STANDARDS OF NURSING

PRACTICE
MANAGEMENT CREATING A
PATIENT SAFETY AND CULTURE
UNIT EXPECTED OUTCOMES
At the end of this unit, the students are expected to:

AFFECTIVE:
Work effectively in collaboration with inter-, intra- and multi-disciplinary and multi-
cultural teams
Join actively in class discussions and group activities.
Appreciate and support one’s opinion and comments toward each other
Engage in life-learning with a passion to keep current with national and global
developments
Accept mutual responsibility for reaching predetermined supraordinate goals.

PSYCHOMOTOR:
Demonstrate a professional attitude during the providing nursing to patients regardless
of the race, age sex, gender etc.
INTRODUCTION
Nurse as the largest group of healthcare service providers in the
nation, are vital members of this team. Keeping patients safe:
Transforming the Work Environment of Nurses made it explicit that
nurses are the healthcare service professional most likely to
intercept errors and prevent harm to patients.

Given the role that nurses play in care and quality improvement, it is
important for nurses to know what proven techniques and
interventions they can use to enhance patient and organizational
outcomes.
INTRODUCTION
The Department of Health, through the Health Facility Development Bureau, in
collaboration with active partners from both the public and private sectors.

Safety in healthcare organizations aims to prevent harm to patients their

families and friends, healthcare, professionals, contract of service workers,
volunteers, and the many other individuals whose activities bring them into
an environment.

Safety is one aspect of quality where quality includes not only avoiding,
preventable harm, but also making appropriate care available providing
effective services to those who could benefit from them and not providing
ineffective or harmful services.
 KEY
ELEMENTS OF
PATIENT
SAFETY
LEADERSHIP

Leadership and political commitment are essential at the

health facility level where patient safety becomes an integral
component of quality care

The Leadership shall address strategic priorities for institutional

development.

Its culture and infrastructure, engage its various stakeholders

communicate and build awareness.
 INSTITUTIONAL DEVELOPMENT

Approaches to institutionalize patient safety and quality in the

health facilities will have to consider the following:

 financial and human resource;

 facility and equipment management;

 strengthen management responsibility,

authority and competency;
 INSTITUTIONAL DEVELOPMENT

 formulate standards of what is expected from health

providers; communicates;

 provide training;

 enforce the standards that comes with the policies and give
the patients a voice through a feedback system or a patient
satisfaction survey
REPORTING SYSTEM

The National Patient Safety

Committee shall develop and
institutionalize a pro-active
reporting and learning
system that requires its
leadership to encourage
reporting of events
 FEEDBACK AND
COMMUNICATION
FEEDBACK & COMMUNICATION

To communicate leadership responses

To the reports shall be established

To demonstrate commitment

To patient safety and ensure continuous improvement.

Adverse Event Prevention and Risk Management

Risk and reduction strategies thorough patient

Risk assessment,

Patient feedback survey health technology assessment and

safety assessment code
DISCLOSURE OF REPORTED SERIOUS EVENTS

The reporting system ensures confidentiality of individual

cases.

The events can be made available to the public through

disclosure of results of investigation,

summary reports or annual reports that summarize

events and actions taken
PROFESSIONAL DEVELOPMENT

It is necessary to instill standard

Training and supervision of the norms of behavior of courtesy,
healthcare staff to improve promptness and efficiency
their decision and clinical among the healthcare workers
judgments is imperative. and improve the quality of
service given to patients.
PATIENT CENTERED CARE AND
EMPOWERMENT OF
CONSUMERS

Patients must be at all center of patient safety

initiatives and must be partners in all aspects
of the process.

Patient centered care and patient safety is a

national priority and a core agenda

● to improve quality care in all health

● to protect patients, form faulty system
IMPORTANCE
OF SAFETY IN
HEALTH CARE
Improve patient satisfaction and clinical outcomes.

Ensure accuracy of patient’s identification.

Enhance the effectiveness of communication among healthcare

personnel.

Improve the safety of using medications.

Reduce the risk of healthcare associated infections

Reduce the risk of harm resulting from injuries.

Improve staff productivity and retention rate

Increase awareness of occupational health and environmental control like

ergonomically- designed workplace.

Workers must be trained to. Workers also must be convinced why it is important
to pay attention to prevention and be educated about the benefits in terms of
reduced pain and discomfort of adopting good practices and work methods.

A strong ergonomics integration prevents injuries and increases productivity.

Together, they make the workplace safer and reduce costs.
5 WAYS TO IMPROVE STAFF SAFETY IN
HEALTHCARE
Working in the healthcare profession is one of the
most rewarding careers you can choose, but
working in healthcare also puts your own health
at risk.

Aside from the physical demands of crowded

hospitals and the stress that comes with long
shifts and treating serious ailments working with
sick patients puts you at risk for the same
illnesses that brought them to the hospital.
PROMOTE A CULTURE OF SAFETY

Company culture heavily influences the general attitude of

a working environment.

Hospitals that place a big emphasis on staff safety are

more likely to prevent incidents because safety is aligned
with professionalism in the workplace.
MEASURE THE PERFORMANCE OF SAFETY PROTOCOLS

One of the fundamental practices that make hospitals as effective

as they are is the use of record keeping.

Nurses and Doctors are bombarded with information and urgent

tasks throughout the day without checklist, scheduled, and other
methods of monitoring task, it would be nearly impossible to keep
track of everything.
MEASURE THE PERFORMANCE OF SAFETY PROTOCOLS

Reporting incidents and learning form them is critical to

implementing staff safety.
OPTIMIZE STAFF SCHEDULING

Hospital management faces many challenged – two of the most

areas, finding enough qualified people to fill their teams.

When hospital teams are understaffed,

employees are overworked,

the risk of safety incidents increases.

while management needs to control labor costs for

hospitals to remain profitable
IMPROVE PATIENT HANDLING

Moving and handling patients can be one of the most physically

demanding aspects of healthcare professions.

Dependency of patients on nursing staff (2) increases and equipment gest

more complex, patient-handling methods form the past might not be as
effective today.
 USE SAFER MEDICAL EQUIPMENT
Medical device is quickly improving, and recent innovations, eliminate
health risks that plagued staff and patients in the past.
Improving Infection Control

Helping prevent needle stick injuries

Reducing medication errors

Increasing protection against exposure to blood and drugs

Minimizing disconnections, air embolism and misconnections

Ultimately, these serviced make hospitals safer for everyone and
make it easier for nurses and doctors to do their jobs
effectively.

Resources:
OSHA:
http://www.osha.gov/dsg/hospitals/dpcuments/1.1_Data_hig
hlights_508,pdf

http://www.scielo.br/scielo.php$pid=S141481452016000300205&s
cript=sci_arttext&ting=en
TYPES OF
ERRORS
● ADVERSE HEALTH CARE EVENT – event or omission arising during
clinical care and causing physical or psychological injury to a
patient.

● ERROR – failure to complete a plan action as intended or the use of

an incorrect plan of action to achieve a given plan.

● HEALTH CARE NEAR MISS – situation in which an event or omission (

or sequence) arising during clinical care fails to develop further
whether or not as the result of compensating action thus preventing
injury.
ADVERSE DRUG REACTION – any response a drug which is
noxious, an intended and occurs at doses used for
prophylaxis, diagnosis or therapy (Predictable /
Unpredictable).

MEDICATION ERROR – any preventable event harm may cause

or lead to inappropriate medication use or patient harm
while the medication is in the control of health professional,
patient or consumer.
SENTINEL ERROR – surgery on the wrong body part, surgery on the
wrong patient, patients receiving the wrong medication.
 INDICATORS AND
PARAMETERS OF SAFETY
The Patient Safety Indicators (PSIs) are a set of measure that
screen for adverse events that patients experience as a result of
exposure to the health care system.

(PSIs) are set of indicators providing information on potential in

hospital complications and adverse events following surgeries,
comprehensive literature review, analysis of ICD-9-CM codes,
review by a clinician panel, implementation of risk adjustment, and
empirical analyses.
● Medical Error
● Falling Incident
● Needle Stick Injury
● Splash / Spills Incident
● Hospital acquired infection like CLABSI, CAUTI, VAP, HAPU/
healthcare associated infection
● Blood and blood component transfusion error
● Intravenous Therapy complications like infiltration, extravasation
and phlebitis
● Nurse sensitive indicators namely
● Hazardous materials exposure
BENEFITS OF CHECKLIST
HEALTH CARE
Checklist used in the medical setting can promote process improvement
and increase patient safety.

Implementing a formalized process reduces errors caused by lack of

information and inconsistent procedures.

Checklist have improved processes for hospital discharges and patient

transfers as well as for patient care in intensive care and trauma units.

Along with improving patient safety, checklist create a greater sense of

confidence that the process is completed accurately and thoroughly

Checklist can have a significant positive impact on health outcomes,

including reducing mortality, complications, injuries and other patient
harm. Clinical quality.
GUIDE INCLUDES CHECKLIST,
DEVELOPED BY CYNOSURE
HEALTH FOR THESE 10 AREAS
Adverse drug events (ADEs)

Catheter-associated urinary tract infection (CAUTIs)

Central line-associated blood stream infections (CLABSIs)

Early elective deliveries (EEDs)

Injuries from falls and immobility

Hospital-acquired pressure ulcers (HAPUs)

Preventable readmissions

Surgical site infections (SSIs)

Ventilator-associated pneumonias (VAPs) and ventilator- associated events
(VAEs)

Venous thromboembolism (VTEs) to prevent process breakdown due to

human factors, each checklist identifies the top evidence based interventions
that health care organizations can implement and test to reduce harm
 Nursing Actions to Improve Patient Safely
Knowledge and implementation about healthcare policies and procedures.

Open communication and teamwork among all other healthcare providers.

Review the medication rights before giving the medications.

Engage in creating and updating reporting system to avoid a blaming culture,

Involve in research and evidence-based activities for better decision making.

 Nursing Actions to Improve Patient Safely
Be updated on all life-saving certification like CPR, BLS, ACLS, PALS, NALS and
other Nursing Specialty Certification Programs

Engage in hospital committees to make the healthcare system safe effective

and patient-centered.

Be responsible in reporting all errors and near misses not only for the patient to
prevent sentinel and adverse events to happen again.

Ensure better lighting and less clutter in the work areas.

 NURSE WERE ASKED TO ENGAGE IN THE
FOLLOWING ACTIVITIES.

● Promote awareness about changes in the health care system that

undermine quality and safety of patient care.

● Support the development of a National Center for Patient Safety and the
establishment of a national mandatory state-based error reporting
system.

● Support the development and implementation of performance standards

by regulators and accrediting agencies that require healthcare
institutions and system to implement patient safety programs and
process with defined executive responsibility.
 NURSE WERE ASKED TO ENGAGE IN THE
FOLLOWING ACTIVITIES.

● Support the implementation of proven medication safety system and

practices by health care organization

● Promote passage of whistle blower legislation that protects the essential

role of nurses in efforts to correct system errors.

● Demonstrate the improvement of quality of care and reduction of errors

through collection of data using nursing quality indicators.

● Promote nursing research in patient safety and educate nurses in the

science of system safety issues.
 TIPS ON HOW TO IMPROVE THE SYSTEM AND PREVENT
FUTURE ERRORS FROM OCCURRING

● Adapt a culture of safety in the workplace

● Focus on the task at hand
● Reduce distracting noise to prevent accidents / errors
● Develop a personal note-taking system
IMPLEMENTING POLICIES ON
ACCIDENTS
PERSONNEL SAFETY IMPLEMENTING POLICIES

Always observe necessary safety measure when using wheelchair,

stretcher, beds and other equipment available for the patient.

Never operate electrical equipment with wet hands.

Do not attempt to use an equipment unless, you are familiar with its
operation.

Be sure that the electrical equipment is plugged into the proper type of
outlet.
● Never smoke or allow anyone to smoke in a room where oxygen
is in use. This is a “No Smoking “Hospital.

● Report any unsafe conditions such as following to the janitorial

supervisor or Supervising Nurse:
Wet and slippery floors
Defective equipment
Inadequate lighting

● Fire drills are conducted so that employees know how to act

during emergencies
Needle stick injuries surveillance

Recommend staff for immunization on the following: FLU

Vaccination, Pneumonia, Rabies, Hepatitis B and C.
 OCCUPATIONAL AND
ENVIRONMENTAL HEALTH NURSING

Is the specialty practice that provides for and health and safety
programs and services to workers, worker populations and
community groups?

The practice focuses on promotion and restoration of health prevention

of illness and injury and protection from work related and
environment hazards.
ROLE OF OCCUPATIONAL HEALTH NURSES
CASE MANAGEMENT

Providing treatment, follow up and referrals and emergency care

for job related injuries and illnesses.

COUNSELLING AND CRISIS INTERVENTION

Involves counselling workers about work related illness and injuries,

substance abuse and emotional and/or family problems.

They handle referrals to employee assistance programs and/or

other community resources and coordinate follow up care.
HEALTH PROMOTION
Is the teaching of skills and developing health education programs
that encourage workers to take responsibility for their own health?

Smoking cessation, exercise, nutrition and weight control, stress

management, control to keep workers health and productive.
WORKER AND WORK PLACE
HAZARD DETECTION
Includes monitoring the health status of workers by conducting
research on the effects of the data to prevent injury and illness.
INFECTION PREVENTION
AND CONTROL
The goal of an organization’s Infection and control program is to
identify and reduce the risk of acquiring and transmitting
infections among patients, staff, health care professionals,
contract workers, volunteers, students and visitors.

The infection risk and program activities may differ from

organization to organization depending on their clinical activities
and services, patient’s population served, geographic location,
patient volume and number of employees.
IMPORTANCE OF INFECTION
PREVENTION AND CONTROL
● Maintain a safe environment for patient and staff by reducing
the risk of acquiring the healthcare – associated infections

● Prevent spread of transmissible disease in healthcare settings

through evidence based-control measures.

● Learn the multidisciplinary approach in prevention and infection

control practices particularly for the emerging and non-
emerging infections.

● Develop strategies to reduce hospital and community acquired

infections through evidence-based research.
Respond effectively and efficiently to outbreak of infections within
the community

Provide support for infections control preparedness and response

to public health emergencies of potential concern.

Reduce patients’ length stay and cost of confinement through

stringent implementations of prevention and infection control
policies and protocols.

Prevent complaints and litigations related to healthcare

associated infections that can potentially incurred by patients,
significant others, and staff.
 STANDARD PRECAUTION
INFECTION PREVENTION AND
CONTROL
Standard Precaution are meant to reduce the risk of
transmission of blood borne 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.

The nurses play a critical role in preventing and

controlling hospital infections.
Thus, nurses’ actions for infection prevention and
control are the implementation of universal standard
precaution such as:
Hand Hygiene

Perform hand hygiene by means of hand rubbing for 20-30

seconds using enough hand disinfectant to cover all areas of the
hand rub hands until dry or

Perform hand washing for 40-60 seconds using soap and water
and rinse and dry hand thoroughly with a single towel.

Perform hand hygiene or hand washing:

a. Before and after any direct patient contact and between patients,
whether or not gloves are worn,

b. Immediately after gloves are removed,

c. Before handling an invasive device,

d. After touching blood, body fluids, secretions, excretions, non-intact

skin, and contaminated items, even if gloves are warm,

e. During patient care, when moving from a contaminated to a clean

body site of the patient,

f. After contact with inanimate objects in the immediate vicinity of the

patient.
Personal Protective Equipment (PPE)

PPE includes the use of gloves, impermeable gowns, face

masks, eye shield. Select PPE based on the assessment of
risk.

Assess the risk of exposure to body substance or

contaminated surfaces before any health-care activity.
Make this a routine.
NEEDLE STICK AND SHARPS
INJURY PREVENTION
Use care when handling needles, scalpels, and other sharp instruments or
devices, cleaning used instruments, and disposing used needles. Example are:
Do not recap needles. If recapping is necessary use single hand
technique or use mechanism device like forceps.

Establish engineering controls and safe injection practices.

All used needles, blades/lancets and other sharp instrument should be

disposed to punctured proof resistant container immediately after use.

Punctured proof resistant container should be accessible so that the operator

can dispose immediately the sharp and avoid mixing it with other wastes.
Do not overfill sharp containers and seal properly if ready for disposal.

Report all needle and sharp injuries for evaluation and management.
 CLEANING AND DISINFECTION

Use adequate procedures for the cleaning and disinfection of

environmental and other frequently touched surfaces.

Clean, disinfect, and reprocess reusable equipment

appropriately before use with another patient.
RESPIRATORY HYGIENE LIKE COUGH ETIQUETTE
Cover nose and mouth when coughing / sneezing with tissue or mask, dispose of
used tissue and mask, a perform hand hygiene after contact with respiratory
secretions.

Place acute febrile respiratory symptomatic patients at least 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 practice respiratory hygiene / cough etiquette.

Consider making hand hygiene resources, tissues and masks available in

common areas and areas used for patients with respiratory illnesses.
 WASTE DISPOSAL
Ensure safe waste management by following waste segregation
protocol

Treat waste contaminated with blood, body fluids, secretions and

excretion as clinical waste, in accordance with local regulations.

Discard single use items properly

SAFE INJECTION PRACTICES
Prepare injections using aseptic techniques in a clean area.

Disinfect the rubber septum on a medication vial with alcohol before

piercing

Do not use needles or syringes for more than one patient. This includes
manufactured prefilled syringes and other devices such as insulin pen.

Medication containers (single and multi-dose vials, ampules, and bags)

are entered with a new syringe, even when obtaining additional doses for
the same patient.

Use single -dose vials for parenteral medication when possible

Do not use single-dose medication vials, ampules, and bags or bottle of
intravenous solution for more than one patient.

Do not combine the leftover contents of single-use vials for later use,
(Center for Disease Control and Prevention).
GUIDING PRINCIPLE
Routine Practices must be incorporated into the culture of each
healthcare setting and into the daily practice of each healthcare
provider.

Routine Practices apply to all Body Fluids, Non-Intact Skin, Mucous

Membranes or Equipment Contaminated with Blood, Body Fluids or
Tissues.

A point a Care Risk Assessment must be done by healthcare providers

before each interaction with the patient or their environment to
determine which interventions are required to prevent transmission of
microorganism during that interaction.
PPE is used to prevent transmission of infectious agents both from
patient-to-patient and from patient-healthcare provider. Healthcare
settings must ensure sufficient supplies of, and quick, easy access to PPE
is provided.

Routine practices are used by ALL healthcare providers for ALL

patients/residents/clients in ALL settings ALL of the time infection
Prevention and Control

Preventing transmission of microorganism to other patients is a patient

safety issue, and preventing transmission to staff is an occupational
health and safety issue.
 Procedure
Point of Care Risk Assessment to be done before each
interaction with a patient or their environment.
 What type of environment is high risk for
patient?

● Shared space (i.e.multi-bed room, shared bathrooms

● Crowded areas such as waiting rooms, hallways

● Shared equipment

● Use avoidance procedures that minimize contact with droplets (e.g.

sitting next to, rather than in front of, a coughing patient when taking
a history or conducing an examination).
Hand Hygiene

Personal Protective Equipment (PPE) Determine the

appropriate PPE to use that will decrease exposure risk
and prevent transmission of infectious agents: include
gloves, mask, N95 respirators, eye protection, and gowns
/ aprons.
THANK YOU
GOODLUCK