Staffers often dismissed when they voice safety concerns
Staffers often dismissed when they voice safety concerns
Disruptive behaviors, intimidation in the workplace, and a culture of disrespect among healthcare professionals have repeatedly surfaced as significant barriers to patient safety. However, the nonprofit Institute for Safe Medication Practices (ISMP) in Horsham, PA, warns that there is a risk that often goes unnoticed: Staff do speak up about potential concerns, but they are too easily convinced that their concerns are unfounded.
When a person voices a concern, there’s often no disruptive, disrespectful, or obvious intimidating behavior involved per se, but rather an explanation from competent practitioners that dispels the initial concern too quickly, before it has been given sufficient consideration, the ISMP explains.
For example, a pharmacist reassures a technician that the compounding directions are correct when questioned about an unusual volume of ingredients; a pharmacist assures the nurse that the strength of the infusion is correct when questioned about the final volume; a nurse reassures a patient that the medication is correct when questioned about its appearance; or a physician convinces a pharmacist that the prescribed dose is correct when questioned because it differs from a protocol. (For the full ISMP report, go to http://tinyurl.com/ismpalert.)
To improve patient safety, all healthcare practitioners need to encourage and be receptive to staff members who ask questions, the ISMP advises, even if staff just have a sense that “something” is wrong or can’t articulate the concern well. In particular, the ISMP cautions that healthcare providers should never accept these responses when voicing a safety concern:
- The attending told me to order it that way.
- The patient says that’s how he takes it at home.
- It was published in [a medical journal].
- This is a special case.
- The patient’s been titrated up to that dose.
- The patient is on a protocol [without being specific about the protocol].
- The dose is the same as listed on the patient’s old chart.
- That’s the way the dose is written in the progress notes.
- It’s on the list of medications the patient gave me.
- We always give it that way.
ISMP refers to a 2010 study conducted by VitalSmarts, the Association of peri-Operative Registered Nurses (AORN), and the American Association of Critical-Care Nurses (AACN), that offers insight into the key skills that can encourage an appropriate response to voiced concerns. (That report is available online at http://tinyurl.com/c9nyv8f.)
To encourage a useful response that does not dismiss patient safety concerns, the study offered these tips:
- Explain your positive intent, how you want to help the caregiver as well as the patient.
- Use facts and data as much as possible to support your concern.
- Assume the best, but speak up.
- Make an effort to communicate the concern in a safe environment — away from patients and caregivers, if possible — to avoid defensive posturing.
- Don’t show frustration or anger. Keep emotions in check, even if the initial response is not as expected.
- Avoid telling negative stories, making accusations, or using threats.
- Diffuse or deflect the person’s anger and emotion by staying calm.
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