Quality Standards for Health Provider Organizations: Safe Practice and Environment

Presented to Dr. Betty Polido in Partial Fulfillment of the Requirements in the Course N414 F

Karel S. Sogo-an Anelen P. Solidarios July 10, 2012

SAFE PRACTICE AND

CONTROL

OBJECTIVES
Discuss

the safety measures in the healthcare

setting. Enumerate the employers responsibilites with health and safety. Explain the importance of a safe environment. Describe the factors affecting the safety in healthcare setting. Enumerate the key components of standards precautions. Discuss the nursing code of ethics.

INTRODUCTION
Maintaining

a safe environment reflects a level of compassion and vigilance for patient welfare that is as important as any other aspect of competent health care. The way to improve safety is to learn about causes of error and use this knowledge to design systems of care to make errors less common and less harmful when they do occur.Most important, improving the work environment may also improve the quality and safety of patient care.

A. WORKPLACE HEALTH AND SAFETY

The

focus is on the prevention of injuries and the fair and equitable treatment of nurses who are injured at work or develop a work- related illness. Nurses have the right to work in an environment that does not threaten their health, safety or welfare.

a. Safe Works Environment Maintaining a healthy office environment requires attention to chemical hazards, equipment and work station design, physical environment (temperature, humidity, light, noise, ventilation, and space), task design, psychological factors (personal interactions, work pace, job control) and sometimes, chemical or other environmental exposures. As an employer, it is your responsibility to provide a safe work environment for all employees, free from any hazards and complying with all state and federal laws.

 Health

and safety in the workplace is about preventing work-related injury and disease, and designing an environment that promotes well-being for everyone at work. is the key ingredient in providing a safe work environmentif everyone knows the correct procedures then accidents and injuries can be kept to a minimum.

Knowledge

 EMPLOYER RESPONSIBILITIES WITH HEALTH

AND SAFETY

Occupational health and safety procedures must be implemented wherever the work is being conducted, be that in an office, factory, construction site or home. You should develop and have in place an occupational health and safety policy to meet the following standards: ensure that the way work is done is safe and does not affect employees health ensure that tools, equipment and machinery are safe and are kept safe ensure that ways of storing, transporting or working with dangerous substances is safe and does not damage employees health

provide employees with the information, instruction and training they need to do their job safely and without damaging their health consult with employees about health and safety in the workplace monitor the work place regularly and keep a record of what is found during the checks. Policies should be developed in consultation with all employees. In some instances it may be necessary to organise support persons or interpreters for employees with disability so that all employees may participate in the consultation process.

HEALTHY WORK ENVIRONMENTS

Safety measures are in place in relation to blood borne and body fluid pathogens to prevent contamination of nurses and patients by adhering to the standard precautions.

STANDARD PRECAUTIONS

Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens from both recognized and unrecognized sources. They are the basic level of infection control precautions which are to be used, as a minimum, in the care of all patients. Hand hygiene is a major component of standard precautions and one of the most effective methods to prevent transmission of pathogens associated with health care. In addition to hand hygiene, the use of personal protective equipment should be guided by risk assessment and the extent of contact anticipated with blood and body fluids, or pathogens.

 In

addition to practices carried out by health workers when providing care, all individuals (including patients and visitors) should comply with infection control practices in health-care settings. The control of spread of pathogens from the source is key to avoid trans-mission. Among source control measures, respiratory hygiene/cough etiquette, developed during the severe acute respiratory syndrome (SARS) outbreak, is now considered as part of standard precautions.

 Worldwide

escalation of the use of standard precautions would reduce unnecessary risks associated with healthcare. Promotion of an institutional safety climate helps to improve conformity with recommended measures and thus subsequent risk reduction. Provision of adequate staff and supplies, together with leadership and education of health workers, patients, and visitors, is critical for an enhanced safety climate in healthcare settings.

 KEY COMPONENTS:
1. Hand hygiene Before and after any direct patient contact and between patients, whether or not gloves are worn. Immediately after gloves are removed. Before handling an invasive device. After touching blood, body fluids, secretions, excretions, non-intact skin, and contaminated items, even if gloves are worn. During patient care, when moving from a contaminated to a clean body site of the patient.

2. Gloves Wear when touching blood, body fluids, secretions, excretions, mucous membranes, nonintact skin. Change between tasks and procedures on the same patient after contact with potentially infectious material. Remove after use, before touching noncontaminated items and surfaces, and before going to another patient. Perform hand hygiene immediately after removal.

3. Facial protection (eyes, nose, and mouth) Wear a surgical or procedure mask and eye protection (eye visor, goggles) or (a face shield to protect mucous membranes of the eyes, nose, and mouth during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, and excretions. 4. Gown Wear to protect skin and prevent soiling of clothing during activities that are likely to generate splashes or sprays of blood, body fluids, secretions, or excretions. Remove soiled gown as soon as possible, and perform hand hygiene.

5. Prevention of needle stick and injuries from other sharp instruments Use care when: Handling needles, scalpels, and other sharp instruments or devices. Cleaning used instruments. Disposing of used needles and other sharp instruments.

6. Respiratory hygiene and cough etiquette Persons with respiratory symptoms should apply source control measures: Cover their nose and mouth when coughing/sneezing with tissue or mask, dispose of used tissues and masks, and perform hand hygiene after contact with respiratory secretions.

Health-care facilities should: Place acute febrile respiratory symptomatic patients at least 1 metre (3 feet) away from others in common waiting areas, if possible. Post visual alerts at the entrance to health-care facilities instructing persons with respiratory symptoms to practise respiratory hygiene/cough etiquette. Consider making hand hygiene resources, tissues and masks available in common areas and areas used for the evaluation of patients with respiratory illnesses.

7. Environmental cleaning Use adequate procedures for the routine cleaning and disinfection of environmental and other frequently touched surfaces. 8. Linens Handle, transport, and process used linen in a manner which: Prevents skin and mucous membrane exposures and contamination of clothing. Avoids transfer of pathogens to other patients and or the environment.

9. Waste disposal Ensure safe waste management. Treat waste contaminated with blood, body fluids, secretions and excretions as clinical waste, in accordance with local regulations. Human tissues and laboratory waste that is directly associated with specimen processing should also be treated as clinical waste. Discard single use items properly.

10. Patient care equipment Handle equipment soiled with blood, body fluids, secretions, and excretions in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of pathogens to other patients or the environment. Clean, disinfect, and reprocess reusable equipment appropriately before use with another patient.

 SAFE PATIENT CARE

Safe Administration of Medication The administration of medication is often a chief responsibility of the nurse. The practice of administering medication involves providing the patient with a substance prescribed and intended for the diagnosis, treatment, or prevention of a medical illness or condition.

 The

central action of medication administration involves actual and complete conveyance of a medication to the patient. However, there is a wider set of practices required to achieve safe, effective patient outcomes and to prepare for and evaluate the outcome of medication administration. Preparation for medication administration begins with the order for medication, in most circumstances written by the physician. Nurse practitioners and physician assistants are also often authorized to write prescriptions. State laws vary regarding these privileges. A record of orders

for medication and other treatments is kept in the medical chart. Universally accepted safe clinical practice guidelines and state laws govern the components of medication orders in order to ensure consistency and patient safety. All orders should contain the patient's name, the date and time when the order is written, and the signature of the ordering clinician. Caregivers administering medication are responsible for checking that these components are present and clear. The

name of the medication is accompanied by the dosage, or how much of the drug should be given; the route of administration, or how the medication should be given (ie, intramuscular injection); and frequency, or how often the drug is to be given.

 ADHERENCE TO THE CODE OF ETHICS

NURSES

AND PEOPLE The nurses primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment.

The nurse holds in confidence personal information and uses judgement in sharing this information. The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. The nurse also shares responsibility to sustain and protect the natural environment from depletion, pollution, degradation and destruction.

NURSES AND PRACTICE

The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. The nurse maintains a standard of personal health such that the ability to provide care is not compromised. The nurse uses judgement regarding individual competence whenaccepting and delegating responsibility. The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public confidence. The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people.

 NURSES

AND THE PROFESSION The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in developing a core of research-based professional knowledge. The nurse, acting through the professional organisation, participates in creating and maintaining safe, equitable social and economic working conditions in nursing.

 NURSES

AND CO-WORKERS

The

nurse sustains a co-operative relationship with co-workers in nursing and other fields. The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a coworker or any other person.

 SAFE WORKPLACE DESIGN

Maintaining

a safe workplace is almost but not entirely totally unlike following OSHA regulations.

WORKPLACE SAFETY TIPS

Maintain a clean work area. Not only will you remove many hazards from a work area by keeping it clean, but you will also provide a more productive work environment for your employees. Use guards and engineering solutions wherever possible instead of relying on PPE personal protective equipment. PPE is hard to police and uncomfortable to wear. Find a way to prevent the exposure in the first place. Your workers will be much more productive if they are comfortable

 Assume

your employees want to work safely and give them that chance. Many safety incentive programs seemed to be based on the idea that employees want to get hurt and you have to bribe them not to stick their hand in the machine.

Give

clear work instructions. Make sure your employees know the right way to do what you expect of them. Don't just give them a list of things not to do. Include safety instructions in every procedure you write.

 Maintain

the machinery in good working order. Many times employees get into dangerous situations by having to compensate for a machine defect or wear. In the case of wear, it may have occurred so gradually that they think it is normal. A strong preventive maintenance program makes for a strong safety program. unnecessary hazards. Look for new materials or equipment that can eliminate the hazards your workers are exposed to.

Avoid

 Maintain

a clean work area. See workplace safety tip number one above. Potential exposures to hazardous material and conditions can be dramatically reduced simply by keeping the work area clean. And the benefit in employee productivity and morale is worth the effort even without the safety incentive.

 FACTORS AFFECTING SAFETY

Healthcare Setting The healthcare environment contains many opportunities for safety violations and hazards. The American Nurses Associations (ANA,2004) provided recommendations to transform the nursing workplace environment to enhance clients safety and quality of care. Generally, problems with equipment, procedural errors and impairement of clients cause falls, fires, and adverse medication errors. Heavy use or misuse of equipment can lead to flaws that result in excessive leakage of electricity.

 Healthcare

facilities have developed procedures and policies for client care and equipment operation to minimize hazards. Teams at the hospital analyze the environment and the factors that contribute to a sentinel event and develop solutions to eliminate the possibility of that safety issue occurring again.Nursing assessment of factors that put clients at risk for injuries should help identify safety concerns and the precautions necessary to minimize risks.

Healthcare workers must also be aware of the risks to their own safety in any healthcare environment. Common risks include exposure to blood-borne pathogens from stick injuries via used needles, back injuries caused by heavy lifting, and potential adverse reproductive outcomes as result of over exposure to antineoplastic medications. Threats of violence and assaults from clients and visitors had also emerged in recent years as s serious hazards for healthcare workers. All hazardous exposures or conditions requires some type of intervention to protect workers. Training regarding strategies for preventions is essential. Controls to prevent violence in the healthcare setting can include use of alarms, increased security measures, improved lighting, and increased staffing.

 LESSONS LEARNED
Safety

and security are basic human needs. Safety is a paramount concern that underlies all nursing care, and it is the responsibility of healthcare providers. The focus on safety encompasses all healthcare facilities as well as the time, workplace, and community. There are universal safety concerns common to all age groups as wells as unique safety considerations for each. Once a person recognizes danger in the environment, he or she takes measures to avoid or to prevent those dangers and thus practices safety.

 Prevention

is a keystone characteristic of safety. Safety practices involve self-care but also should provide safety for others. Safety not only prevents harm and injury but also allows people to feel secure in their actions. The sense of safety reduce stress, which promotes general health. Safety allows a person to meet other basic human needs such as love, belonging, and self-esteem and to accomplish personal goals. A positive outlook in ife, in turn, results in better mental health and more effective functioning.

 BIBLIOGRAPHY

Books Craven, R; Hirnle, C. (2007). Fundamentals of Nursing Human health and Function. Factors Affecting Safety.Philadelphia: Lippincott Co;p.678. Electronic Resources http://jobaccess.gov.au/Employers/Before_you_start/Preparin g_and_modifying_the_workplace/pages/How_to_provide_a_safe_w or.aspx http://www.cdc.gov/niosh/topics/officeenvironment/ http://www.enotes.com/administration-medicationreference/administrationmedication http://www.icn.ch/about-icn/code-of-ethics-for-nurses/ http://humanresources.about.com/od/safetyworkplacesafety/S afety_Workplace_Safety _and_Employee_Safety.htm