safety

Safety in Healthcare: Overview

  • Introduction by Rich discussing the importance of safety

Jayco (Joint Commission on Accreditation of Healthcare Organizations)

  • Definition:

    • A nonprofit organization that accredits healthcare organizations in the United States.

    • Often referred to simply as the Joint Commission.

  • Role:

    • Not a government entity; it serves as an accrediting body.

    • Key for hospitals wanting to receive Medicare or Medicaid payments through CMS.

    • The leading accrediting organization in the United States.

National Patient Safety Goals

  • Purpose:

    • Aim to decrease harm to patients admitted to healthcare facilities.

    • Intended to prevent injury and promote patient safety.

  • Requirements:

    • Accreditation organizations must implement interventions to meet these safety goals.

  • Overview of Goals:

    • Perpetual issues remain consistent; minor sub-goals might change.

    • National Patient Safety Goals from 2025 highlight one addition: "improve healthcare equity."

Nursing Patient Safety Goals

  • Goal 1: Identify Patients Correctly

    • Requirement:

      • Use at least two identifiers (name, date of birth, medical record number, or unique identifier number) for patient identification.

    • Importance of avoiding room numbers as identifiers due to patient mobility and risk of confusion with visitors.

    • Mandatory practice:

      • Double-check identifiers against the chart; do not rely on memory.

    • Armbands:

      • Can be used for identification but only reflect identifying information.

  • Preventing Patient Falls

    • Falls are a common issue; everyone is at risk regardless of mobility.

    • Importance of fall risk assessments tailored to patient situations.

  • Evaluating Fall Risk:

    • Risk factors include:

    • Poor vision, cognitive dysfunction, gait issues, balance problems, and medications that cause sedation.

    • History of prior falls and gender can also factor into risk assessment.

    • Evidence-based tools for assessing fall risk:

    • Morse Fall Scale

    • Hendrick Fall Risk Tool

    • Hester-Davis Fall Risk Tool

    • “Get up and Go” test:

      • Timing a patient's ability to stand, walk three meters, and return to a seated position helps assess risk.

  • Evidence-Based Fall Prevention Interventions:

    • General interventions:

    • Implement hourly purposeful rounding to assess patient needs.

    • Reorient patients frequently about their environment.

    • Ensure call light is accessible and beds are in low positions.

    • Use side rails as permissible; lock wheels on beds and wheelchairs.

    • Keep personal items within reach.

    • Adequate lighting and remove clutter from floors.

    • Offer non-skid footwear and employ bed/chair alarms for high-risk patients.

Restraints

  • Two main categories:

    • Medical Restraints: Used to prevent the removal of medical devices such as IV lines.

      • Must have orders signed within 24 hours, and renewed every 24 hours.

    • Violent Restraints: To prevent harm to self or others.

      • Requires face-to-face assessment by the physician within 1 hour and renewal every 1 to 4 hours based on patient age.

  • Points of Concern for Restraint Use:

    • While restraints can prevent injury, they also pose risks:

    • Potential physical harm such as strangulation or broken limbs.

    • Use restraints as a last resort after exhausting alternatives, documented ineffectiveness of less restrictive interventions.

    • Frequent monitoring needed, with assessments every 2 hours to check circulation and ensure hydration.

  • Types of Restraints:

    • Physical Restraints:

    • Examples include soft wrist restraints, side rails under certain conditions, and bed rails (considered restraints if they prevent mobility).

    • Chemical Restraints:

    • Psychotropic medications not given for standard treatment purposes, but to chemically restrain a patient from harmful behavior (e.g., administering lorazepam for agitation in a non-anxious patient).

    • Seclusion:

    • A designated room where patients cannot leave; must be monitored continuously and is considered a restraint due to confinement.

    • Alternatives to restraints:

    • Frequent orientation, family presence, situational placement near nurses’ stations, and offering stimulation methods.

OSHA Regulations

  • Definition: The Occupational Safety and Health Administration, ensuring safe workplace conditions.

  • Focus on:

    • Microbiological regulations and bloodborne pathogens (e.g., hepatitis B, C, HIV).

    • Proper needle handling: Do not recap needles; use scoop method for safety.

    • Employ safety mechanisms on needles to avoid stick injuries.

    • Dispose of contaminated materials correctly.

  • Post-Exposure Protocol:

    • Wash and irrigate the wound.

    • Notify a supervisor and seek further treatment/testing as necessary.

Workplace Hazards

  • Musculoskeletal Injuries:

    • High occurrence among nurses due to lifting and forceful movements.

    • Recommendations: Use lifting devices, request assistance, maintain ergonomic positions while lifting, and engage leg muscles.

  • Adverse Events in Healthcare:

    • Never Events: Clearly preventable incidents resulting in serious patient harm (e.g., surgery on the wrong site).

    • Sentinel Events: Result in death, permanent harm or necessity of life-sustaining treatment.

    • Near Misses: Potential for harm identified before impact occurs.

Environmental Hazards

  • Examples include:

    • Fire safety procedures through acronyms RACE (Rescue, Alarm, Contain, Extinguish) and PASS (Pull, Aim, Squeeze, Sweep).

    • Handling hazardous chemicals and using protective equipment during radiation exposure.

    • Equipment malfunctions causing electrical hazards.

Safety Considerations Across the Adult Lifespan

  • Age-related safety issues:

    • Impaired vision, cognitive decline, mobility challenges, orthostatic hypotension, weakness, and medication effects.

  • Environmental hazards:

    • Poor lighting and clutter about the home.

    • Safety in bathrooms (e.g., non-slip mats, avoiding scalding water).

    • Remove extension cords; prevent standing on chairs to reach high items.

    • Caution with open flames to avoid burns.

Cultural and Social Factors Influencing Safety

  • Variances in safety perception across cultures affect patient adherence to safety protocols.

  • Potential barriers:

    • Patients' reluctance to voice concerns or request translators due to cultural beliefs.

    • Potential over-trust in healthcare systems leading to non-questioning of care.

  • Importance of cultural competency in tailoring patient interventions.

  • Conclusion: Reinforcement of the importance of patient safety, care practices, restraint use, and workplace regulations in delivering quality healthcare.

  • Note: Always be vigilant about safety protocols and implement strategies to improve patient care.

Thanks for following along with this comprehensive overview of healthcare safety measures and compliance.