Patient Safety

NPSG: Identify Client Safety Risks: Reduce the Risk of Suicide

• 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).

NPSG: Universal Protocol: Prevention of Adverse Events in Surgery

• 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:

  1. Use two identifiers to confirm client identity.

  2. Mark the surgical site when applicable.

  3. 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).

NPSG: Improve Health Care Equity

• 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).

NPSG: Use Alarms Safely

• 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.

NPSG: Prevent Hospital-Acquired Infections

• 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:

  1. Central line-associated bloodstream infections (CLABSI)

  2. Catheter-associated urinary tract infections (CAUTI)

  3. Surgical-site infections (SSI)

  4. 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).

Using Medications Safely: Labeling and Anticoagulant Management

• 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.

NPSG: Improve Staff Communication

• 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.