Making Patient Safety Job One: Nurse-led Initiatives


By Jennifer Larson, contributor

When it comes to patient safety, the magic number is zero. Zero errors, zero infections, zero falls, zero problems. That’s the aim of every hospital and healthcare organization. Even hospitals with stellar patient safety records want to improve.

Nurses ensure patient safety through countless tasks that they perform every day at the bedside, noted Martha Cangany, DNP, RN, ACNS-BC. For example, they monitor patients for clinical deterioration, detect errors and near misses, and understand the care processes--and weaknesses--in some systems.

“Nurses spend more time with patients than any other providers of care,” said Cangany, a medical-surgical clinical nurse specialist with Franciscan St. Francis Health in Indianapolis. “We truly oversee all that is occurring with that patient.”

So it makes sense that nurses are leading the way to find new and innovative ways to improve patient safety.

Take Children's Mercy Hospital in Kansas City. A team of nurses decided to tackle their CLABSI (central line-associated bloodstream infection) rate. They decided that a quarterly audit of all central lines on one particular unit would provide an opportunity to discuss potential barriers and problems to lowering the rate with the nurses providing care for those patients. The bedside nurses responded very positively to the extra attention and opportunity for conversations with their peers.

“We had open communication and real-time feedback,” said team member Jessica Jameson, BSN, RN, CCRN.

Jameson and her team eventually won a People’s Choice award during the National Patient Safety Foundation’s 2015 Congress for their poster titled “Innovative Auditing to Enhance Frontline Nurse Participation in Reducing CLABSIs.”

“Nurse are absolutely the front line and can make a huge impact on patient safety,” said Jameson, adding that her hospital has continued with the quarterly audits because they have been so successful--and they hope to possibly roll out some version in other units at the hospital.

As we approach Patient Safety Awareness Week, March 13-19, consider a few other examples of nurses leading efforts to improve patient safety in their facilities and organizations:

Patient falls. With the help of a grant from the American Association of Critical-Care Nurses’ Clinical Scene Investigator (CSI) Academy, the Progressive Care Unit at Franciscan St. Francis Health became a No Fall Zone. Bedside nurses were empowered to educate their fellow nurses and staff members, as well as patients and families, about decreasing patient falls. On one unit alone, they drastically reduced the number of falls that patients experienced--a 70 percent reduction, Cangany noted. Plus, the initiative saved nearly $250,000 in associated costs over two years. “To see that we’ve had a decrease in our total number of falls and falls with injury over the course of the year brings great joy to me professionally as well as personally,” said Cangany.

Pressure ulcers. As part of AACN’s CSI Academy, a team of nurses at St. David's North Austin Medical Center in Texas launched an initiative to reduce hospital-acquired pressure ulcers. Their “Keep Austin Intact” program focused on educating nurses and other staff about prevention, documentation and treatment, starting with a series of drop-in educational sessions. More than 200 nurses, or nearly 50 percent of the nursing staff, attended the sessions. The organizers estimated that their efforts to reduce pressure ulcers saved the hospital at least $58,000 per year.

UTIs. A nurse-driven protocol at a long-term care facility on the Gulf Coast was responsible for decreasing a very high rate of urinary tract infections among patients. The initiative also addressed the over-prescription of antibiotics and decreased the use of Foley catheters among patients who didn’t actually need them, which tends to decrease the risk of getting an infection. The results were presented at the American Association of Nurse Practitioner’s national conference in 2015.

If you have an idea for a strategy or program to address some patient safety concern at your facility, don’t be afraid to speak up. Your knowledge of your patient and his or her situation is invaluable.

“Nurses’ vigilance at the bedside is instrumental to assure patient safety,” said Cangany.

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