Best Practices for Patient Safety: Know More, Do More


By Debra Wood, RN, contributor

Despite all of the safety improvements one hears about in U.S. hospitals, statistics suggest more than 1,000 people die each day due to preventable hospital errors, according to The Leapfrog Group, which recently released its Fall 2014 Hospital Safety Score. Every nurse wants to work in a safer hospital, and staff nurses and travel nurses alike are a large part of making that happen.

In fact, when considering assignments, travel nurses may want to ask about the hospital’s safety track record, culture and processes.

More than a quarter of the 2,500 reporting general hospitals, 790, earned an “A” as their hospital safety score. But that is not a perfect indicator. Even “A” hospitals make mistakes, and sometimes patients are harmed, said Leah Binder, president and CEO of The Leapfrog Group, a nonprofit organization that aims to improve quality, safety and transparency in the nation’s health system. Yet the Hospital Safety Score is a good starting place for consumers and travel nurses to begin comparing hospitals, she said.

Many “A” hospital leaders shared how nurses are responsible for their high ranking, including having a say in how process improvements are made. While travel nurses would not be serving on hospital committees or shared governance councils, they are on the front lines of delivering safe care.

“We’ve been able to enhance outcomes because we have been able to engage the frontline team,” said Christina McGuirk, RN, BSN, MSHA, NEA-BC, chief nursing officer at Health Central in Ocoee, Fla. “It’s a multidisciplinary approach. We have nurses alongside pharmacy, radiology, reaching toward the same goal: optimal patient experiences and better outcomes.”

Health Central posts metrics data, so everyone working on the unit can see where additional action is needed. Transparency and sharing the background about why something happened empowers nurses to try harder.

Dianne King, RN, MA, CPHQ, director of quality at Cleveland Clinic Florida in Weston, Fla., credited high-reliability nursing care with contributing to its “A.” Nurses consistently pay attention to evidence-based bundles and protocols.

“Adherence to safe practices, careful assessment with regular reassessments is essential to mitigating the risk of many hospital acquired conditions, like pressure ulcers or an injury from a fall,” King said.

Hospitals such as Cleveland Clinic Florida or Memorial Regional Hospital in Hollywood, Fla., empower nurses to “stop the line” and address high-risk concerns. Nurses at Memorial Regional receive a financial award for stopping the line if it prevents a risk of harm to the patient. They also receive recognition from the hospital’s chief executive officer for truly putting the “Patient First.”

“A critical measure of hospital safety is open communication in an atmosphere of trust where nurses are encouraged and comfortable with regularly providing safety-related information for process-improvement actions,” King added.

A safe and just culture is important, with attention toward safety a top focus on each shift.

“We’ve moved from a culture of blame,” said Maggie Hansen, RN, chief nursing officer at Memorial Regional. “We analyze the processes that contributed to that event almost or actually occurring.”

Memorial nurses believe they can completely avoid some hospital-acquired conditions. And the hospital recognizes their efforts. It rewards units as “Zero Heroes” if they go for one year without one safety mishap. Nurses share stories about their near misses, so everyone can learn from them.

The Leapfrog Group recognizes organizations with a learning culture, team collaboration and communication, and a strong culture of nursing, added Mary Robinson, RN, PhD, NEA-BC, chief nursing officer at Texas Health Harris Methodist Hospital Southwest Fort Worth.

“The key to improving is looking at overall performance, and when there is a fallout, looking at what we can do differently,” Robinson said.

Travel nurses are often brought in to assist with staffing, but they can still ask about general staffing levels and the degree of collaboration with other professionals. Nursing metrics are part of Leapfrog scoring, not just nurse-sensitive outcomes, such as pressure ulcers and falls. Leapfrog also incorporates the National Quality Forum safe practice in nursing workforce and Magnet status into the scoring. Binder said that The Leapfrog Group survey is the only such survey to consider nursing indicators, such as staffing and nursing influence.

“Patient safety is nursing; it’s about nursing,” Binder said. “You don’t have a safe hospital without great nursing leadership and influence.”

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