Question

• Reflect on the QSEN definition of the concept of safety. What does this mean to you in your practice?
• Identify 5 safety concerns you identified for the clients today?
• Identify 2 system processes that you could utilize in practice that are aimed at promoting safety related to those 5 safety concerns.

Answer 1

1) Minimizes risk of harm to patients and providers through both system effectiveness and individual performance,knowledge,skills,attitudes.The Quality and Safety Education for Nurses (QSEN) project addresses the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.
2) The goal of this chapter is to provide some fundamental definitions that link patient safety with health care quality. Evidence is summarized that indicates how nurses are in a key position to improve the quality of health care through patient safety interventions and strategies.Many view quality health care as the overarching umbrella under which patient safety resides. For example, the Institute of Medicine (IOM) considers patient safety indistinguishable from the delivery of quality health care.Ancient philosophers such as Aristotle and Plato contemplated quality and its attributes. In fact, quality was one of the great ideas of the Western world.Harteloh reviewed multiple conceptualizations of quality and concluded with a very abstract definition: Quality is an optimal balance between possibilities realised and a framework of norms and values.This conceptual definition reflects the fact that quality is an abstraction and does not exist as a discrete entity.Rather it is constructed based on an interaction among relevant actors who agree about standards (the norms and values) and components (the possibilities).Work groups such as those in the IOM have attempted to define quality of health care in terms of standards. Initially, the IOM defined quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.This led to a definition of quality that appeared to be listings of quality indicators, which are expressions of the standards. Theses standards are not necessarily in terms of the possibilities or conceptual clusters for these indicators. Further, most clusters of quality indicators were and often continue to be comprised of the 5Ds -death, disease, disability, discomfort, and dissatisfaction rather than more positive components of quality.The work of the American Academy of Nursing Expert Panel on Quality Health focused on the following positive indicators of high quality care that are sensitive to nursing input: achievement of appropriate self-care, demonstration of health-promoting behaviors, health related quality of life, perception of being well cared for, and symptom management to criterion.Mortality, morbidity, and adverse events were considered negative outcomes of interest that represented the integration of multiple provider inputs.The latter indicators were outlined more fully by the National Quality Forum.Safety is inferred, but not explicit in the American Academy of Nursing and National Quality Forum quality indicators.The most recent IOM work to identify the components of quality care for the 21st century is centered on the conceptual components of quality rather than the measured indicators: quality care is safe, effective, patient centered, timely, efficient, and equitable. Thus safety is the foundation upon which all other aspects of quality care are built.
Many patient safety practices, such as use of simulators, bar coding, computerized physician order entry, and crew resource management, have been considered as possible strategies to avoid patient safety errors and improve health care processes; research has been exploring these areas, but their remains innumerable opportunities for further research.Review of evidence to date critical for the practice of nursing can be found in later chapters of this Handbook.The National Quality Forum attempted to bring clarity and concreteness to the multiple definitions with its report, Standardizing a Patient Safety Taxonomy.This framework and taxonomy defines harm as the impact and severity of a process of care failure: temporary or permanent impairment of physical or psychological body functions or structure.
In the past, we have often viewed nursing’s responsibility in patient safety in narrow aspects of patient care, for example, avoiding medication errors and preventing patient falls. While these dimensions of safety remain important within the nursing purview, the breadth and depth of patient safety and quality improvement are far greater.The most critical contribution of nursing to patient safety, in any setting, is the ability to coordinate and integrate the multiple aspects of quality within the care directly provided by nursing, and across the care delivered by others in the setting. This integrative function is probably a component of the oft-repeated finding that richer staffing (greater percentage of registered nurses to other nursing staff) is associated with fewer complications and lower mortality.While the mechanism of this association is not evident in these correlational studies, many speculate it is related to the roles of professional nurses in integrating care (which includes interception of errors by others near misses), as well as the monitoring and surveillance that identifies hazards and patient deterioration before they become errors and adverse events.Relatively few studies have had the wealth of process data evident in the RAND study of Medicare mortality before and after implementation of diagnosis related groups. The RAND study demonstrated lower severity adjusted mortality related to better nurse and physician cognitive diagnostic and treatment decisions, more effective diagnostic and therapeutic processes, and better nursing surveillance.
3) Hand hygiene,nurse-patient ratios,drug and medical supply shortages,quality reporting,resurgent diseases,mergers and acquisitions,physician burnout.
4) safety and health management system means the part of the Organisation's management system which covers: the health and safety work organisation and policy in a company.The planning process for accident and ill health prevention.The line management responsibilities and the practices, procedures and resources for developing and implementing, reviewing and maintaining the occupational safety and health policy.The system should cover the entire gambit of an employer's occupational health and safety organisation.The key elements of a successful safety and health management system are:
1. Policy and commitment

The workplace should prepare an occupational safety and health policy programme as part of the preparation of the Safety Statement required by Section 20 of the Safety, Health and Welfare at Work Act 2005. Effective safety and health policies should set a clear direction for the organisation to follow.They will contribute to all aspects of business performance as part of a demonstrable commitment to continuous improvement.Responsibilities to people and the working environment will be met in a way that fulfils the spirit and letter of the law. Cost effective approaches to preserving and developing human and physical resources will reduce financial losses and liabilities. In a wider context, stakeholders expectations, whether they are shareholders, employees or their representatives, customers or society at large, can be met.

2. Planning

The workplace should formulate a plan to fulfil its safety and health policy as set out in the Safety Statement. An effective management structure and arrangements should be put in place for delivering the policy. Safety and health objectives and targets should be set for all managers and employees.

3. Implementation and operation

For effective implementation, organisations should develop the capabilities and support mechanisms necessary to achieve the safety and health policy, objectives and targets. All staff should be motivated and empowered to work safely and to protect their long term health, not simply to avoid accidents. These arrangements should be: underpinned by effective staff involvement and participation through appropriate consultation, the use of the safety committee where it exists and the safety representation system and sustained by effective communication and the promotion of competence, which allows all employees and their representatives to make a responsible and informed contribution to the safety and health effort.There should be a planned and systematic approach to implementing the safety and health policy through an effective safety and health management system. The aim is to minimise risks. Risk Assessment methods should be used to determine priorities and set objectives for eliminating hazards and reducing risks. Wherever possible, risks should be eliminated through the selection and design of facilities, equipment and processes. If risks cannot be eliminated, they should be minimised by the use of physical controls and safe systems of work or, as a last resort, through the provision of PPE .Performance standards should be established and used for measuring achievement. Specific actions to promote a positive safety and health culture should be identified. There should be a shared common understanding of the organisation‘s vision, values and beliefs on health and safety. The visible and active leadership of senior managers fosters a positive safety and health culture.

4. Measuring performance

The organisation should measure, monitor and evaluate safety and health performance. Performance can be measured against agreed standards to reveal when and where improvement is needed. Active self monitoring reveals how effectively the safety and health management system is functioning. Self-monitoring looks at both hardware (premises, plant and substances) and software (people, procedures and systems, including individual behaviour and performance). If controls fail, reactive monitoring should find out why they failed, by investigating the accidents, ill health or incidents, which could have caused harm or loss. The objectives of active and reactive monitoring are: to determine the immediate causes of substandard performance to identify any underlying causes and implications for the design and operation of the safety and health management system.

5. Auditing and reviewing performance

The organisation should review and improve its safety and health management system continuously, so that its overall safety and health performance improves constantly. The organisation can learn from relevant experience and apply the lessons. There should be a systematic review of performance based on data from monitoring and from independent audits of the whole safety and health management system. These form the basis of complying with the organisation’s responsibilities under the 2005 Act and other statutory provisions. There should be a strong commitment to continuous improvement involving the development of policies, systems and techniques of risk control. Performance should be assessed by: internal reference to key performance indicators.External comparison with the performance of business competitors and best practice in the organisation’s employment sector.Many companies now report on how well they have performed on worker safety and health in their annual reports and how they have fulfilled their responsibilities with regard to preparing and implementing their Safety Statements. In addition, employers have greater responsibilities under Section 80 of the 2005 Act on ‘Liability of Directors and Officers of Undertakings’ that requires them to be in a position to prove they have pro-actively managed the safety and health of their workers. Data from this Auditing and reviewing performance process should be used for these purposes.