IPSG - FARAH.pptx

IPSG in Hospital

1. KPJ HEALTHCARE BERHAD INTERNATIONAL PATIENT SAFETY GOAL ( I PSG ) 1 IDENTIFY PATIENT CORRECTLY Upon admission : Print patient’s sticker for inpatient use, fasten the ID band with patients information prior to sending patient to the ward.

2. 1) Full Name & Blue – Boy IPSG 1 : Identifying Patient correctly 2 Identifiers ID Band 2) MRN/IC/Passport No. Pink – Girl White – Adult

3. I PSG 2 : Effective Communication Verbal orders – listen, document & Read out loud, Timely reporting Abbreviation that cannot be used. 4) Situation, Background. Assessment & R ecomm en d a t i on Improve Effective Communication Among Caregivers No Change Except Emphasis On Verbal order to be evidence based - documentation

4. Goal 3 : Improve the Safety of Using Medications Incorporated Goal 4: Accurately and Completely Reconcile Medications Across the Continuum of Care - adopted as continuous improvement activities ie part of procedures but not as Patient Safety Goal Initiative.

5. DEFIN I T ION 1) Identification & handling of LASA drugs Risk of potentially harmful medication errors may be increased with LASA drugs due to i) misinterpretation of a written order misunderstanding of a verbal order inappropriate dispensing of LASA drugs, especially when medication or solutions are transferred to other containers and labels are incorrect/absent are drugs which have the potential for mix-up/confusion due to: look-alike packaging look-alike appearance sound-alike names (generic or brand) prescribers ’ ambiguous handwriting LASA = L ook- A like, S ound- A like

6. Incorporated : Improve The Safety Of Using Medications; Management Of High Alert Drug (And Concentrated Electrolytes). Management Of Anticoagulant “All patients on anticoagulant therapy will have continuous International Normalized Ratio (INR) monitoring, with documentation in the medical record”.

7. 2) Management Of High Alert Drug Definition: medications that have an increased risk of causing significant harm to a patient when used in error. Hospital to establish a list of High Alert Medications (approved by the Pharmacy and Therapeutic Committee

8. Medications are not kept as floor stock and must be indent from the Pharmacy using a “High Alert Medication - HAM Box”. Additional label to be attached i.e. “High Alert medication” to the medication. In the ward, the medication must be stored in the HAM storage box accordingly and all medication has ‘ High Alert Item’ sticker.

9. 1 Adrenergic agents Levophed (Noradrenaline) 4mg /4ml Inj Dopamin Conc 200mg/5ml 2 Concentrated Electrolytes Calcium Gluconate 10% 1gm / 10ml Magnesium sulphate 49.3% 5ml Inj Sodium chloride 3% (hypertonic saline) Potassium Chloride 1gm/10ml Inj Potassium Dihydrogen Phosphate Inj Cardioplegia Infusions 3 IV Heparin / Thrombolytics / Anticoagulant Heparinol 5000iu/ ml 5ml Inj Arixtra 2.5ml/0.5ml Inj (Fondaparinux) Warfarin 1mg / 3mg / 5mg 4 Medications for ambulatory peadiatric sedation Chloral hydrate Ketamine 50mg Inj Midazolam 5mg/ml Inj 5 IV Inotropics Agents Lanoxin (Digoxin) 500mcg/2ml Inj 6 Insulin 7 Neuromuscular blocking agent Esmeron 50mg/5ml Inj (rocuronium) Suxamethonium Chloride 100mg/2ml 8 Narcotics and opiates Fentanyl patch 25mcg & 50mcg Fentanyl Inj 0.1mg/2ml Morphine Sulphate 10mg/ml Inj Pethidine 50mg/ml & 100mg/2ml Inj 9 Antineoplastic Methotrexate, oral 2.5mg Type of High Alert Drug

10. 3) Reconciliation The Doctor ordering the medication reviews the list of medications the patient has been taking - to continue or discontinue each medication. Reconciliation of medications will include: Any omissions Any duplications Interactions Dosing errors Name/dose/route confusion

11. The Medication Round Safety Vest

12. PLEASE DO NOT DISTURB NURSE ON MEDICATION ROUND Remember we cannot change the workload, but we can change the way we address it” through measures like the apron; Recommendation: Apron – RED For children printed ones Words – as stated both sides front (english)& back ( bahasa) a. Newly graduates are given the drug calculation test and are mentored throughout the 6 months period and based on their competency allowed to do medication independently. b. if one staff is dedicated to the medication round, then the rest of the team need to support them and be around to address other patient needs

13. I PSG 4 : Ensure Correct Site Correct Procedure Correct Patient Surgery

14. I PSG 4 : Ensure Correct Site Correct Procedure Correct Patient Surgery Patient ID Consent Site Marking Imaging Film Time out

15. I PSG No 4 : Ensure Correct Site , Correct Procedure Correct Patient Surgery Revisit Site Marking: Policy has been reviewed emphasizing only 2 symbols allowed to prevent ambiguity. ONLY 2 Symbol of site marking - ‘ circle’ and arrow . For single eye surgery the arrow pointing as closed as to the incision site shall be marked at the temple or between lateral canthus and the ear. Emphasized on use of “green band” for patients refusing site marking - nature of procedure including side & site indicated on the wristband.

16. Revisit Site Marking: Nose , throat surgeries & endoscope , skin prep done – no site marking required. Neonates or premature infants or patient where it is anatomically and technically difficult to mark the operative site includes areas such as perineum, is be exempted from site marking. I PSG No 4 : Ensure Correct Site Correct Procedure Correct Patient Surgery

17. I PSG 5 :Improved Hand Hygiene to Prevent Associated Infection Hand hygiene – hand rub & hand wash. 5 Moments – hand hygiene

18. I PSG 6 : Reduce the Risk of Patient Harm Resulting from Falls Outpatient – brochures on fall prevention, yellow label/sticker at A&E & other fall prevention strategies. Inpatients - Morse Fall Score , falling Star & Orange ID band.

19. Pt safety Guideline Content Fall risk assessment for inpatients - Adult –Morse Fall Scale -Pediatric –Humpty Dumpty Scale Pt classified as “High Risk” for fall – LR,Nursery,HDU,ICU/CICU,OT,Cath-Lab and pt’s under going SPD procedures. NCP (Adult and Pediatric)

20. I PSG 5 : Improved Hand Hygiene to Prevent Associated Infection Hand hygiene – hand rub & hand wash. 5 Moments I PSG 3 : 1) Improve the safety of Using Medications 2) Management of High Alert Medication 1. LASA I PSG 6 : Reduce the Risk of Patient Harm Resulting from Falls Outpatient – brochures on fall prevention, yellow label/sticker at A&E & other fall prevention strategies. Inpatients – MFS falling Star & Orange ID band. I PSG 1 : Identifying Patient correctly I PSG 2 : Effective Communication Verbal orders – document & Read out loud, Timely reporting Abbreviation that cannot be used. Situ a t i o n , B a ckg r o u nd. Assessment & R ec o mme nd a t i on 2 Identifier Full Name & MRN/IC/Passport No. ID Band Blue – Boy Pink – Girl White - Adult I PSG 4 : Ensure Correct Site Correct Procedure Correct Patient Surgery Pt ID Consent Site Marking Imaging Film Time out SUMMARY OF IPSG’S Patient S a f e ty Go a ls