Sunday, November 22, 2015

Reflective Journal Week 13: Maintaining a Culture of Safety Overview


1) I expected to learn ways to maintain a culture of safe practicing nurses for patients.

2) I learned that the best doctor or nurse can make a tiny error that leads to really big consequences for patients. Thus, it is imperative for nurses (and all healthcare professionals) to learn to practice safely, lead by example, and help unify others in maintaining a culture of safety. This can lead to the best and safest results for patients. From the case studies we read, I think I most learned to always question a patient’s situation and think deeper into WHY they are experiencing the symptoms they are. I also learned to educate my patients thoroughly about doctor’s orders, interventions I am performing, and why they are needed. If the patient or family members feel they don’t agree with the care plan, they have every right to disagree. We must remember they are partners in the care plan and a consensus can be reached that is most safe for the patient.

Lastly, I learned from a Quality and Safety in Nursing youtube clip(Vital Smarts India, 2012) that policy is only effective if nurses are willing to follow it. This statement is so true. Rules, policies, and guidelines are in place for patient safety. They were likely created and implemented because of a patient harm that occurred (or by risk management teams foreseeing risks and designing processes to prevent them from occurring). If nurses don’t abide by the rules, then what is the point of having them? No safe care will be rendered to patients. The same mistakes, medication errors, patient harms, and accidental deaths will keep occurring. This unit lesson really taught me the importance of having integrity as a nurse. What I am taught and trained to do, which is best practice for the patient, is what I will always do

3) The team discussion was interesting to me. I felt stopping the IV, continually monitoring the patient for a change in status, and then calling a Rapid Response may have been the most efficient and safe solution to the patient’s situation. Others in my group felt discussing the issue with the charge nurse would be a good idea. Another felt like the hospitalist should come assess the patient. I think calling the Rapid Response team would bring more sets of eyes and hands to come in and assess the patient. They are trained professionals that can have an open dialogue about the patient and their situation—while getting the doctor back on the phone with more specific orders for the patient (i.e. changing antibiotic, dose of IV Benadryl or subcutaneous epinephrine, or a steroid). I feel like just talking to the charge nurse doesn’t really solve any problems. Things actually need to be communicated and implemented as a team to ensure the patient’s safety.

4) This unit lesson really taught me the importance of having integrity as a nurse. I plan to look up evidence-based practice guidelines on online sites such as Up-to-Date and National Guidelines Clearinghouse (www.guideline.gov) whenever I am in doubt about a patient and their situation. This information can guide me to make safe decisions for the patient and open up dialogue with the practitioner to discuss safer options for the patient. This way I will be advocating for the patient. I will also show through my example I support and am implementing a culture of patient safety.  

5) The Case Study about a four-year-old, Noah Lord, who died from post-surgical hemorrhage, possible infection, and dehydration really scared me. It showed me that poor communication among healthcare professionals and the patient/family members can result in patient death. This experience has instilled a desire in me to make all of my actions meaningful as an emergency room nurse. Patients should not be discharged until they feel safe to go home. The right physicians and specialists should be attending to patients. Admitting a patient for observation is always a possibility to ensure their safety.  

Reference


Vital Smarts India (2012). The silent treatment: Patient safety. Retrieved online from https://www.youtube.com/watch?v=ly0wW95Or7I&list=PLUuOgSK-0gzFg1N0A4o_ZbKvzcCXEFyR-&index=3

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