Enhancing Patient Safety in Nursing: Strategies and Practices

Medical errors are a healthcare professional’s worst nightmare. Unfortunately, they are also quite common. According to research from Johns Hopkins University, nearly 800,000 Americans become permanently disabled or die due to a misdiagnosis every year. One of the most effective ways to reduce this number is by focusing on patient safety in nursing.

Reducing medical errors can be a complex issue involving many factors. However, targeted strategies can significantly decrease incidence rates. For many hospitals, achieving better outcomes begins with the implementation of improved patient safety protocols.

If designed and deployed effectively, safety protocols empower healthcare administrators to learn from past mistakes, minimize errors, improve the reliability of their medical staff — and most importantly — reduce patient mortality rates.

What is patient safety in nursing?

Understanding the scope of patient safety in nursing is the first step toward reducing the risk of medical errors. Patient safety was defined by the Institute of Medicine two decades ago simply as “the prevention of harm to patients.”

Others have expanded this definition, emphasizing the need to promote patient safety through the creation of a care delivery system that focuses on preventing errors and learning from those that occur. A successful patient safety strategy uses evidence-based outcomes to constantly improve safety protocols, thereby establishing an ongoing culture of learning and improvement.

Nurses are a crucial part of a hospital’s efforts to improve patient safety, as they have more direct interaction with patients of any healthcare professional. They monitor patients’ conditions, administer medication, and convey self-care and discharge information. Because nurses are directly involved with patients on a day-to-day — and often hourly — basis, improving their ability to provide high-quality care is critical to a successful patient safety strategy.

How do nurses ensure patient safety in the care setting?

Many nurses find it helpful to categorize patient safety tactics into separate sets of activities geared towards minimizing medical errors and improving patient outcomes, including:

Monitoring patients

A patient’s medical condition can change instantly, and nurses must quickly identify complications that may arise. Continuing education significantly improves nurses’ patient monitoring skills to detect issues before they become dangerous. This helps nurses to better understand the nuances of things like wound progression, pressure ulcers, and other ailments.

Access to technology also helps nurses monitor patients more effectively. While bedside alarms are common in most hospital settings, technological innovations like medicine barcode scanning and laser temperature checks continue to improve the quality and efficiency of patient monitoring.

Educating patients

Patients’ lack of compliance with post-discharge self-care routines — including wound management, medication regimens, and occupational therapy — is a common source of preventable errors in health care. According to a study from the Mayo Clinic, approximately 50% of patients experienced medication errors on or after discharge. For example, the study found that 59.2% of cardiac patients had a misunderstanding of the indication, dose, or frequency of their medication.

Educating patients about their post-discharge care is a simple yet effective example of how nurses can improve patient safety. By working with patients to ensure they have a thorough understanding of their medical condition and self-care routine before they are discharged, nurses help facilitate adherence and optimal recovery. If patients seem unable to recall or comprehend their outpatient care requirements, it may be necessary for nurses to ensure compliance with a family member.

Assisting physicians

Despite their strong focus on patients’ conditions, physicians are still susceptible to human error. In the operating room and beyond, nurses can serve as an extra pair of eyes, ready to alert a physician to a potential mistake.

To help doctors avoid mistakes whenever possible, nurses must maintain a keen understanding of each patient’s existing medical record and any procedure they are undergoing. A heightened awareness empowers nurses to more readily identify conflicting medications or surgical risks that could put a patient in jeopardy.

How can nurses promote and advance patient safety?

Promoting patient safety in nursing requires the cultivation of intentional communication and collaboration — a responsibility that falls on nurse leaders. In a healthy workplace environment, effective nurse administrators applaud those who strive to diligently minimize medical errors and alert others when they have occurred, setting the tone for a respectful, transparent medical team.

On the other hand, administrators who penalize their employees for making honest mistakes or calling attention to the mistakes of others stifle communication and create an unsafe environment. Afraid to speak up, employees may hesitate to disclose a mistake, directly jeopardizing patient safety. This type of fear-induced workplace culture adds an additional source of anxiety to an already stressful profession, further impacting a nurse’s ability to effectively care for patients.

But while nurses play a vital role in ensuring patient safety, they cannot do it alone. Safety must be a collaborative effort, one in which hospital administrators, doctors, and physicians’ assistants are equally engaged. Only when the entire healthcare team commits to reducing medical errors will meaningful, measurable improvements occur holistically across an organization.

Types of medical errors that threaten patient safety

Guidance from the National Institutes of Health (NIH) explained that medical errors fall into two major categories:

1 – Errors resulting from actions not taken

Medical errors that occur from inaction can have serious consequences. For example, if a patient does not receive a needed medication or screening, they may experience an adverse event. This type of error can have an immediate undesired effect, such as when a patient falls due to not being properly secured in a wheelchair or stabilized on a gurney. Or a patient may eventually develop advanced disease due to not having the right screening early on.

2 – Errors resulting from wrong actions taken

Medical errors also commonly occur because of an incorrect course of action. For example, an incorrect medication or dose can cause immediate harm. These types of errors also include diagnostic errors, surgical errors, and communication errors. For example, patients who undergo the wrong surgery or procedure experience the serious impact of incorrect actions.

Both types of medical errors can be devastating to all involved. In addition to patients’ physical harm, the NIH reported that both patients and clinicians can suffer from long-term negative psychological effects. A provider or healthcare organization may also be subject to disciplinary or legal action.

Unfortunately, errors will continue to occur, and focusing on blame will not eliminate them. It is more productive for healthcare organizations to emphasize accountability so that they can learn from adverse events and work to reduce future errors as much as possible.

Causes of medical errors: underlying factors

The underlying factors of medical errors vary depending on the context in which they occur. Examining these factors can help healthcare organizations understand where they most urgently need to address their safety efforts. NIH defines the following types of errors based on these underlying causes:

1. Active failure — when an error occurs due to a wrong action at the direct point of contact with a patient, such as amputating the wrong foot
2. Latent failure — when an error occurs due to a faulty system, process, or policy, such as storing different medication strengths in a way that could easily lead to incorrect dosing
3. Organizational system failure — when poor management, culture, protocols, or practices lead to errors, such as inconsistent staff training or communication
4. Technical failure — when a facility or resource unexpectedly fails, such as a power outage that compromises care delivery

These factors can have different root causes. For example, active failure can be caused by unintended acts, negligence, or intentional wrongdoing. Or it could be caused by deviations in the process of care during the planning, implementation, or execution of a care plan, either intentional or unintentional. Errors can also cause secondary harmful events, such as pressure sores or hospital-acquired infections.

Patient safety reporting and learning systems

Implementing a robust error-reporting system is critical for improvement. Without a solid grasp of your organization’s safety data, it could be difficult to identify, monitor, and target areas that are lacking.

It is important to identify the issues that led to errors and implement measures to correct them. Do you need to improve team communication, address clinician and provider fatigue, bring in better training and education, address system failures, or work on culture?

Creating a culture of safety involves conveying to all staff that your organization prioritizes quality and safety and encourages — rather than penalizes — staff who report both errors and near-misses so they can be analyzed, understood, and addressed. A good incident-reporting system helps leaders identify trends, analyze root causes, and implement effective prevention strategies.

Many healthcare organizations implement a quality improvement program to address safety. The concept of continuous quality improvement helps strengthen an organization’s safety culture by providing a methodology that consistently drives action. Components include Plan-Do-Study-Act (PDSA) cycles, root cause analysis studies, and other research-driven quality improvement efforts.

Improve patient safety outcomes for your organization

For nurses and their organizations to enhance safety and improve patient outcomes, education and awareness are key. Those who continuously learn from past mistakes and proactively adopt more effective patient safety practices are better able to reduce errors and save lives.

Relias’ extensive suite of workforce solutions empowers you to expand and hone your teams’ patient safety skills. For each area of risk mitigation — from patient monitoring and patient education to continuous quality improvement — we provide intuitive, expert insights that clinicians and providers can easily integrate into their daily practice. Looking for free resources to enhance your patient safety practices? Visit FreeCME for free continuing education courses.