Patient safety is of utmost importance in health care today, especially in an oncology setting where mistakes can have grave impacts on patients with complex care needs. The Health and Medicine Division, formerly the Institute of Medicine, estimated that 44,000–98,000 Americans die each year from preventable medical errors.

The healthcare industry is a fast-moving operation that’s always in action. 24 hours a day, 7 days a week, 365 days a year, medical professionals are working to care for patients and limit potentially harmful situations. However, near misses occur all the time, and accidents can happen in the blink of an eye. Only when safeguards are developed and new interventions implemented can a culture of safety truly take hold. Rather than wait for change, oncology nurses can create their own culture of safety. Learn how two groups of nurses implemented interventions in their clinical settings and increased patient safety in their practices.

Takeaway Lessons From Froedtert Hospital

  • Nurses want to be confident they are practicing safely and protecting themselves in the process.
  • Staff can never have enough education or training. Don’t assume the staff always knows. Conduct annual competency checks.
  • The perception of safe practice can’t be changed by technology alone.
  • Nurses need training on how to confront their peers about unsafe practices.
  • Safe practice can be addressed and improved without increasing the time to care for patients.
  • Oncology nursing leaders need to be aware that the perception of safety is equally as important as addressing confirmed safety issues.

Identifying the Need

A team at Magnet-recognized Froedtert Hospital in Milwaukee, WI, including ONS member Julianna Manske, MSN, RN, OCN®, staff nurse; Tina Curtis, MBA, MSN, RN, NEA-BC, director of outpatient cancer services; and other clinical nurses, developed a safety program that addressed the improvement of safety procedures for chemotherapy administration in their outpatient clinic.

“New staff nurses had identified the lack of a uniform double-check process for chemotherapy administration,” Manske says. “A group of experienced RNs developed a standardized process, congruent with the ONS guidelines, around dual-nurse independent chemotherapy dose verification.”

According to Manske, previous practice on the unit didn’t reflect standardized administration policies. Nurses identified that adherence to proper personal protective equipment needed to be improved, double verification was inconsistent, and the use of a closed-system transfer device for the chemotherapy agents was desired.

“The purpose of our efforts were to lead and sustain practice change that improved safety and staff satisfaction,” Manske says.

Jamilyn Kennell, MSN, RN, OCN®

Meanwhile, two states away at the Magnet-recognized University of Pittsburgh Medical Center (UPMC) Shadyside campus in Pittsburgh, PA, ONS member Jamilyn Kennell, MSN, RN, OCN®, advanced clinical education specialist, and her colleagues, Dori Kuchta, MSE, RN, Victoria Perla, BSN, RN, OCN®, Patricia Macara, MSN, RN, OCN®, and Sharon Hanchett, MSN, RN, OCN®, identified a safety risk among the patients in their institution and decided to act.

“We focused on reducing falls for patients on the inpatient medical-oncology unit,” Kennell says. “Falls are not unique to our institution. They’re often deemed one of the most preventable means of injury in institutional settings. Falls are costly in the sense of debilitating injuries to the patients, but also in terms of dollar amount for the institution via prolonged hospitalization, rehabilitation, additional testing, and even possible surgery.”

Creating Meaningful Change

Identifying the need for change was just the first step toward creating a unit driven by safety. From an idea, safety interventions need to be implemented and supported across multidisciplinary lines.

Manske says that she and her colleagues used the Plan, Do, Study, Act framework to create and sustain change. With the support of nursing leaders, other changes at Froedtert Hospital occurred as a result of this work. They created an oncology Pharmacy-Nursing Committee to improve communication between the nursing staff and oncology pharmacists, provided a clinical nurse specialist as a professional practice resource for the work unit, and they implemented a closed-system transfer device to reduce the potential for chemotherapy exposure.

The group credited the success of improving the safety practices at Froedtert Hospital to active engagement of clinical nursing staff in the change process. This resulted in impactful and sustainable change.

In Pittsburgh, “Our project had multiple sub-tools that were implemented throughout the course of the falls initiative, which is still ongoing with different approaches to reducing falls,” Kennell says. “We started with a falls analysis to determine the population of patients who fell. We then educated staff on these findings and empowered them to use assessment tools and injury reduction strategies available to them from the institution. These strategies included no-slip socks, bedside signage, bed alarms, chair alarms, low beds, bedside commodes, walkers, and assessment-based room location.”

Methods Used to Create Falls Risk Safety Interventions

  • Falls risk assessment: three questions classifying patients as universal, low, or high risk
  • Proper equipment usage: no-slip socks, bed alarms, signage, low beds
  • Hourly rounding: conducting purposeful rounds on all patients
  • Regular safety huddles: brief sessions to touch base about high-risk falls patients
  • Unit-based falls team: group to disseminate information, conduct debriefings, and implement new strategies
  • Patient education about falls: awareness about falls risk, posters in common areas, provide assistance as needed
  • Staff education about falls: educational sessions, identify unit-based risk factors, empower bedside staff with proper tools and resources

Involving all facets of the organization was crucial at UPMC Shadyside in Pittsburgh, just as it was at Froedtert. According to Kennell, “Our administration was in full support of this project. They helped support me, as a staff nurse, to get people to come to educational sessions by making scheduling allowances and offering paid time for these sessions. The administration was crucial to ensuring that proper tools were available at the bedside to keep our patients safe.” Engaging staff nurses with educational resources and providing the unit with the proper tools facilitated the culture of safety to address preventable injuries to patients with cancer.

Working Beyond Implementation

Implementing change and seeing results is just the beginning. Safety programs and initiative must remain sustainable and enforced to see a lasting shift in patient safety. “At Froedtert Hospital, we were able to successfully improve the perception of safety within a large, outpatient cancer center seeing more than 100 patients a day,” Manske says. “These efforts were a combination of nurse-led practice changes, expert consultations, and the implementation of technologies aimed at safe chemotherapy administration.”

“Safety is an ongoing battle,” Kennell adds. “You can’t just educate once and hope for change, you really have to work day after day to create a culture of safety.” In Pittsburgh, they resolved to celebrate each milestone, no matter how big or small. For a month without any falls on the unit, they held a pizza party for nurses on staff.

The change enacted at both hospitals started at the staff level. “Safety has to be at the forefront of the work of bedside staff,” Kennell says. “Trying new things keeps everyone engaged, so you don’t get in a rut and overlook what’s going on.” She notes that the process isn’t always quick or smooth, and some changes may not stick at first, but “if you can learn from your failed attempts, then the next go around will be that much better.”

Recognizing potential safety concerns is key for all healthcare facilities, but especially to oncology units. Developing, researching, and crafting interventions that address unit-wide problems can protect patients as well as providers. The pathway to creating a culture defined by safety and quality care for all patients can start with nurses everywhere.