Wednesday, December 2, 2009

Environment Leads To Higher Quality Nursing Care

To Err Is Human Blog Series Logo

This post is part of our two-week series commemorating the 10-year anniversary of the seminal IOM Report "To Err Is Human." To see all posts in the series, please click here.

“One of the report’s main conclusions is that the majority of medical errors do not result from individual recklessness or actions of a particular group—this is not a bad apple problem. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.”---To Err Is Human.

The Institute of Medicine report identified faulty systems as a major cause of medical errors in hospitals and nurse researcher Linda Flynn has been homing in on one such system ever since. Her research suggests that a positive work environment helps nurses catch errors before they have a chance to harm patients.

With funding from INQRI Flynn has been studying 83 medical and surgical units in 14 New Jersey hospitals. Her study suggests that in order to prevent medication errors nurses on the front lines must be able to think critically about a medication order or a prescription. A nurse must be able to review the chart and evaluate whether the drug, the dose and the timing make sense for the patient. If something doesn’t seem quite right, the nurse must be able to question the order, says Flynn, who leads a multi-disciplinary research team at Rutgers University College of Nursing.

Her research indicates that nurses are more likely to raise an alert on units with a positive atmosphere. For example, a nurse might notice the dose of a drug seems too high and suspects a miscalculation. On a supportive unit, the nurse might feel very comfortable calling the doctor and asking him or her to double check the dose.

But in units without a good atmosphere, the nurse might be afraid to speak up and question the doctor. She might remain silent because she knows that if she says something her manager will not support her—even if she is right.

Such units represent a faulty system, Flynn says--one where mistakes and errors can flourish.

Her research suggests that units that foster collegial relationships and build teams can provide an atmosphere in which good care is the goal. Doctors, nurses and others on the unit must work together to provide safety checks at every point in a hospital stay. The nurse is often a critical player in this team effort because he or she is often the last point of contact with the patient.

If that nurse notices an error, he or she must feel confident enough to stop and double check it—before it has a chance to harm the patient, Flynn says.

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