Safety CNA 2 OSBN Curriculum

National Pt. Safety Goals The Joint Commission Purpose is to Improve Pt. Safety Goals focus on Problems in Healthcare Safety How to Solve Them Condensed Version as to CNA2’s www.jointcommission.org for a Complete List Videos: National Pt. Safety goals Safety Goals: • The Joint Commission National Patient Safety Goals as they apply to CNA practice. • These goals pertain to healthcare workers and patients. (NOTE: Some Safety Goals have been moved to standards elsewhere in system, so are not listed here. These goals change or are revised every year). Hospital National Patient Safety Goals 2012 (effective January 1st 2012) http://www.jointcommission.org/assets/1/6/NPSG_Chapter_Jan2012_HAP.pdf Use at least two patient identifiers when providing care, treatment, and services. Eliminate transfusion errors related to patient misidentification. Report critical results of tests and diagnostic procedures on a timely basis. Label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings. Note: Medication containers include syringes, medicine cups, and basins. Reduce the likelihood of patient harm associated with the use of anticoagulant therapy. Maintain and communicate accurate patient medication information. 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. Implement evidence-based practices to prevent health care–associated infections due to multidrug-resistant organisms in acute care hospitals. Implement evidence-based practices to prevent central line–associated bloodstream infections. Implement evidence-based practices for preventing surgical site infections. Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI). * Identify patients at risk for suicide. Conduct a preprocedure verification process. Mark the procedure site. A time-out is performed before the procedure. https://www.youtube.com/watch?v=iLR0kuTY4BE

Top 6 Goals Goal 1 Goal 2 Goal 3 Improve Accuracy of Pt. Identification Goal 2 Improve Staff Communication Goal 3 Safety Using Medications Oxygen is a Medication Goal 1 • Improve the accuracy of patient identification. Use at least two patient identifiers (do not use the patient’s room number) whenever obtaining specimens for clinical testing, or providing any other treatments or procedures- patient’s name and date of birth. Goal 2 • Improve the effectiveness of communication among caregivers. • Quickly get important test results to the right person. • Standardize abbreviations, acronyms and symbols used throughout the facility. Goal 3 • Improve the safety of using medications. (CNAs are not to handle any patient medications for any reason). • Take extra care and caution with patients who take medication to thin their blood. • Remember that Oxygen is considered a medication! Do not increase OR decrease O2. Goal 4 • Eliminate wrong-site, wrong patient, wrong-procedure surgery. (CNAs are not responsible for marking surgical sites; but can be aware of patient concerns or questions regarding surgical site marking, and communicate this to the nurse)

Top 6 Goals Con’t Goal 4 Use Alarms Safely Goal 5 Goal 6 http://www.npr.org/blogs/health/2014/01/24/265702152/silencing-many-hospital-alarms- leads-to-better-health-care http://www.npr.org/2011/02/15/133785372/Report-Nurses-Can-Become-Desensitized-To- Monitor-Sounds Goal 5 Reduce Risk of Healthcare Associated Infections Goal 6 Prevent Mistakes in Surgery Goal 5 • Reduce the risk of health care-associated infections. For example, CNAs must adhere to the hand hygiene guidelines from the Centers for Disease Control. Use PPE when necessary. ALWAYS use gloves when handling blood or body fluids! • Follow all precautions and guidelines to prevent central line infections. • Follow all precautions and guidelines to prevent surgical site infections. Goal 6 • Accurately and completely reconcile medications across the continuum of care. For example, the CNA may assist the client in documenting a list of their medications from home, under the direction of the nurse. Goal 7 • Reduce the risk of patient harm resulting from falls. For example, the CNA is integral in the implementation of fall reduction programs. • Safe lift and patient handling equipment • Friction-reducing devices • Mechanical lifts, including sit-to-stand lifts • Bariatric equipment • Make sure that pts. are wearing eyeglasses if they require them, especially when getting out of bed or ambulating Goal 8 • Encourage the active involvement of patients and their families in the patient’s care as a patient safety strategy. For example, the CNA may be the bridge that relays information from the patient’s family to the appropriate care provider. Goal 9 • Identify which patients are most at risk to develop pressure ulcers. • Prevent health care-associated pressure ulcers. For example, the CNA follows the plan for pressure ulcer prevention. They can also report their observations of skin integrity, and intake and output. • Safe lift and patient handling equipment: 􀂃 Friction-reducing devices 􀂃 Mechanical lifts including sit-stand lifts 􀂃 Bariatric equipment

Accident Prevention Maintain a Safe Environment GOOD BODY MECHANICS ALL THE TIME!!!! Good Base Support Get Help PRN Push Better than Pull Raise the Bed Remove Broken Equipment Open Doors SLOWLY Report ALL Accidents Safety/Accident Prevention: • Maintaining a Safe Environment 􀂃 USE GOOD BODY MECHANICS AT ALL TIMES! (Protect yourself and your pt.) 􀂃 Good base of support (foot position and body alignment) 􀂃 Get help as needed 􀂃 Push loads, don’t pull them, as much as possible 􀂃 Protect your back-raise beds to do any bending over pt. work 􀂃 Remove all broken equipment from pt. use and report it to Guest Services/ Engineering for repair. 􀂃 Be alert to opening doors, especially those that open into hallways-move through them SLOWLY 􀂃 Move equipment slowly and safely around corners 􀂃 Report any accidents; fill out incident/accident report forms and seek follow-up care with Employee Health Nurse or as directed- (ER, Occupational Health, etc.)

Fall Prevention Fall Prevention >50% in Pt.’s >65 Age Related Changes #1 Activity r/t Falls is Elimination Fall Prevention Follow “Fall Risk” Protocol Watch Dizziness/Balance Before Walking Proper Transfer Tech. CLEAN Glasses/Hearing Aides Proper Lighting Respond to Call Lights PROMPTLY • Over 50% of all hospital falls occur in pts. over 65. Age-related changes contribute to falls: 􀂃 Problems with vision, hearing, dizziness, decreased muscle strength, balance, reaction time and decreased bladder capacity 􀂃 The number one related activity to falls is elimination. Over half of all falls occur while a patient is attempting to use the bathroom or commode. • Actions to Prevent Falls (in ALL pts.): 􀂃 Use Fall Risk cards/categories 􀂃 Observe for dizziness and gait balance before walking a pt.; report any pt. changes to nurse 􀂃 Make sure pt. has necessary assistive devices; w/c, walker, cane 􀂃 Use proper transfer techniques 􀂃 Make sure pt. has CLEAN eyeglasses/hearing aides as needed 􀂃 Keep call light within pt’s reach; use soft- touch call lights when needed 􀂃 Keep brakes on beds and commodes locked when pt. sitting in them 􀂃 Use proper lighting in pt. room 􀂃 Respond to call lights/alarms promptly to prevent unassisted transfers and possible falls! 􀂃 Wipe up spills right away; get guest services help as needed

At Risk Behavior Escalating/Potential Combativeness Be Aware of Factors Factors Cultural Increasing Violence Access to Weapons Drug and Alcohol Use Medications SE’s of Illnesses Chaotic Environment Violent Behavior Coming Tense Posture Loud Profane Speech Increased Motor Activity Recognizing at Risk Behavior (escalating or potential for combativeness): • Being aware of risk factors for increased violence can help keep caregivers safe. • Some risk factors include: cultural acceptance of violence as normal, over all increase in violence, increased access to weapons, increased drug and alcohol use, lack of training on violence management, and insufficient staff for adequate response, past suicide attempts, past history of violence, poor medication adherence, psychosis, personality disorders, medications or illnesses that cause delirium or dis-inhibition, and a chaotic or controlling environment. • Violent behavior may be preceded by tense postures, loud profane speech or increased motor activity. Fear and frustration often trigger assaultive behavior. • De-escalation techniques: For example, the CNA may be involved in a situation where communication techniques are effective. Reducing stimulation and distracting the upset person may also be effective. The CNA should be aware of their surroundings, their attitude and their support if it should be needed. • If situation appears to be out of CNA’s control, and escalating, call Nurse, Security and appropriate facility overhead code.

De-Escalation Calm Communication Re-Assuring Reducing Stimulation Distraction Out of Control Call Security Call a Code De-escalation techniques: For example, the CNA may be involved in a situation where communication techniques are effective. Reducing stimulation and distracting the upset person may also be effective. The CNA should be aware of their surroundings, their attitude and their support if it should be needed. • If situation appears to be out of CNA’s control, and escalating, call Nurse, Security and appropriate facility overhead code.