
Promote health, prevent illness/injury

Broad knowledge base needed to meet patient needs in different health care settings


Interventions to save patient lives:

Deploy Rapid Response Team (RRT)

Provide evidence-based care for acute myocardial infarction

Prevent central line infections


Interventions to save patient lives (cont’d):

Prevent adverse drug events

Prevent surgical infections

Prevent ventilator-associated pneumonia
(VAP)



Institute of Medicine (IOM) “To Err is
Human” report (2000)
Require health care organizations to focus on patient safety and quality care


Address high risk issues:

Drug administration

Fall reduction

Pressure ulcer prevention

Communication


Requires health care organizations to create culture of safety

National organization

Peer evaluation every 3 years


Errors caused by health care team/system

Anything leading to patient injury or harm


Intervenes for people at beginning of clinical decline

Can be used by family

Decreases medical complications and number of arrests





Provide patient-centered care
Collaborate with interdisciplinary health care team
Implement evidence-based practice
Use quality improvement in patient care, informatics


IOM added safety as separate competency

Knowledge, skills, attitudes (KSAs) added to develop each core competency
 www.qsen.org






Collaborative nursing functions
Independent nursing functions
Patient education
Patient advocacy-caring
Respect for ethical principles:



Patient autonomy
Beneficence
Justice




Case manager
SBAR
PACE


Often used for hand-off communication

4 steps:

S - Situation

B - Background

A - Assessment

R - Recommendation


Used for patient reporting

Stands for:

P – Patient problem

A – Assessment/action

C – Continuing/changes

E – Evaluation


Transferring a task/activity to a competent person

Certain tasks delegated to UAP
(unlicensed assistive personnel)

Nurse always accountable for the task/activity delegated!


Guidance or direction, evaluation, and follow-up to ensure a task/activity is performed appropriately




Turning and positioning
Vital signs
Intake & output measurements


Right task

Right circumstances

Right person

Right communication

Right supervision


Integration of the best current evidence to make decisions about patient care





Identify monitoring indicators
Collect data
Recommend ways for improvement
Implement activities for improvement


Information & technology used to:

Communicate

Manage knowledge

Mitigate errors

Support decision-making


Nurses play a key role in safety promotion and error prevention


Nine key areas where nursing practice needs improvement:
1.
Medication administration
2.
3.
Clear communication of patient data/clinical assessment
Attentiveness/patient surveillance

4.
5.
6.
Clinical reasoning or judgment
Prevention of errors/complications
Intervention (carrying out nursing actions)

7.
8.
9.
Interpreting authorized provider orders
Professional responsibility and patient advocacy
Mandatory reporting

What is an expected outcome for the patient who is scheduled to undergo a surgical procedure if the nurse successfully implements patient-centered care?
A.
B.
C.
D.
Home health care for 8 weeks once he or she is discharged
Physical therapy while hospitalized after the procedure to accelerate his or her rehabilitation
Implementation of a low-fat, high-protein diet
Questions about the procedure answered and a signed informed consent

A patient who had been admitted for evaluation of heart failure begins to act confused. At 4 AM, the nurse notes that his blood pressure has dropped from 132/78 to
108/60 and his pulse is 115 beats/min. The nurse should take what action next?
A.
B.
C.
D.
Call the patient’s physician.
Call the code team.
Call the Rapid Response Team.
Call the in-house resident physician.

The nurse observes an increased incidence of contaminated blood cultures as indicated by laboratory report, thus requiring that the blood be redrawn. What quality improvement step could the nurse implement to reduce the blood culture contamination rates?
A.
B.
C.
D.
Contact the hospital quality improvement nurse to inform him or her about the observation.
Obtain data on the unit blood culture contamination rates to evaluate trends and develop a plan for improvement.
Inform the unit nurse manager of this concern.
Post a journal article on the unit that addresses proper blood culture technique.