Tuesday, July 6, 2010

Defining "Safe"

As members of the Minnesota Nurses' Association file to their respective polling places to vote whether to ratify their new contract, they are faced with the reality that safe patient care in general and "safe" staffing levels in particular are going to be a complex and protracted endeavor.

However, before they even attempt to engage their respective hospital administrations in a discussion about patient safety, nurses need to arrive at their own, specific definition of "patient safety."
Of course, everyone wants patients to be "safe." Do all parties mean the same things by the word "safe"? Corporations, most recently Toyota and British Petroleum, are notorious for a more elastic definition of "safe." Classically, corporations will comply with the letter of the law, but no more. Any additional safety initiatives are closely monitored, and are considered a success if they save at least as much money (in the form of litigation fees, fines, settlements, and so on) as they cost. If they don't, no matter how much improved safety is realized from the program, it's "financially unsupportable."
Nurses have a more stringent definition...somewhere. It's difficult to define patient safety, and tease it out from such phenomena as optimal care or a busy patient assignment. Does it necessarily follow that not getting a meal break means patient safety was at risk? Some say yes, some say no, some simply aren't sure.
Moreover, is "safe patient care" enough? I would contend that safe patient care is a component, but not the totality of either effective patient care or optimal patient care, both of which beg their own definitions. When the best I can say about my shift is, "I gave really safe care," I'm trying to console myself, not congratulate myself.

In my evidence-based practice research around patient falls prevention, it occurred to me the interventions to prevent falls broke down into three categories:
  1. Decreasing the number and intensity of risk factors.
  2. Supporting, improving, and increasing the patient's adaptive behaviors to prevent falls.
  3. Interrupting behaviors that increase patient falls risk.

It occurs to me that safe patient care requires similar capacities from the caregiver. Specifically:

  1. Identification of risk factors, events, or processes that increase the exposure of the patient to harm.
  2. Intervention to decrease or eliminate these risk factors, events, or processes, thereby decreasing the risk of harm to the patient.
  3. "Rescuing" the patient from emergent harmful situations.
  4. Adequate resources (personnel, equipment, training) to carry out these safety activities.

I can't even guess if this is a workable definition, or even the foundation for someone else to develop one. I do know, however, that if we can't clearly define what we consider "safe patient care," we can't measure it and we can't effectively advocate for it. It requires profound limberness of logic to insist that because you can pay for whatever damage you've caused and no one was hurt (much), you're a safe driver. Unless we have a definition with more veracity, this may well end up stuck with this one.

Safe patient care is not excellent patient care, but excellent patient care is safe patient care. Until we have a standard to which we can compare the caregiving circumstances we face, we will be unable to truly know what is required to provide safe and excellent patient care. And odds are, we'll end up providing neither.

No comments:

Post a Comment