Patient safety

PATIENT SAFETY
By / Mahmoud Shaqria
‫شقريه‬ ‫محمد‬ ‫محمود‬

OUTLINES
◦ DEFINITION OF RISK
◦ DEFINITION OF SAFETY
◦ LIST INTERNATIONAL PATIENT SAFETY GOALS
◦ DISCUSS NATIONAL PATIENT SAFETY GOALS
◦ DISCUSS HOW TO IMPLEMENT NATIONAL
PATIENT SAFETY GOALS
◦ MENTION GENERAL PATIENT SAFETY STANDARDS
ACCORDING TO NATIONAL SAFETY RECUIREMENTS(NSR)

DEFINITIONS
RISK:
Risk is defined as ” combination of the probability of occurrence of
harm and the severity of that harm.”
SAFETY:
Safety is defined as “freedom from which is not tolerable .”
PATIENT SAFETY:
Patient safety was defined as ” the prevention of harm to patient.”

INTERNATIONAL PATIENT SAFETY
GOALS
◦Goal 1: Identify patients correctly.
◦Goal 2: Improve effective communication.
◦Goal 3: Improve the safety of high alert medication.
◦Goal 4: Ensure safe surgery.
◦Goal 5: Reduce the risk of health care associated
infections.
◦Goal 6: Reduce the risk of patient harm resulting from
falls.

NATIONAL PATIENT SAFETY
GOALS
◦ Goal 1: Improve the accuracy of patient identification .
◦ Goal 2: Improve the effectiveness of communication among
caregivers .
◦ Goal 3: Improve the safety of using medications .
◦ Goal 4: Reduce the likelihood of patient harm associated with
the use of anticoagulant therapy .
◦ Goal 5: Maintain and communicate accurate patient
medication information.

CONT-NATIONAL PATIENT SAFETY
GOALS
◦Goal 6: Reduce the harm associated with clinical
alarm systems, Improve the safety of clinical alarm
systems .
◦Goal 7: Reduce the risk of health care–associated
infections .
◦Goal 8: Conduct a pre-procedure verification process
.

NATIONAL PATIENT SAFETY
GOALSGoal 1: Improve the accuracy of patient
identification.
 Use at least two patient identifiers when:
providing care, treatment, procedure, or services.
administering medications, blood, or blood components
collecting blood samples and other specimens for clinical testing
The patient's room number or physical location is not used as an
identifier.
Label containers used for blood and other specimens in the presence
of the patient.

 Eliminate transfusion errors related to patient
misidentification.
Before initiating a blood or blood component
transfusion:
-Match the blood or blood component to the order.
-Match the patient to the blood or blood component.
-Use a two-person verification process or a one-
person verification process accompanied by automated
identification technology, such as bar coding.

Goal 2: Improve the effectiveness of
communication among caregivers .
Develop written procedures for managing the
critical results of tests and diagnostic
procedures that address the following:
The definition of critical results of tests and
diagnostic procedures
 By whom and to whom critical results of tests
and diagnostic procedures are reported

 The acceptable length of time
between the availability and reporting
of critical results of tests and
diagnostic procedures.
Implement the procedures for
managing the critical results of tests
and diagnostic procedures.
Evaluate the timelines of reporting
the critical results of tests and
diagnostic procedures

Goal 3: Improve the safety of using
medications
1.Abbreviations not to be used throughout the organization
Abbreviations not to be used throughout the organization are:
• U/ IU
• Q.D., QD, q.d., qd.
• Q.O.D., QOD, q.o.d., qod.
• MS, MSO4
• MgSO4
• Trailing zero (5.0)
• No leading zero ( .5)
• Dose x frequency x duration

2.Documentation & communication of
patient's current medications & discharge
medication
3.Prevent errors from high risk
medications
4.Prevent errors from look-alike, sound-
alike medications

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5.Label all medications, medication
containers, and other solutions on and off
the sterile field in perioperative and other
procedural settings.
 Label medications and solutions that
are not immediately administered.
 Labeling occurs when any medication or
solution is transferred from the original
packaging to another container.

Both on and off the sterile field, medication or
solution labels include the following:
- Medication or solution name
- Strength
- Amount of medication or solution containing medication (if
not apparent from the container)
- Diluent name and volume (if not apparent from the container)
- Expiration date when not used within 24 hours
- Expiration time when expiration occurs in less than 24 hours
 Verify all medication or solution labels both verbally and
visually.

Label each medication or solution as soon as it is
prepared, unless it is immediately administered.
Immediately discard any medication or solution
found unlabeled.
Remove all labeled containers on the sterile field
and discard their contents at the conclusion of the
procedure.
All medications and solutions both on and off the
sterile field and their labels are reviewed by
entering and exiting staff
responsible for the management of medications

Goal 4: Reduce the likelihood of patient harm
associated with the use of anticoagulant
therapy
 Use approved protocols for the initiation and
maintenance of anticoagulant therapy.
 Before starting a patient on warfarin, assess
the patient’s baseline coagulation status
 for all patients receiving warfarin therapy, use a
current International Normalized Ratio (INR) to
adjust this therapy.
 The baseline status and current INR are
documented in the clinical record.

Provide education regarding anticoagulant therapy
to prescribers, staff, patients, and families.
Patient/family education includes the following:
- The importance of follow-up monitoring
- Compliance
- Drug-food interactions
- The potential for adverse drug reactions and
interactions.
 Evaluate anticoagulation safety practices, take
action to improve practices, and measure the
effectiveness of those actions in a time frame
determined by the organization.

Goal 5: Maintain and communicate
accurate patient medication
information.
Obtain and/or update information on the
medications the patient is currently taking.
This information is documented in a list or
other format that is useful to those who
manage medications.
Define the types of medication information to
be collected in different settings and patient
circumstances.

 Compare the medication information with the
patient with the medications ordered for the
patient in order to identify and resolve
discrepancies.
 Provide the patient (or family as needed) with
written information on the medications the patient
should be taking at the end of the episode of care
(for example, name, dose, route, frequency,
purpose).
 Explain the importance of managing medication
information to the patient at the end of the episode
of care.

Goal 6: Reduce the harm associated with
clinical alarm systems. Improve the safety of
clinical alarm systems
Leaders establish alarm system safety as a hospital priority.
Identify the most important alarm signals to manage based on
the following:
 Input from the medical staff and clinical departments
Risk to patients if the alarm signal is not attended to or if it
malfunctions
 Whether specific alarm signals are needed or unnecessarily
contribute to alarm noise and alarm fatigue
 Potential for patient harm based on internal incident history
 Published best practices and guideline.

Establish policies and procedures for
managing the alarms at a minimum, address
the following:
- Clinically appropriate settings for alarm signals
- When alarm signals can be disabled
- When alarm parameters can be changed
- Who has the authority to set alarm parameters
- Who has the authority to change alarm parameters
- Who has the authority to set alarm parameters to
“off”
- Monitoring and responding to alarm signals
- Checking individual alarm signals for accurate
settings, proper operation, and detectability.

Goal 7 :Reduce the risk of health care–associated
infections
 Comply with either the current Centers for Disease Control and
Prevention (CDC) hand hygiene guidelines or the current World
Health Organization (WHO) hand hygiene guidelines.
Implement a program that follows either the current Centers for
Disease Control and Prevention (CDC) or the current World
Health Organization (WHO) hand hygiene guidelines.
Set goals for improving compliance with hand hygiene
guidelines.
Improve compliance with hand hygiene guidelines based on
established goals.

Implement evidence-based practices for preventing
surgical site infections.
Example: hyperthermia after three days of patient
admission indicate hospital accuired infection.

Educate staff and licensed independent practitioners
involved in surgical procedures about surgical site
infections and the importance of prevention.
Education occurs upon hire, annually thereafter, and
when involvement in surgical procedures is added to
an individual’s job responsibilities.
Educate patients, and their families as needed, who
are undergoing a surgical procedure about surgical
site infection prevention.
Implement policies and practices aimed at reducing
the risk of surgical site infections, meeting the
evidence based guidelines (CDC,WHO)

As part of the effort to reduce surgical site
infections:
- Conduct periodic risk assessments for surgical site
infections in a time frame determined by the
organization.
- Select surgical site infection measures using best
practices or evidence-based guidelines.
- Monitor compliance with best practices or
evidence-based guidelines.
- Evaluate the effectiveness of prevention efforts.

Administer antimicrobial agents for prophylaxis for a
particular procedure or disease according to methods cited
in scientific literature or endorsed by professional
organizations.
When hair removal is necessary, use a method that is
cited in scientific literature or endorsed by professional
organizations.

Goal 8: Conduct a pre-procedure verification
process
Implement a pre-procedure process to verify the correct procedure,
for the correct patient, at the correct site.
Identify the items that must be available for the procedure and use
a standardized list to verify their availability. At a minimum, these
items include the following:
- Relevant documentation (for example, history and physical, signed
procedure consent form, nursing assessment, and pre-anesthesia
assessment)
- Labeled diagnostic and radiology test results (for example, radiology
images and scans, or pathology and biopsy reports) that are properly
displayed
- Any required blood products, implants, devices, and/or special
equipment for the procedure

Match the items that are to be available in the
procedure area to the patient.
Mark the procedure site.
Identify those procedures that require marking of
the incision or insertion site. At a minimum, sites are
marked when there is more than one possible
location for the procedure and when performing the
procedure in a different location would negatively
affect quality or safety.
Mark the procedure site before the procedure is
performed and, if possible, with the patient involved.

The procedure site is marked by a licensed
independent practitioner who is ultimately
accountable for the procedure and will be present
when the procedure is performed.
 The method of marking the site and the type of
mark is unambiguous and is used consistently
throughout the health organization.
 A written, alternative process is in place for patients
who refuse site marking or when it is technically or
anatomically impossible or impractical to mark the
site (for example, mucosal surfaces or perineum).

A time-out is performed before the
procedure
Conduct a time-out immediately before starting the invasive
procedure or making the incision.
The time-out has the following characteristics:
- It is standardized, as defined by the organization.
- It is initiated by a designated member of the team.
- It involves the immediate members of the procedure
team, including the individual performing the procedure,
the anesthesia providers, the circulating nurse, the
operating room technician, and other active participants
who will be participating in the procedure from the
beginning.

When two or more procedures are being
performed on the same patient, and the person
performing the procedure changes, perform a
time-out before each procedure is initiated.
During the time-out, the team members agree, at
a minimum, on the following:
- Correct patient identity
- The correct site
- The procedure to be done
Document the completion of the time-out

General Patient Safety Standards:
◦ The patient’s safety policy defines Egyptian & WHO Patient
Safety recommendations & solutions, including at least the
following:
◦ NSR.1.1 Accurate standardized patient identification in all
service areas.
◦ NSR.1.2 Standardized process for dealing with verbal or
telephone orders
◦ NSR.1.3 Handling critical values/tests
◦ NSR.1.4 Hand hygiene throughout the organization

NSR.1.5 Prevention of catheter & tubing mis-connections
NSR.1.6 Prevention of patient's risk of developing pressure
ulcers
NSR.1.7 Prevention of patient's risk of falling
NSR.1.8 A standardized approach to hand over
communications
NSR.1.9 Preventive maintenance and testing of critical
alarm systems is implemented and documented.

NSR.1.10 The hospital has systems in place to
ensure hospital-wide recognition of & response to
clinical deterioration.
NSR.1.11 The hospital implements guidelines to
reduce venous thromboembolism (deep venous
thrombosis & pulmonary embolism).

NSR.1.2 Standardized process for dealing with verbal
or telephone orders
 Miscommunication is the commonest root cause for
adverse events. Writing down & reading back the
complete order or test result, by the person
receiving the information, minimizes
miscommunication.
 No verbal / telephone order with the following
1. blood/blood components transifution
2. Administrating anesthetic medication

NSR.1.5 Prevention of catheter & tubing mis-connections
 Patients, especially within critical & specialized care areas, are
connected to many tubes & catheters, each with a special function
(monitoring, access, drainage). During care, these tubes & catheters may
be misconnected leading to the administration of wrong material via the
wrong route resulting in grave consequences.
NSR.1.6 Prevention of patient's risk of developing pressure ulcers
 Identifying patients who are more prone to develop pressure ulcers is a
better preventive strategy than trying to treat them, as this not only
consumes lots of resources but also has a negative impact on the
patients themselves. Effective preventive measures to minimize
pressure ulcer development are those that are tailored to each patient &
directed towards the risks identified from risk assessment.

NSR.1.7 Prevention of patient's risk of falling
 Each patient's risk of falling, including the potential risk
associated with the patient's medication regimen, is
assessed & periodically reassessed. Action is taken to
decrease or eliminate any identified risks of falling.
 All patients are liable to fall; however, some are more prone
to. Identifying the more prone is usually done through a risk
assessment process in order to offer them tailored
preventative measures against falling. Effective preventive
measures to minimize falling are those that are tailored to
each patient & directed towards the risks being identified
from risk assessment.

NSR.1.10 The hospital has systems in place to ensure
hospital-wide recognition of & response to clinical
deterioration.
Functional & long-term outcome of early detection & timely
providing urgent care to deteriorating patients is more
superior to resuscitation of patients with cardio-pulmonary
arrest. Studies have shown that this strategy has positive
impact on reducing in-hospital mortality & improving patient
safety.

Patient safety

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