any harm – does it mean that future patient safety incidents won’t occur? What about the patient whose EHR was used?
3. Patient misidentification jeopardizes patient data integrity
This answers the question asked in the previous point. Whenever a medical record is used for someone else other than the actual patient, it leads to patient data integrity failure. Not only is the information in the EHR corrupt, but it also becomes quite dangerous. Just imagine that the patient who has heart disease is getting prescribed medication for chronic kidney disease – the consequences can be quite disastrous!
4. Patient misidentification generates preventable medical errors
This is closely tied to the previous points and is a consequence of them. When a patient is misidentified, they will be getting the wrong treatment, radiation overdoses, blood transfusion errors, wrong medication, and so on. While patients are usually misidentified during the registration process, it might also occur during treatment, and both of them lead to detrimental healthcare outcomes. However dangerous these events might seem, they are entirely preventable if patients are accurately identified.
While these were some of the patient safety and risk management issues in the pre-pandemic era, what do caregivers need to do in the post-pandemic one?
5. Improving patient safety in a post-pandemic world
To be honest, there are still many unresolved issues within healthcare facilities that jeopardize patient safety and risk management. However, the pandemic has added more issues into the mix – as a result, caregivers need to work on all of the problems simultaneously.
So, how can caregivers focus on patient safety as some of them are opening their doors to in-person visits?
Continue providing virtual healthcare sessions
Starting off, we all know how the pandemic has shown the many advantages of telehealth. Fortunately, a lot of patients have accepted telehealth and are even wanting to continue using it after the national health emergency is over.
If the caregivers continue to provide telehealth services, they can keep patient volumes down within their facilities and continue treating everyone. This ensures patient safety as lesser patients come in for in-person visits and keep HAIs (hospital-acquired infections) at bay.
6. Ensure everyone is properly wearing PPE
While it looked like the pandemic was waning in the U.S., COVID-19 cases have increased once again. We’re still at a critical stage, and as new infectious and dangerous variants are popping up, healthcare providers must ensure the safety of everyone that comes into their facilities.
Enforcing PPE usage on everyone is the only way to safeguard both patients and caregivers. While restrictions might have eased for other industries, enforcing PPE usage on people who visit the hospitals can reduce infections and even save lives in the process.
7. Utilize solutions that eliminate physical touch
Due to the pandemic, many organizations are working towards innovative solutions, one of which is making them contactless or at least reducing the number of physical interactions required. This is more applicable for healthcare facilities, as these are places where patients might become victims of HAIs.
While many organizations are coming up with contactless solutions, some already exist, for instance, many healthcare providers are using a touchless patient identification platform. Not only does such a solution help ensure positive patient identification, but it also reduces the risk of HAIs as it’s contactless.
Hospitals must protect patients at all costs
Patient safety incidents have always been an issue of the U.S. healthcare system, and with COVID-19 cases spiking once again, it looks like hospitals and health systems have their hands full. However, with careful planning, utilizing appropriate strategies, and making informed decisions, hospitals can prevent deaths, medication errors, mix-ups, and more – improving patient safety in the process.
Fall prevention and mitigation of patient injury if a fall does occur is a critical part of a hospitalized patient’s plan of care. Having a comprehensive strategy in place to prevent in-hospital falls has grown challenging in recent years. Patients are getting older and sicker, the nursing workforce is aging, and of course, hospitals and caregivers are wrestling with the enormous pressures and limitations created by the pandemic. To work around these obstacles, the healthcare industry must become more aggressive in its approach to fall prevention and improving patient outcomes.
Patient falls continue to be a common adverse event reported in hospitals. Every year, between 700,000 and 1 million people fall while being treated in the hospital. It is also estimated that up to 11,000 U.S. patients die annually due to injuries sustained from a fall during hospitalization.
Not only is the cost of these falls to the healthcare system enormous—$20 billion annually—but the Centers for Medicare and Medicaid Services (CMS) is no longer reimbursing providers for treating patient injuries resulting from falls in a hospital.
For patients, the long-term effects of falls can be debilitating. Caregivers are also equally impacted. From a personal perspective, during my time working at the bedside on a MedSurg unit, I have personally experienced two patients falling during my watch. It is something I will never forget from an emotional perspective, and how draining it was on both the individual and team morale on the unit. My current clinical work today is in the hope that no other nurses or patients have to endure another patient fall.
Today, the criticality of patients is increasing. Nurses are seeing sicker patients than ever before. Patients are also living longer, with those 65 years and older representing nearly 40 percent of hospitalized adults. Nurse-to-patient ratios have also gotten out of balance, which can lead to fatigue, burn-out, and mistakes. In my experience, on any given night, a Med/Surg nurse could have up to eight patients at one time in his or her care. When you couple this with the fact that the nursing workforce is aging, a potential shortage could also pose big problems. The onset of COVID-19 has also presented its set of challenges.
For nurses, the restrictions that caring for a patient in the COVID “bubble” has placed on them–from donning and taking off PPE to the limited interaction they can have with patients–is something very new and hard to navigate. These protocols can leave patients susceptible to falls. Additionally, there are concerning reports that many COVID patients experience delirium, which also elevates the risk level for falls.
There are a number of ways hospitals can address these challenges to help improve patient outcomes.
One of the most important is improving bed technology—including standardization and interoperability. One studyshowed that 79% percent of falls were unassisted. In addition, 85% of falls occurred in the patient’s room. The problem is many hospitals today use multiple generations of beds, all with varying degrees of technology and options. This makes training on beds much more challenging. Hospitals should consider standardizing their beds to one specific kind, as this helps support a nurse’s interaction with the bed becoming a hardwired process and promotes easier decision-making. Thankfully, technology has arrived to help achieve these ends.
Stryker, for example, just came out with a new bed, the first of its kind, that can connect wirelessly to any nurse call system and can be used for all acuity levels. Called ProCuity™, this “intelligent” hospital bed not only helps alert nurses if a patient is out of position or has left the bed, it also eliminates difficult tasks like ensuring a nurse call cable is properly plugged in. By streamlining usability, training, and maintenance, technological advancements like this help hospitals make their beds work better for patients and staff.
With wireless technology, hospital beds can be connected to any nurse call system.
Another important fall prevention strategy is data analysis. Numbers don’t lie and so one of the best ways to ensure a hospital’s fall prevention strategy is on track is to routinely monitor and analyze data around fall rates. By determining the cause and type of falls that occur, hospital administrators have a 360-degree view of the issue and can take forward-thinking action to prevent reoccurrence.
Communication is also paramount. When a fall occurs, all appropriate stakeholders in charge of a patient’s care should conduct post-fall huddles to assess all the factors that contributed to the accident and plan an appropriate mitigation strategy. Effective after-action review may also improve team performance by 20-25%. Likewise, nurses should communicate with their patients—what I call teach-back education. By asking open-ended questions about their well-being and state, nurses can help identify potential fall risk problems beyond just finding a shaky grab bar in the bathroom.
When it comes to fall prevention, there is no one size-fits-all-plan. But as the pandemic and other healthcare challenges have shown us, we can no longer be reactive in our planning. With better technology, more data, and increased education and communication, we can more quickly reach our desired outcomes—improving the safety of our patients and caregivers.
After Arthur Kallan was discharged from the hospital, the feisty little nurse who had cared for him loomed large in his mind. Initially, when her former patient began to call and said that he missed her, Mercy was nonplussed, to say the least. The devout Roman Catholic recalled, “I thought, ‘What the heck is this? I’m supposed to become a nun.’ But we started dating.” In fact, the match worked out so well that she acquired her fondness for horse races from her patient-turned-spouse.
