Environment of Care
1.Why is it important to make sure safety features are not blocked?
2.What items should not be blocked?
1.Safety features are built into our facility to be able to quickly access to maintain safety in the event of an unexpected problem such as a fire, malfunction or other event.
2.Items that should not be blocked (not a complete list)
a)Means of Egress (exit)
b)Fire Extinguishers
c)Medical Gas Panels
d)Electric Panels
What are some basic infection control practices you employ?
•Proper hand hygiene
•Wear proper PPE
•Ensuring equipment has been cleaned prior to use on patients
•Bottom shelf is solid or has liner
•Instruments are pretreated prior to sending to SPD
•Microwaves are clean
•Ice machines and water dispensers are clean and free from lime scale/build up
•Scrub the hub
•Dwell times for disinfectants
•Biohazard waste properly disposed
•Tape residue removed
•Clean linens are covered while stored
•Disinfectants are mixed to the appropriate proportions
•Correct dry time allowed for skin prep prior to procedure
When should you label medications?
When the medication or solution is prepared, unless it is immediately administered.
When any medication or solution is transferred from the original packaging to another container.
NPSG 15
Identify Patient Safety Risks:
Reduce risk of fire in homes of patients who receive oxygen.
How do we reduce these risks?
Conduct an oxygen safety assessment before starting oxygen in the home and on admission (i.e. working smoke detectors, smoking/open flames, etc.)
Re-evaluate fire risk periodically and document the re-evaluation.
Inform and educate patient and family around risks identified, precautions needed, and recommendations for interventions. Document.
Assess and document the patient and family comprehension of fire risks and education provided.
What tools do you have available to assist you with patients:
1.Whose primary language is not English?
2.Who are deaf and hard of hearing?
3.Is it ever allowed to use family, friends, or untrained staff members to translate?
1.Video Remote Interpretation Carts at FMH. Off site locations have access to an iPad with interpreters.
2.Amplified phone receivers, personal amplifiers, pre-printed and laminated sheets with basic questions, white boards, and hand-written notes.
3.Yes, only in the event of an unforeseen emergent situation.
•Do you know the emergency codes and your role in them at the hospital?
•How do you report an emergency?
Some Examples:
Blue-Respiratory or Cardiac Arrest
Red- Fire
Pink-Infant/Child Abduction
Reporting:
Hospital - Dial 1000
Off-Site - Dial 911
Glucometers:
•When should you clean them?
•What do you use to clean them?
•Glucometers should be cleaned between each patient AND prior to docking the meter.
•Never immerse the glucometers to clean.
•Always use an approved wipe to clean the meter surface.
•Isopropanol-based cleansers (such as the Sani-Cloth) and 10% bleach are acceptable.
•Note: When using 10% bleach, follow up by wiping with water moistened gauze to prevent corrosion.
What’s the maximum amount of time that verbal orders can remain unsigned?
48 hours
NPSG 15
Identify Patient Safety Risks:
Reduce risk for suicide
How do we reduce these risks?
•Screen patients for suicidal ideation using CSSR or ASQ screening tool
•Mitigate risks to patients at risk for suicide (location, 1:1 sitter, etc.)
•Perform suicide assessment for those identified at risk for suicide using Safe-T Protocol or BSSA
•Document identified patients overall risk and plan to mitigate
•Follow associated policies/SOP’s for reassessment, monitoring patients, and counseling and follow up care at discharge
•Ensure staff properly trained and competent to care for patients
•What elements are required for a History and Physical (H&P)?
•What are the acceptable timeframes for a H&P?
•Per Policy MS10 History & Physical a complete H&P consists of:
•Chief complaint
•Details of present illness
•Medical history and allergies
•Relevant past social and family histories
•Current medications (and any past relevant to current treatment)
•Review of systems
•Physical Exam
•Diagnosis or problem list with plan of care
•H&P must be completed:
•Completed within 24 hours of admission and prior to procedure
OR
•Within last 30 days and updated within 24 hours of admission and prior to procedure
•Notes:
•A H&P done during a telemedicine appointment would not qualify as a complete H&P as there would not be a physical exam.
•A H&P >30 days does NOT qualify as a current H&P even if updated with stamp.
•When is a sharps container considered full?
•What do you do if you see a full sharps container?
•A sharps container is considered full when contents reach the full line indicated on the container (~3/4 full)
•Some areas secure their own containers: Close and secure the top and place in dirty utility location for pick up
•All other areas: Call EVS Hotline at 74429
When should you perform hand hygiene?
When starting work
Before patient contact
After patient contact
Before/after eating
After unsanitary tasks
Before donning and after doffing gloves
Before/after using the restroom
How do you report an Adverse Drug Event?
Complete an incident report and notify your patient’s physician
Your FMH pharmacist will be notified via Verge but if the ADE is severe/life threatening please also phone or verbally alert
FMH Pharmacy reports severe ADRs using MedWatch Program
NPSG 9
Prevent Patients from Falling
What are some ways to reduce the risk of falls?
Assess the patient’s risk for fall. If patient at risk, make that a part of the care plan.
Implement interventions to reduce falls based on risk. Patient goals and interventions to focus on fall prevention. Ensure the environment is as safe as possible based on patient’s specific environment and abilities
Educate the patient and family on individual fall reduction strategies. Teach patient and caregiver to maintain and develop strategies for a safe environment related to the patient’s mobility.
How are our patients’ religious or cultural needs met?
Chaplain Services
Patient/family care conferences
Individualized care plan
Dietary preferences are honored
Non-English patient educational material
Language interpretation through the phone/video service
Where can you find the Safety Data Sheets (SDS)?
Locate the SDS information for your unit or on the LOOP under “Be Safe and Secure”.
Alcohol-based hand sanitizer may be used if hands are not visibly soiled. What are some exceptions requiring soap and water?
Your patient has C-DIFF, or other spore forming bacteria
You have used the restroom
How do you store and use medications in your department?
Food is stored in a separate refrigerator from all refrigerated floor stock and patient medications
Drug manufacturers labeled Multi-dose vials may be used for up to 28 days if a Beyond Use date label is applied to the vial and as long as recommended storage conditions have been followed or unless there is concern for contamination or the manufacturer lists less than 28 day stability at which point the vial is discarded
Drug Vials that are not labeled by the manufacturer as MDV or that have a SINGLE USE ONLY label applied by FMH Pharmacy should be discarded after initial use
Disinfectants and items for external use are properly labeled and kept separate from internal medications
The temperatures of the medication refrigerators are wirelessly monitored 24/7 by both Plant Operations and FMH Pharmacy
What are the National Patient Safety Goals (NPSGs)?
Hospital
•NPSG 1: Identify patients correctly
•NPSG 2: Improve communication of critical test results
•NPSG 3: Use medications safely by labeling meds properly, follow anticoagulation protocols, and medication reconciliation
•NPSG 6: Use clinical alarms safely
•NPSG 7: Prevent infection by performing proper hand hygiene
•NPSG 15: Identify patient safety risks for suicide
•UP: Universal Protocol to verify correct patient, correct procedure, correct site
Home Services
•NPSG 1: Identify patients correctly
•NPSG 3: Use medications safely by collecting and recording accurate information
•NPSG 7: Prevent infection by performing proper hand hygiene
•NPSG 9: Prevent patients from falling
•NPSG 15: Identify patient safety risks for patients receiving oxygen
When should a patient be assessed for pain?
Pain should be assessed 1) On admission 2) With change of caregiver and 3) With any new report of pain
Pain should be re-assessed 1) After medication administration and 2) After non-pharmacological interventions
How often must fire drills be conducted in a healthcare setting?
At least once per shift per quarter.
We work hard to prevent infections such as Multidrug-resistant organisms (MDRO), Central line-associated blood stream infections (CLABSI), Catheter-associated urinary tract infections (CAUTI), and Surgical site infections (SSI).What are we working on to prevent Healthcare-Associated Infections?
Having policies and practices based on evidence based practice to reduce occurrence
Implementing processes for prevention
Measuring and monitoring our infection prevention processes, outcomes and compliance using evidence based guidelines and best practices
What steps should you take to reduce the risk of a medication administration error?
Ensure you have the right patient, medication, dose, and route of administration at the right time.
Time Out
•When is it performed?
•What are the requirements?
•Before all operative or other invasive procedures (including regional anesthesia)
•After prepping and draping patient
•Immediately before incision or procedure start.
Providing care includes 4 core processes, what are they?
1.Assessing needs
2.Planning care
3.Providing care
4.Coordinating care
Providing care also includes aspects of; infection control, medication management, recording the care, and honoring patient rights.