I read an article recently in Modern Healthcare
by Joe Carlson and Sabriya Rice called “Patient Safety Advocates Issue Call for Regulation.”
The point of the article is that patient safety is an area highly under-regulated, with many incidents of adverse effects going unreported. The authors quote Harvard professor and National Patient Safety Foundation Chairman Dr. Lucien Leape, who said, “We need the health equivalent of the Federal Aviation Administration, which sets the rules and then enforces them. And then the National Transportation Safety Board, which investigates accidents. We need to have that in healthcare, and I don't see that happening.”
The numbers are staggering. Adverse events in hospitals contribute to 15,000 deaths a month and 134,000 injuries, according to the Health and Human Services Office of Investigation. And I’m not sure these numbers include incidents of workplace violence that may result in harm to a patient. The majority of “events” discussed in situations like these are medication errors, falls, hospital-acquired infections, and things of that nature. But this got me thinking . . .
So, I’m a nurse going about my everyday care-providing when I’m disrespected by a colleague in front of other colleagues. As I walk away, I’m distracted and I literally bump into a visitor. The visitor promptly yells at me for not watching where I’m going. As I try to apologize, the visitor adds, “And why is it taking so long for my mother’s medication? I asked about it at least half an hour ago!”
As I begin to explain that I am not the nurse assigned to this visitor’s mother’s case, but I’m happy to go check and see, the visitor gives me another earful about the incompetence of our staff. Now doubly distracted, first by lateral violence and second by aggression from a visitor, is this where I forget to wash my hands before I go in to help my next patient? Is this where I turn my back on a patient who I shouldn’t—and they fall? Is this where I attempt to “shortcut” a procedure and strain my back lifting someone inappropriately? Is this where I lose my cool, and yell at a colleague or a patient?
You’ve heard me say before that staff safety and patient safety are inherently intertwined
. I believe that more and more as each day passes. I can’t help but wonder how it’s all interconnected. Yet, just as we have little oversight on the reporting and documenting of adverse events in healthcare, we also have little oversight regarding training for staff who encounter these stressful situations every day. The attention to detail required for excellence in healthcare does not jibe with workplace violence—whether that be discourtesy or disrespect or verbal or physical violence. Being exposed to incidents of workplace violence can only contribute to an increased risk of other adverse events.
So, yes, implement hand-washing and medication-error reduction programs. Aim to reduce falls and needle sticks. But don’t forget about the situations that distract us from successfully implementing those initiatives. Staff who are equipped with the skills to recognize the early warning signs of potential crisis, who are equipped with skills to understand the Precipitating Factors contributing to potential violence, and who are equipped with skills to quickly resolve conflict will be safer in the workplace all the way around.