safety

Safety in Healthcare

Presented by: Brenda Michel, EdD, FNP
Source: ATI Engage Fundamentals Module: Foundational Concepts of Nursing Practice: Safety
Reading Assignment: ATI Fundamentals: Chapter 12 & 13

Introduction

  • Health care provided in a safe manner and in a safe community environment is essential for a patient's survival and well-being.

  • Safety: Defined as a basic human need, second only to survival needs such as oxygen, nutrition, and fluids.

The Joint Commission (TJC)

  • TJC has evolved as an impartial national organization that accredits hospitals and other health care facilities based on their safety performance, policy, procedures, practice, and outcomes.

National Patient Safety Goals (NPSG)

  • Initiated by TJC to identify established relevant safety practices health care institutions should accomplish.

  • Most health care organizations embrace and routinely practice these goals, cataloged into a register of adopted "Standards of Compliance" that must be met consistently.

  • There are currently over 250 standards of compliance.

Identifiers Used in Care

  • Need 2 patient identifiers when providing care, treatment, and services:

    • Name

    • Date of Birth

    • Designated hospital number

    • Telephone number

    • Alternate client-specific documentation

  • Important Note: Room number is never to be used as an identifier.

Communication of Critical Lab Results

  • NPSG: Improve Staff Communication:

    • Report critical lab results promptly as they can be life-threatening.

    • Includes a specified time frame for notification and documentation of when the results were reported and whom they were reported to.

Safe Medication Practices

  • NPSG: Use Medications Safely:

    • Label all medications used in surgeries or procedures.

    • Nurses to discard medications found without a label to decrease errors, particularly with anticoagulant medications.

    • Monitor weight, renal, and hepatic labs, prescribe the correct dosage, observe for drug interactions, and inform clients of risks, benefits, and precautions.

Medication Reconciliation

  • Reconcile the client's medications upon admission and at discharge.

Clinical Alarm Systems

  • NPSG: Use Alarms Safely:

    • Purpose to reduce harm and improve the safety associated with alarm systems.

    • Types of alarms: Chair alarm, Bed alarm, IV pump alarms, NG tube feeding alarms, Heart monitors, and Ventilators.

    • Alarm Fatigue: A phenomenon where clinicians become desensitized to alarms due to their frequency.

Infections Prevention Policies

  • NPSG: Prevent Hospital-Acquired Infections (HAIs):

    • Implement evidence-based practice (EBP) policies to prevent:

    • Central line-associated bloodstream infection (CLABSI)

    • Catheter-associated urinary tract infections (CAUTI)

    • Surgical Site Infections (SSI)

    • Ventilator-associated pneumonia (VAP)

  • Key Point: Hand hygiene is the single most important step in prevention of multi-drug organisms in acute care settings.

Fall Prevention

  • NPSG: Reduce Falls:

    • Implement measures to reduce the risk of patient harm resulting from falls.

Pressure Ulcer Prevention

  • NPSG: Pressure Ulcers:

    • Assess and periodically reassess each patient’s and resident’s risk for developing pressure ulcers and take action to address identified risks.

Risk Assessment

  • NPSG: Risk Assessment:

    • Organizations must identify safety risks inherent in their patient population, including risks associated with home oxygen therapy and suicide.

Suicide Risk Management

  • All clients 12 years and older with a behavioral diagnosis need to be screened for suicidal ideation.

  • A detailed assessment is required for all identified at-risk individuals.

  • Supervision Requirements: Round-the-clock supervision is necessary if the patient is at risk—often requiring 1:1 supervision and removing potentially harmful objects from rooms.

Time-Out Protocol

  • NPSG: Universal Protocol: To prevent wrong site, wrong procedure, wrong person surgery.

    • A pause in personnel actions prior to surgery or a procedure to confirm the correct client, site, and procedure.

    • Two Identifiers: Establish identity before the procedure and mark the surgical site if possible.

Unexpected Events

Sentinel Events

  • Definitions:

    • A near miss: A potential error or circumstance that could have caused harm but was avoided.

    • A client safety event: An unexpected occurrence that happened without injury to the client.

    • A sentinel event: A critical, unexpected adverse event causing severe physical or psychological harm to a patient, which may include death, dismemberment, permanent injury, or severe temporary injury.

Healthcare-acquired Complications

  • Complications that can lead to serious injury or death should never happen in a hospital and are usually preventable.

    • Clear Examples Include:

    • Foreign objects left in a patient after surgery

    • Administering the wrong type of blood

    • Falls and trauma

    • Infections associated with IVs and Foley catheters

Incident Reporting

  • Incident reports are intended to track near misses or events, not to punish individuals involved.

  • Reports are internal and not to be mentioned in hospital records but might be used for legal purposes in the future.

Root Cause Analysis (RCA)

  • The RCA process is utilized to probe potential or actual errors. It will determine whether human error or system failure led to the error and establish a corrective action plan.

Barriers to Reporting

  • Identify common barriers to event and near miss reporting:

    • Fear of repercussions or backlash

    • Lack of time to write reports

    • Unclear facility policies and standards

    • Bullying and insufficient education/training

    • Lack of understanding of team member roles and favoritism

Evidence-Based Recommendations for Client Safety

  • Various recommendations to determine measures for improving client safety:

    • Work with a patient safety organization to identify risks

    • Improve facility design supportive of client safety

    • Survey personnel to assess safety culture

    • Enhance communication and response times with better teams

    • Employ evidence-based protocols for invasive procedures.

Safety Types

Electrical Safety

  • Check for faulty electrical equipment and ground fault circuit interrupter (GFCI) damage.

  • Utilize safe work practices.

Chemical Safety

  • Definition of a Poison: Any substance that impairs health or destroys life when ingested, inhaled, or absorbed.

    • Death can occur from excessive intake of common substances.

    • Sources of Poison: Medications, solid and liquid substances, and gases/vapors found at home.

  • Poison often affects major organ systems and should contact Poison Control Center for help in poisoning cases.

Radiation Safety

  • Key factors to consider when working with radiation include minimizing exposure time, increasing distance, and using shielding techniques.

Physical Hazards
Falls Prevention

  • Falls in adults aged 65 years and older are the leading cause of both fatal and nonfatal injuries.

  • Recognize that falls are a significant problem in healthcare settings.

Fall Risk Assessment

  • Conduct fall-risk assessments during admission and at regular intervals using tools such as Morse Fall Risk and Hendrich Fall Risk.

  • Implement timely responses to call lights and utilize fall-risk alerts like wristbands and signs to enhance awareness.

Direct Observation

  • Utilize bedside sitters for clients at risk of falls and provide adequate lighting, regular toileting, and proximity to nurse’s stations.

Restraint Use

  • Restraints should be utilized primarily for the safety of patients, staff, and other individuals.

  • Common rationales for restraint use include:

    • Prevent injury from falls

    • Protect therapy such as IV infusions

    • Control aggressive or confused patients

  • Types of Restraints:

    • Physical: direct holding

    • Mechanical: use of devices (straps, vests)

    • Chemical: medication-based sedation

Restraint Policies

  • Documentation is critical for legal purposes.

  • A physician’s order based on face-to-face assessment is required and needs renewal every 24 hours.

  • Ongoing assessment is critical for patients under restraint to ensure safety.

Workplace Safety and Violence

  • Workplace Bullying: Defined as repetitive harassment, social isolation, or belittlement of individuals.

  • Active Shooter Protocol:

    • Run away, hide if unable to escape, or fight if necessary.

  • Needlestick Injury Protocol:

    • Use a needleless system and avoid recapping needles.

Back Injury Prevention

  • Engage in correct use of patient transfer aids like mobile lifts and ceiling lifts.

Conclusion

  • Safety in clinical practice can be enhanced through adherence to established protocols, effective communication, and continuous education on emerging safety practices and requirements.