RSSArchive for December, 2012

High rate of “never events” in surgery points to need for quality improvement

At least 4,000 “never events” occur in the U.S. each year, according to findings published recently in the journal Surgery. A “never event” is an event that should never occur in surgery, such as leaving a foreign object inside a patient or performing the wrong surgery.

Researchers from Johns Hopkins University School of Medicine found that U.S. surgeons perform the wrong procedures 20 times a week and perform wrong-site surgery 20 times a week; foreign objects are left inside the surgical patient’s body nearly 40 times per week. Approximately 80,000 “never events” occurred between 1990 and 2010, resulting in 9,744 paid malpractice judgments totaling $1.3 billion.

The study calls for improved procedures to avoid “never events,” such as using permanent ink to mark the surgical site, mandating time-outs in the operating room, and using electronic bar codes to track surgical instruments. Nurses often assist with or perform these procedures, and should be involved with improvement initiatives regarding never events, as should the entire surgical team.

What types of procedures does your organization have in place to reduce the number of “never events”?

To err is human, but what can be forgiven?

Just one week after the news that nurses have once again been ranked as the most ethical and honest profession in the United States, a story has emerged in New Hampshire that has issues of trust and honesty in nursing at its core. Heather Stickney, a nursing student at NHTI in Concord, N.H., made the news recently when she was suspended for taking home scrubs she wore during her rotation at Catholic Medical Center. Her clinical advisor has accused her of stealing the scrubs and lying about it.

At first, it appears that the punishment is extreme for what could be described as a minor offense. After all, Stickney did not harm a patient or steal medications; she borrowed a set of scrubs to observe a procedure and said that she wanted to keep them as a memento. According to Stickney, she asked her clinical adviser whether she could keep the scrubs and was told to return them, but upon asking a man in the linen department the same question she was told she could keep them. The clinical adviser, noticing that the scrubs were still missing, gave Stickney an administrative failure, suspending her from the class and from the nursing program.

The issue raises the question as to whether Stickney’s actions should be interpreted as a “rookie mistake” or as a more significant character flaw, one that could lead to her lying about more serious offenses. Stickney has appealed the suspension and points to her otherwise exceptional record in the NHTI program, while nursing professors and nurse administrators indicate that nurses mist be trusted to tell the truth.

Errors happen in healthcare, and it is often how those errors are handled that makes the difference in the total impact of the incident. Nurse leaders are often told they must create an environment in which nurses feel comfortable coming forward and admitting to errors, rather than trying to hide them and potentially making the situation worse. Stickney made a mistake in disobeying her clinical adviser, but nothing in the news reports indicates that she has admitted to making a mistake or apologized for her actions. It may seem like a lot of fuss over a pair of scrubs, but it does highlight a need to instill values of honesty and ethics in nurses during training to carry over as they move into nursing careers.

Do you feel that Stickney’s suspension is an appropriate punishment for her actions? How would your organization handle a similar infraction? Leave a comment and let us know!

More time working with patients, less time documenting them

What would you be able to accomplish if you had one extra hour in your day? What about if you had several extra hours? Documentation, though a necessary part of healthcare, is potentially eating into hours that otherwise could be spent on patient care. Last month, MIT Technology Review wrote about a system designed by Xerox to automate and streamline some of the time-consuming tasks associated with technology, such as logging into computers, documenting details of patient care, reviewing patient files, and coordinating duties with colleagues.

According to the article, Xerox’s research into nursing documentation was spurred by a 2008 study published in The Permanente Journal that found that more than a third of nurses’ practice time was spent on documentation, with an additional 20% of nurses’ time spent on care coordination. Of the nursing practice time, only 20% was spent on patient care and 7% was spent on patient assessment and reading of vital signs.

We polled readers at StrategiesForNurseManagers.com to find out what percentage of their time was spent on documentation. Nearly half of all respondents (49%) indicated that documentation takes up more than 50% of their time, while another 22% estimated that it took 40%-50% of their time. A quarter of readers responded that 20%-40% of their day was comprised of documentation, and only 6% replied that documentation took up less than 20% of a given shift.

Given that nurses may also be working longer than their scheduled shifts to complete all documentation, and that longer shifts have been linked to nurse burnout and adverse effects on patient outcomes, is not unreasonable to connect the dots and state that less time spent on documentation could potentially improve patient outcomes and patient satisfaction. It seems that nurses would welcome any technology or system that would streamline documentation processes and allow them to get back to providing quality patient care.

Has your organization devised any methods for making documentation more efficient? Please share in the comments section!