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Copyright 2007 Partners Radiology
Patient Safety TrainingPatient Safety Training
““Patient Safety in Radiology”Patient Safety in Radiology”
Partners Radiology Patient Safety TeamPartners Radiology Patient Safety Team
Copyright 2007 Partners Radiology
GoalGoal
““Improve patient safety by providing Improve patient safety by providing staff with education about key staff with education about key
components of patient safety and to components of patient safety and to assess staff competency in doing so”assess staff competency in doing so”
Copyright 2007 Partners Radiology
ObjectivesObjectives
At the end of the training the participant will At the end of the training the participant will be able to:be able to:
– Identify JCAHO required radiology patient Identify JCAHO required radiology patient safety practicessafety practices
– Identify effects patient safety on patient, Identify effects patient safety on patient, department and hospitaldepartment and hospital
– Define & deploy the National Patient Safety Define & deploy the National Patient Safety GoalsGoals
Copyright 2007 Partners Radiology
Target AudienceTarget Audience
All clinical and non-clinical personnel - All clinical and non-clinical personnel - Techs, Techs, MDs, RNs and Support MDs, RNs and Support StaffStaff
Copyright 2007 Partners Radiology
Topic 1Topic 1
JCAHO PastJCAHO Past
Scheduled hospital accreditation visitsScheduled hospital accreditation visitsReview of Policy ManualsReview of Policy ManualsTalking primarily with managersTalking primarily with managersVisiting some specialty UnitsVisiting some specialty UnitsMinimal Patient ContactMinimal Patient Contact
Copyright 2007 Partners Radiology
Topic 1Topic 1
JCAHO PresentJCAHO Present
Unannounced VisitsUnannounced VisitsTalking primarily to ground level staffTalking primarily to ground level staffTracer methodologyTracer methodologyFollowing a patient’s trail throughout the Following a patient’s trail throughout the
hospitalhospitalTalking directly to patientsTalking directly to patientsAssure we are following our own policiesAssure we are following our own policies
Copyright 2007 Partners Radiology
FlammableFlammableCorrosiveCorrosiveChemically reactiveChemically reactiveCompressed GasCompressed GasBiohazardBiohazard
DefinitionDefinition
Topic 2Topic 2
Copyright 2007 Partners Radiology
Material Safety Data SheetsMaterial Safety Data Sheets Know where to find themKnow where to find them All MSDS containAll MSDS contain
– Product informationProduct information– PPE informationPPE information– IngredientsIngredients– Health Hazard DataHealth Hazard Data– Disposal InformationDisposal Information– Fire and Explosion informationFire and Explosion information
MSDS SheetsMSDS Sheets
Topic 2Topic 2
Copyright 2007 Partners Radiology
Know who to callKnow who to callAlert coworkers in immediate areaAlert coworkers in immediate areaWear PPE defined on container or MSDSWear PPE defined on container or MSDSAvoid contact with skin and eyesAvoid contact with skin and eyesEvacuate the area if respiratory hazardEvacuate the area if respiratory hazardClose off and ventilate the areaClose off and ventilate the area
What to do if you have What to do if you have a chemical spilla chemical spill
Topic 2Topic 2
Copyright 2007 Partners Radiology
Common AcronymsCommon Acronyms
Topic 3Topic 3
R.A.C.ER.A.C.E..– Rescue Rescue – Activate AlarmActivate Alarm– Contain FireContain Fire– Extinguish/EvacuateExtinguish/Evacuate
P.A.S.S.P.A.S.S.– PullPull– AimAim– SqueezeSqueeze– SweepSweep
Copyright 2007 Partners Radiology
Fire ExtinguishersFire Extinguishers
Topic 3Topic 3
Contain dry chemicals for class A, B, and C Contain dry chemicals for class A, B, and C fires.fires.– Class A FiresClass A Fires
ordinary materials like burning paper, lumber, cardboard, ordinary materials like burning paper, lumber, cardboard, plastics etc.plastics etc.
– Class B FiresClass B Fires flammable or or combustible liquids such as gasoline, kerosene, liquids such as gasoline, kerosene,
and common and common organic solvents used in the laboratory. used in the laboratory.
– Class CClass C energized electrical equipment, such as appliances, switches, energized electrical equipment, such as appliances, switches,
panel boxes, power tools, panel boxes, power tools, hot plates and stirrers. and stirrers.
Copyright 2007 Partners Radiology
Shut off and unplug Shut off and unplug burning or smoking burning or smoking equipmentequipment
Shut off wall oxygen Shut off wall oxygen supply system after supply system after converting patients to converting patients to portable tanksportable tanks
Close doors and Close doors and windowswindows
Use ElevatorsUse Elevators Telephones except for Telephones except for
emergenciesemergencies Open Fire DoorsOpen Fire Doors Store anything within Store anything within
18 inches of a 18 inches of a sprinkler headsprinkler head
Topic 3Topic 3
DoDo Do NotDo Not
Copyright 2007 Partners Radiology
Topic 3Topic 3
Do you know?Do you know?
The location of your fire alarms?The location of your fire alarms?What number to call and what information What number to call and what information
to give the operator?to give the operator?The location of your fire extinguishers?The location of your fire extinguishers?Your evacuation route?Your evacuation route?How and when to evacuate?How and when to evacuate?
Copyright 2007 Partners Radiology
Topic 3Topic 3
Area of RefugeArea of Refuge
Usually exit stairwells are built to provide Usually exit stairwells are built to provide up to 2 hours of fire protectionup to 2 hours of fire protection
Copyright 2007 Partners Radiology
Hand HygieneHand Hygiene Hand Hygiene is the easiest and most effective Hand Hygiene is the easiest and most effective
way to prevent the spread of Infection – Your way to prevent the spread of Infection – Your mother was right!mother was right!
Must be performed correctlyMust be performed correctly– Hands must be washed with soap and water in four Hands must be washed with soap and water in four
specific casesspecific cases Before eatingBefore eating After using the bathroomAfter using the bathroom When hands are visibly soiledWhen hands are visibly soiled After caring for a patient with C. Diff.After caring for a patient with C. Diff.
– Wash for as long as it takes to sing Happy Birthday Wash for as long as it takes to sing Happy Birthday twicetwice
Topic 4Topic 4
Copyright 2007 Partners Radiology
Hand HygieneHand Hygiene
– Cleanse the hands with an alcohol-based hand Cleanse the hands with an alcohol-based hand cleaner BEFORE and AFTER every contact cleaner BEFORE and AFTER every contact with the patient or the patient environmentwith the patient or the patient environment
– Use only approved hand lotion that is Use only approved hand lotion that is compatible with your particular cleanser twice a compatible with your particular cleanser twice a shift shift
– Do not wear artificial nails or nail jewelryDo not wear artificial nails or nail jewelry– Nails should be no more that ¼ inch long and Nails should be no more that ¼ inch long and
only polished with clear polishonly polished with clear polish
Topic 4Topic 4
Copyright 2007 Partners Radiology
PrecautionsPrecautions Universal or Standard PrecautionsUniversal or Standard Precautions
– Wear gloves, gown and/or mask whenever you might Wear gloves, gown and/or mask whenever you might be expected to be exposed to body fluidsbe expected to be exposed to body fluids
– Clean hands immediately after removing glovesClean hands immediately after removing gloves Contact Precautions – skin infections, Hep A, Contact Precautions – skin infections, Hep A,
chicken pox, E. colichicken pox, E. coli– Glove and Gown requiredGlove and Gown required– Isolate individual equipment like stethoscopes and BP Isolate individual equipment like stethoscopes and BP
cuffscuffs– Clean hands immediately after removing glovesClean hands immediately after removing gloves
Topic 4Topic 4
Copyright 2007 Partners Radiology
PrecautionsPrecautions
Contact Precautions Plus – C. DifficileContact Precautions Plus – C. Difficile– Gloves and Gowns required for careGloves and Gowns required for care– Spores are resistant to alcohol based cleanersSpores are resistant to alcohol based cleaners– Need to use soap and water after removing glovesNeed to use soap and water after removing gloves
Airborne Precautions – Measles, TB, chicken poxAirborne Precautions – Measles, TB, chicken pox– Negative Pressure roomNegative Pressure room– N95 TB maskN95 TB mask– Patient can be transported with regular surgical maskPatient can be transported with regular surgical mask
Topic 4Topic 4
Copyright 2007 Partners Radiology
PrecautionsPrecautions
Droplet Precautions – German measles, Droplet Precautions – German measles, meningitis, influenza, pneumonia, pertussismeningitis, influenza, pneumonia, pertussis– Need Private room or cohort with same illnessNeed Private room or cohort with same illness– Must wear a surgical mask within 3 feet of Must wear a surgical mask within 3 feet of
patientpatient– Patient must wear surgical mask for transportPatient must wear surgical mask for transport
Topic 4Topic 4
Copyright 2007 Partners Radiology
All medications must be securedAll medications must be secured– INCLUDES IV fluids and Contrast media!!INCLUDES IV fluids and Contrast media!!
Locked cabinets or Omnicell or Pyxis machinesLocked cabinets or Omnicell or Pyxis machines Stocked by trained personnelStocked by trained personnel
All Patients need documented assessment of All Patients need documented assessment of patient response after pain medicationpatient response after pain medication
All medication orders must be reviewed by All medication orders must be reviewed by a pharmacist before first dosea pharmacist before first dose
Topic 5Topic 5
Medication ManagementMedication Management
Copyright 2007 Partners Radiology
To ensure and accurate list of patient’s To ensure and accurate list of patient’s medications across the continuum of caremedications across the continuum of care– PAML – check meds on admissionPAML – check meds on admission– Any point of entryAny point of entry
Procedural patients full medication listingProcedural patients full medication listing At MGH, we check modality specific lists, like the Metformin At MGH, we check modality specific lists, like the Metformin
products that might interact with Contrastproducts that might interact with Contrast
Upon discharge, the list is again reconciled with Upon discharge, the list is again reconciled with the hospital records and the Outpatient/ PCP the hospital records and the Outpatient/ PCP recordsrecords
Topic 5Topic 5
Medication ReconciliationMedication Reconciliation
Copyright 2007 Partners Radiology
Goal 2A - For verbal or telephone orders or for Goal 2A - For verbal or telephone orders or for telephonic reporting of critical test results, verify telephonic reporting of critical test results, verify the complete order or test result by having the the complete order or test result by having the person receiving the order or test result "read -person receiving the order or test result "read -back" the complete order or test resultback" the complete order or test result
Goal 2C - Measure, assess and, if appropriate, take Goal 2C - Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and action to improve the timeliness of reporting, and the timeliness of receipt by the responsible the timeliness of receipt by the responsible licensed caregiver, of critical test results and licensed caregiver, of critical test results and valuesvalues
Topic 6Topic 6
Requirements for Goal Requirements for Goal 2A & 2C2A & 2C
Copyright 2007 Partners Radiology
Ineffective Communication is the most Ineffective Communication is the most frequent category of root causes of sentinel frequent category of root causes of sentinel eventsevents
Effective Communication, which is timely, Effective Communication, which is timely, accurate, complete, unambiguous and accurate, complete, unambiguous and understood by the recipient, reduces error understood by the recipient, reduces error and results in improved patient safetyand results in improved patient safety
Topic 6Topic 6
Rationale for Rationale for Requirement 2ARequirement 2A
Copyright 2007 Partners Radiology
The receiver of the information The receiver of the information writes writes down the complete order or test result or down the complete order or test result or enters it into a computerenters it into a computer
The receiver of the information The receiver of the information readsreads back back the order or test resultthe order or test result
The receiver of the information The receiver of the information receivesreceives confirmation from the individual who gave confirmation from the individual who gave the order or test resultthe order or test result
Topic 6Topic 6
Implementation for Implementation for Requirement 2ARequirement 2A
Copyright 2007 Partners Radiology
The organization defines critical tests and critical The organization defines critical tests and critical results/valuesresults/values
The organization defines the acceptable length of The organization defines the acceptable length of time between the ordering of critical tests and time between the ordering of critical tests and reporting the test valuesreporting the test values
The organization defines the acceptable length of The organization defines the acceptable length of time between the availability of critical time between the availability of critical results/values and receipt by the responsible results/values and receipt by the responsible licensed care giverlicensed care giver
Topic 6Topic 6
Implementation for Implementation for Requirement 2CRequirement 2C
Copyright 2007 Partners Radiology
The organization collects data on the timeliness of The organization collects data on the timeliness of reporting critical test results/valuesreporting critical test results/values
The organization assesses the data and determines The organization assesses the data and determines whether there is a need for improvementwhether there is a need for improvement
The organization takes appropriate action to The organization takes appropriate action to improve and measure effectiveness of those improve and measure effectiveness of those actionsactions
Topic 6Topic 6
Implementation for Implementation for Requirement 2CRequirement 2C
Copyright 2007 Partners Radiology
HEICS or HICSHEICS or HICS Hospital Emergency Incident Command has been Hospital Emergency Incident Command has been
recently revisedrecently revised The new name is HICS – Hospital Incident The new name is HICS – Hospital Incident
Command SystemCommand System The Incident Command Structure helps provide The Incident Command Structure helps provide
order instead of chaos for planned or unplanned order instead of chaos for planned or unplanned eventsevents
It is important for all employees to follow the It is important for all employees to follow the Chain of Command during an emergencyChain of Command during an emergency
Topic 7Topic 7
Copyright 2007 Partners Radiology
Sample Sample Hospital Incident Command Hospital Incident Command
StructureStructure
Topic 7Topic 7
S a fe ty/S e cu rity
P u b lic In fo O ffice r
M e d ica l O ffice r
L ia son O ffice r
H o sp ita l Inc id en t C om m an d er
L o g is tics P la nn ing F in an ce O p e ra tio ns
Radiology
Copyright 2007 Partners Radiology
Sample Radiology Incident Sample Radiology Incident Command StructureCommand Structure
Topic 7Topic 7
C lin ica l an d S u p po rt S ta ff
O p era tion s M a n ag e rs R a d io lo g is ts
R a d io lo g y U n it Le a d er
A n c illa ry S e rvice s D ire c to r
O p e ra tio n s C h ie f
H o sp ita l Inc id en t C om m an d er
Copyright 2007 Partners Radiology
Know the location of the Know the location of the department and hospital department and hospital Emergency Response Emergency Response plan.plan.
Know the location of the Know the location of the department telephone treedepartment telephone tree
Your role in a disasterYour role in a disaster Request needed supplies Request needed supplies
and staff through the chain and staff through the chain of command.of command.
Do not report to the Do not report to the hospital unless hospital unless specifically contacted.specifically contacted. Depending on the Depending on the situation you may be situation you may be needed for future shifts. needed for future shifts. All staff need to be All staff need to be accounted for. You must accounted for. You must check in with your chain check in with your chain of command when you of command when you arrive.arrive.
DoDo Do NotDo Not
Topic 7Topic 7
Copyright 2007 Partners Radiology
Are you prepared to help Are you prepared to help out during a disaster?out during a disaster?
Topic 7Topic 7
Disasters can strike at any time Disasters can strike at any time As healthcare workers we need to be prepared to As healthcare workers we need to be prepared to
respond in an organized and efficient manner respond in an organized and efficient manner Disasters can be of short or prolonged duration Disasters can be of short or prolonged duration Preparation in the workplace and in your home Preparation in the workplace and in your home
can insure that you will be ready to respond if can insure that you will be ready to respond if neededneeded
Copyright 2007 Partners Radiology
Family PreparednessFamily Preparedness
Topic 7Topic 7
Have a plan in place for your family in case Have a plan in place for your family in case you need to report to the hospital you need to report to the hospital
Make arrangements in advance for care of: Make arrangements in advance for care of: – Children Children – EldersElders– PetsPets
Copyright 2007 Partners Radiology
National Patient Safety GoalsNational Patient Safety Goals
Topic 8Topic 8
Copyright 2007 Partners Radiology
Use 2 patient identifiers (name & DOB or Use 2 patient identifiers (name & DOB or for newborn’s name & medical record #) for newborn’s name & medical record #) when providing carewhen providing care
Label all specimen containers in the Label all specimen containers in the presence of the patientpresence of the patient
Topic 8Topic 8
Improve the Accuracy of Improve the Accuracy of Patient IdentificationPatient Identification
Copyright 2007 Partners Radiology
Use Read-Back for verbal & telephone Use Read-Back for verbal & telephone orders or critical tests/values orders or critical tests/values
Write it Down - Read it back - Receive Write it Down - Read it back - Receive confirmationconfirmation
Write out the “dangerous 13” abbreviations Write out the “dangerous 13” abbreviations in all orders or medication documentationin all orders or medication documentation
Topic 8Topic 8Improve the Effectiveness Improve the Effectiveness
of Communication of Communication Among CaregiversAmong Caregivers
Copyright 2007 Partners Radiology
Measure and take action, if needed, to Measure and take action, if needed, to improve timeliness of reporting and receipt improve timeliness of reporting and receipt of critical test resultsof critical test results
Implement a standardized approach to Implement a standardized approach to "hand off" communications, include time "hand off" communications, include time for Q&Afor Q&A
Topic 8Topic 8Improve the Effectiveness Improve the Effectiveness
of Communication of Communication Among CaregiversAmong Caregivers
Copyright 2007 Partners Radiology
Standardize and limit the number of drug Standardize and limit the number of drug concentrations available in the organizationconcentrations available in the organization
Identify look-alike/sound-alike drugs used in Identify look-alike/sound-alike drugs used in the organization – prevent interchange errorsthe organization – prevent interchange errors
Topic 8Topic 8
Improve the Safety of Using Improve the Safety of Using MedicationsMedications
Copyright 2007 Partners Radiology
Label all medications, medication containers Label all medications, medication containers (e.g., syringes, medicine cups, basins) & (e.g., syringes, medicine cups, basins) & solutionssolutions
Label one at a time, 2 persons visually & Label one at a time, 2 persons visually & verbally verify if one prepares and another verbally verify if one prepares and another uses/givesuses/gives
Topic 8Topic 8
Improve the Safety of Using Improve the Safety of Using MedicationsMedications
Copyright 2007 Partners Radiology
CDC Hand Hygiene Guidelines:CDC Hand Hygiene Guidelines:– Before patient contact – hand sanitizer or soap and Before patient contact – hand sanitizer or soap and
waterwater After patient contact -After patient contact -
– Hands visibly dirty or “contact precautions +” – Use Hands visibly dirty or “contact precautions +” – Use soap and watersoap and water
– Hands not visibly dirty – Use hand sanitizer or soap Hands not visibly dirty – Use hand sanitizer or soap and waterand water
Perform a RCA on all deaths or permanent loss of Perform a RCA on all deaths or permanent loss of function related to healthcare associated infectionsfunction related to healthcare associated infections
Topic 8Topic 8
Reduce the Risk of Healthcare Reduce the Risk of Healthcare Associated Infections Associated Infections
Copyright 2007 Partners Radiology
Document a complete list of the patient's Document a complete list of the patient's current medications (home medication list)current medications (home medication list)
Compare & resolve discrepancies between Compare & resolve discrepancies between this list of medications to initial ordersthis list of medications to initial orders
On transfer of service and at discharge, On transfer of service and at discharge, reconcile new orders/prescriptions with reconcile new orders/prescriptions with home & current meds home & current meds
Topic 8Topic 8
Reconcile Medications Across Reconcile Medications Across the Continuum of Care the Continuum of Care
Copyright 2007 Partners Radiology
Communicate the list to the next provider at Communicate the list to the next provider at discharge or end of visitdischarge or end of visit
Provide the patient an inclusive list of Provide the patient an inclusive list of medications to take at discharge or end of medications to take at discharge or end of visitvisit
Topic 8Topic 8
Reconcile Medications Across Reconcile Medications Across the Continuum of Care the Continuum of Care
Copyright 2007 Partners Radiology
Fall reduction program – identify patients at Fall reduction program – identify patients at risk, teach patients and families to “Call…risk, teach patients and families to “Call…Don’t Fall”Don’t Fall”
Topic 8Topic 8
Reduce the Risk of Patient Reduce the Risk of Patient Harm Resulting from Falls Harm Resulting from Falls
Copyright 2007 Partners Radiology
Tell patients and their families how to Tell patients and their families how to report concerns about safetyreport concerns about safety
Topic 8Topic 8
Encourage Patients’ Active Encourage Patients’ Active Involvement in Their CareInvolvement in Their Care
Copyright 2007 Partners Radiology
Identify patients at risk for suicide, ensure Identify patients at risk for suicide, ensure safe setting and competent caresafe setting and competent care
Provide crisis hotline information to them Provide crisis hotline information to them and their families on discharge and their families on discharge
Topic 8Topic 8
Identify Safety Risks Inherent Identify Safety Risks Inherent in the Patient Populationin the Patient Population
Copyright 2007 Partners Radiology
Complete pre-operative / pre-procedure Complete pre-operative / pre-procedure verification processverification process
Mark the site so it is visible after prepping Mark the site so it is visible after prepping and draping (laterality, multiple structures, and draping (laterality, multiple structures, multiple levels)multiple levels)
Team “time out” immediately before the Team “time out” immediately before the procedureprocedure
Topic 8Topic 8
Universal Protocol: Ensure Universal Protocol: Ensure Correct Person ProceduresCorrect Person Procedures