Nurses have a significant impact on patient safety. This integrative review of clinical practice guidelines identified 6 themes representing nursing care strategies to manage risk and prevent harm – (1) detect risk or early change, (2) act early to prevent deterioration, (3) identify and treat underlying conditions, (4) grade escalation of care, (5) provide a safe care environment, and (6) engage patient and care partners. These findings highlight the complexity of nursing work and illustrate strategies that nurse leaders can integrate into local practice to improve safe care.

… making; and lack of provider training. … Manias E, Bucknall T, Hutchinson A, et al. Resident and family engagement in …

Interprofessional communication is critical to safe medication management during transitions of care. Researchers conducted this ethnographic study to explore inter- and intra-professional communications during older adults’ transitions of care. Communication was influenced by the transferring setting, receiving setting, and ‘real-time’ communication. Lack of, or poor, communication impacted medication safety; researchers recommend more proactive communication and involvement of the pharmacist.

Medication administration errors are common and account for a significant fraction of medication errors. This systematic review examined the effect of medication double-checks on medication administration errors. Investigators identified 13 studies (3 were considered high-quality) that demonstrated variable adherence to double-checking protocols. Only one high-quality study showed improvement in medication administration error rates when a double-check took place. No studies demonstrated differences in patient harm with double-checking compared to usual medication administration practice. The authors call for higher-quality studies to determine whether the time-intensive practice of double-checking medication administration confers a meaningful safety benefit. A previous WebM&M commentary discussed an incident involving a nurse who bypassed the double-check policy for verifying the order prior to administration, which led to a medication administration error.

… of elderly patients during care transitions. … Manias E, Bucknall T, Hughes C, Jorm C, Woodward-Kron R. Family …

Rapid response teams are well established in adult and pediatric hospitals. As part of efforts to increase patient engagement in safety efforts, some hospitals allow patients to summon the team directly. This qualitative study of patients and caregivers at two Australian hospitals identified significant barriers to family-activated rapid response teams. Principally, patients did not feel they had the knowledge to make a clinical decision regarding their care and expressed concern about overriding the clinical staff's decisions.

This qualitative study of hospitalized patients in Sweden found that patients expressed interest in engaging in their care. Themes included shared decision-making and increasing patient understanding of health conditions. Patients also expressed concern about the power dynamic between patients and providers and uncertainty about how to best participate in their own hospital care.

Efforts to improve the safety of handoffs have focused on standardizing the signout process. In this mixed methods study, researchers observed 185 anesthetist-to-nurse handoffs from the operating room to the postanesthesia care unit across 3 hospitals. They then conducted focus groups to better understand aspects of safe handoff practices. This work led to the development of a more standardized handoff structure.

In this study, conducted at seven hospitals in three countries, nearly one-third of patients seen by a rapid response team ultimately had limitations placed on their care (such as do-not-resuscitate orders). This finding indicates a need for improved advanced care planning.

This review found that nurses play a major role in developing processes and technologies for safe medication delivery.

Australian hospitals are using a wide variety of measurement tools to evaluate patient safety, including both process measurement and quantitative measurement methods.