We nurses often hear the term patient safety. But what does it mean, really?
Taber's Cyclopedic Medical Dictionary defines safety as a "practice that ensures protection from harm or injury."1 Seems simple and clear enough. Yet owing to the complexity of health care delivery and the many financial constraints that hospitals and other health care organizations face, patient safety isn't always easy to achieve.
Infusion nurses must overcome a number of challenges to keep patients safe and ensure optimal outcomes. The first is not recognizing or underestimating the risks associated with infusion therapy. In our specialty, we handle complications such as central line-associated bloodstream infections (CLABSIs), phlebitis, infiltration, and extravasation. Mix-ups can occur when a patient has multiple catheters. Similar-looking medication names or misread dosages can cause serious errors.
Technology keeps advancing rapidly, and sometimes it's difficult to keep up. We have high-tech smart pumps and alarms, but they frequently sound off when no real problem exists, leading to alarm fatigue. So when patients' alarms sound for a very real purpose, they're often ignored-treated in much the same way as a car alarm that goes off for no apparent reason. In addition, many of the alarm systems are not configured properly, causing further risk to patient safety.2
Electronic medical records were meant to keep patients safe by making their records easily accessible to all members of the health care team. But their universal implementation has lagged, owing chiefly to a lack of interoperability, that is, computer systems that should, but aren't, working together. Health information technology must make possible the exchange of useful information throughout (and beyond) an organization, regardless of the manufacturer of the hardware or software.3
Part of the difficulty in keeping patients safe is that harm is not always visible. Although we can readily see signs of bruising, phlebitis, infiltration, and infection, some ills are not so obvious, such as psychosocial and socioeconomic crises, lack of health care literacy, or inability to pay for care or medication. In such circumstances, nurses need to approach patients holistically, a concept that infusion nurses understand well.
All participants in health care delivery-nurses, physicians, pharmacists, administrators, academics, risk managers, policy makers, industry, as well as patients and their families-are responsible for creating a culture of safety. Success will require a continuous journey of analysis, awareness, education, reporting, and adopting of new technologies.
So what else can we do to promote patient safety? Keep up with the latest advances in science and technology; incorporate the Infusion Nursing Standards of Practice into everyday practice; engage in research and integrate evidence into practice; teach and mentor others; be an active partner in interprofessional teams; and as I always recommend, get certified!
Although this litany of labor may seem daunting to already-busy nurses, step back for a moment and think about all we have to offer our patients. Our education, licenses, certification, and experiences provide us with a solid underpinning to practice safely. Our organizations offer us the necessary tools to build on that foundation. And while patient safety may mean different things to different people, the passion for our work guides our delivery of safe patient care.
Mary Alexander, MA, RN, CRNI(R), CAE, FAAN
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