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Goal 1 Improve the accuracy of patient identification

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  • 1. 2010 National Patient Safety Goals Presentation for Clinical Staff Sue Fuller, RN, CPSO Patient Safety Specialist Georgia Hospital Association Partnership for Health & Accountability
  • 2. Goal 1 Improve the accuracy of patient identification • NPSG 01.01.01 – Use at least two patient identifiers – Acceptable identifiers may be the individual’s name, date of birth, an assigned ID number, telephone number, or other personal ID Please tell me yourname and date of birth
  • 3. Goal 1 Improve the accuracy of patient identification • NPSG 01.01.01 – Use at least two patient identifiers – Acceptable identifiers may be the individual’s name, date of birth, an assigned identification number, telephone number, or other personal identification When “active patient involvement” is not possible or the patient’s reliability is in question, hospital policy will document the designated caregiver responsible for the patient’s identity verification
  • 4. Goal 1 Improve the accuracy of patient identification • NPSG 01.01.01 cont. – Use at least two patient identifiers – Acceptable identifiers may be the individual’s name, DOB, an assigned ID number, telephone number, or other personal identification • Use patient identifiers when administering meds, collecting blood samples, or other specimens
  • 5. Goal 1 Improve the accuracy of patient identification • NPSG 01.03.01 – Eliminate transfusion errors related to patient misidentification Before initiating a blood or blood component transfusion: • Match the blood or blood component to the order • Match the patient to the blood or blood component • Use a two-person verification process
  • 6. Goal 2 Improve the effectiveness of communication among caregivers • NPSG 02.03.01 – Addressing timely reporting of critical tests and critical results – NEW (Orion conference 01/2010) • Revised to focus on critical test results (as defined by the organization) • The organization determines how to evaluate the effectiveness of the program
  • 7. Goal 3 Improve the safety of using medications • NPSG 03.04.01 – Label all medications, medication containers, and other solutions on and off the sterile field in peri-operative and other procedural settings. – NEW (Orion conference 01/2010) • EP 7 which requires the retention of medication vials until completion of the procedure is now deleted) • Label meds and solutions not immediately administered • Label when the med or solution is transferred from the original package to another container • Verify all meds and solutions verbally and visually • Immediately discard meds or solutions found unlabeled
  • 8. Goal 3 Improve the safety of using medications • NPSG 03.05.01 – Reduce the likelihood of patient harm associated with the use of anticoagulant therapy – Assess baseline coagulation status – Use programmable pumps for consistent and accurate dosing – Provide written evidence based policies/protocols – Evaluate anticoagulation safety practices – Educate staff, patients/families
  • 9. Goal 7 Reduce the risk of health care-associated infections • NPSG 07.01.01 – Comply with either the Center for Disease Control and Prevention (CDC) and hygiene guidelines or the current World Health Organization (WHO) hand hygiene guidelines • Use soap and water for: •Visibly soiled hands •Clostridium difficile (C-Diff) • Use alcohol based hand rub for all other situations
  • 10. Goal 7 Reduce the risk of health care-associated infections • NPSG 07.03.01 – Implement evidence based practices to prevent health care associated infections due to multidrug-resistant organisms. • Hand hygiene • Contact precautions • Cleaning and disinfecting patient care equipment • Environmental cleaning and disinfecting
  • 11. Goal 8 Medication Reconciliation • NPSG 8 is still under revision but let’s not forget the intent of the goal and the patient safety implications if not met. – Gather a complete list of medications on admission (involve the patient and family) and include dose, route, frequency and last dose taken. Be sure to consider all points of entry. From the office From the ED From the ICU From non ICU In-patient area To home, LTC, Hospice
  • 12. Goal 8 Medication Reconciliation cont. – Identify a process to compare this patient list to the admission list of meds and reconcile any differences at that point. – As the patient moves through the continuum, with changes in LOC and acuity, and when transferred off of one area and moved to another, the meds must be reconciled again. (IV changed to PO, paralytics D/C’d after extubated, etc.) IV PO Home meds
  • 13. Goal 8 Medication Reconciliation cont. – Upon discharge or transfer to another facility, the original list and the discharge med list must be reconciled. – Remember, the patient still has all of the original meds at home and new instructions may need to be given if these meds have changed or if the instructions have changed.
  • 14. Goal 15 Suicide Prevention • NPSG 15.01.01 – The hospital identifies patients at risk for suicide • Conduct a risk assessment including environmental features • Address patient’s immediate safety needs • Upon discharge, provide crisis hotline information Warning signs of suicide include: Observable signs of serious depression: Unrelenting low mood Pessimism Hopelessness Desperation Anxiety, psychic pain and inner tension Withdrawal Sleep problems www.ASFP.org
  • 15. Goal: Universal Protocol Standardized List Time Out Prior to Incision Bedside Invasive Procedures Site Markers OR Team Participation

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