How do we improve patient safety in the Emergency Department?
The A&E clinical indicators are what Emergency Departments are measured against looking at how long a patient waited, how many waited over 4 hours, how many left without being seen, how many patients returned, percentage seen by triage within 15 minutes, percentage seen by clinician in 1 hour and the feedback comments received from patients. These are useful in terms of departmental performance but in the last few years they have become almost impossible to achieve.
7 years ago most EDs were able to achieve seeing 95% of all patients within 4 hours. Now almost no EDs are able to achieve this. In those 7 years ED attendances have gone up by over 10%, staffing numbers have been stagnant despite constant asking, staff training has been almost non existent, and funding has reduced. So how is it going to be possible to maintain safe effective patient care without commitment to change.
I’ve worked in the ED for around 15 years and I’ve never before known morale to be so low. If you ask any of the nurses I work with the one thing that they say to be a factor is that they haven’t been able to look after their patients properly during their shift. This is happening every single shift. They are also being blamed for not achieving the quality indicators every day. I have shifts where I am spending time consoling upset staff, trying to raise morale, give constructive advice, debrief for bad shifts and everyday I go home exhausted! Then I get a day off and have several phone calls, texts emails and social media posts asking for advice or help to cover shifts …. no wonder the staff are exhausted and morale is low.
So what can be done to help improve the situation?
The firefighting needs to stop and start planning for the future, look at staffing levels and training, review incidents to see where mistakes have happened. Allow staff to have a work – life balance and start to look after them, provide pastoral care and forums to bring up suggestions.
There are tools to help assist patient safety, the BEST staffing audit from the RCN Emergency Nurse Forum can help to identify nurse staffing needs. To be fair this is a great tool but should be done independently, and is significantly time consuming to do.
RCN competencies for Emergency nurses can identify training needs. It is so important to train nurses to work in the ED. Don’t just shove any old nurse into a vacancy but give them the appropriate skills to work in the ED to make them more effective, and ultimately making patient care safer.
Create a safety culture instead of a blame culture. When the department is not performing look at what would make it safe instead of blaming the people working in that situation for the performance.
Policies for overcrowding. I’ve not seen any of these but I think it’d be useful so that the nurse in charge has the ability to understand how to manage safety with overcrowding.
Has anyone else got any ideas we can try?