Protectors on the Frontlines
Two patient safety nurses describe their objectives at Bayview Medical Center and Howard County General Hospital

Susan Will monitors safety for obstetric patients at Bayview Medical Center.

In this era of spiraling malpractice costs and a continued emphasis on reducing medical errors, nurses are quickly evolving into the sentinels of safety. Nowhere is this more evident than in the birth of a new role: the patient safety nurse. Skilled in performance improvement and staff mentoring, these nurses make safety initiatives their sole professional focus.

Susan Will, a clinical nurse specialist with more than two decades of experience in obstetrics, began in July 2004 as the patient safety nurse for the obstetrics programs at Bayview Medical Center and Hopkins Hospital. She was hired after MCIC Vermont, the liability insurer for both hospitals, determined that the high-risk obstetrics practices would benefit from having a go-to person to coordinate safety efforts.

A few months later, veteran pediatrics nurse Linda Ellwood took the reins as the patient safety nurse for all of Howard County General Hospital. Dome recently sat down with Will and Ellwood to find out how this new breed of nurse can affect care at a large institution and a community hospital.

Dome: What issues are unique to your particular institutions?

Will: Labor and delivery is an incredibly tense environment. Bayview’s staff is smaller than Hopkins Hospital’s—there are about 500 fewer deliveries a year—but the acuity is very high. The Center for Addiction and Pregnancy draws many obstetric patients with multiple addictions. And most Hispanic patients in Baltimore City deliver at Bayview, so the staff must often work through interpreters. But everyone is incredibly enthusiastic about patient safety, and there’s a lot of mutual respect between staff and leadership.

Linda Ellwood oversees safety at Howard County General Hospital.

Ellwood: We’re a tight little family. That’s good and bad—it creates better teamwork, but it also makes people feel like they’re “tattling” if they bring up a safety concern. As for the patients, most are well-educated, yet many don’t realize that it’s OK to question the decisions we make as health care professionals. We need them and their families to be as vigilant as we are.

Dome: How are you making patient care safer?

Will: Right now, my biggest initiatives are MCIC mandates. I’m conducting teamwork training sessions, called MedTeams, for all labor and delivery staff on both campuses. The goal is to improve communication between team members—from physicians to housekeepers—using techniques borrowed from aviation. I’m also collecting data to establish a baseline for risk factors and comparing it with statistics collected at other MCIC-insured medical centers.

Bayview had a well-established obstetrics safety program before I arrived. In addition to hiring me, the OB leadership committee added a charge nurse to the staff to improve coordination of care. They also hired more nurses, opened the newborn nursery 24 hours a day and developed a collaborative orientation program with Hopkins Hospital.

Ellwood: My challenge here is heightening awareness and breaking down old fears. Opening the door for discussions, I’ve found, is the best way. So I started a monthly meeting of the safety team leaders from every unit. I’ve also initiated monthly executive rounds, where a hospital executive “adopts” an individual unit so they can discuss safety issues face-to-face with frontline staff. Finally, I’ve hosted a couple of two-day retreats where nurses, techs and managers leave the unit and learn tools for working through problems.

An in-house publication, The Goal Post, reinforces patient safety and infection control campaigns. For the public, we’re developing a patient-safety section for our Web site (www.hcgh.org) and writing about safety from a patient perspective in our community newsletter, Wellness Matters.

Dome: Any other plans?

Will: I want to be very visible at both Hopkins Hospital and Bayview. After I wrap up the MedTeams training, I’ll be spending a lot of time on both labor and delivery units to observe practice and support staff in their safety projects. I’ll also be monitoring reports logged with Patient Safety Net for trends that could have a negative impact on patient safety at JHH, and manually reviewing cases at Bayview until they roll out with PSN.

Ellwood: It’s clear that in the last six months, patient safety has jumped higher on people’s radar screens. Now I’d like to see all units doing monthly executive rounds. I’d like more people to report and be even more open about it. This isn’t just for nurses or physicians or techs. It’s about dietary and maintenance and environmental services too. Everyone is responsible.

—Lindsay Roylance