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Practice comment

What one thing could you change to improve patient safety?


The Change One Thing campaign calls on all nurses to think of one idea  to make care safer. Nurse leaders must be receptive to ideas, says Dawn Wardell

If you could change one thing tomorrow to improve patient safety, what would it be? As this issue moves higher up the political agenda, the Change One Thing campaign is asking all nurses to propose one single idea to improve care.

Launched to coincide with the Patient Safety Congress in May, a joint event organised by Nursing Times and Health Service Journal, this campaign recognises the vital part nurses play in improving patient safety.

Change One Thing gives nurses an excellent opportunity to shape the way in which services are delivered. It is well recognised that we are there for patients 24 hours a day, seven days a week, and provide continuity of care for them and their families. There are over 600,000 nurses in the UK - if we all put forward just one idea, we could achieve amazing things. It sounds so simple, so why aren’t we already doing that? What are the barriers to improving patient safety?

I went on a “walkabout” in my trust to ask frontline staff what stops them suggesting ideas to improve patient safety. They said it depended on managers’ and nurse leaders’ attitudes to their ideas; if staff are made to feel stupid or generally not listened to when making suggestions it can discourage them from proposing new ideas in the future.

Nurse leaders need to act on this feedback and cultivate, support and nurture these ideas. It takes courage for staff to come forward and suggest new things, and how managers respond to the initial approach is crucial. An appreciation of the fact that they are thinking about how to improve services and have taken the trouble to come up with ideas is important – regardless of whether the idea is workable or not. 

Productivity is the key word in the current economic climate so if any ideas involve improved effectiveness, quality and/or cost efficiency I am sure senior staff will be interested.

You can probably remember a time when someone made a change in your area and you thought, “Why do that? It’s not practical, it won’t work”. But the crucial question is, did you have a better idea? We can either be done unto or take the initiative and lead from the front.

An important maxim to remember is “Don’t knock it until you’ve tried it”. It is not necessary to have a complex project plan, go through several committees and take six months before seeing benefits in the quality of care. The way service improvement works is by using small tests of change, for example, a change in care delivery for one patient on one occasion.

Many nurses will protest they are too busy and changing care delivery would create more work. But if it was your family, wouldn’t you want the best for them? Would you be happy if the nursing team told you they were too busy to make changes to prevent harm?

As for me, what one thing will I do today? I have been giving this much thought and have decided that improving medicines administration is my next challenge.

I am going to try using a highlighter pen to mark on the drug administration card where medicines are not administered for any reason. This will show clearly just how much therapeutic treatment a patient may not be receiving, potentially delaying recovery. It may make us think of alternative routes, timings and preparations, to ensure patients have continuous medication. It will be on one drug round on one ward for one bay. The aim is to keep it simple and see if it works. That’s my idea – what’s yours?

DAWN WARDELL is acting director of nursing, George Eliot Hospital Trust, Warwickshire


Readers' comments (20)

  • More Staff would help... don't you think????

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  • i agree with the previous entry....more staff is the one change that would improve the safety of all patients...

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  • Oooooh so many to choose from....if we've got more staff covered as above then I would say braver management

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  • good communications between colleague is most important, and when implementing new change how to make care safe...

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  • More staff Meeting targets with so little staff, causes stress on nurses leading to possible mistakes. Get rid of managers and put more staff on the shop floor

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  • The system needs more O2 rather than being prodded to run on sats of something like 89%. Stop starving the system and there will be a system that safely works with willing, vital and effective workforce.

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  • No brainer, more staff!

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  • As previously noted this one is easy, more staff please! Not only would this ensure safer patient care, this would also enhance staff's health and well being. Which in return will directly benefit our patients!

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  • I agree with most people's suggestion, more staff obviously will definitely make a huge difference. Also more support to staff education, training and development.

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  • I agree with the above comments...more staffs,willingness to work and commitments to the job..and of course good team work.

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