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.

Interested in learning more? Visit cneexplorer.com for a wide range of online nursing ce topics.

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.

 

Interested in viewing more online nursing ceus? Visit us at cneexplorer.com for more information!

More on Sepsis and Nursing

Sepsis is one of the most serious conditions in health care facilities around the world. As such, it is crucial for nurses to be up to date on the clinical presentations and protocols in order to provide prompt intervention.

 

What Is Sepsis?

Sepsis is best defined as a complication of a bacterial, fungal or viral infection within the body. Severe inflammation in response to the chemicals released in the body to fight infection can cause varying degrees of sepsis. Sepsis can occur anywhere in the body – including, but not limited to the, brain, bloodstream, heart, and lungs.

 

Sepsis Risk Factors:

• Immunosuppressive diseases (HIV and AIDS)
• Patients with chronic illnesses (diabetes and cardiovascular disease)
• Pediatric or Geriatric Patient populations are at higher risk
• Patients who have undergone invasive procedures (intravenous line, surgery)
• Patients with Drug-Resistant bacteria
• Patients with severe wounds
• Patients currently hospitalized in the ICU

 

Sepsis Signs and Symptoms

There are three general categories of Sepsis (Sepsis, Severe Sepsis, and Septic Shock). The earlier the condition is identified, the higher the likelihood of survival.

 

Sepsis

Diagnosis is made when at least two of the following symptoms are present:

Fever above 101F or below 96.8 F

Rapid heartbeat greater than 90beats/ minute

Rapid breathing greater than 20breaths/ minute

Possible or confirmed infection

 

 

Severe Sepsis

Diagnosis of severe sepsis occurs when one of the items listed below is also present – this may begin to indicate organ failure:

Chills

Weakness

Confusion

Significant decrease in urine output

Difficulty breathing

Unconsciousness

 

Septic Shock

Diagnosis is made with any of the signs and symptoms of severe sepsis along with extremely low blood pressure.

 

How Nurses Can Help Prevent Sepsis

Early detection and intervention can improve a patient’s chances of survival. Regular and consistent nursing assessments can identify early signs and symptoms and help to initiate a plan of care.

The following are recommended:

Know signs and symptoms

Regularly monitor at risk patients

Be sure to clean or change IV lines, catheters, or breathing tubes (per hospital policy) in order to prevent the growth of microorganisms

Aseptic technique and hand washing protocols should be followed at all times

Teach patient to recognize complications

 

Interested in learning more evidence based guidelines for nursing care? Visit our sister site at www.cneexplorer.com for more online nursing CE.

 

Nursing Specialties – 5 In Demand Specialties

We are all familiar with the current nursing shortage within the United States and the expectation that nursing needs will continue to grow within the United States. As our profession continues to grow, the demand for various nursing specialties will also grow. Currently there are over 100 nursing specialties in the United States and it can often be difficult to keep up with the ever growing list. We decided to list 5 of the fastest growing nursing specialties here:

Critical Care Nurse

Critical care nurses work within a team of health care providers to make sure critical patients in the hospital (or other facility) get the best care possible. Demand in this specialty is expected to increase by at least 25% through 2020.

Diabetes Nurse

A diabetes nurse works with patients who have diabetes. As our population continues to age, the number of patients with diabetes will increase proportionately. Accordingly the need for diabetes nurses is expected to grow as much as 39%!

Gerontological Nurse Practitioner

A gerontological nurse practitioner is a nurse who has gone through the nurse practitioner certification process and who works with elderly populations. As our population continues to age, the specialty is in high demand. The large need for these specialty nurses is expected to increase by over 25% through 2020.

Informatics Nurse

The informatics nurse’s job is to collect, interpret, and relay necessary medical data coming from and into hospitals, clinics, doctor’s offices, and nursing homes. Informatics nurses also help to design or implement new technology and processes for a variety of nursing interests. At the most basic level, job growth for medical records administrators is projected to be 22%. Advances in technology will affect this both positively and negatively.

Medical-Surgical Nurse

The image of a registered nurse working within a hospital or surgical center is the common image most of the American public entertains. Around 17% of all nurses work within this specialty at any time – making it the largest nursing specialty. Overall demand for medical-surgical nurses is expected to increase by 30% through 2020.

 

Interested in learning more about the growing nursing field and how nursing continuing education can help you get there? Visit CNE Explorer for more information.

Looking Into Infiltration and Extravasation

Infiltration and Extravasation are two commonly overlooked IV complications that are often tough to detect and can cause serious damage. The IV Complication referred to as Extravasation is best defined as the accidental administration of a vesicant fluid or solution into the surrounding tissue area. The term infiltration refers to the accidental administration of a non-vesicant fluid or medication into the surrounding tissues.

 

In both situations, the amount of tissue damage depends on the type of drug or fluid being infused and the amount of time that it remains in the tissue area before being discovered. Tissue damage can range in severity from mild instances to tissue necrosis requiring surgical intervention.

 

There are a variety of reasons why infiltration or extravasation may happen in some patients. These include:

• Selecting an Improper Site (insertion over an area of flexion for example)
• Traumatic insertions that have caused damage to the internal lining of the vessel.
• Inadequate securement of the intravenous device (catheter tip penetrates the catheter wall or the catheter slips out of the vessel)
• Improper device utilization for a specific treatment
• Obstructions to blood flow around or through the catheter

 

Patients with small sclerosed veins (diabetes or atherosclerosis) are at an increased risk of infiltration or extravasation. Children, elderly patients, and patients who are unable to communicate clearly with the staff are at an increased risk of complications. Without a doubt, prevention is the ideal strategy in regards to infiltration and extravasation. Several prevention oriented strategies are:

 

• Accept that these complications can occur and educate staff, patients and family on the early identification of signs and symptoms.
• Quickly respond to complaints of pain or discoloration at the insertion site.
• Monitor patients with IVs regularly – employ a standardized method for visually inspecting an insertion.
• Protect the infusion site form excessive movement.
• Avoid areas of flexion.
• Have a prepared policy and process in place for handling different types of infiltrations and extravasations.

 

Despite our best efforts, infiltration and extravasation can still occur. As health care providers we must be prepared and aware of the most recent evidence based guidelines for handling these sorts of situations. Facilities should actively encourage learning opportunities for providers and hands on learning programs. However, professionals should never be limited by the amount of on-the-job training available. For interested nurses, there is a large amount of content available online that focus on intravenous insertions and complications. Of course, these nursing ceu programs are by no means substitutes for hands on learning, they are options for nurses seeking to learn more about the subjects.

Air Embolisms and IV Therapy

Although the chances of an air embolism occurring is rare, it is still a significant potential side effect during infusion therapy. An air embolism occurs when an air bubble or group of air bubbles enter a vein or artery and block the normal flow of blood. Air embolisms can travel throughout the body and cause severe cardiovascular and pulmonary issues.

Several of the common causes for air embolism include:

• Infusion lines that are not properly filled and completely vented.
• Errors occurring during the execution of a pressure infusion.
• Accidentally during specific surgical interventions that require the opening of the vascular system (neurosurgical, vascular, obstetric, gynecological, orthopedic, etc.)
• During parallel infusions (gravity infusions and infusion pumps).
• Air entering through open IV access and infusion systems. This can be influenced by the position of the vein and patient with respect to the right side of the heart.
• Non Intravenous/ non health care oriented causes include cases of scuba diving and rare cases involving orogenital sex during pregnancy.

Regardless of how they occur, an Air Embolism is a serious complication that can endanger the well being of a patient and add significant costs to any form of patient care. The best way strategy of handling air embolisms is prevention. Several key preventive strategies are listed below:

• When a peripheral cannula is inserted, the risk of air embolism can be reduced by ensuring that the selected arm of the patient is kept below the level of the heart during the insertion or removal procedure.
• The supine or Trendelenburg position is ideal for the insertion of a central venous catheter.
• The use of Luer-Lock connections can minimize the potential for the accidental disconnection of administration sets and syringes from intravenous catheters.

The above listed items are in no way all inclusive. For a detailed and evidence based discussion of air embolisms in the clinical setting it is advisable for nursing teams to seek out continuing education on the topic. There are several excellent sources of nursing continuing education available online and it is crucial for health care providers to stay up to date on the latest evidence based practices.

The Growing Luxury World of Vitamin IV Therapy

Within the last 4 years the growth of “party IVs”, Vitamin IVs, and other forms of alternative IV therapies has been tremendous. Across the United States, swanky luxury clinics have opened up across California, Nevada, Arizona and Florida. Many other practitioners in other states have also added vitamin IVs to their menu of additional infusion solutions.

 

Although the main stream Vitamin IV phenomenon in the US and Canada are relatively new, Vitamin IV drips have been offered throughout Europe and Asia for years now. The movement within the United States can be traced back to the late Dr. Myers and his work throughout the mid-60s and 70s.

 

Dr. Myers designed and administered a unique solution of vitamins and minerals which would later become known as the Myers’ Cocktail (or simply the Myers). Dr. Myers would administer the solution to patients of his who suffered from a variety of chronic issues such as migraines, fatigue, depression, etc..

 

Even though there are few clinical trials investigating the efficacy of the Myers cocktail, the number of ardent supporters of the infusion are significant. Many regular patients claimed that without the infusion, their symptoms would return quickly. Recognizing this need, entrepreneurial clinicians quickly began to satisfy these needs across the nation.

 

Recently, practitioners have expanded their offering to include high dose Vitamin C infusions (used in a variety of situations), and other targeted infusions to create a health living sort of appeal Thus, clinic owners have begun to appeal to athletes, mothers, the elderly, etc. as potential clients. The clinics themselves are now built to resemble luxury spas and high end retreats, and the costs of the infusions have increased tremendously. In certain cities (Miami and Las Vegas), there are practitioners who offer Vitamin IV therapies straight to hotel rooms, to homes, or even on a schedule bus or shuttle. In these cities which have traditionally been associated with partying and heavy drinking, practitioners are capitalizing on both the healthy living and the hangover cure aspects of their infusions.

 

Celebrities and athletes are now frequent patients and public interest seems to be continuously increasing. As such, health care providers have begun to receive more and more inquiries into the safety of said infusions. Unfortunately, the amount of available online continuing education courses for nurses on this subject is minimal and there is a great deal of conflicting messages on this point. Moving forward, both nurses and physicians will need to be able to communicate the benefits and potential complications of vitamin IV therapy to their interested patient populations.