1. MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS Nursing Advocacy Presenation Melonie Martin Spalding University School of Nursing

2. INTRODUCTION  PROBLEM:  Due to unsafe staffing of nurses, medical and medication errors occur that lead to complications, failure to rescue, and increasing mortality rates.  AIM:  This advocacy presentation aims at implementing a statewide hospital policy in improving patient safety through mandated nurse- to-patient ratios in Kentucky. Nursing associations and safety experts have identified that “it’s a key factor in poor quality of care, higher rates of readmission, infection and mortality, lower patient satisfaction, and staff burnout” (Rice, Got Enough Nurses, 2015). This presentation will examine the need for policy change on nurse- to-patient ratios as it relates to medical and medication errors. MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

3. ACCESS TO CARE  Access to care is deficient because nurses have too many patients to care for at one time.  With a heavy patient load, nurses may not be as thorough as they should be on several processes such as assessments, medication administration, and discharge teaching, which can lead to medical and medication errors.  Examples:  Standards for Medication Administration  Standards for Discharge teaching MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

4. PATIENT ENGAGEMENT IN CARE & CLINICAL INFORMATION  The patient should be the source of control and care should be customized according to the patients values, needs, and expected outcomes.  Nurses struggling to keep up with the workload from having too many patients at one time, will not be able to uncover valuable information for the patient’s care.  Example:  Obtaining informed consent and missed opportunities MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

5. QUALITY OF CARE  Kentucky nurses are stretched too thin and patients do not always receive high quality care.  Less time with patients can result into poor quality and unsafe care.  Statistics show that medication administration errors account for 26% to 32% of total medication errors (Anderson, Medication Errors: Don’t Let Them Happen to You, 2010)  Example:  Nurse fails to do thorough assessment and dangerously gives medication MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

6. DELEGATIONS AND USE OF INTERDISCIPLINARY TEAM  Facts: Evidence shows that preventable medical errors continue to be the No. 3 killer in the U.S.—behind heart disease and cancer. Approximately 400,000 people die each year due to medical errors.  Medical errors include all contributors to direct patient care and care coordination such as physicians, nurses, pharmacists, respiratory therapists, physical therapists, nurse aides, etc.  Miscommunication or lack of communication can be problematic to the care that the patient receives.  Example: Delegation and Communication MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

7. ROUTINE PATIENT FEEDBACK TO HEALTH CARE PROVIDER  Feedback from patients is an important aspect of patient- centered care.  “[…] nurses are expected to provide patient-centered care, and yet the shortage impacts the nurses’ ability to provide this care—less time, more stress, more acutely ill patients requiring more time, not enough staff, and so on. This causes conflict and frustration” (Finkelman, Professional nursing concepts: competencies for quality leadership, 2013, p. 272). MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

8. BACKGROUND AND SYNTHESIS OF INFO  The problem with RN-to-patient ratios hit the market hard in 1996, when the Institute of Medicine (IOM) released a study called “Nursing Staff in Hospitals and Nursing Homes: Is it Adequate?”  In 2002, Dr. Linda Aiken, PhD, FAAN, FRCN, RN published a study that validated the relationship between nurse-to patient-ratios, patient mortality, and failure to rescue (deaths following complications).  Healthcare organizations continue to focus on productivity and lowering liability, ignoring this issue with inadequate staffing.  After 12 years of fighting for policy change, California was the first state to adopt a mandatory nurse-to-patient staffing law in 2004. MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

9. THEORETICAL FRAMEWORK  I suggest that the state of the Kentucky base its policy change on the Watson’s theory on caring  The theoretical framework has been set by Linda Aiken whose research shows why having mandated nurse-to-patient ratios according to the unit type is needed.  Using this framework, I suggest a year long research study involving the major hospitals in the state of Kentucky examining the relationship between nurse staffing and the occurrence of medication errors in Kentucky.  RN-to-patient ratios could be determined using the suggestions from Linda Aiken’s research, the California law, and this local research MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

10. LIMITATIONS  A major concern from those who oppose mandated RN-to- patient ratios is the shortage of nurses that exists today  More nurses need to enter the workforce and the way to see momentum is to offer scholarships or tuition assistance.  Universities could offer funding in exchange for years served as clinical instructors in the hospitals.  To get more nursing staff, clearly differentiate the roles of the Certified Nurse Aides (CNA), LPNs, RNs, and BSNs  If magnet status stands for patient safety and quality of care, then the understanding should be to get more nurses on the units MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

11. SUMMARY  It is important to the profession of nursing and ultimately the patients that we make way for necessary changes.  Advocates must take a stand and push for improvements.  Hospitals should be a place of hope, never a fear of death. Let’s make change happen and get these RN-to-patient ratios in place! MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS

12. CITATIONS  Anderson, P. (2010, March 11). Medication errors: Don't let them happen to you - American Nurse Today. Retrieved January 2016, from http://www.americannursetoday.com/medication-errors-dont-let-them-happen-to-you/http://www.americannursetoday.com/medication-errors-dont-let-them-happen-to-you/  Collective Patient Advocacy Trailblazers: The Road to Ratios. (September 2012). National Nurse, pp.19-31 Retrieved January 2016, from http://connection.ebscohost.com/c/articles/83445014/collective-patient-advocacy- trailblazers-road-ratios  Collective Patient Advocacy Trailblazers, Part 2 The Road to Ratios. (November 2012). National Nurse, pp. 22-34. Retrieved 2016, from http://connection.ebscohost.com/c/articles/84511346/collective-patient-advocacy- trailblazers-part-2-road-ratios  Finkelman, A., & Kenner, C. (2013). Provide Patient-Centered Care. In Professional nursing concepts: Competencies for quality leadership (Second ed., pp. 272-273). Sudbury, Mass.: Jones and Bartlett.  Frith, K., Anderson, E., Tseng, F., Fong, E. (2012). Nurse Staffing Is an Important Strategy to Prevent Medication Errors in Community Hospitals. Nursing Economics, 30(5), 288-293. Retrieved January 1, 2016, from https://www.nursingeconomics.net/necfiles/specialissue/2012/Frith_Staffing.pdf  Kentucky: Health Status. (2014). Kaiser Family Foundation. Retrieved January 2016, from http://kff.org/state- category/health-status/?state=ky  McCann, E. (2014, July 18). Deaths by medical mistakes hit records. Healthcare IT News HIMSS Media Retrieved January 2016, from http://www.healthcareitnews.com/news/deaths-by-medical-mistakes-hit-records  Rice, S. (2015, October 25). Got enough nurses? Nurse groups cite Kentucky case to support push for staffing ratio laws. Modern Healthcare. Retrieved January 2016, from http://www.modernhealthcare.com/article/20151024/MAGAZINE/310249979  Ungar, L., The (Louisville, Ky.) Courier-Journal. (2014, June 8). More patients flocking to ERs under Obamacare. Retrieved January 2016, from http://www.usatoday.com/story/news/nation/2014/06/08/more-patients-flocking- to-ers-under-obamacare/10173015/ MEDICAL AND MEDICATION ERRORS RELATED TO UNSAFE NURSE-PATIENT RATIOS