Safety: Clinical decision making

Patient safety involves the protection from psychological and physical injury by minimizing risk of harm to individuals seeking health care. Prioritizing patient safety allows nurses to successfully navigate patient needs within various clinical scenarios and is essential for providing safe, quality care and improving patient outcomes.

Now, preventing patient harm is a top priority for healthcare organizations and requires a culture of safety, where every health care team member shares responsibility for keeping patients safe.

Healthcare organizations adopt evidence-based practices that are recommended by organizations like the Joint Commission and the Agency for Healthcare Research and Quality to enhance patient safety.

These practices involve implementing systems and processes that help nurses plan and prioritize safe care during activities such as patient identification, communication, medication administration, and the prevention of adverse events like falls and infections.

Starting with patient identification, nurses use at least two methods to identify patients, such as their name and birthdate, to prevent misidentification.

Similarly, communication tools, like SBAR, which stands for Situation, Background, Assessment, and Recommendation, allow the health care team members to organize and share the most essential information about a patient's condition across teams and settings.

As far as medication administration goes, safety can be enhanced by several methods. For instance, using medication reconciliation to compare the medications they are currently taking to the medications a patient has been prescribed can reduce errors by providing an up-to-date medication list.

Additionally, medication errors can be reduced when systems are in place to properly label, store, prescribe, dispense, and administer Sound-Alike Look-Alike Drugs, or SALAD for short. For example, diazePAM and dilTIAZem; or metFORMIN and metroNIDAZOLE; which use “Tall Man” lettering to help distinguish differences.

Another way to promote patient safety is to implement universal fall precautions. These can include orienting patients to their environment; ensuring patients know how to use the call system; keeping personal items within reach; and keeping beds in a low position with wheels locked and two side rails up. Also, each patient's fall risk should be evaluated using a standardized fall risk assessment tool so specific strategies can be applied based on their individual risk factors.

Lastly, preventing infections is another way to keep patients safe. Infection control practices can include routinely performing hand hygiene; using clean or sterile techniques, as indicated; and implementing transmission-based precautions, as needed, to protect other patients, their families, and members of the health care team. On top of that, health care workers should follow the latest evidence-based guidelines to prevent hospital-acquired infections related to invasive equipment, such as indwelling urinary catheters and central lines.

Now let’s look at a scenario where a nurse uses principles of patient safety to make decisions and prioritize care.