Safety Round Program – Enhancement on Caring Critically Ill Patients

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Authors (including presenting author) :
Chow SW, Cheung HH, Lo WH, Chow YT, Liu CW, Lui WK, NG YB
Affiliation :
Ward 9B, Department of Medicine & Geriatrics, United Christian Hospital
Introduction :
Nowadays, critically ill patients are often being cared in a general medical ward setting. With a high nurse to patient ratio, caring a critically ill patient is a stressful task for most nurses. Those patients may also receive suboptimal care leading to increased morbidity and mortality (McQuillan et al., 1998).
Objectives :
To align good and proper nursing practice in focused area in a medical ward
Methodology :
A safety round team consisting of nurses in different seniority was set up in a medical ward. The team first invited all nursing staff to vote the top four aspects of nursing care that they considered the most important when caring for a critically ill patient. The four topics selected were: 1) Oxygen Therapy, 2) Ventilator Care, 3) Pressure injury prevention and 4) Turning. The safety round team would then conduct a safety round for these topics for all nursing staff in the ward every two months. Before the safety round, the team first needed to prepare a standard of care checklist. In designing the checklist, we considered items that were easily missed or improperly practiced by nurses in daily practice. The preparation work included were an extensive search on current HA and international guidelines, consulting nurse specialist in relevant field when necessary and incorporating good current ward practice. During the safety round, the team members would go through the standard of care checklist on a real patient with a case nurse and see whether the existing nursing care complied with the items in the checklist. Any noncompliance were discussed, and explanations of why certain standard of care are important were provided. Staffs were also required to return demonstrate nursing skills related to ventilator care and turning. After the completion of all safety round topic, we invited all nursing staff to take a MC quiz and a questionnaire. The MC quiz involved 12 questions with equal weight on each topic, focusing on critical items mentioned in each safety round. The questionnaire evaluated whether the participants agree that the program has achieved its intended learning outcomes by a 1 to 5 rating scale.
Result & Outcome :
Result: Compliance rate with standard of care checklist for each subgroup: oxygen therapy, 85.7%; Turning, 82.1% ; Pressure injury, 88.7%. Compliance rate with ventilator care could not be done due to lack of ventilator case. All staff complied with the proper technique in the return demonstrations. In the MC quiz, the average correct rate was 90.4%. In the questionnaire, participants rated a mean value of 3.6 to show the Safety Round program has achieved it’s intended learning outcome. Conclusion: A safety round program can identify areas for improvement in caring a critically ill patient. It can also help align good and proper nursing practice in focused area, which was shown to improve safety in healthcare (Rozich, et al., 2004).

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