Ever since 1999, when the Institute of Medicine released its landmark report on medical errors, patient safety has become a national priority. As a result, healthcare has adopted a systems approach to errors, recognizing that because humans are fallible the focus should be on creating a system of policies, procedures, and technologies that can be used to catch errors before they occur.
Today we have checklists that reduce our reliance on our imperfect memories. We have electronic medical records and databases that improve our access to information, helping to ensure we won’t overlook a patient’s drug allergy or abnormal lab results. We even use high tech barcode scanners at the bedside to ensure that the right patient is getting the right dose of the right drug at the right time.
Yet from a nursing perspective, patient safety is not just about matching barcodes or using technology to prevent medical mishaps. One of the most basic functions of nursing is daily patient surveillance – that fundamental practice of monitoring and assessing a patient’s condition, and acting on any symptoms that develop, that is crucial to patient safety and wellbeing.
Nursing Assessments and Patient Advocacy
As a nurse, you are a knowledge worker. You use your knowledge every day to recognize conditions that might cause a complication or breakdown in care and to select an appropriate intervention – and you do this not only by following established safety protocols, but by looking patients in a very human way, to assess and define their condition from a holistic perspective.
The nursing assessments you perform allow you to play an advocacy role for the patients in your care, keeping them safe during their encounters with the healthcare system. In a hospital setting, these assessments might include:
- Mobility and balance. Inability to move independently might put a patient at risk for a fall or for pressure ulcers. (In some cases it can also lead to deep vein thrombosis.)
- Level of awareness. A patient who is heavily sedated, unconscious, suffering from dementia, or in an impaired cognitive state for any other reason may not be able to clearly communicate about his condition or any worsening symptoms.
- Mental and emotional state. Anxiety regarding treatments, depression, and short term memory problems can all have an impact on a patient’s ability to navigate the healthcare system.
- Vital signs. A change in respiration, pulse, or blood pressure may call for an immediate intervention.
- Pain. This is particularly important in post-surgical patients.
During a health crisis, patients are vulnerable. Every time you have an encounter with a patient, you have an opportunity to serve as a patient advocate. This is especially true when the assessments listed above indicate that a patient is unable to advocate for himself. Many nurses don’t give this advocacy role very much thought, believing it to be part of their job to look out for the patient’s wellbeing. Yet effective advocacy is an important leadership skill.
You can also advocate for your patient’s safety by following all protocols and reminding others to do so as well – whether it’s washing your hands, double-checking the patient’s blood type before a transfusion, or ensuring that minimum staffing ratios are being met. And finally, don’t let your place in the healthcare hierarchy keep you from practicing effective communication. Always speak up when you notice something that doesn’t seem quite right, because doctors and pharmacists are human and can make errors as well.
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