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)

• Use of Restraints• 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

http://www.jointcommission.org/assets/1/6/HAP_NPSG_6-10-11.pdf

Joint Commission National Patient Safety Goals

• Identify patients correctly• Improve staff communication• Use medicines safely• Prevent infection• Identify patient safety risks• Prevent mistakes in surgery

• www.jointcommision.org

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 best-known 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

37 Million Admissions(Source: The AHA National Hospital Survey for 2005)

(Source: IHI “Global Trigger Tool” Guiding Record Reviews)

X

40 Injuries per 100 Admissions=

15 Million Injuries per Year

How Many Injuries in the United States?

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 (Assessing

Risk)• Home Hazard Appraisal• 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

ImplementationOlder 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

Figure 49-7 A mitt restraint.

Clicker Question Which of the following

restraints would be preferred for a patient pulling at IV lines:

• A. Wrist restraints• B. Belt restraints• C. Mitt restraints• D. Bed Alarm

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 - 39

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

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”