Top patient safety concerns in today's health care facilities

While tremendous efforts have been made to increase patient safety in healthcare facilities, there’s still work to do. With an aging population and more people having healthcare insurance coverage, patient loads continue to increase. And with this increase comes the challenge of managing increasingly complex diseases and conditions.

Many factors influence patient safety, and it’s difficult to determine which ones are more critical than others. But taking a closer look shows that two top issues continue to crop up for nurses and other healthcare providers nationwide. One of them may surprise you.

Health care-associated infections

Infection prevention remains a top priority for patient safety. Drug-resistant pathogens present a new challenge in preventing new and recurring infections among patients. While total levels of health care-associated infections (HAIs) have dropped, rates of some types of infections, particularly those caused by drug-resistant organisms, has actually increased.

Organisms like MRSA, Pseudomonas, and C. diff can survive in hospital environments for as many as five months. And when they survive, they do so in high enough concentrations to spread from person-to-person or from environment-to-person.

Proper hand hygiene is a solid first line of defense. But even though nurses know better, it’s difficult to sustain healthcare provider compliance rates with this practice. Additionally, prior room occupancy has been shown to increase a patient’s risk for HAIs, especially if environmental infection control isn’t as effective as it should be.

Nurses can help prevent HAIs by ensuring provider compliance with hand washing and other infection control measures. A little effort goes a long way in preventing the spread of disease.

Missed nursing care

It’s a problem that’s gaining more attention as organizations look for ways to increase patient safety. Omissions of nursing care, or missed nursing care, is described as the failure to do the right thing, such as failure to reposition a patient. Missed nursing care can also be defined as any aspect of nursing care that’s omitted or significantly delayed.

In many cases, errors of omission are difficult to spot. Recent studies suggest the six most common aspects of missed nursing care are:

• Assessment of the effectiveness and necessity of medications
• Mouth care
• Patient ambulation
• Patient teaching
• Timeliness of medication administration
• Turning patients every two hours

Studies also suggest that missed nursing care significantly impacts patient safety and outcomes for the worst. As a result of missed care, patients are more likely to self-report medication errors, skin breakdown, new infections, intravenous infiltration, and other complications occurring during their hospitalization.

So why do these issues exist—and persist—in our healthcare facilities? There are two huge reasons:

• Nurse-patient ratios: Chronic understaffing in many hospitals puts many nurses in charge of caring for more patients than they can safely handle. Recent research indicates that every extra patient a nurse receives beyond her standard patient load increases mortality rates by a full 7%. And for every 10% increase in missed nursing care, there was a 16% rise in mortality following surgery.
• EHR challenges: Even though more healthcare facilities are adopting electronic health records (EHR) systems, healthcare provider competence and interoperability with these systems is still low. Late last year, only 14% of polled providers reported “deep interoperability” with EHRs. Other studies suggest a lack of user training, combined with EHR systems failing to meet clinical needs, contribute to the prevalence of patient safety issues. This is especially true since many systems aren’t driven by interventions that actually make a difference in patient care. Instead, many EHRs are dictated by regulatory and accreditation requirements.

While some aspects of missed nursing care continue to slip through the cracks, others are in the spotlight thanks to more informed healthcare consumers. Missed nursing care, combined with health care-associated infections, still represent substantial threats to patient safety in all areas of clinical practice.