JHQ 309 Quality and Safety in Nursing - Recommendations From a Systematic Review-JHQ 309 Article

JHQ 309 Article

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This article reports a systematic review aimed at developing evidence-based recommendations to strengthen the Quality and Safety (Q&S) element of the U.S. military nursing Joint Professional Practice Model (JPPM). Recognizing nurses as the only consistent 24-hour presence in hospitals and therefore central to preventing errors and improving outcomes, the authors note that patient safety progress has been uneven since <em>To Err Is Human</em> and argue for renewed, practical guidance.

Using PRISMA 2020 reporting standards, a tri-service team of nurse scientists searched five databases (CINAHL, Embase, Joanna Briggs, PubMed, Scopus) for literature from January 2001–December 2020. Studies were included if they addressed patient safety through nursing interventions, nurse quality indicators, Q&S systematic reviews, or qualitative/quantitative research; opinion pieces, non-generalizable settings (e.g., hospice/long-term care), non-nursing–focused work, and many international studies were excluded. Covidence software supported screening, extraction, and collaboration; interrater reliability for extraction was 0.88. Of 13,597 records identified, 249 articles were synthesized (only 2% military-specific).

The synthesis produced 94 actionable recommendations organized into eight focus areas: (1) communication, (2) adverse events, (3) leadership, (4) patient experience, (5) quality improvement, (6) safety culture/committees/councils, (7) staffing/workload/work environment, and (8) technology/electronic health record. Adverse events had the strongest evidence base and the most recommendations (e.g., reducing medication interruptions via “no interruption zones,” using barcode medication administration, implementing rapid response systems and early warning criteria, early ICU mobility, and checklists). Some areas—especially staffing and work environment—showed strong associations with outcomes but fewer tested interventions.

The authors conclude these recommendations can guide facilities in prioritizing Q&S initiatives, identifying gaps, and tailoring implementation based on local resources, with full JPPM implementation targeted for military treatment facilities by mid-2024.

Keywords

systematic review

PRISMA 2020

military nursing

Joint Professional Practice Model (JPPM)

quality and safety (Q&S) recommendations

patient safety nursing interventions

adverse event prevention

medication safety (barcode administration, no interruption zones)

safety culture and leadership

staffing workload and work environment