Collaborative Efforts

Local organizations, along with international, federal, and state agencies, collaborate to support quality health, safety, and cost-efficiency initiatives in healthcare.
Collaborative community initiatives may be started by community members in response to a serious, community-wide health issue.
Initiatives may begin through state-funded or federally funded programs that start in response to larger statewide or nationally recognized health issues and provide funding at the community level to address these issues.
National healthcare safety initiatives vary in approach but, in general, support collaboration among government agencies, healthcare facilities, and people who work in healthcare to create safe, healthy work environments and to provide patients with safe, quality care for the best patient outcomes.
Table 51.1 lists a number of current safety initiatives.

Safety Culture

Even with safety initiatives in place, injuries, accidents, and errors can still occur in healthcare facilities, homes, and communities.
Initiatives, policies, and mandates need to include the "people factor" to be successful.
Everyone in healthcare wants a safe and healthy environment; it takes everyone to make it happen by creating a culture of safety.
A safety culture is a general feeling of shared attitudes, values, practices, and beliefs that result in behaviors and feelings of responsibility for safety in all daily routines (AHRQ, 2019a).
Safety awareness is heightened throughout all areas.

Evidence-Based Practice: Effective Hand Hygiene as a Defense Against Infectious Disease

Background

Critical Thinking Application prompts:
- 1) To reinforce the importance of hand hygiene to others, what can nurses do?
- 2) How can hand hygiene compliance affect the number of healthcare-associated infections that occur? Who needs to participate in this safety prevention behavior?
The World Health Organization (WHO) works with countries around the world when an infectious disease has been identified or a new pathogen has been discovered. An infectious disease can progress quickly from a localized outbreak, to an epidemic, and finally to a worldwide pandemic, threatening lives and health of large numbers of people.
To stop infectious disease from spreading, the first recommended prevention step by the WHO is effective handwashing.
The Centers for Disease Control and Prevention (CDC) considers hand hygiene the most efficient and cost-effective way to limit disease dissemination.
In one research project, researchers focused on the global transmission of respiratory viruses during air travel and in airports. Using epidemiological modeling and simulations, researchers concluded that hand hygiene inside airports could potentially inhibit a pandemic by $24\% \text{ to } 69\%$ (Cohut, $2020$ ; Nicolaides et al., $2020$ ).

Problem

Over the past $100$ years, the United States has been affected by periodic worldwide viral infectious disease outbreaks, epidemics, and pandemics from novel influenza viruses and novel coronaviruses such as:
Sources include CDC reports and related research: Cohut ( $2020$ ); MPHoline (2020); Nicolaides et al. ( $2020$ ); World Health Organization (2020a, 2020b).
Historical outbreaks/epidemics include:
- Spanish influenza (H1N1), $1918$ pandemic
- Asian flu (Influenza A, H2N2), $1956$ pandemic
- Hong Kong flu (Influenza A, H3N2), $1968$ pandemic
- Severe acute respiratory syndrome (SARS), $2003$ epidemic
- Zika virus, $2014$ epidemic
- Ebola virus, $2014$ outbreak
- Novel coronavirus (COVID-19), declared a pandemic by the World Health Organization in $2020$

Quality and Safety Education for Nurses (QSEN)

In $2005$ , the Robert Wood Johnson Foundation funded a group of distinguished nursing leaders and faculty to use the Institute of Medicine's healthcare clinician competencies from the Crossing the Quality Chasm: A New Health System for the 21st Century report.
These nursing competencies, called Quality and Safety Education for Nurses (QSEN), help prepare nursing students with practical experience in providing safer, more effective care.
They are further defined with the specific knowledge, skills, and attitudes (KSAs) necessary to provide better quality and safety in healthcare settings (see Table 51.2).
QSEN KSAs emphasize mastery of knowledge, skills, and attitudes required to improve safety and quality of care.
See Table 51.2 for detailed KSAs.
Across decades, countries, and diseases, one evidence-based practice remains essential to reducing disease transmission: hand hygiene. Correctly done, hand hygiene is an essential, cost-effective safety practice in the prevention and control of infectious diseases spread through person-to-person transmission (see Fig. 51.2).
Many materials and tools developed by the WHO were used in the response and recovery of the areas involved in outbreaks and pandemics. The WHO works with public health agencies and governments around the world to ensure essential information on disease prevention, including hand hygiene, is available in numerous languages and formats.
The CDC uses a scientific approach to protect the United States from infectious disease threats through research and evidence-based prevention and control policies and programs. Data are collected by monitoring, assessing, and surveillance in support of the country's preparedness and response capacity.
In $2020$ , the CDC developed two national handwashing campaigns called "Clean Hands Save Lives" and "Life is Better with Clean Hands" to reduce the spread of infectious respiratory illness, promote healthiness, and raise awareness about the importance of hand hygiene. Campaign materials included videos, posters, and public service announcements.
Organizations and employees working together can build and maintain a safety culture, resulting in improved safety and quality of care for patients and fewer unsafe and unhealthy conditions for themselves.
A safety culture is a blame-free environment. With a focus on systems, individuals can report errors or near misses without fearing reprimand or punishment. Some healthcare facilities have created a just culture that looks not only at systems but also at how they may have contributed to an individual's unsafe action (see Module 50, Quality Improvement, for further information).
Everyone in a healthcare safety culture is aware of the importance of their work and is determined to consistently do their work correctly and safely. Everyone is involved with the planning, implementation, and evaluation of initiatives for safety and health concerns, actively working together to find methods for quality improvement.

What healthcare facilities can do to support safety initiatives

1) Make necessary resources available
2) Include all levels of employees in decision making about safety initiatives
3) Celebrate improvements when quality programs are implemented
4) Conduct management walk-arounds to support staff
5) Offer periodic safety training
6) Share successes in improved patient outcomes and safety goals attained
Benefits of creating a safety culture include:
- Improved job satisfaction for staff
- Fewer safety and health hazards that affect both patients and employees
- A decrease in injuries, accidents, illnesses, and errors
Implications:
Nurses in all settings can help reduce the spread of any infectious illness by teaching and modeling good hand hygiene.
Effective handwashing remains an important evidence-based standard transmission-based precaution to prevent transmission of infectious disease, along with:
- Maintaining social distancing
- Not touching the eyes, nose, and mouth
- Covering the mouth and nose or using tissues when coughing or sneezing

Quality and Safety Education for Nurses (QSEN) — Revisit

The same background: In $2005$ , RWJ funded leaders to implement IOM competencies; QSEN defines KSAs for safer, more effective care (see Table 51.2).

National Patient Safety Goals (NPSG)

The Joint Commission began its National Patient Safety Goals (NPSG) program in $2002$ to help accredited organizations address specific topics on patient safety.
NPSGs are developed and revised with input from healthcare professionals, providers, consumers, subject-matter experts, risk managers, engineers, and government agencies such as the Centers for Medicare & Medicaid Services (CMS).
Goals are determined by analyzing safety and quality concerns and evaluating which will have the maximum impact and usefulness in providing safe and quality care at the minimum cost.
NPSGs are updated annually.
Each goal is accompanied by Elements of Performance that The Joint Commission identifies as necessary to meet the goal.
Example: Among the NPSGs required for hospital accreditation in $2020$ is the goal that agencies identify patients correctly, which includes two Elements of Performance:
- (1) consistently using two methods of identifying the patient, and
- (2) ensuring that patients receiving blood transfusions are correctly identified prior to transfusion.
Note: For detailed guidance, refer to The Joint Commission materials (NPSG) and related safety frameworks.