The general theme of this paper is the importance of safety. The American Association of Colleges of Nursing, otherwise known as AACN, competency chosen was quality improvement and safety. The competency chosen from Quality, Safety Education for Nursing, otherwise known as QSEN, was safety.
The reason for the selection of these competencies is based on the importance of safety within the nursing profession. Safety has become a very prominent factor within nursing. Facilities are scored and ranked on their safety scores which are made public. Many factors play into safety. QSEN states the old definition of safety was individual performance and vigilance to keep patients safe. Their new definition of safety is to minimize the risk of harm to patients and providers through system effectiveness and individual performance (QSEN Institute, 2019). Essentially, the old definition stated that it was up to the individual provider to ensure patient safety. The new definition brings together all aspects of patient care, even those indirectly linked to patient care.
We all know that a medication error is a multi-system failure when it occurs. The physician gives a verbal order or writes the order out, and the nurse picks up that order. Two nurses are supposed to ensure then this order is correct before the order is transcribed and continues in the chain of events. Once the order is submitted to the pharmacy, the pharmacist then checks for the order's accuracy. When the pharmacist deems the order is accurate and safe, the medication is filled and sent to the floor. The nurse administering the medication then checks the order against the medication to ensure accuracy before administration. The old definition was focused on physicians, pharmacists, and nurses. The new definition is broader and focuses on the original group, but included as well are administrators writing the protocol for order entry or order transcription, pharmacy machines dispensing the medication, software used to document medication administration, and even manufacturers of said medication. All of these components work together to play a part in safety. Essentially, if all of the pieces to this complex moving machine are not cared for, well-oiled, and checked frequently for issues, there could be a system failure, which could potentially lead to patient harm.
According to Quality, Safety Education for Nursing, there are core domains. Some of these core domains are culture, leadership, risk identification and analysis, data management and system design, mitigating risk, and external factors. Culture consists of teamwork, patient involvement, education, and training. An example that would fit into this domain would be asking a patient for their home medication list and reconciling their medications with the physician for continuity of care. Risk identification and analysis consist of multiple failures. One failure is latent failure where resources or policies and procedures fail. Active failure is when the system breaks down and there is direct contact with the patient, such as a medication error. Organizational or system failure would relate to management or organizational issues. An example would be if a unit were to be understaffed below accepted or standard nurse-to-patient ratios. Technical failure would be indirect failure such as a pharmaceutical company failing to notify the facility of a drug recall.
According to QSEN, there are 1,100 medication errors daily across the United States that are reported. Weekly in the United States, 40 people have the wrong body part or extremity operated on due to provider error. Other errors related to safety include diagnostic inaccuracies, equipment failure, transfusion errors, laboratory errors, system failures such as short staffing, and environmental hazards. Patient involvement is a very important aspect of ensuring safety. When a patient is involved in reconciling their medications upon admission to the hospital, fewer medication errors might occur, or fewer adverse reactions might occur. When including a patient in a pre-surgical consult and asking them to mark the limb that is to be operated on, fewer errors are likely to occur related to the site. These are all policies, procedures, and protocols implemented because of errors and negative patient outcomes. As we continue to make errors, which do occur because we as providers are human and make mistakes, we continue to learn a better, more effective, or more efficient way of completing a task. It is extremely important to be able to speak of these errors or 'near misses' in order to better care for patients and minimize these errors in the future.
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There have been many inventions and technological advances to assist in preventing negative patient outcomes from occurring. Some of these inventions include auto-safety syringes, needleless hub systems, and more recently bar-coded medication administration. All of these things were invented or implemented due to an issue that arose in relation to some form of patient care. Take auto-safety syringes as an example. These were invented with the thought that they would decrease the incidence of accidental needlesticks. Unfortunately, the auto safety feature of these syringes is only effective when the product is used in the exact way it was intended to be used. If it is not used according to the manufacturer's suggestions, this tool used to prevent needlesticks is ineffective.
As we learn of issues and discover solutions that we can implement to remedy these issues, we must always remember the importance of education. We also must remember that we are nurses and we care about patients. We do not care for monitors. We must assess our patients and use the data collected from the monitors as an adjunct to our skilled assessments. Too many times a nurse has seen a patient flatline on a monitor and call the code only to get to the bedside and realize simply a lead fell off. The nurse's role in regard to safety is one that we must consider to be on the front lines. A lot of responsibilities are placed on the nurse to be the last fail-safe before a negative patient outcome. Going back to the example previously mentioned, the nurse administering the medication is the last person to potentially notice an error and prevent that medication error from being made.
The way in which we will achieve the competency of safety is first through continuing education. It is important to always be on the forefront and know what the current issues are and the solutions available to fix those issues, whether that be new protocols, new policies, new equipment, interdisciplinary involvement, or the culture surrounding the issue. Research in the field of nursing continues to be extremely important as this discovers new ways of handling these issues and what is most effective in preventing errors from occurring. I personally continue to ask, “Is there a better way?”. Sometimes, there is a better way, and if there is, I feel it is my duty as a nurse to attempt to implement that better way. I find myself constantly searching, reading, and discussing; to try and find a more effective and safer way to deliver patient care. If we all stopped learning when we graduate from nursing school, not only would we be providing extremely basic nursing care but we would become stagnant. Education is the only constant in nursing.
Many agencies have also been created to focus on patient safety and safety in general. Some examples of these agencies are the Occupational Safety and Health Administration (OSHA), the Agency for Healthcare Research and Quality (AHRQ), the American Society for Healthcare Risk Management (ASHRM), the National Center for Patient Safety, and the National Quality Measures Clearinghouse. All of these agencies or centers have been formed to keep safety at the forefront of healthcare and maintain adequate levels of safety within healthcare facilities.
In conclusion, patient safety should be our number one priority. Without ensuring our patients' safety, we have done a disservice to them. We need to ensure that we are at our best, emotionally, mentally, physically, and intellectually. We also must ensure every other fail-safe is in perfect, or as close to perfect, working order as possible to ensure we are guaranteeing our patients' safety and leaving nothing to chance.
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