Building a Culture of Safety

1.  What did I expect to learn about this topic before beginning the unit?
Safety is such an important aspect of healthcare. I was hoping to learn about how to build that culture of safety and what I can do as an RN to promote safety in all aspects of care not only for my patients but for myself as well.

2.   What I actually learned:

       The discussion this week was great! I hope I am never in that situation that RN was in with a nurse to patient ratio of 32:1. I realize that this does happen and it needs to stop. This is not creating a safe environment for staff or for the patients. Intermountain is focusing a lot on zero harm. A situation like this is not in line with the zero harm initiative in any way. I feel the need to stand up for myself and the patients and talk with a manager and/or supervisor about any situation that is compromising safety. Safety should be the number one priority.

       With the critical thinking exercise I was able to reflect on the values of Intermountain healthcare and examine the facility and its employees and how compliant the employees are to the values. I agree and love the values intermountain strives to uphold.  I do see employees with these values and find it to be a wonderful place to work. I will continue to strive to have these values as well because I know that because of their mission, vision, and values, Intermountain has become a highly reliable facility. A highly reliable facility also becomes a safe facility. That is and should be a main focus for all facilities to have.

       The case study this week was complex and had many different aspects to think about but it was very interesting to analyze the situation. It is so unfortunate that a young boy had to lose his life for people to realize a break in the system. But I am so glad to have people that are willing to let us learn from mistakes and help better the system rather than just seeking revenge. Reflecting on this scenario really made me realize how important it is for me to really know my stuff and to now be afraid to speak up, no matter what!  I hope I am never involved in a lawsuit or anything like this but reality is I might be. I hope I can always remember this and always document fully, communicate with my team and especially the doctors, and not always rely on the “system” to be my second check. It is not bad to question things sometimes and seek clarification.

3.  My feelings/experiences from the individual and team activities:

      Like I said, I really liked the case study and the fact that I was able to read and learn about a real event and reflect on it. The discussion was a good topic as well because I know this happens and we may be faced with unethical situations like the one in the scenario and it is good for us to talk with each other and decide what we should do about it and who we should talk to fix it.

4. How I will utilize the information learned in my nursing practice:

      Like I have mentioned before, I want to make sure I am communicating with doctors and other nurses regarding my patients and their care so we are all on the same page with what is going on. I want to help create that safe and reliable environment for not only the patients but for myself and my fellow coworkers.

5. My personal feelings about the material covered:

I think safety is a great topic to discuss and I liked the direction we went with it this week with the case study and looking at working conditions for staff and how that affects the patients. I also thought it was important to look up the values of institutions and see how those values really affect the reliability of an institution in analyzing if the employees actually uphold those values. 

Informatics

1.      What did I expect to learn about this topic before beginning the unit?

I knew we would be talking about technology and its use in healthcare. I was expecting to learn about how technology has evolved or affected healthcare in both good and bad ways.

2.      What I actually learned:

CRITICAL THINKING

1.       The use of EMR does not guarantee error-free patient care. While using the EMR often helps catch mistakes or limit the amount of them, there is still room for mistakes and errors. Nurses and others using the EMR can override the bar code scan. It is also possible that the order was written down incorrectly and put in the MAR incorrectly. That is why it is important for nurses to verify the EMR with the written order from the doctor before verifying it in the EMR.

2.       Nurses who do not pay attention to the alerts and choose to bypass those just because they are in a hurry jeopardizes patient safety. Also, nurses may choose not to scan the medication or double check and just administer it because the patient is in a hurry or the nurse is in a hurry. That is never an ok thing to do and often results in mistakes. A friend told me a story about something that happened on her floor. The charge nurse administered heparin IV to the wrong patient. My first question was how was she able to scan that in?...she didn’t scan it. She did not verify and take the extra 15 seconds to do so and that resulted in a huge mistake. I sure hope the patient is ok. That behavior is never ok.

3.       Excessive system alerts may just get annoying but honestly I don’t feel that there is a danger to having them. I guess the danger would be that nurses stop paying attention to or stop reading them. They may also just get so annoyed and bypass them because of that. I don’t feel that there are excessive alerts right now in the system I am currently using.  I have actually caught myself giving the entire tablet instead of just giving half like I am supposed to because of the system alerts.

4.       Nurses cannot become lazy. Nurses need to see the value and understand the importance of those alerts. Nurses should not have the annoyed attitude either.  If a bypass is necessary for some reason the nurse should be calling the pharmacist directly and have them in the room witnessing it. I would hope nurses see the value in the alerts of the EMR and take the time to check the orders and the MAR before just assuming a new medication is correct for that patient.

Technology is an amazing thing and we have made so many advancements with technology in healthcare. The EMR is incredible and being able to do all computerized charting is crazy! It is so helpful in so many ways. The critical thinking exercise this week made me realize though how important it is to always be checking the MAR and orders especially with medication administration. There have been many times I am in a patient room or gathering medications and I see a new order in the computer. Many nurses will just give it. I try very hard to always check the chart for the order and verify that it has been correctly entered into the system and it is for the correct patient before I give it. I also was reminded of the importance of barcode scanning. This has helped so much with minimizing medication errors. I don’t want to always just rely on the scanner and I know I need to be checking and doing the 5 patient rights. I also have promised myself that I will never bypass an alert. If there is an alert, more times than not, it means I have made an error of some kind whether I scanned the wrong barcode, the wrong medication, or it is the wrong dose. I will always immediately call the pharmacist and verify if I am unsure.

CASE STUDY

1.       Diabetic Patient: The nurse should look at the patient’s history and see what his blood sugars have been and see if there is a pattern or trend. A blood sugar of 54 is pretty low and does cause some concern for most patients. I would advise the nurse to contact the patient directly or contact nursing personnel in his area to visit him and get a set of vital signs. I think it would be good for the nurse to call him or have someone call him and can ask him about how he is currently feeling (checking for signs of hypoglycemia) and tell him to drink some apple juice or have graham crackers and milk. I would then ask for a repeat glucose after 1 hour.

2.       The first thing is to try and call the patient and/or family and contact nursing staff in their area. If the nurse didn’t get an answer I would ask nursing to visit the patient.  Best case scenario the patient just forgot to report or was delayed. Worst case, the patient was taken to the hospital or the patient is not doing well at home. Calling first can prevent any unnecessary action but following up will determine the status of the patient.

Because of technology we are able to do nursing and communicate with patients and nurses across the country. I liked the case study this week and realized how difficult it may be to make medical decisions without even seeing the patient. I know that I will get calls from friends and family desperate for help or for an answer and I want to be confident and educated enough to be able to make a decision and help others in those situations. I know I won’t always know what exactly is going on but I can know enough to decide whether they should go to the hospital or if it is something I can assist with. Technology also allows for pictures to be sent and other helpful resources for everyone to use.

The discussion this week was interesting. It is perfect for what is happening with IHC with switching to ICENTRA and more recently the new CareFusion pumps. I know there were staff members that did not want to use the new pumps and would hide /stash the old pumps to pull out and use when they worked. I think this is terrible. But it is hard to make a change after years and years of using a system. Computer charting is very difficult-I am still learning so much and can’t imagine how difficult it is going to be for those that have used Tandem for 30 years to switch to a new system. But we are in a profession of change and adaptation. Change is necessary and it is a good thing. I want to be helpful to all my coworkers and help be the motivation to comply with new policies and changes. Doctors are very intimidating to me and with this discussion I realized how hard it would be to approach them. I realized all the resourced I had and who I can go to for help. But, if patient safety is a concern, I will go directly to the doctor.

3.      My feelings/experiences from the individual and team activities:

I enjoyed the discussion this week with my team and thought we worked well together coming to a consensus. We all provided information to each other that was helpful and I definitely learned some new things from my teammates. Focusing on informatics and doing the critical thinking and case study exercises was helpful and reading the article from AHRQ reminded me about patient safety and they tied together well.

4. How I will utilize the information learned in my nursing practice:

Technology is amazing and can be so helpful to me. However, I need to not allow myself to become completely reliant on the EMR or the scanning or computer system to ensure patient safety. I always need to be checking all patient rights with medication administration and always checking the orders from the physician. I also feel empowered as a new nurse and realize I can be an influence and speak up. I can approach doctors if necessary and let them know that what they are doing is possibly jeopardizing patient safety if that is the case. I am a smart person and I am a smart nurse. There are so many resources out there for me to use and I need to always embrace the change.

5. My personal feelings about the material covered:

Informatics in many ways is complicated and hard to understand but the material this week was presented in a great way and the discussions were helpful. I liked the case study and critical thinking exercises this week and felt they were very applicable to my current situations in my nursing practice. 

Quality Improvement Strategies IV

11.   What did I expect to learn about this topic before beginning the unit?

I expected to learn about how we can involve our patients specifically with continuous quality improvement. I also hoped to have a better understanding of indicators and benchmarks and how those are identified/created. 

2.   What I actually learned:

The discussion this week was difficult for me to understand. I guess I learned/understood more of what indicators are and how to create an effective benchmark. I realized how many elements need to be considered when creating process of care or outcome indicators and how impactful and important these are/can be. Benchmarks are also important and need to be created properly and at an attainable range, otherwise, hospitals may never meet the specified benchmark if it was created with improper data and that can reflect false information.

As we continue to develop our CQI in healthcare, it is important to remember the involvement of the patient. It is crucial for patients to be involved in their treatment. I understand that error rates haven’t necessarily dropped significantly with this new initiative but I believe in the long run, these rates will go down as people are more and more educated about healthcare with the advancing technology. I would hope that I can empower my patients to speak up and help them gain that desire to be involved in the quality improvement and their healthcare specifically.

The critical thinking exercise this week was interesting. I was able to think of a problem and I asked myself “why” five times. I do feel that with each time I asked myself the question I was able to have more clarity and understanding of the root of my problem. I think this is beneficial and can be applied to all problems in life. I need to stop and think about it for a few minutes and ask myself the why question multiple times. By doing this I allow myself to brainstorm possible causes and can come to a conclusion and begin to fix it if possible. If I don’t allow myself that time to think about the root cause, I may continuous have the problem and not realize how to fix it.

The case study this week got me thinking about what authority I have as a new nurse and how I can stand up for my patients as well as myself, even if it means calling a doctor out on something. I realize that I have the responsibility to speak up for my patients in all aspects but especially when something could possibly compromise their safety and well-being. IHC is focusing on Zero Harm. I believe this specific situation that was discussed is part of zero harm and I need to take action no matter what. If the doctor needs to speak to me afterward that is fine. I want to always be respectful of all members of the interdisciplinary team and I believe I can be respectful but still remind them of proper care/technique if necessary.
3.  My feelings/experiences from the individual and team activities:

I thought the case study and critical thinking exercises were beneficial this week. I did learn more about myself and how I might handle certain situations. It was good to think about how I might approach an MD who isn’t following proper protocol. I know this is something that will happen in my career. The discussion was complex and abstract for me. I don’t know that I fully understood what was being asked.
4. How I will utilize the information learned in my nursing practice:

Like I have previously mentioned, I appreciate the fact that I was able to think about how I might solve some problems in life and how I can communicate with physicians and feel that I do have proper authority. I will also involve patients in their care and encourage them to be a part of the continuous quality improvement.
5. My personal feelings about the material covered:

This week was full of a lot of good things. I really had a difficult time with the discussion and hope to receive more clarity and understanding as we continue with more units. 

Quality Improvement Strategies II

1.       What did I expect to learn about this topic before beginning the unit?

I wanted to understand more of how my role as a nurse can influence/help improve quality improvement in the facility I work in. I also expected to learn about customer satisfaction and be reminded of the importance of those surveys.

2.      What I actually learned:

Patient satisfaction is a very important part of quality improvement. It is also very important in the hospital industry. People do their research. I would not want to work at a hospital that has a bad reputation in any sense. I know that my nursing practices have an influence on the scores my hospital/unit receives from each patient I interact with. I like the definition of satisfaction that was presented in this unit: satisfaction is how closely the result matched the expectation. This is very simple and very true. I would hope that those patients on my unit feel that their expectations were/are met. HCAHPS is a very important aspect of satisfaction and overall quality of the hospital. I know there is a website anyone can go onto and see the scores of many different hospitals in many different areas. These scores can make a huge difference in the decision making process of the patients or future patients. I want to help keep those scores of the hospital I work at high.

The case study this week helped me understand more of the importance of risk management. It is important to always pay attention to details and trends (good trends but especially negative trends).  It’s amazing what can happen if all the team members are noticing things all the time and paying attention to their practices and procedures. We are all here to help people heal and go back to living their lives. We owe it to them to do our jobs and reduce risks.

The discussion about EBP helped me realize how I can be an influence to other coworkers regarding EBP. I do feel intimidated to speak up sometimes to other coworkers because I know I am a new grad and they have much more experience than I do. However, I feel empowered from this discussion and know that I can speak up just like we tell patients to do. I need to be the example and follow EBP myself before I can expect others to do the same. I can encourage others just by doing it. I also want to focus on being proactive and doing the research for myself to understand why we do things a certain way. By taking the time to understand it for myself, I can help teach others and have data and evidence to back me up.

3.      My feelings/experiences from the individual and team activities:

I though the discussion this week went well. I liked that is was focused on a topic that we are dealing with right now. I think it was good for all of us to share our feelings about being a new nurse and how that can come across to others and what things we can do to combat that with EBP. The case study was good in reminding us of the risk management resources we have. It is good to know that if we miss something as nurses there is another team double checking us. I though the reading was interesting and easy to understand. Patient satisfaction is a fun topic to discuss and one that definitely makes a huge difference in the overall quality of the hospital.

4.      How I will utilize the information learned in my nursing practice:

Being reminded of customer satisfaction scores and their importance makes me want to ensure that I really focus on those things with my patients. I want to make sure they feel their pain needs are addressed and under control. I want them to feel they have direct and effective communication with myself as well as the doctors if I can help it. I want to make sure they feel comfortable in their rooms and that I do what I can to ensure its cleanliness. I want to be a part of a magnificent hospital. While I think the hospital I work at is very close to that, there is always room for improvement and that begins with me. I want to be an example to my coworkers and help influence them to not be lazy and follow EBP with everything they do.

5.      My personal feelings about the material covered:

I thought this week was nice. The material was not complicated but still very important. Customer satisfaction, survey scores, risk management, and EBP are all things I felt were focused on and they all have an influence on each other as well as contributing to continuous quality improvement. 

Quality Improvement Strategies

1.      What did I expect to learn about this topic before beginning the unit?

I was expecting to learn about strategies to improve quality improvement meaning things we can do as nurses or what other members of the interdisciplinary team can do to improve quality.

2.      What I actually learned:

Measurement is essential in continuous quality improvement. I guess I realized the value of collecting accurate data and being able to display it using charts/graphs/pictures/explanation in a way that makes sense and shows trends or issues. It does take time to gather the information but without it, how does a facility know what areas to improve in? I can apply this to myself and my nursing practice. Each day after a shift I can take some time to reflect on that day-what went well, what still needs improving. I can organize it in my head or even write some things down in a way that allows me to analyze the “data” and see progression/digression over time. By doing this I will be able to continuously improve my quality of care and that will translate to the continuous quality improvement of my facility.

I also realized that everything is going to vary-variability is not a bad thing but you have to identify what the variability is and either remove it or minimize its overall influence in order to reach the goal in mind.

I also learned about care processes and how analyzing the processes I use as a nurse can help determine why errors are made. This goes back to what I previously mentioned about reflecting on my day. As I look at the care processes I use for patients, I may notice a trend I have or way of doing something that may be setting me up for failure or potentially causing harm to patients. I don’t want that to happen so I can use these strategies to minimize that risk.

The group discussion this week helped me realize how much I do know about involving other members of the interdisciplinary team. I work very closely with PT, OT, speech, and dietary on my  floor because its neuro/rehab. Patients are always battling with learning how to eat again and many have feeding tubes because they cannot tolerate oral intake yet. Dietary is so helpful in helping the patients as well as me to understand how to decide what is best to eat and to help provide patients with their preferred options so they want to eat and are able to meet their daily calorie goal.

The critical thinking exercise made me realize that it is important to read all the options and pick an option that is all encompassing…especially when we are defining something (in this case, a fall). I think it was beneficial that the definition I chose outlined from beginning to end what a “fall” in the hospital actually is.

3.      My feelings/experiences from the individual and team activities:

I always enjoy the discussions and felt this week that my team had a many of the same views as to how to involve the patient/family with eating and who we can call upon for help from the interdisciplinary team. It’s always helpful to have insight from other class members and I feel that I learned some things. The individual activities were very straight forward this week and really helped to solidify some concepts for me.

4.      How I will utilize the information learned in my nursing practice:

I mentioned this previously but I really feel that I can benefit from this week by learning how to analyze my own care processes, identify the variables, and organize the information in a way that allows me to improve my quality of care. In addition, this will help improve the quality care at my facility. I have realized how helpful other members of the team are to a patient’s care and the fact that we all work together for the same common goal.

4.      My personal feelings about the material covered:

I thought this week was full of good concepts. It was very straightforward, not too deep, and are concepts we can all apply and relate to.

Quality Applications: Benchmarking

 1. What did I expect to learn about this topic before beginning the unit?

I have to be honest and say that I really had no idea what to expect with this unit. The term "benchmarking," especially when related to healthcare was foreign to me. I guess I got the idea from looking over the objectives but I really had no expectations and was completely curious.

2.      What I actually learned:

Benchmarking was somewhat of a foreign idea to me at first but through reading and some research I realized that essentially it is a way for hospitals to create goals and targets and compare results with other hospitals. Not having a benchmark is a big deal…it’s like not having a goal in mind or anything to work toward. I think that these benchmarks are a way for the public to see how well a hospital is doing with certain aspects and decide if that is where they would like to receive their care. Benchmarks can be very beneficial to hospitals if created, used correctly, and actually met.  This goes along with the balanced scorecards of hospitals. I think it is important for those scores to reflect many different aspects and come together to show/prove that a hospital is successful and the main outcome/goal should be patient centered.

In the case study this week , I was reminded of the importance of proper catheter care for patient safety. I’m happy to say that through my research I realized the way we do it on my floor is correct and the most recommended. I think it is so important to research these things and make sure there is evidence based practice out there supporting a certain care. At the hospital we can use the CPGs for basically anything and those will provide the proper protocol.

Electronic health records can save lives!!! I was reminded of the importance and the responsibility I have to utilize the computer charting system to read about the histories of my patients to ensure proper continuity of care as well as safe medication administration. 

3.      My feelings/experiences from the individual and team activities:

The discussion this week was very difficult for me. I think the main reason was because I was not understanding the questions being asked and I was still trying to grasp the concept of benchmarking. After reading the posts of my teamates, I think I mostly understood what it meant but we all had somewhat different ideas. The critical thinking assignment about the score cards was also new and different. I liked looking those up and seeing the different variations of what is included and think I found a great one that really focuses on patient outcomes. The case study about the catheter care was a good reminder as well and I realized how it sort of ties in with the benchmarking. 

4.      How I will utilize the information learned in my nursing practice:

I think this information is helpful because now I realize the goals that are set for the hospital I work for or even goals on my unit specifically are all essentially contributing to that benchmark and comparison to other hospitals around the state and nation. I feel lucky to participate in these targets and goals and hope I have a positive influence. It is a good reminder to me to always practice safely and uphold the guidelines and evidence based practice that is in place because those were created as a result of benchmarks/goals met/not met. 

5.      My personal feelings about the material covered:

The material this week definitely made me think outside the box and it was abstract in many ways. I think I understand what it all means and how it ties together but I still can't say for sure. I like being challenged and understand that this is a high level class so some weeks like this is expected. I could have benefitted from some clarification or more guidance on this topic as well. 

Roles of Health Professionals

1.      What did I expect to learn about this topic before beginning the unit?

I know the interdisciplinary team includes many different specialties and that each member plays a special/important role in the outcome of the patient. I wanted to learn more about how I can involve other members of the team and how I can utilize those other members to provide more complete care to my patients.

2.      What I actually learned:

I learned/realized many different things from working on this unit this week. I was reminded of the importance of team work in healthcare and the positive impact it has on the overall functioning and quality of the hospital, the patient’s outcome, and the happiness of the employees. Working as a team can be difficult at times but this past week I have really been reminded how important it is and to realize that we as healthcare workers are in this together. We all have a common goal at the hospital no matter what department/specialty you work in: we all come to work each day to serve others and want our patients to have the best outcome possible. In order for teams to be successful we have to have that open communication, respect, and collaboration. With my current job on the Neuro/Rehab unit, I work with PT, OT, and speech on a daily basis. My medication administration schedule is partly dictated by the patient’s therapy schedule. Therapy is SO important for these patients and I try my very best to never interrupt them to give medications. On a weekly basis each member of the team meets to discuss each patient for 5-10 minutes and the progression/digression that is happening. Every member is there: MD, nurse, PT, OT, speech, SW, dietary…care notes are made and e-mails are sent out to the nurses who primarily care for those patients. I feel like this is an exceptional example of team work on our unit and how beneficial it is to do this so that every member of the team is updated on the patient’s status and we all understand where the patient needs help.

I have also learned this week the many different ways I can involve other members of the interdisciplinary team with diabetic education specifically. It’s also important to make sure the family understands what is being said/does a return demonstration of insulin administration or just explain the information given in their own words. Diabetic counselors/educators can be so helpful to us as nurses. They can take the time to educate our patients. Home health nurses are also good resources to use so we get a more complete picture of what home/daily life is like for these families. This is especially important with diabetes because daily lifestyle (what we eat/exercise) can impact a person’s diabetic management and overall health.

3.      My feelings/experiences from the individual and team activities:

The discussion this week was really good. I think we had a lot of different perspectives and input as a team to decide how we were going to approach the situation with our diabetic 11 year old with different family dynamics and need for interpretation services. Although each of us was functioning as the nurse, I felt like we represented an interdisciplinary team and we discussed how we wanted to approach this patient. We went back and forth about what needs this patient may have and came to a consensus. This is exactly how the team really works! J

The case study and critical thinking assignment required more complex thinking and I needed to find a solution to a dilemma that is something that will happen in my nursing career. With research, I have had times that I have not been able to find proper articles for EBP and I feel like I come to a dead end. I was able to reflect on ways to prevent this from happening again and I explored resources I have for help.

4.      How I will utilize the information learned in my nursing practice:

I want to make sure I am actively participating in my team duty and being collaborative and respectful to the other team members. I can remember these scenarios and examples of how I can utilize other team members to help the patient (interpretation services, dietary, diabetic counselors/educators, home health nurses).

5.      My personal feelings about the material covered:

I felt that the material this week was very valuable and a good reminder of how important it is for us as nurses to recognize all the team members involved in each of our patient’s care and that a successful team is only successful if we are actively participating and doing our part.