Patient Safety: Whose Responsibility Is It?

Patient Safety: Whose Responsibility Is It?A recent article on the WebMD website advised consumers to “understand your hospital risks and ask these vital questions, to keep those risks in check.” It clearly outlined a variety of adverse events and poor outcomes that might befall a hospitalized patient, including medication errors, hospital-acquired infections, pneumonia, deep vein thrombosis, and complications from anesthesia. The article ominously suggested to readers that being passive about any of these things could prove deadly, and it urged consumers to take proactive steps to check up on their care providers – for example, by making sure they actually see nurses washing their hands and always asking them, when they come in with medications, what that pill is for.

It’s true that our healthcare system has basic system flaws that can potentially be detrimental to patient safety. But airline passengers are not routinely reminded to ask pilots if they have completed the pre-flight safety checklist and diners are not urged to actually watch their server wash their hands. So what has led to this notion that patients must somehow remain vigilant and on constant alert, even when they are sick or medicated? Isn’t it fair to expect that caregivers will adequately look out for patients who have low health literacy or are impaired in some way? These are interesting questions. A 2003 article from the Online Journal of Issues in Nursing reminds us that:

Ultimately, all stakeholders are responsible to see that no harm occurs to patients. These stakeholders include: society in general; patients; individual nurses; nursing educators, administrators, and researchers; physicians; governments including legislative bodies and regulators; professional associations; and accrediting agencies.

In many instances, however, it is nurses who seem to have the greatest impact on patient safety. A report from the Agency for Healthcare Research and Quality (AHRQ) outlines this in the following statement:

Doctors are perceived—by patients and clinicians—as being the captain of the health care team, with good reason. But, physicians may spend only 30 to 45 minutes a day with even a critically ill hospitalized patient, whereas nurses are a constant presence at the bedside and regularly interact with physicians, pharmacists, families, and all other members of the health care team. Of all the members of the health care team, nurses therefore play a critically important role in ensuring patient safety by monitoring patients for clinical deterioration, detecting errors and near misses, understanding care processes and weaknesses inherent in some systems, and performing countless other tasks to ensure patients receive high-quality care.

Nurses have always been called on to advocate for their patients’ safety by taking measures to prevent falls, pressure ulcers, and medication errors. Today, the strengthened emphasis on preventing hospital-acquired infections means nurses are also charged with ensuring timely catheter removal, taking action at the first sign of C. difficile, and implementing best practices in managing surgical incisions and central lines. Clearly, nurses need a substantial knowledge base to improve these kind of patient safety efforts – and this is why the skillset and training of nursing staff has been so strongly linked to patient outcomes, as in the classic study that demonstrated hospitals with a more highly educated nursing workforce tended to have lower mortality rates among surgical patients.

Nurses should actively support patient engagement and help patients to actively participate in their care. At the same time, we have to recognize that our patients don’t have the same skillset and clinical training that we have. It is our professional responsibility to keep them safe from harm, to the best of our abilities. And one of the most effective ways we can do that is by staying current and always expanding our knowledge, through advancing our formal education or seeking certification in a specialty area.

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