2.50
Hdl Handle:
http://hdl.handle.net/10755/162361
Type:
Presentation
Title:
Good Catch Project to Enhance Patient Safety
Abstract:
Good Catch Project to Enhance Patient Safety
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Aston, Erin, RN, BSN
P.I. Institution Name:WakeMed Children's Emergency Department
Title:Staff Nurse
Contact Address:504 Commander Drive, Wendell, NC, 27591, USA
Contact Telephone:919-350-2883
[ENA Annual Conference - Evidence-based Practice Presentation]
Purpose: Reports of potential events in a southeast Children's Emergency Department (CED) were noted to be infrequent. With the knowledge that reporting these potential or 'near-miss' events can decrease actual events and enhance patient safety, an investigation was conducted into CED staff's knowledge and thoughts regarding near-miss reporting in an effort to increasing reporting of these events.

Design: This project involved interviewing, educating, and soliciting ideas from the staff with the goal of quality assurance for pediatric emergency patients.

Setting: This project was conducted in a Children's Emergency Department within a level 1 trauma and teaching center.

Participants/Subjects: Nursing staff in the Children's emergency department.

Methods: A baseline interview was conducted with staff in an oral, one-on-one basis in November 2008. The interview included the following 3 questions: (1) What is a near miss? (2) How do you report it? and (3) Please demonstrate how you would report the near miss. Barriers to reporting surfaced during the interview process.
An education plan was then formulated and provided at staff meetings. A representative from Risk Management reviewed the near-miss reports for the CED, and the hospital's Patient Safety Resource Specialist emphasized the importance of near-miss reporting as it related to the hospital's established culture of safety. The presentation opened a dialogue between staff, management, and patient safety officers. In an effort to continually engage staff and encourage feedback, the meeting was concluded with a 2-question survey: What is your greatest fear/concern related to reporting every near-miss event? What do you still need help with to start reporting every near miss?

Results/Outcomes: At baseline, 94% of staff nurses could explain/describe a near miss event and 82% reported the correct action to take, but only 62% could accurately demonstrate the reporting process. The 2 common barrier themes noted was a too lengthy online reporting process and fear of punitive action. A reporting tool was then introduced to the staff, replacing the time-consuming online report. This simple written tool consists of the following questions: What happened? What did you do/what actions were taken? What suggestions do you have to help avoid this event in the future? Completed forms, which could be done anonymously, are deposited in a locked box on the unit.
Good Catch reporting in the CED has significantly increased since the project began in November 2008 (data displayed in chart format), and staff have become excited about making that 'good catch' which has led to enhanced patient safety.

Implications: The results reinforce the importance of education, as well as staff acceptance and willingness to embrace the culture of safety. Feedback and follow-up is important when asking staff to report potential events. Staff needs encouragement co-workers and management, in reporting potential events, but also, hospital leaders to promote a culture of safety. A future goal of this project is to compare statistics on actual and potential events to see if actual events decreased as more potential events were reported.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleGood Catch Project to Enhance Patient Safetyen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162361-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Good Catch Project to Enhance Patient Safety</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Aston, Erin, RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">WakeMed Children's Emergency Department</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Staff Nurse</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">504 Commander Drive, Wendell, NC, 27591, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">919-350-2883</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">easton@wakemed.org</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Evidence-based Practice Presentation] <br/>Purpose: Reports of potential events in a southeast Children's Emergency Department (CED) were noted to be infrequent. With the knowledge that reporting these potential or 'near-miss' events can decrease actual events and enhance patient safety, an investigation was conducted into CED staff's knowledge and thoughts regarding near-miss reporting in an effort to increasing reporting of these events.<br/><br/>Design: This project involved interviewing, educating, and soliciting ideas from the staff with the goal of quality assurance for pediatric emergency patients. <br/><br/>Setting: This project was conducted in a Children's Emergency Department within a level 1 trauma and teaching center.<br/><br/>Participants/Subjects: Nursing staff in the Children's emergency department.<br/><br/>Methods: A baseline interview was conducted with staff in an oral, one-on-one basis in November 2008. The interview included the following 3 questions: (1) What is a near miss? (2) How do you report it? and (3) Please demonstrate how you would report the near miss. Barriers to reporting surfaced during the interview process. <br/>An education plan was then formulated and provided at staff meetings. A representative from Risk Management reviewed the near-miss reports for the CED, and the hospital's Patient Safety Resource Specialist emphasized the importance of near-miss reporting as it related to the hospital's established culture of safety. The presentation opened a dialogue between staff, management, and patient safety officers. In an effort to continually engage staff and encourage feedback, the meeting was concluded with a 2-question survey: What is your greatest fear/concern related to reporting every near-miss event? What do you still need help with to start reporting every near miss?<br/><br/>Results/Outcomes: At baseline, 94% of staff nurses could explain/describe a near miss event and 82% reported the correct action to take, but only 62% could accurately demonstrate the reporting process. The 2 common barrier themes noted was a too lengthy online reporting process and fear of punitive action. A reporting tool was then introduced to the staff, replacing the time-consuming online report. This simple written tool consists of the following questions: What happened? What did you do/what actions were taken? What suggestions do you have to help avoid this event in the future? Completed forms, which could be done anonymously, are deposited in a locked box on the unit.<br/>Good Catch reporting in the CED has significantly increased since the project began in November 2008 (data displayed in chart format), and staff have become excited about making that 'good catch' which has led to enhanced patient safety.<br/><br/>Implications: The results reinforce the importance of education, as well as staff acceptance and willingness to embrace the culture of safety. Feedback and follow-up is important when asking staff to report potential events. Staff needs encouragement co-workers and management, in reporting potential events, but also, hospital leaders to promote a culture of safety. A future goal of this project is to compare statistics on actual and potential events to see if actual events decreased as more potential events were reported.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:26:51Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:26:51Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.