Safety on the rise: How aviation concepts can lift nursing to a higher plane

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Former pilot Gary L. Sculli, RN, MSN, ATP, no longer works in the skies. But some might say he now leads his nursing unit to even greater heights.

Aviation safety concepts Sculli learned during his previous career are changing the way his staff members practice nursing at Baptist Memorial Hospital in Memphis, TN. Now nurse manager of a 40-bed unit, he has transferred his knowledge and experiences in the air to the bedside in the quest to improve safety in patient care.

One of the key changes Sculli promotes is instituting unit-based safety briefings that inform staff of safety concerns at the start of their shift. Specific information is discussed during this time between the off-going charge nurse and the on-coming staff member. By using a laminated checklist—a common tool in the airline industry—staff have a clear list of items to disclose, such as which patients are receiving high-risk medications or if there are patients with similar last names.

"The period is centered on unit safety," says Sculli of the briefing. "It is short, structured, and informational. And it gives the nurse a chance to ask questions."

The briefings also allow time to bring out any potential variances or close calls so that staff can share important information and errors can be avoided. 

A year ago, Sculli implemented another important initiative on his unit from his prior experiences in the aviation industry, this time to help reduce distractions during medication administration. By using an airline principle called the "sterile cockpit rule," Sculli says staff members learned how to maintain their concentration—even through chaotic times. In aviation, the rule mandates that pilots refrain from speaking to other crew members and partaking in other activities during critical phases of flight. Sculli says this same idea can be practiced during critical phases of nursing such as medication delivery. 

During this time, Sculli asked nurses preparing medications to wear a vest labeled, "do not disturb." The vest allowed the nurse to stay focused and made other nurses aware they should avoid diverting his or her attention and should intercept any potential distractions.

Piloting new projects in nursing

Where Sculli has exposed staff to concepts such as the "sterile cockpit rule" in the past, he is in the process of making them part of the everyday nursing practice in his unit at Baptist. A second pilot project is planned to make this possible.

One aspect of the new project is dividing the workload among nurses.

"Task load management is a major component of aviation's crew resource management, especially during periods of high workload where operational success is critical," says Sculli.

Sculli's approach is to create distinct roles, so certain nurses would be responsible for administering medication and others would be in charge of patient assessments. Sculli believes that combining a team-oriented approach with reduced distraction during medication administration will increase situational awareness. This ultimately leads to better decision-making opportunities for nurses and serves to reduce error and maintain operational safety. 

Briefings between nurses and nursing assistants are another big concept in the model that Sculli says can enhance teamwork and communication.

Sculli, along with Robert Koch, PhD, assistant dean at the University of Memphis Lowenberg School of Nursing, is in the midst of developing a nursing leadership curriculum for the University's undergraduate nursing program. The content will teach crew resource management (CRM)-based aviation safety concepts. The first seminar takes place this summer and will be directed at applying CRM principles to nursing care and practice.

In addition to his job at Baptist, Sculli frequently travels to hospitals and healthcare organizations across the country promoting the importance of exporting CRM directly into nursing practice. 

And just as CRM transformed aviation, Sculli believes it can transform healthcare.

"This needs to be implemented," says Sculli. "We can make our practices safer by implementing the basic pillars of CRM."