National Patient Safety Goals for 2015

The goals listed below are the items identified by the Joint Commission for Health Care Accreditation for 2015. Each year the JC identifies the goals that it feels will help improve the levels of patient care and safety in health care organizations around the world.

 

These goals were developed by a panel of patient safety experts made up of nurses, physicians, risk managers, and others who have experience with patient safety issues.

 

In regards to improving the accuracy of patient identification:

 

1. A minimum of two patient identifiers should be used to confirm a patient receiving treatment or medication of any kind. Labeling of specimens and blood samples are to be done at the bedside to avoid confusion. Possible identifiers could include: name, medical record, birth date, telephone number, etc.

 

2. In an effort to prevent transfusion errors – two identifiers should be used to match blood products and a two person verification process is used. One person must be the person who will administer the blood product, and the other must be qualified to verify blood (per hospital policy). One person verification processes are possible whenever bar coding or other forms of automated identification technology exists.

 

Improving the effectiveness of communication among caregivers:

 

3. The joint commission recommends defining the test results and timeframes for reporting items.

 

Improving the safety of using medications:

 

4. All medications and diluents in any syringe or container are to be labeled with the name of the substance, the strength, the volume and the respective expiration date.

 

5. Face-to-face anticoagulant therapy risks should be reduced through patient-provider education and face-to-face teaching including the precautions they need to take and the need for regular INR monitoring.

 

6. Comparing the medications a patient is taking with newly ordered medications to address duplications, omissions, and interactions should be regular practice.

 

To reduce the harm associated with clinical alarm systems:

 

7. Recognizing the point at which alarms contribute to noise pollution is crucial. Make sure that alarms are responded to on time.

 

Reducing the risk of healthcare-associated infections:

 

8. Standard hand cleaning guidelines from the CDC and WHO are to be employed. Organizations should set goals and assess their compliance with the CDC and/or WHO guidelines and foster a culture of hand hygiene.

 

9. Hospitals should use proven guidelines such as hand hygiene, contact precautions, and cleaning and disinfecting patient care equipment to prevent the spread of organisms such as methicillin resistant staphylococcus aureus (MRSA), clostridium difficile (CDI), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram-negative bacteria.

 

10. Use evidence-based practices to prevent bloodstream infections from short- and long-term central venous catheters and peripherally inserted central catheter (PICC) lines.

 

11. Prevent infection after surgery using best practices and monitoring compliance.

 

12. Implement policies to prevent indwelling catheter-associated urinary tract infections (CAUTI). The usage and total amount of days needed for indwelling catheters should be kept to the absolute minimum.

 

Assess Patient Populations for Inherent Safety Risks:

 

13. Examine psychiatric patients for suicide inclinations. Identify environmental features that may increase the risk for suicide. Provide suicide prevention information such as crisis hotlines or other forms of help upon discharge.

 

To prevent mistakes in surgery:

 

14. Pre-procedure verification processes should be conducted – make sure all relevant documents are available and have been reviewed. Any discrepancies should be resolved prior to surgery, ensure pre-admission testing and assessment is completed fully.

 

15. Physically marking the correct site on the patient’s body prior to beginning the procedure is key. This is especially important for situations in which there is more than one possible location.

 

16. Employ time-outs prior to surgery. A “Time-Out” is a final check that the correct patient, site, and procedure have been identified correctly. Questions or concerns are to be resolved prior to the procedure taking place.

 

For more detailed information, visit the Joint Commission’s National Patient Safety Goals site. For more patient safety focused continuing education visit cne explorer.com. CNE Explorer is an online provider of nursing CE for nursing professionals around the world.

A Look at Sepsis

Sepsis Definition

 

In Non-Coronary intensive care units within the United States, sepsis is the leading cause of death Current estimates place the mortality rate between 28 and 50%. Sepsis, however, does not refer to a specific bacteria, but rather to the body’s immune response to an overwhelming infection. Infections, at any point on the body, can lead to sepsis. In hospitals, common sites of the initial infection include IV catheters, surgical sites, and pressure ulcers.

 

Pathophysiology

 

Within normal circumstances, the body’s immune response seeks to increase blood flow and the capabilities of macrophanges to control an infection. .

 

In response to the foreign antigen, the body releases pro-inflammatory mediators such as prostaglandins, tissue necrosis factor, cytokines, and platelet-activating factors. These mediators damage the delicate endothelial lining, leading to capillary leakage. Additionally, they activate neutrophils (which release nitric oxide) and lead to edema. Platelet-activating factors begin to circulate systematically, and coagulation is increased. Together, these effects create symptoms of hypotension, edema, and microthrombi which impair the perfusion of tissues and lead to multi-organ failure.

 

Signs and symptoms

 

Hypothermia, tachycardia, tachypnea, peripheral vasodilation/edema, unexplained shock, and unexplained mental status changes all can indicate sepsis. The CBC will indicate infection and clotting factors will be noted.

 

Prevention

 

The only way to reduce the incidence of sepsis is to prevent infection. Strict adherence to policies regarding IV site care and careful monitoring and treatment of surgical site infections are the best way to prevent healthcare-associated infections leading to sepsis.

 

Surviving Sepsis

 

Sepsis Bundles are evidence-based clinical recommendations for the treatment of sepsis and septic shock. Originally introduced by The Surviving Sepsis Campaign, these bundles have proven to be effective when used together to combat sepsis.

 

The term “bundle” refers to a series of evidence based protocols that are used together. When implemented together, these elements have greater results than any of the interventions used alone. Hospitals are meant to use the bundles as a framework for creating sepsis protocol in their institutions.

 

What’s in the Bundles?

 

Once a patient is triaged in the ED or identification is made of symptoms consistent with severe sepsis, the following steps are to be taken:

 

TO BE COMPLETED WITHIN 3 HOURS:

1) Labs: Lactate levels

2) Obtain blood cultures

3) Administer broad spectrum antibiotics after blood cultures are done

4) Give 30 ml/kg of crystalloid for hypotension or lactate =4 mmol/L

 

TO BE COMPLETED WITHIN 6 HOURS:

5) Give vasopressors (for hypotension not responding to initial fluid resuscitation) to maintain a mean arterial pressure (MAP) =65 mmHg

6) In the event of persistent hypotension after fluid resuscitation (MAP < 65 mm Hg) or if initial lactate was =4 mmol/L, re-assess volume status and tissue perfusion and document findings

7) Re-measure lactate if initial lactate was elevated.

 

DOCUMENT REASSESSMENT OF VOLUME STATUS AND TISSUE PERFUSION WITH

• Repeat focused exam by independent licensed provider (vital signs, assessment of perfusion, fluid status)

OR TWO OF THE FOLLOWING:

• CVP
• ScvO2
• Bedside cardiovascular ultrasound
• Assessment of fluid responsiveness using passive leg raise (does the patient show an increase in stroke volume?)

 

Successful implementation should strive for a twenty five percent reduction in mortality from Sepsis within their organization

 

Interested in learning more about evidenced based nursing care. CNE Explorer is a US based online provider of continuing education for nurses and provides online CE courses to nurses around the world.

Medical Errors

Medical errors are preventable adverse events that result from medical care, and they are the third leading cause deaths in the US!

 

Medical errors include everything from adverse medication events, surgical site infections or wrong-site surgery, blood transfusion errors, falls, pressure ulcers, and other complications. Medical errors with serious consequences are most common in intensive care units, operating rooms, and emergency departments.

 

What Are the Causes of Medical Errors?

 

Most medical errors are not due to one group or the actions of a single individual, but rather from faulty systems and processes that allow people to make mistakes or fail to prevent them.

 

Many hospitals use computerized systems that flag suspicious orders for review as well as flagging drug allergies and drug incompatibilities. These safety mechanisms are meant to make it harder for people make mistakes and seek to reduce errors. Many hospitals are still in the process of moving to electronic MARs and computerized documentation systems, though, and these systems and others are not foolproof.

 

How Can Medical Errors Be Reduced?

 

One way hospital seek to address medical errors is through root cause analysis (RCA).  This method is used to analyze medical errors, accidents, and serious adverse events. Root cause analysis seeks to find the underlying issues that lead to mistakes being made while avoiding blaming individuals. RCA allows the identification of patterns that can reveal where systems may be improved to increase safety. Staff are still held responsible for their actions, but when an error occurs, blaming an individual does little to make the system safer or to prevent the same error from occurring again.

 

Communication failures are commonly cited as the cause of most medical errors, and the Joint Commission has focused efforts on improving hand off communication and preoperative time outs to remedy this. Proving organized and thorough information about your patient in hand off is a great way to ensure that nothing is overlooked.

 

Part of preventing medical errors is building a culture of safety by focusing on root causes instead of blame. This in turn improves morale and communication among staff, one of the best ways to ensure safety and continuity of care for patients.

Interesting in learning more about evidence based nursing? Visit CNE Explorer.com for evidence based online continuing education.

Women and Heart Disease

Prevalence

Statistics have shown that since 1984, more women than men have died from heart disease. It accounts for 1 in 3 female deaths each year. An estimated 43 million women in the U.S are affected.

 

Cause of Heart Disease

Heart disease is caused from the narrowing or obstruction of the coronary arteries by the build-up of plaque, a process known as atherosclerosis. Over time, it impedes or stops blood flow, causing serious complications.

 

Risk Factors

High blood pressure

High cholesterol

Overweight or obesity

Depression or stress

Diabetes

Family history of heart disease

 

You are also at risk if you:

Smoke

Have Poor diet and nutrition

Drink alcohol excessively

Being physically inactive

 

Reducing the Chances of Heart Disease

In order to reduce the risk levels of heart disease, women need to be more proactive about their health. Regular doctor visits allows for early diagnoses and treatment. Other preventative measures include:

-Monitoring and controlling blood pressure, blood sugar and cholesterol levels

-Quit smoking

-Eating healthy

-Exercising

-Weight control

-Limiting alcohol intake

-Lowering stress levels

-Being familiar with your family health history

 

Heart disease is a serious illness that affects millions of men and women each year. As healthcare providers it is our duty to keep patients informed of ways to reduce the likelihood of heart disease and to provide patients with all the necessary information in order to make positive lifestyle choices.

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What is MRSA?

Methicillin-resistant Staphylococcus aureus (MRSA) refers to infection caused by a strain of staph bacteria that evolved to survive treatment with common antimicrobials.

 

Infection with MRSA often begins with small red bumps on the skin that may be mistaken for insect bites. These become deeper, painful abscesses. Surgical incision and drainage is often required. If the infection is allowed to spread, it often leads to pneumonia or serious infections affecting the bones, heart valves, or the bloodstream.

 

How common is MRSA?

 

Current data indicates that even though the overall rates of MRSA infections are trending downwards, colonization rates are increasing – this indicates that greater infection control efforts are required within healthcare systems. The majority of reported cases are health care associated; community acquired MRSA cases are also serious issues and have become slightly more prevalent in recent years.

 

Who is at Risk?

 

Patients in nursing homes or receiving treatment for chronic conditions are particularly at risk. MRSA infections often occur when invasive devices or procedures are present (such as dialysis, chemotherapy, or invasive surgeries).

 

In the community, those living in dormitories, sharing gym facilities, and child care workers have higher rates of infection.

 

Additionally, healthcare workers and others in contact with healthcare personnel are at an increased risk of contamination. For these populations, hand washing and proper barrier protections are crucial to preventing infection.

 

Overall Prevention and Infection Control

 

If a patient tests positive for a MRSA infection there are several immediate precautions which should be implemented. MRSA is spread by direct contact, thus personal protective equipment (gown and gloves) should be worn during all patient interactions. MRSA can be found on all surfaces in the patient’s room, so precautions are required for any care provided, not only for direct physical contact.

 

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