National Patient Safety Goals - NC-NET

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Dec 14, 2013 (3 years and 10 months ago)

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Beth Downing, MSN, RN
-
BC, ONC



Recognize The Joint Commission’s 2012
Hospital National Patient Safety Goals.



Apply The Joint Commission’s 2012 Hospital
National Patient Safety Goals to clinical
practice.



Developed in 2002 to improve patient safety



Reviewed annually for updates/changes



9 different NPSG Programs


Home Care


Hospitals**


Critical Access Hospitals


Behavioral Health Care


Ambulatory Health Care


Laboratory Services


Long Term Care


Long Term Care (Medicare/Medicaid)


Office Based Surgery

** This presentation will focus on 2012 Hospital NPSGs


Correctly identify patients


Improve staff communication


Use medications safely


Prevent infections


Identify patient safety risks


Prevent mistakes in surgery

Use at least 2 patient identifiers to ensure that
each patient gets the correct medications and
treatments.

To ensure that the correct patient gets the
correct blood/blood component during a
transfusion.

Communicate important test results to the
correct staff member in a timely manner.

Correct labeling of medications before a
procedure. For example: medicines in
syringes, cups, and basins set
-
up prior to a
procedure.


Perioperative



or


Bedside


Procedures

Take additional care for patients who are
receiving medications to thin their blood.


Anticoagulant Use:

Heparin

L
ow molecular weight heparin

or Warfarin


(If patients coagulation labs are expected to be
out of the normal range with this therapy)

Record and communicate correct information
about patient’s medications.


Medication Reconciliation

(Are there discrepancies?)

Compare what the patient is taking at home with new medications


Complete on admission & discharge


Name, Dose, Frequency, Route, & Purpose

Scheduled & PRN Medications

Use hand hygiene guidelines from the Centers
for Disease Control (CDC)
OR

World Health
Organization (WHO); and set goals to improve
the hand hygiene process.




Hand hygiene is 1 of the most important ways
to minimize healthcare associated infections
(HAIs)

Additional Resources

Links for CDC & WHO hand hygiene guidelines


http://www.cdc.gov/handhygiene/


http://www.cdc.gov/HandHygiene/download/ha
nd_hygiene_core_minus_notes.pdf


http://whqlibdoc.who.int/publications/2009/97
89241597906_eng.pdf


Facilities use guidelines from either the CDC or WHO to establish their policies

Use proven guidelines to prevent infections that are
difficult to treat.


MDRO

Multidrug
R
esistant Organisms


Methicillin
-
Resistant
S
taphylococcus
Aureus

(MRSA)

Clostridium
Difficile

(CDI)

Vancomycin

R
esistant Enterococcus (VRE)

Multidrug
-
Resistant Gram
N
egative Bacteria


Risk assessment


Who is at risk?


Surveillance program


Monitor patients who are at risk or are positive


Educate staff upon hiring & annually


Educate patients diagnosed with a MDRO


Lab alert system


Identifying patients newly diagnosed with a MDRO


Alert system on readmission or transfer

of
patients with a MDRO

Use proven guidelines to prevent infection of the
blood from central lines.


CLABSI

Central line associated bloodstream infections


Short & long
-
term central venous catheters (CVC)
such as:

Multi
-
lumen, Hickman, Port
-
a
-
cath
,

Peripherally inserted central catheters (PICC)


Educate patients before insertion


Educate staff upon hiring & annually


Implement a checklist/protocol for insertion


Perform hand hygiene before insertion or care


For insertion: standardized kit/cart &
antiseptic


Standardized protocol to disinfect hubs/ports


Evaluate central lines routinely

Use proven guidelines to prevent infection after
surgery


SSI

Surgical site infection


Use evidence based practice (EBP) to:


Educate staff upon hiring & annually


Educate patients about prevention


Determine antimicrobial agent for prophylaxis


Determine hair removal method


Measure SSI rates for 30 days after procedures


Conduct risk assessments


Evaluate effectiveness of protocols

Use proven guidelines to prevent infections of
the urinary tract that are cause by catheters.


CAUTI

Catheter associated urinary tract infections


Full implementation on January 1, 2013



Doesn’t apply to pediatric patients


Use EBP to
to

determine:


Insertion protocol based on EBP


Aseptic technique for site prep & insertion


Limit use of catheters


Does the patient really need this catheter?


Secure catheter to maintain urine flow


Maintain sterility of system


Protocol for urine specimen collection


Identify which patients are most likely to
attempt to commit suicide.


Applies to:

Psychiatric Facilities

Patients treated for emotional or behavioral
disorders in general hospitals


Conduct a risk assessment


Who is at risk?



Address immediate safety needs



What is the most appropriate setting for the
patient?



At discharge provide suicide prevention
information (i.e. crisis hotline)


Ensure that the correct surgery is done on the
correct patient at the correct location.



Complete:


At preadmission testing


At admission


At time of procedure


Identify patient & involve them in the process


Verify:


History & Physical


Consent


Assessment


Diagnostic &
l
aboratory results


Required equipment/supplies


Mark the procedure site


Involve patient


Site is marked by whoever is accountable for
procedure (MD, APRN, PA)


Mark at or near the surgical site


Consistent marking method throughout the
facility

Pause before surgery to make sure an error is
not being made.

Involve ALL procedural

team members


Agree on:

Right Patient

Right Site

Right Procedure


The nurse enters the patient’s room to
administer medications. Which could the
nurse use to correctly identify the patient?
(Select all that apply)

A.
Full name

B.
Date of birth

C.
Room number

D.
Telephone number

E.
Medical record number

TJC recommends using options A, B, D, E as
identifiers; also a facility assigned ID
number can be used.

Room numbers and
locations cannot be used.

Which activities require the nurse to verify 2
patient identifiers? (Select all that apply)

A.
Collecting sputum specimen

B.
Changing a dressing

C.
Obtaining a blood sample

D.
Inserting an intravenous line

E.
Removing a urinary catheter

All treatments, procedures, and
medications require verification of
patient identification. Options A&C
also should be labeled in the patients
presence.

A patient is ordered to receive a unit of packed
red blood cells (PRBCs). What steps should be
included in the verification process to prevent
a transfusion error?


Match the blood product to the physicians
order

Match the patient to the blood product

Use a 2 person verification process OR

Use a 1 person verification process with an
automated identification system (
barcoding
)

The verification should include
patient identity, physicians order,
consent, blood type, blood product,
typenex

number, & expiration date.

An adult patient’s initial laboratory report lists a
panic low hemoglobin level of 6.1 g/
dL
. What
is the nurses best action?

A.
Notify the physician on the next round.

B.
There is no need to notify, the patient was
admitted with anemia, this result is expected.

C.
The patient was already ordered to receive a
blood transfusion, so it is not necessary to
notify.

D.
Call the physician immediately to notify of
the result.

Hospital policy will determine the reporting
process

including who does the reporting ,
whom the report is called to, and an
acceptable time frame for reporting.

The next time you are in the clinical setting
review your clinical agency policy and
procedure for reporting critical results of
tests and diagnostic procedures.


What is the time frame to report?

What is the procedure for reporting?

Who can report it?

Is there an exception to reporting?


The nurse is setting up medications for a
bedside procedure. Which label includes the
correct information?

A.



B.



C.



D.


Lidocaine

1% 50 mg

Exp 6/1/12 @1800

Lidocaine

1% 50 mg/5
mL


Prepared 5/31/12 @ 1800
Exp 6/1/12 @ 1800

Lidocaine

50 mg/5
mL

Exp 6/1/12 @ 1800

Lidocaine

1% 5mL

Prepared 5/31/12 @ 1800

Option B includes:
medication name,
strength, quantity,
volume/diluent, and
expiration date.
Expiration time is a
requirement if it
occurs in less than
24 hours

A patient is being started on Warfarin
(Coumadin) after surgery to prevent a deep
vein thrombosis. What should the nurse
include in the plan of care when initiating this
therapy? (Select all that apply)


A.
Baseline INR result verification

B.
Education regarding food & drug interactions

C.
INR monitoring throughout the therapy

D.
Reinforcing the importance of compliance

E.
Education on adverse reactions &
interactions with other drugs


In addition to these 5 requirements, TJC requires
hospitals to have approved protocols for
intiating

&
maintaining anticoagulant therapy.

Home Medications

MD Orders


Prilosec

20 mg
po

daily


Claritin 10 mg
po

daily


Multivitamin 1 tab
po

daily


Tylenol 650 mg
po

q4 hr
prn

mild pain or fever


Protonix

40 mg IV q12 hr


Keflex

500 mg
po

q6 hr


Prilosec

20 mg
po

daily


Claritin 10 mg
po

daily


Multivitamin 1 tab
po

daily


Aspirin 81 mg
po

daily


Tylenol 650 mg
po

prn




Clarification would be necessary for: Prilosec &
Protonix

both are the
same class of medications, Aspirin is omitted, Tylenol on home
medication list does not have a
prn

indication or time, Keflex is a new
medication is it appropriate for this patient?


Medication Name

Dose

Route

Frequency

Reason why patient is taking it



All of this information should be discussed with the
patient to ensure correct administration at home and
to improve patient knowledge of medications.
Patients should be instructed to keep an accurate
medication list with them at all times in the event of
an emergency.

Match the hand hygiene methods to the time
frames required for them to be effective.


Soap & Water







Alcohol Based Hand Rub





Surgical Scrub


60 Seconds



2
-
6 Minutes



15 Seconds



10 Minutes



Until Dry

These time frames determined by the
CDC have been proven to be effective at
providing hand hygiene. Completing
these for a longer period of time had not
proven to be any more effective.

In which situations is the use of alcohol based
hand rub an appropriate hand hygiene
method? (Select all that apply)

A.
After removing gloves

B.
Before inserting a urinary catheter

C.
When hands are visibly soiled

D.
Preoperatively before donning sterile gloves

E.
Before taking a patients blood pressure


If hands are visibly soiled, soap and water method of hand hygiene is
recommended. For additional recommendations please refer to the hospital
policy, CDC, or WHO.
http
://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf

These guideline are from the CDC Hand Hygiene in Health Care Settings.
Please review page 32 of this link for more information.


A patient is scheduled for a right knee
replacement. Which documents should be
included in the pre
-
procedure verification
process? (Select all that apply)

A.
History & Physical

B.
Signed procedure consent form

C.
Nursing assessment

D.
X
-
ray result

E.
Anesthesia assessment


All of these documents should be verified prior to the procedure.
These documents will assist in verifying that the correct patient is
having the correct procedure (H&P) on the correct anatomical site
(
xray
, nursing assessment) and the patients expectations of the
procedure (signed consent, anesthesia assessment).

True or False:




Site should be marked before the procedure



The patient marks the site



A small black dot is an appropriate mark



PA or APRN can mark the site



Patients may choose the type of mark



An alternative method is necessary for
certain procedures








T


F


F


T


F


T

The site should be marked by whomever is
accountable for the procedure (MD, APRN,
PA), the mark should be unambiguous and
universal for the hospital. Certain procedures
(involving teeth, through a natural orifice,
mucosal surface, or perineum).

A circulating nurse completes a time out
procedure, with the anesthesiologist, and
surgeon, 2 hours before a patient is to
undergo a right arm surgery. During the time
out they verify the patients identity by having
him state his full name, and verify that he is
having an incision and drainage completed.


What is correct & incorrect about this process?

CORRECT

INCORRECT


All relevant members
were
present


Type of procedure is
verified



Too long before
procedure


Name verification only
using 1 method


Did not verify site of
procedure


The time out should be completed immediately prior to procedure or
marking of the site. The procedure must be standardized for the
hospital and initiated by a member of the team. Documentation of the
time out must also be completed as determined by the hospital.

The Joint Commission (2012). National Patient
Safety Goals. Retrieved June 10, 2012 from
http://www.jointcommission.org/standards_info
rmation/npsgs.aspx




http://www.patientidexpert.com/laserwristbandstyle.html



http://www.carefusion.com/medical
-
products/medication
-
management/point
-
of
-
care
-
verification/pyxis
-
transfusion
-
verification.aspx



http://www.cdc.gov/ncbddd/dba/transfusion.html



http://www.pregnancylab.net/critical
-
result/



http://www.sandelmedical.com/products.asp?id=862



http://www.blog.wheretofindcare.com/2010/02/how
-
does
-
wrong
-
site
-
surgery
-
happen
-
part.html



http://orthoinfo.aaos.org/topic.cfm?topic=A00269



http://www.aorn.org/2012timeout/#axzz1yonOfy3V