Vol. XXXII No. 1 JOURNAL OF VASCULAR NURSING PAGE 1www.jvascnurs.net

Persp

ectives

Cindy Lewis, MSN, RN, ACNS-BC

Declaration of Conflicting Interdeclared by the author.

J Vasc Nurs 2014;32:1-2.

1062-0303/$36.00

Copyright � 2014 by the Society fo

http://dx.doi.org/10.1016/j.jvn.2013

FROM THE EDITOR’SPERSPECTIVE.

Ensuring patient safetyis our nursing responsibilityand is an essential and vitalcomponent of quality nur-sing care. A variety of stake-holders, society in general,patients, individual nurses,nursing educators, adminis-

trators, researchers, physicians, governments and legislativebodies, professional associations, and accrediting agencies areall responsible for ensuring that patient care is safely deliveredand that no harm occurs to our patients.

We all know that patient safety is of the utmost importance. Toreduce harm, it is necessary that we all take the accountability andresponsibility to make necessary changes to protect our patients.As health care providers, we track many ‘‘sentinel’’ events andstrive to have rates that approach zero. The use of technologyand safety systems in our organizations has improved our out-comes. As nurses, we have clearly been concerned with definingand measuring quality long before the current national emphasison patient safety. In 1855, Florence Nightingale analyzed mortal-ity data among British troops and accomplished significant reduc-tions in mortality by implementing organizational and hygienicpractices. She is also credited with creating the world’s first per-formance measures of hospitals in 1859.1 The most criticalcontribution of nursing to patient safety in any setting is the abil-ity to coordinate and integrate the multiple aspects of qualitywithin the care directly provided by nursing, and across thecare delivery system.

The national patient safety considerations for 2014 are ad-dressed below.2

� Patient identification. Patient identification and the match-ing of a patient to an intended treatment is an activity thatmust be performed routinely in all care settings. Standard-ization of processes and incorporating safety routines suchas utilizing standardized patient identification bands andbar coding help to ensure our patients receive the right com-

ests: No conflict of interest is

r Vascular Nursing, Inc.

.12.004

ponents of their care, whether diagnostic, therapeutic, orsupportive.

� Handoff communications. The role of nursing as a primecommunication link in all health care settings is evident.To ensure continuity and safety of patient care, controlduration of stay and costs, a standardized approach to hand-off communication is vital. The handoff provides accurateinformation about our patient’s care, treatment, and ser-vices, current condition, and any recent or anticipatedchanges. Improving communication requires processesand structures for information transfer. Good communica-tion has been linked with strong safety cultures and goodworkplace relationships, so investing in a safety culture inaddition to standardizing ways and means of transferringall medically necessary information between relevant clini-cians is a vital step to ensuring that we provide continuityand safety of care.

� Medication safety. As the rate of comorbidities rise, theaverage patient today tends to be on more medications atone time. This can lead to more severe potential side effectsand more potential challenges for our patients once theyleave our care. As nurses, we are vital to implementing acomprehensive medication history and reconciliation pro-cess during care transitions as well as needing to provideincreased patient education to reduce associated risks.

� Alarm fatigue. The sensory overload from sounds emittedby monitors, infusion pumps, ventilators, and other devicescan cause an alarm overload and desensitization resulting indelayed responses or missed alarms, and may contribute tonegative patient outcomes. The Joint Commission has re-corded sentinel events associated with alarm fatigue. Inaddition, alarm fatigue earned a spot on the ECRI Institute’s‘‘Top 10 Health Technology Hazards’’ list, where it hasmade frequent appearances since the list’s inception in2007.3 Creating guidelines to customize alarm settings toindividual patients, rather than keeping strict alarm settingshas been suggested as a solution to alleviate this problem.

� Prevent infections. Health care-associated infections(HAIs) are both prevalent and costly. Multidrug-resistantinfections compound the difficulty in reducing HAIs. Tomanage the most prevalent HAIs, criteria have been de-signed to screen populations at risk. Following the US Cen-ters for Disease Control and Prevention guidelines forcorrect hand washing techniques, targeting surgical site in-fections through the Surgical Care Improvement Projectguidelines, preventing central line infections through theCentral Line Associated Blood Stream Infections guide-lines, and preventing urinary tract infections by followingthe Catheter-Associated Urinary Tract Infections criteriahelp to ensure the specific steps to protect our patients.

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� Prevent surgical complications. Although surgical compli-cations such as retained foreign objects, mistaken identity,and wrong-site surgery thankfully do not happen often, po-tential consequences can be severe when they do. Surgicalchecklists help to ensure necessary compliance with basicstandards of care. Use of a checklist can ensure good plan-ning and attention to detail from all members of the surgicalteam. At the present, this seems to be the only reliable so-lution to improving surgical complications.

� Prevent falls. A growing number of baby boomers arejoining the ranks of senior citizens, me included! In addi-tion to causing a care shortage some time in the future, car-ing for a greater number of older patients necessitatespreparation for the complications that are associated withadvancing age, such as risk for falls. Routine screeningfor patients at risk for falls, such as those with reducedmobility, low blood pressure, and dementia, should be stan-dard protocol in our plans of care.

� Implement a culture of safety. Strong safety cultures allowpatient safety events to be identified and analyzed and theirroot causes to be eliminated. Although in a perfect world allclinicians would speak up about every error, or potential er-ror that may occur, it is human nature that this is often notthe case. Allowing clinicians to stop fearing retribution forerror reporting is the responsibility of organization’s leader-ship. The Joint Commission model for moving to a safetyculture includes four steps: Planning the change, inspiringpeople to change, launching the framework, and supportingthe change both to completion and afterward. These stepscan facilitate buy-in from staff and increase the odds of suc-cess in safety culture implementation.

What is nursing’s role in ensuring patient safety? Each of us isaccountable to ensure these safety goals are addressed andmanaged. Improvement is about creating a culture of safetywithin our organizations. Patient safety is the foundation tohigh-quality health care. Much of the work defining safety prac-tices that prevent harm have focused on negative outcomes suchas morbidity and mortality. As nurses, we are critical to the sur-veillance and coordination that reduces such adverse outcomes.It is imperative that we make measurable commitments, createsolutions, and share our successes. Yet much work remains tobe done in evaluating the impact of our nursing care on positivequality indicators and other measures of improved health status.Share with us your strategies for success, your patient stories,and your professional challenges. How have electronic medicalrecords aided in your daily care activities? What are some strate-gies you have utilized to encourage your patients involvement intheir safety and care? Our journal is our avenue to promote andhighlight the quality work we are providing and achieving. Sharewith us your practices and outcomes! We look forward to hearingfrom you!

REFERENCES

1. Nightingale F. In: Goldie SM, editor. ‘‘I have done my duty’’;Florence Nightingale in the Crimean War. Manchester, UK:Manchester University Press; 1987:1854-6.

2. The Joint Commission. Joint Commission Perspectives.2013;33:7.

3. ECRI Alarm Safety Resource Site: https://www.ecri.org/Forms/Pages/Alarm_Safety_Resource.aspx