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Approach to Improving Safety
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Search results for "Health Care Executives and Administrators"

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Journal Article > Commentary

AORN Position Statement on Patient Safety.

AORN J. 2017;105:501-502.

This position statement outlines recommendations from the Association of periOperative Registered Nurses on core components of safe perioperative nursing and its role in strengthening patient safety. Elements discussed include error reduction, patient engagement, and appropriate staffing levels.

Journal Article > Study

Use of personal electronic devices by nurse anesthetists and the effects on patient safety.

Snoots LR, Wands BA. AANA J. 2016;84:114-119.

Personal electronic devices such as smartphones are now ubiquitous, and many clinicians use them for both work and personal purposes. Although considered a necessity, these devices can serve as a distraction, which could compromise patient safety. This review found that many certified registered nurse anesthetists and anesthesiologists acknowledge using personal electronic devices in the operating room despite knowledge of the potential risks. Currently, no formal guidelines exist regarding what constitutes inappropriate use of such devices in the operating room. The authors call for further research in order to develop policies to balance the risks and benefits of personal electronic devices. A WebM&M commentary discusses a case where an interruption due to receiving a text message on a smartphone led to a serious medication error.

Journal Article > Study

Tune-in and time-out: toward surgeon-led prevention of "never" events.

Jones N. J Patient Saf. 2016 Jan 11; [Epub ahead of print].

This study surveyed surgical nurses at an Australian hospital regarding their perceptions of surgeon adherence to the World Health Organization surgical safety checklist. Though nurses felt surgeon-led time outs are valuable and lead to fewer adverse events, 94% of them reported experiencing hostility from surgeons, such as a "condescending, sarcastic attitude" related to the time out process.

Journal Article > Commentary

Speaking up to reduce noise in the OR.

Ford DA. AORN J. 2015;102:85-89.

Noise in health care settings can hinder communication and contribute to distractions. This commentary discusses noise in the operating room and reviews strategies for nurses to reduce its presence, including raising awareness of the problem, enhancing team communication, and designing alarm management initiatives.

Journal Article > Review

Concept analysis: wrong-site surgery.

Watson DS. AORN J. 2015;101:650-656.

Despite large-scale efforts to prevent wrong-site surgeries, they continue to occur. This concept analysis found limited evidence regarding the role of nurses in wrong-site surgery and recommends that future research focus on theoretical frameworks around how preoperative nurses can help avert these never events.

Journal Article > Study

Communication elements supporting patient safety in psychiatric inpatient care.

Kanerva A, Kivinen T, Lammintakanen J. J Psychiatr Ment Health Nurs. 2015;22:298-305.

In this study, researchers interviewed psychiatric nurses to explore how they conceptualize communication that contributes to patient safety in the inpatient psychiatric setting. A similar approach was used in an earlier study to identify how patients on such units viewed safety issues.

Special or Theme Issue

Special Focus Issue: Patient Safety.

Wagner VD, ed. AORN J. 2014;100:351-456.

Articles in this special issue explore strategies to establish a culture of safety in health care settings, including coaching to improve team briefing and debriefing discussions, a guideline to confirm safe perioperative on-call staffing, and the value of workforce safety to promote high reliability.

Journal Article > Commentary

10 years in, why time out still matters.

Guglielmi CL, Canacari EG, DuPree ES, et al. AORN J. 2014;99:783-794.

The Universal Protocol has been widely adopted in the decade since its release. Successful utilization of the protocol to prevent wrong-site surgery has been determined to extend beyond checklist use. This commentary features insights from a multidisciplinary panel on their experiences with time outs and why are still needed to ensure safety in surgery.

Journal Article > Study

The perceptions of nurses towards barriers to the safe administration of medicines in mental health settings.

Hemingway S, McCann T, Baxter H, Smith G, Burgess-Dawson R, Dewhirst K. Int J Nurs Pract. 2015;21:733-740.

Medication errors are common in mental health care. This survey of nurses and nursing students identified interruptions and insufficient medication knowledge as major barriers to ensuring medication safety in outpatient mental health.

Journal Article > Study

Barriers to the reporting of medication administration errors and near misses: an interview study of nurses at a psychiatric hospital.

Haw C, Stubbs J, Dickens GL. J Psychiatr Ment Health Nurs. 2014;21:797-805.

Researchers interviewed mental health nurses to determine perceived obstacles to reporting medication administration errors or near misses. Many factors were identified, including insufficient knowledge, fear of consequences, or burden of work associated with reporting. These have also been cited as reasons for under-reporting of errors in prior nursing studies.

Journal Article > Study

Workplace bullying in the OR: results of a descriptive study.

Chipps E, Stelmaschuk S, Albert NM, Bernhard L, Holloman C. AORN J. 2013;98:479-493.

Although this survey of perioperative nurses, technologists, and unlicensed staff in two academic medical centers found disruptive behavior to be common, staff did not perceive any impact on patient safety, contrary to evidence. An AHRQ WebM&M commentary discussed how a physician reacted negatively after a nurse spoke up about his unsafe practice.

Journal Article > Commentary

Measure twice, cut once.

Atkinson WK. AORN J. 2013;98:77-80.

This piece relates how focusing on quality, education, responsibility, and standardization can help clinicians ensure safe care.

Journal Article > Study

Strategies for preventing distractions and interruptions in the OR.

Clark GJ. AORN J. 2013;97:702-707.

Distractions can be dangerous for patient safety, particularly during critical processes. This study describes strategies to reduce or eliminate distractions for anesthesia clinicians during the administration of nerve blocks and for nurses during final surgical counts.

Journal Article > Commentary

Top 10 patient safety issues: what more can we do?

Steelman VM, Graling PR. AORN J. 2013;97:679-701.

This commentary reveals nurses' concerns about patient safety along with interventions to address them.

Journal Article > Study

Priority patient safety issues identified by perioperative nurses.

Steelman VM, Graling PR, Perkhounkova Y. AORN J. 2013;97:402-418.

Perioperative nurses identified wrong-site surgery and medication errors as the most pressing patient safety concerns in their area of practice.

Journal Article > Study

Using simulation training to improve perioperative patient safety.

Mullen L, Byrd D. AORN J. 2013;97:419-427.

This article describes a simulation training program for multidisciplinary surgical teams to practice emergency scenarios, including surgical drape fires, cardiac arrests, and malignant hyperthermia.

Journal Article > Commentary

Creating a culture of safety by using checklists.

Huang L, Kim R, Berry W. AORN J. 2013;97:365-368.

This commentary reveals how implementing perioperative checklists in conjunction with the Safe Surgery 2015 initiative can promote a culture of safety in surgical care.

Journal Article > Commentary

The perianesthesia nurse's role in the prevention of opioid-related sentinel events.

Pasero C. J Perianesth Nurs. 2013;28:31-37.

This commentary reviews strategies to prevent adverse events associated with opioid use and advocates for improved monitoring to reduce risks.

Journal Article > Study

Reducing interruptions to improve medication safety.

Freeman R, McKee S, Lee-Lehner B, Pesenecker J. J Nurs Care Qual. 2013;28:176-185.

A series of interventions was implemented in order to reduce interruptions during medication administration on a telemetry unit.

Journal Article > Study

Supporting a psychiatric hospital culture of safety.

Mahoney JS, Ellis TE, Garland G, Palyo N, Greene PK. J Am Psychiatr Nurses Assoc. 2012;18:299-306.

The TeamSTEPPS teamwork training program was successfully implemented at a psychiatric hospital, with resulting improvement in staff perceptions of teamwork.

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