Case Assignment: Safety Needs

Case Assignment: Safety Needs

Case Assignment: Safety Needs

Case Assignment: Safety Needs


The first step is to listen to the person to hear concerns and to help defuse the situation. Arguing or interrupting only increases the person’s anger or emotion. After the patient or fam- ily member has had his or her say, the nurse manager can then attempt to solve the problem by


asking what is expected in the form of a solution. The nurse manager should ensure that immedi- ate patient care and safety needs are met, collect all facts relevant to the incident, and if possible, comply with the patient or family member’s suggested resolution.

Sometimes, a simple apology from a staff member or moving a patient to a different room on the unit can resolve a difficult situation. If the patient and/or family member’s requested resolution exceeds the nurse manager’s authority, the nurse manager should seek the assistance of a nurse administrator or hospital legal counsel. Offering vague solutions (e.g., “everything will be taken care of”) may only lead to more problems later on if expectations as to solution and timing differ.

All incidents must be properly documented. Information on the incident form should be detailed and include all the factors relating to the incident, as demonstrated in the previous ex- amples. The documentation in the chart, however, should be only a statement of the facts and of the patient’s physical response; no reference to the incident report should be made, nor should words such as error or inappropriate be used.

When a patient receives 100 mg of Demerol instead of 50 mg as ordered, the proper documen- tation in the chart is, “100 mg of Demerol administered. Physician notified.” The remainder of the documentation should include any reaction the patient has to the dosage, such as “Patient’s vital signs unchanged.” If there is an adverse reaction, a follow-up note should be written in the chart, giving an update of the patient’s status. A note related to the patient’s reaction should be written as frequently as the status changes and should continue until the patient returns to his or her previous status.

The chart must never be used as a tool for disciplinary comments, action, or expressions of an- ger. Notes such as, “Incident would never have occurred if Doctor X had written the correct order in the first place” or “This carelessness is inexcusable” or “Paged the doctor eight times, as usual, no reply” are wholly inappropriate and serve no meaningful purpose. Carelessness and incorrect orders do indeed cause errors and incidents, but the place to address and resolve these issues is in the risk management committee or in the nurse manager’s office, not on the patient chart.

Handling a complaint without punishing a staff member is a delicate situation. The manager must determine what happened in order to prevent another occurrence, but using an incident report for discipline might result in fewer or erroneous incident reports in the future. Learn how one manager handled a situation of this kind in Case Study 6-1.

A Caring Attitude With employees, the nurse manager sets the tone that contributes to a safe and low-risk environ- ment. One of the most important ways to reduce risk is to instill a sense of confidence in both patients and families by emphasizing and recognizing that they will receive personalized atten- tion and that their needs will be attended to with competence. This confidence is created envi- ronmentally and professionally.

Examples of environmental factors include cleanliness, attention to patients’ privacy, promptly responding to patients’ and family members’ requests, an orderly looking unit, and engaging in minimal social conversations in front of patients. One example of portraying pro- fessional confidence is to provide patients and families with the name of the person in charge. A sincere visit by that person is reassuring. In addition, a thorough orientation creates indepen- dence for the patient and confidence in an efficient unit.

The nurse manager needs to foster the attitude that any mistake that does occur is perceived as an opportunity to improve a system or a process rather than to punish an individual. If the nurse manager has developed a patient-focused atmosphere in which patients believe their best interests are a priority, the potential for risk will be reduced.

Creating a Blame-Free Environment The health care environment is known to be a blame culture that “is a major source of medical errors and poor quality of patient care” (Khatri, Brown, & Hicks, 2009, p. 320). Such a culture inhibits reporting of inadequate practice, underreporting of adverse events, and inattention to possible safety problems.


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