PROMOTING SAFETY IN HEALTH CARE ENVIRONMENT

1. PROMOTING
SAFETY IN
HEALTH CARE
ENVIRONMENT
BINAL JOSHI
ASSISTANT PROFESSOR
MTIN,CHARUSAT

2. •Physical environment – Temperature, Humidity, Noise,
Ventilation, Light, Odor, Pest control Reduction of Physical
hazards – fire, accidents
•Fall Risk Assessment
•Role of nurse in providing safe and clean environment
•Safety devices –Restraints – Types, Purposes, Indications, Legal
Implications and Consent, Application of Restraints
•Skill and Practice guidelines
•Other Safety Devices – Side rails, Grab bars, Ambu alarms, non-skid
slippers etc

3. SAFETY

4. SAFETY OF
PEOPLE INFRASTRUCTURE EQUIPMENT

5. SAFETY OF PEOPLE
STAFF VISITOR PATIENT

6. INTRODUCTION

7. PATIENT SAFETY
Patient safety is the absence of preventable harm to a
patient during the process of health care.
The discipline of patient safety is the coordinated efforts
to prevent harm to patients, caused by the process of
health care itself.
It is generally agreed upon that the meaning of patient
safety is…“Please do no harm”

8. In addition to being knowledgeable about the
home and health care environment and the
inherent safety risks, nurses need to be familiar
with a patient’s developmental level; mobility,
sensory, and cognitive status; lifestyle choices;
and knowledge of common safety precautions.
They also need to be aware of the special risks to
safety that are found in health care settings.

9. FACTROS AFFECTING PATIENT
SAFETY

10. DEVELOPMENTAL
STAGES

11. Infant, Toddler, and Preschooler
School-Age Child
Adolescent.
ADULT
Older Adult

12. INDIVIDUAL
RISK
FACTORS.

13. LIFE STYLES

14. IMPAIRED
MOBILITY

15. SENSORY OR
COMMUNICATION
IMPAIRMENT.

16. LACK OF
SAFETY
AWARENESS

17. RISKS IN THE
HEALTH CARE
AGENCY.

18. 1. MEDICAL
ERRORS

19. 2.PATIEN
T FALL
This Photo by Unknown author is licensed under CC BY.

20. 3.PATIENT
INHERENT
ACCIDENTS

21. 4.PROCEDUR
E RELATED
ACIDENTS

22. 5.EQUIPMENT
RELATED
ACCIDENTS

24. THE 2009 CENTERS FOR MEDICARE AND
MEDICAID SERVICES HOSPITAL
ACQUIRED CONDITIONS
(PRESENT-ON ADMISSION INDICATORS)

25. • Foreign object retained after surgery
• Air embolism
• Blood incompatibility
• Pressure ulcer stages III and IV
• Falls and trauma (fracture, dislocation, intracranial injury, crushing
injury, burn, electric shock)
• Catheter-associated urinary tract infections
• Vascular catheter-associated infections
• Manifestations of poor glycemic control (diabetic ketoacidosis,
nonketotic hyperosmolar coma, hypoglycemic coma, secondary
diabetes with ketoacidosis, secondary diabetes with hyperosmolarity)

26. • Surgical site infections following:
• Mediastinitis following coronary artery bypass graft
• Certain orthopedic procedures (spine, neck, shoulder, elbow)
• Bariatric surgery for obesity (laparoscopic gastric bypass,
gastroenterostomy, laparoscopic gastric restrictive surgery)
• Deep vein thrombosis and pulmonary embolism following certain
orthopedic procedures (total knee replacement, hip replacement)

28. ENVIRONMENTAL
SAFETY

29. There is a direct link between work
environment and patient safety
If we do not have a formal program in place
addressing work environment issues, little will
change.
Creating healthy work environments requires
changing long-standing cultures, traditions and
hierarchies
Therefore, though everyone must be involved
in the creation of healthy work environments,
the onus is on organizational, departmental
and unit

30. ADEQUATE
LIGHT

31. Adequate ventilation, exhaust fan —
Stairs with hand rails
Window-door-closer —
Slip preventing floors
Fire extinguishers and fire alarms
Prevent noise pollution
Heavy and fixed beds
Safe wheel chairs and trolleys
No water logging in bathrooms
Call bell system for patients
Adequate no. of bed screens to maintain privacy of the patient.

32. MEDICAL SAFETY

33. Writing prescription by doctors.
Wrong medicines or wrong does or wrong patient.
Wrong injection, wrong does or wrong patient, wrong route of administration.
Drip sets: air bubbles, over hydration, drip speed.
Oxygen flow: check empty gas cylinders.
Clear, written medication guidelines.
Identification of each patient with Similar patient names
Proper handing taking over during change of shift. —
Look alike and Sound Alike “LASA”

34. Medication Error
• Patient’s name and location (ward, room No, and bed No) .
• Medication Generic Name.
• Dosage, frequency and route of administration.
• Signature of the physician.
• Date and hour the order was written. B- Any abbreviations used in medication orders should be agreed to and jointly
adopted by the medical, nursing, pharmacy, and medical records staff of the institution.
• Lately, in the interest of patient safety, “Do Not Abbreviate” Is the new practice nowadays. C- Before dispensing the
drug: The pharmacist must receive the physician’s original order or a direct copy of the order (except in emergency
situations).This permits the pharmacist to
• Resolve questions or problems with drug orders before the drug is dispensed and administered.
• Eliminate errors which may arise when drug orders are transcribed into another form for use by the pharmacy. D- to
check at least two patient identifiers before providing care, treatments or services, likr Patient name and medical record
number

35. Methods of sending
the Physician’s orders to the pharmacy are:
1. Self-copying order forms: This method provides the pharmacist with a duplicate copy of the order and does
not require special equipment. There are two basic formats: a. Orders for medications included among
treatment orders. b. Medication orders separated from other treatment orders on the order form.`
2. Electromechanical: Copying machines or similar devices may be used to produce an exact copy of the
physician’s order. Provision should be made to transmit physicians’ orders to the pharmacy in the event of
mechanical failure.
3. Computerized: Computer systems, in which the physician enters orders into a computer which then stores
and prints out the orders in the pharmacy or elsewhere

36. SURGICAL
SAFETY

37. SURGICAL
SAFETY
• Consent of the patient/ relative in writing
• Proper identification of patient: wrist band
• Proper identification mark of parts to be
operated
• Pre- anesthetic check-up
• Anesthetic Safety
• Ensure no foreign body left inside
Safety measures from ward to OT &
coming back (Safety check list)
• Prevention of surgical wound infections
• Use of Surgical safety proforma in all
operations
• Check Safety code if available WHO
SURGICAL SAFETY CHECKLIST
• The primary benefit of the checklist may
be to engage the medical team. By
using the checklist, we may be gaining
the ability to open communication by the
medical team, to encourage teamwork

38. EQUIPMENT
INSTALLATION
SAFETY
• Regular checking of equipments
• Proper earthling to avoid shock
• Regular maintenance & repair
• Training of nurses & technical staff
• How do you control hazards?: Preventing
inadvertent harm to patients requires use of
human factors engineering principles.
• The “hierarchy of hazard control:”
• Eliminate hazard
• Guard against hazard
• Train to avoid hazards Warn against
hazards

39. ELECTRICAL
SAFETY

40. ELECTRICAL SAFETY
Safety fuses with each equipment
No loose wires or connection
Properly plugged and fixed
If short circuit call electrician
Electricity back up battery/ generator
Use of CVT/UPS

41. FIRE SAFETY

42. • Use Fire proof material for construction
• Have Fire Exit in all Buildings.
• Smoke detectors and water sprinklers on the roof of all Floors.
• Fire Extinguishers in all areas.
• Fire Hydrants in all buildings.
• Training in Fire management
• Mock drills

43. BLOOD SAFETY

44. • Proper grouping & cross matching
• Tests of HIV, Inf. hepatitis & VDRL
• Proper labeling of group, name of the patient
• Standard operating procedure
• Screening against HIV, Hepatitis. VD, Malaria.
• Control blood transfusion reactions

45. SANITATION-
INFECTION
CONTROL

46. SANITATION- INFECTION CONTROL
• BMW DISPOSAL
• Proper segregation & transportation of biomedical wastes
• Sanitation & hygiene of different parts of hospital to avoid infection
• Use of sterile procedures
• Safety in use of incinerator, autoclave, shredder, needle destroyers and proper disposal of biomedical waste.
• Formation of hospital infection control committee
• Investigation of all hospital infections
• Use of proper antibiotics in right doses in right time

47. LABORATORY
SAFETY

48. LABORATORY SAFETY
• Avoid needle stick injuries & spilling of blood
• Safety measures in Radiology & Radiotherapy departments
• Safety norm guide lines for different areas of hospitals.
• Regular pest control measures
• Care in handling acids, reagents, inflammable substances.
• BMW segregation and disposal

49. PRACTICE OF PATIENT SAFETY ( WHO)
Be aware of Look-Alike, Sound-Alike Medication Names.
Proper Patient Identification.
Explain in Detail During Patient Hand/Take- Overs.
Performance of Correct Procedure at Correct Body Site.
Careful About Electrolyte Imbalance.
Assuring Proper Treatment During Shifting.
Avoid Catheter and Tubing, Wrong Connections .
Single Use of Injection Syringes.
Improved Hand Hygiene to Prevent Health Care- Associated Infections
Proper Disposal of BMW and Good House Keeping.
Practice Surgical Safety Guide Lines.

50. TIPS FOR IMPROVING PATIENT
SAFETY
• Constitution of Patient Safety Committee.
• Develop clear policies and protocols for patient safety.
• Discuss regularly patient safety initiative within hospital staff.
• Orientation, Re-orientation hospital staff on patient safety
• Encourage transparency in the regular death review.
• Incident reporting by staff.
• Each department to devise their own patient safety protocols.
• Investigate each accident/ incident reported and take remedial measures.

51. MEDICAL ERRORS
Errors can involve: Medicine Surgery Diagnosis
Equipment Lab reports Radiology reports Dietary dept
What are these Errors: Failure of planned action to be completed as intended (error of
execution) or use of wrong plan to achieve an aim (error of planning); accumulation of errors
result in accidents.
Active Errors: An error that occurs at the level of front line operator and whose effects are felt
almost immediately. At point of human interface with complex system.
Latent Errors: Errors in design, organisation, training or maintenance that lead to operator errors
and whose effects typically lie dormant in system for lengthy period of time. (system design)

52. Classification Human errors
• Error of omission
• Error of commission
• Interpretation/evaluation System Errors
• Inadequate staffing or untrained staff
• Poor communication between providers, facility and pharmacy
• Poor coordination between pharmacy and facility for drug ordering and
delivery
• Poor documentation and reporting system of patient specific concerns and
human errors
Process framework for a safer health care Core elements
• Identify risk
• Measuring the identified risk in terms of magnitude and frequency of
occurrence
• Prioritizing and controlling the risk
• Constantly monitoring the effectiveness of control measures