“I am passionate about Speaking Up because it is one of the best ways to eliminate preventable harm to patients and colleagues,” exclaims Nurse Clinician Dionna Long, the SGH winner of the Target Zero Harm Individual Award 2021. Not only does she practise it, she also makes sure to train her juniors so that they learn the importance of raising safety concerns.
In March this year, NC Dionna showed her nurses how close they came to giving a patient a double-dose of medication because they did not clarify when they were in doubt. PO Resonium was prescribed to lower the patient’s potassium level. If the patient had been overdosed on PO Resonium, she might have suffered tachycardia or worse – paralysis.
As the Nurse Clinician supervisor on duty, NC Dionna was listening to the handover between two staff nurses in the afternoon. “I noticed that the medication records system had highlighted the entry for PO Resonium in red. The system was alerting us that either the drug had been given but the staff did not sign in to indicate it as such, or that it had not been served,” she explained.
But the nurses did not seem to know that something was amiss. When asked, the day nurse said she did not know why the entry was in red. Neither had she clarified with the colleague from the previous shift during their handover, as the medication should have been served at 2am. “Immediately, I instructed her to check with the night nurse from the previous shift. We found out that PO Resonium had been served, but the records were not updated,” recounts NC Dionna, who works at SGH Ward 53C looking after geriatric patients.
“Then I asked both nurses to reflect on how their actions could have harmed the patient. And I reminded them to be vigilant during handovers and - when in doubt – to speak up and clarify with the nurse who was handing over.”
NC Dionna knew she had succeeded in delivering an important lesson when her nurse told her, “Sister, I will forever remember this incident. It has been imprinted on my mind.”
At another handover in May this year, NC Dionna made a good catch and prevented a patient from suffering kidney damage. “I heard that a patient on PO Metformin was going for a CT scan that evening. However, I noticed that PO Metformin had not been suspended according to the protocol,” recalls NC Dionna.
PO Metformin interacts with the dye, which is injected during a CT scan, to cause lactic acidosis where the blood becomes too acidic and damages the kidneys. “At once, I told the nurse to check the protocol for a CT Scan. Hence, PO Metformin was suspended on the day of the CT Scan and for the next 48 hours,” says NC Dionna.
And instead of berating or scolding her juniors, NC Dionna said her approach was to ask them to reflect how their actions could have harmed the patient. "I also reminded both nurses to be vigilant during handovers, and to go through the protocol for a CT scan when handing over to remind themselves that PO Metformin must be suspended."
This way, NC Dionna builds the Speak Up culture – by facilitating open and honest sharing with one another in the hospital – about near misses, best practices and observations. “This transparency will not only result in a safer SGH, but it also focuses everyone's efforts on continually identifying potential problems and ﬁxing them - helping to build and sustain a safety culture within SGH,” reiterates NC Dionna.