I learned long ago that many patient safety events that result in injury are mitigated in an effort
to reduce the overall seriousness. I often wonder, why not just say we are sorry for the event, own up to it, look forward for opportunities of improvement and allow those grieving the event to be a part of the new change. Sounds great, right? Unfortunately the country has the expectation that nothing should ever go wrong in a hospital. I must say, I agree! Before we ever get to making this statement true, we have much work to do.
One of the greatest joys of being a nurse manager is the impact your ideas can have on multiple people. While the clinical nurse helps the patients they are assigned, the nurse manager impacts hundreds. So, how do I, the nurse manager, keep the risk team happy? To answer this, I am going to pose two different scenarios dealing with patient falls. You, the reader tell me what hospital you favor.
Scenario 1: The confused, 98 year old patient suffering from dementia is admitted to the busy medical floor. The nursing team identifies risk by performing an accurate assessment. Next, the team implements a series of interventions such as a bed alarm, yellow socks and blanket, door markers, a fall contract with the family, hourly safety rounds and leadership safety rounds. Despite all these initiatives, the patient continues to attempt to get out of bed and has a near miss fall. This is identified by the management team after an event report is created as a near miss. The decision is made to place a video monitor in the room for additional safety. The increased awareness keeps the patient safe until she is discharged to her home with around the clock nursing care.
Scenario 2: The patient does well at home until the day she trips while walking to the bathroom. She is brought to a neighboring hospital by the rescue squad and is admitted to a medical floor for evaluation. The nurse greets her, settles her into her bed, ensures the family the patient will be alright and moves on to her next function. The nurse aide caring for the patient watches as she attempts to climb out of bed. After a few repetitive times of telling the patient she cannot get out of bed, the nurse aide leaves the room. Hours later a loud thud is heard. Staff find the patient on the floor with blood seeping from her head.
These are two very different scenarios with two very different outcomes. Investing in systems, hardwired procedures, a culture of safety and management support reduces the overall risk of injury to the patient. I am often baffled when I hear from other healthcare professionals at how risk is managed. Administration must buy into evidence-based practice and forfeit the initial costs they impose in order to reduce the costs that can incur.
Risk managers must work with nursing managers to improve processes and avoid the overall mitigation process due to negative outcomes. As the family member of a loved one who fell in the hospital and broke a hip, I felt much less about sueing when systems were in place than if hospital administration chose to turn their heads on baisc interventions. Our family did not sue, we accepted the hospital’s apology, understood the processes in place and that not all falls can be prevented.
So as parting words, I say, “keep the risk team happy!” Happy endings are far more pleasant than court room drama and wishing you did something different after-the-fact. Been there, done that.