Читать книгу Kelly Vana's Nursing Leadership and Management - Группа авторов - Страница 243

Individuals use skill‐based performance for routine, familiar tasks that can be done without thinking about them. The drive home, for example, may be so familiar that drivers arrive without knowing how they got there. Nurses often function in this mode because of the repetitive nature of some nursing tasks. Consider, for example, Jerry who is completing his documentation in the EHR. Jerry logs onto the EHR many times each day and he doesn't need to think about his user identification or his password. He's on auto‐pilot. He pulls up his assigned patients in the EHR and begins to document.

Generally, skill‐based performance is accurate, but there is still risk for error. Slips occur when, without intending to, the individual does the wrong thing. Jerry could open a patient's record and document care that was delivered to a different patient. Lapses occur when, without intending to, the individual fails to do what he meant to do. Jerry could document on the correct patient but forget to save or file his work before closing the record. Fumbles occur when, without intending to, an individual mishandles a word or action. Jerry might notice that his patient was visited by a “dear friend” and accidently document that the patient was visited by a “dead friend.”

Several strategies help nurses to stop and think before acting to prevent skill‐based errors. Nurses may use PAR (Pause‐Act‐Review). With this technique, nurses pause for 1 or 2 s to focus their attention on the task; act by concentrating and performing the task; and review their actions to check for the desired result. This self‐checking takes only a few seconds but greatly reduces the probability of making an error. Double checking one's own work also helps to prevent these errors. Nurses learn to check, re‐check, and check a third time before administering medications. Determining that the right drug in the right dose is being given by the right route, at the right time, and to the right patient involves checking the medication label against the medication order or medication administration record three times. In addition, two unique patient identifiers are verified prior to administering the medication. Health care facilities typically define which two patient identifiers are to be used, most often full name and date of birth. High risk medications, such as insulin, may require independent verification by another nurse. The independence of this double‐check helps to prevent skill‐based errors.