The Nightingale Principle Today: using technology to improve patient safety

Written on October 24, 2016 by Mary Jahrsdoerfer

Dr. Mary Jahrsdoerfer

“The very first requirement in a hospital is that it should do the sick no harm.”
-Florence Nightingale, 1860-

In today’s high-tech hospital environment, how do we mitigate patient harm? In the clinical communication & collaboration (CC&C) space, this is achieved one of two ways: First by closing the gaps in communication surrounding patient care, and secondly, by eliminating redundancy and inefficiencies in clinical workflows. The foundation that was set by Nightingale so long ago has served as the basis upon which nursing science has grown. Over one hundred years later, there are many attributes of both nurse and system that directly affect patient safety; mutually grounded in the common denominator of surveillance.

istock_000009610742xlargeIn today’s acute care environment, many disparate data sources are a realistic factor in patient care delivery, which means that nurses’ critical thinking skills and subsequent intervention are largely affected by the context in which this decision-making data are managed. Literature also speaks to the desensitization of clinicians, due directly to frequent interruptions and noise stimuli that result in sensory overload, causing the response to an event to be delayed or missed.

In 2015, The Joint Commission (TJC) recorded 936 sentinel events. Of these, 76 were a delay in treatment, 95 were patient falls, 14 were medical equipment related, 41 were medication errors, 3 were radiation overdoses, 1 was a transfer related event, 9 transfusion errors, 2 ventilator deaths, 6 maternal deaths, 111 wrong-patient/wrong-site/wrong-procedure, and 54 cases reported had an ‘unassigned’ reason. This summary reflects 44% (n=412) of the total reported events recorded by TJC in the calendar year 2015, as being most indicative of requiring clinical surveillance.

Yet, the clinical outcomes in this current fast-paced mobile environment are only as good as the clinician interpreting the real-time data. This begs the question – what tools and processes do we use to communicate and collaborate in today’s hospital while deliberately keeping patient safety at the forefront of every single action?

At Extension Healthcare, we have concluded that the following 7 attributes are essential for patient safety regarding clinical mobility of communication and collaboration:

  1. Clinical Integration
  2. 510k device clearance
  3. Advanced clinical rules
  4. A seamless combination between alarm management and event driven patient-centric text messaging
  5. Clinical context
  6. Secure messaging inside and outside the hospital walls
  7. Delivering the right information to the right person at the right time

As Florence Nightingale noted, “The most important practical lesson that can be given to nurses is to teach them what to observe—how to observe—what symptoms indicate improvement—what the reverse—which are of importance—which are of none—which are evidence of neglect—and of what kind of neglect. All this is what ought to make part, and an essential part, of the training of every nurse.”

When planning the clinical communication strategy for your institution, how many of the seven attributes to help ensure patient safety can you check off around mobility?

Dr. Mary Jahrsdoerfer

Dr. Mary Jahrsdoerfer – is the CNO of Extension Healthcare; the clinical authority in alarm safety issues in hospitals. Mary has her clinical foundation as a critical care nurse, with a focus in cardiology. With over 2 decades of experience in hospital leadership and program development, her career interests grew to emerging healthcare technologies specific to patient safety. At Philips Healthcare, she used evidenced-based research, publication in peer-reviewed journals, and public speaking to disseminate her message. Her role at Extension Healthcare is strategic, with the intent to cultivate an understanding amongst hospital leaders, that as a nation, we are in the midst of a paradigm shift. We are moving from clinical alarm fatigue to a new era of patient-centric alarm management and event response.

Mary has a BSN from Stony Brook University; an MHA from Long Island University; and a PhD from UMass Amherst. Mary is a Registered Nurse and member of the Sigma Theta Tau International Honor Society.

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