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Keeping Patients Safe: Transforming the Work Environment of Nurses
tions learn what is important by observing where the organization focuses its time, energy, and resources. When an organization spends the money to create redundancy, there is no question in anyone’s mind that the organization takes the possibility of errors very seriously (Roberts and Bea, 2001).
In manufacturing industries, a person or machine may be unable to respond to a request on demand because of an unexpected mechanical breakdown. For this reason, surplus stocks of parts and equipment are maintained. When customer needs are so large and unpredictable that it is impossible for a plant to adjust production in a timely manner, “buffer stock” is kept at or near the shipping point as a countermeasure (Spear and Bowen, 1999). In the work environment of nurses, redundant staffing or “slack” in staffing is recommended (see Chapter 5) as one way to ensure the ability to respond to unexpected variations in need for additional staff.
Using constraint and forcing functions The most unambiguous way to design work so as to prevent a worker from making an error is to render the worker incapable of taking the erroneous action (referred to as a constraint) (Reason, 1990). For example, the design of certain vehicles prevents automatic door devices from being deployed accidentally when the vehicle is in motion. Conversely, a forcing function forces a worker to take a correct action.
Avoiding reliance on individual vigilance Because of the limits of humans’ ability to maintain a high intensity of vigilance over prolonged periods of time, it is important not to rely on a single individual’s vigilance to monitor for threats to safety. A good example of how equipment has been engineered to decrease the need for extensive vigilance on the part of a nurse is the use of alarms on automatic IV pumps and other patient care and patient monitoring devices. The patient and family members can provide additional monitoring assistance. When patients and their families are knowledgeable about any treatment protocols and prescribed medications, they can take a more active role in monitoring care, as well as providing self-care.
Reducing and compensating for hand-offs A number of strategies to address issues associated with patient hand-offs (see the discussion earlier in this chapter) are being implemented today. “Universal rooms,” single-stay units, and acuity-adaptable rooms all aim to place a single patient in a care room or nursing unit for his/her entire hospital stay (Gallant and Lanning, 2001). The room or unit adapts to the changing health status of the patient, eliminating the need for patient transfers. However, early testing of acuity-adaptable rooms has indicated that several factors are critical to their appropriate use.