... What Was Learned From Evaluating the Impact of Change Interventions? ... quality care using a... more ... What Was Learned From Evaluating the Impact of Change Interventions? ... quality care using alerts and reminders; (4) improve medication safety (eg, implementing bar coding and computerized ... it was not reported or not collected, made statistical analysis of the impact of the ...
Background and Purpose: The purpose of the study was to evaluate the reliability and construct va... more Background and Purpose: The purpose of the study was to evaluate the reliability and construct validity of the Complexity Compression Questionnaire (CCQ), a 28-item instrument designed to explain nurses’ experiences when assuming multiple responsibilities in a compressed time frame. Methods: Data were obtained from 607 registered nurses in an academic medical center in the midwestern United States who participated in a larger study on system-wide organizational change involving upgrading electronic health records. Results: Cronbach’s alpha for the 26-item CCQ, was .91. Exploratory factor analysis supported a 5-factor solution that explained 53.6% of the variance. Conclusions: The CCQ may be a useful tool for measurement of the effects of organizational change on the complexity of the work of nurses.
This chapter examines reporting of health care errors (e.g., verbal, written, or other form of co... more This chapter examines reporting of health care errors (e.g., verbal, written, or other form of communication and/or recording of near miss and patient safety events that generally involves some form of reporting system) and these events' disclosure (e.g., communication of errors to patients and their families), including the ethical aspects of error-reporting mechanisms. The potential benefits of intrainstitutional and Web-based databases might assist nurses and other providers to prevent similar hazards and improve patient safety. Clinicians' fears of lawsuits and their self-perceptions of incompetence could be dispelled by organizational cultures emphasizing safety rather than blame. This chapter focuses on the assertion that reporting errors that result in patient harm as well as seemingly trivial errors and near misses has the potential to strengthen processes of care and improve the quality of care afforded patients. Error Reporting & Disclosure Ethical Implications of Reporting and Disclosure Health care providers are typically so devastated and embarrassed by their mistakes that they may attempt to conceal them or defend themselves by shifting the blame to someone or something else. 15 Some attribute failure of honestly acknowledging health care mistakes to providers' personal difficulty with admitting mistakes and incriminating other providers. 16-19 Ethical frameworks operate when health care mistakes are made. 20 Respect for patient autonomy is paramount, as is the importance of veracity. Fidelity, beneficence, and nonmaleficence are all principles that orient reporting and disclosure policies. Providers might benefit from accepting responsibility for errors, reporting and discussing errors with colleagues, and disclosing errors to patients and apologizing to them. 21 When providers tell the truth, practitioners and patients share trust. The fiduciary responsibility of institutions exists in patients' and families' trust that providers will take care of them. If providers cover up errors and mistakes, they do not necessarily stay hidden and often result in compromising the mission of health care organizations. Consistent with their mission, institutions have an ethical obligation to admit clinical mistakes. Professional and organizational policies and procedures, risk management, and performance improvement initiatives demand prompt reporting. When patients, families, and communities do not trust health care agencies, suspicion and adversarial relationships result. 18 Likewise, the breach of the principle of fidelity or truthfulness by deception damages provider-patient relationships. 22 Fidelity and trust, implicit to the provider-patient relationship, do not coexist with deception. 23 Physicians, nurses, and other health care providers have legal and ethical obligation to report risks, benefits, and alternative treatments through informed consent mandates. Legal self-interest and vulnerability after errors are committed must be tempered by the principle of fidelity (truthfulness and loyalty). 24-26 This ethical principle has been reinforced by practical lessons learned from errors; especially when an adverse event causes serious harm or even death, there is an ethical and moral obligation to disclose information. 27, 28 Candid reports and disclosure of errors by physicians as well as other health care providers (or institutional leadership if the physician refuses to disclose) 19 might result in greater patient trust and less litigation. 29 Furthermore, it is essential to act after errors are reported, with interventions aimed at protecting the welfare of patients by targeting iatrogenic problems and documenting the care given. Additionally, the ethical principles of beneficence (doing good) and nonmaleficence (preventing harm) are violated when errors are not reported or disclosed. These ethical principles, beneficence and nonmaleficence, shape caring nursing practice, and caring presupposes that nurses act in the best interests of patients. For example, sharing information and preventing harm to patients through truth telling, regardless of good or bad news, build relationships between elder residents and nursing home staff. 30 Putting residents' interests first represents nurse caring and characterizes relationships in which sharing information, rather than hiding it, surrenders nurses' control related to withholding information. Thus, failure to disclose health care mistakes can be viewed from the perspective of provider control over the rights of patients or residents.
A national research agenda is needed to promote inquiry into the impact of credentialing on healt... more A national research agenda is needed to promote inquiry into the impact of credentialing on health care outcomes for nurses, patients, and organizations. Credentialing is used here to refer to individual credentialing, such as certification for nurses, and organizational credentialing, such as American Nurses Credentialing Center Magnet recognition for health care organizations or accreditation of providers of continuing education in nursing. Although it is hypothesized that credentialing leads to a higher quality of care, more uniform practice, and better patient outcomes, the research evidence to validate these views is limited. This article proposes a conceptual model in which both credentials and standards are posited to affect outcomes in health care. Potential research questions as well as issues in research design, measurement, data collection, and analysis are discussed. Credentialing in nursing has implications for the health care professions and national policy. A growing body of independent research that clarifies the relationship of credentialing in nursing to outcomes can make important contributions to the improvement of health care quality.
As background for a National Institutes of Health State of the Science Conference on Endof-Life-C... more As background for a National Institutes of Health State of the Science Conference on Endof-Life-Care, we performed a systematic review of end-of-life care and outcomes. The systematic review was intended to evaluate the evidence in the field from the perspective of concerns important to patients, caregivers, and the health care system. This article relates the challenges in performing a systematic review of end-of-life care and outcomes, and describes the methods that we used to define the scope, search the literature, develop exclusion and inclusion criteria, incorporate various types of articles, and synthesize the results. Major challenges to conducting a review included the need to define "end of life," clarify a conceptual framework of outcomes including definitions of terms and the relationships among terms, and determine specific goals for the review. The review identified 24,423 total citations, of which 911 comprised the final set used for the evidence report. This very large, diverse body of literature reflects the tremendous growth of the field of end-of-life care over the last decade. S-4 INTRODUCTION: THE TASK AND QUESTIONS FOR A SYSTEMATIC REVIEW OF END-OF-LIFE CARE T HE DEMOGRAPHIC CHALLENGE of the rapidly aging Baby Boomer generation will soon challenge the quality, affordability, and accessibility of the American health care system. Several recent reviews have addressed the literature in part, but focused on one portion of the literature (e.g., cancer or particular interventions) or relied heavily on expert opinion. A major recommendation of the 2001 report of the Institute of Medicine Improving Palliative Care for Cancer 1 was to convene a National Institutes of Health State of the Science Conference on this topic.
THE MOMENTUM that started with 2 Institute of Medicine (IOM) reports, To Err Is Human: Building a... more THE MOMENTUM that started with 2 Institute of Medicine (IOM) reports, To Err Is Human: Building a Safer Health System1 and Crossing the Quality Chasm: A New Health System for the 21st Century,2 persists. Eight years later, patient safety and quality improvement are, together, fundamental American healthcare policy concerns. While the quality of care in the United States remains substandard in many pivotal areas, there is no doubt that the nation’s healthcare service stakeholders are united in their desire to reshape the system and are working hard to achieve this. As part of this reinvigorated quality improvement movement, we have come to heed the lesson that transformation is a team effort with each team member bearing significant responsibility. Nurses, as the largest group of healthcare service providers in the nation, are vital members of this team. The IOM report Keeping Patients Safe: Transforming the Work Environment of Nurses3 made it explicit that nurses are the healthcare service professionals most likely to intercept errors and prevent harm to patients. Nurses’ significant role in pro-
Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Jo... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Journal of Nursing Care Quality. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information ...
The US Department of Health and Human Services has been collecting, analyzing, and disseminating ... more The US Department of Health and Human Services has been collecting, analyzing, and disseminating population-based healthcare data and information for more than 40 years.1–3 While the Centers for Medicare & Medicaid Services primarily uses claims-based data, the Center for Disease Control and Prevention’s National Center for Health Statistics has used national healthcare surveys. The annual Medical Expenditure Panel Survey (MEPS) is one of the national healthcare surveys for the US civilian noninstitutionalized population. Conducted by the Agency for Healthcare Research and Quality (AHRQ), in partnership with the National Center for Health Statistics, the MEPS is a national probability survey of health, providing in-depth data and information for estimates on healthcare use, expenditures, sources of payment, and insurance coverage for a representative sample of the general US population. Collected from a sub-
Background Surgery is one area of health care in which preventable medical errors and near misses... more Background Surgery is one area of health care in which preventable medical errors and near misses can occur. However, until the 1999 Institute of Medicine report, To Err Is Human, 1 clinicians were unaware of the number of surgery-associated injuries, deaths, and near misses because there was no process for recognizing, reporting, and tracking these events. 2 Of great concern is wrong-site surgery (WSS), which encompasses surgery performed on the wrong side or site of the body, wrong surgical procedure performed, and surgery performed on the wrong patient. 3 This definition also includes "any invasive procedure that exposes patients to more than minimal risk, including procedures performed in settings other than the OR [operating room], such as a special procedures unit, an endoscopy unit, and an interventional radiology suite" 4 (p. 11). WSS is also defined as a sentinel event (i.e., an unexpected occurrence involving death or serious physical or psychological injures, or the risk thereof) by the Joint Commission (formerly called the Joint Commission on Accreditation of Healthcare Organizations), which found WSSs to be the thirdhighest-ranking event. 5 Causes and Consequences of Wrong-Site Surgery WSS can be a devastating experience for the patient and have a negative impact on the surgical team. 6, 7 State licensure boards are imposing penalties on surgeons for WSS, 8 and some insurers have decided to no longer pay providers for WSS or wrong-person surgery, nor for leaving a foreign object in a patient's body after surgery. 9 Surgery performed on the wrong site or wrong person has also often been held compensable under malpractice claims. Indeed, 79 percent of wrong-site eye surgery and 84 percent of wrong-site orthopedic claims resulted in malpractice awards. 10, 11 WSSs are rare events, but we are learning more about their prevalence. Because reporting of sentinel events to the Joint Commission is voluntary, it could be that only 10 percent of actual WSSs are reported. 12 Researchers have confirmed that the Joint Commission's numbers are low, finding wide variations in the number of WSSs: 1 out of 27,686 cases, 6 or 1 out of every 112,994 surgeries, 13 or 1 in 5 hand surgeons during their career, 7 or 1 out of 4 orthopedic surgeons with 25 years' experience. 14 Regardless of the exact number of WSSs, they are seen as a preventable medical error if certain steps are taken and standardized procedures are implemented in the perioperative setting. 15, 16 The incidence of reported WSS has increased in recent years. From the inception of the Joint Commission's Sentinel Event program, the number of WSSs reported has increased from 15 cases in 1998, to a total of 592 cases reported by June 30, 2007. 17 Of these, WSSs most commonly occur in orthopedic or podiatric procedures, 5 general surgery, and urological and neurosurgical procedures.
Complexity and chaos inherent in health care initiate opportunities for errors and make it diffic... more Complexity and chaos inherent in health care initiate opportunities for errors and make it difficult to improve patient safety. Effectively improving patient safety requires embracing the complex health care environment, care processes, and patients.
The insights and expertise that nursing can afford is all too often missing from health services ... more The insights and expertise that nursing can afford is all too often missing from health services research that influences policy and change. Health services research analyzes systems and processes of care and their impact on utilization, cost, and quality of care. In the Federal Government, there are three primary funders of health services research: the National Institutes of Health, the Agency for Healthcare Research and Quality (AHRQ), and the Veterans Administration. Clear and methodologically sound grant applications are key to being successful in receiving federal research grants. For purposes of this article, the primary perspective will be that from the AHRQ, but steps to take before submitting grant application can be applied to other funders as well. There are several considerations that should be taken into account before any application is submitted. When developing grant applications, it is important to consider the following points ALIGN WITH FUNDERS' INTERESTS
ven on the best days, health care is a stressful endeavor-and many days are not ideal. Decisions ... more ven on the best days, health care is a stressful endeavor-and many days are not ideal. Decisions need to be made quickly, often without the benefit of a full slate of data or evidence to inform them. The unexpected is the rule. Resources are stretched and tempers flare. The health care enterprise depends on communication and teamwork, and under difficult circumstances, these can, and often do, break down. Nurses are central to the successful provision of health care, both when the process flows smoothly and when it does not. As the largest group of health care providers in the nation, nurses are vital and pivotal members of the health care team. The Institute of Medicine's report Keeping Patients Safe: Trans forming the Work Environment of Nurses 1 makes it clear that nurses are an indispensable part of a quality health care system and that the system's success depends on their active participation. When the system reaches a breaking point, however, nurses are among the victims. The stressful health care environment has led many nurses to seek jobs that do not involve direct patient care or even to leave the profession altogether, 2-4 exacerbating an already severe nursing shortage and further endangering the quality and safety of patient care. Given this, it is important to analyze factors that place undue strain on nurses in the work environment. The Agency for Healthcare Research and Quality (AHRQ), with support from the Robert Wood Johnson Foundation, recently published a handbook for nurses that will assist in this analysis. Patient Safety and Quality: An Evidence-Based Handbook for Nurses 5 identifies several of these nurse stressors, with the goal of examining them and setting forth the evidence that can help relieve the stress on nurses that is burdening our system.
This chapter examines reporting of health care errors (e.g., verbal, written, or other form of co... more This chapter examines reporting of health care errors (e.g., verbal, written, or other form of communication and/or recording of near miss and patient safety events that generally involves some form of reporting system) and these events’ disclosure (e.g., communication of errors to patients and their families), including the ethical aspects of error-reporting mechanisms. The potential benefits of intrainstitutional and Web-based databases might assist nurses and other providers to prevent similar hazards and improve patient safety. Clinicians’ fears of lawsuits and their self-perceptions of incompetence could be dispelled by organizational cultures emphasizing safety rather than blame. This chapter focuses on the assertion that reporting errors that result in patient harm as well as seemingly trivial errors and near misses has the potential to strengthen processes of care and improve the quality of care afforded patients.
... What Was Learned From Evaluating the Impact of Change Interventions? ... quality care using a... more ... What Was Learned From Evaluating the Impact of Change Interventions? ... quality care using alerts and reminders; (4) improve medication safety (eg, implementing bar coding and computerized ... it was not reported or not collected, made statistical analysis of the impact of the ...
Background and Purpose: The purpose of the study was to evaluate the reliability and construct va... more Background and Purpose: The purpose of the study was to evaluate the reliability and construct validity of the Complexity Compression Questionnaire (CCQ), a 28-item instrument designed to explain nurses’ experiences when assuming multiple responsibilities in a compressed time frame. Methods: Data were obtained from 607 registered nurses in an academic medical center in the midwestern United States who participated in a larger study on system-wide organizational change involving upgrading electronic health records. Results: Cronbach’s alpha for the 26-item CCQ, was .91. Exploratory factor analysis supported a 5-factor solution that explained 53.6% of the variance. Conclusions: The CCQ may be a useful tool for measurement of the effects of organizational change on the complexity of the work of nurses.
This chapter examines reporting of health care errors (e.g., verbal, written, or other form of co... more This chapter examines reporting of health care errors (e.g., verbal, written, or other form of communication and/or recording of near miss and patient safety events that generally involves some form of reporting system) and these events' disclosure (e.g., communication of errors to patients and their families), including the ethical aspects of error-reporting mechanisms. The potential benefits of intrainstitutional and Web-based databases might assist nurses and other providers to prevent similar hazards and improve patient safety. Clinicians' fears of lawsuits and their self-perceptions of incompetence could be dispelled by organizational cultures emphasizing safety rather than blame. This chapter focuses on the assertion that reporting errors that result in patient harm as well as seemingly trivial errors and near misses has the potential to strengthen processes of care and improve the quality of care afforded patients. Error Reporting & Disclosure Ethical Implications of Reporting and Disclosure Health care providers are typically so devastated and embarrassed by their mistakes that they may attempt to conceal them or defend themselves by shifting the blame to someone or something else. 15 Some attribute failure of honestly acknowledging health care mistakes to providers' personal difficulty with admitting mistakes and incriminating other providers. 16-19 Ethical frameworks operate when health care mistakes are made. 20 Respect for patient autonomy is paramount, as is the importance of veracity. Fidelity, beneficence, and nonmaleficence are all principles that orient reporting and disclosure policies. Providers might benefit from accepting responsibility for errors, reporting and discussing errors with colleagues, and disclosing errors to patients and apologizing to them. 21 When providers tell the truth, practitioners and patients share trust. The fiduciary responsibility of institutions exists in patients' and families' trust that providers will take care of them. If providers cover up errors and mistakes, they do not necessarily stay hidden and often result in compromising the mission of health care organizations. Consistent with their mission, institutions have an ethical obligation to admit clinical mistakes. Professional and organizational policies and procedures, risk management, and performance improvement initiatives demand prompt reporting. When patients, families, and communities do not trust health care agencies, suspicion and adversarial relationships result. 18 Likewise, the breach of the principle of fidelity or truthfulness by deception damages provider-patient relationships. 22 Fidelity and trust, implicit to the provider-patient relationship, do not coexist with deception. 23 Physicians, nurses, and other health care providers have legal and ethical obligation to report risks, benefits, and alternative treatments through informed consent mandates. Legal self-interest and vulnerability after errors are committed must be tempered by the principle of fidelity (truthfulness and loyalty). 24-26 This ethical principle has been reinforced by practical lessons learned from errors; especially when an adverse event causes serious harm or even death, there is an ethical and moral obligation to disclose information. 27, 28 Candid reports and disclosure of errors by physicians as well as other health care providers (or institutional leadership if the physician refuses to disclose) 19 might result in greater patient trust and less litigation. 29 Furthermore, it is essential to act after errors are reported, with interventions aimed at protecting the welfare of patients by targeting iatrogenic problems and documenting the care given. Additionally, the ethical principles of beneficence (doing good) and nonmaleficence (preventing harm) are violated when errors are not reported or disclosed. These ethical principles, beneficence and nonmaleficence, shape caring nursing practice, and caring presupposes that nurses act in the best interests of patients. For example, sharing information and preventing harm to patients through truth telling, regardless of good or bad news, build relationships between elder residents and nursing home staff. 30 Putting residents' interests first represents nurse caring and characterizes relationships in which sharing information, rather than hiding it, surrenders nurses' control related to withholding information. Thus, failure to disclose health care mistakes can be viewed from the perspective of provider control over the rights of patients or residents.
A national research agenda is needed to promote inquiry into the impact of credentialing on healt... more A national research agenda is needed to promote inquiry into the impact of credentialing on health care outcomes for nurses, patients, and organizations. Credentialing is used here to refer to individual credentialing, such as certification for nurses, and organizational credentialing, such as American Nurses Credentialing Center Magnet recognition for health care organizations or accreditation of providers of continuing education in nursing. Although it is hypothesized that credentialing leads to a higher quality of care, more uniform practice, and better patient outcomes, the research evidence to validate these views is limited. This article proposes a conceptual model in which both credentials and standards are posited to affect outcomes in health care. Potential research questions as well as issues in research design, measurement, data collection, and analysis are discussed. Credentialing in nursing has implications for the health care professions and national policy. A growing body of independent research that clarifies the relationship of credentialing in nursing to outcomes can make important contributions to the improvement of health care quality.
As background for a National Institutes of Health State of the Science Conference on Endof-Life-C... more As background for a National Institutes of Health State of the Science Conference on Endof-Life-Care, we performed a systematic review of end-of-life care and outcomes. The systematic review was intended to evaluate the evidence in the field from the perspective of concerns important to patients, caregivers, and the health care system. This article relates the challenges in performing a systematic review of end-of-life care and outcomes, and describes the methods that we used to define the scope, search the literature, develop exclusion and inclusion criteria, incorporate various types of articles, and synthesize the results. Major challenges to conducting a review included the need to define "end of life," clarify a conceptual framework of outcomes including definitions of terms and the relationships among terms, and determine specific goals for the review. The review identified 24,423 total citations, of which 911 comprised the final set used for the evidence report. This very large, diverse body of literature reflects the tremendous growth of the field of end-of-life care over the last decade. S-4 INTRODUCTION: THE TASK AND QUESTIONS FOR A SYSTEMATIC REVIEW OF END-OF-LIFE CARE T HE DEMOGRAPHIC CHALLENGE of the rapidly aging Baby Boomer generation will soon challenge the quality, affordability, and accessibility of the American health care system. Several recent reviews have addressed the literature in part, but focused on one portion of the literature (e.g., cancer or particular interventions) or relied heavily on expert opinion. A major recommendation of the 2001 report of the Institute of Medicine Improving Palliative Care for Cancer 1 was to convene a National Institutes of Health State of the Science Conference on this topic.
THE MOMENTUM that started with 2 Institute of Medicine (IOM) reports, To Err Is Human: Building a... more THE MOMENTUM that started with 2 Institute of Medicine (IOM) reports, To Err Is Human: Building a Safer Health System1 and Crossing the Quality Chasm: A New Health System for the 21st Century,2 persists. Eight years later, patient safety and quality improvement are, together, fundamental American healthcare policy concerns. While the quality of care in the United States remains substandard in many pivotal areas, there is no doubt that the nation’s healthcare service stakeholders are united in their desire to reshape the system and are working hard to achieve this. As part of this reinvigorated quality improvement movement, we have come to heed the lesson that transformation is a team effort with each team member bearing significant responsibility. Nurses, as the largest group of healthcare service providers in the nation, are vital members of this team. The IOM report Keeping Patients Safe: Transforming the Work Environment of Nurses3 made it explicit that nurses are the healthcare service professionals most likely to intercept errors and prevent harm to patients. Nurses’ significant role in pro-
Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Jo... more Advertisement. Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Journal of Nursing Care Quality. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information ...
The US Department of Health and Human Services has been collecting, analyzing, and disseminating ... more The US Department of Health and Human Services has been collecting, analyzing, and disseminating population-based healthcare data and information for more than 40 years.1–3 While the Centers for Medicare & Medicaid Services primarily uses claims-based data, the Center for Disease Control and Prevention’s National Center for Health Statistics has used national healthcare surveys. The annual Medical Expenditure Panel Survey (MEPS) is one of the national healthcare surveys for the US civilian noninstitutionalized population. Conducted by the Agency for Healthcare Research and Quality (AHRQ), in partnership with the National Center for Health Statistics, the MEPS is a national probability survey of health, providing in-depth data and information for estimates on healthcare use, expenditures, sources of payment, and insurance coverage for a representative sample of the general US population. Collected from a sub-
Background Surgery is one area of health care in which preventable medical errors and near misses... more Background Surgery is one area of health care in which preventable medical errors and near misses can occur. However, until the 1999 Institute of Medicine report, To Err Is Human, 1 clinicians were unaware of the number of surgery-associated injuries, deaths, and near misses because there was no process for recognizing, reporting, and tracking these events. 2 Of great concern is wrong-site surgery (WSS), which encompasses surgery performed on the wrong side or site of the body, wrong surgical procedure performed, and surgery performed on the wrong patient. 3 This definition also includes "any invasive procedure that exposes patients to more than minimal risk, including procedures performed in settings other than the OR [operating room], such as a special procedures unit, an endoscopy unit, and an interventional radiology suite" 4 (p. 11). WSS is also defined as a sentinel event (i.e., an unexpected occurrence involving death or serious physical or psychological injures, or the risk thereof) by the Joint Commission (formerly called the Joint Commission on Accreditation of Healthcare Organizations), which found WSSs to be the thirdhighest-ranking event. 5 Causes and Consequences of Wrong-Site Surgery WSS can be a devastating experience for the patient and have a negative impact on the surgical team. 6, 7 State licensure boards are imposing penalties on surgeons for WSS, 8 and some insurers have decided to no longer pay providers for WSS or wrong-person surgery, nor for leaving a foreign object in a patient's body after surgery. 9 Surgery performed on the wrong site or wrong person has also often been held compensable under malpractice claims. Indeed, 79 percent of wrong-site eye surgery and 84 percent of wrong-site orthopedic claims resulted in malpractice awards. 10, 11 WSSs are rare events, but we are learning more about their prevalence. Because reporting of sentinel events to the Joint Commission is voluntary, it could be that only 10 percent of actual WSSs are reported. 12 Researchers have confirmed that the Joint Commission's numbers are low, finding wide variations in the number of WSSs: 1 out of 27,686 cases, 6 or 1 out of every 112,994 surgeries, 13 or 1 in 5 hand surgeons during their career, 7 or 1 out of 4 orthopedic surgeons with 25 years' experience. 14 Regardless of the exact number of WSSs, they are seen as a preventable medical error if certain steps are taken and standardized procedures are implemented in the perioperative setting. 15, 16 The incidence of reported WSS has increased in recent years. From the inception of the Joint Commission's Sentinel Event program, the number of WSSs reported has increased from 15 cases in 1998, to a total of 592 cases reported by June 30, 2007. 17 Of these, WSSs most commonly occur in orthopedic or podiatric procedures, 5 general surgery, and urological and neurosurgical procedures.
Complexity and chaos inherent in health care initiate opportunities for errors and make it diffic... more Complexity and chaos inherent in health care initiate opportunities for errors and make it difficult to improve patient safety. Effectively improving patient safety requires embracing the complex health care environment, care processes, and patients.
The insights and expertise that nursing can afford is all too often missing from health services ... more The insights and expertise that nursing can afford is all too often missing from health services research that influences policy and change. Health services research analyzes systems and processes of care and their impact on utilization, cost, and quality of care. In the Federal Government, there are three primary funders of health services research: the National Institutes of Health, the Agency for Healthcare Research and Quality (AHRQ), and the Veterans Administration. Clear and methodologically sound grant applications are key to being successful in receiving federal research grants. For purposes of this article, the primary perspective will be that from the AHRQ, but steps to take before submitting grant application can be applied to other funders as well. There are several considerations that should be taken into account before any application is submitted. When developing grant applications, it is important to consider the following points ALIGN WITH FUNDERS' INTERESTS
ven on the best days, health care is a stressful endeavor-and many days are not ideal. Decisions ... more ven on the best days, health care is a stressful endeavor-and many days are not ideal. Decisions need to be made quickly, often without the benefit of a full slate of data or evidence to inform them. The unexpected is the rule. Resources are stretched and tempers flare. The health care enterprise depends on communication and teamwork, and under difficult circumstances, these can, and often do, break down. Nurses are central to the successful provision of health care, both when the process flows smoothly and when it does not. As the largest group of health care providers in the nation, nurses are vital and pivotal members of the health care team. The Institute of Medicine's report Keeping Patients Safe: Trans forming the Work Environment of Nurses 1 makes it clear that nurses are an indispensable part of a quality health care system and that the system's success depends on their active participation. When the system reaches a breaking point, however, nurses are among the victims. The stressful health care environment has led many nurses to seek jobs that do not involve direct patient care or even to leave the profession altogether, 2-4 exacerbating an already severe nursing shortage and further endangering the quality and safety of patient care. Given this, it is important to analyze factors that place undue strain on nurses in the work environment. The Agency for Healthcare Research and Quality (AHRQ), with support from the Robert Wood Johnson Foundation, recently published a handbook for nurses that will assist in this analysis. Patient Safety and Quality: An Evidence-Based Handbook for Nurses 5 identifies several of these nurse stressors, with the goal of examining them and setting forth the evidence that can help relieve the stress on nurses that is burdening our system.
This chapter examines reporting of health care errors (e.g., verbal, written, or other form of co... more This chapter examines reporting of health care errors (e.g., verbal, written, or other form of communication and/or recording of near miss and patient safety events that generally involves some form of reporting system) and these events’ disclosure (e.g., communication of errors to patients and their families), including the ethical aspects of error-reporting mechanisms. The potential benefits of intrainstitutional and Web-based databases might assist nurses and other providers to prevent similar hazards and improve patient safety. Clinicians’ fears of lawsuits and their self-perceptions of incompetence could be dispelled by organizational cultures emphasizing safety rather than blame. This chapter focuses on the assertion that reporting errors that result in patient harm as well as seemingly trivial errors and near misses has the potential to strengthen processes of care and improve the quality of care afforded patients.
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Papers by Ronda Hughes