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Patient Safety and Quality

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Intensive care nurses tend to identify patient safety practices from self-initiated tasks

Intensive care unit (ICU) nurses at four community hospitals who participated in a project to decrease catheter-related bloodstream infections (CRBSIs) did not generalize that experience to other aspects of patient safety. They also did not associate the project with management's interest in patient safety, reveals a new study. Despite safety education from management (classes, posters, and notices), these nurses continued to define patient safety primarily by their own experiences in patient care. They viewed patient safety as actions that they initiated each day, which have immediate results they can see, such as double-checking patients' medications and checking their restraints to make sure they don't fall out of bed or pull out their intravenous lines.

Failing to vigilantly perform these tasks can result in obvious and immediate patient harm, such as falls and seizures. These are also the same tasks that comprised nearly half the checklist items from leadership walk-rounds. On the other hand, safety programs like the CRBSI project offer no immediate feedback on patient safety, whether catheter insertion followed protocols or not. Patient harm due to problems such as CRBSIs may not show up until the patient has left the hospital.

These findings are consistent with many adult learning theories, where self-initiated tasks, combined with immediate but temporary problem-solving, are stronger learning forces than management-led activities with delayed feedback, explains University of Cincinnati researcher Nancy C. Elder, M.D. Dr. Elder and colleagues analyzed conversations among 33 nurses from 8 focus groups, safety climate survey responses of 92 nurses and managers, and review of 3 separate leadership walk-around checklists. The study was supported in part by the Agency for Healthcare Research and Quality (HS13914).

More details are in "Intensive care unit nurses' perceptions of safety after a highly specific safety intervention," by Dr. Elder, Suzanne M. Brungs, R.N., M.S.N., M.B.A., Mark Nagy, Ph.D., and others, in Quality and Safety in Health Care 17, pp. 25-30, 2008.

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