Quality Care Happens at the Bedside

      The 1999 publishing of the Institute of Medicine's (IOM) landmark report, To Err is Human: Building a Safer Health System spawned a great deal of work toward improving patient safety. It was estimated in that report that up to 98,000 people die in hospitals every year due to medical errors (Wikipedia, 2010). Reports from around the world during the late 1990's also were estimating large numbers of patients harmed by errors. Based on the data, the World Health Organization has concluded that 1 in 10 patients worldwide experience preventable harm while hospitalized (WHO, 2008).  National milestones in the patient safety improvement movement in the United States are as follows (Milestones, 2009):

2001        IOM Report: “Crossing the Quality Chasm” here
2003        The Joint Commission National Patient Safety Goals
2004        IHI 100,000 Lives Campaign
2005        Patient Safety and Quality Improvement Act
2007        IHI 5 Million Lives Campaign
2009        CMS Statement of Work

     So, what do we do with all of this information? Hospitals work together and independently to make changes consistent with recommendations from the IHI, IOM, The Joint Commission, the WHO and a myriad of other patient safety advocacy groups. Leaders develop safety plans, agencies monitor progress, and legislators introduce laws. Has all of this action made a difference?

     The Hearst Corporation undertook an investigation and estimated that 200,000 people would die in the year 2009, about half from medical mistakes and the other half from hospital acquired infections. Read about the project here. That's not progress.

     I have been an acute care Registered Nurse for 13 years. Six of those years have been spent as a unit based educator in interventional cardiology at a large urban medical center. Our quality is better than the national average in many indicators.  This is to the credit of the extremely hard working Registered Nurses and support staff. Sometimes I don't know how they manage to take such good care of the patients when practically on a daily basis, someone is asking them to learn a new process, fill out a new form (we do not have EHR yet), attend a new class or in-service, perform a new audit, or train new staff.  Oh, and also spend more time at the patient's bedside.  Really?

    Registered Nurses are highly trained to be the coordinators of care for their patients. As patient advocates, Registered Nurses work for the care and recovery of the sick and maintenance of their health.  Registered Nurses want to provide the best possible care for all patients at all times.  They are devastated when they make an error, especially when it leads to permanent harm or death.  But the "system" often contributes to conditions that lead to such errors.

     Effective nursing leadership is essential to promoting quality care.  Change is inevitable. We live in a world that is changing very rapidly.  Technology and the body of knowledge are expanding faster than we can keep up with it.  Poorly implemented new processes will not lead to sustainable changes. As well, diligent follow-up and process modification is perhaps more important than the initial implementation, yet there is often no time for follow-up as the next change is rolling down the pike.

It is my passion and my goal to study the issues surrounding the support that bedside Registered Nurses need to be able to provide the best care to their patients at all times.  I will be posting articles related to this topic and exploring methods to accomplish this goal.  Please join me in this endeavor!



References

1. To Err is Human. (2010, September 1). In Wikipedia, The Free Encyclopedia. Retrieved October 24, 2010, from http://en.wikipedia.org/w/index.php?title=To_Err_is_Human&oldid=382362903

2. World Health Organization: 10 facts on patient safety (2008, November 6). Retrieved October 24, 2010.

3. Milestones in the Patient Safety Movement. (2009). Retrieved October 24, 2010, from Missouri Center for Patient Safety: http://www.mocps.org/docs/2009_10_IOM_Descriptions.pdf