title: Improving patient safety and optimizing nursing teamwork using crew resource management techniques.
abstract: OBJECTIVE
  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.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Crew resource management techniques can be used to improve efficiency, morale, and patient safety in the healthcare setting.
authors.affiliation: Health Research Scientist, National Center for Patient Safety Field Site, Veterans Health Administration, White River Junction, Vermont, USA. priscilla.west@va.gov
authors.forename: Priscilla
authors.initials: P
authors.lastname: West
authors.forename: Gary
authors.initials: G
authors.lastname: Sculli
authors.forename: Amanda
authors.initials: A
authors.lastname: Fore
authors.forename: Nwoha
authors.initials: N
authors.lastname: Okam
authors.forename: Cleveland
authors.initials: C
authors.lastname: Dunlap
authors.forename: Julia
authors.initials: J
authors.lastname: Neily
authors.forename: Peter
authors.initials: P
authors.lastname: Mills
mesh_terms: D017598:Efficiency, Organizational; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007318:Inservice Training; D009013:Morale; D009740:Nursing Staff / Q000193:education* / Q000458:organization & administration; D015279:Organizational Culture; D010348:Patient Care Team / Q000458:organization & administration*; D061214:Patient Safety; D010559:Personnel Management / Q000379:methods*; D013192:Staff Development; D013781:Texas; D017749:Total Quality Management; D014481:United States; D014493:United States Department of Veterans Affairs