Standardizing Nurse Leader Safety Rounds to Promote Highly Reliable Care

Despite decades of intensive resource allocation to eliminate preventable harm and increase high reliability in the hospital, the prevalence of serious harm remains consistent.

A hospital reduced targeted preventable harms using audit and feedback (A&F) but failed to globally reduce harm or increase proactive awareness. Nurse leaders lacked a defined process for identifying errors, mitigating risk, and teaching systems thinking to influence resiliency among teams.

Nurse leaders underwent A&F of daily safety rounds. Adherence data on frequency, high-quality, and high-reliability organizational (HRO) leader practice standards and precursor incident reporting rates were trended.

Rounding practice adherence increased for the following defined standards: frequency (63%-79%); high quality (50%-90%); and HRO leadership (0%-67%). Precursor incident reporting rates increased 25%.

A&F reinforced quality and accountability for daily safety rounds. HRO theory-guided feedback offered an innovative way to translate HRO influence into nurse leader practice.