Safety

National Patient Safety Goals (NPSGs)

Annual goals created by The Joint Commission that focuses on client safety, safe and effective delivery of health care and recommendations to avoid adverse outcomes.

  • Identifying clients

    • Use two client identifiers to ensure that the medication, treatment, procedure, or care is intended for that specific client.

    • Could be name, DOB, designated hospital number, telephone number, or alt client-specific documentation.

    • Ask pt. open ended questions (e.g. What is your name and date of birth?) and confirm the pt.’s identity with their ID bracelet or electronic medical record.

    • Do not use pt.’s assigned room for identification purposes.

  • Improving interprofessional communication

    • Reporting critical results and findings promptly.

    • Lab or diagnostic procedure results that are outside expected range and can be cause adverse reactions or potentially fatal if not immediately improved.

    • Includes the ff. elements: facility’s definition of a critical result; defined time frame from when the results are available to when they are reported to the provider.

    • Written documentation of the notification of results to the provider (who received the results and who communicated them).

    • Always convey information directly to the provider in person or by telephone.

    • Should meet the HIPPA requirements and standards.

  • Safe medication

    • Label all medications, include date and time it was mixed and the medication name and dose. Discard any medication that has no labels.

    • Decrease errors associated with anticoagulant medications. Practical anticoagulant initiatives includes pt.’s weight, renal and hepatic lab values, dosage frequency, prescribed amount, interaction potential (all of which should be reviewed by pharmacists, providers, and nurses).

    • Medication reconciliation

      • Process in which the member of the healthcare team assesses the pt.’s current home medications and compares them with the newly prescribed medications, identifies any discrepancies or interactions, and takes steps to resolve these issues.

      • Medications could be continued, held, added or discontinued during the hospitalization.

      • It could be done any time but is routinely done on admission, discharge, or transfer or with provider change.

  • Use Alarms Safely

    • Audible alert devices built into medical equipment to warn healthcare providers if a potentially serious event may be occurring.

    • Could also be a machine malfunctions. (nuisance alarms) This alarm can cause sensory overload from noise pollution or alarm fatigue which affects pt. outcomes negatively.

    • ICUs have the highest amount of noise pollution.

  • Preventing HAIs

    • More than 500,000 persons acquire HAIs from health care facilities each year.

    • CDC has developed evidence-based protocols for healthcare facilities to help prevent four types of HAIs.

    • CLABSI, CAUTI, SSI, VAP

    • Multidrug-resistant organisms (MDROs) are microbes that causes infection and is resistant or unaffected by the various antimicrobial medications used to treat and destroy the pathogen. (e.g. MRSA, VRE, C.diff and other gram-negative bacteria organisms).

  • Identifying risks

    • Reduce the risk of suicide: death by suicide is the tenth leading cause of death in the United States as a whole and the second leading cause of death among people between ages 10 and 34.

    • Any pt.’s 12 years and older who are admitted for behavioral health conditions must be screened for suicidal ideations.

    • Pt. who are at risk for suicide are placed on round-the-clock suicide while in a nonpsychiatric hospital.

    • Potentially harmful items should be removed from the room by the nursing. Searching and limiting items brought into the pt. room and managing visitation by nonhospital staff are also necessary.

    • Minimizing adverse events during surgery: Have a timeout in the OR/procedure room; use two client identifiers to confirm the pt.’s identity; mark the surgical site if possible.

  • Improving disparities

    • Assess the pt.’s social needs (literacy, housing, transportation, and access to food upon admission).

    • Nurses should continue to assess the pt.’s needs throughout hospitalization, including discharge planning.

Medical that fails to satisfactorily meet these guidelines risk losing their accreditation. There are more than 250 standards (medical error prevention; verification of qualifications and competency of the healthcare staff; rights and education of clients; infection control; management of medications; emergency preparedness).

Culture of Safety

Three key elements: commitment to consistently follow safe operations; a just culture without punishment for errors; a commitment by the organization.

The nurse is the final safety net between the patient and a potential medication error.

How can nurses promote a culture of safety:

Participating in annual competency checks

Fire and disaster drills

Continuing education

Unit based council

Rapid response team

Communication - ISBARR

Rights of medication administration

Ask if unsure

Adverse Events committee: should be comprised of the members of interprofessional teams.