Patient Safety
PCS Clinical Competencies |
|
Page contents:
|
Section 1: Patient ID
Other acceptable identifiers are the patient's medical record number (MRN), or social security number (you must match two). Example: MRN is the second identifier used for blood transfusion specimens and blood transfusion. Patients who cannot be positively identified by name are given a "DOE" full name and MRN. The patient room number cannot be used. Birth dates as second identifiers might pose special issues with our immigrant populations. Names may seem similar and countries that do not recognize birth dates are all given a common birth date of January 1, and the year of their immigration to the United State. Using a third identifier in these cases will ensure the right patient. Section 2: Medication Safety
Shortcuts should be avoided when giving medications · The Right Patient 2 IDs for patient verification, this means every patient, every time · The Right Drug check for misfills in pyxis, review multi-ingredient items (ie · The Right Dose check drip/pump rates · The Right Time first dose NOW for antibiotics, standard doses & times · The Right Route includes giving the appropriate dosage form Looking up information about the med to be administered may prevent an error. To look up a medication quickly, the "Clinical Toolkit" icon on the desktop contains a link to the on-line reference MICROMEDEX. A nurse should never hesitate to question an order that looks incorrect. Patients should be taught about the medications they're receiving. The patient who notices a discrepancy between the order and what he or she is familiar with may trigger the discovery of an error. 24hour medication/allergy checks improve accuracy of patient profile, communication and prevent errors. Send allergy information/allergy updates to pharmacy. Double check patient allergies before medication administration.
Section 3: High-Alert Meds
Another JCAHO safety goal is to improve the safety of using High-Alert Medications. High alert medications are drugs that have a "heightened risk of causing significant patient harm when they are used in error" (Institute for Safe Medication Practices, Dec 2003). Orders for high alert medications should trigger closer attention to indications for use, appropriate dosing, and possible complications, as well as the usual safety practices used for medication administration. Example: The nurse notes an order for continuous IV heparin in a patient less than 2 days post surgery, and verifies with the physician that the indication for anticoagulation outweighs the risk of hemorrhage. You should be able to list two of the most common medications given on your unit that are classified as "high-alert" medications due to heightened risk for causing significant harm if administered incorrectly. Those that are commonly prescribed in the hospital setting include:
Section 4: Suicide Risk Assessment
JCAHO has developed new requirements for patient safety. These include identification of patients at risk for suicide, including those being treated for emotional or behavioral disorders in non-psychiatric areas of the hospital. Specifically, suicide risk must be identified in patients with a primary diagnosis or primary complaint of a psychiatric disorder, including diagnoses of chemical dependency. The requirement does not include patients with a secondary psychiatric or chemical dependency diagnosis. It also does not include patients being treated for illness or injury related to a known suicide attempt, because the suicide risk for these patients is already clearly identified.
If the patient answers "Yes" to two or more of these four questions, an order for a psychiatric consultation must be obtained within two hours. Precautions should be taken to maintain patient safety, including maintenance of a safe environment, while awaiting psychiatric consultation. These precautions may include removal of potentially dangerous items, and addition of a sitter. Because patients with active substance abuse may become suicidal as they withdraw from these substances, this assessment will also be required when a patient who has been an inpatient for longer than 24 hours has a new CIWA order, or is determined to be in withdrawal from other chemicals of abuse. The assessment will be instituted soon, when the policy detailing these changes is distributed. Section 5: Impaired Worker
Healthcare providers tend to view themselves as caregivers rather than the recipients of care and frequently deny their own vulnerability.
Impairment is defined as a decrease in physical or cognitive ability which affects the performance of the provider to perform the essential duties of their job and may jeopardize patient safety. Impairment may result from many causes including but not limited to alcohol or substance abuse, sleep deprivation, undiagnosed physical illness or personal stressors. Unfortunately, statistics report that one out of ten healthcare providers will be challenged by substance abuse at some time over the course of their career which may lead to an impairment in their work performance. Appropriate and effective treatment can save a professional's career, license, and even his/her life. If you desire more information or suspect you have a problem, confidential resources are available to assist you in caring for yourself.
If you would like more information regarding this topic, you can obtain?a publication from the Department of Health.???A Guide for Assisting Colleagues Who Demonstrate Impaired Performance.? To obtain a copy, you may call 360-236-2880 or email at whps@doh.wa.gov. Section 6: Pressure Ulcers
A pressure ulcer develops from constant pressure applied to skin over a bony prominence. The pressure ulcer is staged according to depth of injury:
Those at risk for developing a pressure ulcer include the following individuals:
Risk assessment The Braden scale is a validated risk assessment tool used to identify individuals who are at-risk for developing pressure ulcers. The scale has six general risk factors:
The patient is rated and the summative score indicates level of risk for developing a pressure ulcer. Interventions should be based on any low score(s). Ready to start the quiz?
|
Send mail to:
twillega@u.washington.edu Last modified: 7/31/2008 12:28 PM |