Page 61 - ACCCN's Critical Care Nursing

3 Quality and Safety

Wendy Chaboyer
Karena Hewson-Conroy

INTRODUCTION
Learning objectives
Today’s critical care units are both busy and complex,
where nurses, doctors and other health professionals use
After reading this chapter, you should be able to: their knowledge, skills and technology to provide patient
● describe the contribution that evidence-based nursing can care. In fact, this complexity makes errors a common
make to critical care nursing practice. occurrence; one large international study in 205 Intensive
● identify the steps in developing clinical practice guidelines. Care Units (ICU) showed that 39 serious adverse events
● explain the role care bundles and checklists have in occurred per 100 patient days. The Institute of Medicine
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promoting quality and safety in critical care nursing (IOM) in the USA defines quality of health care as ‘the
practice. degree to which health services for individuals and popu-
● discuss rapid response systems used to respond to lations increase the likelihood of desired health outcomes
deteriorating patients. and are consistent with current professional knowledge’.
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● describe the use of information and communication Critical care nurses are well known for their skills in
technologies in critical care. patient assessment. In fact, this ongoing surveillance of
● identify techniques used to understand situations that place patient condition means that nurses are ideally posi-
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patients at risk of adverse events in critical care. tioned to prevent, discover and correct medical errors.
● identify strategies to improve the safety culture in critical Thus, nurses play a key role in improving quality and
care. safety in health care. This chapter provides a review of
quality and safety in critical care. First, an overview of
evidence-based nursing and clinical practice guidelines is
given to provide a foundation to consider quality and
safety. Next, quality and quality monitoring is con-
sidered. Included in this section are the topics of care
bundles, checklists, rapid response systems and informa-
tion and communication technologies. Finally patient
Key words safety, including safety culture is described. In Chapter 2
we addressed risk management, clinical governance and
the role of clinical leaders and managers in delivering
quality improvement critical care services; this information is complementary
patient safety to what will be discussed in Chapter 3.
evidence-based nursing
clinical practice guidelines EVIDENCE-BASED NURSING
health outcomes Evidence-based nursing (EBN) is the ‘Application of
adverse events valid, relevant, research-based information in nurse
information and communication technology decision-making.’ Research evidence, however, is only
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care bundles one of four considerations in making a clinical decision.
checklists Three other considerations include: (1) knowledge of
safety culture patients’ conditions (i.e. preferences and symptoms); (2)
measurement the nurses’ clinical expertise and judgment; and (3) the
rapid response systems context in which the decision is taking place (i.e. setting,
liaison nurse resources). Figure 3.1 provides a schematic representation
medical emergency team of EBN, using an example of a decision about weaning a
root cause analysis patient from a mechanical ventilator.
failure mode and effects analysis EBN has emerged as a way to improve nursing practice
38 by considering the care that nurses give to patients, and