Jobs Well Done: 4 Nurses Week Safety Stars


By Debra Wood, RN, contributor

The Nurse Week 2016 theme, “Culture of Safety: It Starts with YOU,” encourages nurses to take a leading role in creating safer environments for patients and health care workers. Many nurses have already pursued initiatives to enhance safety, including some with notable results.

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Early recognition and intervention with delirium patients

“I truly believe that there is no better person to innovate and champion for patient safety and change in health care than the clinical nurse; we are right at the front line of delivery and know what our patients need,” said Kaitlyn Gregory, RN, DNP, interim clinical nurse specialist in critical care at Fox Chase Cancer Center in Philadelphia. Gregory led an American Association of Critical-Care Nurses Clinical Scene Investigator (CSI) project to prevent delirium, which affects up to 80 percent of ICU patients.

The nurses implemented protocols to recognize delirium symptoms early and to intervene to lessen the burden of delirium. These interventions would help keep patients and staff safer.

RELATED:  The Top 6 Things Nurses Can Do to Improve Patient Safety

Changing perceptions to reduce patient falls

Renee Samples Twibell

In a study published in the American Journal of Critical Care, Renee Samples Twibell, RN, PhD, CNE, an associate professor in the school of nursing at Ball State University and a nurse researcher at Indiana University Health Ball Memorial Hospital, both in Muncie, Ind., recognized falls are the most common adverse event among hospitalized patients.

Her team explored patient perceptions about falling and found acutely ill inpatients are not afraid of falling and do not believe there are adverse consequences to falling. They had confidence they could perform high-risk behaviors without help and without falling. Yet nurses know that’s not the case. The study found 10 percent of the patients would not call for help for a mobility-related activity. The research team pointed out that nurses can tailor communications about falls and reshape perceptions to help patients stay safe.

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Cutting call light response times

Daniel Hudson

Daniel Hudson, MSN, RN, a graduate of Chamberlain College of Nursing’s MSN executive track, led a project to speed up call light response teams. Patients may tire of waiting and try to get up on their own, resulting in a fall. The team, which included Victor Dimacali, RN; Kathy Coe, BSN, RN; Jessica Shen, BSN, RN; and Zue Sun, used lean principles to identify process waste and test the changes, which included call triage, a buddy system of alternate responders, daily and mid-shift huddles, at which time the nurses can reassess fall risk and call light volume and redistribute staff as needed.

“An improvement project will not be sustainable unless the experts of the work processes are included, in this case meaning the interprofessional frontline staff,” Hudson said.

Training nurses to recognize signs of potential violence

A 2016 review article in The New England Journal of Medicine found violence in the health care workplace is under-reported by as much as 70 percent, and that 154 shootings took place at hospitals between 2000 and 2011. Seventy percent of staff members are physically assaulted each year, as are 59 percent of nursing home aides.

Bobby Morton

“Most violence in hospitals is in psychiatric units, the emergency department and geriatric units,” said Bobby Morton, DNP, a board-certified mental health nurse practitioner and full-time adjunct faculty member with Kaplan University School of Nursing. “Any nurse can encounter this at any time in any setting. Usually it happens when nurses are trying to set limits.”

Morton has developed a training program for nurses to recognize signs leading up to aggression and violence and take action to diffuse the situation, using the nursing process. He brings in actors to help nurses learn how to talk with patients and overcome their fears.

“We find some middle ground and build a therapeutic relationship,” Morton said. “It’s giving nurses effective communication tools and building relationships with patients.”

YOUR role: Take small steps to improve the big picture

While any nurse can lead the quest for a safer health care environment, the AACN CSI Academy provides tools and education to allow frontline staff to become change agents.

“If a nurse is interested in creating a safety change, my suggestion is to start small and make incremental changes to tackle the big picture,” Gregory said. “You will feel more accomplished and less overwhelmed when you set and achieve the small goals. Creating change is a marathon, not a sprint.”

© 2016. AMN Healthcare, Inc. All Rights Reserved.

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