Improving Patient Safety and Optimizing Nursing Teamwork Using Crew Resource Management Techniques

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This project describes the application of the “sterile cockpit rule,” a crew resource management (CRM) technique, targeted to improve efficacy and safety for nursing assistants in the performance of patient care duties.


Crew resource management techniques have been successfully implemented in the aviation industry to improve flight safety. Application of these techniques can improve patient safety in medical settings.


The Veterans Affairs (VA) National Center for Patient Safety conducted a CRM training program in select VA nursing units. One unit developed a novel application of the sterile cockpit rule to create protected time for certified nursing assistants (CNAs) while they collected vital signs and blood glucose data at the beginning of each shift.


The typical nursing authority structure was reversed, with senior nurses protecting CNAs from distractions. This process led to improvements in efficiency and communication among nurses, with the added benefit of increased staff morale.


Crew resource management techniques can be used to improve efficiency, morale, and patient safety in the healthcare setting.

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