Make these changes to improve safety

Give staff a variety of ways to report errors

Would you like to improve retention and satisfaction of nursing staff and make patients safer at the same time? The two goals are intrinsically linked, according to Diana Berkland, MS, RN, vice president of clinical administrative services and chief nurse executive at Sioux Valley Hospital USD Medical Center in Sioux Falls, SD.

Here are key factors that led to the organization’s recent designation as a Magnet facility by the American Nurses Credentialing Center’s Magnet Recognition Program For Excellence in Nursing Service:

There is a nonpunitive culture for medication error reporting.

"We encourage people to report both errors and near misses," Berkland says. "With a punitive environment, people tend to underreport."

Absolutely no punitive action is taken anytime a medication error report is submitted, stresses Geni Chariker, MS, MBA, director of strategic improvement. "We ask that the individual talk to us about how they might have prevented the error, but it is never part of somebody’s evaluation." Here are some ways staff are encouraged to report errors:

  • A "good catches" program rewards nurses who report errors.

    "We make a real big deal when staff catch an error," Chariker says.

    Quality managers find out the shift the nurse is working and personally present a giant cookie with a baseball mitt in the middle of it. Colleagues are gathered, and the nurse is encouraged to tell the story of the caught error, Berkland notes. "I believe that there is a lot of power in hearing stories, as opposed to just listening to another rule or regulation."

  • Staff are given a variety of ways to report.

    An anonymous hotline is provided, but many individuals still choose to report via a paper reporting system. "People do what they are most comfortable with, and we’ve had paper for years," she says. "We are working on a process where staff can report on-line."

  • Medication error reports are tracked on a monthly basis and classified by type of error.

    "Those are then tracked and trended," adds Berkland. "Based on what we see, we make interventions."

    Most of the interventions involve systems as opposed to individual staff members, Chariker says. "For example, we just changed our insulin to one concentration, because we feel that errors are caused by confusion in concentrations, not individual negligence."

Nursing staff are asked for input.

Here are some ways this is accomplished:

  • Include frontline nursing staff on the failure mode and effect analysis team.

    "The goal is to find holes in your process and change your process, not expect people to be superhuman in their ability to prevent error," Chariker says.

  • Make rounds.

    "The visibility of nurse and quality leaders is important," Berkland adds. "I am there to listen and learn, and find out from our staff what they need to deliver safe patient care. I also make a special attempt to go to a unit that has reason for celebration. This reinforces our culture of recognition."

  • Ask staff how to fix a problem.

    "I make the assumption there is a problem with our process, we designed it wrong, and find out how we can do the right thing," Chariker says. When one unit identified a problem with patients not having an identification armband, the staff decided to do two things: Stock armbands in the patient room so one is immediately available when a replacement is needed, and add an armband to the admission paperwork package. "Because the armband flops around on the paperwork packet and annoys you, you promptly get it on the patient!" she notes. "We have not had a missing armband in that unit since the group made these changes in their own process. They have sustained this improvement for about six months."

  • Share data with nursing staff.

    A Nursing Dashboard is shared with nursing units on a monthly basis, with data on nosocomial infections, medication errors, restraint use, falls, and staff injury. The dashboard data are shared with the nursing performance improvement council, which consists of bedside nursing staff, and is posted in the units. "It’s not enough just to post it, though," Berkland notes. "If you notice a positive trend, you need to celebrate, and if you notice a negative trend, you need to see what you can do to make a difference."

    The dashboard is color-coded so nurses will notice problem areas at a glance, Chariker says. "If you are in the green, you are at or above benchmark; if you’re in the red, you better do something quick. It is immediately diagnostic of how serious the situation is."

[For more information, contact:

  • Diana Berkland, MS, RN, Vice President, Clinical Administrative Services, Chief Nurse Executive, Sioux Valley Hospital, USD Medical Center, 1305 W. 18th St., P.O. Box 5039, Sioux Falls, SD 57117-5039. Phone: (605) 333-3252. E-mail:
  • Geni Chariker, MS, MBA, Director of Strategic Improvement, Sioux Valley Hospital USD Medical Center, 1305 W. 18th St., P.O. Box 5039, Sioux Falls, SD 57117-5039. Phone: (605) 333-6595. E-mail:]