Pme lecture 2012presentationpart3

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  • Hand hygiene is a general term that applies to either handwashing, antiseptic handwash, alcohol-based handrub, or surgical hand hygiene/antisepsis. Handwashing refers to washing hands with plain soap and water. Handwashing with soap and water remains a sensible strategy for hand hygiene in non-healthcare settings and is recommended by CDC and other experts. Antiseptic handwash refers to washing hands with water and soap or other detergents containing an antiseptic agent. Alcohol-based handrub refers to the alcohol-containing preparation applied to the hands to reduce the number of viable microorganisms. Surgical hand hygiene/antisepsis refers to an antiseptic handwash or antiseptic handrub performed preoperatively by surgical personnel to eliminate transient and reduce resident hand flora. Antiseptic detergent preparations often have persistent antimicrobial activity.
  • Healthcare workers should wash hands with soap and water when hands are visibly dirty, contaminated or soiled and use an alcohol-based handrub when hands are not visibly soiled to reduce bacterial counts.
  • Hand hygiene is indicated before: patient contact, donning gloves when inserting a central venous catheter (CVC), and inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don ’t require surgery. Hand hygiene is also indicated after contact with a patient ’s intact skin, contact with body fluids or excretions, non-intact skin, or wound dressings, and after removing gloves. Gloves should be used when a HCW has contact with blood or other body fluids in accordance with universal precautions.
  • These recommendations will improve hand hygiene practices of HCWs and reduce transmission of pathogenic microorganisms to patients and personnel in healthcare settings. When decontaminating hands with an alcohol-based handrub, apply product to palm of one hand and rub hands together, covering all surfaces of hands and fingers, until hands are dry. When washing hands with soap and water, wet hands first with water, apply the amount of soap recommended by the manufacturer, and rub hands together for at least 15 seconds, covering all surfaces of the hands and fingers. Rinse hands with water, dry thoroughly with a disposable towel, and use the towel to turn off the faucet.
  • Pme lecture 2012presentationpart3

    1. 1. 2012 Patient Safety Goals <ul><li>Reduce the likelihood of patient harm </li></ul><ul><li>associated with the use of </li></ul><ul><li>anticoagulation therapy. Anticoagulant </li></ul><ul><li>drugs can cause bleeding. </li></ul>
    2. 2. Case Study <ul><li>Three neonates died at a hospital as a </li></ul><ul><li>result of accidental heparin overdoses. </li></ul><ul><li>A pharmacy technician inadvertently filled </li></ul><ul><li>the automated dispensing cabinet with </li></ul><ul><li>1ml vials of heparin containing </li></ul><ul><li>10,000 units/ml instead of the1ml vials of </li></ul><ul><li>heparin10 units/ml. The nurses did not notice </li></ul><ul><li>the discrepancy and the heparin was </li></ul><ul><li>administered to the neonates. </li></ul><ul><li>ISMP Medication Safety Alert Oct 2006 4/10 </li></ul>
    3. 3. Recommendations <ul><li>In order to prevent this tragedy from happening again </li></ul><ul><li>the following recommendations have been made: </li></ul><ul><li>Eliminate 10, 000 units/ml concentration vials stocked in the hospital. If this concentration remains in the pharmacy, keep the vials separate from other concentrations. </li></ul><ul><li>Require an independent double check of drug. </li></ul><ul><li>Reduce look alike/ sound alike drug packaging </li></ul><ul><li>The vials of heparin had similarities that may have contributed to the error. </li></ul><ul><li>For all recommendations see reference </li></ul>
    4. 4. Unintended Medication Discrepancies at the Time of Hospital Admission 6% Severe harm potential 61% No harm potential 33% Moderate harm potential More than half of patient have  1 unintended medication discrepancy at hospital admission Reference: http://www.ahrq.gov
    5. 5. Unintended Medication Discrepancies at the Time of Hospital Admission <ul><li>Cornish,Knowles & Marchensano(2005)found greater than 50% of patients had at least 1 medication discrepancy upon hospital admission. The most common error was omission of a regularly used medication. Obtaining an accurate medication history at the time of admission is critical to prevent such errors. </li></ul>Reference: http://www.ahrq.gov
    6. 6. 2012 National Patient Safety Goals <ul><li>Goal 8- Accurately and completely Reconcile Medications across the continuum of care </li></ul>
    7. 7. 2012 National Patient Safety Goals <ul><li>Goal 7- Reduce the risk of health care </li></ul><ul><li>associated infections </li></ul><ul><li>A. Meeting Hand Hygiene Guidelines </li></ul><ul><li>B. Preventing Multidrug-Resistant Organism Infections </li></ul><ul><li>C. Preventing Central Line–Associated Blood Stream Infections </li></ul><ul><li>D. Preventing Surgical Site Infections </li></ul>
    8. 8. Centers for Disease Control (CDC) Report <ul><li>Health-care--associated infections (HAIs) account for a substantial portion of health-care--acquired conditions that harm patients receiving medical care. Nearly one in every 20 hospitalized patients in the United States each year acquires an HAI. Central line--associated blood-stream infections (CLABSIs) are one of the most deadly types of HAIs, with a mortality rate of 12%--25% . </li></ul>http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm?s_cid=mm6008a4_w
    9. 9. TEST YOUR KNOWLEDGE <ul><li>Which is the most </li></ul><ul><li>frequently occurring </li></ul><ul><li>nosocomial </li></ul><ul><li>infection? </li></ul><ul><li>A. Urinary tract infection </li></ul><ul><li>B. Pneumonia </li></ul><ul><li>C. Vascular Catheter related </li></ul><ul><li>Which of these are risk </li></ul><ul><li>factors for development </li></ul><ul><li>of nosocomial infections? </li></ul><ul><li>A. Age </li></ul><ul><li>B. Urinary catheter >24hrs </li></ul><ul><li>C. Mechanical ventilation </li></ul><ul><li>D. Severe underlying disease </li></ul><ul><li>E. Extended stay in acute or chronic care facility </li></ul>Answers on next slide
    10. 10. <ul><li>Additional considerations include: </li></ul><ul><li>Overuse of antimicrobials </li></ul><ul><li>Contaminated equipment-instruments </li></ul><ul><li>Poor HANDWASHING </li></ul><ul><li>Adherence to the CDC Hand </li></ul><ul><li>washing guidelines is critical </li></ul>Urinary tract infections, all are risk factors
    11. 11. Definitions-CDC <ul><li>Hand hygiene </li></ul><ul><ul><li>Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis </li></ul></ul><ul><li>Handwashing </li></ul><ul><ul><li>Washing hands with plain soap and water </li></ul></ul><ul><li>Antiseptic handwash </li></ul><ul><ul><li>Washing hands with water and soap or other detergents containing an antiseptic agent </li></ul></ul><ul><li>Alcohol-based handrub </li></ul><ul><ul><li>Rubbing hands with an alcohol-containing preparation </li></ul></ul><ul><li>Surgical hand hygiene/antisepsis </li></ul><ul><ul><li>Handwashing or using an alcohol-based handrub before operations by surgical personnel </li></ul></ul>Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
    12. 12. Indications for Hand Hygiene-CDC <ul><li>When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. </li></ul><ul><li>If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. </li></ul>Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
    13. 13. Specific Indications for Hand Hygiene <ul><li>Before: </li></ul><ul><ul><li>Patient contact </li></ul></ul><ul><ul><li>Donning gloves when inserting a CVC </li></ul></ul><ul><ul><li>Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don ’t require surgery </li></ul></ul><ul><li>After: </li></ul><ul><ul><li>Contact with a patient ’s skin </li></ul></ul><ul><ul><li>Contact with body fluids or excretions, non-intact skin, wound dressings </li></ul></ul><ul><ul><li>Removing gloves </li></ul></ul>Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
    14. 14. Recommended Hand Hygiene Technique <ul><li>Handrubs </li></ul><ul><ul><li>Apply to palm of one hand, rub hands together covering all surfaces until dry </li></ul></ul><ul><ul><li>Volume: based on manufacturer </li></ul></ul><ul><li>Handwashing </li></ul><ul><ul><li>Wet hands with water, apply soap, rub hands together for at least 15 seconds </li></ul></ul><ul><ul><li>Rinse and dry with disposable towel </li></ul></ul><ul><ul><li>Use towel to turn off faucet </li></ul></ul>Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
    15. 15. Additional Safety Concerns <ul><li>Reduce the Potential of Patient Harm resulting from falls </li></ul>
    16. 16. Falls in the Elderly <ul><li>Falls are a leading cause of death in people 65 and older. </li></ul><ul><li>Approximately 50% of those that fall suffer injuries that reduce mobility and independence. One third of those that sustain hip fractures require nursing home placement </li></ul><ul><li>Ten percent of fatal falls for older adults occur in hospitals. </li></ul>
    17. 17. Fall Risk Factors <ul><li>>65 years of age </li></ul><ul><li>Inability to understand or follow directions </li></ul><ul><li>Confusion </li></ul><ul><li>Altered level of consciousness/ </li></ul><ul><li>delirium </li></ul><ul><li>Inability to use call light </li></ul><ul><li>Impaired vision or mobility </li></ul><ul><li>Unsteady gait </li></ul><ul><li>Dizziness/fainting </li></ul><ul><li>Recent history of falls </li></ul>
    18. 18. Fall Risk Factors <ul><li>Medication Therapy </li></ul><ul><li>Hx of nocturnal/urgency/ frequency in elimination </li></ul><ul><li>Hx of seizures </li></ul><ul><li>Surgical Procedure </li></ul><ul><li>Orthostatic hypotension or hypertension </li></ul><ul><li>Children in cribs </li></ul><ul><li>Use of assistive devices </li></ul>
    19. 19. Meds Requiring Fall Alert <ul><li>Tricyclic Antidepressants </li></ul><ul><li>Antipsychotics </li></ul><ul><li>Sedative-Hypnotics </li></ul><ul><li>Antihypertensives </li></ul><ul><li>Antihistamine/Anticholinergics </li></ul><ul><li>Hypoglycemic agents </li></ul><ul><li>Diuretics/Laxatives </li></ul><ul><li>Anticonvulsants </li></ul><ul><li>Muscle Relaxants </li></ul><ul><li>Narcotic Analgesics </li></ul>
    20. 20. Fall Assessment-High Risk <ul><li>Identify high risk patients and communicate </li></ul><ul><li>to staff-Morse Fall Scale </li></ul><ul><li>Place yellow fall identification band on patients wrist </li></ul><ul><li>Observe patients identified at risk for falls every 2 hours </li></ul><ul><li>Review patient ’s medications that may increase the risk of falls on a daily basis. </li></ul>
    21. 21. Interventions- Initiate Safety Measures <ul><li>Dangle feet from bed prior to sitting/ambulation </li></ul><ul><li>Assist with ambulation </li></ul><ul><li>Apply fall alert ID armband </li></ul><ul><li>Place bed/chair in low position </li></ul><ul><li>Ensure correct use of least restraint </li></ul><ul><li>Free environment of clutter </li></ul><ul><li>Review medications </li></ul><ul><li>Consider interdisciplinary consult </li></ul><ul><li>Document assessment, interventions, response </li></ul><ul><li>Educate patient & significant others </li></ul>
    22. 22. Additional Safety Concerns <ul><li>Prevent health care–associated pressure </li></ul><ul><li>Ulcers </li></ul><ul><li>Assess high risk patients </li></ul><ul><li>Turn every 2 hours </li></ul><ul><li>Keep patient dry and clean </li></ul><ul><li>Promote good nutrition </li></ul>
    23. 23. 2012 Patient Safety Goals <ul><li>The organization identifies safety risks inherent </li></ul><ul><li>in its patient population. </li></ul><ul><li>Nurses must identify individuals who are at </li></ul><ul><li>increased risk of injury and implement safety </li></ul><ul><li>interventions. </li></ul>
    24. 24. High Risk Patient Populations <ul><li>Elderly </li></ul><ul><li>Pediatric </li></ul><ul><li>Language Barriers </li></ul><ul><li>Vision Impairment </li></ul>
    25. 25. Case Study <ul><li>An elderly blind patient was hospitalized </li></ul><ul><li>for treatment of a deep vein thrombosis(clot). </li></ul><ul><li>His discharge medications included injections </li></ul><ul><li>of a anti coagulant. A nurse and pharmacist </li></ul><ul><li>provided the patient with written information </li></ul><ul><li>sheets and counseling regarding self </li></ul><ul><li>administration of his medications. Neither </li></ul><ul><li>noticed that the patient was blind. </li></ul>Reference: http://www.ahrq.gov
    26. 26. Case Study <ul><li>Several days following discharge the </li></ul><ul><li>patient called the office and told the nurse </li></ul><ul><li>he had a bag full of medications including </li></ul><ul><li>injections, but he had not taken any of </li></ul><ul><li>them since he could not read the </li></ul><ul><li>instructions. The patient had to be </li></ul><ul><li>readmitted to the hospital for continuation </li></ul><ul><li>of anticoagulate therapy. </li></ul>
    27. 27. What Happened? <ul><li>False assumptions regarding the patients visual acuity </li></ul><ul><li>Inadequate discharge teaching. Written information is insufficient. </li></ul><ul><li>They did not have the patient return demonstrate the injection procedure. </li></ul><ul><li>Over 1 million persons living in the US are legally blind. Proper assessment is essential to patient education. </li></ul>
    28. 28. Interventions For High Risk Patients <ul><li>Medication training/competency </li></ul><ul><li>Interpreter use </li></ul><ul><li>Available patient education materials </li></ul><ul><li>Large print </li></ul><ul><li>Available outside resources </li></ul>
    29. 29. Case Study <ul><li>Following an overdose a 26 year old </li></ul><ul><li>woman was admitted for observation with </li></ul><ul><li>a 72 hour hold by psychiatry. A 24 - hour </li></ul><ul><li>attendant was placed with the patient. The </li></ul><ul><li>patient was to go to x-ray but requested to go to </li></ul><ul><li>the bathroom first. She was left in the bathroom </li></ul><ul><li>alone. The attendant and transporter began to </li></ul><ul><li>talk. </li></ul><ul><li>Reference: http://www.ahrq.gov </li></ul>
    30. 30. Case Study <ul><li>Upon return to patients room, the nurse </li></ul><ul><li>became concerned and found patient with her </li></ul><ul><li>gown tied around her neck, standing on the </li></ul><ul><li>upside down garbage can. She was seconds </li></ul><ul><li>from stepping off and hanging herself. </li></ul><ul><li>Fortunately no harm came to the patient. </li></ul><ul><li>NEVER LEAVE PATIENT UNATTENDED </li></ul>
    31. 31. Psychiatric Patients <ul><li>Review of 76 cases found only 40% of inpatients who committed suicide were admitted for suicidal ideation. </li></ul><ul><li>Prevention Strategies- Assessment, safe environments, use of a one to one attendant, </li></ul><ul><li>Never leave patient alone </li></ul>
    32. 32. 2012 Patient Safety Goal <ul><li>Conduct a pre procedure verification Process </li></ul><ul><li>A. Conducting a Pre-Procedure Verification Process </li></ul><ul><li>B. Marking the Procedure Site </li></ul><ul><li>C. Performing a Time-Out </li></ul>
    33. 33. Patient Safety Considerations <ul><li>Encourage patients ’ active involvement in their </li></ul><ul><li>own care as a patient safety strategy. </li></ul><ul><li>Improve recognition and response to change </li></ul><ul><li>in a patients condition. Many hospitals have </li></ul><ul><li>instituted rapid response teams which usually </li></ul><ul><li>consist of a nurse, respiratory therapist and </li></ul><ul><li>other health care team members who respond </li></ul><ul><li>to a patient in need. </li></ul>
    34. 34. Patient/Family <ul><li>Patients and family members can provide additional safety checks. </li></ul><ul><li>Encourage patients and families to ask questions. </li></ul><ul><li>Inform patients of their rights. </li></ul><ul><li>Educate patients and family members on all aspects of their care. </li></ul><ul><li>Provide written material as well as verbal. </li></ul>
    35. 35. Available Resources for Patient Education include <ul><li>Institute for Safe Medication Practices </li></ul><ul><li>access www.ismp.org </li></ul><ul><li>Agency for Healthcare Research & Quality - access www.ahrq.gov http://www.ihi.org/IHI/ </li></ul><ul><li>Institute for Healthcare Improvement access: http://www.ihi.org/IHI/ </li></ul>
    36. 36. TEAM WORK IS THE KEY

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