Closing the Gap and Raising the Bar: Assessing Board Competency in Quality and Safety.

BACKGROUND: Despite recognition of the important role that governance and executive leaders play in ensuring patient safety and quality, little research has examined leaders' involvement in these areas beyond surveys that assess higher-level knowledge and understanding of patient and workforce safety concepts. METHODS: A survey was sent to a convenience sample of board members and CEOs, as well as unpaired safety and quality leaders (SQLs). The survey included approximately 36 questions asking board members and other non-CEO executives their knowledge, understanding, and board activities related to safety and quality, and SQLs their perceptions of their own boards' knowledge, understanding, and activities related to safety and quality. An analysis of the responses of each of the three groups was conducted to assess baseline ratings, as well as to examine similarities and differences. RESULTS: Overall, similar patterns of self-reported knowledge, understanding, and activities related to safety and quality were evident between the board and CEO groups across virtually all areas examined in this survey, although groups were unpaired. Differences of varying degree were found at the level of individual survey items between board members' and CEOs' responses. SQL ratings were generally lower than the ratings of both board members and CEOs. CONCLUSION: This survey reveals specific areas of focus for improving governance and leadership practices at board meetings, as well as several areas where knowledge and understanding of safety and quality were variable. Further research and consensus would be beneficial to identify best practices for board education and governance activities to drive quality and safety.

Advancing sedation assessment to promote patient comfort.

As sedation assessment continues to evolve towards a more disciplined and standard part of clinical practice, the use of subjective sedation scales and objective sedation tools such as the BIS monitor continues to grow and show promise. The efforts of critical care nurses and their colleagues to better understand the value of these tools is integral to guiding their use and optimizing patient comfort.