Nursing Notes

March 25, 2010

10 Best Practices for Patient Safety

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This article lists 10 ways we, as nurses, can advocate for our patient’s safety.  These are not new and really are things we all are already doing in our daily nursing practices, but it never hurts to be reminded that patient safety is our first concern and should be taken seriously.

Read this list and then let me know if you have anything else to add.


By Susan Kreimer, MS, contributor

March 18, 2010 – Just before the new millennium, health care began building a foundation to advance patient safety. The catalyst: a 1999 landmark Institute of Medicine report that highlighted safety problems and paved the way for reducing medical errors. Since then, many evidence-based practices have evolved to offer effective solutions to common adverse events.

Many are simple, common-sense practices that need to remain at the forefront of nurses’ work habits, including these 10 important safety measures.

10 Best Practices for Patient Safety:

1. Curb infection spread – Wash and sanitize hands before coming into direct contact with each patient. Data indicate that health care-associated infections are the most common serious hospital complication. Each year, they affect nearly two million patients, lead to an estimated 99,000 deaths, and cost the health care system as much as $20 billion, according to the Centers for Disease Control and Prevention. The most frequent infection of this type is methicillin-resistant Staphylococcus aureus, or MRSA.

2. Identify patients correctly – Rely on at least two pieces of information, such as name and date of birth. This helps ensure that patients receive the medicine or other treatment intended for them. Also, check for the appropriate blood type before a transfusion, according to The Joint Commission’s 2010 Hospital National Patient Safety Goals. (Editor’s Note: See related Devices & Technology column for the latest in patient identification technologies.)

3. Use medicines safely – Label all drugs, including those in syringes, cups and basins. Take extra precautions with patients on blood thinners. With the enormous number of prescription drugs on the market, there is significant potential for error due to confusing brand or generic names and packaging. The Joint Commission’s safety goals require finding out which medicines each patient is taking. Make sure that any additional medication doesn’t conflict with current ones.

4. Avoid surgical errors – Follow The Joint Commission’s “Universal Protocol” to prevent wrong-site or wrong-person surgery and performing the wrong procedure. One effective strategy is called “time-out.” This a specific period for all team members to independently verify an impending clinical action, according to the World Health Organization’s Collaborating Centre for Patient Safety Solutions, which consists of The Joint Commission and The Joint Commission International.

5. Prevent venous thromboembolism (VTE) – Eliminate hospital-acquired VTE, the most common cause of preventable hospital deaths. A free guide from the Agency for Healthcare Research and Quality spells out the essential first steps, presents evidence and identifies best practices, analyzes care delivery, and tracks performance with metrics and interventions.  “Included in the guide are examples of standard order sets that can help ensure patients receive evidence-based care shown to prevent these clots,” said Jeff Brady, MD, MPH, the agency’s lead for the patient safety portfolio. It also would help to classify patients based on risk, ranging from low to mid and high.

6. Customize hospital discharges – Create an easy-to-follow plan for each patient. It should include a medication routine, a record of all upcoming medical visits, and names and numbers of whom to call if problems arise. These steps can help decrease potentially preventable readmissions by 30 percent, according to the agency. Medications and follow-up care may have changed due to hospitalization, Brady said. “It’s not only telling the patient about any changes in medication regimens and what needs to happen after discharge, but also actually scheduling appointments for follow-up evaluation and care,” he added. Equally important is documenting vital information clearly so that a patient understands.

7. Use good hospital design principles — Prevent patient falls with evidence-based design of patient rooms and bathrooms as well as decentralized nurses’ stations. This allows for easier observation and access to patients. Falls can result in serious injuries, extend a patient’s stay and dramatically drive up health care costs. For more information, nurses and administrators can download a free 50-minute DVD from the AHRQ, “Transforming Hospitals: Designing for Safety and Quality.”

8. Assemble better teams and rapid response systems – Encourage everyone on the team, including junior members, to speak up. “One thing that can be a barrier to effective communication is the hierarchy that exists on healthcare teams,” Brady said. A free toolkit called TeamSTEPPS™, which stands for Team Strategies and Tools to Enhance Performance and Patient Safety, can be tailored to any health care setting, from emergency departments to ambulatory clinics.

9. Share data for quality improvement – Participate in The National Database of Nursing Quality Indicators (NDNQI)®. This proprietary database of the American Nurses Association (ANA) collects and evaluates unit-specific, nurse-sensitive data from more than 1,500 participating U.S. hospitals. The facilities receive unit-level data reports that they can compare to similar units regionally, statewide and nationwide. This gives nurses and their managers the opportunity to evaluate performance and staffing levels relative to patient outcomes and set organizational goals for improvement.

“The future of health care is evidence-based practice. To have the evidence, you need to collect the data and make apples-to-apples comparisons – your nursing unit’s performance versus similar hospitals’ performance for the same type of unit,” said Isis Montalvo, MBA, MS, RN, director of ANA’s National Center for Nursing Quality®, which oversees the NDNQI program. “The days are gone when nurses did what seemed right, or did things because that’s the way they had always been done. Our decisions today should be made based on a scientific foundation. Through NDNQI, we have data that allows us to make the best practice decisions possible. We know what practices lead to reduced fall rates, reduced hospital-acquired pressure ulcers and other adverse patient outcomes.”

10. Foster an open-communication culture – Minimize mistakes due to lack of communication between doctors, nurses and other health professionals. A similar strategy worked for the airline industry. About 30 years ago, it became obvious that better communication between a pilot and crew members reduced human-error-related accidents and fatalities. The Institute of Medicine in 2004 suggested emulating high-reliability industries such as the airlines to transform nursing. Since then, various “Crew Resource Management (CRM)” programs have been adopted in many U.S. hospitals. Through interactive sessions, nurses learn to maintain awareness in changing clinical situations, said Gary Sculli, RN, MSN, a former airline transport pilot who is now program manager at the VA National Center for Patient Safety in Ann Arbor, Mich. This approach “challenges nurses to think differently about their work and empowers them to transform their practice.”

Here’s the link to the original article

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March 8, 2010

Overworked and understaffed

Here’s an article I found that is an opinion of Dennis Kosuth.   Although I am usually not rabid in my push for improved nurse staffing, I do find myself looking around and thinking, “There has to be a better way to do this.”

I search out and find numerous articles about staffing ratios, staffing laws, etc.  I read them all.  What stands out in my mind is the fact that hospitals are a business and will continue to act just like every other business in the world.  The bottom line is God.  Hospitals, so far, have escaped the notice of the public–who still view hospitals as a haven of safety and help.  When will the public realize that patients and patient care are not that important to the hospitals except in the way they affect the bottom line?

Please read this article and then come back and let’s talk.  I sometimes feel that I am out her alone, but I know that can’t be right, can it?


Dennis Kosuth, an ER nurse in Chicago and member of the National Nurses Organizing Committee, makes the case for laws mandating nurse-to-patient ratios.

March 8, 2010

AMONG NURSES who work in the emergency room, there’s an understandable fear that when you go to check on one of your patients, they may have stopped breathing. Because many people come in with undiagnosed conditions, it’s sometimes impossible to predict the direction they’re headed before it is too late.

In a public hospital, this concern is compounded by a waiting room bursting at the seams, where sick patients with nowhere else to turn sometimes sit for 18 hours before being seen by a doctor. While waiting for tests or a bed upstairs, patients are routinely wheeled into the hallway to make room for the next one, so the pressure building out front can be relieved.

Depending on the day, this can result in one nurse having seven or eight patients, and when their covering nurse goes on lunch, the number doubles. All this endangers the patients that nurses are responsible for–not to mention straining nurses to their physical limits.

Every day, in hospitals across the country, this ticking time bomb is wound up, and everyone crosses their fingers, hoping that nothing bad happens to themselves or their loved ones. According to an investigative feature in the San Francisco Chronicle, “[A]ll of the available research indicates that the death toll from preventable medical injuries approaches 200,000 per year in the United States.”

The profit-driven health care system has no interest in getting to the bottom of these numbers, mainly because it would involve investigating itself. It simply stands to reason that an overworked nurse with too many patients is not an accident waiting to happen, but a guarantee that accidents will happen.

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ON A Friday evening in February in Chicago, almost 50 registered nurses gathered at a forum sponsored by the National Nurses Organizing Committee (NNOC) to discuss the need for safe nurse-to-patient ratios in the state of Illinois.

Bills (known as SB0224 and HB5033) have been introduced in each chamber of the Illinois legislature to establish a maximum number of patients per nurse, depending on the level of care. In the ER, for example, the legislation would mandate a maximum of four patients per registered nurse (RN), and this ratio would have to be maintained during breaks as well.

The Illinois bills are modeled after California, the only state to have such regulations. In 1999, Governor Gov. Davis signed the legislation, which mandated compliance by 2004. It was twelve years between the legislation first being introduced to a law going into effect.

Throughout the process, significant resistance was organized by the hospital industry, aided by their friends in state government. Even after the bill was signed into law, Davis’ successor, Arnold Schwarzenegger, was particularly obstructive, helping to wage a legal battle against the new law. So the California Nurses Association (CNA) protested him wherever he went, inside the state and out.

The Illinois Hospital Association (IHA) is vehemently opposed to nurse-patient-ratio legislation. One complaint is that in California, the new law raised health care costs by more than $1 million per hospital, “with 23 percent attributable to increase in nurse wages,” the IHA claimed in a statement.

But the hospital owners don’t say is that having more nurses will actually save medical costs by reducing errors and recovery time–not to mention other insignificant questions like saving some of the 200,000 lives lost to medical error every year. The focus on profits blinds the IHA to measures that would actually improve patient care.

Another excuse for opposing the new legislation is that Illinois already has the “Nurse Staffing by Patient Acuity Act,” which took effect in January 2008 and was supported by the IHA, as well as the Illinois Nurses Association (INA), a professional organization that also represents some Illinois nurses through collective bargaining agreements.

But this existing law only requires hospitals to have a written plan for nurse-to-patient ratios, which is designed by a committee made up of at least 50 percent nurses. There is nothing about monitoring, regulation or enforcement of the wishes of bedside nurses. This is a toothless bill that leaves ratios in the hands of management.

There are currently 136,000 RNs in the state of Illinois, making for a definite nursing shortage. This leads to another IHA claim–that mandating nurse-to-patient ratios would further exacerbate the shortage.

The fact is, however, that many nurses don’t stay in the field because working conditions are so stressful.

According to one study in 2007, for example, the average voluntary turnover rate for first-year nurses was 27.1 percent. The federal government’s quadrennial survey found that only 83 percent of people with a license to work as an RN chose to do so in 2004. With the total number of RNs at 2.9 million, that means there were almost 490,000 nurses nationwide who didn’t work in the field.

Ratio laws can actually turn these trends around. In the short time since ratios went into effect in California, the state has seen an increase in the number of nurses being retained, an influx of nurses to California and a greater interest in nursing as a job. Once conditions were improved, nurses went back to work at the bedside, started moving to California from out of state, and more people have enrolled in nursing school.

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THE REAL reason the hospital industry opposes the Illinois ratio proposals and similar national legislation is profit, flexibility and speedups. A recent article in Becker’s Hospital Review listing “10 Best Practices for Increasing Hospital Profitability” starts with “reducing staffing costs” through flexible scheduling and reducing benefits for full-time employees.

While health care was one industry that created jobs during the recession, this hasn’t lessened the corporations appetite to improve their bottom lines. Profits returned at large community hospitals in the first quarter of 2009, partly due to an improved stock market, but also from a decrease in hospital labor costs. Many employers were able to gain significant concessions from workers by playing on their economic fears.

For example, Mount Sinai Medical Center, a large Chicago hospital that serves the poor, has not only gotten away with wage freezes for the past couple years, but has also been on a campaign to get employees to make donations to the hospital. This is the same “not-for-profit” institution that spent significant resources to successfully fight off a unionization drive by nurses three years ago.

On the federal level, Sen. Barbara Boxer of California recently introduced legislation to institute nurse-to-patient ratios nationally. This national bill and other state legislation could produce important improvements in patient care and working conditions.

But this isn’t the only path to ratios. Union nurses at Saint Mary’s Regional Medical Center in Reno, Nev., recently won contract language that mandates the same nurse-to-patient ratios as exist in California.

The introduction of these bills is a good first step, but it’s only the beginning. If the mammoth resistance to even the tepid measures promoted by Barack Obama and the Democrats in their “reform” legislation is any indication, the health care industry will stop at nothing to fight mandating ratios.

As one public health nurse said at the Chicago forum last month, “I’ve been to Springfield, written letters and called my representatives. We need to start thinking about protest actions that are just on the other side of the law if we’re going to get the change we need.”

Ratios themselves won’t solve the ongoing health care crisis in this country, but organizing around this issue can bring nurses together with patients and others to address one of the more glaring aspects of it–and force the issue of the present nursing shortage higher on the agenda.

Here’s the link to the original article

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February 14, 2010

Costs on rise, nurses protest staffing changes

I am a staunch supporter of some type of national nurse-to-patient ratio to be enacted.  I feel this way because I know what it is like to work a shift with too many patients and not leave at the end of your shift.  I know what it is like to wake up from a dead sleep to call the unit to make sure I did (or did not) do some task because I was so busy during my shift.

That said, I have to now say that the following article does not surprise me in the least.  I read articles each and every day that describe the effects on health care of all the budget cutting going on.  I know that hospitals really are a business and are always looking for ways to save money (read increase profits).  I knew it would not be long before “nursing costs” were under scrutiny and new and novel means developed to decrease those costs.

Granted, these nurses have been working with fewer patients than the norm.  Granted, these nurses are well paid.  However, it sets a really dangerous precedent for this hospital to increase nurse-to-patient ratios as a cost-cutting tactic.  What do you suppose will happen to that same hospital when it cannot find or keep nurses at the bedside?  Hospitals cannot operate without nurses, period.

Is there no other way to save money and increase profits besides increasing patient loads?  Surely there are some intelligent and creative people out there with better solutions to this problem.


Nerrissa Shurtluff and others gathered outside Tufts Medical Center in Boston. Nurses from Tufts and Boston Medical Center protested what they say are dangerous changes to staffing.
Nerrissa Shurtluff and others gathered outside Tufts Medical Center in Boston. Nurses from Tufts and Boston Medical Center protested what they say are dangerous changes to staffing. (Wendy Maeda/Globe Staff)

By Liz Kowalczyk Globe Staff / February 12, 2010
Tufts Medical Center says it has found a way to trim the high cost of nursing while improving care, but the plan prompted a protest yesterday outside the Boston hospital by nurses, who say it is an example of the intense cost-cutting pressure on hospitals statewide.

But they said cost was not the primary reason for the change, adding that they want to improve care and working conditions for nurses. The hospital is bringing on 35 technicians to free up nurses from unskilled jobs like transporting patients to imaging tests and tracking down missing meals, so they can focus on monitoring vital signs, giving medications, and providing essential patient care.

“Our nurses will be working smarter,’’ said Nancy Shendell-Falik, Tufts’ chief nursing officer, who said she believes patients could get more, not less, attention from their nurses. She said a consultant hired by the hospital found that nurses at Tufts – and, by extension, other Boston teaching hospitals – care for fewer patients than is typical for similar hospitals elsewhere in the country.

But many nurses are upset by the changes. They say that requiring nurses on the hospital’s medical and surgical floors to each care for five patients, most of whom are extremely ill, is dangerous. Tufts nurses have traditionally cared for three or four patients on regular floors. In intensive care units, Tufts is assigning two patients to each nurse in most cases, up from one, but can increase the number of nurses if patients are especially ill.

“Nurses are overwhelmed,’’ said Barbara Tiller, a nurse at Tufts for more than 20 years. “They are behind their entire shift. Patients slowly deteriorate now, and no one picks it up until they’re in a crisis mode.’’

The Massachusetts Nurses Association, a large union, also organized a protest at Boston Medical Center yesterday, which plans to increase the number of patients assigned to some nurses from two to three. Hospital administrators said that they are assigning patients who are not as ill to those nurses and that they hired the same consultants as Tufts, who said nurses in intermediate care units nationally usually care for three patients.

“Of course, cost is included in our decision, but we have to be responsible about patient safety first,’’ said Lisa O’Connor, vice president of nursing at BMC.

The union also bought newspaper advertisements yesterday criticizing the changes at the hospitals.

“We understand that everyone is in a budget crisis,’’ said Lisa Sawtelle, a nurse at Boston Medical center. “We will not complain about the money we bring home. But they’re making it more and more difficult for us to do our job at the bedside.’’

Soaring hospital costs statewide are under increasing scrutiny. Medical costs in Massachusetts are growing more than 7 percent annually, driving up insurance premiums and threatening to bankrupt businesses. Last month, the attorney general’s office found that the increases are largely driven by higher prices charged by hospitals and doctors, and Governor Deval Patrick proposed legislation Wednesday that would allow the administration to review and reject medical provider rates.

At the same time, some hospitals, including Tufts, have been at a financial disadvantage because they get lower reimbursement rates than their larger competitors with more market clout. Boston Medical Center, too, is struggling with cutbacks in state funding and has sued the state over the issue.

Nursing always has been a huge expense for hospitals. Administrators who testified at hearings held by the Division of Insurance last month said labor accounts for up to 70 percent of their costs, of which nurses are the largest component.

Massachusetts nurses have enjoyed some of the highest salaries in the United States, which is typical of states with strong nurses unions. The average salary for a nurse in Massachusetts was $79,000 in 2008, up from $57,000 in 2003, and second only to California, said Judith Shindul-Rothschild, a nurse and professor at Boston College. Massachusetts nurses also enjoy some of the best working conditions in the country and are among the most highly educated, she said.

The Advisory Board Co., the Washington, D.C.based consultants hired by Tufts, found that Tufts nurses have lighter workloads than average. Tufts nurses typically have cared for 3.7 patients each on regular medical and surgical floors, while the national average is 4.5 for teaching hospitals and 5.7 for all hospitals. The company, however, also found the hospital had lower than average numbers of support staff.

It is unclear whether the new Tufts plan or the consultant’s findings will lead other hospitals to assign more patients to their nurses.

Karen Nelson, a nurse and senior vice president of clinical affairs for the Massachusetts Hospital Association, said the deciding factor will be whether the hospital is able to maintain good results for patients.

Shindul-Rothschild cautioned against comparing nurse-to-patient ratios in Massachusetts with national averages, because they may not account for differences in patients and because they do not indicate if the state’s higher concentration of nurses leads to better care.

“Yes, maybe we have higher ratios,’’ she said. “But you can’t look at those in isolation of patient outcomes.’’

Here’s the link to the original article.

November 4, 2009

Healthcare Advocates Demand More Nurses

When I found this article, my first thought was, “Oh, another article about why staffing ratios won’t work.”  So then I read the entire article to see if I was right.

Wrong!  This is a new approach to safe staffing laws.  Instead of coming from the nurses’ perspective, it is coming from the patients’ or families’ viewpoint.
That is wonderful.  Maybe if enough patients or family members speak up about the terrible staffing, something really would get done.

I work at a hospital where it is expected that each nurse will have 8-9 patients at the least.  Granted, these are ambulatory patients–so no IV’s, no oxygen, no ventilators, etc.  However, these are psychiatric patients who are unpredictable and can become aggressive quite easily.  Some days, just passing medication takes up all of my time.  Some days, my focus is on one specific patient who is having trouble and may become out of control.

I cannot imagine caring for 8-10 medically compromised patients at all.  How on earth can one person be in 8 or 10 places at one time?  To expect that to happen is simply crazy.

Read the article below and see what I mean.

By Justine Judge
Story Published: Nov 2, 2009 at 7:25 PM EST
Story Updated: Nov 2, 2009 at 7:25 PM EST

Healthcare advocates are warning that there aren’t enough nurses to go around and it is taking its toll on patient care.

John Bennett is one of many healthcare advocates hoping to see a change in patient care. Bennett was at his wife’s bedside at Mercy Medical Center for months as she battled cancer. He knows first hand how difficult it can be.

“The monitor alarm would go off and nobody would come. We would press the nurse’s button and nobody would come. I would go out in the hall and all of the lights would be on with every single room saying they needed a nurse. Well, there just weren’t enough nurses,” Bennett said.

Not having enough nurses is something they want to change through the Patient Safety Act which goes before a legislative health committee Tuesday in Boston. If passed, the legislation would call upon the State Health Department to set safe limits on how many patients a nurse can care for at once.

Stephen Mikelis is a Staff Nurse at Mercy. He said patients are not getting the care they deserve.

“Nurses are having to take care of seven patients during the day, and sometimes at night they are having to take care of nine or 10 patients. A safe patient load per RN should be four patients per nurse,” Mikelis said.

Mark Fulco is the senior vice president for the Sisters of Providence. He said the proposed “one size fits all” strategy is the wrong prescription for Massachusetts and will only increase patient cost.

“Nurse staffing needs to be based on the equity of the patient. Each individual patients needs are different and the professional nurses need the flexibility to determine what care is most appropriate for each patient and in what quantity,” Fulco said.

If passed, the bill would prohibit mandatory overtime for nurses.

Healthcare Advocates Demand More Nurses | CBS 3 Springfield – News and Weather for Western Massachusetts | Local News

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October 28, 2009

Prescription for success: Don’t bother nurses

When I read the following article, I sat and thought to myself, “How obvious!”  It amazes me that we never take the time to step back and observe the entire process that we go through daily in taking care of our patients. 

I can tell you that in my current practice, I am bombarded constantly for prn medications, and my patients are all up and out of bed, so they can come and find you.  There are days when I literally have full sheets of prn MARs for each patient and I usually have a patient load of 8 or 9.

Passing meds is the most critical time for a nurse.  There are so many factors to take into account.  We have to not only check our own processes, but we also have to recheck the last shift’s administration processes to ensure safe administration. 

I was shocked to see how much medication errors cost each year, but I am mortified to know that each error involved a real, live person. 

Please read this article and let me know what you think.

Victoria Colliver, Chronicle Staff Writer
Wednesday, October 28, 2009

For nurses, constant interruptions while tending to a patient are part of the job. But a distraction that happens while they’re giving medications could have deadly results.

UCSF program to improve accuracy in administering drugs – with particular emphasis on reducing interruptions that often lead to mistakes – resulted in a nearly 88 percent drop in errors over 36 months at the nine Bay Area hospitals, according to results being released today.

“Medication errors make up the largest slice of the medical error pie,” said Julie Kliger, director of UCSF’s Integrated Nurse Leadership Program, which developed the medication errors program. “Improving these numbers is a huge benefit to patient safety and, secondarily, it reduces costs.

“Errors in administering medication cause about 400,000 preventable injuries in hospitals and about $3.5 billion in extra medical costs a year, according to the Institute of Medicine.

The UCSF program, which was funded by the Gordon and Betty Moore Foundation, involved UCSF Medical Center, Kaiser hospitals in Hayward and Fremont, San Francisco General Hospital, St. Rose Hospital in Hayward, Contra Costa County Medical Center, Stanford Hospital in Palo Alto, San Mateo Medical Center and Sequoia Hospital in Redwood City.

Low-tech solutions

Striving to reduce interruptions that lead to mistakes, teams of nurses at the different hospitals came up with a variety of methods – often surprisingly low tech – to alert others they were administering medications. The strategies included everything from wearing brightly colored vests or sashes to establishing “quiet zones” or making announcements at key points in the day when medications are being administered.

At San Francisco General, for example, nurses found they were constantly being interrupted in the medication room because their colleagues could see them through the windows. So they covered the windows.

The solutions “have to be low tech because we, as staff nurses, don’t have the money or ability to make high-tech changes,” said Celeste Arbis, a registered nurse in the medical-surgical unit there. “Something as simple as changing the process just a little bit can make a big difference.

“Some hospitals, such as Kaiser, have high-tech methods to reduce medication errors. Kaiser hospitals use bar-coded patient identification bands, which allow nurses to scan the bar code on the medication against the patient’s wristband to make sure they match.

Such advances may reduce mistakes by decreasing the risk of giving the wrong medicines, but they don’t stop interruptions or eliminate all mistakes, said Joanne Mette, chief nursing officer at Kaiser Permanente in Hayward and Fremont.

Mette said nurses can be interrupted five to 10 times in the course of giving one medication. Kaiser nurses opted to use fluorescent sashes to signal they were in the middle of giving a patient medications and conducting necessary safety checks.

Airline comparison

“We wear the sash because you can get interrupted doing the bar coding,” Mette said, adding that a medication error isn’t limited to giving the wrong medication, but includes even a minor delay in delivery. “We liken it to flying a 747. They never give up their safety checks and we don’t give up ours.

“The flight comparison is particularly apt, given that the program borrowed its techniques from the airline industry. The Federal Aviation Administration established the “sterile cockpit” rule, which means pilots must refrain from all nonessential activities during critical phases of the flight, typically under 10,000 feet.

“Distraction for them is anything under 10,000 feet,” said Kliger, of the nurse leadership program. “In the nurses’ world, it’s when giving medications.

“Aside from reducing interruptions, the program established other safety techniques, including requiring nurses to check two forms of patient identification before giving medications, explaining the drug to the patient and keeping it in the package until they’re at the bedside.

Nurses attributed much of the program’s success to allowing those on the front lines to develop and tailor their own solutions. What worked in one hospital sometimes didn’t work in another. Success also varied from unit to unit within each hospital.

At St. Rose Hospital in Hayward, for example, nurses in the maternity wards found the sashes too flimsy and opted instead to use bright green vests. In the large medical-surgical units, nurses rejected the vests and sashes in favor of carrying yellow folders. In the hospital’s intensive care unit, nurses put a border on the floor around the electronic medication dispensing machine along with an overhead sign.

Linda Aug, nursing supervisor in the medical-surgical unit, said St. Rose nurses were a bit apprehensive at first because they didn’t realize they were distracted or making mistakes. But the techniques reduced the hospital’s interruption rate from 53 percent of the time in 2006 to 32 percent in 2007 and 2008. The rate for the first nine months of this year has been just 12 percent. The program did not reveal individual hospital error rates.

“It’s been a whole hospital-wide awakening,” she said. “We learned that it wasn’t something to be afraid or threatened by. It’s for the patient.

“Reducing errors

A 36-month program involving nine Bay Area hospitals found:

— Accuracy in administering medications improved from an average of 83.8 percent at the start of the program in 2006 to 93 percent after 18 months and 98 percent after 36 months.

— Between September 2006 and September 2009, medication errors at the hospitals dropped by an average of 87.7 percent.

— The adherence to a series of “best practice” principles, which included such techniques as checking two forms of patient identification before administering drugs and explaining each medication to the patient, increased from 79.5 percent at the start of the program to 96 percent after 36 months.

Source: Integrated Nurse Leadership Program

E-mail Victoria Colliver at

Prescription for success: Don’t bother nurses

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