Domain 5: Quality and Safety

Descriptor: Employment of established and emerging principles of safety and improvement science. Quality and safety, as core values of nursing practice, enhance quality and minimize risk of harm to patients and providers through both system effectiveness and individual performance.

Contextual Statement: Provision of safe, quality care necessitates knowing and using established and emerging principles of safety science in care delivery. Quality and safety encompass provider and recipient safety and the recognition of synergy between the two. Quality or safety challenges are viewed primarily as the result of system failures, as opposed to the errors of an individual. In an environment fostering quality and safety, caregivers are empowered and encouraged to promote safety and take appropriate action to prevent and report adverse events and near misses. Fundamental to the provision of safe, quality care, providers of care adopt, integrate, and disseminate current practice guidelines and evidence-based interventions.

Safety is inclusive of attending to work environment hazards, such as violence, burnout, ergonomics, and chemical and biological agents; there is a synergistic relationship between employee safety and patient safety. A safe and just environment minimizes risk to both recipients and providers of care. It requires a shared commitment to create and maintain a physically, psychologically, secure, and just environment. Safety demands an obligation to remain non-punitive in detecting, reporting, and analyzing errors, possible exposures, and near misses when they occur.

Quality and safety are interdependent, as safety is a necessary attribute of quality care. For quality health care to exist, care must be safe, effective, timely, efficient, equitable, and personcentered. Quality care is the extent to which care services improve desired health outcomes and are consistent with patient preferences and current professional knowledge (IOM, 2001). Additionally, quality care includes collaborative engagement with the recipient of care in assuming responsibility for health promotion and illness treatment behaviors. Quality care both improves desired health outcomes, and prevents harm (IOM, 2001). Addressing contributors and barriers to quality and safety, at both individual and system levels, are necessary. Essentially, everyone in health care is responsible for quality care and patient safety. Nurses are uniquely positioned to lead or co-lead teams that address the improvement of quality and safety because of their knowledge and ethical code (ANA Code of Ethics, 2015). Increasing complexity of care has contributed to continued gaps in healthcare safety.

Entry-Level Domain 5 Competencies

5.1 Apply quality improvement principles in care delivery.

  • 5.1a Recognize nursing’s essential role in improving healthcare quality and safety.
     
  • 5.1b Identify sources and applications of national safety and quality standards to guide nursing practice.
     
  • 5.1c Implement standardized, evidence-based processes for care delivery.
     
  • 5.1d Interpret benchmark and unit outcome data to inform individual and microsystem practice.
     
  • 5.1e Compare quality improvement methods in the delivery of patient care.
     
  • 5.1f Identify strategies to improve outcomes of patient care in practice.
     
  • 5.1g Participate in the implementation of a practice change.
     
  • 5.1h Develop a plan for monitoring quality improvement change.

5.2 Contribute to a culture of patient safety.

  • 5.2a Describe the factors that create a culture of safety.
     
  • 5.2b Articulate the nurse’s role within an interprofessional team in promoting safety and preventing errors and near misses.
     
  • 5.2c Examine basic safety design principles to reduce risk of harm.
     
  • 5.2d Assume accountability for reporting unsafe conditions, near misses, and errors to reduce harm.
     
  • 5.2e Describe processes used in understanding causes of error.
     
  • 5.2f Use national patient safety resources, initiatives, and regulations at the point of care.

5.3 Contribute to a culture of provider and work environment safety.

  • 5.3a Identify actual and potential level of risks to providers within the workplace.
     
  • 5.3b Recognize how to prevent workplace violence and injury.
     
  • 5.3c Promote policies for prevention of violence and risk mitigation.
     
  • 5.3d Recognize one’s role in sustaining a just culture reflecting civility and respect.

Advanced-Level Domain 5 Competencies

5.1 Apply quality improvement principles in care delivery.

  • 5.1i Establish and incorporate data driven benchmarks to monitor system performance.
     
  • 5.1j Use national safety resources to lead teambased change initiatives.
     
  • 5.1k Integrate outcome metrics to inform change and policy recommendations.
     
  • 5.1l Collaborate in analyzing organizational process improvement initiatives.
     
  • 5.1m Lead the development of a business plan for quality improvement initiatives.
     
  • 5.1n Advocate for change related to financial policies that impact the relationship between economics and quality care delivery.
     
  • 5.1o Advance quality improvement practices through dissemination of outcomes.

5.2 Contribute to a culture of patient safety.

  • 5.2g Evaluate the alignment of system data and comparative patient safety benchmarks.
     
  • 5.2h Lead analysis of actual errors, near misses, and potential situations that would impact safety.
     
  • 5.2i Design evidence-based interventions to mitigate risk.
     
  • 5.2j Evaluate emergency preparedness system-level plans to protect safety.

5.3 Contribute to a culture of provider and work environment safety.

  • 5.3e Advocate for structures, policies, and processes that promote a culture of safety and prevent workplace risks and injury.
     
  • 5.3f Foster a just culture reflecting civility and respect.
     
  • 5.3g Create a safe and transparent culture for reporting incidents.
     
  • 5.3h Role model and lead well-being and resiliency for self and team.