Infection Control Today

FEB 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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18 ICT January/February 2019 www.infectioncontroltoday.com feature patients and nurses. According to their study, published in the November 2018 issue of the journal Health Affairs, between 2005 and 2016, only 21 percent of hospitals substantially improved their clinical work environments; 71 percent made no improvements and 7 percent experienced deteriorating work environments. Hospitals that improved their work environments saw their patient safety indicators improve as well, with favorable nurse and patient appraisals of patient safety increasing by 11 percent to 15 percent. Grades on patient safety remained the same for hospitals in which work environments remained the same, and favorable grades on patient safety fell by 19 percent in hospitals with worsening care environments. "A key recommendation of the National Academy of Medicine in 1999 for improving patient safety was to transform nurse work environments in hospitals to ensure adequate nurse staffi ng and clinical work environments that freed nurses to spend their time in direct patient care," says Aiken, who is also the Claire M. Fagin Leadership Professor in Nursing at Penn. "Our recent study of nurses and patients suggests that those recommendations have not been uniformly adopted by hospitals, which may be hampering progress toward improving patient safety and preventing patient harm." The study included 535 hospitals in four large states in two time-periods — 2005 and 2016 — and reports from 53,644 RNs and 805,881 patients who practiced or received care at these hospitals. Nearly 30 percent of hospital nurses in 2015-16 gave their hospitals unfavorable grades on patient safety, and 55 percent would not defi nitely recommend their hospital to a family member or friend who needed care. Patients also expressed concern about quality and safety with 30 percent reporting that they would not defi nitely recommend their hospital. Nearly 40 percent of patients said that they did not always receive help quickly from hospital staff, and nearly 40 percent reported that medications were not always explained before given. "Patients' and nurses' appraisals show patient safety in hospitals remains a concern almost 20 years after the NAM originally called for national action to reduce patient harm," says Aiken. "Our fi ndings show that clinicians continue to face challenging but modifi able work environments that interfere with their ability to implement safety interventions consistently. Improving work environments through organization and culture change is a comparatively low-cost intervention to improve quality of care and patient safety." The study found that: ✦ More than 80% of nurses rated the clinical work environments in their hospitals less than excellent. ✦ Close to 30% of nurses gave their hospital an unfavorable grade on infection prevention. ✦ More than 30% of hospital nurses score in the high burnout range on standardized tests. ✦ 39% of patients reported that medications were not always explained before given. Greater Investments in Nurses is Key to Preventing Patient Harm By Kelly M. Pyrek O ne of the drivers of healthcare reform, a landmark study by the National Academy of Medicine (NAM) issued nearly 20 years ago, highlighted the prevalence of medical errors and called for a national commitment to reduce patient harm. Despite substantial investment by government and private institutions to increase patient safety, progress has been slow and uneven, experts say. One of those experts is Linda Aiken, PhD, RN, director of the Center for Health Outcomes and Policy Research at Penn State, who, along with colleagues from the Center for Health Outcomes and Policy Research (CHOPR) of the University of Pennsylvania School of Nursing, say that progress in improving nurse working environments and improving nurse staffi ng is lacking. She also emphasizes that this fi nding can impact the performance of nurses functioning as infection preventionists (IPs). "An IP will not likely have successful outcomes in an institution where nurse staffi ng is inadequate and where clinical work environments are chaotic and waste clinicians' time," Aiken says. "Despite good science showing how to prevent healthcare-associated infections, our study fi nds that almost one-third of bedside care nurses give their hospitals unfavorable grades on infection prevention. Among the 535 hospitals we studied, those that had improved their work environments more than 10 percent over the decade had signifi cantly better grades on infection prevention. And in our research, we have found that job dissatisfaction among all staff and staff turnover is higher in hospitals with poor clinical care environments." The researchers investigated whether this key NAM recommendation corresponded to improved patient safety, as reported by

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