CHAPTER 8. Safety
Dina A. Krenzischek
OBJECTIVES
At the conclusion of this chapter, the reader will be able to:
1. Define patient safety.
2. Describe the American Society of PeriAnesthesia Nurses (ASPAN) position statement on perianesthesia safety.
3. List 2009 The Joint Commission (TJC) National Patient Safety Goals, patient safety resources, and Council on Surgical and Perioperative Safety (CSPS) safety goals.
4. List perianesthesia safety net, harm levels, and methods of reporting/analysis.
5. Identify key elements of safety culture, including workplace civility.
I. OVERVIEW
A. Patient safety
1. The core of standard practice of perianesthesia nurses
2. Considered the highest priority
3. The freedom from accidental injury caused by medical care or medical error
4. The achievement of intended outcomes
B. Safety is defined as
1. A condition of being safe from undergoing or causing hurt or loss
2. Protection against failure, breakage, or accident
C. ASPAN position statement on perianesthesia safety
1. Responsible in defining the principles of safe quality nursing practice in the perianesthesia setting
2. Highly committed to the culture of safety
3. A collective of shared knowledge and beliefs regarding safe health care practice settings and the provision of safe practice
4. revention of any incidence or risk of injury, danger, or harm
5. Goal is to promote a safe perianesthesia care setting and provide guidelines for best practices.
II. CORE VALUES AND TENETS OF A SAFETY CULTURE
A. Communication
1. Reporting errors/safe practices
2. Ensuring a complete and systematic approach to hand-off processes and transfer of care
3. Developing and using effective listening skills
B. Advocacy
1. Protecting patient from harm
2. Upholding ethics of care
3. Maintaining patients’ rights
4. Seeking and implementing best practices
C. Competency
1. Achieving and supporting professional competence in clinical practice
2. Initiating, supporting, and providing education for staff and patients
3. Demonstrating appropriate clinical judgment and critical thinking
4. Measuring and monitoring quality measures and nurse-sensitive indicators
D. Efficiency/timeliness
1. Maintaining a healthy environment of care
2. Providing timely interventions and reports
3. Appreciating cues and initiating appropriate interventions
E. Teamwork
1. Collaborating with health care providers
2. Building mutual trust between all health care providers
3. Supporting an organizational culture of safety
III. 2009 TJC SAFETY GOALS AND KEY POINTS
A. Goal 1: Improve the accuracy of patient identification.
1. Use two identifiers for:
a. Medication administration/IV fluids
b. Blood products
c. Blood samples and specimens
d. Blood transfusion
e. Treatment procedures
f. Charts and forms
2. Final verification process before surgery or procedure
B. Goal 2: Improve the effectiveness of communication among caregivers.
1. Hand-off communication: verbalize accurate, clear, complete, interactive
2. Read back including critical results and provider’s orders
3. List of abbreviations, acronyms, symbols, and dose—not used
4. Timeliness of reporting, receipt of critical test results and values
5. Standardized approach to hand-off communications
C. Goal 3: Improve the safety of using medications.
1. Review and verify allergies.
2. Be alert and take action on look-alike/sound-alike medications.
3. Label medications, containers, and solutions.
4. Attention to anticoagulant therapy, insulin, cardiac medications, etc.
5. Verify unclear orders.
6. Avoid distraction and interruptions during medication administration.
D. Goal 7: Reduce the risk of health care–associated infection.
1. Wash hands (15 seconds) before and after patient contact.
2. Assess and report any signs of infection.
3. Implement evidence-based practices to prevent health care–associated infections.
4. Implement best practices or evidence-based guidelines to prevent central line–associated bloodstream infections.
5. Implement best practices for preventing surgical site infections.
6. Implement and encourage others to follow isolation protective techniques.
E. Goal 8: Accurately and completely reconcile medications across the continuum of care.
1. Obtain and verify medication list from patient (name, unit dose, dose amount, frequency, last dose).
2. Reconcile medication list to provider’s order.
3. Document any changes noted.
4. Communicate the completed reconciled list to the next receiving unit nurse, including other assessments.
5. Communicate and educate patient directly and family as needed when patient is going home, using the completed reconciled list.
6. Report any inconsistency or problems to the provider.
F. Goal 9: Reduce the risk of patient harm resulting from falls.
1. Follow institutional fall precaution protocol.
2. Follow institutional restraint protocol including any competency training
3. Stay with patient or delegate someone to assist patient when dressing to go home.
4. Adjust patient assignment depending upon the needs of high- risk patients.
G. Goal 10: Reduce the risk of influenza and pneumococcal disease in institutionalized older adults.
1. Follow institutional flu vaccine protocol.
2. Follow administration protocol of pneumococcus vaccine.
3. Report any known cases of influenza.
H. Goal 11: Reduce the risk of surgical fires.
1. Assess and report any equipment with damaged electrical parts.
2. Manage patient’s injuries as a result of fire that occurred intraoperatively.
I. Goal 13: Encourage patients’ active involvement in their own care as a patient safety strategy.
1. Encourage patients and families to report safety concerns.
2. Identify ways of reporting and communicate to patient and family members.
3. Identify process of correcting patient and family concerns in a timely manner.
J. Goal 14: Prevent health care–associated pressure ulcers (decubitus ulcers).
1. Assess areas of potential pressure ulcer.
2. Follow institutional protocol for management of high-risk patients, including documentation.
K. Goal 15: The organization identifies safety risks inherent in its patient population.
1. Identify patients with risk for suicide.
2. Assess and document potential signs of suicidal behaviors.
3. Report any problem to the provider and facilitate psychiatric consult as ordered.
4. Provide resource to watch patient and determine type of resource when transferring patient to a receiving unit.
L. Goal 16: Improve recognition and response to changes in a patient’s condition.
1. Provide competency training to staff to meet the needs of the population to be served, including critically ill patients.
M. Implement universal protocol.
1. Conduct a preprocedure/surgical verification process.
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