Abstract

Over recent years there has been a widespread incorporation of non-technical or ‘human’-factors-based safety procedures into clinical practice to improve care quality and patient safety during emergencies in a hospital setting. Many medical emergency and arrest teams all over the U.K. currently use start-of-shift briefing and role allocation as a standard procedure to improve teamwork and patient safety during emergencies. However, despite usually being the first staff group to identify the deteriorating patient and initiate emergency care, ward nurses do not routinely use non-technical safety procedures prior to emergency team arrival. This study set out to examine and improve nurses’ perceptions of non-technical factors during emergencies in a ward-setting. The initial survey highlighted issues with leadership, role allocation, feelings of stress and confusion and overcrowding of staff during emergencies. Based on the survey responses, an intervention was designed comprising a pre-shift emergency briefing procedure, supported by a briefing poster and a written guide for lead nurses, along with a emergency management role allocation system for nurses, supported by identification badges. Two wards in a large tertiary care centre were chosen for the trial – a Level 1 surgical ward and a Level 2 medical ward – and lead nurses were trained in conducting briefings and allocating roles. The intervention was trialled on the two wards for one year, with regular visits to the ward to gather live feedback, resolve issues and monitor compliance. Following the trial, written feedback was collected from the involved nursing staff to examine whether nurses felt that the intervention improved their experience of emergencies. In the follow-up survey nurses reported significant improvement in perceived leadership, teamwork and individual confidence during emergencies and 52 of 56 (93%) respondents felt the system should be introduced Trust-wide.