safety

Patient Care Safety Overview

  • Definition of patient safety involves:
    • Preventing medical errors, such as:
    • Failure to ask for patient's name and birth date for identification
    • Incorrectly marking surgical procedures, e.g., performing amputation on wrong limb
    • Adverse drug events due to medication reactions
    • Preventing client falls and suicides

The Joint Commission (TJC)

  • Established in 1951
  • Functions as an impartial national organization which accredits hospitals and healthcare facilities based on:
    • Safety performance
    • Policy and procedure adherence
    • Positive health outcomes
  • TJC accreditation is crucial for facilities to receive
    • Funding from CMS (Centers for Medicare & Medicaid Services)
  • Over 22,000 healthcare institutions and programs currently accredited by TJC
  • TJC evaluations occur every three years:
    • Includes monthly submission of safety and quality performance outcomes
    • Trends are identified through outcomes that are quantifiable
    • Quarterly performance measures are tracked with action plans for specific outcomes

National Patient Safety Goals

  • Identify safety practices that healthcare institutions should accomplish
  • Based on trends of adverse and sentinel events in healthcare nationally
  • Standards of compliance catalogued and emphasized within facilities
  • Goals are defined to ensure safe and effective delivery of healthcare
    • Recommendations are made to avoid adverse outcomes

Creating a Culture of Safety

  • Involves cooperation between:
    • Healthcare team
    • Patients
    • Patients' families
  • Initiated by:
    • Nurses performing handoff reports at the client's bedside

Key Practices for Promoting Safety

  • Correct identification of patients by confirming:
    • Name and date of birth
    • Special considerations for similar names among patients
  • Improving staff communication, especially for critical lab results:
    • Results should only be communicated directly to the patient's nurse or charge nurse
  • Safe use of medications includes:
    • Correct labeling and medication reconciliation
    • Verifying anticoagulant administration timing with physicians prior to procedures
  • Safe use of alarms:
    • Ensure alarms are activated before leaving bedside
  • Prevention of healthcare-associated infections:
    • Strict adherence to hygiene protocols
  • Reducing risk of suicide through:
    • Routine surveillance of at-risk patients
    • Removing potentially harmful objects from vicinity
  • Prevention of adverse events during surgery through:
    • Conducting timeout procedures
    • Performing safety checks

Recommendations for Transforming Care

  • Nurses should spend 70% of their time at the bedside through:
    • Hourly rounding
    • Bedside shift report
    • Responding quickly to call light requests
  • Strengthening management:
    • Establish leadership development programs
    • Develop rapid response teams for deteriorating patient conditions
  • Implementing standardized communication frameworks such as ISBAR (Introduction, Situation, Background, Assessment, Recommendation)

Unexpected Events in Healthcare

  • Definitions:
    • Near Miss: A potential error caught before causing harm
    • Patient Safety Event: An event that occurred without harm, e.g., medication errors not resulting in patient injury
    • Sentinel Event: Critical adverse events that cause severe harm or death to a patient

Communication of Events

  • Importance of openly reporting errors without fear
    • Incident reports are confidential, not part of patient's chart
  • Root cause analysis for error investigation includes addressing three key questions:
    • What happened?
    • Why did it happen?
    • What can be done to prevent it?

Barriers to Reporting Events

  • Barriers include:
    • Fear of repercussions
    • Lack of time or clarity around reporting protocols
    • Insufficient education and training
    • Personal bias or favoritism among staff

Nurse Safety Awareness

  • Maximum work periods and exhaustion recognition are pivotal
    • Mental and emotional state can affect decision-making in patient care
  • Facilities collaborate with agencies for safety protocols regarding:
    • Client identification
    • Electrical and chemical safety
    • Radiation safety

Age Related Safety Concerns

  • Infants: Risk of burns, poisoning, choking, drowning, and car safety
  • School-aged children: Vehicle safety, sports injuries, internet safety
  • Adolescents: Alcohol, water safety, and bullying
  • Adults: Substance abuse and workplace accidents
  • Elderly: Falls are primary concern

Hospital-Acquired Injures

  • Types of hospital-acquired injuries include:
    • Falls, burns, and pressure injuries
    • DVTs (Deep Vein Thrombosis) and unsafe insulin use

Safety Protocols and Procedures

  • RACE Acronym for fire safety:
    • R: Rescue
    • A: Alarm
    • C: Contain
    • E: Evacuate
  • Insulin administration verification must be performed by two nurses in the room

Prevention Strategies for Falls

  • Strategies include:
    • Non-skid footwear
    • Bed positioned lower
    • Clutter-free environments and adequate lighting
    • Regular hourly rounding and prompt response to call lights
  • Restraint use should be a last resort after all other measures fail, and monitored diligently

Restraints

  • Check patients under restraint every hour and document findings
  • Physical vs. chemical restraints and proper applications

Conclusion

  • Importance of maintaining patient safety protocols as a fundamental aspect of healthcare provision and legal responsibility.