1. Basic Human Needs Safety

2. Clicker Question What percentage of medical errors are considered preventable? A.50% B.35% C.70% D.40%

3. Safety A basic human need Freedom from psychological or physical injury Concept central to nursing and health care today Environmental, Personal, Patient Safety Needs

4. Where do you feel safe?

5. Why focus on patient safety? Medical mistakes kill as many as 98,00 patients per year

6. NAME SOME SAFETY ISSUES IN HEALTH CARE SETTINGS

7. 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 21 st Century The Agency for Healthcare Research and Quality Institute for Healthcare Improvement National Patient Safety Foundation

8. 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)

9. Environmental Safety Basic Needs Physical Hazards Transmission of Pathogens Pollution Terrorism/Bioterrorism

11. 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

12. Recommended Immunizations DPT MMR Hepatitis A & B Varicella Haemophilus influenzae Pneumonia Polio Rotavirus HPV (females 13-18) Yearly flu vaccine TB (health care workers)

14. Terrorism/Bioterrorism

15. Personal Safety

16. 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

18. Patient Safety: Scope of the Problem Medical errors are the 8 th 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)

19. 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

20. National Patient Safety Initiatives The Joint Commission National Patient Safety Goals Institute for Healthcare Improvement “5 Million Lives” Campaign The Leapfrog Group

21. 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

22. 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 patient’s condition www.jointcommission.org/patientsafety/nationalpatientsafetygoals

23. 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

24. 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

25. 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?

26. 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

27. Keeping Patients Safe Making Hospitals Safer http://www.youtube.com/watch?v=D35EmKbjTmI Josie’s Story http://today.msnbc.msn.com/id/32917267 Discussion

28. Safety and the Nursing Process Assessment Nursing Diagnosis Planning Implementation Evaluation

29. Assessment Nursing History Home Environment Assessment Risk for falls Medication Reconciliation

30. 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

31. 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)

32. Environmental Interventions General Preventive Measures: Meet client needs (Oxygen, nutrition/fluids, temperature) Medical Asepsis Isolation Precautions Environmental lighting Security measures and concerns

33. Healthcare Worker Safety Proper Body Mechanics and Use of Lifting /Transfer Devices Blood & Body Fluid Exposure Radiation Exposure Exposure to pathogens

34. 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

35. 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

36. 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

37. 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

40. 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

41. Patient Safety Internet Resources Institute of Safe Medication Practice http://www.ismp.orghttp://www.ismp.org The Joint Commission http://www.jointcommission.org http://www.jointcommission.org National Patient Safety Foundation http://npsf.org http://npsf.org Agency for Healthcare Research and Quality http://www.ahrq.govhttp://www.ahrq.gov Institute for Healthcare Improvement http://www.ihi.orghttp://www.ihi.org

42. primum non nocere “First do no harm”