Monday, 18 April 2016

Hospital wards (1): nurses and clinical safety








Often, when we talk about clinical safety, we refer to specific activities such as hand washing or surgical checklist, but in this post I will try to explain the repercussions that the methods of working in hospital wards have on the quality of care. When people are admitted to a hospital, they put themselves in the hands of an army of professionals, who follow guidelines and are subject to shifts and medical guards. We must pay attention to all this, because the evidence has been warning us that what we call organizational factors weigh more than we think when it comes to hospitalized people’s health.

The 12-hour shifts are less secure for patients than the 8 hours shifts

A study conducted by the University of Maryland concludes that the probability of error is 3 times higher for nurses who work in 12-hour shifts compared to the one who work on 8 hours shifts. This finding has been corroborated by extensive research (22,000 records) conducted by the School of Nursing at the University of Pennsylvania.

Qualified shift changes should reduce errors

Although I have not found published evidence, there is a perception among clinical safety experts that if the nurses in hospital wards are allowed enough time to perform the shift changes in a sufficiently qualified manner, and preferably in the presence of the patients, the actions of the incoming nurse should be less prone to errors.

Nurses’ training and workload influences mortality

Two separate studies: the doctoral thesis of Mireia Subirana, Nurse Director at Hospital de Vic and an European observational study undertaken with the input from more than 26,000 nurses from 9 countries, show that both the educational level of nurses and the provision of hospital units have an influence in the mortality of the discharged patients.







The traditional model of communication between doctors and nurses is neither sufficiently efficient nor safe

Without any evidence on the table, doctors’ traditional method of work - clinical sessions (usually exclusive); patients’ visitor (with or without nurses, depending on the ward); medical orders and interdepartmental requests -  is archaic, especially for more complex patients. Therefore, a radical change in methodology is needed: multidisciplinary working sessions where all the professionals that deal with each patient develop a joint individualized action plan (see post: "General Hospital versus Factory Hospital"). Only the involvement of professionals can increase efficiency and reduce errors.

Hospital wards are suffering from structural problems such as 12-hour shifts, medical guards and saturation of workloads and this affects the quality of care. However, patients’ safety also requires that doctors and nurses do a lot more team work than they are doing at the moment.

A recommended reading related to the topic: "The Huddle Safety Meetings".



Jordi Varela
Editor

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