by Jessica Dzubak, RN
In honor of Patient Safety Awareness Week, let’s bring attention to the top five patient safety concerns for nurses.
1. Medication Errors
The FDA estimates that approximately one person dies every day from a medication error, and approximately 1.3 million people are harmed by these errors annually. Ask any nurse, and they are all too familiar with medication errors, regardless of practice area. Nurses in areas like quality improvement are dedicated to studying these metrics because it is such an important problem. Despite increased education and implementation of electronic medical records (EMRs) and safety measures, medication errors are still happening. All nurses could recite the 5 rights to medication administration, but yet somehow in busy units when nurses have too many tasks at hand, they do happen. In fact, it’s easy to make a medication error. The nurse might grab the wrong medication with a similar name, administer the wrong dose in an urgent situation, or click the wrong patients name in the medication dispensary. Medication errors remain at the top of the list because of their dangerous potential. Medication errors kill. And medication errors are 100% preventable. Let’s do better, for our patients. Let’s eliminate medication errors from this list.
Because of the high prevalence, danger, and cost of patient falls, just about every patient care facility now has a fall prevention plan in place. Some EMRs include fall risk assessments in their patient intake or triage charting. Hospitals have color-coded signs to place on patient room doors, special patient socks, and specific care plans for those at risk. Many patients in hospital and long term care facilities might be weak, confused, and on multiple medications that add to these problems or create new ones, such as increased need to go to the restroom. All of these factors can contribute to an increased risk for falls. Falls can cause serious injuries, can increase length of stay (LOS), and cost hospitals significant money. A 2014 article published by the Joint Commission estimates that “the average cost for a fall with an injury is $14,000”. Additionally, the Joint Commission noted that approximately 63% of the falls noted in hospitals resulted in death. Patients come in to the hospital to get better, not leave with more injuries than they came in with. Nurses are on the frontline to assess all patients for their fall risk, and implement the best interventions to protect them.
3. Hospital acquired infections (HAI)
Prevalent hospital acquired infections (HAI) include pneumonia, bloodstream infections, surgical site infections, and urinary tract infections. According to the CDC, HAIs are generally on the decline, with the exception of catheter associated urinary tract infections (CAUTIs) which are only noted to have “some progress” in acute care settings. The verbiage for CAUTI prevention and treatment on the National Patient Safety Goals (NPSG) has been updated for 2017 to reflect new data. Nurses understand that a majority of patients may be immunocompromised, on more than one antibiotic, and exposed to many pathogens during their stay, which all increase their risk for developing these infections. Unfortunately, patients can become exposed to serious bacteria simply through healthcare workers if proper personal protective equipment (PPE) and handwashing guidelines are not followed. Something as fundamental as proper handwashing has been shown to decrease these risks for patients and other healthcare staff. Dangerous bacteria such as clostridium difficle (C-diff), norovirus, Vancomycin-resistant Enterococcus (VRE) and MRSA are all carried on the hands. Nurses have a unique role and can not only protect their patients by wearing PPE and handwashing, but can educate patients and families on infection prevention measures. Nurses can also encourage other healthcare workers to follow these prevention guidelines, making their unit safer for their patients, and themselves.
4. Wrong patient
Ensuring you have the right patient goes beyond medication errors. Multiple people are involved in a patient’s care at any given time, and can lead to things like wrong blood tests being drawn, ordering the wrong blood products, discharging an infant home to the wrong parents, or taking the wrong patient to a test (Pennsylvania Patient Safety Authority). More dramatically, wrong person/wrong site surgical procedures are still happening. We now have “time out” and extensive checklists for procedures, greatly decreasing the prevalence of surgical errors, but what about everything else? Barcode scanning and EMRs with patient’s pictures are helping close that gap, but nurses still need to be just as vigilant about double checking everything every single time. Using name AND birth day for every encounter may seem redundant, but it’s one of the ways nurses can do their part for ensuring they have the correct patient.
5. Pressure Ulcers
As many as 2.5 million patients a year are affected by pressure ulcers (Agency for Healthcare Research and Policy). Many patients in inpatient settings cannot move themselves properly and have fragile skin as well as poor nutrition and complex disease processes. These, generally non-modifiable, risk factors increase the patient’s chances of developing these dangerous ulcers. With great vigilance, nurses can help decrease the formation of pressure ulcers by following a strict turning schedule and ensuring incontinent patients are being cleaned promptly and adequately. Nurses can educate patient’s families on pressure ulcer prevention for when they are discharged home. In addition to turning, nurses need to continuously assess for the beginning stages of an ulcer, understanding the need to intervene before it gets worse. Pressure ulcers are similar to other patient safety concerns in that that they not only cost the hospitals money but they increase length of stay (LOS) and decrease overall state of health. The Agency for Healthcare Research and Policy notes that pressure ulcers “cost $9.1-11.6 billion in healthcare costs per year in the US”, adding approximately $43,180 to hospital stay. In addition to the hefty price tag of a pressure ulcer, the patient now has an increased risk of infection, LOS, and mortality.
So how, as nurses, do we ensure these concerns do not manifest into reality? We must be the leaders of our healthcare team – which includes being the ultimate advocate for our patients’ needs.