Nursing

Lori Paine, RN

Lori Paine, RN

By Lori Paine, RN

In his best-selling book, All I Really Need to Know I Learned in Kindergarten, Robert Fulghum writes about the value, and the challenge, of following simple life lessons—about sharing and apologizing, to name a couple. “I realized,” he writes, “that I already know most of what’s necessary to live a meaningful life—that it isn’t all that complicated. I know it. And have known it for a long, long time. Living it—well, that’s another matter.”

I submit that the same is true for patient safety.

When I entered nursing school in 1983 and took Nursing 101, I learned about the importance of frequent hand-washing for infection control. I was taught to ensure medication safety by ensuring that the five “rights”—the right patient, dose, drug, route and time—were verified before administration. I was trained to prevent patient falls through such practices as keeping bedrails up and the call-bell within the patient’s reach. I acquired communication skills, such as documenting treatment through SOAP notes. We were taught the value of checking one another’s work at critical points. To graduate, we had to demonstrate these fundamental skills throughout nursing school.

So why do studies suggest that handwashing habits among healthcare workers are woefully lacking? Why do we continue to see medication errors and patient falls? Why are communication failures responsible for the majority of sentinel events reported to the Joint Commission? Why do we see mistakes that could have been caught with simple cross-checks?

Simplicity has given way to complexity. Nurses and other caregivers are tending to very ill patients with complicated treatment plans, and doing so with greater dependence on other disciplines. Resident work-hour limitations have increased the number of patient handoffs—yet more opportunities for communication errors. We’re surrounded by technology intended to make work easier and less error-prone, but which can lead to new errors. We’re driven by long to-do lists that can distract us at critical points in patient care, such as medication administration or shift changes.

Demands on caregivers are greater now than ever. Our challenge, similar to Fulghum’s, is to re-acquaint ourselves with the fundamentals of patient care and safety and then find ways to give them priority with every patient, every time. We must find a way to step outside of the chaos, slow things down and ensure that the fundamentals are followed.

At Hopkins Hospital, intensive care units have demonstrated what’s possible when we focus on the basics. Simple steps, including handwashing and wearing full-barrier protection before inserting central catheters, were among simple steps that reduced bloodstream infections.

I think patient safety would benefit greatly if each of us decided, as a start, to “re-adopt” a fundamental practice that has become a challenge to follow in health care today.