Patient Safety PDF

Patient Safety Safety and security are basic human needs; Health care must be provided in a safe manner. Safe community and environment are essential for survival and well- being. Safety is an individual, community and national concern. Patient Safety: Freedom from Unintended Health Care Errors /...

Patient Safety Safety and security are basic human needs; Health care must be provided in a safe manner. Safe community and environment are essential for survival and well- being. Safety is an individual, community and national concern. Patient Safety: Freedom from Unintended Health Care Errors / Injuries due to Medical Management. Patient Safety Practices: A type of process or structure whose application reduces the probability of adverse events resulting from exposure to the health care system across a range of diseases and procedures. Factors Affecting Safety: 1. Age: Risk for injury varies with chronological age and developmental stage. 2. Lifestyle Lifestyle practices can increase a person’s risk for injury and potential for disease. Individuals who operate machinery; experience stress, anxiety, and fatigue; use alcohol and drugs (prescription and nonprescription); Injury, Risk-taking behaviors such as driving vehicles at high speeds, and smoking are factors associated with accidents 3. Sensory and Perceptual Alterations Sensory functions are essential for accurate perception of environmental safety (cognitive awareness)> 4. Mobility: Mobility impairments may be a result of Poor balance or coordination, Muscle weakness, or Paralysis. Clients who have impaired mobility are at increased risk for injury, especially Falls, Decubitus ulcer or Emotional complications such depression 4. Emotional State: such as depression and anger affect a client’s perception of environmental hazards and degree of risk-taking behavior. Types of Accidents: In the health care setting, accidents are categorized as: 1. Client behavior accidents: For example, poisonings, burns, and self-inflicted cuts and bruises. 2- Therapeutic procedure accidents: Occur during the delivery of medical or nursing interventions; as Medication errors, Client falls during transfers, Contamination of sterile instruments or wounds and, improper performance of nursing activities. 3- Equipment accidents: Result from the malfunction or improper use of medical equipment; for example, electrocution and fire Building a safe healthcare system Principles Policies Procedures Practices Mission of Joint Commission International To improve the safety and quality of care in the international community through the provision of education, publications, consultation, evaluation, and accreditation services. What is the Joint Commission International Healthcare Organization (JCIHO): An independent, non-profit, non-governmental agency Patient Safety Goals Goal 1 :Improve the accuracy of patient identification. Use at least two patient identifiers when providing care, treatment, and services. Label containers used for blood and other specimens in the presence of the patient. Use the client’s room number as an identifier )passive technique ( Conducting a verification process to confirm that the correct procedure for the correct client is to be performed. Goal 2 :Improve the effectiveness of communication among caregivers.  Report critical results of tests and diagnostic procedures on a timely basis. Standardize a list of abbreviations that are not to be used throughout the organization. Goal 3 :Improve the safety of using medications. Label all medications, medication containers, and other solutions on and off the sterile field in preoperative and other procedural settings. Medication orders should be written legibly in ink and should include: ✓ Patient name ✓ Medication Generic name ✓ Dosage, frequency and rout of administration ✓ Signature of physician ✓ Date and hour were written Any abbreviations used in medication orders should be agreed to and jointly adopted by medical, nursing, pharmacy and medical records staff. Before dispensing the drug, the pharmacist must receive the physician’s original order or a direct copy of the order (except in emergency stations). To check at least two patient identifiers before providing care, treatments or services. Patient name and medical record number. Discourage Telephonic orders, do not accept verbal order. Examine safety code. Goal 4 :Ensure Correct-Site, Correct Procedure, Correct-Patient Surgery There is a documented process just before starting a surgical or invasive procedure : The precise site where the surgery or invasive procedure will be performed is clearly marked with the involvement of patient. 1. Consent of the patient/relative in writing  2. Proper identification of patient, name wrist band 3. Proper identification mark of parts to be operated 4. Pre anesthetic check up 5. Anesthetic safety 6. Ensure no foreign body left inside 7. Prevention of surgical wound infections 8. Use of surgical safety pre format in all operation 9. Check safety code if available Goal 5: Reduce the risk of health care–associated infections. Comply with either the current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or The Current World Health Organization (WHO) hand hygiene guidelines. Safe care is a basic need of all clients regardless of the setting. Nurses are responsible for providing the client with a safe environment through the delivery of professional, quality nursing care that incorporates: Safety precautions, Infection control practices &Hygiene assistance. Nosocomial infection: Definition of nosocomial infection: A nosocomial infection is one that is acquired by patients during hospitalization or by health care workers through their work in the hospital Moreover, nosocomial infections are also known as hospital-acquired infections or, more recently, health-care associated infections. Nosocomial infections are which manifest 48 to 72 hours after admission to or discharge related to diagnostic or therapeutic procedures Community acquired infections: are infections present or incubating at the time of admission. Chain of infection: This process is known as the infection chain, and contains six links: (1) microorganism (infectious agent), (2) source or reservoir, (3) portal of exit from reservoir, (4) mode of transmission, (5) portal of entry into host and (6) susceptible host. (I) Infectious agent: Agents that produce infections can consists of bacteria, viruses, fungi, protozoa and rickettisa (II) Reservoir (source): Reservoir or source is a place for organism to live while awaiting a host. Inanimate objects include: medications, air, food, water or any other material on which organism can find nourishment or lie dormant, and survive. Inanimate objects, human being, and animals are sources. The human body is the most common reservoir. Human sources include other clients, health care personnel, family members, visitors and clients themselves. In order to survive, the microbe needs food, oxygen (if aerobic), a viable temperature range (around 95˚F), and water, a pH of 5-8 and lack of sunlight. (III) Portal of exit: The portal of exit is a mean for microorganism to leave the source. Portals of exit in the human body include all body orifices (openings)  and skin discharges. Microbes may leave the body in any of its discharges: Sputum, emesis, stool, urine, blood, wound drainage or secretions from genitals all permit microorganisms to exit the source. (IV) Mode of transmission: Refers to the way in which the organism moves or is carried from the source's portal of exit. The five main routes of transmission are contact, droplet, vehicle, airborne and vector. 1. Contact transmission: Contact transmission is the most frequent means of transmitting infections in health care facilities. Contact transmission is by direct or indirect contact. (A) Direct contact: Direct contact involves body surfaces to body surfaces contact causing the physical transfer of organism between an infected or colonized person and a susceptible host such as touching, shaking hands, kissing, or sexual intercourse. Healthcare personnel can transfer organisms to client during care. (B) Indirect contact: Indirect contact occurs when a susceptible host is exposed to a contaminated object such as a dressing, needle or surgical instrument, used syringes or drinking cups. 2. Droplet transmission: Droplet transmission occurs when mucous membrane of the nose, mouth or conjunctiva is exposed to secretions of an infected person who is coughing, sneezing or talking. 3. Vehicle transmission: Vehicle transmission involves the transfer of microorganisms by way of vehicles, or contaminated items that transmit pathogens. Food can carry Salmonella, water can carry Legionella, drugs can carry bacteria from contaminated infusion supplies, and blood can carry hepatitis, and human immunodeficiency virus. 4. Air-born transmission: Air-born transmission occurs when fine particles are suspended in the air for a long time or when dust particles contain pathogens. Air currents widely disperse organisms, which can be inhaled by or deposited on the skin of a susceptible host. 5. Vector transmission: living carriers of pathogens are called vectors. Mosquitoes, flies, fleas, ticks, and lice are the most common vectors that transmit diseases to human beings. (V) Portal of entry: Pathogens need a portal of entry to gain access to a person's body. They can enter through the respiratory, gastrointestinal, urinary, and reproductive system and through breaks in the skin or mucous membranes. Open wounds, incisions puncture sites from injections, or body orifices into which catheters (tubes) or similar devices are inserted are common portal of entry. (VI) Susceptible host: Susceptible host is a person whose own body defense mechanism when exposed, are unable to withstand the invasion of pathogens. Factors affecting the risk for infection: ▪ Integrity of skin and mucous membrane which protect the body against microbial invasion. ▪ PH level of gastrointestinal and genitourinary tracts ▪ Age, sex, race, and hereditary. ▪ Immunization ▪ Level of fatigue, nutritional and general health status ▪ Stress level ▪ Health habits ▪ Some medical therapies and diagnostic procedures e.g. use of invasive or indwelling medical devices ▪ Certain medications e.g. Antineoplastic (anticancer), Anti-inflammatory medications, such as adrenal corticosteroids, some antibiotics ▪ Diseases that lessen the body's defenses against infection places the client at risk. e.g. chronic pulmonary disease, peripheral vascular disease, immune system diseases as leukemia and aplastic anemia & Diabetes mellitus. Standard precautions: Have replaced the term universal precautions. Standard precautions are applied to blood, all body fluids, secretions, excretions, contaminated items regardless of whether or not they contain visible blood and non-intact skin and mucous membrane. Standard precautions are used for all clients to protect against blood and body fluid transmission of potential infective organisms. The elements of standard precautions include: 1. Hand washing, 2. Gloves use, 3. Use of personal protective equipment 4. Handling of patient care equipment, 5. Environmental control, 6. Handling of linen, 7. Occupational health and blood borne pathogens 8. Patient placement. Standard precaution: 1. Hand washing: The world Health Organization (WHO) clearly defined the five moments for hand hygiene: ✓ Moment 1: before touching a patient ✓ Moment 2: before a clean or aseptic procedure ✓ Moment 3: after a body fluid exposure ✓ Moment 4: after touching a patient ✓ Moment 5: after touching patient surroundings ▪ Alcohol rubs: can be used as an alternative to routine hand washing with soap and water, but should not be used if hands are visibly soiled. 2. Gloves use: Wear clean non sterile gloves when touching blood, body fluids, excretion or secretion and non-intact skin. Change gloves between tasks on the same patient as necessary and remove gloves properly. 3. Use of personal protective equipment: such as mask, eye protection, face shield or fluid repellent gown during procedures and care activities that are likely to generate splashes or sprays of blood or body fluids. Use gown to protect skin and prevent soiling of clothing. 4. Handling of patient care equipment: ✓ Ensure that reusable equipment is not used for the care of another patient until it has been cleaned and reprocessed appropriately. ✓ Ensure that single-use items are discarded properly. ✓ Clean and reprocess items appropriately. ✓ Decontamination: Is the process by which microorganisms are removed or destroyed in order to render an object safe. It includes Cleaning, Disinfection, and Sterilization. ❖ Cleaning: is the removal of all foreign material (dirt and organic matter) from the object being reprocessed. ❖ Disinfection: is a procedure which achieves the removal or destruction of vegetative microorganisms to safe or relatively safe levels, but not necessarily the spores. ❖ Disinfectants: A disinfectant is a chemical agent that destroys most pathogens but may not kill bacterial spores. Disinfectants are used on inanimate objects only and not on living tissue. ❖ Sterilization: is the process of exposing articles to steam under pressure or to chemical disinfectants long enough to kill all microorganism and spores. ❖ Steam sterilization (autoclave) is the most common and most preferred method employed for sterilization of all items that penetrate the skin and mucosa if they are heat stable. Steam sterilization is dependable, nontoxic, inexpensive, sporicidal, and has rapid heating and good penetration of fabrics. 5. Environmental control: ▪ Ensure that the hospital has adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces, beds, bedrails, bedside equipment, and other frequently touched surfaces, ensures that these procedures are being followed. 6. Linen handling: ▪ Put on gloves and wear a plastic apron during bed making ▪ Linens are kept away from body to avoid contamination ▪ Placing linens on chair, tables or on the floor are avoided ▪ Soiled linens are kept in leak proof bags ▪ Shake or toss linens are avoided 7. Occupational health and blood borne pathogens ▪ Place needles, sharps and scalpels in appropriate puncture resistant container; ▪ Avoid recapping or manipulate used needles. ▪ If you must recap, never use two hands. ▪ Use a needle-recapping device or the one hand technique. ▪ When container is 2/3 full is replaced with new one. 8. Patient placement: ✓ Review room assignments carefully. Place patient who may contaminates the environment in private room. ✓ If a private room is not available, place the patient in a room with a patient(s) who has active infection with the same microorganism but with no other infection (cohorting). Goal 6: Reduce risk of patient fall: Falls occur among clients who are weak, fatigued, uncoordinated, paralyzed, confused, or disoriented Factors that Contribute to Falls: Age >65 History of falls Impaired vision or balance Altered gait or posture, impaired mobility Medication regime Postural hypotension Slowed reaction time Confusion or disorientation Unfamiliar environment Methods of assessing clients at risk for injury Nursing history Physical examination  Getting up to walk: Sit on your bed for a short time before getting up Remember to get up slowly and make sure you are steady before moving off If you have a walking aid, make sure that you use it correctly Have your walking aid within reach at all times If you are having problems with walking, please tell your nurse or care staff, we can arrange for a physiotherapist or your doctor to assess and treat you If you feel dizzy or unsteady, please tell your nurse or care staff Don’t wait to ask for help when you need it Do not try to get up or walk if you feel dizzy Wear properly fitting shoes with non-slip soles Properly fitting shoes are much safer than Slippers Do not wear socks without shoes Staying active helps to reduce falls N.B. The last 2 steps are very important to prevent fall in elderly Try to stay active but do not take risks Keep your glasses in reach Remember to wear your glasses Remember to wear your hearing aid When a patient has a seizure  Loosening any clothing around the neck and chest prevents constriction that might occur during the seizure that could compromise the airway. Do not try to place anything in the mouth during the seizure. A client should never be restrained during a seizure. The nurse should stay with the client and call for assistance, if needed. If possible, the client should be turned onto the lateral position, not supine, to allow for any secretions to drain out of the mouth. When a patient has Alzheimer’s disease: lf the patient continually tries to get out of bed at night Alzheimer’s disease causes impaired intellectual functioning, so a safety device that is weight sensitive would alert the nurse when the client is trying to get out of bed. Explaining procedures, orienting to surroundings, and using relaxation techniques would not be appropriate alternatives to use with this client. Apply Restraints: Restraints are used to Protect the client, Allow for treatment in a safe environment and, Reduce the risk of injury to others. Types of physical restraints: Belt; Mitten or Hand, Elbow, Limb or Extremity or Mummy When applying restraints on a client, the nurse would secure a doctor’s order and  Padding bony prominences will prevent possible skin breakdown. The limb with a restraint should be assessed frequently, At least every 32 minutes. When a restraint is secured in place, a clove-hitch knot ‫ عقدة الوتد‬should be used. Restraints are never tied to a side rail. The ends should be secured to the part of the bed that moves to elevate the head.