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.

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.

 

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.

Forensic Nursing within the United States

Forensic nursing is commonly defined as the application of the forensic aspects of health care combined with the bio/psycho/social education of the registered nurse in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of violence, criminal activity, and traumatic accidents. Although forensic nursing is often associated with sexual assault investigations, it is truly a diverse field. Forensic nurses can be found at nearly all points where health care and legal systems interact (correctional nursing, death investigations, trauma nursing, etc.). Programs within the United States have been operating since the mid-70s, and it was in 1995 that the American Nurses Association formally recognized forensic nursing as a specialty in the US.

Interestingly, of all the medical professionals that prosecutors may come into contact with, forensic nurses can be extremely beneficial expert witnesses. Forensic nurses often have extensive experience with victims of violence and can help address crucial issues such as delayed reporting and ranges of trauma reactions.

Many states across the nation have begun to change their requirements in regards to Forensic Nurse presence. This is especially significant in states that have large rural populations and large distances between major cities. Texas for example, which has a high number of cities that are over 200 miles from a major medical center, recently enacted a Senate Bill requiring all hospitals to have medical personnel trained in basic forensic evidence collection. The purpose of this bill was to reduce situations in which a rural patient entered an emergency room, was treated for injuries, and then was referred 100+ miles away to have evidence collected.

A detailed report of the overall impact within Texas rural communities is not yet available, but the current belief is that the bill will have a positive effect for rural patients. To help in the effort, the Texas state nursing Board, recently instituted specific continuing education requirements in regards to Forensic Nursing nursing CE. The point being to introduce all nurses to the skill set and to thus drive interest in the materials.

Illegal Drug Use among Emergency Department Patients

The use of illegal drugs is a major issue for health care providers around the world. Drug use has been associated with cardiovascular disease, HIV/AIDS, and a wide range of health related issues. Further, it is believed that current drug users underutilize preventative and regular medical care and over utilize hospital and emergency room care.

It is estimated that approximately 9.2% of the United States’ population have used some form of illegal drugs within the past month. Within the health care system, it is estimated that over 6.5% of all patient attendances are either directly or indirectly related to illegal drug use. In 2011, over 5 million of the 125 million general emergency room visits can be considered drug related. These numbers have increased steadily and represent a 100% increase in relation to the 2004 numbers.

Of particular concern is the sharp increase in emergency department visits involving the non-medical use of pharmaceuticals (Over the counter, prescription, and dietary supplements). Within the past ten years the amount of emergency room visits related to non-medical usage of pharmaceuticals increased by over 95%. The most commonly reported drugs involved were hydrocodone, alprazolam, and oxycodone. Each of those three drugs reported increases of over 100% in reported emergency room visits.

The only other “traditional illegal drug” to have increases in emergency room visits by over 100% is ecstasy. Which has seen a tremendous resurgence in both attributable emergency room visits and popular culture.

Another key driver of emergency room visits related to illegal drug use is the combination of alcohol and other drugs. Alcohol combinations are most commonly linked with the non-medical pharmaceuticals listed earlier, cocaine, heroin, and marijuana. In 2009, approximately 32% of all drug abuse emergency room visits involved the use of alcohol alone or in combination with another drug.

For health care providers it is important to understand the ramifications of drug abuse throughout the United States health care system. Further, it is important for health care providers to be knowledgeable in regards to the referral options and additional follow-up support options that are available within your organization and community in the event that a patient requests additional help in detoxification and helping with drug addiction. For many, emergency room visits present a valuable intervention point where the health care team can inform the patient about the risks associated with continuing drug abuse behaviors.

A Crucial Skill – Infusion Nursing

Gaining access to a vein, venous access, is a critical skill necessary for basic patient care in both the hospital and ambulatory patient settings. There are several different forms of Venous Access Devices and today we will briefly examine each of the different devices and their uses or contraindications.

 

Peripheral IV – These are the traditional IVs that come to mind. They are ideal for short-term access (no more than 72 hours in the same site).. The majority of short term situational needs can be meet with a conventional PIV line. Veins can be accessed on the hand, arm, or even foot.

 

Peripherally Inserted Central Catheters – PICC’s are commonly inserted in either the basilic, brachial, or cephalic veins and many facilities utilize skilled nursing teams to insert them. Common uses for these insertions are for repeated blood transfusions, parenteral delivery of nutrition, antibiotics, analgesics, and chemotherapy.

 

Centrally Inserted Catheters – The three main types are listed below:

 

Non-Tunneled Catheters – used for short term time frames in an emergency department, operating room, or intensive care unit.

 

Skin-Tunneled Catheters – Used in situations where the catheter will need to stay inserted for longer period of time. Regular infusions of medication or blood are potential examples. Again, skilled staff and protective measures are needed for successful insertion.

 

Implantable ports – A much more technically complex device, consists of a catheter attached to a reservoir that is implanted into a surgically created pocket on the chest wall. These devices are expensive, difficult to insert, and time consuming to remove.

 

It is important to note that there are no “infection or complication proof” venous access devices. Each process runs the risk of complications and it is absolutely crucial that nursing teams are familiar with the different forms of complications and that they are able to educate the patient and family as well. Educating patients is another important factor – patients who are educated about potential complications are better positioned to identify issues earlier.

 

IV insertions and infusions are among the most common hospital procedures performed in health care facilities around the world. Despite their regularity of use, it is essential for health care providers to consistently seek out the most current evidence based IV therapy information in order to provide consistently high levels of patient care.

 

Even though there are a number of online IV therapy CE providers, real world bedside training of nurses remains the key. Regular training consisting of evidence based material reviews and practical hands-on learning are essential to maintaining an evidence based nursing culture.

Nurse Sensitive Indicators: What Are They and How You Can Use Them

The idea of quality improvement has become synonymous with the classic image of a hard-nosed businessman. For many, words like driving quality, QI initiatives, and focusing on quality seem like tired phrases commonly spoken once a year in an annual meeting. However, for nurses, improving “quality” means improving the level of patient care and safety. That is something that has to be done each and every day.

Although most nurses focus on providing the best care that they can, it helps to measure the frequency at which trouble issues occur. Let’s imagine that we are working within a surgical unit and that we would like to reduce the number of unnecessary patient falls. In order to “reduce a number” we first have to understand what the current number is.

This is where nurse sensitive indicators come into play. They are simply a way of measuring and monitoring the “numbers” that you are trying to reduce or improve. Nursing sensitive indicators are especially powerful in that they are easy to communicate and can be understood by all levels of an organization.

Looking at the example above, if we know the amount of patients (per every 100 or 1,000) patients that fall within a unit we can then begin to examine why the patients are falling. From that point we can then begin to investigate different nursing interventions that may be able to help reduce the current number.

There is tremendous variety in the amount of available nurse sensitive indicators. They can examine every facet of nursing care with the overall goal of improving the levels of patient care and safety.

Cancer within the United States – 2015 Facts and Figures

Oftentimes the scope of a disease escapes us as we move throughout our daily lives. Here are several relevant cancer facts and figures for the 2015 year (From the American Cancer Society):

• Approximately 14.5 million Americans with a history of cancer were alive in January 2014.
• Approximately 1.6 million new cancer cases are expected to be diagnosed in 2015 (this does not include basal or squamous skin cell cancers).
• The 5 year relative survival rate for all cancers diagnosed from 2004-2010 is now at 68%.
• Cancer accounts for 1 out of every 4 deaths in the US.
• In 2014, Kentucky had the highest age adjusted incidence rates for cancer (all types).
• Approximately 9,000 people die from skin cancer each year.

These are just a quick glance at some interesting cancer related facts. In virtually every country in the world, cancer is one of the leading causes of death. Cancer care is a physical, emotional, and financial burden in the United States and has become a part of both our national discussions and our national culture.

The Growth of Ambulatory Care Nursing in the US

Within the past ten years we have seen a tremendous change in the way patients seek care. Patients are more technologically savvy, and expect answers and information much faster than before. Accordingly, the field of ambulatory care nursing now employs over 25% of all RN’s in the United States.

Due to the recent increases in technology, the amount of outpatient surgeries has more than tripled since the mid 90’s. Today, approximately 2/3 of all surgeries are considered outpatient surgeries. Patients are arriving in the morning, undergoing surgery, and leaving in the afternoons. There is currently tremendous demand for nurses with operating room experience who can transition into an ambulatory care unit.

Despite the opposition from traditional health care providers, ambulatory care facilities and ambulatory care nursing is growing – and it is growing rapidly. As our population continues to both grow and age, the amount of people entering these facilities will only increase. On the nursing side, the practice will continue to evolve as nurses begin to play larger and larger roles in these facilities. As such, it is crucial that ambulatory care nurses stay up to date on the most recent evidence based practices via specialized ambulatory care continuing nursing education.

Neat Facts About the Human Brain

These neat facts about the human brain kept us thinking all day. Take a look:

• Tickles. You can’t tickle yourself because your brain distinguished between unexpected external touch and your own touch.
• World Champion. A world champion memorizer, Ben Prioress memorized 96 historical events in 5 minutes and memorized a single, shuffled deck of cards in 26.28 seconds.
• Dream showings. Japanese researchers have successfully developed a technology that can put thoughts on a screen and may soon be able to screen people’s dreams.
• Bilingual brains. Children who learn two languages before the age of five alters the brain structure and adults have a much denser gray matter.
• Water. The brain is made up of about 75% water.

Interested in learning more neat facts that will be applicable to your nursing practice? Visit CNE Explorer for more continuing education opportunities.