Safety

SAFETY IN HEALTHCARE

CONCEPT OF SAFETY

  • Definition: Safety is defined as protection from harm or injury for patients and providers achieved through both system effectiveness and individual performance.

NATIONAL PATIENT SAFETY GOALS (NPSG)

  • The Joint Commission (TJC) creates National Patient Safety Goals (NPSGs) and standards annually to promote client safety and effective healthcare delivery.

  • NPSGs aim to avoid adverse outcomes through the implementation of care standards that positively impact client safety.

NPSG: IDENTIFY CLIENTS CORRECTLY

  • Goal: Accurately identify every client using two identifiers.

  • Potential Identifiers:

    • Client's name

    • Date of birth

    • Hospital ID number

    • Telephone number

    • Alternate client-specific documentation

  • Second part of the goal: Ensure that the treatment, procedure, or care is specifically for that identified client.

NPSG: IMPROVE STAFF COMMUNICATION

  • Focus: Improve staff communication regarding reporting critical results promptly.

  • Importance:

    • Effective communication minimizes misunderstandings and errors.

    • Fosters collaboration to identify and address potential safety issues swiftly.

    • Enhances overall workplace safety.

NPSG: USE MEDICATIONS SAFELY

  • Components of this goal include:

    • Labeling all medications before procedures.

    • Reducing medication errors specifically related to anticoagulants (blood thinners).

    • Maintaining an accurate current medications list for each client, including reconciliation with new medications ordered.

    • Focus on enhancing the safety and quality of medication administration and management processes.

NPSG: USE ALARMS SAFELY

  • Purpose: Alarms are audible alert devices within medical equipment that warn of potential serious events or machine malfunctions.

NPSG: PREVENT HOSPITAL-ACQUIRED INFECTIONS

  • Types of Infections:

    • Central Line–Associated Bloodstream Infection (CLABSI): Occurs when pathogens enter the bloodstream via a central line.

    • Catheter-Associated Urinary Tract Infection (CAUTI): Results from pathogens entering the urinary system via a catheter.

    • Surgical-Site Infection (SSI): Infection at the site of surgery.

    • Ventilator-Associated Pneumonia (VAP): Pneumonia that develops in clients on a ventilator.

NPSG: IDENTIFY CLIENT SAFETY RISKS - REDUCE THE RISK OF SUICIDE

  • Screening: For clients at risk of suicide or with suicidal intentions.

  • Actions Required:

    • Place clients at risk under round-the-clock surveillance.

    • Remove potentially harmful items from their rooms.

    • Utilize an environmental checklist to support nursing staff in identifying risks.

    • Implement management strategies for personal items and visitation by non-hospital staff.

NPSG: UNIVERSAL PROTOCOL - PREVENTION OF ADVERSE EVENTS IN SURGERY

  • Protocol includes:

    1. Use two client identifiers to establish identity.

    2. Mark the surgical site if applicable.

    3. Conduct a time-out in the operating/procedure room to confirm all details before proceeding.

CULTURE OF SAFETY

  • Key Strategies:

    • Redesign bedside care to allow nurses to spend 70% of their time at the bedside.

    • Develop leadership skills among management.

    • Implement a rapid response team for medical-surgical units.

    • Establish standardized communication frameworks.

TYPES OF SAFETY EVENTS

  • Near Miss: Potential error that could have caused harm but was caught before harm occurred.

  • Client Safety Event: Unexpected event or circumstance that could lead to harm.

  • Adverse Event: A situation causing unexpected harm to a client.

  • Sentinel Event (Never Event): Serious unexpected occurrences leading to severe harm or death.

DOCUMENTATION OF UNEXPECTED EVENTS

  • Events requiring documentation in an occurrence report include:

    • Accidents or injuries to clients, staff, or visitors (e.g., falls)

    • Unexpected vaccine or drug reactions

    • Incorrect administration of vaccines or drugs

    • Property damage or lost items

    • Exposure to infectious materials

    • Atypical behaviors against facility policies.

SAFETY ASSESSMENT

  • Importance: Ensuring client and staff safety is regulated by various organizations including:

    • The Joint Commission (TJC)

    • CMS (Centers for Medicare and Medicaid Services)

    • OSHA (Occupational Safety and Health Administration)

    • State Health Departments and Nursing Boards.

INJURIES AMONG NURSES

  • Sleep Deprivation Impact:

    • Nurses with less than 4 hours of sleep within 24 hours have an increased motor vehicle accident risk of 11.5 times compared to those with at least 6 hours of sleep.

ELECTRICAL SAFETY PRECAUTIONS

  • Steps to prevent injury when using electrical devices:

    • Check electrical cords for fraying or severe creasing.

    • Avoid plugging/unplugging devices with wet hands.

    • Prevent rolling over electrical cords with client beds/equipment.

    • Always unplug by grasping the plug, not the cord.

    • Do not use extension cords; tag and remove unsafe devices from the workspace.

CHEMICAL SAFETY PRECAUTIONS

  • Proper use of Personal Protective Equipment (PPE) is essential when handling chemicals:

    • Chemicals can enter the body via inhalation, skin/eyes, ingestion, or injection.

AGE-RELATED SAFETY

  • Tailoring care to specific age-related safety factors is critical for improving patient outcomes and minimizing risk.

IDENTIFYING SOURCES OF HARM

  • Key Focus Areas:

    • Severity

    • Occurrence

    • Detection

    • Knowledge Dissemination

PLAN FOR CONTINUOUS IMPROVEMENT IN SAFETY

  • Zero Harm: Commitment to providing a gold standard of care through actionable evidence-based practices and accountability.

HOME HAZARD ASSESSMENT STEPS

  1. Install handrails on staircases.

  2. Clear floors of clothes and objects.

  3. Increase lighting in high-traffic areas.

  4. Use non-slip mats in the shower.

  5. Remove exposed cords from appliances.

  6. Make kitchen items easily accessible.

FIRE HAZARD PREVENTION

  • Tips for home fire safety:

    • Install smoke and carbon monoxide detectors on each floor.

    • Have fire extinguishers ready and check their functionality monthly.

    • Establish and practice an emergency fire escape plan for your family.

    • Oxygen safety measures for home use:

    • Turn off the oxygen supply valve when not in use.

    • Store oxygen safely away from flames and electrical devices.

    • Avoid smoking around oxygen.

EMERGENCY RESPONSE PROCEDURES

  • R.A.C.E.

    • R - Rescue

    • A - Alarm

    • C - Contain the fire

    • E - Extinguish if safe

  • P.A.S.S.

    • P - Pull the pin

    • A - Aim at the base of the fire

    • S - Squeeze the trigger

    • S - Sweep side to side to cover the area.

ACTIVE SHOOTER RESPONSE

  • Strategies for surviving a shooting event:

    1. Run when it's safe to escape.

    2. Hide if running is not possible.

    3. Fight only if your life is at risk.

    4. Call 911 when safe to do so.