The scenario: You are a DNP clinical coordinator in an urban teaching hospital that includes medical school students and a physician residency program. After an unexpected interruption, a medical resident inadvertently injected air into a patient’s central line, which resulted in the patient experiencing an air embolism. The patient was subsequently treated in the ICU and has made a full recovery. After much discussion among nursing staff, medical residents, and supervising physicians, the resident and supervising physician disclosed the error and apologized to the patient.

You are troubled by the delay in the disclosure and the lack of coordination among the nurses, supervising physician, and residents. You discuss your concern with the chief nursing officer (CNO) and ask to lead a project to develop a hospital-wide disclosure policy that includes the medical staff and teaching facilities and places more emphasis on appropriate elements of an apology The CNO supports your plan and announces her support during a nursing leadership meeting. You review hospital policies and find that the hospital has a nursing policy for disclosing medical errors.

Still, the policy does not address medical students, residents, or supervising or attending physicians. You conduct interviews with key hospital staff and medical staff to reveal that there has been no collaborative discussion regarding medical error disclosure between the hospital and medical staff, much less with the affiliated teaching facilities.

Working with the CNO, you have selected a project team that includes administration, staff nurses, medical staff members; faculty and students from the medical school; members of the medical ethics, quality-improvement, and risk management committees, as well as a former patient. Initially, you begin by drafting an aim statement to present to team members at the first meeting. Patterned on the SMART goals method, the aim statement reflects specific, measurable, attainable, realistic, and time-bound goals, but you also review IHI recommendations for aim statements for guidance. The IHI information regarding aim statements can be gotten from the following website:

www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovement TipsforSettin-gAims.aspx

Exercise: Develop an aim statement that reflects both SMART goals and IHI recommendations that you plan to present to the project team. What are some of the most important considerations in writing the aim statement? What type of comments do you anticipate from the various team members? How will you respond to their comments?