Actively participating in an organization's safety initiatives

AORN Journal, May, 2008 by Suzanne C. Beyea

This column is the fifth in a series focusing on safety goals for perioperative nurses. This month s goal is that all nurses will learn about and participate in their organization's patient safety initiatives.

In today's health care environment, the safety policies that are in place have been designed to make health care safer and more reliable. Every nurse needs to be aware of the safety initiatives in effect at the health care organization in which he or she works, as well as any changes being made to existing safety practices.

Some nurses working in perioperative settings may mistakenly believe that changes in policies or practices in other departments do not affect them, but this may not be true. Each clinician must be aware of how a change in practice in one department affects patients that are transferred to other areas. It is only when all health care providers work together (ie, intradepartmentally) that the health care organization will be able to fully address certain hazards.

For example, when a patient is at risk for falling, the nurses in the preoperative holding area, OR, and postanesthesia care unit all need to be aware of the patient's risk factors. Only then will nurses in each department be able to take the appropriate precautions to prevent the patient from falling.

COMPLIANCE WITH NATIONAL PATIENT SAFETY GOALS (NPSGs)

Organizations that are accredited by the Joint Commission direct many of their patient safety efforts toward compliance with the Joint Commission's National Patient Safety Goals (NPSGs). (1) These goals address various safety interventions that are designed to help reduce risks in the health care environment. The NPSGs were created and continue to be updated in response to the Joint Commission's review and analysis of sentinel events reported by health care organizations across the country.

The 2008 NPSGs for acute care hospitals include the following:

* improving the accuracy of patient identification,

* improving the effectiveness of communication among caregivers,

* improving the safety of medication administration,

* reducing the risks of health care-associated infections,

* accurately and completely reconciling medications across the continuum of care,

* reducing the risk of patient harm resulting from falls,

* encouraging patients' involvement in their own care as a patient safety strategy,

* defining and communicating a means for patients and their family members to report concerns about safety and encouraging them to do so,

* identifying safety risks inherent in an organization's patient population, and

* improving recognition of and response to changes in a patient's condition. (1)

Additionally, there are NPSGs specific to other types of health care organizations, including office-based surgical sites and critical access hospitals.

All nurses need to be aware of and fully understand what their organization is doing in response to each of these goals. More specifically, a nurse must understand what he or she should do to comply with these directives in order to ensure the continuity of care.

THE 5 MILLION LIVES CAMPAIGN

The Institute for Healthcare Improvement (IHI) is another organization that has taken a leadership role in promoting quality and safe patient care in health care organizations. (2) Many health care organizations are voluntarily participating in IHI's "5 Million Lives Campaign" (3) by implementing numerous initiatives that are designed to reduce or eliminate the risk of harm and ensure that those in a health care organization do no harm as they provide care to patients. This campaign began in response to data that indicated medical harm occurs in the United States at the rate of 15 million instances each year. (3)

The 5 Million Lives Campaign is striving to improve patient safety through a number of key interventions implemented during a two-year period that will end in December 2008. The campaign comprises 12 interventions that include

* deploying a rapid-response team at the first sign of patient decline;

* delivering evidence-based care for acute myocardial infarction;

* preventing adverse drug events by implementing medication reconciliation strategies;

* preventing central line infections by implementing evidence-based practices;

* preventing surgical site infections by properly administering perioperative antibiotics;

* preventing ventilator-associated pneumonia by implementing evidence-based interventions;

* preventing harm from high-alert medications such as anticoagulants, sedatives, and narcotics;

* reducing surgical complications by implementing the interventions that have been recommended by the Surgical Care Improvement Project; (4)

* preventing pressure ulcers by using evidence-based practices;

* reducing methicillin-resistant Staphylococcus aureus infections;

* delivering reliable, evidence-based care for congestive heart failure; and

* gaining the support of the health care organizations' boards of directors for these safety efforts. (3)

For more information on the campaign and to obtain materials, clinicians can visit the IHI web site at http://www.ihi.org.