This document outlines several goals and safety measures to reduce patient harm at a hospital. It discusses identifying patients correctly, improving communication, safely managing high-alert medications, preventing wrong-site procedures, reducing healthcare-associated infections, and minimizing falls. Specific strategies are provided, such as conducting vulnerability assessments, monitoring high-risk patients more frequently, using safety checklists, and keeping patients accompanied and call bells within reach. The overall aim is to establish a culture of safety and reporting of any adverse events.

1. Ms.Nikethana R Nair, M.Sc (OBG), MBA (HA), M.Ṣc (Psy)M.Phil (HHSM),
Nursing Superintendent,
Meenakshi Mission Hospital & Research Center - Madurai

3. Goal 1
Identify the Patient Correctly

6. Goal 2
Improve Effective Communication

10. Other Documents....
• Adverse event data are tracked and used to
identify improvements for hand over
communications.
• Handover between patients and families

11. Goal 3
Improve
the Safety of
High-Alert Medication

12. High alert medications are those medications involved in a high percentage of
errors/sentinel events, medications that carry a higher risk for adverse outcomes
as well as look- alike / sound alike medications.
•Chemotherapeutics
•All Narcotic Drugs – Fentanyl patches & Injections, Inj. Pethidine, Morphine
injections & Tablets, Pentazocine injection
•Concentrated electrolytes – I.V. KCL 2mEq/ml or more concentrated, I.V. Potassium
Phosphate, I.V. Nacl (more than 0.9%), I.V. Mg Sulphate (50% or more concentrated)
•Mg sulfate is stored in 3 to 10 ampules for managing pre eclampsia
•Look Alike/ Sound Alike drugs – Staff should know all drugs in LASA
•Narrow Therapeutic Index drugs – I.V. Phenytoin, I.V. Aminophylline, Inj.
Tacrolimus, Inj. Digoxin, Tab. Lithium carbonate
•Anticoagulants – I.V. Heparin, Tab. Acenocoumarol (Acitrom), Tab. Warfarin
•Insulins
•Antipsychotics – Inj. Haloperidol
•Anesthetic – Inj. Ketamine Hydrochloride (All CCU) kept under double lock

13. Cont....
• High alert sticker for all high alert medications
• Double lock for Narcotics and high concentrated electrolytes
• Key custodian
• Tall Man lettering for LASA labels
• Store LASA drugs in separate racks - Segregation
• Color coding for insulin storage
• Concentrated electrolytes are stored only in the specific areas
• Independent Double check and double sign
• Replace the empty ampoules of narcotics
• Wastage of narcotics should be discarded in the presence of doctor
and obtain doctor’s signature
• HAM monitoring
• Adverse events to be reported

15. Goal 4
Eliminate Wrong site,
Wrong patient,
Wrong procedure/Surgery

19. Goal 5
Reduce the risk of Healthcare
Acquired
Infections

21. Goal 6
Reduce the Risk Of Patient Harm
Resulting from Falls

22. CARE OF PATIENT
Patient safety is a new
healthcare discipline that
emphasizes the reporting,
analysis, and prevention of
medical error that often lead to
adverse healthcare events.

23. Who & When
For safety of the patient vulnerability
assessment should be done for all the
patients at the time of admission

24. When to be Used.....
• If the AFRAT score is more than or
equal to 45 then the Reassessment is
done every 48 hrs
• If it is less than 45 then re-
assessment is done every 7th day
• It is done except for HDU and ICU
patients because they are already
considered to be vulnerable
• It is done at the time of admission
for all the patients
• Fall Risk reassessment is done
when the patient condition changes
eg.when the patient shifted from
ICU to ward, after surgery when
the patient shifted to ICU or ward
• Moarse Fall Risk Assessment &
safety first policy is used to meet
the standards

26. CRITERIA FOR REASSESSMENT
There is a change of disposition in the clinical condition of the
patient (eg.post code orange ,code blue)
When the patient undergoes a surgery for any reason
Patients is placed on restraint
Patient ,during his course of stay in the hospital has /develops
hearing/vision impairment even with the use of aids
Patient uses assistive devices to aid in mobility
(eg.crutches,cane,walkers)
Patient is disoriented- with impaired cognition, altered sensorium

27. SAFETY MEASURES
• Patient should not be left unattended
• Any untoward incident to be reported immediately
• To use Safety belts while transporting patient
• Bed to be locked always
• Vitals have to be recorded
• Safety brochure and fall prevention education to be given.
• In case of falls, incident reports have to be documented.
• Record the above in PFE form.
• IDTR should be filled after 72 hours of admission

28. Cont....
• Safety first sticker is placed at the head end of the patient
• Side rails should be always up & wheels should be locked when the patient is in
the bed
• Patient should not be left unattended
• Avoid slippery floors
• Accompany the patient to the wash room
• Safety belt should be on when the patient is transported in the wheel chair or
stretcher
• Call bell should be at the reach of patient
• Any untoward incident should be reported immediately in AIRS
• All vulnerable patient’s elimination needs are to be met at the bedside. A
bedside commode or bedpan should be provided