No abstract

Complex, multidrug chemotherapy protocols commonly are administered to patients with cancer. At every step of the chemotherapy administration process, from the point that chemotherapy is ordered to the point that it is infused and beyond, potential for error exists. FMEA, a proactive process that promotes systematic thinking about the safety of patient care, is a risk analysis technique that can be used to evaluate the process of chemotherapy administration. Error prevention is an ongoing quality improvement process that requires institutional commitment and support, and nurses play a vital role in the process.

Chemotherapy education at a mid-sized community hospital was redesigned to help novice oncology nurses improve patient safety and their own practice by implementing error prevention techniques during chemotherapy administration. Using a proactive approach with multidisciplinary participation and open communication, a systems analysis was conducted to identify potential chemotherapy errors. Then, chemotherapy processes were devised or strengthened to avoid errors. The project required a philosophical shift from error measurement to safety promotion.

This is the second in a two-part series on designing healthcare settings to improve patient safety. Part I addressed concepts of error theory and evidencebased practice as they relate to planning safe care environments (Sheridan-Leos, 2008). Part II describes the design and planning of oncology care settings to prevent fungal infections and improve provider handwashing.There is currently an explosion of healthcare construction and remodeling in the United States; as the oncology population will soon be increasing, oncology care settings are part of the building boom. Given the number of organizations that are adding or planning to add care facilities, the time is now for nursing's input into the design of healthcare facilities.The design of healthcare facilities has an impact on patient safety issues relating to nosocomial infection. A white paper on nursing-sensitive patient outcomes published by the Oncology Nursing Society recognizes prevention of infection as an important safety outcome that is sensitive to nursing interventions (Given & Sherwood, 2005). Additionally, 3 of the 15 outcomes endorsed by the National Quality Forum (2007) as nursing-sensitive performance measures are related to infection. Oncology nurses need to be part of the planning, design, and demolition phases of constructing and remodeling healthcare facilities to mitigate risks for patients with cancer. The objectives of this article are to: (a) describe the impact of healthcare-associated infections on patients with cancer and (b) describe evidence-based design of healthcare environments to prevent fungal infections and promote handwashing.

Oncology care is delivered under challenging circumstances. The principles of reliability science are used extensively in numerous high-risk and high-tech industries to improve quality and safety. This two-part series will discuss the concept of reliability science in the context of oncology nursing practice as a way to improve the quality and safety of care provided to patients with cancer.