30 Safe Practices

in 30 Minutes

Creating a SafeMedical Practice

10/7/20133:15 – 3:45 pm

Michael A. O’ConnellMHA, FACMPE, FACHE

Vice President of Clinical/Support Services

Goal: Increase Patient Care & Quality by Minimizing

Mistakes and Reducing Risk

Part TwoObjectives:

1. Learn important safety practices needed in a successful medical practice.

2. Understand how diverse safety practices contribute to creation of a safe environment.

3. Apply lessons learned in one’s medical practice with key safety take aways.

1

Why create a Culture of Safety?1) Implement safety before, not after the fact. Be proactive!

2) Prevent breaks to patient & employee safety.

1

Rule: Implement role based access, audit trails, password protection, and data encryption. Continuously reassess and increase IT safety measures.

Information TechnologyCause of Hazard: Easy EHR access

Effect: Corruption of PHI, PHI breach

Reference: NYC Health

2

Rule: Implement a policy to stop cutting and pasting (without editing) of anything included in an EHR.

Cut & PasteCause of Hazard: Clinicians not typing original work

Effect: Patients’ medical records are incorrect, medical errors can ensue

Reference: American Medical News

3

Rule: Enforce policy on use of Facebook and other social media, educate vendors and staffing agencies on the policy. Be an example, guide younger employees on appropriate professional behavior.

FacebookCause of Hazard: Inappropriate employee use of social mediaEffect: Disclosure of patients’ PHI, unprofessionalism, distraction from work

Reference: Healthcare IT News

4

Rule: Test and monitor the system often, work with other systems to develop best practices, remove “extra clicks”, and update often.

CPOEsCause of Hazard: Too many alerts

Effect: Physicians begin to ignore allergies or drug interactions

Reference: Health Leaders Media

5

Rule: Establish a culture of legibility, implement policies for poor handwriting.

LegibilityCause of Hazard: Illegible clinicianhandwriting

Effect: Incorrect prescription fills, incorrect medical records

Reference: Patient Safety & Quality Healthcare

6

Rule: TIMEOUT checklist in the OR before procedure begins, where the whole operative team confirms correct patient identity, correct side and site, and agreement on procedure to be done.

Surgical Sites & ProceduresCause of Hazard: Lack of confirmation

Effect: Wrong site, wrong procedure, wrong person surgery

Reference: American Association of Orthopaedic Surgeons

7

Rule: Implement a hard-stop alert that appears when clinicians attempt to enter unapproved abbreviations.

AbbreviationsCause of Hazard: Unapproved abbreviations

Effect: Medical errors, confusion

Reference: Journal of the American Medical Informatics Association

8

Rule: Keep carts stocked, locked, checked, accessible, and plugged in. Store only full oxygen tanks on the carts.

Crash CartsCause of Hazard: Not prepared for emergency use

Effect: Unnecessary patient harm

Reference: Emergency Medicine MIMs

9

Rule: Use lifting guidelines with bariatric patients. Educate staff on proper lifting procedures.

Wheelchair LiftingCause of Hazard: Improper technique

Effect: Injury to staff or patient

Reference: Caring Today

10

Rule: Create safe footwear policies, such as no open-toed shoes and no shoes with holes in them.

FootwearCause of Hazard: Use of chemicals, bodily fluid spills, dropping heavy objects

Effect: Injury, spreading of infection

Reference: Patient Safety & Quality Healthcare

11

Rule: Use a comprehensive checklist (like the one in the link) to look for, and fix, anything that would promote a slip, trip, or fall.

Slips, Trips, and FallsCause of Hazard: Changes in elevation, spills

Effect: Slips, trips, and falls

Reference: CDC

12

Rule: Follow quality protocols for safe dosages, proactively prepare for possible accidents, and properly label injections.

Nuclear MedicineCause of Hazard: Lack of protocol use

Effect: Improper injections, unsafe dosages, accidental injuries, or unintentional reactions.

Reference: European Association for Nuclear Medicine

13

Rule: Use blunt-tip or retractable needles as much as possible. Use proper disposal methods for sharps.

NeedlesCause of Hazard: Careless use

Effect: Accidental sticks

Reference: FDA

Reference: OSHA

14

Rule: Remove latex as much as possible, and replace with non-latex alternatives. Create designated latex-free areas.

LatexCause of Hazard: Employee/patient allergies

Effect: Harm to employees/patients

Reference: Infection Control Today

15

Rule: Use teach-back methods for patient education on treatment plans, make sure informed consent forms can be readily seen in EHR programs.

Informed ConsentCause of Hazard: Patients not understanding treatment plans, lost forms

Effect: Cancelled procedures, lack of treatments in a timely manner

Reference: Patient Safety & Quality Healthcare

16

Rule: Reduce the need for restraints. Make sure all patients who have been restrained/secluded are evaluated face-to-face by a physician or PA.

RestraintsCause of Hazard: Devices used to restrain, overusing restraint, lack of evaluation

Effect: Injury to patients

Reference: Premier Inc.

17

Rule: Screen patients for risk and post appropriate alert on EHR, hourly rounding.

Patient FallsCause of Hazard: Frail patients, patients not wanting to ‘bother’ a nurse to get up

Effect: Falling, injuries

Reference: Strategies for Nurse Managers

18

Rule: Labeled for patient food ONLY, have thermometers inside monitoring temperature and audit, have cleaned properly and often, have an alarm on the fridge in case its temperature drops.

Patient RefrigeratorsCause of Hazard: Not properly cleaned, not tested regularly, no alarms, expiration of food

Effect: Waste, patient harm

Reference: UTMB Healthcare Policies & Procedures

19

Rule: Use Braden score & weekly skin documentation audits, increase nurse-to-nurse communication on patient skin condition.

Pressure UlcersCause of Hazard: Poor nurse communication, lack of skin condition audits

Effect: Preventable pressure ulcers

Reference: Patient Safety & Quality Healthcare

20

Rule: Use appropriate contact precautions & PPE (monitor adherence), isolate patient, transport only when medically necessary, educate infected patients on proper hygiene

C. difficile PatientsCause of Hazard: Inappropriate contact or poor PPE

Effect: Infection spread

Reference: APIC

21

Rule: Implement an Antibiotic Stewardship Program to protect patients.

Antibiotic StewardshipCause of Hazard: Overuse

Effect: Increase of C. difficile patients and general resistance to antibiotics

Reference: Joint Commission

22

Rule: Write the purpose of the med on the RX to prevent errors. Provide generic and brand names of drugs for med orders. Do not store meds alphabetically.

SALADCause of Hazard: Sound-alike, Look-alike Drugs

Effect: Patients receive incorrect meds

Reference: Joint Commission

RX

23

Rule: Have dual sign-off procedures implemented when administering insulin.

InsulinCause of Hazard: Incorrect insulin administration

Effect: Patients harmed

Reference: Institute for Safe Medication Practices

Reference: ASHP

24

Rule: Separate and properly label storage carts as “Full”, “Less than Full”, and “Empty”. Store tanks accordingly.

Oxygen TanksCause of Hazard: Improper storage

Effect: Patient harm, creation of projectile

Reference: Joint Commission

25

Rule: Educate and implement clean hands measures about when & how to hand wash or hand rub.

Hand CleanlinessCause of Hazard: Improper washing, or lack or washing

Effect: Spread of infection

Reference: WHO

26

Rule: Perform testing on stations to ensure proper functioning. Place stations anywhere they may need to be accessed.

Eye Wash StationsCause of Hazard: Lack of safety checks, lack of stations in needed areas

Effect: Injury to patients, visitors, employees

Reference: OSHA

27

Rule: Keep all medication and dirty utility rooms locked.

Lock Medication RoomsCause of Hazard: Unlocked med rooms or dirty utility rooms

Effect: Harm to patients/visitors/staff.

Reference: HC Pro

Reference: NC Baptist Hospitals Policy

28

Goal: Have an error-reporting system to identify trends and system issues that could result in future patient harm.

Report and Track ErrorsCause: System-related vs. Fault Related

Effect: Provide additional data for analysis

Reference: MGMA White Paper – 10 Steps to improve patient safety in the practice

Just

Elements of a safe culture

High Reliabilit

y

Learning

Teamwork

Activated

PatientJust

29

30

Why create a Culture of Safety?1) Implement safety before, not after the fact. Be proactive!

2) Prevent breaks to patient & employee safety.

Safety Resources

▪ MGMA Patient Safety and Quality Advisory Committee

▪ The MGMA Center for Research developed the Physician Practice Patient Safety Assessment (www.physiciansafetytool.org)

▪ www.mgma.com/store and search “MGMA patient safety” for white papers

▪ The Essential Guide for Patient Safety Officers

▪ A Clinical Improvement Action Guide

▪ Making Health Care Safer II

▪ Measuring Patient Safety

▪ Establishing a Culture of Patient Safety

Questions?

Michael O’Connell, FACMPE

moconnel@ccf.org216-587-8087