A little over a year ago I noticed an announcement about the Nurse Faculty Scholars/AJN Mentored Writing Award. The goal of this annual program is to promote scholarly writing among nurses. Experienced writers are encouraged to partner with novice writers who have not previously been first author of an article published in a peer-reviewed journal.
I have often thought that, as the longest running journal for nurses, American Journal of Nursing (AJN) is a virtual treasure trove of nursing history. Since the year 1900, it has documented the development and maturation of the nursing profession – both professional and clinical. Some years ago I found myself wondering how the concept of patient safety has evolved over time. I’m sure many nurses of a “certain age” look back and cringe at some of the practices of the past. When I saw the Nurse Faculty Scholars/AJN Mentored Writing Award announcement, it clicked. The answer could be found in in the 1,392 issues published since 1900. I knew one of my colleagues at the University of Detroit Mercy, Sonya Kowalski, was focusing on patient safety as she pursued a Doctor of Nursing Practice (DNP) degree. When I broached the idea, despite teaching a full load and taking DNP courses, she readily agreed.
Fortunately, all issues are available electronically. For the next nine months we read over 1086 articles, looking for attention (or lack of attention) to safety practices. It was a fascinating journey starting with nursing’s beginnings as “handmaiden” to the physician, evolving into an important, autonomous profession. We found that nurses in the early days, before the discovery of antibiotics, were most concerned with infection control. The principles of asepsis and isolation were the only tools in their bag. As a brand new profession, nurses were not yet aware of some of the potential dangers of hot water bottles and bedrest. However, as time went on, it was apparent that data collection led to improvements in patient care and safety. With the advent of antibiotics, attention turned to other issues related to patient safety, particularly to prevention of medication errors, falls and other adverse events.
We learned that World War II was particularly instrumental in promoting new ideas of patient safety. Military nurses returned to civilian nursing bringing concepts of shock carts, recovery rooms and intensive care units. The Kardex and patient identification bracelet were introduced as hospitalization became more common in the 1940s and 1950s, and organization of patient information and identification became increasingly important.
Unfortunately, we also learned that many of the patient safety measures encouraged or mandated today were first suggested as many as 80 years ago! Consistent use of generic or trade names of medications, no interruptions when nurses are prepared or administering medications, and double checking insulin prior to administration are a few examples.
What can we learn from this exploration of nursing’s role in patient safety? Embrace safety recommendations. It is estimated that more than 400,000 deaths each year are attributed to preventable adverse events (James, 2013). Patient safety in home care has not been as well studied as patient safety in hospitalized patients. As the complexity of equipment and care in the home has increased, patients are at a substantial increase in risk for injuries related to faulty equipment, operator error, intravenous therapy, and complex medication regimens. Be a leader in home care safety – don’t wait for mandates from accrediting bodies. Be alert to potential dangers, near misses, and adverse events, and collect data in a systematic way so that safety can be addressed proactively. And don’t play the blame game – ask how and why it happened, and what you can do to ensure it doesn’t happen again.