According to new research from Charles Darwin University, more nurses are needed to reduce the number of preventable deaths occurring in Australian hospitals each year.
Analysing the causes of system failure for her PhD, Charles Darwin University lecturer Melanie Underwood noticed a gap in the traditional review process.
“At the time of a death in a hospital, a review is undertaken, but often there is no follow up with staff at the frontline of care to analyse …how and why it happened,” Dr Underwood said.
“In the majority of cases, the number or skill mix of nurses was related to the unsafe act occurring.
“As nurses represent the largest group in the health care workforce, providing 24-hour care, they are in a key position to contribute to improving patient safety.”
Dr Underwood’s research was the first Australian study to analyse nurse-related adverse events resulting in the death of patients.
The former nurse of eight years used the Human Factors Analysis and Classification System, which was originally utilised in the US military to analyse failures resulting in adverse events.
Ninety nine variables, including nursing shift, type of death, specific types of unsafe acts and environmental factors were studied to understand how the behaviour of staff was impacted by the system.
“I found that almost all variables that had led to the deaths in each case were foreseeable and therefore often preventable,” she said.