Safety is the fundamental foundation to delivering quality patient care. No matter your role, you play a vital part in ensuring patients receive this standard of care. In partnership with the Patient Safety Movement Foundation, the AARC encourages all members to commit to improving patient safety.
AARC Members Kevin McQueen, MHA, RRT, and Sharon Armstead, EMBA, RRT, share their tips for improving patient safety.
Create a Safe Environment
“One of the most important aspects of building a healthy culture of patient safety is for leaders to create an environment where staff feel safe to speak up when errors occur,” McQueen said. “If staff do not feel safe to report all levels of concerns, they will only report significant errors that they are not able to hide.”
McQueen continues to explain that “leaders need to promote a fair and just culture in an environment where frontline staff can openly discuss not only apparent adverse events, but also human errors and system failure.”
McQueen’s Tips for Leaders:
- Survey all frontline staff asking them to list their top three patient safety concerns.
- Evaluate the results to determine the highest risk items to focus on for improvement.
- Ensure the topic of patient safety needs is a standing agenda item at every staff meeting.
- Candidly discuss what is working well and what needs improvement for patient safety.
- Close the loop between reporting safety concerns and preventing future incidents. If the staff do not hear back about improvements being made they will stop reporting.
“RTs need to bring forward safety concerns that include: near misses, close calls, good catches, systems failures, poorly designed processes, and incidents of patient harm,” McQueen said. “The results can provide invaluable information for performance improvement activities.”
Have a Plan
Earlier in her career, Armstead helped train her colleagues in patient safety.
“High Reliability was the term and all employees, including Leadership, were required to take the training,” Armstead said. “I was one of the trainers and I have never forgotten those tools because they truly created a culture of safety within our hospital at all levels.”
It’s been a few years since she last trained, but Armstead uses these tools each day.
Armstead’s Favorite Tools
- The Clarifying Question – It is better to ask a question to clarify a situation or an order than to just assume you know the answer. This is important for students to learn so they can become comfortable asking questions when they’re in the hospital. The clarifying question should be asked in all high-risk situations and when you need to make sure you understand the situation.
- The “ARCC” Tool –
A: Ask a Question
R: Make a Request
C: Voice a Concern
C: Use the Chain of Command
Have you ever been in a situation where you had a concern for a patient, but no one was listening to you? This is when you would use the ARCC tool.
The key phrase is: “I have a concern.”
“This is my absolute favorite tool because it says to me that a physician cannot break policy,” Armstead said. “I use this when a physician writes an order that goes against policy. Many may disagree with me here, but the only physician that can write an order to override policy is the medical director who signs it.”
Armstead continued to explain that this tool is also used when you have a concern about your patient and cannot get physician buy-in.
“You move up the chain of command to receive it,” Armstead said.
- The Incident Report – According to Armstead, “when an event of harm occurs, we should not be afraid to document the event or speak up about the event.” Document all missed therapy, events of harm, and missed medications.
“Many people fear doing this because they are afraid they will be in ‘trouble,’” Armstead said. “One of the best leaders I know once told me to not consider it writing someone up but writing the incident down or recording it.”
Stay Attentive to Your Patient
“I don’t provide concurrent therapy,” Armstead said. “This is one of our largest patient safety concerns in my mind. Staying with our patients to provide education should be a requirement.”
Armstead reflects on an experience when a lack of patient education encroached on the safety of a patient:
My example here is a time when I arrived with students to treat a COPD patient. He had been in the hospital for three days by the time we arrived. Upon asking him to show us how he administered his MDIs and DPIs, he removed capsules from each one and changed containers and tried to dispense them from the different dispensers. He had been doing that for a while because it was easier for him to get a breath. He did not have the breath strength to do either, yet he had been there for three days receiving therapy.
Creating a safe environment, asking questions to receive clarification, and staying attentive to your patients will help ensure your commitment to patient safety.