1. Managing Hospital Safety: Common Safety Concerns
(Part 2 of 4)

2. Needlestick Injuries Are Common and Can Be Avoided
Needlestick injuries are frequently underreported1
Top 3 times when needlestick injuries occur1:
1. While giving an injection
2. Before activating the safety feature
3. During disposal of a nonsafety device
Needlestick Injuries Are Common and Can Be Avoided
A 2008 survey completed by 700 US nurses indicates that needlestick injuries most commonly occur while giving an injection, before activation of the safety feature, and during the disposal of a nonsafety device
Reference
American Nurses Association study of nurses’ views on workplace safety and needlestick injuries. Accessed January 29, 2009.
More than 80% of needlestick injuries could be avoided with the use of safer needle devices2
1. American Nurses Association study of nurses’ views on workplace safety and needlestick injuries. Accessed January 29, 2009.
2. American Nurses Association. Needlestick prevention guide. Accessed January 29, 2009.

3. Implement Practices to Help Avoid Needlestick Injury
Use prefilled medication devices1
Train health care workers on proper administration and disposal techniques2
Utilize sharps with engineered sharps injury protection1,2
Document sharps-related injuries1
Encourage nonpunitive, convenient reporting of needlestick injuries3
Evaluate and select safety-engineered devices based on caretaker preference2
Implement Practices to Help Avoid Needlestick Injury
Review as stated
1. National Institute for Occupational Safety and Health. Preventing needlestick injuries in health care settings. November Accessed January 29, 2009.
2. Occupational Safety and Health Administration. OSHA fact sheet: bloodborne pathogens. Accessed January 29, 2009.
3. American Nurses Association study of nurses’ views on workplace safety and needlestick injuries. Accessed January 29, 2009.

4. “Never” Events
Serious, identifiable, and preventable medical errors leading to unfavorable consequences
The policies and procedures of health care organizations considerably impact the risk of occurrence of “never” events
“Never” Events
Review as stated
National Quality Forum. Serious Reportable Events in Healthcare, 2006 Update: Executive Summary. Washington, DC: NQF; 2007.

5. Categories of “Never” Events
Surgical
Amputation of incorrect body part
Product/device
Use of contaminated device
Patient protection
Inability to prevent a patient suicide
Care management
Medication error leading to hypoglycemic event
Environmental
Patient fall during hospital stay
Criminal
Impersonation of a health care provider
Categories of “Never” Events
“Never” events can be related to surgical procedures, product/device, patient protection, care management, environment, and crime
Surgical events include incorrect surgery being done, or surgery performed on the wrong body part or patient
Product or device events involve patient death or disability as a result of contaminated drugs or devices, and the occurrence of intravascular embolism
Patient protection events include patient suicide or disappearance of a patient resulting in death or serious disability
Examples of care management events include patient death/serious disability related to a medication error (eg, wrong drug, dose, patient, time, rate, preparation, or route of administration); and death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a health care facility
Environmental events include burns, falls, electric shock, and the use of restraints that result in patient death or serious disability
Criminal events range from abduction and assault to the ordering of patient care by someone impersonating a licensed health care provider
Reference
National Quality Forum. Serious Reportable Events in Healthcare, 2006 Update: Executive Summary. Washington, DC: National Quality Forum; 2007.
National Quality Forum. Serious Reportable Events in Healthcare, 2006 Update: Executive Summary. Washington, DC: NQF; 2007.

6. Hospital-Acquired Conditions: “Reasonably Preventable” Events
Foreign object left in patient postsurgery
Air embolism
Blood incompatibility
Falls and trauma
Pressure ulcers
Vascular catheter-related infection
Catheter-related urinary tract infection
Manifestations of poor glycemic control
Certain orthopedic surgical site infections
Surgical site infection-mediastinitis following CABG
Bariatric surgical site infections
Deep vein thrombosis or pulmonary embolism after orthopedic procedures
Hospital-Acquired Conditions: “Reasonably Preventable” Events
Hospital-acquired conditions (HACs) are defined as “reasonably preventable” with the implementation of evidence-based guidelines
HACs include the following:
Foreign object left in patient postsurgery
Air embolism
Blood incompatibility
Falls and trauma
Pressure ulcers
Vascular catheter-related infection
Catheter-related urinary tract infection
Manifestations of poor glycemic control
Certain orthopedic surgical site infections
Bariatric surgical site infections
Surgical site infection-mediastinitis following CABG
Deep vein thrombosis or pulmonary embolism after orthopedic procedures
Reference
Department of Health and Human Services: Centers for Medicare and Medicaid Services. Fed Regist. 2008;73:
Department of Health and Human Services: Centers for Medicare and Medicaid Services. Fed Regist. 2008;73:

7. CMS Moves Aggressively to Encourage Greater Patient Safety in Hospitals
The following selected conditions were added to the list of hospital-acquired conditions on August 19, 2008:
Surgical site infections following specific procedures, including certain orthopedic surgeries, and bariatric surgery for obesity
Certain manifestations of poor control of blood sugar levels
Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures
CMS Moves Aggressively to Encourage Greater Patient Safety in Hospitals
Review as stated
CMS = Centers for Medicare and Medicaid Services. Department of Health and Human Services. Centers for Medicare and Medicaid Services. Fed Regist. 2008;73:

8. Medicare/Medicaid Cease to Reimburse for Preventable Complications
For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which 1 of the selected conditions is not present on admission1
New York and Massachusetts have further limited Medicaid reimbursement of complications due to medication errors2
Foreign object left in patient postsurgery
Air embolism
Blood incompatibility
Falls and trauma
Pressure ulcers
Vascular catheter-related infection
Catheter-related urinary tract infection
Manifestations of poor glycemic control
Certain orthopedic surgical site infections
Surgical site infection-mediastinitis following CABG
Bariatric surgical site infections
Deep vein thrombosis or pulmonary embolism after orthopedic procedures
Medicare/Medicaid Cease to Reimburse for Preventable Complications
Review as stated
1. Department of Health and Human Services. Centers for Medicare and Medicaid Services. Fed Regist. 2008;73:
2. National Conference of State Legislatures. "Never Events" become ever present as more states refuse to pay for mistakes. July 2008.
Accessed January 29, 2009.

9. Who Is Responsible for Maintaining Hospital Safety?

10. Health Care Team Must Work Together to Provide a Safe Atmosphere
Physicians, pharmacists, nurses and support staff must work collectively to provide a safe atmosphere for patients1
A safety officer is often assigned to implement and enforce safety practices within the hospital2
Most medication errors are not a direct result of one causative factor or individual3
Errors are generally caused by a flawed system, or lack of structured practices4
Health Care Team Must Work Together to Provide a Safe Atmosphere
Members of the health care team work in collaboration to provide a safe atmosphere for patients1
Physicians, pharmacists, nurses, support staff
A safety officer is often assigned to implement and enforce safety practices within the hospital2
Most medication errors are not a direct result of one causative factor or individual3
Errors are generally caused by a flawed system, or a lack of structured practices4
Poor communication
Unmanageable patient loads
Lack of backup or double-checks
References
Hellman R. Patient safety and inpatient glycemic control: translating concepts into action. Endocr Pract. 2006;12(suppl 3):49-55.
Institute for Healthcare Improvement. Develop a culture of safety: designate a patient safety officer. Accessed January 29, 2009.
Institute of Medicine. To err is human: building a safer health system. November Accessed January 29, 2009.
Hellman R. Endocr Pract. A systems approach to reducing errors in insulin therapy in the inpatient setting. 2004;10(suppl 2):
1. Hellman R. Endocr Pract. 2006;12(suppl 3):49-55.
2. Institute for Healthcare Improvement. Develop a culture of safety: designate a patient safety officer. Accessed January 29, 2009.
3. Institute of Medicine. To err is human: building a safer health system. November Accessed January 29, 2009.
4. Hellman R. Endocr Pract. 2004;10(suppl 2):

11. Culture of Safety Can Improve Patient Outcomes
Unintended injury
Defective culture No barriers
Initial physician orders
Scope of awareness
Intended therapeutic result
TIME
Correction by physician
Culture of Safety Can Improve Patient Outcomes
The establishment of a “culture of safety” means having a wide scope of awareness about patient-specific clinical information with backup assessments present in critical areas
Teamwork is the key to protecting patients from unintentional harm attributable to medical errors
Reference
Adapted from Hellman R. A systems approach to reducing errors in insulin therapy in the inpatient setting. Endocr Pract. 2004;10(suppl 2):
Nurse and pharmacist
on team
Backup check by peer
Adapted from Hellman R. Endocr Pract. 2004;10(suppl 2):
No injury
“Culture of safety”

12. Major Safety Organizations Strive to Improve Patient Safety
The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
Institute for Safe Medication Practices (ISMP)
Institute for Healthcare Improvement (IHI)
Occupational Safety and Health Administration (OSHA)
Centers for Medicare and Medicaid Services (CMS)
Major Safety Organizations Strive to Improve Patient Safety
The major hospital safety organizations include:
The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)1
Mission is to “…continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations…”
Institute for Safe Medication Practices (ISMP)2
Nonprofit group dedicated to safe medication use and the prevention of medication errors
Institute for Healthcare Improvement (IHI)3
Independent nonprofit organization that works to improve health care throughout the world
Occupational Safety and Health Administration (OSHA)4
Focus on preventing injuries and protecting workers by fostering a safe work environment
Centers for Medicare and Medicaid Services (CMS)5
Mission is “to ensure effective, up-to-date health care coverage and to promote quality care for beneficiaries”
References
The Joint Commission. About us: facts about the Joint Commission. Accessed January 29, 2009.
Institute for Safe Medication Practices. About ISMP. Accessed January 29, 2009.
Institute for Healthcare Improvement. About us. Accessed January 29, 2009.
Occupational Safety and Health Administration. OSHA’s role. Accessed January 29, 2009.
Centers for Medicare and Medicaid Services. Accessed January 29, 2009.

13. Points to Consider
What best practices does your hospital follow to promote patient safety?
In light of CMS’s initiative to not reimburse for preventable complications, what protocols are being implemented in your hospital?
How can you raise awareness about medication errors and improve communication with your health care team?
Points to Consider
Review as stated