Patient safety tips

Patient safety tip: listen to the person and their family

There could be a change in the person's condition. The person or family could be expressing a concern.

The important thing to do? Listen.

"Sometimes as nurses we tend to look for patterns and if someone is complaining from pain, we could attribute that pain to post-operative pain when they could have something else going on," says Kathy Doerksen, Chief Nursing Officer, Health Sciences Centre. "If you're not really listening, it diminishes the assessment you do."

So if someone is saying something isn't quite right, really listen. Check it out further - ask more questions, do further assessment . . . but follow up on those concerns.

Patient safety tip: create a culture of safety

A culture of safety is one where people can feel safe to speak up. That continuum includes the person and their family, as well as health care providers.

"You also need to have the kind of environment where you can approach any of the team and say, 'Something's not right. I need help here,'" says Doerksen.

Patient safety tip: consider SBAR when communicating

Communicating is part of improving patient safety. But it's important to communicate in ways that our colleagues can hear us, says Doerksen.

A communication tool like SBAR (Situation, Background, Assessment and Recommendation) can ensure everyone is using the same language to communicate with each other, and can help enhance the culture of safety.

Patient safety tip: when advocating, ask clearly for what you want

When phoning another health care provider to bring your concerns to light, how you present your concerns and clearly stating your recommendation can impact the outcome.

Doerksen suggests being clear: "I'm calling because I'm worried about person X. This person is day two post-operative from a complex thoracic spine surgery, Their BP is low and has been for the last three checks or hour and a half. They're also dizzy now."

Offering this snapshot of what the issue is, some background and then offering current details is important before offering your recommendations. "The recommendation is the key piece - if we are functioning in good teams, we can communicate our thoughts," says Doerksen.

Following through with the example: "I think the person might be dehydrated and requires increased IV fluids or I think you need to come and assess this person."

"When making that recommendation and request, keep in mind what you want out of the conversation that's best for the patient," reminds Doerksen. "That can be discussed but if you're not clear, determining what's next can be tough."

Patient safety tip: when advocating, follow through to create the result you want/need

Communication needs to be respectful, even when advocating for people we're caring for.

"If you're truly concerned, you need to continue the conversation," says Doerksen. "If you exhaust possibilities with the individual you're speaking with, you need someone else to go to. Part of advocacy is knowing when to push forward with a concern about a patient."

So if you've asked one of your colleagues to assess someone and they don't agree with your recommendations, it's important to tell them you intend to escalate the concerns, and how.

"You have other avenues and can continue to escalate concerns," says Doerksen. "Do it respectfully but always with the patient at the centre."

Patient safety tip: consider a phrase that refocuses everyone

When tension is high and emotions are too, that might be just the moment for the entire team to refocus.

Doerksen explains that a well-chosen phrase the whole team knows like "time out please" can be a cue for everyone to stop, regroup and listen.

"Having a phrase depersonalizes things when the message is lost and can help people refocus in crisis," says Doerksen.

Patient safety tip: be accountable for your practice

"There is increased awareness about systems issues and how individuals don't come to work to harm people," says Doerksen. "In order for us to have a good culture of patient safety, we need accountability at all levels."

Part of what that means, explains Doerksen, is that when tools are put in place to improve patient safety, we can't ignore them. "When we consider best practices and we know what the best thing to do is, we need to be doing it," she says.

Mangers need to be leaders with that. And it starts with reinforcing accountability from moment to moment. "Look at supporting it when it is witnessed. Let's say you're on the floor and you hear the unit assistant explain how they bathed someone and their skin's a bit red," says Doerksen. "Providing immediate feedback in accountability would be to address that person's efforts and how they are important to safe care."

Patient safety tip: build on what's working

Part of professional responsibility is utilizing available best practices - not just because we are clinicians who are caring, but because we recognize there are standards and expectations of how we deliver that care, and as regulated professionals we are individually responsible and accountable.

"When we know practices we should be doing, because we know they work and they are better for patients, why are we not expecting it?" she asks.

Patient safety tip: encourage accountability

If leadership is visible, it helps encourage accountability via conversations with staff about patient safety concerns.

To further encourage accountability, Doerksen suggests noticing what's working, openly talk about situations, learn from what goes well and what we can improve on, and use positive reinforcement to help further a culture of accountability.

Patient safety tip: promote a culture of learning

After an adverse event (critical incidents, occurrences and near misses) has happened, that's an ideal time to learn. A patient safety event can be an opportunity for learning depending on the system's response to the event.

Nursing plays a major role in this through direct practice, reporting and management once an event has occurred. An essential role for nurses is to create and foster a climate of learning in our day-to-day practice and in the nursing profession.

Patient safety tip: model the behaviour you want to see

The most powerful way nurses can impact a culture of learning is by modeling behaviour.
Nurses at all levels can set the tone by not only encouraging the reporting of an adverse event, but also responding with a commitment to a review for learning purposes.

Modeling this behavior in our daily work is essential to build trust within the profession, between professions, and for system-wide learning. Nurses and the nursing profession can take a proactive role for the improvement of service to patients and families.

Patient safety tip: consider transitions

Paying attention to the details during a transition can help improve patient safety. Ask yourself if you're sharing the right information with the right people.

Moreover, as a system, how do we design a transition? What information needs to be shared? Does the person receiving the transfer have enough information to do their job properly?
And when the right information isn't shared, nurses can mentor staff via a huddle to look at what happened and what can be learned from it.

Patient safety tip: be mindful of handoff communication

When handing off care to another sector in the system, it's another transition.

Nurses can take a leadership role in ensuring the right information is available, or shared. Good information not only supports the ease of transition, it enhances communication.

Patient safety tip: what needs to be done before discharge?

Does a person have the right information about their condition and medication to function independently in the community?

If the answer is no, nurses can advocate to make sure the person has the right information, actions or services to support their ability to function in the community.

Patient safety tip: partner with the person and family

Driving a care plan in partnership with a person and their family, for example, from a place of partnership, is a different tone to set when working together. It not only acknowledges that the person has a voice but it ensures people are actively involved in their care. Patient safety experts say this partnership creates safety.

Patient safety tip: use your voice

Sometimes speaking up can be a difficult thing to do that requires a nurse to be brave.
On a day to day basis nurses incorporate safety practices and view the safety of their patient's as a top priority. Together with other members of the health care team our voices must remain strong as there is much we can do to advocate for patients and create safe environments.

Patient safety tip: learn from what's gone wrong

When things happen, the important questions is: what can be learned?

"Critical incidents happen. Even if the extent of the incident is death or permanent injury, we need to learn from them," says Wendy Ducharme, Regional Program Director, Emergency Program.

Patient safety tip: consider huddles to improve communication

Transitions offer good windows of opportunity for huddles, which some facilities have introduced with success.

"A huddle at shift change can make sure the right information is being provided. Transitions are other good times for interprofessional huddles," says Ducharme. "Emerg has done some really interesting work around huddles, briefs. It's a powerful way to share key info."

Patient safety tip: use standardized tools

"Within the emergency program, we want to look at as much consistency between sites as we can," says Ducharme.

A standardized tool like a safe discharge checklist can help enhance the safety of the discharge process.

"The introduction of the checklist was as a result of the learning we did from a critical incident," says Ducharme. "Now there are standard issues being assessed that could impact a patient getting safely home."

Patient safety tip: pay attention to details

Ducharme uses the example of a triage nurse, who is not only assessing a person who is in front of them but also paying attention to other details such as who is coming in, and trying to keep people moving through the system while trying to assess how sick the person in front of them is and how they might be prioritized.

"Nurses play a key role in how a person gets prioritized based on their assessment," explains Ducharme. "Looking at how physicians can play a more active role up front is more of a pull mentality where patient flow is concerned."

As the triage nurse collects information, engaging the right member of the health care team is also on their radar.

"Triage can tell if a person has cognitive or mobility issues," says Ducharme. "How do we engage a physiotherapist, occupational therapist, social worker or home care early to plan for the patient in the most expedient way?"

Patient safety tip: Sharing the right info

The way health care providers communicate can often determine how things get prioritized.

In the example of an elderly male who is having difficulty breathing, key information such as the following is important to communicate:

Bob is 87, had a previous MI. He is hypertensive with diabetes. He's been experiencing shortness of breath. These are the current medications he's on . . .

"Rather than putting Bob through a transfer from the PCH where he lives to an acute care facility for treatment, consider phoning his health care provider and seeing if a course of asithro might be a better option than the emergency room," says Ducharme. "How do we maximize the system to deliver care in patient convenient fashion instead of provider convenient fashion?"

Patient safety tip: nursing leadership

A nurse has a role to play in making sure all members of the health care team can make the best decision.

"We need all of the system to use resources to provide the best resources to people in the most appropriate ways," says Ducharme, noting that includes how we partner with other systems to inform the public. "How do we work with schools, universities and employers? Nurses need to advocate for the most effective use of health resources."

*Thanks to Marilynne Dvorak for contributing her expertise.