ENA study cites barriers to NPSG compliance
ENA study cites barriers to NPSG compliance
Culture must change to engender safer processes
While the response rate (4.6%) was small, the message delivered in the results of a survey by the Emergency Nurses' Association (ENA) was huge: Significant barriers still remain to compliance with National Patient Safety Goals (NSPGs) in the ED.
The survey, which went out to 28,000 ENA members and 2,800 ED managers, was based on replies from 2,200 ED nurses and 129 ED managers, The results were published in the January 2009 issue of The Joint Commission Journal on Quality and Patient Safety.1
In the case of many of the NPSGs, respondents indicated that while policies were in place that reflected the goals, compliance still was being hindered. For example, while 85.7% of the EDs had universal timeout policies, only 23.2% reported no barriers to implementation. Regarding having at least two patient identifiers, while 96.9% of the EDs had a policy in place, only 46.3% reported no barriers to implementation. In some cases, even policies were lacking. For example, only 33.8% of EDs said they had a readily available and visible list of "Do Not Use" standard abbreviations, acronyms, and symbols.
While conceding that the current working environment in the ED — overcrowding, insufficient treatment space, boarding, longer wait times, and patients leaving without being seen — mitigates against compliance, the authors say there are steps ED managers can take to address barriers to implementation. "The first thing an ED manager has to do is look at where they stand on these findings. Some folks do not have as many barriers as others," notes Susan Paparella, RN, MSN, one of the paper's authors and vice president of the Institute of Safe Medication Practices in Horsham, PA. Send the right message and set a culture of shared responsibility for safety, she says. "Safety is not a project, but should be a thread running through all the things we do."
Debby Rogers, RN, MS, vice president of quality and emergency services for the California Hospital Association in Sacramento, agrees. "What I was struck by in reading about barriers is the culture," Rogers says. "For example, while most hospitals used two unique patient identifiers, 19.5% of the nurses said the bracelet was not always available [when meds were ordered], and yet they probably gave the meds anyway."
Changing the culture in the ED could be one possible solution, she suggests. "What if it becomes the culture of the ED that meds are never given without a bracelet?" Rogers poses. "Then that becomes the acceptable practice." Culture change drives the change in practice, she says. "You might look at the list of National Patient Safety Goals and assess the culture in ED around these areas," Rogers suggests.
To address culture change, the California Hospital Association is developing a California Hospital Patient Safety Organization. "The Association for Healthcare Research and Quality has a culture survey that hospitals can give every member of their staff," Rogers points out. "We have automated it, and we will try and get all the hospitals that want to, to use the survey."
The timing couldn't be better to revisit your compliance with National Patient Safety Goals: No new goals will be added this year, according to The Joint Commission.
Reference
- Juarez A, Gacki-Smith J, Bauer MR, et al. Barriers to emergency department's adherence to four medication safety-related Joint Commission National Patient Safety Goals. Jt Comm J Qual Pat Saf 2009; 11:49-59.
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