Culture of Safety

The Culture of Safety



Deborah S. Hickman Mathis, RN, MS, CNOR, RNFA


Renue Plastic Surgery, Renue Surgery Center, 2500 Starling Street, Suite 604, Brunswick, GA 31520, USA


E-mail address: debbie@renuemd.com



Abstract


Following the Institute for Healthcare Improvement’s launch of the 100,000 Lives Campaign, a national effort to reduce preventable deaths in U.S. hospitals began. No one could have imagined the strength of the response. An extraordinary resurgence of spirit and an unprecedented commitment to change and collaboration across the health care industry evolved. This article discusses a program that came out of that effort at Renue Plastic Surgery, a free-standing plastic/cosmetic and reconstructive ambulatory surgery center.



Keywords


• Safety • Error reduction • Nursing standards



Safety


It is the cornerstone of perioperative nursing. It is the responsibility of the perioperative team to continuously monitor the quality of care provided to each patient. AORN states, “A fundamental precept of AORN is that it is the responsibility of professional Registered Nurses to ensure safe, high- quality nursing care to patients undergoing operative and other invasive procedures.”


Safety is not a new effort for healthcare providers, but for many consumers of healthcare normal apprehension has escalated to fear. Their concern had substance with the publishing of “To Err Is Human, Building a Safer Health System,” in 2000, by Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson. This one article was a catalyst to position healthcare under new analysis.


On June 14, 2006, The Institute for Healthcare Improvement and its partner organizations came together to launch the 100,000 Lives Campaign, a national effort to reduce preventable deaths in U.S. hospitals. No one could have imagined the strength of the response. An extraordinary resurgence of spirit and an unprecedented commitment to change and collaboration across the health care industry evolved. A renewed national commitment to improve patient safety through this initiative was so successful that the IHI set a new goal “Protect patients from five million incidents of medical harm over the next two years (December 2006–December 2008).” The 5 Million Lives Campaign challenged American hospitals to adopt 12 changes in care that save lives and reduce patient injuries.


Each year the Joint Commission has expanded on the 12 changes suggested by the IHI. The National Patient Safety Goals program provides a significant focus on patient safety within health care. Adherence to the program is mandatory for more than 15,000 Joint Commission-accredited healthcare organizations. It is designed to stimulate healthcare organizational improvement activities for several of the most pressing patient safety issues that all organizations are struggling to manage effectively.


Oversight of the National Patient Safety Goals is rigorous and the ongoing evolution of this program is a reflection of how complex the processes of health care are to change before sustainable improvements in patient safety can occur.


Healthcare providers at all levels are required to quantify (scientific assessment), evaluate the data (plan), (implement) changes with measurable criteria to (evaluate), with additional elements of oversight (CMS, JCAHO, AAAHC, State, WHO, etc.). This is the core of healthcare provision and nursing practice.


It is for these reasons that all healthcare providers must be able to clearly communicate this to their patients, families, employers, payers, and regulatory agencies.



How do you begin?


First, healthcare providers must be knowledgeable and able to articulate what they as practitioners do each day to keep their patients safe. They must understand the relevance of their individual practice to the whole. They must be educated as to the above and understand their role.


My academic nursing curriculum covered Perioperative Nursing from the perspective of an experience, with a focusing on in-patient hospital pre and post-operative patient care. Working as a Surgical Technician during nursing school my goal was to be a perioperative nurse, but I felt pressure from professors, peers, and even the human resource department to be a “real nurse” first. “Start on the floor first, then work your way to the ICUs,” they would advise. It was at that point the “passion” to teach others what Perioperative Nurses contribute to the Perioperative Team was fueled. I wanted to help nurses articulate what “nursing” means to the patient undergoing surgery. We are patient advocates.


Fast forward, years of experience, higher education and holding leadership positions, has never diminished that early passion for the core nursing role as the patient safety advocate. As a current healthcare leader it is my responsibility to educate the entire perioperative team about this enormous topic of SAFETY. Privately, I asked, “How do you do that?”


The answer was conceived while I was the Director of Surgical Services at our local hospital, and implemented while serving as the Director of Surgical Services for Renue Plastic Surgery, a free-standing plastic/cosmetic and reconstructive ambulatory surgery center. The concept was to simply break down the care we render every day utilizing the National Patient Safety Goals.


We named our program “Surgical Services; A Culture of Safety.”


The program was simple but inclusive to patient safety in the perioperative setting:


1. Draft a policy with the intention to communicate “The Culture of Safety” in an atmosphere where all members of the Perioperative Team can openly express concerns, report errors, and discuss process improvements without fear of reprisal.

2. Define and publish the procedures/tools that the organization has in place to ensure safety. These can be
a. “Hand-Off Communication” Tools to communicate important patient information between team members

b. Pre-Procedural “Check-Lists” to verify the correct patient, procedure, surgical site, all necessary test(s) completed and results communicated, equipment and supplies immediately available, etc.

c. Scripted “Time-Out” verification that is interactive, multidisciplinary, and consistent in elements

d. “Concern Reports” to allow staff to communicate in writing any issue that distracts or hinders safe patient care

e. “Concern Response Form” vital to communicate back to the staff member resolution or course of action taken regarding their written concern report.

f. “Risk Management Variance Reports” for those events of defined serious nature.

g. “Educational Calendar” published after input from staff and other team members to meet the annual education needs of the staff to include competencies, high risk or low volume problem prone areas, new equipment, etc.

h. “Monthly Staff Meetings” A monthly meeting between Renue Surgery Center and Renue Plastic Surgery team members is conducted to meet the educational needs of the staff including competencies, drills, new equipment, regulations, pertinent journal articles, etc.

i. “Quarterly Governing Board Meetings” to share our programs with all stakeholders

3. Address each National Patient Safety Goal with the intent to promote specific improvements in patient safety. Express this to each practitioner and staff member by clearly indentifying their individual roles and practice expectations among the perioperative team.
a. Improve the Accuracy of Patient Identification:
i. Perioperative Implication- Identify the patient prior to any procedure of surgery using their name and date of birth.

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Apr 2, 2016 | Posted by in Reconstructive surgery | Comments Off on Culture of Safety

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