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Patient Safety and Nursing Professional

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Bachchu Kailash Kaini, PhD
Bachchu Kailash Kaini, PhD

This document discusses patient safety and the role of nurses in ensuring patient safety. It makes three key points: 1) Patient safety is an essential part of nursing care according to regulatory bodies, but healthcare carries risks of adverse events due to the large number of available diagnoses, procedures, and medications. A patient has a much higher chance of experiencing a safety incident in the hospital than being killed in a plane crash. 2) Studies show that higher levels of registered nurses on staff are associated with fewer patient complications and lower mortality. Less experienced nurses and those with higher workloads also tend to make more medication errors and have more wound infections. 3) To improve safety, reports recommend increasing nurse staffing levels, making

Gesundheit & Medizin
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Patient Safety and Nursing Professionals Bachchu Kailash Kaini Clinical Governance Manager, Queen Elizabeth Hospital
Health Care: A Risky Business   ―If you fly in a plane you have a 1 in 10 million chance of being killed ... If you go into hospital you have a 1 in 300 chance and not from the illness you went in with‖ Sir Richard Branson, Vice President of the Patient‘s Association    Number of Healthcare Diagnoses listed? > 68,000 Number of Healthcare Procedures available? > 6,000 Number of Healthcare Medications available? > 4,000 January 2010
Patient Safety    ‗reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions‘ (Shojania et al, 2001) An essential part of nursing care (NMC Code, 2008 and RCN Principles of Nursing Practice, 2010) Everyone‘s business
Reference/Courtesy: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG, editor. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.
Nurses Responsibility   Nursing care: different aspects of patient care – e.g. avoiding medication errors and preventing patient falls Broader level: ability to coordinate and integrate the multiple aspects of quality  Collaboration  Assessment  Surveillance  Monitoring
Evidences   Greater percentage of registered nurses to other nursing staff is associated with fewer complications and lower mortality (Tourangeau et al, 2006). The lower the proportion of professional nursing staff employed on a unit, the higher the number of medication errors and wound infections. The less experienced the nurse, the higher the number of wound infections. (McGillis Hall et al, 2004).
Top Three Issues    Pressure ulcers Slips, trips and falls Medication errors
Recent Reports Keogh Report, July 2013 Berwick Report, Apr 2013 Francis Report, Feb 2013
Implications  Mid Stafford Hospital Scandal: 'Nurse count' will be introduced to improve patient safety        Bosses at each hospital will be forced to make public the number of nurses working on each ward (Mirror, 19 Nov 2013) Criminal offence for wilful neglect Duty of Candour Attitude test for compassion and caring Consistent training - common qualification/ assessment across HCPs Appraisals Nursing leadership
Traditional Health Care Culture Mistakes occur because people are:  Inattentive, lazy, careless, negligent & unreliable  Those responsible are identified, blamed, retrained and disciplined  Embarrassment to the organisation is reduced
Consequences of a Person Centred Approach      Close ranks Cover up Admit nothing Tell no one Pretend nothing happened
Modern Focus   Organisational structures and systems influence on the individual leads to mistakes/unplanned outcomes The best way to reduce patient safety incidents is to target the underlying systems failures, rather than take action against individual members of staff
Human Error ―We all make errors irrespective of how much training and experience we possess or how motivated we are to do it right‖.   (in reducing error and influencing behaviour - HSG48) Unintended, unavoidable (or voidable) and unexpected (or expected) incidents
Requirements for Change      An open culture A just culture A reporting culture A learning culture An informed culture
Learning Lessons  "I have not failed. I've just found 10,000 ways that won't work.“ —Thomas Edison
Thank You. For further contact: bkaini@nhs.net

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Patient Safety and Nursing Professional

  • 1. Patient Safety and Nursing Professionals Bachchu Kailash Kaini Clinical Governance Manager, Queen Elizabeth Hospital
  • 2. Health Care: A Risky Business   ―If you fly in a plane you have a 1 in 10 million chance of being killed ... If you go into hospital you have a 1 in 300 chance and not from the illness you went in with‖ Sir Richard Branson, Vice President of the Patient‘s Association    Number of Healthcare Diagnoses listed? > 68,000 Number of Healthcare Procedures available? > 6,000 Number of Healthcare Medications available? > 4,000 January 2010
  • 3. Patient Safety    ‗reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions‘ (Shojania et al, 2001) An essential part of nursing care (NMC Code, 2008 and RCN Principles of Nursing Practice, 2010) Everyone‘s business
  • 4. Reference/Courtesy: Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Hughes RG, editor. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.
  • 5. Nurses Responsibility   Nursing care: different aspects of patient care – e.g. avoiding medication errors and preventing patient falls Broader level: ability to coordinate and integrate the multiple aspects of quality  Collaboration  Assessment  Surveillance  Monitoring
  • 6. Evidences   Greater percentage of registered nurses to other nursing staff is associated with fewer complications and lower mortality (Tourangeau et al, 2006). The lower the proportion of professional nursing staff employed on a unit, the higher the number of medication errors and wound infections. The less experienced the nurse, the higher the number of wound infections. (McGillis Hall et al, 2004).
  • 7. Top Three Issues    Pressure ulcers Slips, trips and falls Medication errors
  • 8. Recent Reports Keogh Report, July 2013 Berwick Report, Apr 2013 Francis Report, Feb 2013
  • 9. Implications  Mid Stafford Hospital Scandal: 'Nurse count' will be introduced to improve patient safety        Bosses at each hospital will be forced to make public the number of nurses working on each ward (Mirror, 19 Nov 2013) Criminal offence for wilful neglect Duty of Candour Attitude test for compassion and caring Consistent training - common qualification/ assessment across HCPs Appraisals Nursing leadership
  • 10. Traditional Health Care Culture Mistakes occur because people are:  Inattentive, lazy, careless, negligent & unreliable  Those responsible are identified, blamed, retrained and disciplined  Embarrassment to the organisation is reduced
  • 11. Consequences of a Person Centred Approach      Close ranks Cover up Admit nothing Tell no one Pretend nothing happened
  • 12. Modern Focus   Organisational structures and systems influence on the individual leads to mistakes/unplanned outcomes The best way to reduce patient safety incidents is to target the underlying systems failures, rather than take action against individual members of staff
  • 13. Human Error ―We all make errors irrespective of how much training and experience we possess or how motivated we are to do it right‖.   (in reducing error and influencing behaviour - HSG48) Unintended, unavoidable (or voidable) and unexpected (or expected) incidents
  • 14. Requirements for Change      An open culture A just culture A reporting culture A learning culture An informed culture
  • 15. Learning Lessons  "I have not failed. I've just found 10,000 ways that won't work.“ —Thomas Edison
  • 16. Thank You. For further contact: bkaini@nhs.net

Hinweis der Redaktion

  1. Keogh Reports - inadequate numbers of nursing staff in a number of ward areas, particularly out of hours - at night and at the weekend. Berwick Report – 8 Recommendations and Francis report – Out of 290, they have said they accept 204 in full, 57 in principle and 20 in part.
  2. PERSON-CENTRED APPROACH
  3. Feelings of GUILT and SHAME
  4. OPEN: staff comfortable to discuss patient safety incidents / raise concerns with colleagues / senior managersJUST: staff / patients / carers treated fairly, with empathy/consideration when involved in PSI / raising concerns NOT blamed or punishedREPORTING: staff have confidence in incident reporting system – use to report near miss and actual incidents / receive constructive feedback / easy to reportLEARNING: committed to learn from incidents / communicates lessons / organisational memoryEXEC / SENIOR MANGERS LEAD BY EXAMPLE…..
  5. OPEN: staff comfortable to discuss patient safety incidents / raise concerns with colleagues / senior managersJUST: staff / patients / carers treated fairly, with empathy/consideration when involved in PSI / raising concerns NOT blamed or punishedREPORTING: staff have confidence in incident reporting system – use to report near miss and actual incidents / receive constructive feedback / easy to reportLEARNING: committed to learn from incidents / communicates lessons / organisational memoryEXEC / SENIOR MANGERS LEAD BY EXAMPLE…..
  6. OPEN: staff comfortable to discuss patient safety incidents / raise concerns with colleagues / senior managersJUST: staff / patients / carers treated fairly, with empathy/consideration when involved in PSI / raising concerns NOT blamed or punishedREPORTING: staff have confidence in incident reporting system – use to report near miss and actual incidents / receive constructive feedback / easy to reportLEARNING: committed to learn from incidents / communicates lessons / organisational memoryEXEC / SENIOR MANGERS LEAD BY EXAMPLE…..