Patient Safety

During the care of patient ensuring safety and quality is one of the biggest challenges in health care setting across the world. As I had worked as a Nurse Team Leader in an acute care set up, I believe that harm prevention is one of the fundamental aspects while providing care to patients as it leads to increased morbidity and mortality rate with economic burden. Center for Disease Control and Prevention (2011) reported 80,000 catheter related blood stream infections occurring annually in US hospitals leading to increased hospital stay, patient suffering and expended financial resources. Now days, patient safety has been very much recognized as priority target of any organization In order to gain trust of patient by achieving the standards

of quality accreditation.
As the primary caregivers in hospitals, nurses are always stood up to improve quality and patient safety. For years, nurses have make every effort for the protection of patient rights, involving them in their care plan and advocating for them according to patient need and situation. Nurses are holistic care providers and therefore coordinate care among the different multidisciplinary teams to ensure better delivery of patient care.
Despite the efforts to promote patients safety and quality patient care, nurses face numerous kinds of barriers to work for future preventions; Health care organization when give importance to financial statistic or in organizations where quantity is preferred versus quality, then it is a big challenge for nurses in ensuring quality and safe care for patient. If volumes of diagnostic services decreases, a special committee is made to explore the low influx of patients but when rates of infections are not controlled, nothing has been done except penalizing infection control department. Though infection control team is dedicated for this work but if health care organization does not provide the required support, resources, authority and encourage ownership by various departments, it cannot work. In addition, Disch et al (2008) mentioned there are organizations where leaders are reluctant to accept changes with recent developments; it is always difficult to bring new ideas into those systems and make stake holders to agree on its adoption. Especially, in cultures, where individuals rather than systems are blamed for failures.
The prime goal of any organization should be to protect their patient from harms either due to individuals, system failures or due to adverse events of medications or treatment procedures.

Nurses work in a multiple context and always play a vital role in transforming healthcare in accordance to protect patient from harm however it is seen that organization are not much supportive towards nurses. Nurses have been taught in their academic program to be advocates of patient safety, raise voices, and question physicians in case of wrong order. But, if we look into real practice it is sometimes different scenario. Nurses are suppressed by the physicians, therefore, they fear to argue them. Sometimes they are scared of getting their professional relation ruined. In addition, Nurses also face the lack of support from management in doing transforming efforts. Which ultimately cause job dissatisfaction and frustration Moreover, Mason (2008) also supported that many times on night shift, patient care suffers as the on call doctors are sleeping and nurses are reluctant to call due to fear of having disruptive behavior by physicians. Those incidences in which patient suffers due to delayed response by physicians, forgotten to send any required investigation or unnecessary antibiotic prescribed by physician will considered as practice variance rather than errors though they are in line with the definition of error. Instead of correcting the misconception, our system appreciates and

accept it. Therefore, in such situation, it is really difficult for nurses to report such complex nature of errors and prevent its future occurrence
In order to transforming health care and to ensure quality and safety of patient and organization, we need leaders. Nursing as a front line profession can lead it since nurses are working on multiple task and aware of different safety issues, way to analyze them and proposed required interventions but they require some platforms for it. Unfortunately, nurses are not very much involved in quality initiatives which further discourage their contribution in quality improvement. This concept has been explicitly comprehended by IHI as mentioned by Viney (2006) that IHI has introduced a new framework of ensuring patient safety i.e. “Transforming Care at Bedside: Designing New Care Systems in an Age of Complexity” to increase patient safety by developing efficient care team. Further, to enhance staff and patient satisfaction and improve staff retention. The purpose of launching this idea was to encourage front line workers and their expertise to attain the goals of patients’ safety effectively.
To conclude, patient safety is the corner stone of all care processes.

With increasing rates of harms, increasing efforts are required by all health care organizations to transform practices to reduce the risk of harms. Along with all other health care teams, nurses can play a significant role in ensuring patient safety by establishing care related policies and procedures, educating, disseminating and ensuring its compliance for patient care processes. Roger et al (2007) mentioned that procedural errors accounted for almost a third of total errors like vigorous suction in high intracranial pressure patients or head elevation to spinal surgery patient etc. Therefore, risk factors related to processes should be examined for their role in error prevention, discovery and correction. Further, we need to develop and implement some harm reduction program to attain international patient safety goals (IPSG) during patient care. There are various barriers such as lack of organization support and authority, lack of involvement in quality initiatives, interruptions during work, long working hours and fear of disciplinary actions etc. faced by nurses leading to decrease contribution of nurses in future harm prevention. Therefore, organization and nurses’ leaders need to establish some strategies to overcome these barriers. Organization needs to appreciate the role of nurses so they can also participate in detecting, reporting and preventing most of the hospital incidence. Organization

should involved them in different quality initiatives, policy making and quality improvement processes to provide them opportunities to address these issues and to interact with various teams to explore the solutions. Further, if an organization provides an environment, which fosters motivation and opportunities to grow, it will increase the job satisfaction and nurses will have less intention to leave the organization and will consequently have less patient harms. Stone et al (2008) suggested that along with patient safety, hospital leaders should provide an environment which is safe for its staff, providing resources like personal protective equipments will create the culture of safety which will in turn create the insight of patient safety among the health care workers. Therefore, nurses leaders need to utilize different tools to assess the positive work environment, need to assess the staff satisfaction on continuous basis to reduces job related stress and finally to retain the staff. Quality is often considered as expensive deal but nurses have the background of evidence base practices can obtain strategies which are effective, safe and cost cutting for patients. Nursing leaders as leaders of organization can do several things having the background and perspective of designing and developing systems and processes to ensure safe and quality care, acquiring resources required, creating a culture of patient safety by bringing the awareness of its significance, and promoting evidence base environment for decision making and staff development. Further, trigger tool methodology can be adopted and utilize periodically to establish a risk based approach focusing on the processes associated with patient harm. Considering its important in health care different voluntary agencies are also making efforts to address this issue of patient safety and develop models and program to ensure it. There is a need to establish international network to discover, evaluate, take up and disseminate patient safety solutions worldwide. There is need to create linkages between organization and individual involve in patient safety such as accrediting bodies, national patient safety agencies etc.