Standardizing Nurse Leader Safety Rounds to Promote Highly Reliable Care

Abstract

Background: Despite decades of intensive resource allocation to eliminate preventable harm and increase high reliability in the hospital, the prevalence of serious harm remains consistent. Local Problem: A hospital reduced targeted preventable harms using audit and feedback (A&F) but failed to globally reduce harm or increase proactive awareness. Nurse leaders lacked a defined process for identifying errors, mitigating risk, and teaching systems thinking to influence resiliency among teams. Methods: Nurse leaders underwent A&F of daily safety rounds. Adherence data on frequency, high-quality, and high-reliability organizational (HRO) leader practice standards and precursor incident reporting rates were trended. Results: Rounding practice adherence increased for the following defined standards: frequency (63%-79%); high quality (50%-90%); and HRO leadership (0%-67%). Precursor incident reporting rates increased 25%. Conclusions: A&F reinforced quality and accountability for daily safety rounds. HRO theory–guided feedback offered an innovative way to translate HRO influence into nurse leader practice.

Implementing High-Reliability Organization Principles Into Practice: A Rapid Evidence Review

“…1). 8,19,30–36 Data extraction for these studies is available in Appendix B, http://links.lww.com/JPS/A352 and quality assessment in Appendix C, http://links.lww.com/JPS/A353.…”

“…We identified articles from 9 health care organizations that reported effects of HRO initiative implementation on patient safety, safety culture, and/or other process outcomes (Table 3). 8,19,[30][31][32][33][34][35][36] Of note, only 1 study explicitly described using one of the implementation frameworks described earlier (i.e., the IHI framework). 30 Of the 9 studies, 4 stood out as implementing the most comprehensive, multicomponent HRO initiatives.…”

Interventions Into Reliability-Seeking Health Care Organizations: A Systematic Review of Their Goals and Measuring Methods

“…One study carried out a qualitative content analysis of the registered incidents of a hospital incident reporting system 53 ; another also uses quantitative thematic analysis to show an increase in awareness of high-reliability principles among staff. 54 Data collection mostly focuses on practices of organizational members. Six of the 7 studies aim to measure the improved reliability in the pursuit of a rather particularistic goal such as improving patient safety in a specific setting.…”

Resilience factors contributing to healthcare professionals’ adaptive capacity with hospital standardization: a scoping review

“…A few studies reported on positive effects of work relationship factors such as peer pressure in the forms of healthcare professionals' reminding each other to wear protective equipment [25], physicians acting as positive role models to other staff members on hand hygiene [30], nurse leaders modelling practicing safety rounds to staff [39] or collegial support from senior medical and nursing staff to junior professionals to improve adherence to standardization practices in the emergency department [71]. When physicians perceived that hospital rules were suggested through dialogue higher levels of compliance were reported [41].…”

“…Several studies reported that the level of adaptation or compliance with hospital standardization practices was in uenced by the level of support healthcare professionals received by their clinical leadership [25,30,34,61,63,66,72]. Leadership support was understood as 'making rounds on the units and offering words of encouragement' to follow infection prevention guidelines and policies [25] p10 and by modeling compliance to standardization practices [25,30,39,66].…”