AHRQ Accountability of Nursing Professionals

AHRQ

Accountability of Nursing Professionals Paper: Select one patient safety practice from the AHRQ resource, and identify and explain how the nursing professional is accountable in relationship to implementing change based on the evidence for practice. Include a patient care situation and how you would change your practice to meet the requirements.

AHRQ article: Patient safety and nurse advocacy

Medical errors are a fact of life: they are the eighth leading cause of death in the U.S., and an estimated 44,000 to 98,000 people die in hospitals each year as the result of medical errors (Medical errors, 2009, AHRQ). That figure is not even including the many patients who do not die, but whose quality of care is severely and needlessly compromised. The causes of medical error are many -- incompetence, overtired nurses, and miscommunication are some of the most common culprits. To reduce error, nurses must work with both patients and other healthcare professionals to minimize the causes of errors, as well as to increase organizational vigilance and fail-safe mechanisms to better guard against errors. The greatest patient safety practice is for the nurse to assume the role of advocate for his or her patients.

For example, one common error according to an Agency for Healthcare Research and Quality (AHRQ) article entitled "Medical errors: the scope of the problem" is that of diagnostic errors: "diagnostic error, such as misdiagnosis leading to an incorrect choice of therapy, failure to use an indicated diagnostic test, misinterpretation of test results, and failure to act on abnormal results" (Medical errors, 2009, AHRQ). Asking patients about their full medical history, encouraging patients to ask questions, and using electronic record-keeping to ensure that comprehensive information is maintained about patients from facility to facility are all ways to reduce error. Nurses must be fluent in culturally sensitive communication strategies to use with their patients to engage in effective fact-finding and interviewing. They must demand that efficient record-keeping is deployed within their organization, to reduce complaints such as negative drug interactions on the ward and misdiagnoses of conditions because symptoms were not transferred on the records from doctor to doctor. For the nurse to take on a role as advocate in favor of more throughout record keeping would also result in fewer errors such as "blood transfusion-related injuries…giving a patient the blood of the incorrect type," and "misinterpretation of other medical orders, such as failing to give a patient a salt-free meal, as ordered by a physician" (Medical errors, 2009, AHRQ).

Another common source of errors is "equipment failure, such as defibrillators with dead batteries or intravenous pumps whose valves are easily dislodged or bumped, causing increased doses of medication over too short a period" (Medical errors, 2009, AHRQ). Although the nurse cannot guard against every technological malfunction, keeping abreast of how to use equipment and keeping a watchful eye on how to maintain new technologies is essential. New technology is dependant upon nurses using their role as advocates to truly work for the patient. Also, if the hospital's equipment is compromising patient care, nurses must act as advocates, and demand higher-quality and new equipment for patients from administrators.

Another problem is that of "infections, such as nosocomial and post-surgical wound infections' (Medical errors, 2009, AHRQ). Careful hand-washing to prevent infections is a required part of most hospital procedures. Nurses should take additional precautions during times when the flu is likely to be spread or epidemic outbreaks. Nurses must strive to spot epidemics or a spike in communicable diseases or infection in their daily work. Once this is spotted, patients can also be educated about minimizing their exposure to harmful infections, by being encouraged to wash their hands, shield their mouth and nose when they cough or sneeze, and engaging in appropriate aftercare.

Nurses are often overtired and overstressed on hospital wards. A lack of sleep can result in a higher propensity to commit errors. The shortage of nurses in America results in the current ranks of nurses required to work longer hours, often back-to-back, and a greater likelihood nurses will be called upon to work at eccentric times, such as nightshifts. This can make it difficult for nurses to become patient advocates, because they are overburdened with nursing duties, and even duties not germane to their profession of nursing.

Yet nurses must act as advocates within the hospital environment to reduce stress upon the members of their profession, and as professionals nation-wide to call for a greater drive to recruit competent students and career-changers into the profession of nursing, which will reduce the pressure upon the current ranks of a rapidly-aging profession. The AHRQ article emphasizes that "most of the medical errors are systems related and not attributable to individual negligence or misconduct. The key to reducing medical errors is to focus on improving the systems of delivering care" (Medical errors, 2009, AHRQ). In other words, there are elements outside of the healthcare practitioner's immediate control. However, the article also shows that having individuals with the needed background on hospital wards dramatically decreases the rate of error and improves the functioning of systems and processes.