Nursing Book Club
Safe Patients, Smart Hospitals
If you don’t have a comprehensive unit safety program in place, read this book
Reviewed by Elizabeth Hanink, RN, BSN, PHN
Have you ever thought of patient safety as an area of study just as important as new drug research? After reading Peter Pronovost’s book Safe Patients, Smart Hospitals on the subject, I bet that you will. His crusade is to improve patient well-being using rigorous methods of data collection and analysis and to spread the welcome news that every patient in every hospital can benefit.
It isn’t just data that will protect the patient; it’s also the use of checklists and the change in hospital culture that can result when participants see, in clearly stated facts and figures, that customary systems aren’t working. All three are necessary components to better patient care.
The Tragic and the Routine
His book is compelling, offering some sobering examples of patient harm and even deaths that resulted from preventable errors. The story of Josie King, who died because staff did not heed a mother’s intuitive concern, is unforgettable. Unfortunately, we all can remember similar if not as dramatic tales.
Mostly though, the author focuses on the routine and mundane practice of everyday medicine and nursing that leads to poor outcomes despite the best intentions: incomplete reports at patient transfer, invasive lines, lack of clarity regarding medications or discharge instructions. Not surprisingly, often the simple solution is the best: labeling equipment, nurse involvement in rounds or daily goals sheets.
Proving Checklists Work
Take central line infections, for example: every year thousands of vulnerable patients die from the use of these necessary devices because somehow they become the source of raging infections. Urinary catheters are the same. Yet in both cases, the number of adverse effects can be almost completely eliminated using a checklist of steps in a standardized procedure. Dr. Pronovost has proven it not only in his home hospital of Johns Hopkins in Baltimore, but also across the entire state of Michigan.
Of course many people understand that following correct technique will prevent infections, but Dr. Pronovost and his colleagues understand that while the checklist is important, you cannot prove you have cut infection rates unless you collect before and after data that is complete and accurate. If you can’t prove the effectiveness of a practice, you will absolutely not get buy-in from those that have the power to make changes, namely doctors, nurses, and administrators. According to Dr. Pronovost, physicians will only respond to scientific proof and administrators are most responsive to cost benefits.
Respect for Nurses
Further, you must change conventional procedures within practice areas so that enforcement is possible by those who are with patients the most — namely nurses. Dr. Pronovost has great respect for the profession of nursing. It is safe to say that without them, none of the change he advocates would be possible. Systems and cultures are always interdependent.
If you don’t have a comprehensive unit safety program in place where you work, read this book. Find out how necessary one is and how you can make it happen. You have nothing to lose and your patients have everything to gain. Dr. Pronovost has the ear of Congress and multiple quality assurance organizations. He needs yours.
Elizabeth Hanink, RN, BSN, PHN is a freelance writer with extensive hospital and community-based nursing experience.