Introducing Nursing Students to an Environmental Safety Assessment Through Simulation

In response to the Institute of Medicine report criticizing health care professionals' competence in providing safe patient care, health care educators were challenged to transform their nursing programs. One powerful tool in developing competent nurses, without endangering patients, is simulation. This article discusses advantages and disadvantages of using simulation as a teaching strategy and describes how to teach environmental safety concepts to beginning nursing students, through a simulated patient room using an environmental safety assessment.     

An Introduction to Patient Safety

A brief historical background of today's patient safety movement helps us to understand how the leap was made from safety in other industries to that in health care. Although comparing studies on adverse events in various countries is difficult, an attempt is made to emphasize both their scope and cost in the United States, Australia, the United Kingdom, and Canada. Sources of error are then examined and a variety of concepts are introduced, namely, human and systemic error; active failures and latent conditions; the Swiss cheese model; and normalization of error. A human versus a system approach to adverse events is also examined.The four basic building blocks or the four Cs of patient safety are reviewed. They are: changing the culture of safety, collecting the data through incident reporting systems, calculating the risk to patients, and clinical audits. This is followed by a review of the three essential supporting activities, namely human factors engineering, effective communication, and staff education on patient safety. Current patient safety initiatives are summarized, along with high reliability organizing concepts and system barriers to health care safety. The article concludes that many adverse events are preventable and that they happen in all areas of health care, and calls for an orderly and comprehensive approach to patient safety. It also concludes that the four Cs of patient safety must be supported by the other three patient safety activities.     

Patient Participation: Current Knowledge and Applicability to Patient Safety

Patient participation is increasingly recognized as a key component in the redesign of health care processes and is advocated as a means to improve patient safety. The concept has been successfully applied to various areas of patient care, such as decision making and the management of chronic diseases. We review the origins of patient participation, discuss the published evidence on its efficacy, and summarize the factors influencing its implementation. Patient-related factors, such as acceptance of the new patient role, lack of medical knowledge, lack of confidence, comorbidity, and various sociodemographic parameters, all affect willingness to participate in the health care process. Among health care workers, the acceptance and promotion of patient participation are influenced by other issues, including the desire to maintain control, lack of time, personal beliefs, type of illness, and training in patient-caregiver relationships. Social status, specialty, ethnic origin, and the stakes involved also influence patient and health care worker acceptance. The London Declaration, endorsed by the World Health Organization World Alliance for Patient Safety, calls for a greater role for patients to improve the safety of health care worldwide. Patient participation in hand hygiene promotion among staff to prevent health care—associated infection is discussed as an illustrative example. A conceptual model including key factors that influence participation and invite patients to contribute to error prevention is proposed. Further research is essential to establish key determinants for the success of patient participation in reducing medical errors and in improving patient safety.Patient participation is a complex concept and arises from the widespread consumer movement of the 1960s that affirmed the consumer''s right to safety, the right to be informed, the right to choose, and the right to be heard.¹ During the past few years, patient participation has been increasingly recognized as a key component in the redesign of health care processes and successfully applied to some aspects of patient care, notably the decision-making process and the treatment of chronic illness. Recently, increasing patient participation has been recommended to improve patient safety. The World Health Organization (WHO) World Alliance for Patient Safety is actively highlighting the role that patients and their families could play in the improvement of health care.² However, this field of patient participation has not been widely researched thus far.We review the underlying principles and the efficacy of patient participation in decision making and self-treatment of chronic illness, as well as the potential obstacles to implementation. Building on these principles, we develop a conceptual framework for patient participation. Finally, we suggest that patient participation could be useful to improve quality of care and prevent medical errors and propose an agenda for research.     

Complying with the 2008 National Patient Safety Goals

IN 2003, THE JOINT COMMISSION began publishing National Patient Safety Goals (NPSGs) and requiring accredited health care organizations to comply with these goals in an effort to reduce the number of medical errors.THE NPSGS ARE UPDATED yearly with new requirements to promote specific improvements in patient safety.THIS ARTICLE PROVIDES A REVIEW of the 2008 NPSGs and suggests ways in which information technology systems can address health care organizations' compliance with some of these goals.     

Designing a Patient Safety Undergraduate Medical Curriculum: The Telluride Interdisciplinary Roundtable Experience

Purpose: Patient safety has emerged as a global concern in the provision of quality health care, and yet, to date, few medical schools have created and/or implemented patient safety curricula. The purpose of this article is to introduce readers to one model of a patient safety undergraduate medical curriculum, as designed by a group of experts attending an annual interdisciplinary roundtable assembled for this purpose. Summary: The Annual Telluride Interdisciplinary Roundtable met in 2005 and 2006 to design what it considered to be a comprehensive patient safety curriculum for medical students. Invited members included stakeholders from a variety of fields, including health care providers, senior health care administration, students, residents, patient advocacy leaders, and curriculum development/assessment experts. The group developed a list of general curricular principles, followed by 11 specific elements felt to be essential to an effective patient safety curriculum for undergraduate medical education students. It also identified a number of challenges to implementing such a curriculum. Conclusions: A patient safety curriculum, developed by a group of experts for an undergraduate medical education population, was successfully developed over a two-year period of time. Future meetings of the Telluride Roundtable group have centered on evaluation and refinement of these curricular elements as pilots occur in a number of medical schools, and new curricular ideas continue to be developed. Continued interprofessional dialogue and collaborative research will enable the development and implementation of a standardized longitudinal patient safety student curriculum.     

The Influence of Patient Safety Culture and Patient Safety Error Experience on Safety Nursing Activities of Emergency Nurses in South Korea

IntroductionThe unique nature of the space and environment of emergency departments is a threat to patient safety. Enhancing patient safety and minimizing safety-related issues are important tasks for ED health care staff. The purpose of this study was to examine the relationships among patient safety culture, patient safety error, and safety nursing activities of emergency nurses in South Korea.MethodsA convenience sample of 200 emergency nurses working in 12 general hospitals in South Korea were surveyed for safety nursing activities using the Hospital Survey of Patients’ Safety Culture, a 4-item questionnaire for patient safety error and ED safety management items in the Guidelines for Patient Safety (seventh revision).ResultsHierarchical regression analysis revealed that the potential factors associated with safety nursing activities were safety training experience (β = 0.180, P=.01), organizational learning–continuous improvement (β = 0.170, P=.04), age (β = 0.160, P=.02), and implementation of domestic and foreign accreditation (β = 0.147, P=.03).DiscussionTo improve patient safety, it is essential to identify problems in medical institutions, determine areas of improvement, and improve the organization’s patient safety activity system on the basis of patient safety error experience reports. After training the emergency nurses for continuous improvement, the effect of patient safety activities must be analyzed.     

患者安全课程的国际比较研究与启示

目的探索国外患者安全教育发展现状与趋势,为我国构建患者安全教育课程提供可借鉴的科学依据。方法采用教育研究中的比较研究法,辅以文献法,采取同类横向比较、定性比较的方法,对6所美国医学院校、2所英国医学院校及2所加拿大医学院校患者安全课程设置的共同性、差异性进行比较。结果美国、英国、加拿大3个国家的医学院校在患者安全课程的学时和教学对象上存在差异;3个国家都涉及对学生患者安全实际能力的培养,但要求不一;国外患者安全课程包括以单一的安全主题为主的课程和涵盖多个患者安全相关主题的综合课程,其中以美国患者安全课程内容最广泛、教学方法灵活多样、教学评价方法形式不一,但大多院校较重视对患者安全理论知识的测试。结论国外医学院校在患者安全教学上积累了丰富的经验和资源,对我国开展患者安全教育具有重要启示。     

Tying a Knot in the Unraveling Health Care Safety Net

The U.S. health care system continues to rely on a diverse and poorly organized health care safety net to provide care for its uninsured and underinsured residents. Last year, the Institute of Medicine (IOM) published a report entitled America's Health Care Safety Net: Intact but Endangered. The IOM cited several threats to the safety net, including inadequate monitoring of safety net function, poor integration of services, financial threats for core safety net providers, and the destabilizing effects of a rapid shift from traditional Medicaid to Medicaid managed care products. This paper reviews the findings of the IOM report, highlighting the key issues for emergency medicine. In response to the IOM's challenges, emergency departments should be used more effectively to monitor local safety net viability and to enhance the integration of community health care safety net delivery systems.     

Patient safety, elephants, chickens, and mosquitoes.

Five years after the landmark report by the Institute of Medicine, To Err is Human (2000), many of us still grapple with making care safer for patients. This article broadly describes how patient safety fits into the picture of quality, concepts in patient safety, and practical safety processes you can implement today.     

Teaching Patient Safety: Conference Proceedings and Consensus Statements of the Millennium Conference 2009

Purpose: The 2003 Institute of Medicine's report “Health Professions Education: A Bridge to Quality” argued for the education of health professionals in patient safety. In response to this call, a number of organizations and institutions have developed frameworks and curricula that provide the educational foundation essential for learning about patient safety. However, there is limited guidance on strategies for implementation of training programs in patient safety. Summary: We convened the “Millennium Conference 2009: Patient Safety—Implications for Teaching in the 21st Century” to develop concrete approaches to teach patient safety in undergraduate and graduate medical education. We selected 9 medical schools through a competitive application process to participate as school teams. We led attendees through structured discussions on three topics: (a) promoting a culture of patient safety, (b) implementing patient safety content into preexisting curricula, and (c) providing faculty development. School teams also met to refine their current local initiatives in patient safety teaching. Conclusions: A group of committed stakeholders gathered to collectively consider strategies for the integration of patient safety education into undergraduate and graduate medical education. The recommendations from this conference proceed from consensus reached by the participants.     

America's Health Care Safety Net Intact or Unraveling?

In virtually every community in this nation, the emergency department (ED) is an integral part of the health care safety net, often serving as the only available point of access to the health care system for many vulnerable and disenfranchised individuals. The authors present a brief overview of the March 2000 report released by the Institute of Medicine that described and assessed the current status of the nation's health care safety net. The authors discuss the role of the ED as a safety net provider and as a window onto the status of the rest of the health care system. The authors describe the Andersen behavioral model of health services use and suggest it as a useful theoretical framework for emergency medicine researchers who are interested in studying these issues.     

Professional Commitment, Patient Safety, and Patient-Perceived Care Quality

Purpose: To examine how professional commitment influences patient safety and patient-perceived care quality.
Design: Investigators for this study used a cross-sectional design with questionnaires. A total of 348 pairs of nurses and inpatients were contacted at two medical centers in Taiwan during the period from August 2007 to January 2008, yielding 284 pairs of completed questionnaires.
Methods: Frequencies of six adverse patient events were used to measure patient safety; and the Service Quality Scale was used to measure patient-perceived care quality. Four items of the Professional Commitment Questionnaire were used to measure professional commitment. Regressions were used for the analyses.
Findings: Professional commitment positively influenced overall patient safety (ß=.19, p =.00) and overall patient-perceived care quality (ß=.13, p =.03). Furthermore, professional commitment positively influenced all patient safety indicators (ß≥.12, p ≤.04), except frequency of nosocomial infections, the coefficient of which reached borderline significance (ß=.11, p =.07). Professional commitment also positively influenced care quality in terms of responsiveness (ß=.16, p =.01) and empathy (ß=.14, p =.03).
Conclusions: Professional commitment may enhance patient safety and patient-perceived care quality.
Clinical Relevance: This study indicates that nurse professional commitment can enhance patient safety and patient-perceived care quality.     

Update on the National Patient Safety Goals--changes for 2005

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EACH YEAR SINCE 2003, the Joint Commission on Accreditation of Healthcare Organizations has established National Patient Safety Goals for accredited health care organizations.

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THE GOALS are developed to promote improvement in patient safety by helping health care organizations address specific safety concerns.

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THIS ARTICLE discusses the current goals and highlights new information for 2005. AORN J 81 (February 2005) 336-341.

     

Patient identification: the foundation for a culture of patient safety

Patients, consumer advocacy groups, and regulatory and accrediting bodies have spoken out about the importance of patient safety in the health care environment. Understandably, patient safety is a leading concern for both consumers and health care providers. These efforts have encouraged health care organizations and providers to review and revise, as necessary, routine practices that contribute to a culture of patient safety and avoid medical errors. This article outlines the process and outcome of a performance improvement initiative to develop a standard patient identification policy.     

Safety Net Research in Emergency Medicine Proceedings of the Academic Emergency Medicine Consensus Conference on "The Unraveling Safety Net"

A primary goal of the Academic Emergency Medicine Consensus Conference, "The Unraveling Safety Net: Research Opportunities and Priorities," was to explore a formal research agenda for safety net research in emergency medicine. This paper represents the thoughts of active health services researchers regarding the structure and direction of such work, including some examples from their own research. The current system for safety net care is described, and the emergency department is conceptualized as a window on safety net patients and systems, uniquely positioned to help study and coordinate integrated processes of care.     

患者安全研究热点的共词聚类分析

目的分析PubMed数据库中2014-2018年患者安全研究的热点,了解该领域研究现状及发展趋势,以期为我国患者安全研究和实践提供参考依据。方法以“patient safety”为主题词,检索PubMed数据库,采用书目共现分析系统软件BICOMB统计高频主题词,并采用SPSS 21.0统计软件对主题词进行共词聚类分析。结果共检索相关文献11913篇。提取高频主题词26个。通过共词聚类分析总铸出2014-2018年患者安全研究的8个研究热点,即患者安全及医疗差错的现况、医务人员的临床能力、跨专业协作与有效沟通、清单工具、患者安全管理与实践的标准及医疗质量改进、患者安全及患者安全文化、用药错误的预防与控制、患者安全立法及法理学研究等。结论近5年患者安全研究热点分析有助于了解该领域的研究现状及发展趋势,为患者安全在我国的实践发展和研究提供参考和借鉴。     

Teaching in crisis. Patient and family education in critical care

Although the critical care setting is not always a positive teaching environment, it is possible to achieve the goal of optimal patient and family education. The critical care nurse must understand the unique learning needs of patients and families who are experiencing a life crisis a recognize that there are substantial obstacles to overcome to educate in this setting. In addition, it takes experience and resources to develop the teaching skills of the bedside nurse, so that those teachable moments are easily recognized and suitably used to give patients and family members valuable information in small doses. The advanced practice nurse is an essential nursing resource who can spearhead the development of teaching skills for all members of the health care team. In addition, the advanced practice nurse is a clinical expert who can assess the educational needs of patients and their families and provide more detailed and individualized health information from a different perspective. Achieving good patient and family education outcomes is possible when patient care continuity is a priority and the advanced practice nurse is an active part of the nursing team. Exploring the use of new technologies and resources to meet patient and family education needs is absolutely necessary. As hospitals continue to evolve and react to the financial demands placed on them, nursing leadership and critical care nurses will need to articulate clearly all of the essential components of patient care, including patient and family education. In keeping with the rich nursing tradition of patient and family education, critical care nurses and advanced practice nurses have the opportunity to demonstrate their unique teaching skills and continue to promote health education as a priority of patient care.     

Priority Patient Safety Issues Identified by Perioperative Nurses

Much of the work done by perioperative nurses focuses on patient safety. Perioperative nurses are aware that unreported near misses occur every day, and they use that knowledge to prioritize activities to protect the patient. The purpose of this study was to identify the highest priority patient safety issues reported by perioperative RNs. We sent a link to an anonymous electronic survey to all AORN members who had e-mail addresses in AORN’s member database. The survey asked respondents to identify top perioperative patient safety issues. We received 3,137 usable responses and identified the 10 highest priority safety issues, including wrong site/procedure/patient surgery, retained surgical items, medication errors, failures in instrument reprocessing, pressure injuries, specimen management errors, surgical fires, perioperative hypothermia, burns from energy devices, and difficult intubation/airway emergencies. Differences were found among practice settings. The information from this study can be used to inform the development of educational programs and the allocation of resources to enhance safe perioperative patient care.     

Optimizing Pediatric Patient Safety in the Emergency Care Setting

This is a revision of the previous American Academy of Pediatrics policy statement titled “Patient Safety in the Emergency Care Setting” and is the first joint policy statement by the American Academy of Pediatrics, the American College of Emergency Physicians, and the Emergency Nurses Association to address pediatric patient safety in the emergency care setting. Caring for children in the emergency setting can be prone to medical errors because of a number of environmental and human factors. The emergency department has frequent workflow interruptions, multiple care transitions, and barriers to effective communication. In addition, the high volume of patients, high decision density under time pressure, diagnostic uncertainty, and limited knowledge of patients’ history and preexisting conditions make the safe care of critically ill and injured patients even more challenging. It is critical that all emergency departments, including general emergency departments who care for the majority of ill and injured children, understand the unique safety issues related to children. Furthermore, it is imperative that all emergency departments practice patient safety principles, support a culture of safety, and adopt best practices to improve safety for all children seeking emergency care. This policy statement outlines the recommendations necessary for emergency departments to minimize pediatric medical errors and to provide safe care for children of all ages.