A SAFE NURSE

1. A presentation delivered as part of a safety professional workshop jointly organised by the Ghana Registered Nurses’ Association and the Commonwealth Nurses Federation towards GRNA Golden Jubilee on 27th April 2010 at GRNA Secretariat, Accra Dr Ernestina S. Donkor (PhD, MSc, BSc, RN,RM, RPHN, GCAP, FWACN) School of Nursing College of Health Sciences University of Ghana Legon A SAFE NURSE

2. OUTLINE OF PRESENTATION • Introduction • The concept of a safe nurse • Attributes of a safe nurse • A safe nursing practice • Challenges • Conclusion

3. Introduction • Who a safe nurse is • Choice of topic is appropriate considering the trends in healthcare delivery and nursing in particular

4. The concept of a safe nurse (1) • A safe nurse is an individual trained and certified to care for the sick / well to recovery, alleviate suffering / ensure a peaceful death • Provides care within the appropriate professional, institutional and legal framework • Determining a safe nurse suggests an input, process & outcome

5. The concept of a safe nurse (2) • Questions – who is recruiting individuals to be trained? How are recruitments done? What socialisation processes are followed in institutions of training nurses? What efforts are in place for personal development?

6. The concept of a safe nurse (3) • Contextualised as a bio-psychosocial being – Physical health is important, Psychological balance is crucial, free from burnout syndromes. • Relationship with norms, values & influences governing social values • Financial soundness • Provision of safe service – enhanced by knowledge, attitude & skills; based on evidence-based and professional standards

7. Attributes of a safe nurse (1) • Huge commitments of one’s time, energy, patience, effort etc • Helping & working with people, understand and connect with people at their levels • Caring, loving, trusted, hardworking, committed and devoted to work – does it well • Dressing code gives a sense of professionalism, polite & communicates professionally to clients & others

8. Attributes of a safe nurse (2) • Loves every aspect of her job each and every day • Empathetic in order to understand people

9. A safe nursing practice • A safe nurse practices safe nursing • Delivers care that conforms to standards of practice – protecting herself and the patient • Legally, nurses are accountable to deliver care in a manner that any prudent nurse will render • Steps of the nursing process have been identified as a universal approach to nursing practice

10. Seven key principles to maintain high standards of practice (Austin, 2008) (1) • Administer medication properly • Medication errors jeopardise patients’ safety; they can be costly • Harm patients, lead to expensive follow up care, monetary awards for damages and litigation • Knowing the drugs you administer is a vital element in the nursing standards of practice for medication therapy

11. Seven key principles to maintain high standards of practice (Austin, 2008) (2) • Prior to administration of an ordered medication, the nurse must understand its purpose & actions, dosage appropriate for the patient’s condition, administration route, possible adverse reactions & contraindications • If unfamiliar, check a current drug reference or ask the pharmacy

12. Seven key principles to maintain high standards of practice (Austin, 2008) (3) -Follow the traditional 5 rights of medication administration • Right patient • Right medication • Right dose • Right time • Right route delivery method or site of medication

13. Scenario A physician writes an order for a drug to be administered IM. But the drug can be administered by IV route only not IM. The pharmacist who reviews the order identifies the error and includes a package insert with the vial indicating that the medication must be administered IV. However, the nurse either does not see or disregards the pharmacist’s instruction, and follows the written order. In view of this, the patient gets the medication via the wrong route. The physician writing the prescription triggered this error. The pharmacist should have contacted the physician to clarify the order and also should have advised the nurse that the drug is to be given IV. The nurse, unfamiliar with the right route should have consulted current drug reference. Instead she administered the medication according to the incorrect order.

14. Seven key principles to maintain high standards of practice (Austin, 2008) (3) 2. Monitor for and report deterioration • Failure to monitor or recognise changes in a patient’s condition could lead to legal actions • Failure to recognise the significant changes or communicate them clearly and promptly could endanger the patient and lead the nurse to open viability • Observe nursing standard of practice

15. Seven key principles to maintain high standards of practice (Austin, 2008) (4) 3. Communicate effectively • Needs to clearly communicate with patients and colleagues • Communication must be accurate for the patient’s health care to be met • Good communication skills are imperative when e.g. • Transferring a patient’s care • Speaking with and educating the patient • Interacting with the patient’s family or other visitors

16. Scenario of poor communication that led to legal trouble A neonate is receiving an infusion of calcium gluconate through an IV line in his right foot when the nurse detects discolouration and oedema at the IV insertion site. As the baby is being transferred to another unit, a transfer note indicates the time the infiltration was noted and the fact that the nurse assessed the area before the transfer. However, these details do not appear in the medical record. In the medical record are flow sheets on which some of the original writing is scratched out and written over. When the baby’s parents arrived and asked the staff about the injury, they are told it is a blister. With time, it leads to considerable scarring and loss of motion. The parents sue the nurse who cared for the baby when the infiltration occurred.

17. Seven key principles to maintain high standards of practice (Austin, 2008) (5) When reporting changes in the patient’s condition or transfer of care, use the abbreviation SBAR • S is for situation (Identify the patient and why he was admitted) • B is for background (medical history, tests/treatment, changes from previous condition) • A is for assessment (Describe current condition) • R is for recommendation (Plan of care)

18. Seven key principles to maintain high standards of practice (Austin, 2008) (6) 4. Delegate responsibility • When delegating, ensure that you know who has the appropriate skills and competencies to meet the patient’s needs • When assigns work you are still responsible for the patient’s care, so delegate appropriately and offer supervision

19. Seven key principles to maintain high standards of practice (Austin, 2008) (7) 5. Document in an accurate and timely manner – reasons: • Means of communication between care givers and ensure continuity of care • Medical record is a legal document • Substantiate insurance reimbursement claims • Evidence in legal proceedings to establish whether or not the care rendered met the legal standard of care

20. Seven key principles to maintain high standards of practice (Austin, 2008) (8) 6. Know and follow facility policies and procedures - Institutional policies and procedures help to establish the nursing standards of care. They must be updated regularly and they should be realistic

21. Seven key principles to maintain high standards of practice (Austin, 2008) (9) 7. Use equipment policy • Ensure that you have received adequate training on the equipment you use to provide patient care • Equipment intended use should be understood • Know how to operate it properly • Never try guessing how to use equipment

22. Scenario • A patient is undergoing hysteroscopy. The equipment is missing a clip, and the nurse improperly connects an exhaust line that is hanging loose to an outflow port. The patient dies and the family sues the hospital.

23. Challenges • Adequate nurse staffing is critical to delivery of quality patient care • Identifying and maintaining the appropriate number and mix of nurses in all settings • Inappropriate and inadequate staffing, unqualified / unacceptable mix of providers, and lack of training are contributing factors to potential error of injury

24. Conclusion • A safe nurse should not be over burdened with heavy workload • Best staffing models and methods should be used • A Safe Nurse saves lives, she saves her own life, that of the family, her clients, her community and the profession

25. THANK YOU FOR YOUR ATTENTION