Presentation Transcript

1. Nursing’s Role in Eliminating Harm

   Nurse Leadership Institute June 5-7, 2013 Carol Moody, MAS, BSN, RN, NEA-BC Sharon Dunning, MBA, BSN, RN Sr. Administrator of Nursing Risk Manager Greenville Health System Greenville Health System
2. Objectives Explore current challenges to engaging nurses in care transformation. Identify factors that may put nurses at risk. Discuss ways nurses can help to eliminate harm. Relate how High Reliability Organizations approach transformation of care.
3. Greenville Health System 5 Medical Campuses with 1268 Beds GMH = 750 Bed Tertiary Center 2 Community Hospitals Acute Surgical Hospital LTACH > 10,000 Employees > 1,250 Medical Staff 731 Employed / Contracted Physicians $1.5B Net Revenue > 42,000 Discharges > 2.3 M Outpatient Visits ~ 170,000 ETS Visits USC School of Medicine – Greenville 7 Residencies / 7 Fellowships > 5,000 Health Care Students
4. Nursing’s Role in Eliminating Harm Today’s environment
5. DANGEROUS REGULATED ULTRA-SAFE (>1/1000) (<1/100K) 100,000 Healthcare Driving 10,000 1,000 Scheduled Airlines Total lives lost per year 100 Chemical Manufacturing European Railroads Mountain Climbing 10 Chartered Flights Nuclear Power Bungee Jumping 1 1 10 100 1,000 10,000 100,000 1,000,000 10,000,000 Number of encounters for each fatality Health Care Hazardous? Leape 2008 Courtesy Dr. Bill Bornstein
6. Opportunities for Error or Failures
7. Terms and Concepts Scope of Practice SC Nurse Practice Act Regulatory Authority requirements Nursing Care Standards Standard of Care Reasonable person Same or similar circumstances Similar training, education, experience
8. Scope of Practice Practice of Nursing – common base of responsibility and accountability. Competency based practice scopes may vary: Basic licensure preparation; Practice experience; Professional development. Responsible and accountable for personal scope of nursing practice.
9. Nursing Professionalism Review Nurse Practice Act annually. Know standards of professional associations. Maintain clinical nursing competencies. Demonstrate skills in annual assessment. Obtain additional education and / or mentoring. Make known educational needs and goals. When asked to perform a nursing act new to you, apply algorithm to determine personal scope of nursing practice.
10. Nursing’s Role in Eliminating Harm Factors that frequently contribute to harm
11. Drift and Suboptimal Behavioral Choices Drift Failure to function within state Nurse Practice Act, licensure, and / or job description. Failure to adhere to standards of care & basics of nursing practice. Behavioral Choices At risk behavior Reckless behavior
12. Technology Use Expectation of average nurse re: technology Requirement to follow organizational policies Risk of professional negligence When technology available and not used Examples Alaris smart pump technology Bar code scanning Harding, A.D., Connolly, M.W., and Wilkerson, T.O. Nurses’ risk without using Smart Pumps. JONA’s Healthcare Law, Ethics, and Regulation. 13/1. Jan-March, 2011. pg. 19.
13. Task-focused Tunnel Vision Tasks Accomplished Patient Status 2010 The Advisory Board Company. Source: Nursing Executive Center interviews and analysis.
14. Critical Thinking Definition: Way of thinking, rather than a method or steps. Critical thinking is: Clear thinking that is: Active; Focused; Persistent; and Purposeful. A process of: Choosing; Weighing alternatives; and Considering what to do. Critical thinking involves looking at reasons for believing one thing rather than another in an open, flexible, attentive way. (Kyzer, 1996; Hansten & Washburn, 1999)
15. Critical Thinking To think (and perform) in such a way that staff will see patterns & ramifications beyond a present issue. Allow focus on patient and staff goals. Facilitate good decisions in a creative and continuous manner. Active follow up on problems.
16. Failure To Rescue Although hospital deaths are unavoidable, many can be prevented. 2004 to 2006: > 188,000 lives. 128 deaths/ 1000 patients at risk of complications. Nurse generally first to detect early signs. Once recognized, quick response is imperative.
17. Failure to Rescue Failure to recognize when a change in the patient’s condition has occurred; Failure to consider a change in a patient’s condition as important; Failure to communicate a trend in changes in a patient’s condition; Failure to apply critical thinking skills.
18. Common Nursing Allegations Failure to follow an order Failure to follow Policy / Procedure Failure to properly assess a patient Failure to adequately document condition & changes Failure to timely notify the physician of changes Failure to re-position the patient Failure to keep the patient safe Medication error Failure to use “chain of command”
19. Nursing’s Role in Eliminating Harm Practice in support of patient safety
20. Avoid Drift Avoid “drift” Adhere to the basics (Pt. ID, Med. Admin.) Comply with licensure, Nurse Practice Act, job description Focus on details Safety first Always be alert to possible safety issues Be proactive
21. Behavioral Choices Manage your behavioral choices: Avoid push to work faster or come up with your own ways to improve efficiency Short-cuts Work-arounds Comply with policies and procedures. Use systems designed to improve safety Do not place your license and livelihood in jeopardy. Your word, your signature, your badge
22. Assessment / Observation / Monitoring Know the patient’s baseline Actively participate in hand off communication. Read the patient’s medical record. Re-monitor on a frequent basis. Reassess when plan of care changes (procedure/surgery) or when condition changes. Be thorough. Document findings and observations.
23. Assessment / Observation / Monitoring Conduct assessments based on: Standards of Practice Orders Policies, and Condition of patient Examples: Suicide risk When at risk (age / condition) (i.e. skin, IV) Assess upon admission to the system and upon transfer to another care setting
24. Treatment and Care Management Lab results Do not assume a result is an aberrant result or that it is an error Report / respond. Repeat. Provide additional explanation of treatments Even when patient appears clinically stable, do not consider changes unimportant.
25. Treatment(s) Decline to provide nursing services beyond scope of practice and current competencies. Document nursing observations and nursing decisions made. Document the clinical signs of pt’s response to treatment as well as the patient’s subjective comments. Pay attention to your instincts. “Too busy” is not an adequate defense. Focus on the patient’s whole picture rather than tasks.
26. Critical Thinking Impact Improvement in patient care Better patient satisfaction Resolution of problems Just Culture Teamwork improves Empowerment Reduction in turnover
27. Transforming Healthcare:High Reliability Organizations Reliability – A probability that a system will yield a specified result. HRO – An organization that is involved in a complex and high risk environment that delivers exceptionally safe and consistently high quality care. Nuclear Power Plant, Aircraft Carrier, Airline Flight, Hospitals The End Result Achieve Excellent Outcomes - Healthcare must be STEEEP Safe, Timely, Effective, Efficient, Equitable, and Patient-centered
28. High Reliability Organizations Key Concepts: Collectivity – Everyone manifests similar behaviors. Collective Mindfulness – A way of thinking, in which people continually evaluate the environment and determine what is happening. Collective Enactment – A way of engaging information and problems, in which people continually respond to their evaluation of the environment, engage the problems, expand possible solutions and act to maintain organizational reliability. Weick and Sutcliffe