N202 Safety

• Safety: Nursing activities implemented to reduce and /or eliminate negative occurrences and optimize patient health.
• Safety


  Nursing activities implemented to reduce and /or eliminate negative occurrences and optimize patient health
• Quality


  The degree of excellence; the extent to which an organization meets clients needs and exceeds their expectations
• Quality improvement programs


  Strive to improve patient care, improving patient safety and resource allocation
• Who is Involved with Quality Control

  • Healthcare Organizations
  • Canadian Government
  • Regulatory Bodies (i.e. BCCNM; NNPBC Accreditation Canada; Canadian Patient Safety Institute; Health Quality BC; Institute for Healthcare Improvement)
• Reduction and mitigation of unsafe acts within the health care system, as well as the use of best practice, shown to lead to optimal patient outcomes
• Launched in 2021, "Healthcare Excellence Canada works with partners to spread innovations, build capability and catalyze policy changes so that everyone in Canada has safe and high-quality healthcare."
• Healthcare Excellence Canada is an amalgamation of the Canadian Patient Safety Institute (CPSI) and Canadian Foundation for Healthcare Improvement (CIHI)
• Healthcare Excellence Canada is an independent, not-for-profit charity funded primarily by Health Canada
• Quality Assurance (QA)


  Reacts to imperfections in the system to achieve ideal outcomes. Involves regular monitoring and evaluating both processes and services. Focuses more on discovery and correcting errors such as mortality and morbidity rates. The culture is often one of blame as it fixes a problem after it is noted.
• Quality Improvement (QI)


  Refers to an ongoing process of innovation, prevention of error, and staff development that is used by institutions that adopt the quality management philosophy. It focuses on outcomes. Continuous Quality Improvement (CQI) is the process that is used to continually improve quality and performance. Includes structure, process, and outcomes.
• Quality processes are used to assess standards in the following categories


  • Structure - adequacy of staffing, effectiveness of documentation, availability of medication dispensation etc.
  • Process - timeliness & thoroughness of charting, adherence to care pathways etc.
  • Outcome - patient fall's, hospital acquired infections, pt satisfaction.
• Steps in Quality Improvement Process

  1. Assemble the quality improvement team

  2. Identify the aim: What are we trying to accomplish?

  3. Identifying the measures: How will we know if a change is an improvement?

  4. Defining the changes- What changes will result in an improvement?

  5. Implement rapid cycle improvements

  6. Sustain the improvements
• Risk Management


  The systematic identification, assessment and prioritization of risks and the development and implementation of strategies to reduce adverse events and liability associated with these risks
• Standard


  An expected and achievable level of performance against which actual performance can be compared. It is the minimum level of acceptable performance.
• Types of Standards


  • Standard of CARE - focuses on the patient
  • Standard of PRACTICE - focuses on the nurse as provider
• Standard Development


  1. Creation of care pathways has been necessary (i.e. fractured hip pathway, CAUTI etc.)

  2. Standardized clinical guidelines: High risk (med errors, complications, falls, pt dissatisfaction etc.)

  3. High volume

  4. High cost

  5. Problem prone
• Nurse Leader Role


  • Nursing is the discipline that is involved in patient care 24 hours a day program
  • High risk areas include: Medication errors, Complications, Falls, Pt/family dissatisfaction, Refusal of treatment
  • Nursing is involved in all of these areas and is critical to patient safety
• Solutions to Improve the Quality of Care

  • Mandatory continuing education; BCCNM self regulating and has license endorsement, carries out its own disciplinary proceedings
  • Development and use of critical (care) paths – variance from the map triggers a review and analysis
  • Risk Management – where risks are evaluated and controlled. May include Patient Safey Learning System (PSLS), audits, review of committee minutes, visitor complaints and client satisfaction questionnaires
• Reporting of Risk OR ADVERSE EVENTS

  1. Risk or adverse events are communicated through electronic reporting systems or through incident reporting

  2. Serve to document organization, nurse and physician accountability

  3. Used to analyze the severity, frequency and causes of occurrences

  4. For every reported occurrence, many more are unreported

  5. It is often the nurses duty and reluctance to report incidents is often due to fear of consequences

  6. Report near miss events (close calls or a good catch!!)
• BC Patient Safety & Learning System (BC PSLS) is a web-based tool used in practice to report & learn from patient safety concerns such as actual adverse events, good catches (near misses) and hazards
• Aim of BC PSLS is to assist healthcare providers, leaders, & others to collect & analyze information that is crucial for patient safety & quality improvement
• BC PSLS is used across all BC health authorities in all care settings
• Go to the BC Patient Safety & Learning System Frequently Asked Questions and review the questions that help you learn about and understand your responsibility to complete PSLS in practice
• For More information: Learning Hub Module FH- PSLS - Patient Safety and Learning System: Introduction to Reporting Events