Tuesday, December 8, 2009

Nursing Research Helps Drive Safety

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.

Ten years after the IOM reported on medical errors, research funded by INQRI has been adding crucial information to the ongoing debate on quality of care. So says Laura Caramanica, Senior Vice President and Chief Nursing Officer for Westchester Medical Center in Valhalla, New York.

She should know. Caramanica is also a member of INQRI’s National Advisory Committee. She says INQRI grantees have been hard at work generating data that’s already being used by policymakers and health care leaders to enact changes aimed at making the U.S. health care system safer for patients.

For example, INQRI funded studies have been investigating the role that nurse staffing levels have on the quality of care that patients receive in hospitals and other health care settings.

“Nurses make a tremendous difference in the provision of high-quality care and often step in and prevent medical errors,” Caramanica says.

Advocates of a safe staffing level suggest that when the number of registered nurses dips too low, the quality of the care can suffer. But INQRI research suggests that the safe staffing question is more complicated than just counting the number of registered nurses. They’re finding that the skill mix and staffing levels for non-nursing positions can also make a difference: For example, nurses on units that don’t have enough staff, including secretarial staff, can end up being pulled away from direct bedside care, Caramanica says.

In fact, INQRI research suggests that a one-size fits all approach like setting a rigid nurse-patient ratios won’t always raise the quality of care. Rather, such research indicates a more sophisticated approach to staffing, one that takes into account the mix of skill levels as well as the severity of illness. Units with lots of very sick patients might need a higher staff ratio than those with relatively stable patients, she says.

INQRI grantees have demonstrated the fact that nurses can make assessments and implement skillful interventions that prevent serious medical complications, like infections. “Patients are monitored 24/7 by a nurse,” Caramanica says. The nurse is often the front line health professional that catches a problem, like an emerging infection, and then gets the patient the care they need. Such early and aggressive treatment for an infection or another untoward event can make the difference between life and death, she says.

Nurses are also providing care that can prevent serious medical complications from occurring after the patient leaves the hospital. For example, a nurse is often charged with educating the patient about the post-hospital medication regime to ensure safety after discharge. Patients can get into trouble once they arrive home: They might mistakenly start to take a double dose by taking medication previously prescribed as well as a new one without realizing that the two drugs do the same thing.

But the discharge nurse reviews the medication list with the discharging physician and can prevent such mistakes. That nurse can also set up an appointment with a nurse in the community who can pay a home visit and check the drugs in the home medicine cabinet.

Nurses have done this kind of detailed, attentive care since the nursing profession began, Caramanica says. For example, Florence Nightingale is credited with pioneering innovations in patient care that still permeate the profession today. Her insistence on sanitary conditions for soldiers wounded during the Crimean War cut the death rate significantly.

Nightingale’s strict attention to statistical data made her case and pushed leaders at the time to improve the conditions at hospitals to keep soldiers and others safe. INQRI grantees are following that time-honored tradition and are building a case, one that shows the true value of the Registered Nurse.

Caramanica hopes that such information will play a role in the current debate over health care reform. “Policymakers are looking for solutions that help keep costs down and at the same time keep patients safe” she says. “INQRI research can offer just that kind of innovative fix, one that reduces errors by putting the nurse at the center of a system dedicated to best practices.

The IOM report noted that as many as 98,000 people die in hospitals each year due to preventable medical errors. Today, research by INQRI has also helped health experts and nursing leaders across the nation reduce that risk. And Caramanica believes that the safety practices that are now in use have surely saved lives.

1 comment:

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