Improving Patient Safety on the Wards:Introduction

Linda Watterson

Programme Manager

Evaluating and Improving

The size of the problem

78% EU citizens think medical errors important problem in their country (Eurobarometer)

44 – 98,000 deaths annually caused by medical error (To err is human)

Adverse events occur in around 10% of hospital admissions, or about 85,000 adverse events per year. (An organisation with a memory)

Spain, France and Denmark have similar figures. Similar types of intervention related adverse event happen in all health care systems despite different organisational and financial systems

The patient perspective

Patient evaluation of care

Patient involvement

Digital Stories

www.patientvoices.org.uk

The nursing contribution

‘nursing staff can provide their hospital with information about the organisation, management and resourcing of care, that can be used to improve patients’ experiences’

Views from the sharp end of care

Blame culture

Feedback

Raising concerns

Views from the sharp end of care

Competing priorities

Workload

Staff deployment

The two words ‘information’ and ‘communication’ are often used interchangeably, but they signify

quite different things. Information is giving out;

communication is getting through.

Sydney J.Harris

The 3-bucket model forassessing risky situations (Reason, 2005)

1

2

3

SELF CONTEXT TASK

Human factors

Leadership

Culture

Communication

Feedback

Targets

Priorities

Equipment

Professional development

Planning

Capacity management

Workload

Staffing

Skill-mix

Health & Safety

Institutional context The clinical team

Organisation &management of care

The individual healthcare worker

Working environment The patient

Blunt’ end of care ‘Sharp’ end of careDecisions made here Impact here

Latent failures Active failures

(Based on Nolan, 2000; Reason et al 2001)

Antecedents, determinants and components of safety performance (Adapted from : Neal & Griffin, 2002)

ANTECEDENTS DETERMINANTS COMPONENTS

Management commitment/leadershipCommunicationRules/procedures/protocols/guidanceAppreciation of risk(s)Involvement Safety Knowledge & Skill Safety Compliance

Work environment Climate Motivation Safety Participation

Supportive environmentPriority of safetyPersonal priorities

Compliance and participation represent behaviours that individuals performwhilst at work. Safety compliance describes the core activities that must be carried out to maintain safety; safety participation describes behaviours that do not directly contribute to safety, but which help to develop an environment that supports safety.

If an individual does not have sufficient knowledge and skill to comply with safety regulations or participate in safety activities, they will not be able to perform these actions. If they do not have sufficient motivation to comply with safety regulations to participate in safety activities they will choose not to carry out these actions.

Safety climate is one of many antecedents of safety performance, for example, management commitment and leadership are felt to play an important role in shaping workers perceptions of the safety climate in their organisation

Management commitment:

Perceptions ofmanagement’s overt

commitment tosafety

Safety rules & procedures:

Views on the efficacyand necessity of

rules &procedures

Personal priorities:The individuals view of

their own health & safety management

and the need for feel safe

Communication:The nature and efficiency

of health & safetycommunications within

the organisation

Priority of safety:The relative status of

health & safety issues with the

organisation

Involvement:The extent to whichsafety is a focus for

everyone and allare involved

Supportive environment:

The nature of the socialenvironment at work,

and the supportderived from it

Personal appreciationof risk:

How individuals viewthe risk associated

with work

Work environment:Perceptions of the

Nature of the Physical

environment

The dimensions covered bythe Safety Climate Tool

Dimension, Descriptor, Associated Questions Dimension:

Perceptions of management’s overt commitment to safety.

Descriptor:

Management act decisively when a safety concern is raised

Questions:

- Management acts only after accidents have occurred

- Corrective action is always taken when management is told about

unsafe practices

- In my workplace management acts quickly to correct safety problems

- In my workplace management turn a blind eye to safety issues

- In my workplace managers/supervisors show interest in my safety

- Managers/supervisors express concern if safety procedures are not

adhered to

REASON, 2005

Strengthening the nursing contribution

Reporting and learning– Value of reporting– Valuing the nurses understanding of safety issues

Developing positive cultures – Blame culture– Empowerment– Training opportunities– Improving communication– Work environment

Staffing level /skill mix /workload issuesUse audit and benchmarking

Sharing solutions– Valuing the nurses role– Sharing best practice– Tools and techniques

Patient / consumer involvement

Proposed approach

Focus for patient safety

Support and strengthen the value of the nursing voice

Provide members with appropriate tools to review safety at all levels

Provide learning and development resources and opportunities

Consider the value of the patient voice for learning and challenging

Sharing best practice

Contact: linda.watterson@rcn.org.uk

References and useful reading Anderson DJ. Webster CS (2001) A systems approach to reduction of medication error on the hospital ward

Journal of Advanced Nursing 35 (1) 34 – 41 Attree M (2007) Factors influencing nurses’ decision to raise concerns about care quality Journal of Nursing

Management 15 392 - 402 Currie L, Watterson L, (2007) Challenges in delivering safe patient care. A commentary on a quality

improvement initiative Journal of Nursing Management 15 (2) 162 - 168 Department of Health Expert Group An organisation with a memory: report of an expert group on learning form

adverse events in NHS Chairman :Chief Medical Officer London: The Stationery Office 2000 http://ec.europa.eu/health/ph_information/documents/eb_64_en.pdf King L Macleod Clark J. (2002) Intuition and the development of expertise in surgical ward and intensive care

nurses Journal of Advanced Nursing 37 (4) 322 – 329 Kohn LT Corrigan JM Donaldson MS eds To err is human: Building a safer health system. Washington, D.C.

National Academy Press 2000 http://www.saferhealthcare.org.uk/ihi Mrayyan MT, Huber DL (2003) The Nurses Role in Changing Health Policy Related to Patient Safety JONA’s

Healthcare Law, Ethics and Regulation 5 91 Meurier CE (2000) Understanding the nature of errors in nursing: using a model to analyse critical incident

reports of errors which had resulted in an adverse or potentially adverse event Journal of Advanced Nursing31 (1) 202 - 207

Sorlie V, Torjuul K, Ross A, Kihlgren M (2006) Satisfied patients are also vulnerable patients – narratives from an acute care ward Journal of Clinical Nursing 15, 1240 – 1246

Storr J TopleyK, Privett S. (2005) The ward nurses role in infection control Nursing Standard 19 (41) 56 – 64 Sdottir H A, Bjornsdottir K (2008) Nursing and patient safety in the operating room Journal of Advanced Nursing

61 (1) 29 - 37 Walker AC, (2002) Safety and comfort work of nurses glimpsed through patient narratives Internationaol Journal

of Nursing Practice 8: 42 – 48 West E, Barron DN, Reeves R (2005) Overcoming the barriers to patient – centred care: time, tools and training

Journal of Clinical Nursing 14, 435 – 443 www.npsa.nhs.uk www.who.int/patientsafety

Ref: Storr J. et al The nurses role in infection control Nursing Standard 19 (41) 22 June 2005

Key action areas for ward nurses in preventing infection