Client Safety and Trust in The Nursing Profession Paper

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While the topic sentence sets up the main idea, the rest of the sentences provide details that support or explain this main idea scan0037.pdf safety_anthonia.docx ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Client Safety and Trust in The Nursing Profession Paper. 445 Concept 47 Safety Gail Armstrong, Gwen Sherwood Patient safety has always been fundamental to the delivery of responsible health care, but recently new knowledge, skills, and attitudes have redefined how it is understood and operationalized. New theories and frameworks inform current applications of safety science that describe how errors and near misses are recognized and reported, ways to manage the myriad of human factors that impact safe care delivery, and competencies required for health professionals to work in cultures of safety. These undergird an emerging approach to safety first developed in other high-performance industries and are being adapted to health care systems. Important shifts in these advances focus not only on considering personal responsibility and accountability in the delivery of safe care but also on how to direct efforts to system changes to mitigate the possibility of errors. Nursing has historically focused on maintaining patient safety and integrating new concepts of keeping patients safe. Safety science now calls for new knowledge, skills, and attitudes to achieve practice changes identified in national reports from the Institute of Medicine (IOM), which are addressed next. The new focus extends personal responsibility and accountability to incorporate safety from a systems perspective so that analysis of events includes system changes to prevent future occurrences. Definition Many of the safety concepts in the health care literature originate from the IOM’s groundbreaking work in patient safety. Beginning with the 2000 publication To Err Is Human, the IOM alerted the health care industry and the public to the problem of deaths from preventable errors. In this report, the IOM offers a definition of safety as “freedom from accidental injury.”1 An expanded definition of patient safety is offered in this report’s appendix: “Freedom from accidental injury; ensuring patient safety involves the establishment of operational systems and processes that minimize the likelihood of errors and maximizes the likelihood of intercepting them when they occur.”1,p11 In Crossing the Quality Chasm (2001), the IOM defines safe care as “avoiding injuries to patients from the care that is intended to help them.”2,p5 An important emphasis in this IOM report is the expectation of consistent safety in our health care systems: The health care environment should be safe for all patients, in all of its processes, all of the time. This standard of safety implies that organizations should not have different, lower standards of care on nights and weekends or during time of organizational change.2,p45 In a third report in this series, Keeping Patients Safe (2004), the IOM defines safe care as care that maintains a focus on using evidence in clinical decisions so to maximize the health outcomes, while also reducing the potential for harm. In its exploration of safe care, this IOM report addresses errors of commission as well as errors of omission.3 The National Patient Safety Foundation (NPSF) is an independent, not-for-profit organization with a mission to improve the safety of care for all patients. NPSF defines patient safety as the “prevention of health care errors, and the elimination or mitigation of patient injury caused by healthcare errors.”4 To further clarify this definition, NPSF defines health care errors as unintended health care outcomes caused by a defect in the delivery of care to a patient. Health care errors may be errors of commission (doing the wrong thing), omission (not doing the right thing), or execution (doing the right thing incorrectly). Errors may be made by any member of the health care team in any health care setting.4 A 2014 NPSF report, Safety Is Personal: Partnering with Patients and Families for the Safest Care, expands the concept of patient safety to reflect recent research. The report emphasizes how collaboration with patients and families through ongoing engagement can transform safety outcomes. Specific action items are clearly identified to enable health leaders, clinicians, and policymakers to accentuate the overlap of engagement and patient safety as interrelated phenomena. A key component is how providers work with the patient and family as a safety ally; they can be invited to observe and report gaps or omissions in care to help avoid errors and near misses.NURS2101 UWG Client Safety and Trust in The Nursing Profession Paper 5 The work of defining safety and safe care by the IOM is relevant for all health care professionals and emphasizes safety from the patient’s perspective. In nursing, a Robert Wood Johnson Foundation-funded national initiative, Quality and Safety for Nurses (QSEN), builds on IOM’s work and defines safety as “minimizing risk of harm to patients and providers through both system effectiveness and individual performance.”6 This competency definition is further explicated by the necessary knowledge, skill, and attitude elements 446to demonstrate safety in one’s practice and can be found on QSEN’s website (http://qsen.org). Levels of errors are important definitions to understand. The IOM offers definitions of an adverse event and a near miss3 and The Joint Commission7 offers a definition of a sentinel event as follows: • Adverse event: An event that results in unintended harm to the patient by an act of commission or omission rather than by the underlying disease or condition of the patient.7 • Near miss: An error of commission (did not provide care correctly) or omission (did not provide care) that could have harmed the patient, but serious harm did not occur as a result of chance (e.g., the patient received a contraindicated drug but did not experience an adverse drug reaction), prevention (e.g., a potentially lethal overdose was prescribed, but a nurse identified the error before administering the medication), or mitigation (e.g., a lethal dose was administered but discovered early and countered with an antidote).7 • Sentinel event: A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called “sentinel” because they signal the need for immediate investigation and response.7 Scope The concept of safety is broad and encompasses the ideal of keeping all patients safe to the unfortunate reality that errors can lead to injury or death (Figure 47-1). Several key elements associated with this perspective include gaining an understanding of the types of errors, placement of errors, and ways of building a culture of safety. FIGURE 47-1 Scope of Safety Types of Errors In nursing, safety has focused on the safe execution of specific procedures and tasks. However, recent safety work has emphasized the variety of errors that compromise patient safety and the range of variables that impact the occurrence of errors in health care. Understanding types of errors in health care is a vital element in addressing individual practice and improving health care systems. In its early report, the IOM cites a pioneer in the field of patient safety, Lucian Leape, who identified four types of errors:8 1. Diagnostic errors are the result of a delay in diagnosis, failure to employ indicated tests, use of outmoded tests, or failure to act on results of monitoring or testing. 2. Treatment errors occur in the performance of an operation, procedure, or test; in administering a treatment; in the dose or method of administering a drug; or in avoidable delay in treatment or in responding to an abnormal test. 3. Preventive errors occur when there are failures to provide prophylactic treatment and inadequate monitoring or follow-up of treatment. 4. Communication failure (meaning a lack of communication or a lack of clarity in communication) can lead to many types of errors. By employing a standardized system for classifying different types of errors, best practices can be developed to address safety compromises in health care systems. Placement of Errors Along with types of error, the placement of errors may be described as active or latent. This distinction is important in further understanding the etiology of health care errors and appropriate improvements. In health care, active errors are made by those providers (e.g., nurses, physicians, and technicians) who are providing patient care, responding to patient needs at the “sharp end,” which is at the point of care (Figure 47-2).9,10 Latent conditions are the potential contributing factors that are hidden and lie inactive in the health care delivery system, originating at more remote aspects of the health care system, far removed from the active end.11 Latent errors—more organizational, contextual, and diffuse in nature or design-related—are called errors occurring at the “blunt end.”NURS2101 UWG Client Safety and Trust in The Nursing Profession Paper 9 A latent failure is a flaw in a system that does not immediately lead to an accident but establishes a situation in which a triggering event may lead to an error.12 Identifying errors as either active or latent in origin allows the exact system that needs improvement to be more accurately identified and corrected. Most bedside nurse clinicians operate at the sharp end of health care and are involved with active errors or inherit latent errors that can be manifest as active errors. For example, a nurse who administers the incorrect medication because of a failure to check the medication order is involved in an active error. However, a medication error can occur where a latent error can lead to an active error. For example, a latent error can lead to an active error if a Pyxis (or other medication administration system) is incorrectly stocked with a look-alike, 447sound-alike medication that a nurse mistakenly administers based on what should have been stocked in a certain Pyxis compartment. As nurses learn about differences between active and latent errors, they can more accurately identify and contribute to processes or systems for improvement. FIGURE 47-2 Active and Latent Errors Culture of Safety The IOM’s work in the past decade has facilitated a clearer focus on patient outcomes for health care clinicians and facilities. Historically, a culture of blame has been pervasive in health care. When an error occurred, the focus was often on identifying the clinician at fault and meting out discipline.13 With greater focus on patient outcomes, health care teams now investigate what went wrong rather than just blaming the individual clinician who executed the error. Balancing the historical emphasis on blame within the broader context of a culture of safety is vital to effectively addressing error occurrence. A commonly cited definition of safety culture derives from the Health and Safety Commission of Great Britain and is utilized by the Agency for Healthcare Research and Quality (AHRQ): “The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management.”14 Organizations with a positive safety culture are characterized by communication guided by mutual trust, shared perceptions of the importance of safety, and confidence that error-preventing strategies will work.15 From an organizational context, a culture of safety acknowledges the influence of complex systems and human factors that influence safety. In a culture of safety, the focus is on teamwork to accomplish the goal of safe, high-quality care. When errors or near misses occur, the focus is on what went wrong rather than on who committed the error. The focus shifts from identifying fault to establish blame and determine discipline to acknowledging and reporting errors and near misses to improve the system. Accountability is a critical aspect of a culture of safety; recognizing and acknowledging one’s actions is a trademark of professional behavior. A 2003 study surveying trends in how hospitals report errors to patients revealed significant variability in the way hospitals disclose errors and share information with patients.16 Although hospitals are increasingly reporting serious injury to patients, hospitals in the survey that were concerned about malpractice implications or disclosure were less likely to disclose incidents of preventable harm to patients.16 A recent extensive review of safety culture literature identified seven aspects of the concept that contribute to a culture of safety in a health care organization: Leadership, teamwork, an evidence base, communication, learning, a just culture, and patient-centered care.17 Safety culture is a complex phenomenon that requires support from the leadership level, the policy level, and the bedside clinician level. NURS2101 UWG Client Safety and Trust in The Nursing Profession Paper 17 Empowering staff to participate in an error-reporting system without fear of punitive action is an important aspect of creating a culture of safety. In surveying nurses and physicians, a barrier to reporting medication errors and near-miss events is the fear of professional or personal punishment.18–20 As the largest segment of the health care workforce, nurses are central to creating and maintaining a culture of safety in any health care setting. From the bedside to the administrative suite, nurses can contribute to all aspects of a culture of safety. Attributes and Criteria What knowledge, skills, and attitudes are required for nurses to effectively contribute to safety in health care? The QSEN project has been the national leader in defining the competency for safety by specifying the knowledge, skill, and attitude objectives for prelicensure students. A national expert panel of thought leaders in each competency used an iterative process to reach consensus on the essential knowledge, skill, and attitude objectives that all nurses need to contribute to emerging systems of safety in health care. Knowledge Historically, the emphasis in nursing has been on the safe execution of discrete skills. However, contemporary nurses need to be knowledgeable in examining human factors and other basic safety design principles as well as make the distinction with commonly used unsafe practices (e.g., workarounds and dangerous abbreviations). Nurses need to be able to describe the benefits and limitations of selected safety-enhancing technologies (e.g., barcodes, computerized provider order entry, medication pumps, and automatic alerts/alarms). Educating nurses in effective strategies to reduce reliance on memory (e.g., checklists) encourages nurses to understand safety as an individual as well as a systems phenomenon. As nurses become more knowledgeable about safety at the systems level, they can delineate general categories of errors and hazards in care (e.g., active vs. latent and diagnostic, treatment, and preventive errors). Nurses need to be able to describe factors that create a culture of safety (e.g., open communication strategies and organizational error-reporting systems). Nurses must understand the processes used in understanding the cause of error and allocation of responsibility and accountability through such processes as root cause analysis (RCA) and failure mode effects analysis. An important facet of nurses’ knowledge is their appreciation of the potential and actual impact of national patient safety resources, initiatives, and regulations to effectively use and contribute to these important facets of standardized safe practices. Skills Nurses need skills to utilize tools that contribute to safer systems. For example, nurses must develop skills in the effective use of technology and standardized practices that support safety and quality as well as effectively use strategies to reduce risk of harm to self or others. Communication failures are the leading cause of inadvertent patient harm.21 A vital skill set for nurses is to communicate observations or concerns related to hazards and errors to patients, families, and the health care team. Nurses have the responsibility to use organizational errorreporting systems for near miss and error reporting and to participate in analyzing errors and designing system improvements (e.g., RCAs). Nurses are responsible for their own individual practices while also contributing to the development of safer systems. Applying the national patient safety resources to his or her professional development will also enhance the capacity to focus attention on safety in care settings. Attitudes Nurses’ personal and professional attitudes are instrumental in shaping their nursing practice and recognizing the cognitive and physical limits of human performance. NURS2101 UWG Client Safety and Trust in The Nursing Profession Paper Safety systems utilize principles of standardization and reliability as part of error prevention strategies. Professionals value their own role in preventing errors and realize the difference that one person can make in prevention, even for one patient and family. Developing an attitude of collaboration across the health care team to ensure safe coordination of care contributes to safe care. It is the collective and shared environmental scanning and vigilance by all team members (e.g., patients, families, and all disciplines and staff) that prevents errors. As nurse clinicians perceive their own local practices as components of the broader national safety initiatives, patient outcomes can be incrementally improved at the local and national levels. 448 Theoretical Links Theoretical links that further explicate safety include human factors, crew resource management, and high reliability organizations. Human Factors Human factors are adapted from engineering and expanded to address processes in health care by studying the interrelationship between people, technology, and the environment in which they work.22 Human factors consider the ability or inability to perform exacting tasks while attending to multiple things at once. Human factors offer a systematic approach to studying process and outcome effectiveness for greater error prevention and greater efficiency. Within human factors health care research, attention is paid to all levels of care provision: external environment, management, physical environment, human–system interfaces, organizational/social environments, the nature of the work being done, and individual characteristics and aspects of performance.11 In employing a human factors framework to health care, the emphasis is on both supporting health care professionals’ performance and eliminating hazards. Supporting health care professionals’ performance in systems design includes physical performance, cognitive performance, and social/behavioral performance.23 Simultaneously, consideration should be given to designing systems that avoid hazards. A hazard is anything that increases the probability of errors or patient/employee injury.23 The dual consideration of supporting health care professionals and eliminating hazards is a qualitative shift to the development of systems that do not respond reactively to error occurrence but instead work proactively to avoid errors in an anticipatory way through the purposeful design of safer systems. A culture of safety requires organizational leadership that gives attention to human factors such as managing workload fluctuations, seeking strategies to minimize interruptions in work, and attending to communication and coordination across disciplines including power gradients and excessive professional courtesy. Applying a human factors framework to guide research in appreciating and quantifying processes that lead to error will increase our understanding of the complexity of nurses’ work in the acute care environment. Ebright and colleagues identify eight patterns that relate to complexity of nursing work in the … Purchase answer to see full attachment Student has agreed that all tutoring, explanations, and answers provided by the tutor will be used to help in the learning process and in accordance with Studypool’s honor code & terms of service . Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10