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Basic Human Needs Safety Clicker Question • What percentage of medical errors are considered preventable? A. 50% B. 35% C. 70% D. 40% Safety • A basic human need • Freedom from psychological or physical injury • Concept central to nursing and health care today • Environmental, Personal, Patient Safety Needs Where do you feel safe? Why focus on patient safety? Medical mistakes kill as many as 98,00 patients per year NAME SOME SAFETY ISSUES IN HEALTH CARE SETTINGS Calls for Improvements in Patient Safety • To Error is Human: Building A Safer System (IOM 1999) • Crossing the Quality Chasm: A New Health System for the 21st Century • The Agency for Healthcare Research and Quality • Institute for Healthcare Improvement • National Patient Safety Foundation Nightingale’s Message • “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm”. (Florence Nightingale, 1859, Notes on Nursing) Environmental Safety • Basic Needs • Physical Hazards • Transmission of Pathogens • Pollution • Terrorism/Bioterrorism Transmission of Pathogens • Pathogen: Any microorganism capable of producing an illness • Medical asepsis • Immunizations • Standard precautions (transmission of HIV, Hepatitis) • Health Care Acquired Infections • Isolation Procedures • STD’s • Adequate disposal of human waste, insect, rodent control Recommended Immunizations • • • • • • • • • • • DPT MMR Hepatitis A & B Varicella Haemophilus influenzae Pneumonia Polio Rotavirus HPV (females 13-18) Yearly flu vaccine TB (health care workers) Terrorism/Bioterrorism Personal Safety Safe Patient Handling • Back pain and injuries in nurses are widespread • Nurses should not lift more than 35 lbs. • How much can nurses push or pull safely? • Very heavy patients threaten nurses’ backs, necks, and knees • Seven states have laws to protect nurses from patient-handling injuries • Lifting and transfer equipment • American Nurse Today July 2010 Patient Safety: Scope of the Problem • Medical errors are the 8th leading cause of death in this country • 2.4 million prescriptions per year are filled incorrectly in Massachusetts • 61% of Americans fear being given the wrong medicine • 70% of medical errors are preventable (www.ahrq.gov) Patient Safety Risks • Preventing Falls/Pressure Ulcers • Client-Inherent Accidents (Seizures) • Procedure-related accidents (surgery, chest tube & catheter insertions, med/IV errors) • Equipment-related Accidents (electrical hazards, fires from faulty equipment) • Preventing Health Care-Associated Infections (HAI) • Preventing Medication Errors • Failure to Rescue National Patient Safety Initiatives • The Joint Commission National Patient Safety Goals • Institute for Healthcare Improvement “5 Million Lives” Campaign • The Leapfrog Group HAI’s: Scope of the Problem • Health care-Associated Infections are one of the top 10 leading causes of death in the U.S. • 1.7 million infections and 99,000 associated deaths per year • Billions of dollars in health-care costs • 32% of HAI’s are UTI’s • 22% of HAI’s are surgical site • 15% of HAI’s are pneumonias • 14% of HAI’s are bloodstream • www.cdc.gov Joint Commission National Patient Safety Goals • Improve the accuracy of patient identification • Improve the effectiveness of communication among caregivers • Improve the safety of using medications • Reduce the risk of health care associated infections (HAI) • Accurately and completely reconcile medications • Reduce the risk of patient harm from falls • Encourage patients’ active involvement in their own care as a patient safety strategy • The organization identifies safety risks inherent in its population • Improve recognition and responses to changes in a IHI Safety Initiatives The six interventions from the 100,000 Lives Campaign: • Deploy Rapid Response Teams…at the first sign of patient decline • Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack • Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation • Prevent Central Line Infections…by implementing a series of interdependent, scientifically grounded steps • Prevent Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time • Prevent Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps IHI Patient Safety Platform New interventions targeted at harm: • Prevent Pressure Ulcers... by reliably using science-based guidelines for their prevention • Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) Infection…by reliably implementing scientifically proven infection control practices • Prevent Harm from High-Alert Medications... starting with a focus on anticoagulants, sedatives, narcotics, and insulin • Reduce Surgical Complications... by reliably implementing all of the changes in care recommended by the Surgical Care Improvement Project (SCIP) • Deliver Reliable, Evidence-Based Care for Congestive Heart Failure…to reduce readmissions • Get Boards on Board….Defining and spreading the bestknown leveraged processes for hospital Boards of Directors, so that they can become far more effective in accelerating organizational progress toward safe care • Source: www.ihi.org/campaign How Many Injuries in the United States? 37 Million Admissions (Source: The AHA National Hospital Survey for 2005) X 40 Injuries per 100 Admissions (Source: IHI “Global Trigger Tool” Guiding Record Reviews) = 15 Million Injuries per Year The Leapfrog Group • Reduce preventable medical mistakes and improve the quality and affordability of health care • Encourage health providers to publicly report their quality outcomes so consumers can make informed choices Keeping Patients Safe • • Making Hospitals Safer http://www.youtube.com/watch?v=D35EmKbjTmI • • Josie’s Story http://today.msnbc.msn.com/id/32917267 • Discussion Safety and the Nursing Process • Assessment • Nursing Diagnosis • Planning • Implementation • Evaluation Assessment • • • • Nursing History Home Environment Assessment Risk for falls Medication Reconciliation Implementation • Health Promotion (wearing seat belts, use of car seats, bike helmets, participation in wellness programs) • Developmental Interventions: • Infant, Toddler, Preschooler • School-Age • Adolescent • Adult Implementation Older Adult • Reduce the risk for falls and other injuries • Compensate for physiological changes related to aging • MVA prevention (Safe driver tips, eyesight/hearing issues) • Burn and scald prevention • Pedestrian accidents (wear reflectors, walk on sidewalks, cross at light) Environmental Interventions • General Preventive Measures: Meet client needs (Oxygen, nutrition/fluids, temperature) • Medical Asepsis • Isolation Precautions • Environmental lighting • Security measures and concerns Healthcare Worker Safety • Proper Body Mechanics and Use of Lifting /Transfer Devices • Blood & Body Fluid Exposure • Radiation Exposure • Exposure to pathogens Specific Safety Concerns • Falls (Fall Assessment Tool) • Restraints and bed alarms • Side rails, bed height, bed and wheelchair locks • Fires • Poisonings • Electrical Hazards • Seizures • Radiation exposure • Preventing medication errors • Preventing health care associated infections Clicker Question • • • • Which of the following restraints would be preferred for a patient pulling at IV lines: A. Wrist restraints B. Belt restraints C. Mitten restraint D. Ambualarm Clicker Question • 1. A newly admitted client was found wandering the hallways for the past two nights. The most appropriate nursing interventions to prevent a fall for this client would include: • A. Raise all four side rails when darkness falls. • B. Use an electronic bed monitoring device. • C. Place the client in a room close to the nursing station. • D. Use a loose-fitting vest-type jacket restraint. 38 - 36 What we can do to prevent errors • Better communication between health care team members • Monitor patients closely for changes in condition • Prevent medication errors • Prevent infection • Prevent falls • Identify patients correctly Break into Groups: • You are assigned to a hospital task force on one of the following safety initiatives. Develop a teaching plan for the staff to improve compliance with the issue: • Preventing Falls • Preventing Medication Errors • Preventing Infection • Improving Staff Communication • Keeping Patients Involved in their Care Patient Safety Internet Resources • Institute of Safe Medication Practice http://www.ismp.org • The Joint Commission http://www.jointcommission.org • National Patient Safety Foundation http://npsf.org • Agency for Healthcare Research and Quality http://www.ahrq.gov • Institute for Healthcare Improvement http://www.ihi.org primum non nocere “First do no harm”
