Uploaded byAhmad Thanin
Ipsg
The document outlines the International Patient Safety Goals (IPSGs) focusing on key areas such as correct patient identification, effective communication, medication safety, and ensuring safe surgical practices. It details strict protocols for identifying patients, managing high-alert medications, and conducting surgeries to minimize errors and enhance patient safety. Emphasis is placed on verification processes, communication strategies, and preventive measures to avoid potential risks during healthcare delivery.
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Ipsg
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- 2. International Patient Safety Goals (IPSGs) IdentifyPatients Correctly. Goal 1 Improve Effective Communication Goal 2 Improve the Safety of High-Alert Medications Goal 3 Ensure Safe Surgery Goal 4 Reduce the Risk of Health Care-Associated Infections Goal 5 Reduce the Risk of Patient Harm Resulting from Falls Goal 6
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- 4. What is thepatient Identification? Patient identification is the process of “correctly matching a patient to appropriately intended interventions and communicating information about the patient's identity accurately and reliably throughout the continuum of care
- 5. Identify the patient Beforegiving Medications Before giving blood and blood products Before Specimen collection. Before taking blood samples and other specimens for clinical testing. Before providing any other Treatments / Procedures/ Surgery/ Investigation etc. Before giving Food. At the time of discharge (NICU and Nursery).
- 6. Patient Identification All patients’:from admission to discharge : wrist band In normal circumstances, a patient’s ID band must only be removed on discharge home. Apply wristband to patient’s dominant wrist (i.e. the right wrist if the patient is right-handed). For newborn: • Immediately after delivery apply two bracelets: one on ankle and one on wrist, It should include • Mother’s three names • MRN • Gender of the baby • date and time of birth • birth order for twins (Twin-1, Twin-2).
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- 8. Removal of ID band:Only at time of discharge Cut the ID band into small pieces before discarding in the waste If ID band is missing: • Replace immediately; and • Write incident report
- 9. Removal of ID bandin OR Wrist band may be intentionally and carefully removed in the Operating Room (OR) during surgery if it obstructs access to the patient’s operative sites, patients IV, etc. Replacement band must be re-applied before removing the existing one. The person who removed the ID band must be witnessed when re-applying and both individuals must confirm the patient’s identification. Nurses in Recovery Room (RR) shall not accept patients for continued care if the correct wrist band is not secured.
- 10. Incorrect Patient Identification Can leadto: Medication errors Incorrect surgery Wrong-site surgery Wrong treatment Wrong baby discharged
- 11. Comatose / Unconscious Patient Without Identity:Unknown Health information system must generate the temporary name as Unknown Patient Number 1, Unknown Patient Number 2 etc with the temporary File/ Medical Record Number. The person who removed the temporary ID band must be witnessed when re- applying the new ID and both individuals must confirm the patient’s identification.
- 12. Disaster Cases - ER PatientName as Disaster Number 1, Disaster Number 2 etc, with File Number of the patient, which should be modified upon confirming the Identification of the Patient The person who removed the temporary ID band must be witnessed when re-applying the new ID and both individuals must confirm the patient’s identification If it is not possible to secure or attach the ID band on the patient’s wrist due to burns case or severe RTA affecting the wrist-apply on ankle.
- 13. How to identifypatient correctly according to IPSG 1? Using two patient identification factors, but without including the room or location of the patient in the complete Medical facility. Complete patient name MR Number Preventative measures should be taken to ensure that the following information is accurate before administering any medicines, withdrawing blood, or collecting other samples for clinical purposes.
- 14. Remember Always ask the patientto tell his/her name. 01 Never read the patients details and allow the patient to passively agree. 02 Never assume that the patient is in the right bed, or has the correct patient record, always check the wristband. 03
- 15. In case ofmore than one patient with the same name: Highlight it at each shift handover 01 Apply alert stickers stating “Alert, Patient with Similar Name” on all relevant documentation 02 Apply a card stating “Alert, Patient with Similar Name” to the patients’ bed. 03 Use extra tools for identification like •National ID confirmation •Birthdate •Family members names. 04
- 16. Positive Patient Identificationfor Patient Protection Positive patient identification (PPID) is an approach to avoiding patient misidentification for the prevention of medical errors, which include errors in medication, transfusion, and testing, as well as wrong-person procedures and the discharge of infants to the wrong family. PPID has been described as a combination of computer systems, hardware devices, and printable products for the purpose of identifying a patient by matching historical records with current records.
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- 18. How to improveeffective communications to meet the standards of JCI Accreditation? Telephone order Verbal order Reporting of critical results ISBAR
- 19. Telephone order When aphysician is not present in the office, orders are taken over the phone to the nursing station. Telephone orders are only accepted at the nursing station if the patient care action is required immediately or immediately after the call. The telephone is not an accepted option of placing routine orders. Orders for the following medicines cannot be made or received over the phone. • Hazardous Medications • TPN • Narcotics or Controlled items
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- 22. Verbal order When averbal order is received, the physician is on site but is preoccupied with emergency situations such as Code Blue or is engaged in a sterile operation, the physician is considered unavailable. Verbal instructions are only to be used in emergency circumstances. Verbal instructions for narcotics or restricted medications from the treating physician are only acceptable in emergency circumstances verification should be done by “Repeat Back” of the entire order with the ordering physician by the nurse/pharmacist receiving the order.
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- 24. Documentation shall include: DATE ANDTIME ORDER RECEIVED NAME OF CLINICIAN RELAYING THE ORDER ORDER AS DICTATED BY THE CLINICIAN ENDORSEMENT OF THE ORDER AS TELEPHONE/VERBAL ORDER. SIGNATURE AND ID NUMBER OF BOTH NURSES
- 25. Reporting of criticalresults When a call from the lab for a critical result is received, the nursing staff must record the critical result and promptly validate the result in the Hospital Information System. If the nursing staff is unable to reach the on-call physician, the nursing staff must follow the escalation procedure.
- 27. Radiology / Laboratory critical result Ifthe Critical Result is confirmed, head of the department will sign the result, and immediately contact the treating Physician by Phone (or the Ward physician on Duty) to notify him/her about the patient Critical Result. if the Head of department or the ( radiology / lab) doctor are not around then the lab technician will call the Doctor and inform him about the initial result) If we could not get the in-charge physician, then a call will be performed for the head nurse in charge. Radiology and laboratory departments will record & Sign in the Logbook of the Critical Result the following Information: • Patient name (three names), • Patient ID, • Critical Diagnostic result, • Reporting time and Date, • name of the Doctor informed.
- 28. ISBAR The ISBAR framework representsa standardized approach to communication which can be used in any situation. It stands for Introduction, Situation, Background, Assessment and Recommendation
- 29. What are theadvantages of ISBAR? Ensures completeness of information and reduces likelihood of missed data is an easy and focused way to set expectations for what will be communicated Ensures a recommendation is clear and professional Gives confidence in communication focuses not on the people who are communicating but on the problem itself.
- 30. Why would healthcareproviders use ISBAR? It is portable, memorable and easy to use Can be used to present information clearly in any situation Helps you to organize what you’re going to say Standardizes communication between everyone
- 31. Where can ISBARbe used? The ISBAR framework may be used in any information handover situation. For example: • Shift changes • Discharge to community services • Inter-hospital transfers • Intra-hospital transfers • Time-critical situations such as medical emergencies or evacuations • Procedure documents • Reports, memorandums and briefings
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- 36. DO NOT USEUSE 5.0 mg 5mg .25 mg 0.25mg MgSO4 Morphine Sulfate or Magnesium Sulfate MSO4 Morphine Sulfate or Magnesium Sulfate MS Morphine Sulfate or Magnesium Sulfate DANGEROUS ABBREVIATIONS DO NOT USE USE Ug mcg cc ml U unit QD daily IU International Unit SC or SQ SubQ
- 37. Goal 3 Improve theSafety of High-Alert Medications
- 38. Definition • Medications thathave a heightened risk of causing significant patient harm when used in error. High Alert Medication • A category of medications in which all drugs included are considered high alert although not listed individually in this guideline High Alert Medication Category
- 39. Definition Look-Alike and Sound-Alike Medications(LASA) • Medications that can look alike (presentation, strength, appearance and name) or sound like (pronunciation) other medications leading to avoidable mix-ups. Tall Man Lettering • a system in which part of a drug's name is written in upper case letters to help distinguish LASA medications from one another in order to avoid medication errors e.g., on storage shelves.
- 40. High-Alert Medications Medications involved ina high percentage of errors and/or sentinel events. Medications that carry a higher risk for adverse outcomes. Look-alike/sound-alike medications
- 41. Circumstances increasing riskerrors in high- risk medications Poorly handwritten medication orders Verbal orders. Similar product packaging Similar medication name Improper packaging/labeling to incorrect administration Oral liquid in IV syringe Topical products stored in IV vials Storage of products with similar names in the same location Similar abbreviations Improper storage of concentrated electrolytes
- 42. Double checking procedure Highalert medication requires a double- checking procedure prior to administration. The minimum requirements for double check will be for: With each dose/injection For infusion • At the time of initiation of therapy • At the time of a concentration change • At the change of each shift or any transfer of care • With any dose change
- 43. Double checking procedure Comparethe label with the product against the prescription and label the product content with the medication administration recorded (MAR) for the subsequence dose. The infusion pump setting will set also and double checked for the correct rate of infusion at initiation of the infusion.
- 44. Preventive strategy Preventive strategywill be implemented to reduce the potential risk associated with the use of High Alert Medication, use these will include: • Not accepting the letter U instead of unit in Physician’s order for Heparin and Insulin. • Verbal and telephone order should be kept to the minimum when prescribing high alert medications (verbal and telephone order for Potassium Chloride Injection is PROHIBITED) • Medication administered as intravenously will have a standard concentration for adult patient.
- 45. IMPORTANT High-Alert medications must beproperly labeled with Red warning sticker “High-Alert” for further dilution.
- 46. Storage and Dispensing: High-Alertmedications should NOT be stored in floors, only a limited quantity will be kept in a separate, locked cabinet away from regular medication stocks in certain areas such as (Operating Room, Emergency Room, and Intensive Care Units). Intravenous anesthetic and skeletal muscle relaxants agent should only be stocked in ICU, OR and ER. Each drug should be stored in separate labeled plastic container. Narcotic and controlled medications should be tightly controlled all over the hospital to prevent misuse or dangerous mix- up, to be kept in separate steel cabinets with double locks. Dispensing of such drugs (Narcotic & Controlled) only against treating consultant or specialist’s written order.
- 47. High-Alert Medication Categories High-Risk Medication Category/RoutePotential Error and Consequences Concentrated electrolytes / I.V • (Potassium Chloride, Calcium Gluconate, Magnesium Sulphate, Potassium Acetate, Sodium Chloride 14.6%, Sodium Phosphate) Potentially Lethal Medications Insulin / S.C / I.V ( only regular insulin can be given I.V ) • Regular ( Humulin, Actrapid ) • NPH (Humulin N,Insulatard HM ) • 70/30 (Humulin , Mixtard ) • Lantus ( Glargine ) • Novomix 70/30 ( Penfill ) • Mixtard 30 HM ( Penfill ) • Levemir Penfill • Inappropriate insulin given due to Look-alike/Sound-alike errors • Confusion of dose (units vs. ml ) • Drip rate errors causing bolus dose infused into patient. • Incorrect sliding scale interpretations/order entry leading to dosing errors. • Insulin errors have the potential to cause severe hypo/hypoglycemia. These effects may require extra monitoring, require treatment or in severe cases may be fatal.
- 48. High-Alert Medication Categories High-Risk Medication Category/Route Potential Error and Consequences Nuromuscular Blockers •Cisatracurium • Atracurium • Mivacurium • Succinylcholine Potentially Lethal Medications (Restricted to critical care and special care areas. (ICU,ER,OR))
- 49. HIGH ALERT MEDICATIONS Potassium chloride(inj) 20meq Magnesium sulfate (inj) 10% (2gm) Magnesium Phosphate (inj) Amidarone (inj) 200mg. Epinephrine (Adrenaline) inj (1:1000) Digoxin (inj) (0.50mg) Sodium Bicarbonate imj. 8.4% Calcium Chloride (inj) 10% Calcium Gluconate (inj) Phenytoin (inj) 250 mg Dopamine inj. 200 mg Phenobarbiton (inj) 250 mg. Dobutamine inj. 250 mg Lidocain 1% for arrhythmia (inj) (IV) Isoproterenol inj 1:500mg Warfarin (tab) 1,2,5 mg Noradrenaline inj-1-2mg/ml Sodium chloride IV 10% Aminophylline 250 mg IV Chemotherapy drugs Heparin Insulin inj
- 50. General Strategies forHigh Alert Medications TALLman lettering ‘LASA’ on label, when applicable “High Alert” on storage label High Alert Medications must be stored in Red Bins using Standardized Medication Labels Medication which must be stored in Red Bins with Lids •Concentrated Electrolytes •Parenteral Skeletal Muscle Relaxants (Paralyzing agents) Patient care areas: Stored in ADC locked Lidded CPOE with clinical decision support, providing immediate warnings if unsafe orders are entered
- 51. General Strategies forHigh Alert Medications Use of smart infusion pumps with dose checking software enabled Order sets. Independent Double-Check (IDC) Procedure in which two healthcare professionals separately check (alone and apart from each other, then compare results) each component of prescribing, transcribing, dispensing and verifying the medication before administering to the patient • Dispensing • Verifying at time of administration
- 53. OTHER LIST OFLOOK – ALIKE AND SOUND – ALIKE (LASA) MEDICATION DRUG NAME CONFUSED DRUG NAME SAFETY MEASURES Amphotericin Liposomal Amphotericin Conventional TALLman letters, Store separately AMILOride AMLOdipine TALLman letters, Store separately BuPROPion BuSPIRone TALLman letters, Store separately DiFLUcan DiPRIvan TALLman letters, Store separately DoPAMine DoBUTamine TALLman letters, Store separately EsMOLol EsMERon TALLman letters, Store separately EpiNEPHrine EpheDrine TALLman letters, Store separately FluOXETine FluPHENazine TALLman letters, Store separately HydrOXYzine HydrALAZine TALLman letters, Store separately HumaLOG HumuLIN TALLman letters, Store separately PeniCILLIN PeniCILLAMINE TALLman letters, Store separately ZanTAC ZyrTEC TALLman letters, Store separately
- 54. Concentrated Electrolytes: Magnesium Sulfate 50% or more concentration Potassium Chloride 2 mmol/mL or more concentration Potassium Phosphate 3 mmol/ml or more concentration Sodium Chloride hypertonic (greater than 0.9%)
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- 57. DIFFENTION Time Out is afinal pause and final verification process to be done on a patient before the performance of a procedure/s in the presence of all clinical team members and in the location where the procedure is to be conducted to assure right patient, right site and right procedure.
- 58. Time Out: Time outshould be done for at least: procedures that investigate and/or treat diseases and disorders of the human body through cutting, removing, altering, or insertion of diagnostic/ therapeutic scopes. The time out applies to any location in the organization where these procedures are performed. And done just before starting the procedure which involves the entire operative team.
- 59. Wrong site surgeryand the Protocol Check that the consent form or procedure request form is correct Check Mark the site with an indelible pen for the surgery or other invasive procedure Mark Confirm identification with the patient Confirm Take a “team time out” in the operating theatre, treatment or examination area for staff to verbally confirm that all is correct Take TIME OUT Ensure appropriate and available diagnostic images. Ensure
- 60. Ensuring Correct Patient,Correct Site, Correct Procedure Protocol Days to hours before procedure Step 1 Consent form or procedure request form, must include: • Patient's full name. • Procedure site. • Name of procedure. • Reason for procedure Step 2 Mark site of invasive procedure: • Must be marked by the person in charge of the procedure or another senior team member who has been fully briefed about the procedure or operation
- 61. Ensuring Correct Patient,Correct Site, Correct Procedure Protocol Just before entering the operation room or treatment room Step 3 Patient Identification, staff must ask the patient to state: • Their full name. • Date of birth. • Site for, or type of procedure Remember to Check the response against the marked site, ID Band, consent form and other documents
- 62. Ensuring Correct Patient,Correct Site, Correct Procedure Protocol Immediately prior to procedure Step 4 Team time out, within the operating theater or treatment room when the patient is present and prior to beginning the procedure. Staff must verbally confirm through “ team time out” when all other activities in the operation room stopped: • Presence of correct patient • The correct site has been marked. • Procedure to be performed • Availability of correct implant where required Step 5 Imaging Data, if imaging data are used to confirm the site or procedure, two or more members of the team must confirm the images are correct and properly labeled
- 63. The surgical siteMarking should: Involve the patient. Be made by the person performing the procedure with a permanent skin marker Done with an instantly recognizable mark. Be consistent throughout the organization. Take place with the patient awake and aware, if possible. Be visible after the patient is prepped and draped. Marked in all cases involving laterality, multiple structures (fingers, toes, lesions), or multiple levels (spine).
- 64. The purpose ofthe preoperative verification process is: To verify the correct site, procedure, and patient. To ensure that all relevant documents, images, and studies are available, properly labeled, and displayed; and To verify any required special equipment and/or implants are present.
- 65. Mark site ofinvasive procedure:
- 66. Surgical Time-Out When apatient goes to surgery, their surgical team takes great care to provide a safe experience. This involves Pre- Procedure Check-In Sign-In Time-Out Sign-Out
- 67. Pre- Procedure Check-In • Pre-op room Where •Patient and Pre-op Nurse Who • History and Physical • Consent • Nursing Assessment, including vital signs • Operative site marked by surgeon • Labs and images available • Blood products, special equipment available if needed What - Verification of: • Before Patient is taken into OR When
- 68. Sign-In • Pre-Op room Where •Patient, OR nurse and Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) Who • Patient, Procedure, Site and Consent • Allergies, Airway Concerns and Aspiration Concerns • Risk of blood loss What – Verification of: • Prior to giving anesthesia When
- 69. Time-Out •Operating Room Where •All membersof the surgical team Who •Surgeon introduces all team members •Verify patient, site and procedure •Verify patient images •Verify specific equipment available •Assess Fire Risk •Verify sterilization indicators for instruments •Verify antibiotics have been given •All members’ concerns addressed What •Prior to skin incision When
- 70. Sign-Out • Operating Room Where •All members of the surgical team Who • Procedure verified • OR RN confirms sponge, sharps and instrument count • Surgical specimens identified and labeled • Identify equipment concerns What • Before Patient leaves OR When
- 71. Example for X– HOSPITAL FORM TEMPLATE
- 72. Rule • Anything thatmay require a consent and/or is a “high risk” procedure requires a TIME-OUT • Don’t forget! The “TIME-OUT process applies to procedures OUTSIDE the OR as well!
- 73. Goal 5 Reduce theRisk of Health Care- Associated Infections
- 74. Introduction • Healthcare AssociatedInfection • is a localized or systemic condition resulting from an adverse reaction to the presence of infectious agent(s) or its toxin(s) that was not present on admission to the acute care facility. • An infection is considered as health care associated in all elements as per Centers for Disease Control and Prevention (CDC) site-specific infection criterion were first present together on or after the 3rd hospital day (day of hospital admission is day 1)
- 75. Infection Control Program Establishingan effective infrastructure for the Infection Control Program by: • Multidisciplinary team to oversee the Infection Prevention Control Program. • Program management. • Policies and procedures.
- 76. Definitions Hand Hygiene: Ageneral term referring to any action of hand cleansing Alcohol-Based Hand Rub: An alcohol-containing preparation designed for application to the hands for reducing the number of viable microorganisms on the hands. Antimicrobial Soap: Soap (i.e. detergent) containing an antiseptic agent. Antiseptic Agent: Antimicrobial substances that are applied to the skin to reduce the microbial flora. Antiseptic Hand Wash: Washing hands with soap and water or other detergents containing an antiseptic agent. Detergents: Compounds that pose a cleaning action. Hand Hygiene: A general term that applies to hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis. Hand Antisepsis: Refers to either antiseptic hand wash or antiseptic hand rub. Decontaminate Hands: To reduce bacterial counts on hands by performing antiseptic hand rub or antiseptic hand washes.
- 78. Infection Prevention and Control Program consist of: StandardPrecautions Hand Hygiene Appropriate Use of Personal Protective Equipment Cleaning, Disinfection and Sterilization Correct Waste Disposal, Proper Sharp Disposal and Sharp Injury Management. Linen Management. Specimen Handling. Environnemental Management and Spillage Management.. Aseptic Technique Cough Etiquette. Transmission-Based Precautions Education . Surveillance
- 79. Standard Precautions Standard precautions arebased on the principle that all blood, body fluids, excretions except sweat, non intact skin and mucous membranes may contain transmissible infectious agents. Standard precautions are intended to be applied to the care of all patients in all health care settings, regardless of the suspected or confirmed presence of an infectious agent. Implementation of standard precautions constitutes the primary strategy for the prevention of healthcare associated transmission of infectious agents among patients and healthcare personnel.
- 80. Hand Hygiene Healthcare associated infectionsare mainly spread through the contaminated hands of health care workers. Hand washing is the single most important way of preventing the spread of infection. Hand hygiene procedures include the use of alcohol-based hand rubs and hand washing with soap and water. Hand hygiene stations should be strategically placed to ensure easy access. Hand hygiene guidelines from WHO (5 moments of hand hygiene) is used to observe and evaluate hand hygiene for all categories of staff.
- 85. Hand Hygiene should bedone in all the following instances When hands are visibly dirty or contaminated with proteinaceous material or are visibly soiled with blood or other body fluids, wash hands with either a nonantimicrobial soap and water or an antimicrobial soap and water. Wash If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating and in all other clinical situations. Use Decontaminate hands before and after having direct contact with patients. Decontaminate Decontaminate hands before clean/Aseptic procedure if moving from a contaminated body site to another body site during care of the same patient. Decontaminate
- 86. Hand Hygiene should bedone in all the following instances Decontaminate hands after contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressings. If moving from a contaminated body site to another body site during care of the same patient. And after removing sterile or non-sterile gloves. Decontaminate hands before and after contact with a patient's intact skin (e.g. when taking pulse or blood pressure and lifting a patient). Decontaminate hands after contact with inanimate objects including medical equipment. After using a restroom, wash hands with a non- antimicrobial soap and water or with an antimicrobial soap and water.
- 87. Factors for pooradherence with hand Hygiene: Hand washing agents may cause irritation and dryness. Sinks are inconveniently located/shortage of sinks. Lack of soap and paper towels. Insufficient time. Lack of knowledge of guidelines. Beliefs that wearing of gloves obviates the need for hand hygiene.
- 88. Appropriate Use ofPersonal Protective Equipment Involves specialized equipment worn by the staff for protection against infectious materials. The selection of personal protective equipment is based on the nature of the patient interaction and potential for exposure to blood, body fluids or infectious agents. This includes gloves, gowns, and masks. A review of available personal protective equipment should be performed periodically due to new product developments and improvements.
- 89. Cleaning, Disinfection andSterilization Reusable medical devices/equipment must be adequately reprocessed for safe reuse. Strict policy regarding single use items. Spaulding’s classification of medical devices: • Critical Item (contact with sterile areas of the body) • Semi-Critical Item (contact with mucous membranes or non-intact skin) • Non-Critical Item (contact with intact skin)
- 90. Correct Waste Disposal, Proper Sharp Disposal and SharpInjury Management Segregate general and infectious waste at the point of generation. Awareness of proper waste management should be emphasized and strictly followed. General Waste • materials with no inherent hazard or infection potential e.g. administrative, food waste etc. (Black / Blue plastic bag) Biohazardous (Infectious Waste) • these are wastes which has the potential for transmitting infections/disease e.g. gloves, masks, blood-soaked dressings etc. (yellow thick plastic bag with Biohazardous sign)
- 91. Correct Waste Disposal, Proper Sharp Disposaland Sharp Injury Management Human Waste Tissue • as defined from fatwas 13290/13291 e.g. amputated body parts, placenta etc. (red thick plastic bag with label). Sharp Disposal • sharps include any object that can penetrate the skin e.g. needles, blades, broken ampoules etc. (puncture resistant sharps container) Safe Sharp Handling • to be managed and disposed of in a manner as to prevent injuries and transmission of disease e.g. no recapping of needles, use of kidney dish for transportation. Sharp Injury • First aid, reporting, laboratory tests, forms.
- 92. Linen Management Proper handling ofsoiled linen (soiled with blood or other body fluids) use of personal protective equipment. Transport from departments to laundry in closed carts. No mixing of clean and soiled linen.
- 93. Specimen Handling Contained in asealed container/plastic bag which is leak proof. Contained specimen must be placed in a secondary biohazard labeled plastic bag. Ensure request form is not contaminated; place in separate pocket of the biohazard plastic bag. Sharps injury must be avoided on collecting, containing and transporting of any specimen.
- 94. Environmental Management and Spillage Management Proper cleaningof patient’s rooms on daily basis. Medical device surfaces and housekeeping surfaces. Terminal cleaning on discharge of patient. Cleaning to be done with hospital prescribed disinfectant. Proper procedure to be followed indicated for relevant spill e.g. blood spill, chemical spill.
- 95. Aseptic Technique Are establishedto prevent or minimize the risk of infection transmission to patients undergoing invasive procedures or wound management. Healthcare worker must observe and practice the principles of aseptic technique as indicated by the type of procedure to be done
- 96. Cough Etiquette Educate healthcarepersonnel, patients and visitors on the importance of source control measures to contain respiratory secretions to prevent transmission of respiratory pathogens. Especially during seasonal outbreaks of e.g. influenza. Tissue to cover mouth when coughing or sneezing. Correct way for tissue disposal and hand hygiene. Avoidance of crowds.
- 97. Transmission-Based Precautions Transmission-based precautionsare used when the route of transmission is not completely interrupted using standard precautions alone. Use transmission-based precautions for patients with documented or suspected infection of colonization with highly transmissible or epidemiologically important pathogens for which additional precautions are needed to prevent transmission. Contact Precautions • gowns, gloves (e.g. MRSA infected patients) Droplet Precautions • surgical mask, gowns, gloves, (e.g. German Measles, Meningitis, Mumps) Airborne Precautions • N95 mask, gowns, gloves, and negative pressure room (e.g. Pulmonary Tuberculosis, Measles, Chicken Pox).
- 98. Education Monthly planned in-serviceeducation program for all departments. On hand education and training whenever the need arises. Comprehensive orientation program for new employees by infection control nurses and demonstration of hand hygiene. Competencies on various infection control practices.
- 99. Surveillance Hand Hygiene Waste Compliance •Catheter Associated Urinary Tract Infection • Central Line Associated Blood Stream Infection • Ventilator Associated Pneumonia. • Surgical Site Infections Health Care Associated Infections
- 100. Environmental hygiene • Environmentalhygiene is a fundamental principle of infection prevention in healthcare settings. • Contaminated hospital surfaces play an important role in the transmission of micro-organisms, including Clostridium difficile, and multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). • Therefore, appropriate hygiene of surfaces and equipment which patients and healthcare personnel touch is necessary to reduce exposure. • Evidence supports the hypothesis that hospital can act as an important reservoir of many nosocomial pathogens in several environments such as surfaces, medical equipment and water system. • Healthcare settings are complex realities within which there are many critical points. • Microbial contamination can result from the same inpatients, relatives and healthcare workers. • The role of environmental hygiene is to reduce the number of infectious agents that may be present on surfaces and minimize the risk of transfer of micro-organisms from one person/object to another, thereby reducing the risk of cross-infection.
- 101. Screening and cohortingpatients • Early detection of multidrug-resistant organisms is an important component of any infection control program. • There is good evidence that active screening of preoperative patients for MRSA, with decolonization of carriers, results in reductions in postoperative infections caused by MRSA. • Isolation or cohorting of colonized/infected patients is a cornerstone of infection prevention and control. • Its purpose is to prevent the transmission of microorganisms from infected or colonized patients to other patients, hospital visitors, and healthcare workers, who may subsequently transmit them to other patients or become infected or colonized themselves. • Isolating a patient with highly resistant bacteria is beneficial in stopping patient-to-patient spread. • Isolation measures should be an integral part of any infection prevention and control program, however they are often not applied consistently and rigorously, because they are expensive, time- consuming and often uncomfortable for patients.
- 102. Antibiotic stewardship • Optimalinfection control programs have been identified as important components of any comprehensive strategy for the control of AMR, primarily through limiting transmission of resistant organisms among patients. • The successful containment of AMR in acute care facilities, however, also requires an appropriate antibiotic use. • Antibiotic stewardship programs (ASPs) can help reduce antibiotic exposure, lower rates of Clostridium difficile infections and minimize healthcare costs. • Most antibiotic stewardship activities effect multiple organisms simultaneously and have as a primary goal the prevention of the emergence of antibiotic resistance. • Thus, ASPs can largely be viewed in the context of horizontal infection prevention. • Additionally, ASPs can contribute to the prevention of surgical site infections via the optimized use of surgical antibiotic prophylaxis.
- 104. Goal 6 Reduce theRisk of Patient Harm Resulting from Falls
- 105. Definition • A fallis an incident in which an adult or a child unexpectedly falls down, unassisted or uncontrolled, from a higher position to a lower position, with or without injuries and which may or may not be related to physical or mental pathology. Fall • sudden loss of balance that does not result in a fall or other injury . • This can include a person who slips, stumbles, or trips but is able to regain control prior to falling. Near Fall • occurs when a patient is found on the floor and neither the patient nor anyone else knows how he or she got there . un-witnessed fall
- 106. All in-patients willbe assessed for the risk of fall upon admission.
- 107. Most Causing toFalls • Loss of consciousness. • Orthopedic disorders. • Hypoglycemia. • Anemia, Vision • Hypotension. • Drugs action. • Post operative (sedation). • Aging and sleeping habits • Paralysis, TIA, CVA Individual • Unsafe higher position. • Beds side rails. • unlocked wheelchair. • Water in the floor. • Wire connections. • Steps or stairs. • Walker. • Interfering Clothes Environmental
- 108. Patient Fall InjuryLevels None: • No injury. Minor: • minor injury with abrasion or bruise treated by dressing, limb elevation, topical medication. Moderate: • injury lead to Suturing or limping treated by bandage, splinting, muscle or joint strain. Major: • which leads for casting, skin traction and surgery, may need neurological and vascular attention. Death: • the patient died as a result of serious injury. UTD: • unable to determine from the documentation .
- 109. Fall assessment All in-patientswill be assessed for the risk of fall upon admission. •post operative. •following procedural sedation. •after administer medication. •after blood transfusion. •transferring patients between 2 units. •after recording incident of fall. •any changing in ambulatory status or elimination status, Reassessment is indicated for all of the following conditions: •Hendrich 11 Fall risk for Adults. •Humpty Dumpty Scale for Pediatrics. •The Morse Fall Scale Applying Risk Fall procedure for patients Standard fall precaution shall be implemented for all patients. Reporting and documenting any fall occurrence. All Falls patients should be classified according to level of Injury
- 110. Post Fall Protocolof Care First Aid. Ensure that patient is safe from further danger . ask for help. don’t reposition the patient until the patient is ready to do so. move the patient safely with attention to moving and handling. complete the post fall assessment Form Reporting. Patient and Family Education.
- 111. Standard Fall Precautionfor Low-Risk Patients 1 Orient the surrounding environment. 2 Provide Medication Information. 3 Instruct patient to call for assistance. 4 Instruct to use the rubber – soled shoes or non – slip footwear to prevent slipping. 5 Secure call bell, phone, bed table. 6 Ensure the clothes are not interfere with the patient mobility. 7 Maintain the bed in the lowest position and ensure bed and wheelchairs are looked. 8 Put side rails. 9 Conduct regular environmental rounds in all areas surrounding the patients to decrease the risk of falls. 10 Keep bathroom light on and the floor dry.
- 112. Standard Fall Precautionfor Moderate Risk Patients Identify as falls risk on medical record and include in shift endorsement. Assist and supervise ambulation, Reinforce to always call for assistance. Conduct hourly safety checks. Perform regular pain assessment Offer assistance to the bathroom or use bedpan hourly while awake. Evaluate for reversible causes • Orthostatic B.P • Monitor Blood Sugar . • Adequate Hydration Check the patients after the visitors leave always. Don’t lower the bed side rails if any nurse rise it up. Patient Education. Family Education. Apply Fall Risk Hand Band
- 114. Standard Fall Precaution forHigh-Risk Patients Apply all low and moderate interventions. Place a high risk for fall sticker/ label on the patient charts and patient room. Raise Both upper and lower side rails. Place mattress on floor. Review the medication. Assess the need of physical therapy consultation. Assess the need for 1:1 monitoring as needed.
- 115. Patient and FamilyEducation both about the risk of falling, Safety Issues, and their Mobility Limitation. Educate patient to make position changes slowly. Teach how important the family to be involving tin the patient safety. Emphasize what patient can do to be healthy, active, and independent Emphasize on
- 116. Interventions based onthe fall-risk assessment Monitoring gait and mobility. Bladder/ Bowel Training Program. Fall Alert Medication. Maintaining a safe environment. Assistive Devices Monitoring.
- 117. Monitoring gait andmobility. Normal/Safe Gait & Balance. Balance Problem while Standing Balance Problem while Walking Change in Gait Pattern while Walking through doorway Jerking/ Unstable when Making Turn Requires an Assistance
- 118. Bladder /Bowel TrainingProgram 45% Falls Identified as Toileting related (Tzeng, 2010) Is a training technique for bladder and bowel to decrease urgency and incontinence based on behavioral modification treatment techniques that involves placing patient on toileting schedule. • > 60 Years Old • On Laxative • Bed Ridden • Postoperative
- 119. MEDICATIONS FALL ALERT Pharmacistare responsible for reviewing medication and supplements to ensure that the risk of falls is reduced Notify the for Drug that depress the central nervous system may cause sedation, drowsiness, ataxia, as well as paradoxical effects like: • Antihistamine • Antiepileptic • Antidepressant • Anticonvulsant • Cardiovascular drugs
- 120. Maintaining a SafeEnvironment Environmental hazards or hazardous activities are described as primary causes for approximately half of all falls, which includes: • Walking on slippery/rough surfaces. • Obstacles. • Inadequate light. • Loose carpets. • Trip Hazard regarding to medical care ( IV Tubing, Urinary Catheter, ). Such hazards are likely to cause trips or slips in any age group but pose a particular risk for community- dwelling elderly persons who may already have multiple intrinsic risk factors for falls.
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