1. Nurse Manager’s Approach:

The nurse manager’s approach of writing reprimands for the decrease in timeliness of antibiotic administration is not ideal. This approach falls into the category of “blame culture”, which can have several negative consequences:

• Fear of reporting: Staff might become hesitant to report future errors or near misses due to fear of punishment, potentially hindering patient safety efforts.
• Decreased morale and motivation: Reprimands can demotivate staff, leading to decreased job satisfaction and potentially impacting the quality of care.
• Lack of focus on root causes: Reprimands address the symptom (delayed medication) but not the underlying causes of the delay.

A more “culture of safety” approach would involve the following:

• Open communication: Encourage staff to openly discuss challenges with the new system and report any issues without fear of punishment.
• Collaboration: Work with staff to identify the reasons behind the delays and develop solutions collaboratively.
• Supportive environment: Provide support and resources to help staff adapt to the new system and overcome challenges.
• Focus on learning: Analyze the situation to understand the root causes of the delay and use it as a learning opportunity to improve the system.

2. Risks of Workarounds:

Workarounds, while seemingly helpful in the short term, can pose significant risks in healthcare settings, including:

• Increased error potential: Bypassing established procedures can increase the risk of errors, potentially leading to adverse patient outcomes.
• Normalization of deviance: Over time, workarounds can become normalized, leading to a decreased sense of urgency to address the underlying problems with the system.
• Difficulty in tracking and addressing issues: Workarounds can make it challenging to track and address systemic problems effectively.

In the case of adding extra patient ID bands, the specific risks include:

• Scanning the wrong band: Scanning the wrong band could lead to medication administration errors.
• Increased confusion: The presence of multiple bands can create confusion for both staff and patients, potentially leading to further errors.
• Erosion of trust in the system: Staff reliance on workarounds can erode trust in the barcoding system, hindering its effectiveness.

Conclusion:

Reprimanding staff solely for a process-related issue is an ineffective approach. Instead, fostering a culture of safety through open communication, collaboration, and support is crucial for successful implementation of new systems while minimizing risks associated with workarounds.