Professional Practice and Patient Safety
What to know
Professional practice focuses on systems, communication, and safety behaviors. Triage uses the Emergency Severity Index from 1 (immediate, life-saving intervention) to 5 (nonurgent), based on acuity and expected resource needs. Handoffs should use a structured tool such as SBAR or I-PASS to reduce omissions. Medication safety requires independent double-checks for high-alert drugs (insulin, heparin, opioids, paralytics, concentrated electrolytes), awareness of look-alike/sound-alike names, and reporting of near misses. Just culture distinguishes human error from at-risk behavior and from reckless behavior, encouraging reporting without punishment. Sentinel events trigger root cause analysis focused on systems rather than individuals. Know EMTALA obligations to screen and stabilize regardless of ability to pay, the elements of informed consent, restraint standards, and chain of evidence for forensic cases.
Traps
Punitive responses suppress reporting. "Blame-free" does not mean accountability-free. Do not accept verbal orders for high-alert medications when policy requires a read-back. Documentation should be timely, factual, and objective rather than editorializing.
Worked example
A nurse notices a heparin infusion programmed at ten times the ordered rate but catches it before administration. This is a near miss and should be reported so the pump library can be corrected. Rule of thumb: report errors and near misses to fix systems, not to assign blame.