Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events.
The document describes how infection prevention and control programs are typically organized within healthcare facilities. It states that programs are overseen by an Infection Control Committee that includes representatives from various departments. The Committee provides oversight and support to the Infection Control Team, which is responsible for the day-to-day activities. The Team includes at least one physician known as the Infection Control Officer and one nurse called the Infection Control Nurse. Other roles include Infection Control Link Nurses within each department. A key tool is an Infection Control Manual that establishes standards of practice for preventing infections.
This document provides a framework for identifying, preventing, and managing aggression and violence in health service workplaces. It recommends establishing an effective program based on risk management processes, consultation, documentation, monitoring, and evaluation. The handbook emphasizes practical measures to prevent incidents and achieve a safe work environment. It is intended to help health services develop strategies to address aggression and violence issues.
This document provides a framework for identifying, preventing, and managing aggression and violence in health care workplaces. It recommends establishing an effective program based on risk management processes, consultation, documentation, monitoring, and evaluation. The handbook emphasizes practical measures to prevent incidents and achieve a safe work environment. It is intended to help health services develop strategies to address aggression and violence issues.
It’s all in the detail developing effective health-related job aidsMalaria Consortium
Malaria Consortium has extensive experience developing job aids for community health workers and health facility workers in several countries. They have identified six key criteria for effective job aids based on this experience: 1) communicate complex information simply, 2) ensure accurate and up-to-date content aligned with health policies, 3) provide clear decision pathways, 4) describe tasks aligned with training and practice, 5) use appropriate language, illustrations and symbols, and 6) produce durable, cost-effective materials. The response provides examples from Mozambique, Uganda and other countries of applying these lessons to design simplified job aids that health workers can easily understand and use to improve performance.
Systems that fail: service user and carer perspectives on patient safetyChris Jacob
The document summarizes a project that used system safety assessments and human factors training to improve patient safety in mental health services. It involved:
1) Conducting system safety assessments at multiple mental health trusts to proactively identify risks and design interventions.
2) Providing human factors training to shift culture towards open safety communication and improve staff skills.
3) Involving service users and carers throughout to incorporate their perspectives into redesigning care pathways.
This document is a project report submitted by Shraddha Shrikant Dalavi to Shivaji University in partial fulfillment of an MBA degree. The report studies the health and safety measures at Ghatge Patil Industries Ltd. Through a survey of 100 workers, the report finds that the company provides necessary safety equipment and policies. Workers have good awareness of safety procedures and are satisfied with facilities like drinking water and the canteen. The report concludes that the company's health and safety practices comply with regulations and have reduced accident rates. It recommends further safety trainings and improving environmental conditions.
Getting Knowledge into Action for Best Quality HealthcareNHSScotlandEvent
NHS Education for Scotland and Healthcare Improvement Scotland are working with NHS Boards to define new approaches to implementing and sharing knowledge which support practitioners to get knowledge into action at the frontline. This shift in focus from accessing to applying knowledge will integrate knowledge management more closely with quality improvement. This interactive workshop will use creative knowledge management techniques to challenge the way we apply knowledge in practice.
The document describes how infection prevention and control programs are typically organized within healthcare facilities. It states that programs are overseen by an Infection Control Committee that includes representatives from various departments. The Committee provides oversight and support to the Infection Control Team, which is responsible for the day-to-day activities. The Team includes at least one physician known as the Infection Control Officer and one nurse called the Infection Control Nurse. Other roles include Infection Control Link Nurses within each department. A key tool is an Infection Control Manual that establishes standards of practice for preventing infections.
This document provides a framework for identifying, preventing, and managing aggression and violence in health service workplaces. It recommends establishing an effective program based on risk management processes, consultation, documentation, monitoring, and evaluation. The handbook emphasizes practical measures to prevent incidents and achieve a safe work environment. It is intended to help health services develop strategies to address aggression and violence issues.
This document provides a framework for identifying, preventing, and managing aggression and violence in health care workplaces. It recommends establishing an effective program based on risk management processes, consultation, documentation, monitoring, and evaluation. The handbook emphasizes practical measures to prevent incidents and achieve a safe work environment. It is intended to help health services develop strategies to address aggression and violence issues.
It’s all in the detail developing effective health-related job aidsMalaria Consortium
Malaria Consortium has extensive experience developing job aids for community health workers and health facility workers in several countries. They have identified six key criteria for effective job aids based on this experience: 1) communicate complex information simply, 2) ensure accurate and up-to-date content aligned with health policies, 3) provide clear decision pathways, 4) describe tasks aligned with training and practice, 5) use appropriate language, illustrations and symbols, and 6) produce durable, cost-effective materials. The response provides examples from Mozambique, Uganda and other countries of applying these lessons to design simplified job aids that health workers can easily understand and use to improve performance.
Systems that fail: service user and carer perspectives on patient safetyChris Jacob
The document summarizes a project that used system safety assessments and human factors training to improve patient safety in mental health services. It involved:
1) Conducting system safety assessments at multiple mental health trusts to proactively identify risks and design interventions.
2) Providing human factors training to shift culture towards open safety communication and improve staff skills.
3) Involving service users and carers throughout to incorporate their perspectives into redesigning care pathways.
This document is a project report submitted by Shraddha Shrikant Dalavi to Shivaji University in partial fulfillment of an MBA degree. The report studies the health and safety measures at Ghatge Patil Industries Ltd. Through a survey of 100 workers, the report finds that the company provides necessary safety equipment and policies. Workers have good awareness of safety procedures and are satisfied with facilities like drinking water and the canteen. The report concludes that the company's health and safety practices comply with regulations and have reduced accident rates. It recommends further safety trainings and improving environmental conditions.
Getting Knowledge into Action for Best Quality HealthcareNHSScotlandEvent
NHS Education for Scotland and Healthcare Improvement Scotland are working with NHS Boards to define new approaches to implementing and sharing knowledge which support practitioners to get knowledge into action at the frontline. This shift in focus from accessing to applying knowledge will integrate knowledge management more closely with quality improvement. This interactive workshop will use creative knowledge management techniques to challenge the way we apply knowledge in practice.
1. The document discusses leadership and administration in patient safety. It outlines national and international goals for patient safety including reducing medical errors and healthcare associated infections.
2. India's National Patient Safety Implementation Framework aims to improve structural systems and establish a culture of safety. It includes objectives like ensuring a competent workforce and preventing infections.
3. Successful leadership in patient safety involves creating a culture that prioritizes safe, high-quality care and supports improvement efforts through resources, training and removing obstacles for clinicians.
We provide live online tutoring which can be accessed at anytime and anywhere according to student’s convenience. We have tutors in every subject such as Math, Chemistry, Biology, Physics and English whatever be the school level. Our college and university level tutors provide engineering online tutoring in areas such as Computer Science, Electrical and Electronics engineering, Mechanical engineering and Chemical engineering.
• www.onlineassignmenthelp.com.au
• www.cheapassignmenthelp.co.uk
• www.freeassignmenthelp.com
• www.cheapassignmenthelp.com.au
• http://btechndassignment.cheapassignmenthelp.co.uk/
This document discusses factors to consider when developing and implementing clinical protocols for older adult patients. It outlines a 4-step process: 1) recognizing areas for improvement, 2) selecting evidence-based protocols, 3) implementing protocols through strategies like education and hardwiring into documentation, and 4) measuring performance through reliable tools. Interprofessional collaboration and support from administrators are also emphasized as key to successful protocol adoption.
This document discusses factors to consider when developing and implementing clinical protocols for older adult patients. It outlines a 4-step process: 1) recognizing areas for improvement, 2) selecting evidence-based protocols, 3) implementing protocols through strategies like education and hardwiring into documentation, and 4) measuring performance through reliable tools. Interprofessional collaboration and support from administrators are also emphasized as key to successful protocol adoption.
The document discusses various aspects of planning and evaluation for a health care institution. It outlines the steps in planning as establishing goals and objectives, designing alternative courses of action, analyzing consequences, selecting the best course, and implementing with evaluation. It also discusses defining evaluation objectives, methodology, intended audience, and gathering credible evidence including demographic, health status, qualitative, utilization and expenditure indicators. The evaluation then analyzes results to determine meaning, compare to objectives, measure success, and recommend improvements.
This course overview summarizes an infection control training program. The 6-month course aims to enhance managerial and technical skills for infection control. It consists of 6 modules covering topics like infection surveillance, standard precautions, occupational health and safety, and environment cleaning. The 180 hours of theory and 420 hours of practical training will help students develop critical thinking, communication and leadership skills needed for infection control nurse roles. Responsibilities include data analysis, education, outbreak management and collaborating with health agencies. The course is eligible for graduate and diploma nurses registered in India.
Patient Safety Collaboratives - Dr Liz Mear, Chief Executive, North West Coast AHSN
Presentation from the Patient Safety Collaborative launch event held in London on 14 October 2014
More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx
This document discusses health technology and health technology assessment. It defines health technology as tools used in healthcare like devices, procedures, vaccines, and systems to protect and maintain health. Health technology assessment evaluates health technologies and informs policy decisions about their use. The goals of health technology assessment are to make healthcare safer, coverage decisions more consistent, and healthcare more cost effective by relying on scientific evidence. Health technology assessment requires experts from various clinical and technical fields to conduct comprehensive evaluations of new technologies. Evidence-based decision making is important for determining whether to adopt new health technologies while considering their impacts on healthcare and health outcomes.
Operational Research (OR) in Public Health.docxMostaque Ahmed
Operational research (OR) applies analytical methods to address complex public health challenges and improve decision-making. OR involves techniques like mathematical modeling, decision analysis, and cost-effectiveness analysis. It has been used to optimize disease control strategies, strengthen health systems, and inform health policies. While OR has led to improved health outcomes and more effective programs, challenges remain around data availability, interdisciplinary collaboration, and building capacity in low-resource settings.
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxspoonerneddy
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that.
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxmccormicknadine86
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that ...
This document discusses patient safety guidelines and creating a culture of safety in healthcare organizations. It defines patient safety and medical errors, and outlines several national patient safety goals. These include correctly identifying patients, improving staff communication, using medications safely, preventing infections and falls, and engaging patients in their care. The document emphasizes that a just culture is needed where staff feel comfortable reporting errors without blame. It also stresses the role of organizational culture and leadership in prioritizing safety. Key aspects of a comprehensive safety program include infrastructure, policies, education, incident reporting, and processes for immediate response to issues.
This webinar provides an overview of key frameworks for identifying barriers and enablers to implementation, with a focus on the Theoretical Domains Framework (TDF). The TDF synthesizes 128 constructs from 33 theories of behavior change into 12 domains to understand factors influencing healthcare professionals' behaviors. The webinar uses a case study of improving physician hand hygiene to demonstrate how the TDF can be applied to identify potential barriers within domains like Knowledge, Skills, Social Influences, and Environmental Context & Resources.
The document outlines a curriculum for home economics and caregiving. It includes several units of competency related to tools/equipment use, calculations, occupational health and safety, infection control, and responding to difficult behavior. For each unit, it lists the relevant content standards, learning competencies, example projects/activities, and assessment methods. The goal is to teach students proper procedures for tasks like tool use, safety protocols, infection control monitoring, and handling challenging situations according to institutional policies.
This document provides guidance on selecting appropriate study designs for evaluating population health and health service interventions. It emphasizes that choosing an effective study design is critical for producing high-quality evaluations that can credibly demonstrate the impact of an intervention. The document outlines key initial steps in evaluation planning, such as developing a program logic model and generating evaluation questions. It then describes experimental, quasi-experimental, and non-experimental quantitative study designs and provides examples of when each may be suitable. The intended audience is NSW Health staff involved in planning, implementing, overseeing or using results from evaluations.
- Active worker participation in all stages of risk assessment and prevention of musculoskeletal disorders (MSDs) is essential for successful interventions. Workers have detailed knowledge of job tasks and how they are affected.
- Employers must consult workers on safety and health issues. Methods for participation include workshops, discussions, and tools like checklists and suggestion boxes.
- Small businesses can actively involve workers through closer relationships and simple methods like discussions.
1) The document discusses patient safety and error prevention in nursing practice. It covers types of errors, root cause analysis, and human factors that can contribute to errors.
2) It summarizes recommendations from several reports on improving patient safety through better systems, use of technology, training, and involving patients in their own care.
3) The importance of critical thinking in nursing is discussed as well as approaches nurses can take to develop critical thinking skills like using the nursing process, concept mapping, journaling, and group discussions.
1) The document discusses patient safety and error prevention in nursing practice. It outlines common medical errors and approaches to analyzing errors, including root cause analysis.
2) Key strategies to improve safety discussed are checklists, standardized procedures, limiting work hours and fatigue, and involving patients in their own care. National organizations provide safety goals and endorse safe practices.
3) Critical thinking is important for nurses to provide safe care through clinical judgment, reasoning, and reflection on practice. Approaches to developing critical thinking discussed are the nursing process, concept mapping, journaling, and group discussions.
The fifth webinar continues the momentum of the series as it focuses on providing concrete approaches for identifying barriers and enablers, emphasising behaviour change approaches.
READ MORE: http://bit.ly/2LOwbj0
This document discusses quality and safety issues in primary care. It notes that 30-50% of complaints relate to safety, and 3-11% of GP prescriptions contain errors. Risk areas for patient safety include prescription errors, drug monitoring, communication, delayed or missed diagnoses, and results management. Ensuring quality and safety is a responsibility for all NHS staff. Tools like the Plan-Do-Study-Act cycle, safety walkarounds, and trigger tools can help proactively identify risks to improve safety. A systems approach is needed to address errors by examining multiple contributing factors rather than blaming individuals.
Test bank clinical nursing skills a concept based approach 4e pearson educati...rightmanforbloodline
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
Emphysema is an abnormal permanent enlargement of the air spaces distal to terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Emphysema of lung is defined as hyper inflation of the lung ais spaces due to obstruction of non respiratory bronchioles as due to loss of elasticity of alveoli.
It is a type of chronic obstructive
pulmonary disease.
It is a progressive disease of lungs.
1. The document discusses leadership and administration in patient safety. It outlines national and international goals for patient safety including reducing medical errors and healthcare associated infections.
2. India's National Patient Safety Implementation Framework aims to improve structural systems and establish a culture of safety. It includes objectives like ensuring a competent workforce and preventing infections.
3. Successful leadership in patient safety involves creating a culture that prioritizes safe, high-quality care and supports improvement efforts through resources, training and removing obstacles for clinicians.
We provide live online tutoring which can be accessed at anytime and anywhere according to student’s convenience. We have tutors in every subject such as Math, Chemistry, Biology, Physics and English whatever be the school level. Our college and university level tutors provide engineering online tutoring in areas such as Computer Science, Electrical and Electronics engineering, Mechanical engineering and Chemical engineering.
• www.onlineassignmenthelp.com.au
• www.cheapassignmenthelp.co.uk
• www.freeassignmenthelp.com
• www.cheapassignmenthelp.com.au
• http://btechndassignment.cheapassignmenthelp.co.uk/
This document discusses factors to consider when developing and implementing clinical protocols for older adult patients. It outlines a 4-step process: 1) recognizing areas for improvement, 2) selecting evidence-based protocols, 3) implementing protocols through strategies like education and hardwiring into documentation, and 4) measuring performance through reliable tools. Interprofessional collaboration and support from administrators are also emphasized as key to successful protocol adoption.
This document discusses factors to consider when developing and implementing clinical protocols for older adult patients. It outlines a 4-step process: 1) recognizing areas for improvement, 2) selecting evidence-based protocols, 3) implementing protocols through strategies like education and hardwiring into documentation, and 4) measuring performance through reliable tools. Interprofessional collaboration and support from administrators are also emphasized as key to successful protocol adoption.
The document discusses various aspects of planning and evaluation for a health care institution. It outlines the steps in planning as establishing goals and objectives, designing alternative courses of action, analyzing consequences, selecting the best course, and implementing with evaluation. It also discusses defining evaluation objectives, methodology, intended audience, and gathering credible evidence including demographic, health status, qualitative, utilization and expenditure indicators. The evaluation then analyzes results to determine meaning, compare to objectives, measure success, and recommend improvements.
This course overview summarizes an infection control training program. The 6-month course aims to enhance managerial and technical skills for infection control. It consists of 6 modules covering topics like infection surveillance, standard precautions, occupational health and safety, and environment cleaning. The 180 hours of theory and 420 hours of practical training will help students develop critical thinking, communication and leadership skills needed for infection control nurse roles. Responsibilities include data analysis, education, outbreak management and collaborating with health agencies. The course is eligible for graduate and diploma nurses registered in India.
Patient Safety Collaboratives - Dr Liz Mear, Chief Executive, North West Coast AHSN
Presentation from the Patient Safety Collaborative launch event held in London on 14 October 2014
More information at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/patient-safety-collaboratives.aspx
This document discusses health technology and health technology assessment. It defines health technology as tools used in healthcare like devices, procedures, vaccines, and systems to protect and maintain health. Health technology assessment evaluates health technologies and informs policy decisions about their use. The goals of health technology assessment are to make healthcare safer, coverage decisions more consistent, and healthcare more cost effective by relying on scientific evidence. Health technology assessment requires experts from various clinical and technical fields to conduct comprehensive evaluations of new technologies. Evidence-based decision making is important for determining whether to adopt new health technologies while considering their impacts on healthcare and health outcomes.
Operational Research (OR) in Public Health.docxMostaque Ahmed
Operational research (OR) applies analytical methods to address complex public health challenges and improve decision-making. OR involves techniques like mathematical modeling, decision analysis, and cost-effectiveness analysis. It has been used to optimize disease control strategies, strengthen health systems, and inform health policies. While OR has led to improved health outcomes and more effective programs, challenges remain around data availability, interdisciplinary collaboration, and building capacity in low-resource settings.
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxspoonerneddy
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that.
Chapter 7. The Evidence for Evidence-Based Practice Implem.docxmccormicknadine86
Chapter 7. The Evidence for Evidence-Based Practice
Implementation
Marita G. Titler
Background
Overview of Evidence-Based Practice
Evidence-based health care practices are available for a number of conditions such as asthma,
heart failure, and diabetes. However, these practices are not always implemented in care
delivery, and variation in practices abound.1–4 Traditionally, patient safety research has focused
on data analyses to identify patient safety issues and to demonstrate that a new practice will lead
to improved quality and patient safety.5 Much less research attention has been paid to how to
implement practices. Yet, only by putting into practice what is learned from research will care be
made safer.5 Implementing evidence-based safety practices are difficult and need strategies that
address the complexity of systems of care, individual practitioners, senior leadership, and—
ultimately—changing health care cultures to be evidence-based safety practice environments.5
Nursing has a rich history of using research in practice, pioneered by Florence Nightingale.6–
9 Although during the early and mid-1900s, few nurses contributed to this foundation initiated
by Nightingale,10 the nursing profession has more recently provided major leadership for
improving care through application of research findings in practice.11
Evidence-based practice (EBP) is the conscientious and judicious use of current best
evidence in conjunction with clinical expertise and patient values to guide health care
decisions.12–15 Best evidence includes empirical evidence from randomized controlled trials;
evidence from other scientific methods such as descriptive and qualitative research; as well as
use of information from case reports, scientific principles, and expert opinion. When enough
research evidence is available, the practice should be guided by research evidence in conjunction
with clinical expertise and patient values. In some cases, however, a sufficient research base may
not be available, and health care decisionmaking is derived principally from nonresearch
evidence sources such as expert opinion and scientific principles.16 As more research is done in a
specific area, the research evidence must be incorporated into the EBP.15
Models of Evidence-Based Practice
Multiple models of EBP are available and have been used in a variety of clinical settings.16–36
Although review of these models is beyond the scope of this chapter, common elements of these
models are selecting a practice topic (e.g., discharge instructions for individuals with heart
failure), critique and syntheses of evidence, implementation, evaluation of the impact on patient
care and provider performance, and consideration of the context/setting in which the practice is
implemented.15, 17 The learning that occurs during the process of translating research into
practice is valuable information to capture and feed back into the process, so that ...
This document discusses patient safety guidelines and creating a culture of safety in healthcare organizations. It defines patient safety and medical errors, and outlines several national patient safety goals. These include correctly identifying patients, improving staff communication, using medications safely, preventing infections and falls, and engaging patients in their care. The document emphasizes that a just culture is needed where staff feel comfortable reporting errors without blame. It also stresses the role of organizational culture and leadership in prioritizing safety. Key aspects of a comprehensive safety program include infrastructure, policies, education, incident reporting, and processes for immediate response to issues.
This webinar provides an overview of key frameworks for identifying barriers and enablers to implementation, with a focus on the Theoretical Domains Framework (TDF). The TDF synthesizes 128 constructs from 33 theories of behavior change into 12 domains to understand factors influencing healthcare professionals' behaviors. The webinar uses a case study of improving physician hand hygiene to demonstrate how the TDF can be applied to identify potential barriers within domains like Knowledge, Skills, Social Influences, and Environmental Context & Resources.
The document outlines a curriculum for home economics and caregiving. It includes several units of competency related to tools/equipment use, calculations, occupational health and safety, infection control, and responding to difficult behavior. For each unit, it lists the relevant content standards, learning competencies, example projects/activities, and assessment methods. The goal is to teach students proper procedures for tasks like tool use, safety protocols, infection control monitoring, and handling challenging situations according to institutional policies.
This document provides guidance on selecting appropriate study designs for evaluating population health and health service interventions. It emphasizes that choosing an effective study design is critical for producing high-quality evaluations that can credibly demonstrate the impact of an intervention. The document outlines key initial steps in evaluation planning, such as developing a program logic model and generating evaluation questions. It then describes experimental, quasi-experimental, and non-experimental quantitative study designs and provides examples of when each may be suitable. The intended audience is NSW Health staff involved in planning, implementing, overseeing or using results from evaluations.
- Active worker participation in all stages of risk assessment and prevention of musculoskeletal disorders (MSDs) is essential for successful interventions. Workers have detailed knowledge of job tasks and how they are affected.
- Employers must consult workers on safety and health issues. Methods for participation include workshops, discussions, and tools like checklists and suggestion boxes.
- Small businesses can actively involve workers through closer relationships and simple methods like discussions.
1) The document discusses patient safety and error prevention in nursing practice. It covers types of errors, root cause analysis, and human factors that can contribute to errors.
2) It summarizes recommendations from several reports on improving patient safety through better systems, use of technology, training, and involving patients in their own care.
3) The importance of critical thinking in nursing is discussed as well as approaches nurses can take to develop critical thinking skills like using the nursing process, concept mapping, journaling, and group discussions.
1) The document discusses patient safety and error prevention in nursing practice. It outlines common medical errors and approaches to analyzing errors, including root cause analysis.
2) Key strategies to improve safety discussed are checklists, standardized procedures, limiting work hours and fatigue, and involving patients in their own care. National organizations provide safety goals and endorse safe practices.
3) Critical thinking is important for nurses to provide safe care through clinical judgment, reasoning, and reflection on practice. Approaches to developing critical thinking discussed are the nursing process, concept mapping, journaling, and group discussions.
The fifth webinar continues the momentum of the series as it focuses on providing concrete approaches for identifying barriers and enablers, emphasising behaviour change approaches.
READ MORE: http://bit.ly/2LOwbj0
This document discusses quality and safety issues in primary care. It notes that 30-50% of complaints relate to safety, and 3-11% of GP prescriptions contain errors. Risk areas for patient safety include prescription errors, drug monitoring, communication, delayed or missed diagnoses, and results management. Ensuring quality and safety is a responsibility for all NHS staff. Tools like the Plan-Do-Study-Act cycle, safety walkarounds, and trigger tools can help proactively identify risks to improve safety. A systems approach is needed to address errors by examining multiple contributing factors rather than blaming individuals.
Test bank clinical nursing skills a concept based approach 4e pearson educati...rightmanforbloodline
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
Test bank clinical nursing skills a concept based approach 4e pearson education
NURSING MANAGEMENT OF PATIENT WITH EMPHYSEMA .PPTblessyjannu21
Prepared by Prof. BLESSY THOMAS, VICE PRINCIPAL, FNCON, SPN.
Emphysema is a disease condition of respiratory system.
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The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
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Basics of Electrocardiogram
CONTENTS
●Conduction System of the Heart
●What is ECG or EKG?
●ECG Leads
●Normal waves of ECG.
●Dimensions of ECG.
● Abnormalities of ECG
CONDUCTION SYSTEM OF THE HEART
ECG:
●ECG is a graphic record of the electrical activity of the heart.
●Electrical activity precedes the mechanical activity of the heart.
●Electrical activity has two phases:
Depolarization- contraction of muscle
Repolarization- relaxation of muscle
ECG Leads:
●6 Chest leads
●6 Limb leads
1. Bipolar Limb Leads:
Lead 1- Between right arm(-ve) and left arm(+ve)
Lead 2- Between right arm(-ve) and left leg(+ve)
Lead 3- Between left arm(-ve)
and left leg(+ve)
2. Augmented unipolar Limb Leads:
AvR- Right arm
AvL- Left arm
AvF- Left leg
3.Chest Leads:
V1 : Over 4th intercostal
space near right sternal margin
V2: Over 4th intercostal space near left sternal margin
V3:In between V2 and V4
V4:Over left 5th intercostal space on the mid
clavicular line
V5:Over left 5th intercostal space on the anterior
axillary line
V6:Over left 5th intercostal space on the mid
axillary line.
Normal ECG:
Waves of ECG:
P Wave
•P Wave is a positive wave and the first wave in ECG.
•It is also called as atrial complex.
Cause: Atrial depolarisation
Duration: 0.1 sec
QRS Complex:
•QRS’ complex is also called the initial ventricular complex.
•‘Q’ wave is a small negative wave. It is continued as the tall ‘R’ wave, which is a positive wave.
‘R’ wave is followed by a small negative wave, the ‘S’ wave.
Cause:Ventricular depolarization and atrial repolarization
Duration: 0.08- 0.10 sec
T Wave:
•‘T’ wave is the final ventricular complex and is a positive wave.
Cause:Ventricular repolarization Duration: 0.2 sec
Intervals and Segments of ECG:
P-R Interval:
•‘P-R’ interval is the interval
between the onset of ‘P’wave and onset of ‘Q’ wave.
•‘P-R’ interval cause atrial depolarization and conduction of impulses through AV node.
Duration:0.18 (0.12 to 0.2) sec
Q-T Interval:
•‘Q-T’ interval is the interval between the onset of ‘Q’
wave and the end of ‘T’ wave.
•‘Q-T’ interval indicates the ventricular depolarization
and ventricular repolarization,
i.e. it signifies the
electrical activity in ventricles.
Duration:0.4-0.42sec
S-T Segment:
•‘S-T’ segment is the time interval between the end of ‘S’ wave and the onset of ‘T’ wave.
Duration: 0.08 sec
R-R Interval:
•‘R-R’ interval is the time interval between two consecutive ‘R’ waves.
•It signifies the duration of one cardiac cycle.
Duration: 0.8 sec
Dimension of ECG:
How to find heart rhytm of the heart?
Regular rhytm:
Irregular rhytm:
More than or less than 4
How to find heart rate using ECG?
If heart Rhytm is Regular :
Heart rate =
300/No.of large b/w 2 QRS complex
= 300/4
=75 beats/mins
How to find heart rate using ECG?
If heart Rhytm is irregular:
Heart rate = 10×No.of QRS complex in 6 sec 5large box = 1sec
5×6=30
10×7 = 70 Beats/min
Abnormalities of ECG:
Cardiac Arrythmias:
1.Tachycardia
Heart Rate more than 100 beats/min
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2. Learning objectives
1. Describe the role of infection prevention and
control (IPC) in patient safety programmes.
2. List at least eight main elements of patient
safety culture.
3. For each element of patient safety culture, give
at least one practical strategy for the IPC
professional.
2
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4. Introduction
• Early pioneers in infection prevention and
control (IPC) promoted safe patient care through
their work
• The World Health Organization Assembly voted
in 2004 to create a World Alliance for Patient
Safety to coordinate, spread, and accelerate
improvements in patient safety worldwide
4
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5. Why is there a patient safety
problem in health care?
• Complexity of human illness and frailties of human
behaviour may result in errors or adverse events
• Healthcare associated infections (HAI) may occur
from:
• Commission (doing something wrong that leads to
infection), e.g., not providing timely preoperative
antibiotics for appropriate patients,
OR FROM
• Omission (failure to do something right,) e.g., using poor
aseptic technique when inserting a catheter 5
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6. A Culture of Patient Safety - 1
Culture has been defined as the deeply rooted
assumptions, values, and norms of an organisation
that guide the interactions of the members
through attitudes, customs, and behaviours
6
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7. A Culture of Patient Safety
Outcomes
7
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8. A Culture of Patient Safety - 2
• Involves:
• Leadership
• Teamwork and collaboration
• Evidence-based practices
• Effective communication
• Learning
• Measurement
• A just culture
• Systems-thinking
• Human factors
• Improvement philosophy
8
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9. Leadership - 1
• Senior leaders are responsible for establishing
safety as an organisational priority
• Leaders set the tone by:
• naming safety as a priority
• supporting approved behaviours, and
• motivating staff to achieve the safest care
9
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10. Leadership - 2
• Strategies for IPC professionals
1. Engage leaders throughout the organisation in
support of IPC; assist them in increasing the
visibility and importance of infection prevention
2. Seek commitment from senior executives, boards of
governance, clinical and support department
leaders, and key staff to IPC principles and practices
3. Present a compelling case to leaders that
emphasises the decreased morbidity, mortality, and
cost when infections are avoided
4. Provide leaders with valid information to help them
make decisions about infection prevention
10
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11. Teamwork and Collaboration - 1
• Combine the talents and skills of each member
of a team
• Serves as a checks and balance method
• Strong collaboration and teamwork help
minimise adverse events.
11
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12. Teamwork and Collaboration - 2
• Strategies for IPC professionals
1. Foster collaboration and teamwork by engaging
staff as partners in developing IPC policies and
procedures
2. Encourage a multidisciplinary approach to IPC
3. Participate with teams of caregivers to address
infection prevention issues
4. Maintain open communication about infection
prevention to include staff and leaders across the
organisation
12
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2013
13. Effective Communication - 1
• Open communication encourages the sharing of
patient, technological, and environmental
information
• Communication strategies include use of written,
verbal, or electronic methods
• for staff education, for sharing IPC data from
surveillance, new policies, procedures, and literature
studies
• Communication should include a reporting system
that allows staff to raise practice concerns or errors
in care without fear of retribution 13
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14. Effective Communication - 2
• Strategies for IPC professionals
1. Make routine rounds and discuss patients with
infections or those at risk of infection with the
direct care providers and listen to staff concerns
2. Share surveillance data and new information
3. Develop a secure system for staff to report infection
risks
14
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15. Evidence-based Practices - 1
• Use of evidence-based strategies is a basic
element of patient safety
• This means translating science into practice and
standardising practices to achieve the best
outcomes
• Adoption of best practices often mean changing
practice
• Changing practice often meets with resistance
15
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16. Evidence-based Practices - 2
• Strategies for IPC professionals
1. Learn about the incentives and barriers to
adopting and implementing preferred practices
in the organisation
2. Address incentives and barriers in the planning
of new and existing policies and procedures for
infection prevention
16
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17. Organisational Learning - 1
• Support members so they can
• learn together
• improve their ability to create desired results
• embrace new ways of thinking
• transform their environment for better care
17
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18. Organisational Learning - 2
• Strategies for IPC professionals
1. Share infection information with all staff
2. Encourage staff to participate in formulating
policies and procedures to reduce infection risk
3. Use adult learning principles to educate staff
18
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19. Measuring Care: Processes
and Outcomes - 1
• IPC staff must collect and report reliable data
• To monitor compliance with patient care practices
• To identify gaps in care
• To understand adverse events experienced by
patients
19
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20. Measuring Care: Processes
and Outcomes - 2
• Strategies for IPC Professionals
1. Emphasise the importance of analysing and reporting
infections to staff and leaders
2. Educate staff about their role for reporting infections in order
to identify gaps in care that can be corrected
3. Be clear about the purpose and use for data that are collected.
This involves precise definitions of colonisation vs. infection,
consistent data collection processes, accurate capture of data,
and validation of infection rates
4. Stratify data whenever possible for more precise analysis, for
example, surgical site infections and infections in the new-
born population
5. Determine when to maintain or to eliminate surveillance
so that measurement is focused and useful
20
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21. “Systems” Thinking - 1
• Virtually all processes in health care
organisations are systems which contain
interconnected components, including people,
processes, equipment, the environment, and
information
21
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22. “Systems” Thinking - 2
• Strategies for IPC professionals
1. Consider the entire system, i.e., how the individual
parts interact and how the system should work,
when designing even simple IPC processes
2. Ensure that the system provides for supplies, that
staff can successfully perform the assigned task(s),
that the infrastructure supports the desired
behaviours, and that coordinating departments
support the infection prevention process
3. Work with others to design a system to achieve and
sustain success
22
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23. Human Factors Theory - 1
• How to enhance performance by examining the interface
between human behaviour and the elements of a work
process (equipment and the work environment)
• The design of a care process, such as an operation or
cleaning a wound, can benefit from using human factors
engineering to reduce infection risk
23
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24. Selected Human Factors
Principles
Simplify the process: minimise steps and make the process logical and easy to
perform, such as having all supplies readily available.
Standardise the process: standardise equipment and processes, e.g., standardising
care of intravascular catheters to prevent bloodstream infections.
Reduce dependence on memory: provide clear written direction, cues, visual aids,
and reminders, for items such as preoperative preparation, hand hygiene, isolation
precautions, or removal of indwelling devices.
Use forcing functions: make it difficult to do it wrong by using equipment like safety
needles and needle disposal devices.
Work toward reliability: performing a task correctly and consistently, focusing on how
to avoid failure, for example, using aseptic technique to insert a Foley catheter into
the bladder. 24
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2013
25. Human Factors Theory - 2
• Strategies for IPC professionals
1. Integrate human factors engineering principles, such as
standardisation, into patient care practices to promote
success in reducing infection risk to patients or staff
2. Anticipate potential process failures in IPC strategies and
incorporate methods to prevent them
1. Such as visual cues for staff of expected behaviours (i.e.,
posters and checklists for surgical preparation) or supplies
such as safety needles
3. Ensure that individuals performing the work are
competent, there is clarity about the task being
performed, that the tools and technologies involved
work properly, and the environment supports the care
process
25
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26. No Blame – “Just” Culture - 1
• When potentially harmful events such as HAIs
occur, an organisation can either review the
systems of care and learn from the errors, or
blame personnel for making them
• In a “just” culture (a key component of a
patient safe environment) errors are addressed
by providing feedback and encouraging
productive conversations, and insisting on
unbiased, critical analysis to prevent future
errors 26
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27. No Blame – “Just” Culture - 2
• Strategies for IPC professionals
1. Help maintain a “just”, no blame culture by
continually focusing on evidence-based practices,
epidemiology, and systems rather than “blaming”
individuals
2. Use critical thinking to identify and analyse the
causes of errors leading to infections so they can be
prevented in the future
27
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28. Improvement Philosophy - 1
• To minimise infections (or errors), leaders
must not tolerate non-adherence to proven
prevention measures
• When “best practices” are known, these
should be expected of all staff
28
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29. Improvement Philosophy - 2
• Strategies for IPC professionals
1. Monitor evidence-based practices for infection prevention,
e.g., isolation/precautions procedures, hand hygiene, sterile
technique, and cleaning, disinfection and sterilisation
2. Work to improve “broken” or dysfunctional processes of care
and defective systems
• Such as lack of soap and water or alcohol gel for hand hygiene,
personal protective equipment for staff safety, or appropriate
ventilation systems
3. Stay up-to-date on evidence-based guidelines and integrate
them into the infection prevention program
4. Focus less on simply achieving “benchmarks” for infections
and work continually toward zero infections
5. Do not accept the “status quo” as a long term goal; continually
strive to reduce infection rates 29
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30. Examples - 1
Patient Safety Issue Infection Prevention and Control
Example
Potential Solutions
Multiple transfers or patient “hand
offs” between staff and services
A patient who is admitted and
prepared for surgery is transferred or
“handed off” from the admission unit
to the nursing staff, the operating
theatre staff, post anaesthesia staff,
and back to the nursing unit.
Inadequate skin preparation, lack of
timely administration of prophylactic
antibiotics, or poor care of the surgical
wound may occur.
Education about each phase of
the surgical process
Clear communication strategies
Monitoring of competence
Reminders, checklists, visual cues
Documentation and analysis of
preoperative and postoperative
processes of care with feedback
to staff
Multiple types of equipment used for
patient care
Patients in intensive care,
haemodialysis, and other high
intensity units often have multiple
“lines”, fluids, ventilators, dialysers,
and other equipment that must all be
managed to avoid infection risks.
Indwelling urinary or intravascular
catheters and ventilators should be
removed when no longer needed.
Utilities such as water and air can
present a risk if malfunctioning.
Education and training of staff on
use of equipment
Competency assessment before
performing work
Human factors engineering
Equipment maintenance
Environmental assessments
30
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2013
31. Examples - 2
Patient Safety Issue Infection Prevention and Control
Example
Potential Solutions
High-risk illness Patients with immunosuppressive
diseases, burns, trauma, and high-risk
conditions related to age (neonates)
are prone to infections. They must be
carefully assessed and monitored to
prevent infections.
Staff education: observation and
reporting criteria
Population-specific criteria
Clear policies and procedures
Careful documentation,
monitoring, and feedback to staff
about infections
Time pressure High intensity environments
commonly have large workloads and
limited time to complete essential
infection prevention tasks. For
example, nurses often indicate that
they are “too busy” to wash hands or
perform hand hygiene when
appropriate.
Time management support;
evaluation of workload; staffing
and assignments
Work environment design, such
as (for hand hygiene) availability
and location of water, sink design
and location, alcohol-based
solutions to decrease hand
hygiene time
31
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2013
32. Examples - 3
Patient Safety Issue Infection Prevention and Control
Example
Potential Solutions
High-risk procedures/medications Patients are at increased risk of unsafe
care and infection during some
procedures and with some
medications. For example, the lack of
preoperative antibiotics at the correct
time and with the correct dose or
discontinuation at the recommended
time can fail to reduce risk of surgical
site infections.
Develop clear protocols and
processes for administration of
preoperative antibiotics
Educate staff about the
procedures
Assign responsibilities
Monitor compliance with
processes and report outcomes
Initiate performance
improvement when appropriate
Distractions and multitasking Distractions during delivery of care or
attempting to perform many tasks
simultaneously can lead to errors. Staff
may omit hand hygiene because of
distractions during busy times. Staff
using aseptic or sterile techniques may
contaminate the area because of
distractions.
Provide work environment with
few distractions
Initiate culture of quiet and lack
of interruption
Encourage one task at a time
Include staff in making decisions
about work flow and
environment
Provide cues to remind staff of
steps in an activity
32
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2013
33. Examples - 4
Patient Safety Issue Infection Prevention and Control
Example
Potential Solutions
Inexperienced or incompetent care
givers:
Inexperience or lack of competence in
healthcare personnel may lead to bad
practice. For example, personnel who
insert intravascular catheters and do
not feel competent to use the
recommended sites, such as the
subclavian vein, may choose the
femoral vein for insertion with its
associated higher infection risk.
Analyse why staff feel
inexperienced
Provide orientation / training for
all staff who insert intravascular
catheters, including rationale and
supervised practice until
competency is established
Periodically monitor skills and
provide feedback
33
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2013
34. Key Points
• Safe patient care, including infection prevention, is a
priority in all health care settings
• A patient safety culture guides the attitudes, norms and
behaviours of individuals and organisations
• In a safe culture of care, all staff and leaders assume
responsibility for the well-being of patients
• Patient safety requires teamwork and collaboration,
communication, measurement, and techniques such as
human factors engineering, systems thinking, no blame -
just culture and improvement philosophy
34
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2013
35. References
1. Thompson MA. Patient Safety. In: APIC Text of Infection Control and
Epidemiology. 3rd edition. Association of Professionals in Infection
Control and Epidemiology, Washington DC.2009; Chapter 12; 12-7-8.
2. Grol R, Berwick DM, Wensing M. On the trail of quality and safety in
healthcare. BMJ 2008; 336(7635):74-6.
3. Murphy D. Understanding the Business Case for Infection Prevention
and Control.
http://www.vhqc.org/files/091020BusinessCaseForIPC.pdf
4. A human factor engineering paradigm for patient safety: designing
to support the performance of healthcare professionals. Qual Sat
Health Care 2006; 15 (Suppl1):i59-
i65.doi:10.1136/qshc.2005.015974 or
http://ncbi.nlm.nih.gov/pmc/articles/PMC2464866
5. Donaldson LJ, Fletcher MG. The WHO World Alliance for patient
safety: towards the years of living less dangerously. Med 2006;
184(10 Suppl):S69-72. 35
December
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2013
36. Quiz
1. Patient safety problems may be due to doing
something wrong or failure to do what is correct. T/F?
2. A culture of patient safety includes
a) Surveillance
b) Standardisation
c) Root cause analysis
d) All of the above
3. Communication should always be verbal. T/F?
36
December
1,
2013
37. International Federation of
Infection Control
• IFIC’s mission is to facilitate international networking in
order to improve the prevention and control of
healthcare associated infections worldwide. It is an
umbrella organisation of societies and associations of
healthcare professionals in infection control and related
fields across the globe .
• The goal of IFIC is to minimise the risk of infection within
healthcare settings through development of a network of
infection control organisations for communication,
consensus building, education and sharing expertise.
• For more information go to http://theific.org/
December
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2013
37
Editor's Notes
The EU Council Recommendation on Patient Safety includes the prevention and control of healthcare associated infections. It was issued in June 2009. It includes definitions of the terms “patient safety”, “adverse event” and “harm”:
"Adverse event" means an incident which results in harm to a patient;
"Harm" implies impairment of the structure or function of the body and/or any deleterious effect arising therefrom;
"Patient safety" means freedom, for a patient, from unnecessary harm or potential harm associated with healthcare.
Healthcare associated infections were the first patient safety issue addressed by healthcare workers. Today there are many other important patient safety issues (medication errors, wrong surgery, pressure ulcers, wrong transfusion, falls, etc.).
REFERENCE: http://ec.europa.eu/health/patient_safety/policy/index_en.htm
If in an healthcare organisation there is a patient safety culture established, that means that every member of staff, from senior leadership to cleaning ladies are committed to keep patients from harm. Everyone is responsible for keeping patients safe, and everyone reports adverse events. In this culture, adverse events could be minimised and many HAIs prevented.
A patient safety culture has been demonstrated to be the best environment for implementing any new method or guideline for infection prevention.
These are all elements of a patient safety culture. It has been shown that a positive organizational culture through fostering working relationships and communication across units and staff groups was evidence based in decreasing HAIs in an organization.
The involvement of senior leadership is crucial for the development of a patient safety culture in an organization.
In developing countries, due to the funds restriction, senior leadership is more focused on some other basic problems in healthcare (lack of medication and equipment, lack of educated staff, etc.) and may not focus on patient safety. In that case it is very difficult to start any successful IPC programme, and maximum engagement of IPC staff should be directed to the involvement of leadership first.
In the World Health Organization’s Guidelines on Hand Hygiene in Health Care there are tools for involvement of leadership for the implementation of a safety culture. http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf
The IPC staff should be very active in engaging not only formal leaders on wards, but also seeking champions among nursing and medical staff to support IPC practices.
Very often when different staff are involved in the care of asingle patient, and if all staff involved are not collaborating very strongly, errors can develop. In a team, all team members are equal and all of them have the right and the responsibility to act in the best interest of patient. Therefore, every member of the team is free in observing actions of other members and freely pointing out a possible wrong action, educating each other in a friendly way, and collaborating in every step of the patient care.
The main method IPC teams can use to influence collaborative work is when developing infection prevention policies and procedures. IPC staff should work closely with all staff involved in a specific procedure/practice and incorporate comments into the procedure.
For example, when developing a procedure for insertion of central venous catheters, IPC first has to listen to staff involved (physicians and nurses). Together with their input, write the proposal for the new procedure. Then discuss this new proposal with all physicians and nurses in that particular area, including senior leaders. In such a way the ward staff will accept the new procedure as their own and everyone will know exactly what is the responsibility of a particular member of the team.
Another important method of collaboration is during clinical rounds; having an open discussion about any infection with all staff members together.
Communication is a vital aspect of patient safety. It has to be based on mutual trust during the planning and delivery of care, and setting goals to achieve best outcomes for patients. Verbal communication should be always followed by a written one; written documentation is very important to ensure clear, effective coimmunication.
IPC staff should be good listeners; always listen to comments and problems of ward staff before giving advice. Even more importantly, the advice should be provided only after careful consideration of all ward staff comments and concerns. In this way IPC personnel will develop trust and better communication with ward staff.
Evidence-based practice is transcribing information from science to guidelines and recommendations. Then these guidelines and recommendations should be put into policies and practices for particular patient care procedures. Staff is often reluctant to change current practice, as they “were doing this way for ever”.
Evidence-based guidelines are available from WHO, US CDC, IHI and EPIC
World Health Organization - http://www.who.int/csr/bioriskreduction/infection_control/en/index.html
Centers for Disease Control and Prevention - http://www.cdc.gov/hai/
Institute for Healthcare Improvement - http://www.ihi.org/explore/hai/pages/default.aspx
Evidence-based Practice in Infection Control - http://www.puricore.com/PDFs/Guidelines_for_Preventing_Healthcare.pdf
When trying to implement a change in existing practices, the IPC staff may have to ask for support from leadership, find ward champions, or act as a part of a team. Implementation of a new guideline or recommendation requires tremendous effort from IPC staff, as this is possible only after removing barriers or introducing incentives. In addition, it requires theoretical learning combined with practical education and training for all ward staff involved.
An example of organisational learning is the adoption of infection prevention “bundles” to prevent HAIs due to devices and procedures. The entire team has to learn simultaneously to think in a new way.
A “bundle” is a group of several evidence-based procedures carried out by teams of caregivers, that reduce HAIs if all are implemented for every patient all the time.
It is very important to use adult learning principles and methods in educating healthcare staff. The IPC staff should ask for help from professionals in adult learning, if they are not competent to do it themselves.
In a patient safety culture, IPC staff use surveillance of patient risks, prevention strategies (processes) and outcomes (infections). Clinical staff should be comfortable reporting infections to the IPC team.
Surveillance is one of the milestones of IPC: if you do not know the situation with infection risks, and incidence of infections, you cannot focus prevention efforts.
Process surveillance (e.g., survey of check lists for insertion of CVC) is also very important; however without outcome surveillance you cannot be sure if your procedure is right or not.
Surveillance data cannot be linearly compared with data from another ward or hospital, even not with the same ward in a different time frame. Definitions of infections may not be the same and data must be stratified whenever possible.
In some countries surveillance data for some HAI are public by law, in other countries (most European and most developing countries) such data are public only as aggregated data, not pointing to a specific hospital or ward.
Care delivery systems are often cumbersome and poorly designed, and they may interfere rather than support safe care.
An example could be giving prophylactic antibiotics for surgery that seems straightforward at first glance, but is very complex: this system involves pharmacy, patient’ family, anaesthesiologists, and surgeons - together with provision, storage, transport of the drug, responsibility for dosage and time of applications, and documentation.
“Systems” thinking is especially useful in the root cause analysis of a case of HAI.
The objective of human factors theory is to make the work easy and successful by removing barriers and using aids. For example, check lists are helpful to assure that approved procedures are used for surgeries or insertion of central venous catheters, or the use of safety needles that reduces the risk of injury for patients and for staff.
These are some of the key principles of human factors theory with application to IPC.
To have sufficient availability of and easy access to material and equipment and optimised ergonomics (like hand rub at the point of care, sinks stocked with soap and single-use towels) is an evidence-based infection prevention policy.
Since health care is delivered by humans, at some point people will inevitably make some error. A just culture adopts a “no blame” approach that focuses on the “system” that led to the error rather than on the individual.
Blaming staff for errors only creates anxiety and fear and does little to solve current problems or prevent them. Eliminating blame is essential for excellence in patient care outcomes. However, a just culture does not allow for purposeful disregard of the rules.
Just Culture doesn't mean a blameless culture... It does focus on processes, but Just Culture uses an algorithm to follow when mistakes are made... and if a person makes a mistake due to willful neglect or reckless behavior, then the employee is a candidate for disciplinary actions. The person's reasons for choosing their behavior are critical in the Just Culture approach to reducing error.
Open communication and discussion with the clinical staff when an infection or outbreak happens is crucial with a “no blame” approach. Staff will then discuss freely every possible cause of that event.
Maintaining an “improvement philosophy” approach to patient safety is crucial for safer care. Not to comply with the best practices, such as not to perform hand hygiene at appropriate times, handling infectious waste inadequately, skipping critical steps in cleaning, disinfection or sterilization – this has to be addressed and not ignored. The consequences for such behaviour should be set in advance.
In the USA this concept is often ferred to as ‘zero tolerance’.
IPC staff should continuously monitor systems and processes to find out possible new risk factors for HAIs that could decrease staff compliance to best practices (less staff due to sick leave or holidays, outbreak situation with more infectious patients, disaster with more overall patients, new procedures/equipment, new staff, etc.).
In the future, new technologies in medicine will become even more sophisticated, and IPC evidence-based policies and procedures will become available. In an organization with a developed patient safety culture both will be easy to implement.