Placing patient safety in the hands of nurses at the bedside involves an element of trust: care is not simply about addressing a patient's physical needs, but also about providing psychological support as part of holistic recovery. Empowered nurses at the bedside motivate not only themselves, but also their colleagues to bring about positive patient outcomes and promote an effective work environment. When the right environment is fostered, nurses are highly capable clinicians, whose excellence is recognised.
Over the past two decades, there has been a paradigm shift in the approaches to error prevention culture building. The common question asked in health care is: ‘what went wrong?’ In my role as a senior nurse, I have moved the focus from what went wrong to what went right: my perspective has shifted to identifying the best nurses and giving them a higher profile.
How do such nurses stand out? Some years ago, one surgeon told me that, during a difficult operation, he was amazed when his nurse passed him a C clamp, which helped him identify the vessel and ligate. Without the nurse's timely action, the patient would have bled profusely. The nurse's presence of mind meant she did a great job and deserved the accolade of best nurse on the surgeon's team.
The World Health Organization's (2017) third global patient safety challenge, Medication Without Harm, focuses on four areas: the health professional; medicines; systems and practices of medication; and patients and the public. It prioritises patient safety and emphasises a strategic approach to building a positive error prevention culture, which focuses on appreciating who identified an error or potential error. When we introduced such an approach across IHH Global Hospitals, which we have termed a ‘best catch’ strategy, it increased the identification and prevention of near misses across the group.
To empower nurses to implement our ‘best catch’ strategy we implemented a predictive, prescriptive and proactive role model. The nursing model we adopted is based on a nursing philosophy centred on professionalism, expertise and advocacy: it envisages registered nurses (RNs) performing their role with integrity, passion and insightfulness, while delivering consistent care and reflecting on daily activities. Our RNs advocate for patients and uphold our nursing philosophy when delivering routine care, thereby enhancing patient outcomes. Nurses are truly the first and final line of defence in health care.
It is important to highlight the silent ‘catches’ made by nurses. Identification of these leads to better outcomes, contributing both, directly, to the bottom line and, indirectly, to the top line in a hospital. ‘Best catches’ save patient lives, aid speedy recovery and reduce length of hospital stay.
To highlight an example from my organisation: a medication management nurse identified during an assessment that a patient with penicillin allergy had been prescribed a penicillin derivative. Her timely identification prevented the patient having an anaphylactic reaction. Another example was that of an infection control nurse who, during regular rounds, identified 13 patients as having a bloodstream infection, which was identified as Ralstonia mannitolilytica. A root-cause analysis identified that the sterile water was contaminated and the product was recalled. This vigilance and timely action by the infection control nurse prevented other patients contracting bloodstream infections. Sharing such stories of ‘best catches’ contributes to creating an error preventing and reporting culture within an organisation. It encourages nurses to become self-motivated and increases their ‘curiosity quotient’, namely their ability to adopt new ways of learning to prevent errors by the bedside, as well as their potential for being creative in providing safer care.
‘Best catches’ should be nurtured with culture-building exercises that support nursing empowerment and governance. When delivering care, nurses must have a sound rationale for their actions and should be able to explain why they are doing something. In clinical practice, the question ‘why?’ is powerful. Giving nurses the confidence to ask ‘why?’ enhances their critical thinking skills, supporting them to think out of the box and to be vigilant. Let us empower nurses and encourage them to feel confident in calling out ‘best catches’. This will help to develop them into future leaders and contribute to assuring safer care and trust in health care systems. BJN