1. A Five Year Journey toward Promoting a Culture of Safety among Nursing Students and Faculty
Michelle M. Compton MSN, RN
Nina P. Barkell MSN, RN, ACNS-BC
Oakland Community College, Waterford, Michigan

2. It all Began with a Sentinel Event
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3. Questions We Asked
How can we prepare our students to become safe practitioners with the skills they are going to need?
How can we make sure our faculty have the knowledge and skills they need for safe, quality practice?
How can we address errors that will occur? How do faculty view errors?
Do we have a culture of safety?
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4. Do we have a Culture of Safety?
“Stop the bullying.”
“…times when I felt belittled…”
“Fear of failure keeps us silent.”
“We have to agree about things we knew were wrong.”
In asking ourselves if we had a culture of safety, reflected on end of program graduate surveys –
Although 93% of students stated they would choose our program again, what you see on slide are some of the negative comments.
We needed to shift the way faculty viewed errors…recognize that we as faculty are fallible, good nurses can make mistakes, good students can make mistakes
We really needed a culture shift. Needed to flatten the hierarchy that existed in our program as it does in health care education and in all of health care in general
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5. Our Balancing Act in Nursing Education
Individual vs. Systems Approach
Distinguish clinical practice that is safe from that which is not
Promoting a Culture of Safety in Clinical
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6. Quality and Safety Committee Goals
Promote a culture of safety among faculty and students
Promote the systematic inclusion of leveled quality and safety content throughout the curriculum
Disseminate evidence based information regarding quality and safety issues to faculty and students
Analyze errors, close calls/near misses, hazards, adverse events and “good catches” that occur in clinical rotations
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7. Quality and Safety Committee: Year One
Membership
Full time faculty
Adjunct faculty
Students
Librarian
Resources
Lit Review
Websites
Planned Safety Theme Program
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8. Quality and Safety Committee: Year One
Safety Theme Program
Important Monthly Safety Messages
Four Components
A Safety Message or “blurb”
An article in the NSA Newsletter
Suggested Post-Conference activities
Resources and References
Examples
Examples of Safety Themes
Fatigue
Don’t Rely on Your Memory
Work Interruptions
High Alert Medications
Alarm Fatigue
Communication
Lateral Violence
Feedback re: Safety Theme Program
Student survey:
Increased awareness
Improved knowledge
Relevant to clinical practice
Faculty Survey:
Incorporated into clinical instruction
Relevant to practice
Improved their knowledge
Useful for their own practice
Utilized survey results to plan themes for second year; in process of doing this for next year.
Length of themes was issue
Most recent survey – want discussion in class, most liked test questions related to safety theme
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9. Quality and Safety Committee: Year Two
Implemented Safety Theme Program
Quality and Safety unit added to Fundamentals course
Developed Quality and Safety Reporting Tool
Facilitates reporting of quality and safety concerns
Voluntary and anonymous
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10. Quality and Safety Committee: Year Three
Implemented Quality and Safety Reporting Tool
Safety Theme Program
Test Questions
Written reflections
Planned Good Catch Program
Good catch program – recognizes interception of an error before it reaches the patient, near misses
Awarded with a pin
Positive not punitive
Discussion re: “good catch” program indicated culture of fear persisted among students
Very few reports the first year
How we overcame barriers:
To solve first two -
Created paper tool; this added another barrier – lack of anonymity
Boxes in campus library, nursing office, and in nursing lab
Same box for good catch and for error reports
Lack of awareness of program
Presentations at Annual Faculty orientation and to NSA twice/year
Continue to identify champions/early adopters
Inclusion of summaries in newsletter format has increased student and faculty awareness;
This has also shown follow up and “closed the loop,” met other goals – disseminating information and learning from our mistakes
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11. Quality and Safety Committee: Year Four
Improved Marketing QSRT
Launched Good Catch Program
Lunch and Learn Program
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12. Quality and Safety Committee: Year Five
Monthly Quality and Safety Newsletter
Dissemination of Data-QSRT and Good Catch
Summaries
Recommendations
Linkage with QSEN Competencies
Safety Theme
ISMP newsletters 5
So how do we get the word out?
Have published Monthly Safety Themes since Fall 2012,
Safety Theme is an important message related to quality and safety
For example: Work Interruptions/High Alert Meds
Article about what current research says about the topic
Case Studies
Post Clinical Discussion/Activities
Newsletter, which started in November 2015 – added
Good Catches
Error Reports
ISMP Newsletter
These are ed to all clinical, FT faculty, posted on Student Resource Site on – Course Mgmt system
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13. Quality and Safety Committee: Today
Clinical Make up Sim Day
Data Base for Reports
Curriculum Review
Evidence Based Practice Articles
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14. Initial Barriers to Event Reporting
Lack of time during clinical day
Lack of access to internet during clinical day
Lack of awareness of the programs
Lack of feedback/follow up
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15. QSRT and Good Catch Reports by Year
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16. Types of Good Catches
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17. Good Catch by QSEN Competency
Most frequently demonstrated competency is teamwork and collaboration
Many examples of students collaborating with staff nurses, physicians, pharmacists
Students are speaking up
Students are advocating for patients
Student received report that elderly patient who had fallen and fractured ribs at home was combative and agitated when night staff got her up to the commode
Student assessed ankle, noted swelling and bruising, notified the trauma resident on rounds
X-ray done - ankle was fractured, patient received appropriate treatment.
This was a student in first med surg rotation
Collaboration with Staff Nurses, Physicians, Pharmacists
Speaking Up – Identifying Safety Concerns
Patient Advocacy
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18. QSRT - Type of Incidents
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19. Student and Faculty Perspectives
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20. Our Message to Students and Faculty Alike
We ALL need to:
Accept responsibility for making our patients safer
Report errors, near misses, or ANY safety concern
Participate in change that decreases occurrence or recurrence of errors
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21. Pitfalls and Pearls Assess Current Culture Engage all Stakeholders
Incremental Change
Save Your Data!
Evaluate Your Results!
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22. Summary Students and Faculty can learn from errors and near misses
Be positive, not punitive. But don’t lose sight of individual factors and students who are not safe.
Don’t wait for a Sentinel Event!
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