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People first – valuing patient safety in the north

Lisa Cutts is the Associate Clinical Nurse Manager on Ward 15 at Whangarei Hospital, one of four hospitals operating under Northland District Health Board, serving a population of around 158,000 and employing a staff of about 2,553.

The first value of Northland District Health Board is: “People First - Taangata i te tuatahi - People are central to all that we do” and it is obvious when talking to Lisa that she is passionate about the work she does and the people she and the Ward 15 staff care for.

Lisa Cutts and Denise WatenePatient safety is a big focus on Ward 15, and a recent visit to Whangarei by First, Do No Harm team members gave an insight into the enthusiasm that Lisa and her team have for improving the experience for patients during their stay in hospital. A large notice board dominates the entrance to the ward, where graphs and charts proudly display the number of days since the last fall with harm has occurred. Asked if this was an effective motivational tool, Lisa replied “It’s a reminder to everyone – staff, patients and their families that we are serious about preventing falls. We always understood the need to enhance patient safety – we ticked the boxes in the way that we were expected to do, but it was only recently that we realised that although we were putting in the hard work, we weren’t seeing the kind of results that we wanted.”

It began when Lisa attended a First, Do No Harm Falls and Pressure Injuries Collaborative learning session 18 months ago and, further conferences and learning sessions later, Lisa says that she can definitely see positive changes not only in the reduction of falls with harm but also in the flow-on effects. Prevention processes that had been put in place are working better, night staff are able to leave on time instead of lengthy hand-overs at shift change and things are generally running more smoothly.

The all-important risk assessment and observation has become part of a total patient management approach, which involves not just one or two staff members, but the entire team.

With the development of a more patient-centric approach involving all staff, Lisa and Denise (Clinical Nurse Manager, Ward 15) made the decision last November [2012] to hold monthly breakfast meetings. A 7.45am start with muffins and coffee as the incentive, ensured the involvement of everyone on the ward.

“The discussion at the meetings is not just about reducing falls, but about patient safety and quality improvement in general.” The culture in health has always been, in her opinion, “when the box is ticked, your job is done”, but that is not the case in reality. “Individual care planning and having goals for patient rehabilitation is so much more important,” Lisa says.

Looking for patterns, collecting wider information and taking a holistic approach to patients’ needs helps to gain greater understanding of why falls are occurring and the approach to take to stop them from happening.

Being mindful of other environmental influences is important too, for example, an ever-changing population. “In the past the ward would be filled with immobile older patients, now days we are seeing younger stroke patients – often men aged around 50, who may be mobile and also have behavioural differences. They can still fall, but they don’t necessarily break - they are more likely to hurt their shoulder than break their hip,” says Lisa. These are things that need to be kept in mind when you are analysing and reflecting on data and establishing suitable interventions.

Involving 2nd and 3rd year student nurses on quality projects is a new initiative that Lisa. “The students bring a different dimension to the team approach of patient safety. They are used to dealing with data in their studies and we hope that they will come up new and innovative ideas, students are very accepting of change implementation. Overall though, everyone is buying-in to patient safety and we have certainly come a long way in this regard. From cleaners through to consultants, every one has their part to play in ensuring that patients do not come to harm while they are in our care.”