30 Safe Practices

in 30 Minutes

Creating a SafeMedical Practice

Michael A. O’ConnellMHA, FACMPE, FACHE

Vice President of Clinical/Support Services

Goal: Increase Patient Care & Quality by Minimizing

Mistakes and Reducing Risk

Part One

Patient Safety & Quality:

2nd Biggest Concern

for CEOs of community hospitals.

Reference: ACHE Division of Member Services, Research

1

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

2) Prevent breaks to patient & employee safety.

Just

2

Elements of a safe culture

High Reliabilit

y

Learning

Teamwork

Activated

PatientJust

3

Rule: Keep sprinkler heads far from air vents. Have a professional clean them if/when dusty.

Sprinkler Heads

Cause of Hazard: DustEffect: Malfunctioning

Reference: www.compliance.gov

4

Rule: 18 inch clearance from the bottom of the sprinkler head.

Exception: Perimeter Shelving – As long as no sprinkler is directly above.

Sprinkler Heads

Cause of Hazard: ObstructionEffect: Reduced Effectiveness

Reference: www.compliance.gov

5

R = RESCUEA = ALARMC = CONTAINE = EXTINGUISH

R.A.C.E.Code Red Response

Reference: Med Senses

Rule: Call Code Red FIRST.

6

P.A.S.S.Code Red Response P = Pull the pin

A = Aim nozzle

S = Squeeze handle

S = Sweep the base

Reference: Med SensesRule: Fire Extinguisher proper usage.

7

Rules:

▪ Are Exit Signs pointing the right direction?

▪ Are Fire Exit Paths clear?

▪ Are Fire Doors in working order?

Fire Exits

Cause of Hazard: Obstruction or MisdirectionEffect: Prevents Evacuation during Code Red

Reference: OSHA

Reference: U.S. Gov. Office of Compliance

8

Blanket WarmersCause of Hazard: OverheatingEffect: Injury to Patients, Fire

Rule: Test temperatures regularly and document. Post maximum temperature range on all warmers (130ºF).

Reference: Environment of Care

9

Electrical OutletsCause of Hazard: OveragesEffect: Shock, Fire, Wire damage

Rule: Do not use power strips. Use items with a grounding conductor. Have sockets tested regularly. Unplug unnecessary items.

Reference: U.S. Gov. Office of Compliance

10

Personal AppliancesCause of Hazard: Not built for commercial use.Effect: Fire hazard, electrical wiring damage, & damage to applianceRule: All appliances within patient care areas must have a grounding conductors. Conduct leakage current tests on all appliances. Prohibit power strips or extension cords unless approved by the Facilities department.

Reference: Safety Management Services, Pages 8-9

11

Improper Item StorageCause of Hazard: ClutterEffect: Fire hazard, Infection control hazard

Rule: Begin to reduce clutter as much as possible. Make it a point to have hallways, patient rooms, storage areas, and stations/desks clear of clutter.

Reference: The Joint Commission

Managing Hospital Clutter on a Daily Basis Checklist

12

Rule: Use fire-retardant furniture and curtains to minimize the potential from harm due to a fire.

Furniture, CurtainsCause of Hazard: Fuel for a fireEffect: Fire hazard

Reference: The Joint Commission

13

Employee Emergency Response KnowledgeCause of Hazard: Unable to respond appropriatelyEffect: Risk to employees & patients

Rule: Educate Employees annually on safety measures, proper Code responses, and where to find more information on what to do in an emergency.

Reference: OSHA

14

Disaster PlanCause of Hazard: Unwritten, not displayedEffect: Lack of preparedness

Rule: Create an easy-to-use Emergency Response Quick Guide to have at all desks/stations. Update annually.

Reference: The Joint Commission

15

TextingCause of Hazard: Distractionwhile driving, lack of patient security Effect: Accidents, HIPAA violations

Rule: 1. Promote not texting-and-driving to all employees regularly. 2. Disallow all texting in clinical environments.

Exception: Implementing a HIPAA-secure texting applications.

Reference: The Joint Commission

16

Parking LotsCause of Hazard: Dark lotsEffect: Unsafe lots, increased criminal activity

Rule: Light all parking lots and walking areas to/from lots.

Reference: Parking Lot Safety

17

Employee LockersCause of Hazard: UnlockedEffect: Vandalism/stolen items, liability

Rule: All employees are to have a lock on their locker, and use it, at all times.

18

SmokingCause of Hazard: Oxygen tanks, patient/employee healthEffect: Fires, patient/employee unhealthy environment

Rule: Ban and enforce no smoking on facility grounds. Stop hiring employees who smoke.

Reference: U.S. News Today

19

Chemical StorageCause of Hazard: Easy access, unsafe storing proceduresEffect: Non-approved personnel usage, injuries, chemical spills, theft

Rule: Differentiate between locked toxic/hazardous chemicals and others (i.e. formaldehyde vs. paint), implement a safe storage policy/procedure based on category.

20

RadiationCause of Hazard: Lack of Radiology verificationEffect: Unsafe, unnecessary exposure

Rule: Dual confirmation of location to receive radiation exposure.

Reference: U.S. FDA

21

Chemical ExposureCause of Hazard: Cleaning methodsEffect: Skin & respiratory irritation

Rule: Limit chemical odors by cleaning when patients are not around, use products with less odor, & make sure cleaned area is dry before patients/employees are in the area.

Reference: Joint Commission

22

Employee IdentificationCause of Hazard: Lack of appropriate identifying agent

Effect: Imposters cannot be identified

Rule: All employees have a standard-issued photo I.D. badge and are required to wear it visibly.

Reference: Joint Commission

23

CredentialsCause of Hazard: Misrepresentation of credentialsEffect: Danger to patients, other employee

Rule: Have HR verify all credentials and degrees prior to new employees start, and verify existing employees who have not been verified.

Reference: Joint Commission

24

Flu Shots & ImmunizationsCause of Hazard: Lack of staff being up-to-dateEffect: Further transmission of flu, etc. to staff and patients

Rule: Confirm that all employees are up-to-date on immunizations. Require direct patient contact personnel to have the flu shot and other vaccinations.

Reference: Joint Commission

25

TrashCause of Hazard: Unsafe collection and disposalEffect: Infection possibilities, injuries

Rule: All collection cans should have lids, and they should be kept down. Empty regularly. Separate items properly upon disposal (i.e. Biohazardous waste vs. paper).

Reference: Basel Action Network

26

StaffingCause of Hazard: Unsafe staffingEffect: More mistakes, more risks

Rule: Staff a variety of skills each shift so that the bases are always covered. Ensure competency. Create & follow minimum standards for core staffing.

Reference: Joint Commission, pg. 11-14

27

Red BagsCause of Hazard: Biohazardous wasteEffect: Infection spread, injuries

Rule: Continue staff education on items for Red Bag disposal. Use an approved vendor to remove Biohazardous waste. Keep all Bills of Lading as documentation. Reference: U.S. Dept. of Energy La

b

28

MercuryCause of Hazard: SpillsEffect: Damage to humans and the environment

Rule: Reduce mercury usage by replacing sphygmomanometers, thermometers, and Cantor & Miller Abbot tube with non-mercurial alternatives.

Reference: EPA

29

HIPAACause of Hazard: Unsafe usage or disclosure; forgetfulnessEffect: HIPAA violations

Rule: Ensure safeguards and implement refreshers to staff on speaking quietly, etc. when discussing PHI, because usually the policy is violated accidentally.

Reference: U.S. Dept. of Health & Human Services

30

Entrances & Waiting AreasCause of Hazard: Lack of personnel present & monitoringEffect: Injuries

Rule: Have staff present in all entrance areas and seating areas monitoring patients and visitors in case of falls, fainting, other sudden-onset problems to increase staff reaction time.

Safety Resources

1. The Essential Guide for Patient Safety Officers, 2nd Ed.2. A Clinical Improvement Action

Guide, 3rd Edition

3. Making Health Care Safer II

4. Establishing a Culture of Patient Safety

5. Measuring Patient Safety

Key Takeaways – Why Safety?

Thank you!

1) Take a fresh perspective, and look around for risks all around you. Safety is everyone’s responsibility.

2) Make safety a priority because it’s the right thing to do. Not just to follow a requirement or standard.

Questions?

Michael O’Connell, FACMPE

moconnel@ccf.org216-587-8087