Safety coaches address more than clinical issues
Documentation, site identification are tackled
When you think about patient safety, the first things that come to mind are usually clinical issues such as identification of correct surgical sites, verification of medication allergies, and proper use of electrosurgical equipment. Safety, however, can involve patient privacy, according to a recent speaker at the patient safety coaches meeting at Sentara Norfolk General Hospital in Norfolk, VA.
An important aspect of protecting patients’ privacy is obtaining approval to release information to people other than the family member who is accompanying them, verify identity of anyone calling into the outpatient unit for information on a particular patient, and limit information to general condition reports unless you are talking directly to the patient, says Iris J. Lundy, RN, BSN, staff development educator and patient safety coach for the outpatient surgery/diagnostic unit at Sentara Norfolk.
These are important safety issues when you realize that in some cases, such as domestic abuse, patients would want to limit who could gather information about their location and condition. In less serious cases, patients would want their privacy protected to prevent unwanted gossip or talk among co-workers or acquaintances, she explains.
The safety coaches are a part of an overall hospital program that appoints certain people within each department to act as liaisons between management and staff to share and discuss patient and employee safety issues. "All of the safety coaches meet monthly to discuss issues that everyone faces, and we have a chance to bring up issues that are specific to our areas," says Lundy.
Another recent program for the safety coaches discussed recognition and management of aggressive patients or family members. While this isn’t a problem that occurs often in outpatient surgery, Lundy points out that it is an important issue in the event a similar situation occurs in her department. Also discussed are results of quality improvement projects related to safety and reports from departments that have successfully addressed safety issues, she adds.
At Sentara Norfolk’s outpatient surgery unit, safety coaches reinforce the philosophy that safety is part of the overall culture, not the job of one or two people. "I take the information from the overall coaches’ meeting to our staff at our monthly staff meeting," Lundy says.
Coaches present "Caught You" certificates to employees who do something in their day-to-day job to improve safety, she adds. Staff members who clean up spills, move equipment out of walkways, or cover linens without being asked to do so are a few examples a coach would hand out a certificate, she explains.
"The most important part of my job as safety coach is to provide real-time feedback to employees," Lundy explains. For example, employees can scan the glucometer results into the computer when they check a patient’s blood sugar, but it’s important to verify that the numbers scanned into the record are accurate, she says. "We always verified numbers when we keyed them in ourselves, so it’s just important to verify them when they are scanned," she adds.
If Lundy notices an employee leaving out a safety step, she reminds them of the importance of each action but does so in a positive way, she says. If Lundy notices that a nurse verifies the surgical site by checking the chart and checking the patient identification but does not announce the verification aloud, she’ll first praise the nurse for checking chart and identification, but add that the verification must be aloud to make sure that everyone in the operating room knows that the task is completed, she explains.
"The safety coach approach is . . . positive, not punitive," she says. "We are creating a culture of safety so that every employee realizes that a safety issue is not someone else’s problem. It is everyone’s problem to address."
An example of how the ongoing safety program emphasizes that safety is everyone’s concern is the monthly environment-of-care round conducted in the same-day surgery program as well as other departments, says Lundy. By having all staff members volunteer to conduct surveys to identify safety concerns, everyone’s awareness of safety issues is raised, she adds.
Lundy is one of two safety coaches chosen for the same-day surgery program. "We both try to attend all of the meetings; but with two of us, we can make sure our department is always represented," she explains. Safety coaches are selected by the department manager and chosen on the basis of leadership, peer respect, and a passion for continual improvement in patient and employee safety, she says. "Peer coaching is an important part of our safety program, so the coaches have to know how to do more than just correct the staff person’s mistake," says Lundy. "We give the rationale for the correct action and explain what we are trying to prevent."
For example, it may be easier to walk away from the patient’s bedside and complete the chart, or several charts, at a central location, but you are less likely to make a mistake if you do one chart at a time while at the patient’s bedside, she says. This makes it possible to double-check patient identity and visually confirm the information you are putting in the chart, Lundy adds. Explaining the rationale for each action is more effective than simply correcting a mistake because the staff member will remember the correct way to handle a task because he or she understands why it is done a certain way, she explains.
Safety at Sentara Norfolk means safety for employees as well as patients, says Lundy. "We had a microscope mounted on the ceiling in one of our operating rooms, which is not uncommon for same-day surgery," she says.
Unfortunately, the location of the microscope and the way it hung from the ceiling meant that employees frequently bumped their heads on it, she says. "We got input from staff members and physicians as to the best place to hang the microscope where it would be easy to access but not in the way," she explains. The microscope was relocated, she adds.
One of the reasons the safety program at Sentara Norfolk is successful is because the safety coaches facilitate two-way communication, says Lundy.
"We hear about safety issues from management and from staff, and we make sure both groups know what is going on in relation to safety by making sure that information is filtered throughout the whole organization," she says.
When you think about patient safety, the first things that come to mind are usually clinical issues such as identification of correct surgical sites, verification of medication allergies, and proper use of electrosurgical equipment.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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