Creating an organizational culture for medication safety.

Medication errors are costly from human, economic, and societal perspectives. All patients are vulnerable to the detrimental effects of these errors. Recommendations regarding the problem of medication errors include: Prevention of error by learning from the nonpunitive reporting of errors and near misses; Evaluation of the system for potential causes of error through failure mode and effects analysis and encouragement of a questioning attitude; Elimination of system problems that increase the risk of error; Recognition that humans are fallible and that error will occur even in a perfect system; Minimization of the consequences of errors when they do occur. An important goal for healthcare organizations should be to create a culture that accepts the imperfection of human performance and solicits the assistance of team members in the development of safeguards for error prevention. Proposed interventions to prevent medication errors can be described by the PATIENT SAFE taxonomy, which includes: Patient participation; Adherence to established policy and procedures; Technology use; Information accessibility; Education regarding medication safety; Nonpunitive approach to reporting of errors and near misses; Teamwork, communication, and collaboration; Staffing: adequate number and staffing mix; Administration support for the clinical goal of patient safety; Failure mode and effects analysis with team member involvement; Environment and equipment to support patient safety

The doctorate in nursing practice: moving advanced practice nursing even closer to excellence.

One of the most significant events to affect advanced practice nursing is the practice doctorate. The doctor of nursing practice (DNP) is firmly established as an educational alternative to the traditional academic research doctoral degree. This option empowers nurses to advance knowledge and skills in clinical practice. This article reviews the historical context that led to the introduction of the DNP and the proposal of the DNP as entry into practice for advanced practice nurses, DNP program parameters, and some of the evolving issues related to nursing's practice doctorate.