Attention to Detail in Nursing: Essential Tips for Patient Safety and Quality Care
Attention to detail
Imagine this: During a routine check of a patient's medication, a nurse notices a slight discrepancy in the dosage. Instead of dismissing it as a minor error, she double-checks the prescription and discovers that the patient has been prescribed double the intended dose. By catching this mistake, she prevents a potentially life-threatening overdose and provides patient safety. This is not just a rare occurrence; studies have shown that attention to detail in medication administration alone can reduce errors by up to 50%, significantly improving patient safety and outcomes. This underscores the crucial role of each nurse in ensuring patient safety through their attention to detail. Your actions as a nurse can truly make a life-saving difference.
Attention to detail is a fundamental quality that can distinguish a good nurse from a great one, ensuring patient safety and high-quality care. For example, a preoperative nurse is given the order to place a Foley catheter during surgery. She remembers the procedure and uses a sterile technique to insert the catheter. Just as she gets urine in the tubing, another nurse calls her to help with her agitated patient. The preoperative nurse leaves the client with a catheter in place, but the balloon is not dilated with normal saline. The patient's bladder becomes quite full during the surgical procedure and releases into the tubing. As the nurses and orderlies pull the patient into the bed on the unit, the catheter comes out. Six hours later, the patient complained of needing to go to the bathroom. The nurse tells her she has a catheter and just to relax, and it will take care of it. The nurse did not check placement at that time.
A nurse pointing out a small error in the patient's chart.
The Multi-Step Nature of Nursing Tasks
Tasks in nursing are complete with multiple actions, such as wound care or medication administration. Wound care alone has many steps; if one is missed, it could cause an infection.
For example: a patient has a pressure ulcer packed with kerlix (a long gauze strip suitable for packing into the deep wound and collecting drainage), and the nurse on the oncoming shift does not read that two kerlix were placed in the deep wound. Upon inspection, after getting the first kerlix out, maybe the nurse could not see another kerlix, so she started packing a new kerlix in the wound. Then, the nurses after her are only told of one kerlix and do not look for the second one. The client spikes a high temperature of 103 three days later. The doctors look at the wound and find the second kerlix full of purulent drainage. After blood cultures, the client has been diagnosed with sepsis. The infection had gotten into the client's bloodstream.
Click the link for instructions on how to treat a pressure ulcer with a packed wound ( Procedure: Wound Packing ).
A real-life medication administration in which all the steps were not followed happened when I was a director of nursing at a local nursing facility. The nurse was doing her morning medication pass. The morning had been hectic, and she was constantly being interrupted by staff and visitors. At the end of the shift, the oncoming nurse and off-going nurse counted the narcotics to ensure all medications were accounted for. Upon inspection, there was one fentanyl patch missing. But when they checked the medication sheet, the patient was only to receive one. The two nurses went to the patient’s bedside and checked her body for the fentanyl patch. One was placed on her chest and one on her back. After reflection by the day nurse, she left the cart after putting in the first patch and did not mark it as given. So when she returned, she placed the one on the client’s back, thinking she needed to remove it from her chest. But again, she was called away and never returned to this patient. Vitals were taken of the client, and her BP was low—her 95/45 Pulse was 62. The MD was called, and new orders were received. Nursing best practice would be to tell staff (and families of patients) to wait until the nurses are done with their medication pass for their patients, and then their concerns can be addressed. This action of telling them to wait, is a nursing best practice.
A nurse going through their checklist
Checklists and Protocols
In school, you were given checklists or protocols in the hospital for the proper procedure for doing these tasks. But as you get more and more comfortable, it is easy to miss steps. That is why priority questions on the NCLEX about putting procedures in order, can be so hard.
What would be the best practice for you as a brand-new nurse? Put your ideas in the comments!
A nurse assisting her patient at their bedside.
Why Attention to Detail Matters
Patient Safety: We have discussed two cases in which the patient was detrimentally affected by the nurse's omission of care. Whether it was due to not getting the second kerlix out of the wound during a dressing change, or due to not documenting medication as given to the patient before leaving the medication cart. We can think of many more. One example is not checking the placement of an NG used for nutritional support between meals. If the NG is in the lungs instead of the stomach, the patient could get aspirational pneumonia and could almost die. Ensure that you follow the procedure for quality of care!
Quality of Care: When we, as nurses, ensure that all the procedure steps are done correctly, our clients get well faster with fewer complications. They go home to their families and can live their lives. I can personally attest to the importance of a nurse who follows the procedure steps, and prevents the patient from getting sick. I had an experience in the hospital where I was receiving TPN and lipids on certain days. The nurses would leave the tubing for the lipids in the room to remind themselves they needed to get it. One nurse came into my room, picked up the tubing, and started to spike the lipids. I stopped her and asked her to get the charge nurse. The charge nurse removed that nurse from my care. I did not get another infection because I stopped her. But it was her job to know, not mine as the patient. This experience underscores the importance of sharing our experiences and learning from each other. By doing so, we create a supportive community of nurses committed to maintaining high standards of care. Your experiences and insights are valuable, and by sharing them, you contribute to our collective learning and growth.
Professionalism and Trust: The nurse's action with the lipids did not build my trust in her; it did the opposite. I also have a reputation for watching nurses do their jobs to protect myself from their mistakes. I wish I did not need to do that. I like being able to make friends with the nurse and just be the patient.
A nurse verifying the MD's orders for his patient.
Developing Attention to Detail
Tips and Strategies: Use checksheets or protocols to ensure you have completed all the nursing procedure steps. Staying organized with the shift report sheet and individual shift reports will help complete all the steps. Writing things down on the shift report sheet as you go will help when it is time to document. Try to document at least every 2 hours or more frequently, depending on the severity of the patient’s condition.
Link to shift report sheet: Shift report sheet
Interactive Comments: What story do you have about attention to detail and its effect on patient outcomes? I want to motivate my readers to implement the strategies discussed and continuously improve their attention to detail. I will post a commitment to pay attention to detail on my Instagram page. Find that post and put #attentiontodetail as your commitment in the comments.Let's see how many committed new nurses and nclex prep students we can get on Instagram!
Additional Resources: Books to help you with your attention to detail
https://amzn.to/3WnaMUy FIGGERRIDOUT: The Attention-To-Detail Handbook Kindle Edition by Dan Fradenburgh (Author) Format: Kindle Edition
https://amzn.to/3WqqUV2 Attention to Detail: A Look at Walt Disney World Attractions (Volume 2) Paperback – May 6, 2014
Share your thoughts and experiences with critical thinking in our blog comments below for new nurses and NCLEX graduates. What strategies have worked for you? Let's learn and grow together!
Remember, we're all here to learn and grow. If you are afraid no one else will say anything or they will make fun of you, I promise I will stick up for you, and they will be removed from the website for a short time to learn that it is inappropriate. I will also talk to you about your answer so that you will be one of many talking in the comments. We're all in this together, learning and improving as a community of nurses.
This adventure is just beginning, and you're already making a difference. Keep up the great work, and stay tuned for more tips and tricks on your nursing expedition!
Comment below!
I invite my readers to join a discussion in the blog comment section to share tips and support each other in developing this essential skill.
Share your thoughts and experiences in the comments:
What would be the best practice for you as a brand-new nurse?
What story do you have about attention to detail and its effect on patient outcomes?
Any tips or stories you'd like to share with your fellow new nurses?
Ready to embark on this learning journey? Let's make this learning experience interactive and fun!
Share your answers in the blog comments to learn from each other.
