Revisedpart iiipme lecture 2012presentationpart3

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Revisedpart iiipme lecture 2012presentationpart3

  1. 1. 2012 National Patient Safety Goals <ul><li>Goal 7- Reduce the risk of health care </li></ul><ul><li>associated infections </li></ul><ul><li>A. Meeting Hand Hygiene Guidelines </li></ul><ul><li>B. Preventing Multidrug-Resistant Organism Infections </li></ul><ul><li>C. Preventing Central Line–Associated Blood Stream Infections </li></ul><ul><li>D. Preventing Surgical Site Infections </li></ul>
  2. 2. Centers for Disease Control (CDC) Report <ul><li>Health-care--associated infections (HAIs) account for a substantial portion of health-care--acquired conditions that harm patients receiving medical care. Nearly one in every 20 hospitalized patients in the United States each year acquires an HAI. Central line--associated blood-stream infections (CLABSIs) are one of the most deadly types of HAIs, with a mortality rate of 12%--25% . </li></ul>http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm?s_cid=mm6008a4_w
  3. 3. TEST YOUR KNOWLEDGE <ul><li>Which is the most </li></ul><ul><li>frequently occurring </li></ul><ul><li>nosocomial </li></ul><ul><li>infection? </li></ul><ul><li>A. Urinary tract infection </li></ul><ul><li>B. Pneumonia </li></ul><ul><li>C. Vascular Catheter related </li></ul><ul><li>Which of these are risk </li></ul><ul><li>factors for development </li></ul><ul><li>of nosocomial infections? </li></ul><ul><li>A. Age </li></ul><ul><li>B. Urinary catheter >24hrs </li></ul><ul><li>C. Mechanical ventilation </li></ul><ul><li>D. Severe underlying disease </li></ul><ul><li>E. Extended stay in acute or chronic care facility </li></ul>Answers on next slide
  4. 4. <ul><li>Additional considerations include: </li></ul><ul><li>Overuse of antimicrobials </li></ul><ul><li>Contaminated equipment-instruments </li></ul><ul><li>Poor HANDWASHING </li></ul><ul><li>Adherence to the CDC Hand </li></ul><ul><li>washing guidelines is critical </li></ul>Urinary tract infections, all are risk factors
  5. 5. Definitions-CDC <ul><li>Hand hygiene </li></ul><ul><ul><li>Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis </li></ul></ul><ul><li>Handwashing </li></ul><ul><ul><li>Washing hands with plain soap and water </li></ul></ul><ul><li>Antiseptic handwash </li></ul><ul><ul><li>Washing hands with water and soap or other detergents containing an antiseptic agent </li></ul></ul><ul><li>Alcohol-based handrub </li></ul><ul><ul><li>Rubbing hands with an alcohol-containing preparation </li></ul></ul><ul><li>Surgical hand hygiene/antisepsis </li></ul><ul><ul><li>Handwashing or using an alcohol-based handrub before operations by surgical personnel </li></ul></ul>Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
  6. 6. Indications for Hand Hygiene-CDC <ul><li>When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. </li></ul><ul><li>If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. </li></ul>Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
  7. 7. Specific Indications for Hand Hygiene <ul><li>Before: </li></ul><ul><ul><li>Patient contact </li></ul></ul><ul><ul><li>Donning gloves when inserting a CVC </li></ul></ul><ul><ul><li>Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery </li></ul></ul><ul><li>After: </li></ul><ul><ul><li>Contact with a patient’s skin </li></ul></ul><ul><ul><li>Contact with body fluids or excretions, non-intact skin, wound dressings </li></ul></ul><ul><ul><li>Removing gloves </li></ul></ul>Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
  8. 8. Recommended Hand Hygiene Technique <ul><li>Handrubs </li></ul><ul><ul><li>Apply to palm of one hand, rub hands together covering all surfaces until dry </li></ul></ul><ul><ul><li>Volume: based on manufacturer </li></ul></ul><ul><li>Handwashing </li></ul><ul><ul><li>Wet hands with water, apply soap, rub hands together for at least 15 seconds </li></ul></ul><ul><ul><li>Rinse and dry with disposable towel </li></ul></ul><ul><ul><li>Use towel to turn off faucet </li></ul></ul>Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
  9. 9. Additional Safety Concerns <ul><li>Reduce the Potential of Patient Harm resulting from falls </li></ul>
  10. 10. Falls in the Elderly <ul><li>Falls are a leading cause of death in people 65 and older. </li></ul><ul><li>Approximately 50% of those that fall suffer injuries that reduce mobility and independence. One third of those that sustain hip fractures require nursing home placement </li></ul><ul><li>Ten percent of fatal falls for older adults occur in hospitals. </li></ul>
  11. 11. Fall Risk Factors <ul><li>>65 years of age </li></ul><ul><li>Inability to understand or follow directions </li></ul><ul><li>Confusion </li></ul><ul><li>Altered level of consciousness/ </li></ul><ul><li>delirium </li></ul><ul><li>Inability to use call light </li></ul><ul><li>Impaired vision or mobility </li></ul><ul><li>Unsteady gait </li></ul><ul><li>Dizziness/fainting </li></ul><ul><li>Recent history of falls </li></ul>
  12. 12. Fall Risk Factors <ul><li>Medication Therapy </li></ul><ul><li>Hx of nocturnal/urgency/ frequency in elimination </li></ul><ul><li>Hx of seizures </li></ul><ul><li>Surgical Procedure </li></ul><ul><li>Orthostatic hypotension or hypertension </li></ul><ul><li>Children in cribs </li></ul><ul><li>Use of assistive devices </li></ul>
  13. 13. Meds Requiring Fall Alert <ul><li>Tricyclic Antidepressants </li></ul><ul><li>Antipsychotics </li></ul><ul><li>Sedative-Hypnotics </li></ul><ul><li>Antihypertensives </li></ul><ul><li>Antihistamine/Anticholinergics </li></ul><ul><li>Hypoglycemic agents </li></ul><ul><li>Diuretics/Laxatives </li></ul><ul><li>Anticonvulsants </li></ul><ul><li>Muscle Relaxants </li></ul><ul><li>Narcotic Analgesics </li></ul>
  14. 14. Fall Assessment-High Risk <ul><li>Identify high risk patients and communicate </li></ul><ul><li>to staff-Morse Fall Scale </li></ul><ul><li>Place yellow fall identification band on patients wrist </li></ul><ul><li>Observe patients identified at risk for falls every 2 hours </li></ul><ul><li>Review patient’s medications that may increase the risk of falls on a daily basis. </li></ul>
  15. 15. Interventions- Initiate Safety Measures <ul><li>Dangle feet from bed prior to sitting/ambulation </li></ul><ul><li>Assist with ambulation </li></ul><ul><li>Apply fall alert ID armband </li></ul><ul><li>Place bed/chair in low position </li></ul><ul><li>Ensure correct use of least restraint </li></ul><ul><li>Free environment of clutter </li></ul><ul><li>Review medications </li></ul><ul><li>Consider interdisciplinary consult </li></ul><ul><li>Document assessment, interventions, response </li></ul><ul><li>Educate patient & significant others </li></ul>
  16. 16. Additional Safety Concerns <ul><li>Prevent health care–associated pressure </li></ul><ul><li>Ulcers </li></ul><ul><li>Assess high risk patients </li></ul><ul><li>Turn every 2 hours </li></ul><ul><li>Keep patient dry and clean </li></ul><ul><li>Promote good nutrition </li></ul>
  17. 17. 2012 Patient Safety Goals <ul><li>The organization identifies safety risks inherent </li></ul><ul><li>in its patient population. </li></ul><ul><li>Nurses must identify individuals who are at </li></ul><ul><li>increased risk of injury and implement safety </li></ul><ul><li>interventions. </li></ul>
  18. 18. High Risk Patient Populations <ul><li>Elderly </li></ul><ul><li>Pediatric </li></ul><ul><li>Language Barriers </li></ul><ul><li>Vision Impairment </li></ul>
  19. 19. Case Study <ul><li>An elderly blind patient was hospitalized </li></ul><ul><li>for treatment of a deep vein thrombosis(clot). </li></ul><ul><li>His discharge medications included injections </li></ul><ul><li>of a anti coagulant. A nurse and pharmacist </li></ul><ul><li>provided the patient with written information </li></ul><ul><li>sheets and counseling regarding self </li></ul><ul><li>administration of his medications. Neither </li></ul><ul><li>noticed that the patient was blind. </li></ul>Reference: http://www.ahrq.gov
  20. 20. Case Study <ul><li>Several days following discharge the </li></ul><ul><li>patient called the office and told the nurse </li></ul><ul><li>he had a bag full of medications including </li></ul><ul><li>injections, but he had not taken any of </li></ul><ul><li>them since he could not read the </li></ul><ul><li>instructions. The patient had to be </li></ul><ul><li>readmitted to the hospital for continuation </li></ul><ul><li>of anticoagulate therapy. </li></ul>
  21. 21. What Happened? <ul><li>False assumptions regarding the patients visual acuity </li></ul><ul><li>Inadequate discharge teaching. Written information is insufficient. </li></ul><ul><li>They did not have the patient return demonstrate the injection procedure. </li></ul><ul><li>Over 1 million persons living in the US are legally blind. Proper assessment is essential to patient education. </li></ul>
  22. 22. Interventions For High Risk Patients <ul><li>Medication training/competency </li></ul><ul><li>Interpreter use </li></ul><ul><li>Available patient education materials </li></ul><ul><li>Large print </li></ul><ul><li>Available outside resources </li></ul>
  23. 23. Case Study <ul><li>Following an overdose a 26 year old </li></ul><ul><li>woman was admitted for observation with </li></ul><ul><li>a 72 hour hold by psychiatry. A 24 - hour </li></ul><ul><li>attendant was placed with the patient. The </li></ul><ul><li>patient was to go to x-ray but requested to go to </li></ul><ul><li>the bathroom first. She was left in the bathroom </li></ul><ul><li>alone. The attendant and transporter began to </li></ul><ul><li>talk. </li></ul><ul><li>Reference: http://www.ahrq.gov </li></ul>
  24. 24. Case Study <ul><li>Upon return to patients room, the nurse </li></ul><ul><li>became concerned and found patient with her </li></ul><ul><li>gown tied around her neck, standing on the </li></ul><ul><li>upside down garbage can. She was seconds </li></ul><ul><li>from stepping off and hanging herself. </li></ul><ul><li>Fortunately no harm came to the patient. </li></ul><ul><li>NEVER LEAVE PATIENT UNATTENDED </li></ul>
  25. 25. Psychiatric Patients <ul><li>Review of 76 cases found only 40% of inpatients who committed suicide were admitted for suicidal ideation. </li></ul><ul><li>Prevention Strategies- Assessment, safe environments, use of a one to one attendant, </li></ul><ul><li>Never leave patient alone </li></ul>
  26. 26. 2012 Patient Safety Goal- <ul><li>Conduct a pre procedure verification </li></ul><ul><li>Process – WHO guidelines include </li></ul><ul><li>Initial verification of the intended patient, procedure, and site of the procedure; </li></ul><ul><li>Marking the intended site with a sterile pen, where applicable; and  </li></ul><ul><li>A final “time-out” immediately before beginning the procedure in which medical team members actively verify each element listed above. </li></ul><ul><li>  </li></ul>
  27. 27. Patient Safety Considerations <ul><li>Encourage patients’ active involvement in their </li></ul><ul><li>own care as a patient safety strategy. </li></ul><ul><li>Improve recognition and response to change </li></ul><ul><li>in a patients condition. Many hospitals have </li></ul><ul><li>instituted rapid response teams which usually </li></ul><ul><li>consist of a nurse, respiratory therapist and </li></ul><ul><li>other health care team members who respond </li></ul><ul><li>to a patient in need. </li></ul>
  28. 28. Patient/Family <ul><li>Patients and family members can provide additional safety checks. </li></ul><ul><li>Encourage patients and families to ask questions. </li></ul><ul><li>Inform patients of their rights. </li></ul><ul><li>Educate patients and family members on all aspects of their care. </li></ul><ul><li>Provide written material as well as verbal. </li></ul>
  29. 29. Available Resources for Patient Education include <ul><li>Institute for Safe Medication Practices </li></ul><ul><li>access www.ismp.org </li></ul><ul><li>Agency for Healthcare Research & Quality - access www.ahrq.gov http://www.ihi.org/IHI/ </li></ul><ul><li>Institute for Healthcare Improvement access: http://www.ihi.org/IHI/ </li></ul>
  30. 30. TEAM WORK IS THE KEY

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