Who gave the passenger safety presentation on your last flight? The flight attendants, of course, because their primary job responsibility is actually passenger safety. Serving drinks is part of the job, but not THE job. If you've ever been involved in a plane incident-for instance, alarming smoke in the cabin-you can relate to the importance of knowing that the flight crew is well-trained, acting for your safety, and understands what to do to protect you. So it goes for nurses, too. Patient safety is our job.
Using aviation crew resource management principles, such as safety checklists and team communication training, has been part of our healthcare journey to patient safety for a long time. We can also relate to aviation rest rules: the crew can't work over a certain number of hours-period. The plane won't fly until a new crew is available. In healthcare systems, we can't close the hospital or stop providing care; however, from a systems perspective, we must do everything possible to avoid the situation from even occurring. That's why there are laws or regulations in 16 states to eliminate mandatory overtime for nurses. It took a flight tragedy for the Federal Aviation Administration to enact stricter rest rules. Haven't we learned that lesson from our own tragedies?
There is good news. The Partnership for Patients Hospital Engagement Networks (HEN) Final Report revealed that during the project's time frame of January 2012 to November 2014, 92,000 patient harms were prevented. Estimated cost savings were $988 million, with more than half of the savings in less readmissions and the next largest amount in hospital-acquired pressure ulcer reduction ($188 million). Over 31 states and 1,500 hospitals were involved. How was it accomplished? Through sharing resources and tools, education, leadership fellowships, standardized measures, data collection, and more.
The HEN's focus on total patient harm or harm across the board (defined as total harm events/1,000 discharges) forces a high level of patient safety. It's the bottom line for safety, just like net profit is the bottom line for the financial statement. You know the numerators: CLABSI, HAPU, SSI, VAE, EED, ADE, CAUTI, VTE-the whole alphabet of harms. You may think about benchmarking against averages; however, being average is a basic expectation in the quality and safety arena, not an ambitious goal.
What's in our way? For one, we still struggle with the balance between individual accountability, "shame and blame," and just cultures while trying to incorporate human factors and systems engineering into our processes. Should taking safety shortcuts be a zero-tolerance situation? Patient identification, hand washing, and medication labeling-just to name a few-are too critical to ignore without consequences, assuming that systems allow for them to happen. We also struggle with honing our communication skills and expectations both inter- and intraprofessionally, as well as true patient and family engagement. Additionally, work is still needed in many organizations to make data available and use it to improve processes and outcomes.
Clearly, patient safety remains an issue. Remember when the ice bucket challenge got our attention? The patient safety challenge is more impactful, although admittedly less creative, and should motivate all nurse leaders to action. We can be as good as and better than our colleagues in the aviation field. Patients must feel safe in knowing that their nurses will protect them from harm, at all times, across the entire continuum of care.
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