safe nursing is like safe sex (but definitely not as fun).

We have all done it at one time or another. Taken a short-cut. Not asked a question, for fear of it being a stupid one. Deviated from hospital policy. Passed on a hand wash. Cut a corner. Skipped a step. Missed a set of obs. Ignored a buzzer. Hurried a procedure. Or, we have stood by whilst someone else did. Well….. if we are going to screw our patients we had better use a condom.

roll it out. roll it on.

Every time a nurse performs an intervention or administers a medication, or carries out a doctors order, they should first cover it with a condom. This protective barrier is composed of overlapping and interwoven layers of evidence based practice, hospital policy, and teamwork. It is often well lubricated with years of personal experience. Its purpose is to protect the patient from being impregnated with errors, mistakes, near misses and systems failures. In the health system we have a veritable orgy of seriously nasty things just waiting for an opportunity to have intercourse with our patients. You might think of the resulting adverse outcomes as Slack-practice Transmissible Disasters or STD’s. Unfortunately many nurses don’t care much for these condoms. They think they are boring or take too long to put on. And others just like to stick them over their heads and blow them up with their noses. But you see, that’s one of the most important roles beholden to us as nurses. To be the patients advocate. To make sure nothing gets near our patients without a condom on it. If its not on, its not on.

pricks in our practice.

Yet each time we slack off and take that little shortcut or stand by while someone else does, we poke a hole in our condom. Usually a small pin-hole granted. We let it slide, hoping that the next person to become involved will slap their own protective condom over the top anyways. The more staff practicing safe nursing the thicker the layers of protection. Unless of course….they, also, make a small pin-hole. The more holes in the protective barriers the more likely an error is going to occur. And the more those holes line up, the more likely it is that the error is going to have a direct line of access to the patient.

the conception of an error.

Lets say for example that you are about to give an IV injection. You check for the correct dose and route and make sure the patient has no medication allergies. On goes a condom. However, everybody is really really busy and you can’t find anyone to double check the medication as per your hospital policy. Oh well, you’ve given this drug a hundred times…so you check it again… by yourself. Now, we have a hole. Luckily, on your way to administer the drug you run across a junior nurse. She double checks the drug for you. On goes a second condom. But she is already trying to multi-task about a zillion other things and doesn’t actually check the drug calculations… she assumes you (as a senior nurse) have done it correctly. Thats two holes. Un-beknownst to you, another nurse has placed an incorrect ID bracelet on the patient. Big hole. Now maybe this will result in a medication error and maybe it will be OK this time. But the continued use of faulty protection will sooner or later get one of your patients *up the duff*. On the other hand. Develop a habit of carrying a nice big mix of multi-purpose condoms (in a wide range of colours and flavours) in your kit, and you can at least be sure you have done your best to give your patients at least one intact layer of protection. Oh, and dont forget to wear one yourself.