Revisedpart iiipme lecture 2012presentationpart3
- 1. 2012 National Patient Safety Goals Goal 7- Reduce the risk of health care associated infections A. Meeting Hand Hygiene Guidelines B. Preventing Multidrug-Resistant Organism Infections C. Preventing Central Line–Associated Blood Stream Infections D. Preventing Surgical Site Infections
- 2. Centers for Disease Control (CDC) Report Health-care--associated infections (HAIs) account for a substantial portion of health-care--acquired conditions that harm patients receiving medical care. Nearly one in every 20 hospitalized patients in the United States each year acquires an HAI. Central line--associated blood-stream infections (CLABSIs) are one of the most deadly types of HAIs, with a mortality rate of 12%--25% . http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm?s_cid=mm6008a4_w
- 3. TEST YOUR KNOWLEDGE Which is the most frequently occurring nosocomial infection? A. Urinary tract infection B. Pneumonia C. Vascular Catheter related Which of these are risk factors for development of nosocomial infections? A. Age B. Urinary catheter >24hrs C. Mechanical ventilation D. Severe underlying disease E. Extended stay in acute or chronic care facility Answers on next slide
- 4. Additional considerations include: Overuse of antimicrobials Contaminated equipment-instruments Poor HANDWASHING Adherence to the CDC Hand washing guidelines is critical Urinary tract infections, all are risk factors
- 5. Definitions-CDC Hand hygiene Performing handwashing, antiseptic handwash, alcohol-based handrub, surgical hand hygiene/antisepsis Handwashing Washing hands with plain soap and water Antiseptic handwash Washing hands with water and soap or other detergents containing an antiseptic agent Alcohol-based handrub Rubbing hands with an alcohol-containing preparation Surgical hand hygiene/antisepsis Handwashing or using an alcohol-based handrub before operations by surgical personnel Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
- 6. Indications for Hand Hygiene-CDC When hands are visibly dirty, contaminated, or soiled, wash with non-antimicrobial or antimicrobial soap and water. If hands are not visibly soiled, use an alcohol-based handrub for routinely decontaminating hands. Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
- 7. Specific Indications for Hand Hygiene Before: Patient contact Donning gloves when inserting a CVC Inserting urinary catheters, peripheral vascular catheters, or other invasive devices that don’t require surgery After: Contact with a patient’s skin Contact with body fluids or excretions, non-intact skin, wound dressings Removing gloves Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
- 8. Recommended Hand Hygiene Technique Handrubs Apply to palm of one hand, rub hands together covering all surfaces until dry Volume: based on manufacturer Handwashing Wet hands with water, apply soap, rub hands together for at least 15 seconds Rinse and dry with disposable towel Use towel to turn off faucet Guideline for Hand Hygiene in Health-care Settings. MMWR 2002 ; vol. 51, no. RR-16.
- 9. Additional Safety Concerns Reduce the Potential of Patient Harm resulting from falls
- 10. Falls in the Elderly Falls are a leading cause of death in people 65 and older. Approximately 50% of those that fall suffer injuries that reduce mobility and independence. One third of those that sustain hip fractures require nursing home placement Ten percent of fatal falls for older adults occur in hospitals.
- 11. Fall Risk Factors >65 years of age Inability to understand or follow directions Confusion Altered level of consciousness/ delirium Inability to use call light Impaired vision or mobility Unsteady gait Dizziness/fainting Recent history of falls
- 12. Fall Risk Factors Medication Therapy Hx of nocturnal/urgency/ frequency in elimination Hx of seizures Surgical Procedure Orthostatic hypotension or hypertension Children in cribs Use of assistive devices
- 13. Meds Requiring Fall Alert Tricyclic Antidepressants Antipsychotics Sedative-Hypnotics Antihypertensives Antihistamine/Anticholinergics Hypoglycemic agents Diuretics/Laxatives Anticonvulsants Muscle Relaxants Narcotic Analgesics
- 14. Fall Assessment-High Risk Identify high risk patients and communicate to staff-Morse Fall Scale Place yellow fall identification band on patients wrist Observe patients identified at risk for falls every 2 hours Review patient’s medications that may increase the risk of falls on a daily basis.
- 15. Interventions- Initiate Safety Measures Dangle feet from bed prior to sitting/ambulation Assist with ambulation Apply fall alert ID armband Place bed/chair in low position Ensure correct use of least restraint Free environment of clutter Review medications Consider interdisciplinary consult Document assessment, interventions, response Educate patient & significant others
- 16. Additional Safety Concerns Prevent health care–associated pressure Ulcers Assess high risk patients Turn every 2 hours Keep patient dry and clean Promote good nutrition
- 17. 2012 Patient Safety Goals The organization identifies safety risks inherent in its patient population. Nurses must identify individuals who are at increased risk of injury and implement safety interventions.
- 18. High Risk Patient Populations Elderly Pediatric Language Barriers Vision Impairment
- 19. Case Study An elderly blind patient was hospitalized for treatment of a deep vein thrombosis(clot). His discharge medications included injections of a anti coagulant. A nurse and pharmacist provided the patient with written information sheets and counseling regarding self administration of his medications. Neither noticed that the patient was blind. Reference: http://www.ahrq.gov
- 20. Case Study Several days following discharge the patient called the office and told the nurse he had a bag full of medications including injections, but he had not taken any of them since he could not read the instructions. The patient had to be readmitted to the hospital for continuation of anticoagulate therapy.
- 21. What Happened? False assumptions regarding the patients visual acuity Inadequate discharge teaching. Written information is insufficient. They did not have the patient return demonstrate the injection procedure. Over 1 million persons living in the US are legally blind. Proper assessment is essential to patient education.
- 22. Interventions For High Risk Patients Medication training/competency Interpreter use Available patient education materials Large print Available outside resources
- 23. Case Study Following an overdose a 26 year old woman was admitted for observation with a 72 hour hold by psychiatry. A 24 - hour attendant was placed with the patient. The patient was to go to x-ray but requested to go to the bathroom first. She was left in the bathroom alone. The attendant and transporter began to talk. Reference: http://www.ahrq.gov
- 24. Case Study Upon return to patients room, the nurse became concerned and found patient with her gown tied around her neck, standing on the upside down garbage can. She was seconds from stepping off and hanging herself. Fortunately no harm came to the patient. NEVER LEAVE PATIENT UNATTENDED
- 25. Psychiatric Patients Review of 76 cases found only 40% of inpatients who committed suicide were admitted for suicidal ideation. Prevention Strategies- Assessment, safe environments, use of a one to one attendant, Never leave patient alone
- 26. 2012 Patient Safety Goal- Conduct a pre procedure verification Process – WHO guidelines include Initial verification of the intended patient, procedure, and site of the procedure; Marking the intended site with a sterile pen, where applicable; and A final “time-out” immediately before beginning the procedure in which medical team members actively verify each element listed above.
- 27. Patient Safety Considerations Encourage patients’ active involvement in their own care as a patient safety strategy. Improve recognition and response to change in a patients condition. Many hospitals have instituted rapid response teams which usually consist of a nurse, respiratory therapist and other health care team members who respond to a patient in need.
- 28. Patient/Family Patients and family members can provide additional safety checks. Encourage patients and families to ask questions. Inform patients of their rights. Educate patients and family members on all aspects of their care. Provide written material as well as verbal.
- 29. Available Resources for Patient Education include Institute for Safe Medication Practices access www.ismp.org Agency for Healthcare Research & Quality - access www.ahrq.gov http://www.ihi.org/IHI/ Institute for Healthcare Improvement access: http://www.ihi.org/IHI/
- 30. TEAM WORK IS THE KEY