By: Maria Stacks, BSN, RN; Lisa Cauthen, MSN, RN, CPN, and Marcia Hancock, MSN, RN Georgia Gwinnett College
The application of patient safety concepts is foundational and a critical element in nursing practice (Kowalski & Anthony, 2017). For novice nurses and students, the importance of patient safety throughout practice is often hard to comprehend. It is necessary to start with the basics in teaching skills and didactic instruction, as these are the foundation of patient safety. One such basic skill is hand hygiene when entering and exiting the room.
Novice nursing students lack a framework or experience that includes caring for patients in an acute care setting. Most students spend five to six weeks in the clinical skills lab preparing for hospital clinical including fundamental skills and concepts about safety and infection control. Supporting The Joint Commission (TJC) National Patient Safety Standards (TJC, 2020), skills checklists provide steps to identify the patient, perform hand hygiene, and communicate to the patient the purpose for entering the room. In a programmatic evaluation, it was noted that these steps were often overlooked by students or inconsistently performed during the validation of a skill or simulation-based experience. Additionally, it was observed that students failed to introduce themselves or communicate the purpose for entering the room. We began using the simple terms Safe Entry and Safe Exit, which bundle these steps into a fundamental algorithm encompassing the initial steps of patient safety and infection control.
Safe entry begins when entering a patient’s room and consists of the following: perform hand hygiene, introduce yourself, identify the patient using two patient identifiers, verify patient allergies, and communicate the purpose for entering the room. Prior to leaving the room, a safe exit is completed by ensuring: the bed is in the lowest position, the patient is comfortable and aware of the call light location, you communicate when you will return, and, when exiting, you perform hand hygiene once again (TJC, 2022; Taylor et al., 2019). The algorithm components for Safe Entry and Safe Exit are introduced in the skills lab at the beginning of the baccalaureate program and culminate to completion for NCLEX preparation (National Council of State Boards of Nursing [NCSBN], 2018) and practice. The terminology is recognized as a critical element on validation checklists, simulation and skills lab experiences, and clinical rotations.
Learners utilize this fundamental algorithm to ensure each component of entering and exiting the room is performed to promote patient safety (TJC, 2022). This simple approach will strengthen a core understanding of safe patient care (NCSBN, 2018) and equip novice nursing students with an organized approach to reinforce patient safety with each encounter. After using Safe Entry and Safe Exit, students expressed a decrease in anxiety about entering patient rooms and communicating with patients in all areas of clinical practice. As nurses and educators, we play a vital role in providing experiences to build knowledge regarding safe, high-quality patient care.
Kowalski, S.L., & Anthony, M. (2017). CE: Nursing’s evolving role in patient safety. The American Journal of Nursing, 117(2), 34-48. https://doi.org/10.1097/01.NAJ.0000512274.79629.3c
National Council of State Board of Nursing. (2018). NCLEX-RN examination: Test plan for the national council licensure examination for registered nurses. https://www.ncsbn.org/2019_RN_TestPlan-English.pdf
National Patient Safety Foundation. Free from harm: accelerating patient safety improvement fifteen years after To Err is Human. Boston; 2015. http://www.npsf.org/? page=freefromharm. http://www.ihi.org/resources/Pages/Publications/Free-from-Harm-Accelerating-Patient-Safety-Improvement.aspx
Taylor, C., Lynn, P., Bartlett, J. (2019). Asepsis and infection control. Fundamentals of nursing: The art and science of person-centered care (9th ed., pp. 622-624). Wolters Kluwer Health.
The Joint Commission. (2022). National patient safety goals. http://www.Jointcommission.org/standards/national-patient-safety-goals/