Study: One in three nurses says pa­tient safety is ‘un­fa­vor­able’ at hos­pi­tals

Lodi News-Sentinel - - NATION - By Tom Avril

PHILADEL­PHIA — Two decades ago, a land­mark re­port from the In­sti­tute of Medicine found that thou­sands of pa­tients die in hos­pi­tals each year from pre­ventable med­i­cal er­rors.

In a new is­sue of Health Af­fairs de­voted to that topic, an as­sort­ment of stud­ies finds that hos­pi­tals have im­proved some­what but have more work to do.

Among the stud­ies was a sur­vey at 535 hos­pi­tals in Penn­syl­va­nia, New Jersey, Cal­i­for­nia and Florida find­ing that 29.6 per­cent of nurses rated pa­tient safety at those hos­pi­tals as “un­fa­vor­able.”

Among other find­ings of that study, led by Uni­ver­sity of Penn­syl­va­nia nurs­ing pro­fes­sor Linda Aiken:

• 54.9 per­cent of the nurses “would not def­i­nitely rec­om­mend their hospi­tal.”

• 28.9 per­cent gave their hospi­tal an un­fa­vor­able grade on in­fec­tion pre­ven­tion.

• 37.3 per­cent said that “im­por­tant in­for­ma­tion is lost” dur­ing shift changes.

• 41.9 per­cent said that “things fall be­tween the cracks.”

• 36.9 per­cent said that “staff do not feel free to ques­tion au­thor­ity.”

The num­ber of nurses an­swer­ing each ques­tion var­ied, rang­ing from about 12,900 to 13,500. Aiken, who is also the di­rec­tor of Penn's Cen­ter for Health Out­comes and Pol­icy Re­search, was joined on the study by au­thors from Penn's Leonard Davis In­sti­tute of Health Eco­nom­ics, Rut­gers Uni­ver­sity, the Uni­ver­sity of Delaware and Emory Uni­ver­sity.

The re­searchers found some pos­i­tive signs when com­par­ing the re­sults with what nurses said when asked the same ques­tions in 2005. On aver­age, nurses gave higher grades for qual­ity of care and pa­tient safety at hos­pi­tals where they said the “clin­i­cal work en­vi­ron­ment” had im­proved since 2005.

Work en­vi­ron­ment was eval­u­ated based on fac­tors such as the de­gree of man­age­rial sup­port for nurses, staffing lev­els, and amounts of re­sources and train­ing.

At hos­pi­tals where nurses said the work en­vi­ron­ment had im­proved, re­searchers found a 15 per­cent jump in the num­ber of nurses who gave the hos­pi­tals fa­vor­able grades on pa­tient safety — de­fined as an A or a B.

But at hos­pi­tals where nurses said the work en­vi­ron­ment had wors­ened since 2005, re­searchers found a 19 per­cent drop in the num­ber of nurses rat­ing pa­tient safety with an A or a B.

The re­port that prompted the na­tional con­ver­sa­tion about pa­tient safety, ti­tled “To Err Is Hu­man,” was pub­lished in 1999 by the In­sti­tute of Medicine, now called the Health and Medicine Di­vi­sion of the Na­tional Acad­e­mies of Sciences, En­gi­neer­ing and Medicine. Among its rec­om­men­da­tions were to im­prove the work en­vi­ron­ment for nurses by en­sur­ing ad­e­quate num­bers of staff.

In a news re­lease, Aiken said the new sur­vey shows that progress on that score has been un­even.

“Our re­cent study of nurses and pa­tients sug­gests that those rec­om­men­da­tions have not been uni­formly adopted by hos­pi­tals,” she said, “which may be ham­per­ing progress to­ward im­prov­ing pa­tient safety and pre­vent­ing pa­tient harm.”

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