IMPROVING PATIENT'S SAFETY by Nursing.pptx

improving patient safety by nursing

1. SAFETY PATIENT’S JK SITI AYUSAFURA BINTI MUZAMIL

2. W ORLD H EALTH O RGANISATION Patient safety is an absence of preventable harm to a patient during the process of health care and the reduction risk of unnecessary harm associated with healthcare to an acceptable minimum .

3. CONTRIBUTING FACTORS

4. WHAT DO WE WANT TO ACHIEVE D IN PATIENT SAFETY? Do no harm to patient & prevent incident Deliver safe healthcare service Prevent & minimize medicolegal implication

5. WHY PATIENT HARM OCCUR? Patient Harm ( eg : wrong dose adminstered ) Unsafe Act ( eg : administer without double checking) & Unsafe Condition ( eg : high work load) System Failure ( eg : no checking system, insufficient staff, no training on 7R)

6. CONTENT 02 01 03 04 MED SAFETY FALL PRESSURE INJURY PHLEBITIS

7. MEDICATION SAFETY

8. ROLES AND RESPONSIBILITIES OF NURSES 1. Education And Training 1.1 CNE/CME at Hospital / Department / Unit level 2. Implement Principle of 7R's whenever administering medication 3. Use 2 identifier of patient before administering medication 4. Implement proper medication storage system  4.1 Label High Alert Medication for example Potassium Chloride 4.2 For Look Alike Sound Alike (LASA) medication use TALL MAN lettering. 4.3 Separate LOOK ALIKE medications further from each other. 5. Ensure that there are written instructions from doctor before serving medicine 6. Use ‘medication nurse’ vest to avoid interference from others while administering medication. 7. Report and learn from medication errors.

9. FALL

10. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss.

11. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss. ADD A MAIN POINT Elaborate on what you want to discuss.

12. 1.Education And Training 1.1 CNE/CME at Hospital / Department / Unit level 1.2 Orientation and mentoring program , bedside teaching 2. Patient Assessment 2.1 Risk assessment of the patient should be done on admission/transfer in using the Morse Fall Scale (Modified Fall Scale), daily and whenever necessary. 2.2 Put proper signage on patient’s bed based on Fall Risk Assessment Score: ( i ) Low risk – Score 1 - 24 (No signage) (ii) Moderate risk – Score 25 - 44 (Yellow signage) (iii) High risk – Score > 45 (Red signage) 3. Implement Fall Prevention action and document in nursing report 4. Report incidence and conduct RCA

13. ROLES AND RESPONSIBILITIES OF NURSES 1. Education And Training 1.1 CNE/CME at Hospital / Department / Unit level 1.2 Orientation and mentoring program , bedside teaching 2. Patient Assessment 2.1 Risk assessment of the patient should be done on admission/transfer in using the Morse Fall Scale (Modified Fall Scale), daily and whenever necessary. 2.2 Put proper signage on patient’s bed based on Fall Risk Assessment Score: ( i ) Low risk – Score 1 - 24 (No signage) (ii) Moderate risk – Score 25 - 44 (Yellow signage) (iii) High risk – Score > 45 (Red signage) 3. Implement Fall Prevention action and document in nursing report 4. Report incidence and conduct RCA

14. PHLEBITIS

15. Phlebitis has a direct/indirect impact on the patient health as it  can cause discomfort, and pain and prolongs in-patient stays  that may lead to the patient suffering. The Nursing Division has been monitoring the indicator of  Thrombophlebitis(advanced level of phlebitis)since 2010 at the  national level under the Quality Assurance Program with a  standard of incidents of < 0.5%.

16. Indicator Incidence of Phlebitis among inpatients with intravenous (IV) cannulation Numerator Total Number Phlebitis incidences (VIP score 1 and above) Denominator Total Number of inserted peripheral venous cannulas Formula Numerator x 100% Denominator Standard ≤ 35 % Data Collection Where: data will be collected from every ward of the hospital. Who: data will be collected by the ward manager/staff nurse/ personnel in  charge of the ward. How frequent: Monthly data collection. Who Should verify: All performance data must be verified by the matron area/ Head of Unit. How to collect: Data will be collected from the record book/ patient’s casenotes .

17. VISUAL INFUSION PHLEBITIS (VIP) SCORES Site Observation Score Action IV site appears healthy No sign of phlebitis OBSERVE CANNULA One of the following signs evident: Pain near IV site (pain score of (1-3)  Slight redness near IV site (May not require analgesics) 1 FIRST signs of phlebitis   OBSERVE / RESITE CANNULA Two of the following signs evident: Pain at IV site (pain score of (4-6) Redness around site - Swelling (Interfere with activities) 2 Early stage of phlebitis RESITE CANNULA THREE of the following signs evident: Pain at IV site (pain score of (4-6) Redness around site -Swelling (Interfere with concentration) 3 Medium stage of phlebitis RESITE CANNULA   CONSIDER TREATMENT                                   FOUR of the following signs evident and extensive: Pain along path of cannula (pain score of (7-9) Redness around site -Swelling Palpable venous cord (Interfere with concentration) 4 Advanced stage of phlebitis or the start of  thrombophlebitis RESITE CANNULA  CONSIDER TREATMENT ALL of the following signs evident and extensive: Pain along path of cannula (pain score of 10)  Redness around site - Swelling Palpable venous cord -Pyrexia (Bed rest required) 5 Advanced stage of thrombophlebitis  INITIATE TREATMENT  RESITE CANNULA

18. PRESSURE INJURY Elaborate on what you want to discuss.

19. Pressure injury happen when an area of skin and the tissues below are damaged as a result of being placed under pressure sufficient to impair its blood supply. Typically they occur in a person confined to bed or a chair by an illness and as a result they are sometimes referred to as 'bedsores', or 'pressure sores’. https://www.nice.org.uk/guidance/cg179

20. Definition of Terms A localized injury to the skin and/or underlying tissue during an inpatient hospital stay Target ≤ 2.1% Numerator Number of HEALTHCARE ASSOCIATED PRESSURE INJURY Denominator Immobilized patient: unable to carry out ADL (e.g. feed or bath by him/herself) Formula  Number of Healthcare Associated Pressure Injury x 100 Total number of Immobilized patient Inclusion criteria 1) Immobilized patient / Braden <16 2) Pressure injury developed 48 hours after admission 3) No sign of pressure injury during admission Exclusion Criteria Pre-existing pressure injury prior to admission Format Reten BKJ-NNIA-1 ( Pind )

21. RISK ASSESSMENT TOOL

22. Reference

23. THANK YOU!