“Nursing’s Role in Promoting Quality and Patient Safety Assignment”
Nurses inherently are concerned with patient safety. They are best positioned to prevent medical errors at the bedside. There is a moral and legal imperative to implement safe practices at all times. Nurses and the profession are negatively impacted when medical errors occur. Until recently the Centers for Medicare & Medicaid Services (CMS) mandated that all patient medications be administered 30 minutes before or after a scheduled time (Department of Health & Human Services [DHHS] & Centers for Medicare & Medicaid Services [CMS], 2011, December 22). Given the expanding role of nurses, the CMS mandate is now unrealistic ...view middle of the document...
The ISMP guideline was designed to distinguish between time sensitive and non time-sensitive medications. Time sensitive medications are to be administered in compliance with the original mandate. The most significant change in the guideline was that non-time critical medications now have a window of one to two hours. As a result of the ISMP revised guidelines, the CMS revised the “30-minute rule”.
Nurses to utilize critical thinking skills
The revised ISMP guidelines insist that nurses apply their critical thinking skills when administering medications. The revision resulted in minimizing the risk of active failures at the bedside. Given the inability of eMAR to differentiate among patients, there is potential for latent failures. Nurses have the ability to differentiate and establish priorities in the face of changing circumstances. In high reliability organizations (HBOs), nurses must embrace five key processes. The processes are painstaking concern focused on potential failure, unwillingness to explain away a potential problem with basic information, maintenance of awareness as to the role of team members, ability to resolve unexpected errors, and willingness to seek help from a more experienced team member. (Good, 2011, p. 412) These processes create effective communication.
Implementation of Guidelines
ISMP guidelines encourage nurses to rely on their multi-disciplinary team. When concerned about a medication, nurses are to seek advice from pharmacists and physicians. As the last line of defense against medication errors, nurses have an obligation to withhold a medication if they are concerned. Toyota developed a concept called “Stop the Line” and health care embraced the idea (Good, 2011, p. 413). “Stop the Line” permits a nurse to seek further clarification before proceeding with a treatment or medication (Good, 2011, p. 413).
Safety within my practice
I was caring for a psychiatric patient who had an emergency appendectomy. I was not familiar with a medication ordered. I was concerned about the medication prescribed. The patient had tolerated several doses before my shift. Because the patient had tolerated several doses prior to my shift, my fellow nurses assured me that the medication was safe to administer. With the...