Many of us associate faulty O’rings with the catastrophic explosion of Challenger in 1986 and a problem with the heat and tiles that caused the burning up of it’s sister ship, Columbia, during reentry in 2003. But, these defective materials/production issues were more like symptoms of a much deeper and insidious problem known as the Normalization of Deviance. Basically it refers to doing something the wrong way many times without any bad consequences. A bad habit evolves. But the right way of doing certain things is the right way for a reason and eventually these bad habits lead can lead to catastrophe.
For instance, take a look at the administration of medication in nursing process. As you can see, (and if you ARE a nurse, already know) it involves a very specific process of matching doctors orders to dispensed medication and identifying the right dose, person, time, route, (by mouth, topically, subcutaneous or intramuscular injection, etc). These steps are drilled into us in nursing school and clinical rotations. WE KNOW how to do it right.
BUT try to enact this process during an understaffed shift or in the midst of endless interruptions and it can be humanly impossible to do it right all the time! Shortcuts like these that may be survival mechanisms during such a shift may begin to take root in every day medication administration, especially if understaffing or endless interruptions are chronic:Shortcuts like these that may be survival mechanisms for understaffing, fatigue, excessive stress... Click To Tweet
- Relying on memory from earlier in the day or previous shift for some steps.
- Stopping in the middle of the process to answer an alarm and then rather than restarting the process picking up where ‘we’ think we left off.
- Trusting the pharmacy sent the right dose/medication.
- Gauging timing as close enough and may be the only opportunity.
- Patient is sleeping and don’t want to wake and there is dried up speghetti sauce on the bracelet bar code, (or scanner isn’t working or someone else has it).
Mostly these shortcuts don’t lead to errors or I should say problems, because the shortcuts ARE errors! But then some day a catastrophe happens, patients and families are hurt, nurse and physician’ careers are ruined, and we look back and say, “How could this have happened?”Not only are bad habits bad b/c they're unsafe, they are secrets, withheld by shame, fear, &… Click To Tweet
I don’t believe we really even know how often these shortcuts are made because they are taboo to talk about. Loss of license and/or respect are likely worries. Not only are the bad habits bad because they are unsafe, but they are also secrets, withheld by shame, inadequacy and fear.
So how do we prevent nurses from developing these bad habits?
WE DO THE THINGS THAT SUPPORT THE RIGHT WAY! These are important keys to administering medications and following any procedure safely. If you are a healthcare professional or consumer, what else would you add to this list?
- Training and review in the process
- Realistic workloads
- Quiet zones
- Enough administrative staff available to answer general questions/interruptions
- Enough nurses to handle appropriate interruptions/questions
- Ensure med cart supplies are well stocked
- Communication training in assertiveness & opportunities to practice with feedback and learning curve
- Medical improv training (A unit who co-creates their own solution will inherently be invested in it!)
Contact Beth: Beth@bethboynton.com