SAFETY

Concept 43

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Goals for This Concept Presentation

Define and describe the concept. 2. Discuss the underlying theory of safety. 3. Identify safety in the nursing and health care practice.
1.

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DEFINE AND DESCRIBE THE CONCEPT OF SAFETY

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Definition
Safety refers to the prevention of health care errors and the elimination or mitigation of patient injury caused by health care errors.

Patient safety Safe Care QSEN

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Definitions
Discuss the types of health care errors and provide an example of each.
Health Care Error Error of commission Error of omission Description Example

Error of execution
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Levels of Errors

Adverse event

Unintended harm by an act of commission or omission rather than as a result of disease process Error of commission or omission that could have harmed a patient, but harm did not occur as a result of chance Unexpected occurrence involving death or serious injury
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Near miss

Sentinel event

Levels of Errors (contd)

Think about examples of each level of error that you have seen or heard about in the health care setting.

Health Care Error Adverse event Near miss

Examples

Sentinel event
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Scope and Category of Concept

Categories of errors

Diagnostic Treatment Preventive Communication

Scope of errors

Latent Active

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Organizational Culture of Safety

Historically, a culture of blame has existed; identify the clinical at fault, followed by disciplinary measures. Nowthe focus is on what when wrong rather than who to blame. Culture of safety is needed to address errors and to prevent a reoccurrence.

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Concept Attributes of Safety

Knowledge

Focus of safety is on the execution of skills, as well as on technology and systems level.

Skills

Nurses need to use tools to contribute to safer systems. Nurses and other health care professionals need to value their roles in safety and collaboration.

Attitudes

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DISCUSS THE UNDERLYING THEORY OF SAFETY

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Reasons Swiss Cheese Model of Accident Causation

The model shows how errors occur when situational factors align, despite multiple layers of safeguards for the prevention of errors.
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Human Factors

Study of the interrelationships among people, technology, and the work environment. Consider the ability or inability to perform tasks while attending to multiple things at once. Work of nurses in acute care environment is very complex. Focus is on supporting health professionals and eliminating hazards.
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Crew Resource Management

Six critical components: 1. Situational awareness 2. Problem identification 3. Decision making by generating alternative acceptable solutions 4. Appropriate workload distribution 5. Time management 6. Conflict resolution

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IDENTIFY SAFETY IN THE NURSING AND HEALTH CARE PRACTICE

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Just Culture

A health care systems value is in reporting errors without punishment.

Disciplinary measures

Just culture seeks to find a balance between the need to learn from mistakes and the need for disciplinary action against employees.

Learning from mistakes

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Transparency in Health Care

share a situation in which an error was disclosed to you and one in which it was not. Compare and contrast these situations, specifically noting how you felt when the disclosure was made versus when you found out.

Feelings When Disclosure Was Made

Feelings When You Found Out About an Error After the Fact

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Interrelated Concepts

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Exemplars of Safety

Point of care Systems level safety

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Standards Of Care
STANDARDS OF PROFESSIONAL NURSING PRACTICE : American Nurses Association (ANA) ANA Standards of Practice ( Uses Nursing Process) Standard 1. Assessment Standard 2. Diagnosis Standard 3. Outcome Identification Standard 4. Planning
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Standards Of Care
Standard 5. Implementation
Standard 5A. Coordination of Care Standard 5B. Health Teaching and Health Promotion Standard 5C. Consultation (Graduate Prepared Specialty or Advanced Practice Nurse) Standard 5D. Prescriptive Authority and Treatment (Advanced Practice Nurse)

Standard 6. Evaluation

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ANA Standards of Professional Performance

Standard 7. Ethics Standard 8. Education Standard 9. Evidence-Based Practice and Research Standard 10. Quality of Practice Standard 11. Communication Standard 12. Leadership

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Standard 13. Collaboration Standard 14. Professional Practice Evaluation Standard 15. Resource Utilization Standard 16. Environmental Health Source: American Nurses Association (ANA) Scope and Standards of Nursing Practice, 2010

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New Jersey Board of Nursing:

QUALIFICATIONS FOR LICENSURE

The practice of nursing in New Jersey is regulated by the state of New Jersey Board of Nursing. One of the duties of the Board of Nursing is to examine the qualifications of applicants for a license to practice nursing. All applicants must submit evidence that she/he "...is of good moral character and has never been convicted or has not pleaded nolo contendere, non vult contendere or non vult to an indictment, information or complaint alleging a violation of any Federal or State law relating to narcotic drugs..." .
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Standards for Accreditation Nursing Programs: AACN/CCNE

CCNE requires, as appropriate, professional nursing standards and guidelines: 1) The Essentials of Baccalaureate / Masters/ Doctoral Education for Professional Nursing Practice [American Association of Colleges of Nursing (AACN),

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STANDARD I Program Quality: Mission & Governance

The mission, goals, and aggregate student and faculty outcomes are congruent with the parent institution, reflect professional nursing standards and guidelines, and consider the needs of the community. Policies support the programs mission, goals, and expected outcomes. The faculty and students of the program are involved in the governance of the program and in the ongoing efforts to improve program quality.
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STANDARD II Program Quality:

Institutional Commitment and Resources

The parent institution demonstrates ongoing commitment and support for the nursing program.

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STANDARD III Program Quality:

Curriculum and Teaching-Learning Practices

The curriculum is developed in accordance with the mission, goals, and expected aggregate student outcomes and reflects professional nursing standards and guidelines and the needs and expectations of the community of interest.

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STANDARD IV Program Effectiveness:

Aggregate Student and Faculty Outcomes

The program is effective in fulfilling its mission, goals, and expected aggregate student and faculty outcomes.

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The Essentials of Baccalaureate Education for Professional Nursing Practice I. Liberal Education for Baccalaureate Generalist Nursing Practice
II. Basic Organizational and Systems Leadership for Quality Care and Patient Safety III. Scholarship for Evidence-Based Practice IV. Information Management and Application of Patient Care Technology V. Healthcare Policy, Finance, and Regulatory Environments VI. Inter-professional Communication and Collaboration for Improving Patient Health Outcomes VII. Clinical Prevention and Population Health VIII. Professionalism and Professional Values IX. Baccalaureate Generalist Nursing Practice

http://www.aacn.nche.edu/education-resources/BaccEssentials08.pdf

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Joint Commission
An independent, not-for-profit organization, The Joint Commission accredits and certifies health care organizations and programs in the United States. Joint Commission accreditation and certification is a symbol of quality that reflects certain performance standards. Goal: All people always experience the safest, highest quality, best-value health care across all settings. National Patient safety Goals ( NPSG) Ex-Improve the accuracy of patient identification: Use at least two patient identifiers when providing care, treatment, and services. Eliminate transfusion errors related to patient misidentification.
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WPUNJ (Handbook)
All Policies relates to Nursing students in the Handbook found online - Overview - Mission Statement - Philosophy - Academic Standards Policy -Grades

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ACADEMIC STANDARDS
Since the role of the professional nurse affects the health and welfare of other human beings, those whom the Nursing Department recommend for this role must conduct themselves according to principles of high moral standards and honor, and display levels of competence which are consistent to the rigorous demands of the profession. Upon graduation, the Department of Nursing recommends students to the State Board of Nursing for licensure examination. This recommendation includes the ability to begin as a professional practitioner as well as conformance to published departmental academic, social, and professional regulations governing the program. The academic standards for good standing in Nursing are designed to assist these goals. A student whose behavior is deemed contrary to the standards or regulations of the Department, the ANA Code of Ethics and/or the N.J. Nursing Practice Act maybe dismissed from the nursing program.

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NURSING STUDENTS STANDARDS OF CONDUCT

The student is expected to follow the American Nurses Association Code of Ethics for Nurses (2001) and the National Student Nurses Association Code of Ethics (2001) for nursing students, Standards of Practice, and the New Jersey Nurse Practice Act.

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NURSING STUDENT HONOR PLEDGE:

I, ______________________________ (print name), have read the Department of Nursing Students Standards of Conduct and the William Paterson University of New Jersey Academic Integrity Policy, I understand the tenets. I will uphold and not violate the Academic Integrity Policy and Standards of Conduct. Failure to uphold the Nursing Students Standards of Conduct and the William Paterson University of New Jersey Academic Integrity Policy may result in dismissal from class, course, program and/or university.
Signature: Please print, complete and submit to the professor.
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Role of the professional Nurse

Caregiver: designers, coordinators, and managers of care Advocate- for patient and the profession Communicator Team Leader Collaborates

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Nursing Education
Levels of Nursing education A. LPN or Vocational Nurse Professional Registered Nurse B. Associate Degree C. Diploma D. Baccalaureate E. RN completion programs to BSN Masters Degree Advanced Practice Nurses (NP, CNS) Doctoral Degree
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Scope and Standards of Practice

May differ for various levels of education Nurse must abide by the scope and standards of practice set forth by the Professional Organizations

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