Statistics on Suicide
Tenth leading cause of death in the U.S. (Heron, 2019; Roeten et al., 2018).
Second leading cause of death for ages 10-34 (Suicide Prevention Resource Center [SPRC], 2020).
Definition: Suicide defined as death from self-injurious behaviors intended to end one's life (SPRC, 2019).
Screening Requirements:
All clients (12 years and older) screened for suicidal ideation using validated tools.
Detailed assessment for those screening positive, exploring thoughts, plans, and self-injury behaviors (Harmer et al., 2021; Roeten et al., 2018; TJC, 2020b).
Safety Measures for At-Risk Clients:
Clients identified at risk for suicide placed under continuous surveillance in nonpsychiatric settings.
Remove potentially harmful items from the client’s environment using an environmental checklist.
Manage items brought into the room and control visitation.
Staff Competency:
Staff training and competency assessment necessary for proper monitoring and care for at-risk clients.
Guidelines for reassessment and written policies required for both inpatient and outpatient therapy (TJC, 2020b).
Definition of Adverse Events:
Situations that cause unexpected harm to patients (TJC, 2019b).
Preoperative Time-Out:
A mandated pause before surgery for confirming client, site, and procedure (TJC, 2020b).
Safety Protocols:
Use two identifiers to confirm client identity.
Mark the surgical site when applicable.
Perform a time-out (TJC, 2020b).
Client identifiers typically include name and date of birth.
Clients encouraged to verbally confirm their identity and surgical procedure.
Site Marking Procedures:
Surgeons must mark correct site for procedures with multiple potential locations.
Exclusions apply for bilateral organs or delicate areas; waivers required (National Patient Safety Goals® Effective January 2021 for the Office-Based Surgery Program Goal 1, n.d.; TJC, 2020b).
New Goal for 2024:
Focus on reducing disparities in healthcare and social injustice to enhance patient safety.
Assessment of Patient Needs:
Organizational leaders must identify factors affecting equity; assess social needs (e.g., literacy, housing, transportation, food access) during patient admission.
Continuous needs assessment throughout hospitalization including discharge planning enables improved equity (AJN, 2023, Stackpath, n.d.; The Joint Commission, 2024).
Standards of Compliance:
Facilities must meet and maintain TJC’s standards for compliance to retain accreditation (Mennella & Walsh, 2019a).
Over 250 standards, including medical error prevention, infection control, and emergency preparedness considered foundational (Mennella & Walsh, 2019a).
Purpose of Clinical Alarm Systems:
Audible alerts in medical equipment to warn of serious events or malfunctions.
Challenges:
Frequent false alarms lead to alarm fatigue, impacting response time to actual emergencies.
High noise levels in areas like ICUs complicate care delivery due to desensitization to alarms.
Policy Development:
Collaborative approach required for creating policies around clinical alarms among nursing staff, leadership, and manufacturers.
Nurses should participate in discussing which alarms require immediate attention to ensure client safety.
Definition of HAIs:
Infections acquired during hospital stay affecting patients due to different clinical conditions (CDC). Over 500,000 cases reported annually.
Types of HAIs:
Central line-associated bloodstream infections (CLABSI)
Catheter-associated urinary tract infections (CAUTI)
Surgical-site infections (SSI)
Ventilator-associated pneumonia (VAP)
Focus on MDROs:
Multi-drug resistant organisms pose significant risk due to their resistance to standard treatments.
TJC mandates hospitals monitor and develop strategies to reduce HAIs, particularly those involving MDROs (Mennella & Walsh, 2019b).
Labeling Requirements:
All medications used in procedures must be labeled accurately; unlabeled medications must be discarded.
Anticoagulant Medications:
Critical to manage carefully due to risks of clotting issues; include routine monitoring of patients and awareness of drug interactions.
Medication Reconciliation:
A crucial process to compare home medications with hospital prescriptions to identify discrepancies; should be routinely performed during admission and discharge for safety.
Importance of Reporting Critical Results:
Rapid reporting of laboratory results that are potentially life-threatening (e.g., critical sodium levels).
Facility Guidelines:
Defined elements for critical results reporting including immediate delivery and documentation of notifications to providers.
Communication Protocol:
Results should not be shared via voicemail but should be communicated directly, enhancing prompt action and complying with HIPAA.