What change in healthcare would lead to the greatest improvement in patient safety? A survey of nurses found these answers:

Mandated staffing ratios: 48.2%
Better communication between nurses and doctors: 29.3%
Electronic medical records: 14.2%
Automated medication administration: 8.3%
Source of study: Advance for Nurses, December 22, 2008

Implications for the attorney/legal nurse consultant: When investigating a nursing malpractice case, ask about mandated staffing ratios. Were there any? How many patients were assigned to the nurse at the time of the incident? Was there a persistent pattern of understaffing? Ask for the staffing sheets and have your expert review them to see if they conformed to industry standards.

According to the Joint Commission’s study of sentinel events/medical errors, communication is the number one factor that results in sentinel events. Miscommunication may occur due to fatigue,  distraction, misunderstandings, accents, failure to communicate, hierarchical issues, not having English as a primary language, bullying, and a host of other factors. These factors should be explored to see if and how they contributed to an untoward outcome.

Electronic medical records are coming- but slowly. They improve efficiency and access to information, which may increase patient safety. But there are privacy, security and confidentiality issues that raise concerns among patients and providers. Computerized medical records carry significant cost and operational issues that are major challenges within health care. At a recent meeting of the American Society of Healthcare Risk Management, many of the risk managers told me they were concerned about the quality of information provided by computerized medical records. Critical information about an incident was not always captured by the records, making it difficult to reconstruct what had occurred. Computerized medical records are an improvement over handwritten records, but many agree they are not a panacea. We’ll never eliminate the need for a thoughtful healthcare provider at the other end of the monitor.

The survey results that identify “automated medication administration” as a patient safety feature may refer to one of two patient safety innovations:

1. The use of an automatic drug dispensing cart, which contains medications in a series of cubicles.
2. The use of bar codes to identify the correct patient to make sure there is a match with the right drug, dose, time and route of administration.

Although neither of these innovations is fool-proof (or immune from attempts to “workaround” these safety features), both of these innovations have been associated with improved safety in medication administration.

What do you think? What can nurses do to make patient care safer?