The 19:1 issue of the Journal of Perinatal & Neonatal Nursing (JPNN) focuses on the timely topic of patient safety. Much has been made of the recent focus on medical errors as one segment of patient safety.1 However, other critical components of patient safety include performance aspects of high-reliability organizations, Crew Resource Management (CRM), and monitoring of patient safety indicators.2-4 In the recent past, JPNN has also published articles focusing on patient safety in the perinatal and neonatal settings.5-7 Within this issue, additional multifaceted parameters of patient safety are explored.
Johnson et al open the issue with a generic article exploring patient safety indicators of the Agency for Healthcare Research and Quality (AHRQ). These indicators have applicability across clinical subspecialties and they cover numerous medical, surgical, and anesthetic components of care. Administrative data to combat patient safety are presented as well as the genesis of how these indicators were constructed. The authors allude to how these indicators might be utilized in perinatal and neonatal settings.
The perinatal section specifically includes 3 other manuscripts that reflect the realm of perinatal patient safety. The first is "Failure to Rescue: Implications for Evaluating Quality of Care During Labor and Birth" by Simpson. Failure to rescue is an indicator in the AHRQ list that has been used to measure quality of care for surgical patients by evaluating the number of patients who die after developing postoperative complications. The author explores application of this concept to the intrapartum setting.
McFerran et al present a quality improvement project related to perinatal patient safety. It involved a multicenter approach to improve perinatal performance at 4 Kaiser Permanente hospitals. The authors contend that high-reliability perinatal units are built on a foundation of timely communication and collegial teamwork. Their perinatal patient safety project utilized human factor techniques and systems improvements for this 1-year pilot project.
Resources for perinatal clinicians regarding patient safety as well as teamwork in perinatal care are compiled by Miller. This manuscript provides a brief entre to CRM as well as a listing of print multimedia and Web resources for clinicians on patient safety.
"To Err Is Human," the report by the Institute of Medicine (IOM, 2000) surprised the nation when it reported that almost half of all adverse events that occur in hospitals are a result of medical errors and that 44,000 to 98,000 patients die annually as a result.1 Nursing represents the largest segment of the healthcare workforce. It becomes imperative, then, that one of nursing's priorities must be the safety and well-being of the hospitalized patient.
Commonly, the term "medical error" is translated to mean "medication error." Medication administration is a high-frequency activity associated with inherent risks, but it is only one category of events that may result in an adverse outcome. Since the IOM report, we have become aware of how structures and processes contribute to less than optimal outcomes. For example, the physical environment in which care is delivered, increased demands for nursing documentation/paperwork, poor communication, and multiple patient transfers all affect safety and efficiency. This series highlights common healthcare activities that may not be initially thought during a discussion of patient safety.
The article "Safety: When Infants and Parents are Research Subjects," underscores the importance of nurses being aware of safety issues when patients and their families participate in research. Safety in research is particularly important because research is not part of standard care and participation is voluntary, and as such, there are a number of rules, regulations, and guidelines that provide direction in determining research risk. Nurses need a basic understanding of the role of the Institutional Review Board in the protection of human subjects. Issues related to safety in research are especially pertinent to high-risk infants because of the nature of parental (or legal guardian) consent and because children are considered a vulnerable group requiring special protection from research risks. Neonatal nurses have multiple opportunities to ensure the safety of infants and their parents in research, including serving an important role by reporting research safety concerns.
"Enteral Feeding High-risk Neonate: A Digest for Nurses Into Putative Risk and Benefits, Safety and Comfort, and Recommendations" highlights the risks associated with providing nutritional support to the high-risk neonate. Few nurses think of the health risks that are posed by virtue of the equipment necessary to deliver nutrients, such as the materials necessary to ensure softness and flexibility of enteral and intravenous tubing. Factors to consider before initiating or advancing feeds is discussed along with evidence-based nursing practice recommendations. Delivery of milk/formulae feedings can involve a number of different routes and methods, all with their own inherent risks and benefits. Individualized care, rather than adherence to protocol, ensures assessment of benefits versus risks for each infant. Based on the review of literature, recommendations are given for use of a feeding system, preparation of enteral feeds, preparation of the neonate, patient monitoring, and documentation of the activity. Owing to the number of gaps identified in the research literature, directions for future research are described to ensure safe and comfortable care for high-risk neonates receiving enteral feedings.
"Maximizing Patient Safety: Filter Needle Use With Glass Ampoules" highlights a case study about changing clinical practice involving the use of glass ampoules in the neonatal intensive care unit. The literature is clear that there is a risk of potential injury due to glass contamination; however, not all hospitals use filter needles when aspirating the contents of these ampoules. There is a paucity of research detailing the consequences of glass particle contamination being given to the neonate; however, results from animal and adult studies can be extrapolated to this high-risk group. The article promotes continued change in nursing practice regarding nurses erring on the side of safety, with the ultimate goal of improving patient safety and outcome. A suggested patient care policy is included to facilitate other neonatal intensive care units' adoption of the practice.
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