Nurses Week 2016: CNOs Speak Out On Safety

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Nurses Week 2016: CNOs Speak Out On Safety

Innovations and Advice for Better Practice

By Working Nurse
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Since the theme of National Nurses Week 2016 is “Culture of Safety: It Starts with You,” we decided to make safety the focus of our annual roundtable. Throughout the issue, nursing leaders from local hospitals share their thoughts on what institutions and individual RNs can do to make hospitals safer.

Photo, clockwise from left: Nancy Blake, RN, Ph.D., CCRN, NEA-BC, FAAN; Lori Burnell, RN, Ph.D., NEA-BC; Shirley Johnson, RN, M.S., MBA;  Joe Lopez-Cepero, RN, BSN, MBA;  Margaret Pfeiffer, RN, MSN; Sarah Stevens, RN, MSN; Lauren Spilsbury, RN, MSN; Bob Merritt, RN, MSN.

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Q: Is there a recent or upcoming safety-related change or innovation at your hospital that you’re particularly excited about or proud of ?


Alarm Fatigue

We have worked very hard to decrease alarm fatigue. Our staff is very good at setting alarm limits specific to the patients, which means there’s no excessive noise caused by non-actionable alarms. That results in a less-stressful environment for the staff and a safer healing environment.

Nancy Blake, RN, Ph.D., CCRN, NEA-BC, FAAN, Director, Critical Care Services, Children’s Hospital Los Angeles


ED Wait Times

Approximately one year ago, a team of clinical stakeholders participated in a week-long kaizen [continuous improvement] event to redesign patient throughput in the emergency department. Door-to-provider times went from an average of 114 minutes to 21 minutes for high-acuity patients and 51 minutes for patients receiving treatment and discharge.

Lori L. Burnell, RN, Ph.D., NEA-BC, Senior Vice President / Chief Nursing Officer, Valley Presbyterian Hospital


Patient Handling

We are in the midst of completing safe patient handling training for all patient care staff, regardless of department. The training includes the use of the many pieces of new equipment we have purchased to support safe movement of patients. The sessions have been well-received and have helped us prioritize which additional equipment is most desired by staff.

Shirley Johnson, RN, M.S., MBA, Sr. Vice President / Chief Nursing and Patient Care Services Officer, City of Hope


ED “Team Care”

We have implemented a new process in our ED called “Team Care,” which is designed to facilitate quickly moving patients to the appropriate provider based on acuity. This also ensures those very sick patients are not held up in our waiting area while waiting for beds.

Bob Merritt, RN, MSN, Interim Chief Nursing Officer, St. Francis Medical Center 


Early Mobility

Our “MOVIN’ @ RCH” program — which was proposed and led by one of our nurses based on research she did as part of her BSN program — emphasizes early mobility to combat deconditioning, prevent hospital-acquired conditions and improve patient experience.

Lauren Spilsbury, RN, MSN, Vice President, Patient Care Services, Redlands Community Hospital 


Smart Devices

As a brand-new hospital, we are very innovative here at MLKCH. For example, our EHR is smoothly integrated with 30-plus devices, including smart pumps that that replenish IV bags and smart beds that weigh patients and provide safety alarms if a patient falls from their bed. 

Sarah Stevens, RN, MSN, Director of Critical Care, Martin Luther King, Jr. Community Hospital


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Q: What’s a specific safety-related change or policy you’d like to see all hospitals and healthcare institutions adopt?

 
Stop the Line

Organizations should have processes that allow anyone to “stop the line” when they feel a patient is being put at risk.

Nancy Blake, RN, Ph.D., CCRN, NEA-BC, FAAN, Director, Critical Care Services, Children’s Hospital Los Angeles


Barcode Technology

A “must have” for every hospital and healthcare institution is barcode verification technology for the electronic medication administration system. When nurses are diligent about scanning each medication before administration, medication errors are virtually eliminated. 

Lori L. Burnell, RN, Ph.D., NEA-BC, Senior Vice President / Chief Nursing Officer, Valley Presbyterian Hospital


Hand Hygiene Adherence

I am hopeful that technology will soon allow us to electronically track hand hygiene adherence. We know that good hand hygiene is important for reduction of many infections. Having better tools to monitor adherence will aid us in ensuring 100 percent compliance.

Shirley Johnson, RN, M.S., MBA, Sr. Vice President / Chief Nursing and Patient Care Services Officer, City of Hope


Psychiatric Zones

I would love to see each ED have an appropriate area for psychiatric patients, staffed with behavioral-health-trained RNs and mental health workers.

Bob Merritt, RN, MSN, Interim Chief Nursing Officer, St. Francis Medical Center 


Common Lingo

I would like all organizations, including nursing schools, to adopt TeamSTEPPS methodology to improve communication in patient care. Having “trigger words” which have the same meaning to all healthcare providers is a powerful tool for ensuring patient safety.

Lauren Spilsbury, RN, MSN, Vice President, Patient Care Services, Redlands Community Hospital 


Patient Reporting

I always want the patients involved in their reporting. At shift changes, we want to ensure that our reporting includes where the patient is not only clinically, but also emotionally. That way, nurses are able to engage and interact with patients in a much more productive manner.

Sarah Stevens, RN, MSN, Director of Critical Care, Martin Luther King, Jr. Community Hospital


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Q: A major safety issue for nurses, particularly ED nurses and those on psychiatric units, is workplace violence. What are some specific steps your institution is taking to better protect nurses?


Safety Workshop

Last year, we brought the security officers and the ED staff together for a workshop to address safety and better communication for the team, especially during high-stress times when census is high and wait times are prolonged. Numerous interventions came out of this project. As a result, the ED nurses feel safer in their environment.

Nancy Blake, RN, Ph.D., CCRN, NEA-BC, FAAN, Director, Critical Care Services, Children’s Hospital Los Angeles 


Better Training and Extra Security

Some of the steps our organization has employed include providing four hours of mandatory training on how to effectively manage aggressive and assaultive behaviors; screening every patient at intake to assess potential risk to themselves or others; placing a security officer in the ED; and an ED renovation and expansion that added stripped-down safe rooms, a tempered glass enclosure for the nursing station and several panic buttons.

Lori L. Burnell, RN, Ph.D., NEA-BC, Senior Vice President / Chief Nursing Officer, Valley Presbyterian Hospital


Security Team Guidance

Our security team is amazing and has collaborated in the development of content that we use with staff for our Code Grey and Code Grey Adam events as well as a video focused on an active shooter situation. Our staff have identified this content as being extremely beneficial to them.

Shirley Johnson, RN, M.S., MBA, Sr. Vice President / Chief Nursing and Patient Care Services Officer, City of Hope


Round-the-Clock Security

To help protect our nurses at Community Hospital of Huntington Park, we have 24/7 security present both in the lobby for the ED and stationed at the room designated for our psychiatric placements.

Joe Lopez-Cepero, RN, BSN, MBA, Chief Nursing Officer, Community Hospital of Huntington Park (Avanti Hospitals)


Psychiatric In-Servicing 

One of the enhancements we have initiated is a dedicated psychiatric “sitter” program in which all ED “sitters” are required to be in-serviced by our behavioral health team prior to working with psychiatric patients. Also, if we are “boarding” psychiatric patients in the ED, a behavioral health nurse from our inpatient unit will round on the patient at least once per shift.

Bob Merritt, RN, MSN, Interim Chief Nursing Officer, St. Francis Medical Center 


Safety Protocols

We have an amazing, well-trained security team. Our ED staff is also experienced and trained to identify, communicate and implement safety protocols that result in patient, visitor and staff safety.

Sarah Stevens, RN, MSN, Director of Critical Care, Martin Luther King, Jr. Community Hospital


Zero Tolerance

We’ve worked to implement a culture of zero tolerance for violence, including physical and verbal violence.

Lauren Spilsbury, RN, MSN, Vice President, Patient Care Services, Redlands Community Hospital

 

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Q: Electronic health recordkeeping is now a reality in most institutions. Has the adoption of EHRs and electronic charting been a boon to patient safety, an obstacle or both?

 

Eliminating Human Errors

There are days when it is both. The beauty of the electronic record is that it is organized and easily read. Also, it is now possible to interface the EHR with technology like the infusion pump, which eliminates some of the human errors that occurred with manual systems.

Nancy Blake, RN, Ph.D., CCRN, NEA-BC, FAAN, Director, Critical Care Services, Children’s Hospital Los Angeles


Hard Stops

One benefit of the EHR has been the ability to incorporate hard stops into the documentation process that require clinicians to enter essential clinical information. On the other hand, documenting in the EHR can be time-consuming and fragmented. Nurses spend too much time in front of a computer screen, taking away valuable one-on-one time with patients.

Lori L. Burnell, RN, Ph.D., NEA-BC, Senior Vice President / Chief Nursing Officer, Valley Presbyterian Hospital


Beward of Workarounds

There have been some improvements, such as being able to include key elements in standard orders and/or force documentation of key areas of observation. But, no system is perfect. It’s important to ensure that challenging documentation issues and staff “workarounds” are identified and resolved to ensure that unsafe practices do not develop or perpetuate.

Shirley Johnson, RN, M.S., MBA, Sr. Vice President / Chief Nursing and Patient Care Services Officer, City of Hope


Must Support Bedside Workflow

The EHR has supported many patient safety initiatives, most notably in medication administration. However, with any new initiative, process flow is essential. Our informatics team has worked hard to ensure that the documentation modules support the workflow of the nurses at bedside. 

Joe Lopez-Cepero, RN, BSN, MBA, Chief Nursing Officer, Community Hospital of Huntington Park (Avanti Hospitals)


Too Many Lists

Having the patient’s records available across the continuum of care is a significant patient safety advance. However, with the advent of EHR systems, we as nurses have slowly gravitated to “task-oriented” patient care, relying on work lists to tell us when to check on the patient.

Bob Merritt, RN, MSN, Interim Chief Nursing Officer, St. Francis Medical Center 


Better Documentation

Once we got over the initial learning curve, the EHR has not become the obstacle many have warned. The clinical staff spend no more time documenting than they did in the past. Documents are legible, immediately accessible and much more complete than before.

Margaret Pfeiffer, RN, MSN, Vice President, Patient Care Services, Good Samaritan Hospital


Preserving the Human Factor

EHR is definitely a boon to patient safety, but at the same time, we can never take out the human factor. I believe technology assists, but it doesn’t heal. People heal.

Sarah Stevens, RN, MSN, Director of Critical Care, Martin Luther King, Jr. Community Hospital


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Q: Safety concerns are a big obstacle for new nurses in getting their first nursing jobs. What is your hospital’s policy/attitude towards hiring new nurses and helping them develop their ability to practice safely?

 

Versant Program

We developed a Versant nurse residency program at CHLA to bridge the transition from school to the workforce. There are confidential debriefing sessions, a preceptor program and a mentor program to support the new graduate as they learn the safety essentials. I encourage all new nurses to go to a hospital with a residency program that provides this support.

Nancy Blake, RN, Ph.D., CCRN, NEA-BC, FAAN, Director, Critical Care Services, Children’s Hospital Los Angeles


Residency Program

We are one of the few hospitals in the San Gabriel Valley to offer a new graduate nurse residency program. Our entry level of new staff hiring is at the BSN level. Depending on the area of practice, the residency program spans 12 to 16 weeks. All new graduates are partnered with a preceptor.

Shirley Johnson, RN, M.S., MBA, Sr. Vice President / Chief Nursing and Patient Care Services Officer, City of Hope


New Faces, New Ideas

We have developed new grad orientations for most of our nursing areas. New nurses can be developed into very strong members of your nursing workforce if you are willing to invest some extra time with them and often bring a renewed “fire” to your organization. 

Bob Merritt, RN, MSN, Interim Chief Nursing Officer, St. Francis Medical Center 


Experienced Nurses Get to Teach

Our hospital will soon start having new grad programs again, which I am excited about. Nursing departments thrive when new staff come into the mix. It stimulates questions and experienced nurses get to teach.

Margaret Pfeiffer, RN, MSN, Vice President, Patient Care Services, Good Samaritan Hospital


Internship Program

We have a robust new graduate internship program designed to provide a supportive environment encouraging the new grad to assimilate into the professional nursing workforce. We allow the graduate nurse to choose their area of specialty. Depending on the area, the program could last between four months and one year.

Lauren Spilsbury, RN, MSN, Vice President, Patient Care Services, Redlands Community Hospital


No New Grads, Yet

Right now, we do not recruit new grads because as a start-up hospital, we operate in a fluid atmosphere, which can make for a difficult environment for new grads. In the future, we would like to bring in graduates with the right attitude and the non-teachable skills we expect.

Sarah Stevens, RN, MSN, Director of Critical Care, Martin Luther King, Jr. Community Hospital


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Q: If you could give all RNs one suggestion or piece of advice about how they can improve safety in their institutions, what would it be?

 

Ask Questions

Ask questions if you don’t know why a specific medication or therapy is being given or if something doesn’t sound or look right. No question is a stupid question — nurses need to understand why they are doing what they are doing. It keeps patients safe.

Nancy Blake, RN, Ph.D., CCRN, NEA-BC, FAAN, Director, Critical Care Services, Children’s Hospital Los Angeles


Speak Up

Speak up when you hear or see an unsafe situation, find solutions and engage in research and evidence-based practice projects designed to mitigate safety risks. You can make a difference!

Lori L. Burnell, RN, Ph.D., NEA-BC, Senior Vice President / Chief Nursing Officer, Valley Presbyterian Hospital


Don’t Ignore Your Instincts

Listen to that small voice that may be telling you something is not quite right with a situation, even though you might not be able to pinpoint what “it” is in the moment.

Shirley Johnson, RN, M.S., MBA, Sr. Vice President / Chief Nursing and Patient Care Services Officer, City of Hope


Don’t Get Complacent

Pay attention to detail and don’t get complacent. Take advantage of every learning opportunity and if you don’t feel comfortable, ask for more support. 

Joe Lopez-Cepero, RN, BSN, MBA, Chief Nursing Officer, Community Hospital of Huntington Park (Avanti Hospitals)


Hear Patients’ Concerns

Communicate with your patients. Patients want to be heard and know their concerns are being addressed. We may not always be able to facilitate their desires, but we at least need to hear their concerns.

Bob Merritt, RN, MSN, Interim Chief Nursing Officer, St. Francis Medical Center 


Do Your Homework

Every day when you go home, read about the conditions of the patients you cared for that day, review medications and learn as much as you can. Also, never forget that you are caring for a person. If you always remember that you are caring for another human being, you’re more likely to avoid shortcuts and pay attention to all aspects of care.

Margaret Pfeiffer, RN, MSN, Vice President, Patient Care Services, Good Samaritan Hospital


Always Keep Learning

Keep learning and growing. When I graduated, my nursing instructor told me, “You are now just beginning. We have not taught you everything you need to know. We have only given you the tools to find what you need to know.”

Lauren Spilsbury, RN, MSN, Vice President, Patient Care Services, Redlands Community Hospital


Make the Best Possible Decision 

Be ready for the times you will ask yourself, “What is the best decision I can make for this patient?” If you can make that best, safest decision, you’re not going to be far off. And if it doesn’t feel right, say something and keep saying it until someone listens to you.

Sarah Stevens, RN, MSN, Director of Critical Care, Martin Luther King, Jr. Community Hospital       


This article is from workingnurse.com.

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