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In certain situations, nurses should raise a "red flag" to protect patient safety

Three important steps can improve patient safety, suggests Ronda G. Hughes, Ph.D., M.H.S., R.N., senior health scientist administrator at the Agency for Healthcare Research and Quality. First, staff fatigue and stress must be minimized. A nurse should work no more than 12 hours per day for a maximum of 60 hours per week and should carry a small enough patient load to ensure each patient's needs are met. Second, staff vigilance against potential threats to patient safety must be supported. For example, work schedules should be arranged so that no one works longer than the recommended daily and weekly hours. Third, what is known must be incorporated into practice now, which may require system redesign.

So what should a nurse do when she or he sees an error in the making? Dr. Hughes suggests some situations in which nurses should raise a "red flag." These include when a nurse lacks the skills or training to perform a task; something doesn't "seem right"; a nurse notices a deviation from standard procedure or a lack of consistency in how a procedure is performed; or a nurse believes that a complex procedure is being performed improperly.

To reduce these potential safety problems, nurses should gain more advanced skills and experience, learn to identify and act upon warning signs, follow procedures carefully, and determine whether and how a procedure can be simplified.

Other red flag situations include encountering unexpected findings (instruments can be incorrectly calibrated or the algorithm being used may be the wrong one); a procedure hasn't been changed despite its association with previous errors or near misses; a necessary step or piece of information is missing or there has been miscommunication (in this case, stop the procedure or process and reevaluate); relying on memory when performing more than one task at a time or nearing the end of a shift when the information must be conveyed to the next shift (use automated or computerized technologies and write down any verbal communication).

See "First do no harm: Avoiding near misses," by Dr. Hughes, in the May 2004 American Journal of Nursing 104(5), pp. 81-84.

Reprints (AHRQ Publication No. 04-0052) are available from the AHRQ Publications Clearinghouse.

Editor's Note: A second article on a related topic describe's the Port Huron Hospital's "Nurse-On-Wheels" (NOW) program, which is designed to enable RNs to be relieved of some tasks unrelated to direct patient care, improve communication between shifts, and reduce the potential for medication errors. For more details, see Sokol, P.E. (2004, May). "Transforming the workplace environment: Port Huron Hospital's transformation model." (AHRQ grant HS12043). Nursing Economics 22(3), pp. 152-154.

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