safety and Quality Improvement. Nurses are concerned with safety and quality of patient care. Throughout history, many nurses have actively worked to find ways to improve patient safety and quality of nursing care. This week, we will consider the broad topics of safety and quality improvement in nursing care and our roles in this important endeavor.
Safety and Quality
Nurses value safety for patients. Doing no harm is often considered a moral and an ethical principle in nursing and healthcare. Safe care is always our plan.
Safety is an important part of quality. Without safety, quality is not an issue. Care is either safe or it is not. Quality, on the other hand, can vary by degrees and can be measured. Is the care of minimum quality, or is it of the highest quality? Safety and quality are often considered together because quality is not possible without the baseline of safety.
Safety in the workplace is also important in nursing. Later in this lesson, we’ll consider how safety for nurses, as well as for patients, is an important part of our quality initiatives.
“Safety: The Nurse of the Future will minimize risk of harm to patients and providers through both system effectiveness and individual performance (QSEN, 2007)” (Massachusetts Department of Higher Education Nursing Initiative, 2016, p. 42). Safety is “critical to promoting high quality patient care” (American Association of Colleges of Nursing, 2008, p. 13).
“Quality Improvement: The Nurse of the Future uses data to monitor the outcomes of care processes, and uses improvement methods to design and test changes to continuously improve the quality and safety of health care systems (QSEN, 2007)” (Massachusetts Department of Higher Education Nursing Initiative, 2016, p. 42).
Improving Quality in Nursing
There are many drivers of quality care in nursing and healthcare today. We are familiar with the efforts of many of these.
- The Joint Commission
- Institute of Medicine
- QSEN Institute
- American Nurses Credentialing Center (ANCC) Magnet Recognition Program
The Joint Commission releases patient safety goals each year that serve to guide healthcare professionals in providing safe, quality care for their patients. These goals are designed to improve patient safety. The goals focus on both problems and solutions (The Joint Commission, 2018).
The ANCC Magnet Recognition Program designates an organization as a magnet when it shows evidence it has the knowledge and expertise to delivery nursing care globally (ANCC, 2018). The ANCC has developed a model with five components that serve as the primary basis including
- Transformational Leadership;
- Structural Empowerment;
- Exemplary Professional Practice;
- New Knowledge, Innovations & Improvements; and
- Empirical Outcomes
- How could my workplace and my care demonstrate the five components of the Magnet Model?
- What changes can I make to further demonstrate these?
As you will see in your assigned textbook readings, there are many approaches to quality improvement. Deming was one of the early quality pioneers. The Deming cycle (often known as PDCA) is commonly used today to improve quality (Hood, 2018).
- How could I use PDCA to improve quality in my professional nursing care?
- How can I improve?
Your facility may also use Six Sigma. While this began as a business model, it has been successfully applied to the healthcare environment to improve quality, decrease errors, and improve processes. Six Sigma uses the following cyclical process to improve quality (Hood, 2018).
- How does DMAIC correlate with the nursing process?
- How can I use this to improve quality at my workplace?
By combining several other philosophies of quality management, one automaker developed Lean, which has since been applied to healthcare. Key practices in Lean include
- how people work;
- how workers connect;
- how work is constructed; and
- how work is improved and errors reduced (Hood, 2018).
Application of these safety and quality principles and processes is important to the real-world clinical setting. Consider the following issues in professional nursing.
Please match the clinical safety issue with the appropriate quality improvement solution.
Fatigue in the nurse is a crucial issue that can affect safety and quality in nursing care. Alarm fatigue (inattentiveness to alarms due to hearing them frequently) is a priority for the American Association of Critical-Care Nurses. This professional nursing organization has developed a toolkit to help nurses avoid alarm fatigue and improve the quality of care (American Association of Critical-Care Nurses, n.d.).
Nurses in many care settings in addition to critical care can experience alarm fatigue.
- What are you and your colleagues doing to prevent this?
Nurse fatigue can seriously impact patient safety and quality. The safety of the nurse can also be impacted by fatigue. Smith-Miller, Shaw-Kokut, Curro, and Jones (2014) reported that working shifts of over 12 hours result in increased errors and nurse fatigue. Nurses and organizations need to work to develop strategies to prevent nurse fatigue in order to improve quality and safety of patient care. Suggested strategies include
- duty-free breaks;
- scheduling that allows for maximal recuperation between day and night shifts;
- limiting the number of consecutive shifts;
- limiting shift duration to no more than 12 hours; and
- eliminating involuntary overtime.
“Praising clinical nurses for extending a 12-hour shift (i.e., staying over) marginalized the significance of recuperation and privileges self-sacrifice over self-care and patient safety” (Smith-Miller et al., 2014, p. 492).
Think About This
How are you, your work unit, and your facility working to decrease nurse fatigue to impact quality and safety? What more can be done? What is the evidence on this issue?
Nurse distraction is also an issue that may contribute to lapses in safety and quality of care. Although many nurses pride themselves on their ability to multitask, we instead need to focus on eliminating distractions and focusing on the critical task at hand to promote safety and quality in healthcare. Any distraction that takes our focus away from the critical task has the potential to result in an error. After we have completed the new task, we need time to regain our focus on the previous critical task to prevent an error.
- What strategies do you and your workplace use to help nurses focus on critical tasks (such as medication administration) and prevent distractions?
- What more can be done?
Many nurses fear punishment if they make an error in the clinical setting. Some nurses are even reluctant to report errors for fear of retribution or punishment. Barnsteiner (2011) suggested a balance between not blaming the person making the error and not tolerating behavior leading to serious errors. As healthcare moves from a punitive to a nonpunitive culture of safety, accountability and system improvement are emphasized to determine what happened, not who made the error.
We have briefly explored safety and quality in nursing in this lesson. You are urged to thoughtfully consider the above areas and learn more about these important nursing core competencies by reading scholarly nursing sources.
Test Your Knowledge