Mistakes are an inevitable part of learning in healthcare, especially nursing. And in today's environment, errors are more apt to happen. COVID-19 has frontline nurses working tirelessly, and even though it's not the sprint it was months ago, and we are now getting a moment to catch our breath and reflect, many are anticipating a surge in the coming months. A few of my nurse leader friends and I were chatting the other day about their units' extreme stress due to COID-19. Staff are looking to them for support, and they are desperate to give it. One of the managers pointed out that many nurses were struggling to remember the basics of nursing because they are hyper-focused on new policies that seem to evolve day by day for COVID-19, they are tired, and they are worried about their own health. It doesn't matter if you are a novice nurse or a seasoned nurse; this pandemic has leveled all healthcare staff's playing fields. What my cohorts are observing is an uptick in errors during the pandemic. Because so many of us are inundated with information daily, nursing basics have become buried deep. For many years as a nurse, I participated in peer reviews for medical errors. Time and time again, I realized that no nurse drives into his or her shift, thinking, "Today I am going to make a mistake!" What I did learn is 3 practices lead to mistakes. Some nurses use these practices to save time or because they are overwhelmed by learning new care plans. Avoiding these bad practices doesn't guarantee you won't make a mistake, but chances are you'll make fewer. All of us need reminders so let's get back to the basics and review the top 3 common mistakes I've seen other nurses make and tips on avoiding them.
Rushing Through an Assessment
We all do it, even though we say we never will. We try to convince ourselves that we can listen to breath sounds and heart sounds simultaneously. When you feel that urge to omit portions of your assessment due to your superhuman abilities, ignore it! You will miss something. It may not happen immediately, but it will one day. And in the end, it’s your patient that will suffer. Take the time every shift to perform a thorough assessment. Take your patients’ socks off and look at their feet. Pay attention to their urine output. Remember to check all their pulses. And please review their vital signs. These simple steps take seconds and can literally save your patient’s life.
Trusting Without Verifying During Shift Report
It's happened to all of us. The off-going nurse tells you she gave a med, or maybe that she didn't give a med, and that the labs ran during the previous shift were all normal. You’re hours into your shift and the rounding physician angrily approaches you because he or she was not called regarding that elevated serum lactate, or they ask why the last dose of vancomycin wasn’t given. You try and explain that the previous nurse assured you all those things were taken care of. You frantically review the chart, and then BOOM! There it is. The red font in the EMR indicating a medication is overdue. Or maybe it’s the red font in the lab screaming that a value is outside of the normal range. The previous nurse made a mistake during the report, and now you’ve made a mistake in practice. While we should trust our co-workers and what they tell us in report, you always have to go back to the source of truth: the patient record. Trust your co-workers, but please verify what they are telling you. Remember: 12 hours is a long time. You have likely reviewed multiple charts and assessed multiple patients. At the end of your shift, patient information runs together when you’re giving report. Don’t rely on your memory when giving report, and don’t rely on your co-worker’s memory when receiving report. Best practice is to always verify.
Not Preparing Your SBAR
Let’s face it – calling doctors is no one’s favorite activity. In fact, if I had to choose between calling a doctor and giving an enema, I would choose an enema, hands down, everytime. In the early days, most of the calls were humiliating and usually ended with me wanting to cry in the clean utility closet. Then, I realized my mistake. I wasn’t preparing my SBAR. When I embraced the simplicity of SBAR, my life changed! Well not my entire life, but I became way more confident when I called doctors.
Take a few minutes before you call the doctor and get your thoughts in order. Summarize why you’re calling in 8-10 seconds (this is the “Situation”). Have all the necessary background information in front of you: lab results, vital signs, output, etc (this is the “Background”). Then quickly summarize your assessment findings and tell the doctor what you need (“Assessment” and “Recommendations”). Another thing I noticed when I started using SBAR is my patients received better care. A systematic review published in 2018 found improved patient outcomes when SBAR was used, specifically in nurse-to-physician communication (Muller M, Jurgens J, Redaelli M, et al, 2018). The doctors trusted my assessments and agreed with my recommendations. And even if they didn’t, they would still order the extra lab I requested. In the end, my patients received better care and that’s really what matters. If you need more help with your SBAR, click here.
Remember, nurses, we all make mistakes. And COVID-19 isn’t going away anytime soon. We have to adjust to the new norm and remember the basics of nursing. For those of us who have the privilege to take a breather and reflect, take some time to hone your nursing basics. Review your head to toe assessments, practice good communication among your team using SBAR. And while you trust your peers, always verify the information provided to you. While these practices don’t guarantee you will never make a mistake, they will decrease your chances of making a mistake. And while mistakes are inevitable, the stakes are high right now, and we have to consciously make an effort to avoid as many mistakes as we can. .
Muller M, Jurgens J, Redaelli M, et al. Impact of the communication and patient hand-off tool SAR on patient safety: a systematic review. BMJ Open 2018;8:e022202. doi:10.1136/bmjopen-2018-022202