My Turn

• Make safety a top priority. Leaders of outpatient facilities must articulate the principles that safety is the utmost priority, and that safety is everyone's responsibility. They should do so with an understanding that we are all in this together. Leaders must also encourage everyone involved in patient care to voice safety concerns, and embrace those concerns.
• Put it into practice. Don't take the traditional approach of creating more policies and procedures in an effort to ensure safe practices; this only complicates matters and adds to nurses' administrative burden. Rather, update existing policies and encourage simple steps that promote critical thinking. Take wrong-site surgery, for example. While it makes sense to update surgical site checklists, it also makes sense to call for a ?time-out' just before each procedure in which all OR team members pause to simultaneously verify the site. This simple idea is at the core of current JCAHO recommendations for avoiding wrong-site surgery.
• Speak up. Because they witness the entire episode of care, nurses are uniquely qualified to police safety practices. They must be willing to seek validation when needed, as in the case of unidentified or misidentified patients that can lead to medication errors. They must also be willing to point out flaws in clinical processes even when it means relinquishing professional responsibility. For example, drug errors occur in the outpatient setting in part because outpatient nurses have access to a large stock of medications. However, nurses are not pharmacists. By voicing these concerns, outpatient nurses can play a crucial role in ensuring that the healthcare team properly controls, identifies and stores ?high-alert' medications.

Dr. Beyea (sbeyea@aorn.org) is Director of Research with the Association of periOperative Registered Nurses.