Nurses face urgent scenarios every day that require quick thinking. A keen sense of situational awareness—i.e. understanding what’s happening with a patient and what’s likely to happen in the future—is critical to clinical decision-making. However, actually achieving situational awareness is threatened by nurse fatigue, which is dangerous for both clinicians and patients.
Every year, between 700,000 and 1 million patients in the United States accidentally fall in a hospital, according to research from the Agency for Healthcare Research and Quality (AHRQ). A bad fall can result in a fracture, laceration, internal bleeding and even death. But research indicates that one-third of falls in the hospital can be prevented.
Situational awareness isn’t a term frequently defined or discussed by circles of clinicians or healthcare professionals. In fact, it’s more commonly used in high-reliability industries such as aviation, military operations and engineering. But as medical professionals begin to understand the important link between situational awareness—i.e. having an accurate understanding of what’s happening with the patient and what’s likely to happen in the future—and clinical decision-making, the phrase is gaining more traction in the healthcare industry.
Staying in the hospital can be a stressful and overwhelming experience for many people. In addition to battling anxiety about medical conditions, tests and procedures, many patients may also be perplexed by the frequent noise, annoyed by beeps and alarms from bedside machines, and simply feel uncomfortable being away from the comforts of home. Research indicates that checking on patients at regular intervals—otherwise known as hourly rounding—helps address basic patient needs, as well as enhance patient safety and the patient experience, says a September 2014 study in the Journal of Nursing Administration.
As the healthcare industry continues to shift toward value-based care, providers are working to improve communication between doctors, nurses and other clinicians. The renewed emphasis is because poor communication leads to poor patient outcomes and decreased patient safety. According to a 2015 study from The Joint Commission, lack of communication was identified as the root cause of 21 percent of sentinel events, or those events resulting in death or serious injury to a patient.
Hospitals are noisy environments—just ask any nurse how many bells, whistles and alarms they hear during a 12-hour shift. Depending on the hospital unit, the number of alarms per patient per day can reach several hundred, resulting in thousands of alarm signals on every unit and tens of thousands throughout the hospital every day, according to the Joint Commission.
The compliment would be a crowning achievement for any healthcare facility: “We have a hospital closer to us, but we heard how good they are at Morgan Memorial, so we decided to go there instead. I am so glad we did!” – A patient at Morgan Memorial Hospital (MMH).
Such a statement from a patient is especially important for Morgan Memorial Hospital. Not so long ago, patients might have driven in the opposite direction instead of going out of their way to reach the Madison, Georgia facility.
This year’s American Organization of Nurse Executives (AONE) conference set a record with more than 3,400 nurse leaders and exhibitors gathering in Fort Worth, Texas. We met many fantastic leaders in nursing at the Amplion booth and throughout the conference that each brought their own unique experiences and insights. This year, three themes really stood out.
In covering the state of nurse call, we have looked at “nurse call frustration” in a blog post titled Why You Should Expect More From Your Nurse Call. What we see from examining anecdotal or research-based evidence is growing dissatisfaction with legacy nurse call systems. Such systems usually provide only one-way communication from the patient to the nurse. They typically don’t collect much, if any, data for use in facilitating and confirming the delivery of care. In most cases, they contribute to the noise and chaos of a hospital floor, instead of enhancing patient and staff satisfaction.
Topics: Nurse Call
Dealing with Chaos
Being a nurse on a hospital floor means dealing with chaos. It’s noisy. Patients have different needs. A patient’s care can change drastically during a shift, completely up-ending your workflow and expectations.
The old communication technology many hospitals are using—legacy nurse call systems, alarms, walkie-talkies, intercoms--contributes to the chaos. When it’s another noise, on a floor full of alarms and systems beeping and co-workers shouting requests, we tune it out. We don’t mean to. But we don’t know how to evaluate what deserves our attention.
This leads directly to issues with our patients. As we’ve worked with hospitals and providers to better understand their challenges, we’ve researched feedback they receive from patients. One of the chief criticisms of care from patients and their families is that they are frustrated by disconnects between all the different parties and nursing staff. They see, hear and feel the chaos. And most importantly, they have to deal with the repercussions.