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Journey to High Reliability Pulmonary Hypertension Nursing practice

Stephanie Ruen


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Conference: 2017 PH Professional Network Symposium

Release Date: 10.06.2017

Presentation Type: Abstracts

File Download: 2017 PHPN Abstract 1036

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Abstract presented at the 2017 PH Professional Network Symposium held in Bethesda, MD on October 5-7, 2017


Design an Inpatient Nursing practice using High Reliability principles to create a zero-defect environment. 


Hospital admissions for Pulmonary Hypertension (PH) patients can be dangerous. The smallest of medication errors could mean serious injury or death. Developing a nursing care program that keeps PH patients safe from harm is not an easy task. High Reliability principles when applied to healthcare result in stunning improvement in quality, safety and outcomes. High Reliability healthcare has been described as a “passionate commitment to excellence” that permeates the daily actions of healthcare workers, producing a culture so effective that nearly perfect safety procedures are the norm.


High Reliability principles were applied in the development of:
1. PH nursing policies and procedures with yearly reviews to continuously improve processes and performance
2. PH nursing education and training at three levels of competence
a. Orientation- Competent Level
• 8 hour class containing 4.5 hours of Lecture, 1.5 hours of skill
stations and 1.5 hours of simulation
b. Proficient Level (Level 2)
• 8 hour class 4.5 hours of Lecture, 1.5 hours of skill stations and 1.5 hours of simulation
c. Expert Level (Level 3)
• Prerequisite pretest using online or printed material
• 4 hour class: 1.5 hours of skill stations and 2.5 hours of simulation
• Requirement to assist in teaching Orientation or Level 2 class or precept new hires in the care of PH patients


Results: Elimination of prostacyclin emergencies and medication errors related to nursing practice in the two core PH nursing units where patients are admitted within the first 12 months of program launch. The program is in the third calendar year with only one minor error occurring on the PH nursing units. A significant increase in near-miss (where error never reaches the patient) reporting through nursing and pharmacy channels.


High Reliability Pulmonary Hypertension Nursing practice is possible when leadership, Medical staff, Pharmacy staff and Nursing staff share the culture and practice where all members of the PH team are acutely aware that even small failures in safety protocols or processes are unacceptable where ZERO is the goal. Maintaining excellence is as difficult as attaining excellence. High Reliability principles provide the tools and guidance to successfully maintain excellence if ZERO defines the attitude of the organization.