Patient Safety: What Nurses Can Learn from Aviation

Since the days of Hippocrates, patient safety has always been of primary concern to health care professionals. The spotlight on specific safety issues grew even more intense, however, after the Institute of Medicine (IOM) released its landmark report on medical errors in 1999. Since that time, it’s often been suggested that health care could improve its safety record by adapting some of the processes used by the aviation industry, which has made a science out of safety standards.

According to a report in The Milbank Quarterly:

The comparative safety records of commercial aviation and health care have been widely publicized, and proposals to borrow safety concepts from aviation abound. In modern aviation, only one passenger’s life is lost per 10 million flights, compared with one iatrogenic death for every one hundred to three hundred hospital admissions (Hall 2006; Levinson 2010). Moreover, when safety concepts have been systematically adopted from aviation, the impact on patient safety has sometimes been substantial.

Clearly, health care and aviation are vastly different in many ways. Yet both are high risk industries, and there are safety principles that would transfer well from aviation to health care. Here’s a look at two of them, and how they specifically affect nurses:

The Sterile Cockpit Rule

This is a well known concept in aviation – and it doesn’t refer to aseptic technique! Instead it means that during certain safety-critical phases of a flight (taxiing, landing, etc.), crew members refrain from non-essential activities like reading or chatting, in order to focus on the task at hand. (The whole crew is advised when the rule is being invoked.)

Obviously, nurses are subjected to many distractions and interruptions while at work. One type of “sterile cockpit” safety initiative recognizes that interrupting a nurse who is administering medication could potentially have deadly results. A group of nine hospitals in the San Francisco area experimented with having nurses wear brightly colored vests or sashes while giving medicine – as a signal to colleagues that they should not interrupt or distract the nurse in any way. The results of this surprisingly low-tech program, as reported on the St. Rose Hospital website:

Accuracy in administering medications improved from an average of 83.8 percent at the start of the program in 2006, to 93 percent after 18 months, and 98 percent after 36 months.

The First Name Only Rule

Airline crews do not use formal titles when talking to each other in the cockpit – they address each other by first name only. This approach is believed to flatten the workplace hierarchy, creating a culture where co-workers feel comfortable enough to question each other, regardless of rank, if they believe something is amiss.

Contrast this now to the culture at many hospitals, where nurses often address physicians by their titles and last names. This kind of traditional hospital hierarchy is notoriously intimidating, and it can have the dire consequence of making nurses hesitant to challenge a doctor who may be ordering the wrong medicine or preparing to operate on the wrong site. There’s a strong argument in health care that a first-name policy may contribute to a culture of safety, as it empowers nurses. If we really value patient safety, even the most junior-level staff member should feel comfortable providing feedback, or sounding the alarm over a perceived hazard, without fear of a backlash.

It Comes Down to Empowerment

Nurses are truly on the front lines when it comes to patient safety. But because humans are fallible, the focus should be on creating a system of policies and procedures that can be used to catch errors before they occur – much like the aviation industry does. Nurses should feel empowered to pitch their patient safety ideas to their managers and hospital administrators. As the saying goes – if you see something, say something.

Another way to empower yourself is to advance your education, which not only increases your awareness of the latest safety issues and mandates, but also improves your confidence and leadership skills. An online MSN degree in a specialization such as case management or infection prevention and control is the perfect way to improve your knowledge, skill and value to your organization.