Search results for "Hospitals"

This tip sheet provides 10 practical steps hospitals can undertake to improve patient safety, based on research funded by the Agency for Healthcare Research and Quality. The tips can be grouped into three areas: 1) reducing health care-acquired infections and retained surgical instruments through use of specific clinical practices; 2) improving drug safety by ensuring access to accurate drug information; and 3) improving the culture of safety through appropriate staffing and work hours for nurses and residents. These tips are based on high-quality research studies documenting the effectiveness of these interventions at reducing errors and improving safety for a broad range of patients.

The investigators surveyed Canadian nurses to explore the relationship between ineffective working conditions and patient safety. Their findings suggest a correlation between a supportive working environment and high-quality, safe care.

This study found that perinatal complications of childbirth, including low Apgar scores, neonatal seizures, and postpartum hemorrhage, were more prevalent during the weekend, echoing the weekend effect in other health settings. Higher patient volume was also associated with worse outcomes, consistent with prior studies of nurse staffing ratios. These results argue for staffing changes to ensure safety at busy times and outside usual business hours.

Higher patient-to-nurse staffing ratios have been linked to worse patient outcomes. In this 8-year observational cohort study in a single intensive care unit, increased patient-to-nurse staffing ratios and arrival of inexperienced resident physicians were associated with higher rates of adverse events including unexpected cardiac arrest, unanticipated extubation, and readmission.

Missed nursing care may explain part of the link between nurse staffing and patient outcomes. In this study, researchers interviewed 729 inpatients from 2 hospitals to measure missed nursing care and found that nurse staffing hours and skill mix were associated with timeliness of nursing care.

Nurses' work-related fatigue has the potential to contribute to medication errors and missed nursing care. This position statement provides recommendations for neonatal nurses and their employers to reduce risks related to long work shifts.

Nurse fatigue has been associated with diminished decision-making skills that can contribute to patient harm. This online training program for clinicians and administrators will explore hazards related to nurse fatigue and provide strategies to address behaviors and systems that increase these risks.

Certified registered nurse anesthetists (CRNAs) do not have formal restrictions on their work hours. This survey found that more than half of CRNAs worked extended duration (greater than 16 hour) shifts, and nearly one-third reported committing a medical error due to fatigue.

This commentary describes the development and implementation of a process designed to enhance safety culture in a perioperative services department. The effort employed incident reporting and adverse event review and improved staff comfort with speaking up about potential safety hazards.

Missed injuries and delayed diagnoses are a relatively common problem in trauma care. This study describes a 150% increase in the number of documented missed injuries that were caught following the introduction of acute care nurse practitioners on a pediatric trauma service. The authors attribute the uptick in identified missed injuries to better charting and follow-up examinations.

This radio news segment reports on patient falls, including risk factors and prevention strategies.

Although 12-hour nursing shifts are common in the United States, this study found that only 15% of European nurses worked 12 hours or more. Similar to prior research, longer nursing shifts were associated with lower quality of care and compromised patient safety. This study also found that nurses working extended shifts reported more care left undone. Nurses who worked overtime, even if shift length was less than 10 hours, described similar concerns. The authors warn that policies to adopt standard 12-hour nursing shifts as a cost-effective way of maintaining nurse–patient ratios may contribute to burnout. A past AHRQ WebM&M interview with Barbara Blakeney discussed the importance of proper nursing staffing for patient safety, and a prior AHRQ WebM&M commentary examines the complexities around balancing nurse staffing and workload.

Clinician fatigue can contribute to poor decision-making and clinical performance. This review explores the prevalence of nurse fatigue and describes work-related factors that influence fatigue among nurses. The authors suggest implementing institution-wide policies and educating nurses and administrators about risks related to fatigue to address the problem.

This direct observation study of nursing medication administration demonstrated that adherence to safe practices such as minimizing interruptions, checking two forms of patient identification, discussing medications with patients and their families, and prompt documentation led to fewer medication administration errors. Characteristics such as higher patient-to-nurse ratios and patient turnover were associated with decreased adherence to safe practices, emphasizing the crucial role of nursing workload in patient safety.

Many studies have pointed to a relationship between nurse staffing ratios and patient safety. This retrospective examination of hospital mortality across multiple sites in Germany found that at high hospital volume, mortality increased for six high-risk conditions drawn from AHRQ Quality Indicators—acute myocardial infarction, heart failure, gastrointestinal hemorrhage, hip replacement, pneumonia, and stroke. This study revealed a tipping point, an occupancy rate of approximately 93% capacity, at which hospital mortality increased. The authors theorize that at high occupancy rates, frontline clinical staff are overworked and thus error-prone, consistent with prior studies on patient-to-nurse ratios. They propose flexible staffing policies in order to improve patient safety. A previous AHRQ WebM&M commentary discusses nurse staffing ratios, including challenges related to costs and and best practices for managing staffing needs.

This retrospective cohort study across nine European countries revealed that higher patient–nurse staffing ratios increased the likelihood of inpatient mortality. A larger proportion of nurses with bachelor's degrees decreased this risk, consistent with previous research that found a relationship between nurse education levels and patient outcomes. This finding emphasizes the importance of maintaining an adequately staffed and trained nursing workforce to support safety in hospitals.

Higher patient-to-nurse ratios have consistently been associated with adverse effects on patient safety and inpatient mortality, but the mechanism driving this relationship remains unclear. Missed nursing care—a type of error of omission in which required care elements are not completed—is relatively common on inpatient wards. This study sought to investigate the relationship between nurse staffing, missed nursing care, and patient safety in England. Nurses frequently reported leaving care undone, and missed nursing care episodes were strongly associated with higher numbers of patients per nurse and lower safety culture ratings. The authors argue that the frequency of missed care episodes should be used to measure nursing quality and that improving the overall work environment for nurses should be a patient safety priority. A preventable death due in part to inadequate nurse staffing is discussed in an AHRQ WebM&M commentary, and the critical role nurses play in ensuring patient safety is explored in a Patient Safety Primer.

Higher nurse staffing levels appear to be associated with reduced inpatient mortality and adverse events, according to this AHRQ-funded systematic review published as part of a patient safety supplement in the Annals of Internal Medicine. However, implementation of this strategy is limited by the fact that no study yet has prospectively evaluated the effect of an intentional change in nurse–patient ratios.

Highlighting the importance of measuring and ensuring adequate staffing levels in hospitals, this commentary describes scenarios drawn from experiences of military nurses that demonstrate how limited staffing can affect nurses, and consequently, patient safety.

The critical role that nurses play in ensuring patient safety can be compromised by excess workload. A large body of literature has linked higher patient-to-nurse ratios to a variety of preventable complications and even increased inpatient mortality. However, it is not clear whether high nursing workload alone can impair patient safety, or if overall working conditions for nurses also plays a role in safety. This study, which examined the association between hospital-acquired infections, nurse staffing, and burnout among nurses found that the number of patients per nurse did not entirely predict safety problems. On the other hand, after controlling for hospital and patient characteristics, the investigators found that increased rates of burnout among nurses was significantly associated with a higher risk of hospital-acquired infections. The complex issue of nurse staffing and workload is discussed in this AHRQ WebM&M commentary.