In a busy pediatric ER at the end of a grueling 12 hour shift, a nurse and a physician were caring for an 18 month old, severe asthma patient. The patient had failed inhalation and epinephrine treatment and required admission. Because there were no beds available on the floor, the team had planned to start his IV theophylline drip in the holding area.
When calculating the weight-based dosage, the fatigued physician missed a decimal point and made one of those proverbial ten-fold errors in the order. The nurse caught the mistake and corrected it, preventing a potentially lethal overdose.
Near-misses like this one happen in hospitals every day. Nurses play a big role in making sure patients like this one are kept safe from harm. They are the largest segment of the U.S. healthcare workforce and are vital to keeping patients of all ages safe in our hospitals, physician offices, ambulatory surgery centers, and other facilities.
Are you empowering yours with the right tools and support to do the following?
1. Identify “wrong site, wrong procedure, wrong patient” errors
High quality hospitals view nurses as the physician’s partner in avoiding errors such as these. In the wake of the Institute of Medicine’s To Err is Human report, a myriad of quality and safety initiatives were implemented in America’s hospitals, and many of could not function optimally without nurse involvement. Nurses are that “second pair of eyes” that supports physicians and the rest of the care team in these efforts.
2. Catch medication mistakes
This is especially important in the hospital environment as patients are transferred from floor to floor and discharged. The nurse’s role in medication management is so important most inpatient floors have “quiet” stations for nurses to do this work uninterrupted. And, in the physician office setting, nurses are often part of the medication reconciliation process too, during which they check for drug interactions and therapeutic class duplications and inform the physician of potential errors when he or she enters the exam room.
3. Educate patients about their medications
Improper usage and non-compliance with medication regimens are major stumbling blocks to getting patients well and keeping them safe from harm - especially for those who have chronic conditions, and the elderly who may be on ten or more medications. Nurses are often the member of the care team best equipped to explain and motivate patients to pick up, refill, and take their medications as prescribed. Often this requires multiple communications or interventions with the patient. Nurses also answer patient follow up questions about medications, and manage communication with caregivers and family members.
4. Reduce patient falls
Falls are a leading cause of death in older Americans.[1] And falling once makes people twice as likely to fall again.[2]
In the inpatient setting, nurses are trained to follow a number of precautions that reduce the risk of falls while ambulating patients. They are on hawkeye watch for unsupervised patients, tripping hazards, and managing the turning and toileting needs of patients too ill or weak to care for themselves. Nurses are also excellent educators in discharge planning and the physician office setting, providing tips and safety sheets for senior patients and their caregivers about removing throw rugs, installing handrails, and other fall reduction tactics.
5. Monitor patients for deterioration
Physicians can’t be in two places at the same time. We count on members of the care team to watch patients for signs of clinical deterioration in both inpatient and outpatient settings. Nurses in particular help us monitor suspicious post-op incision sites, a diabetic’s wound that isn’t healing, the downhill progression of an elderly patient who can’t seem to shake her pneumonia, and the child whose mild rash has worsened.
So, three cheers for America’s nurses. They are often unsung heroes when it comes to to patient safety. But they are invaluable when it comes to delivering it.
You might find this infographic about the future of nursing useful for planning purposes. It’s based on data from the National Academies of the Sciences, Engineering and Medicine.
[1] https://www.cdc.gov/media/releases/2016/p0922-older-adult-falls.html
[2] https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
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