Quality Assurance and Safety Practices

1. Quality Assuranceand Safety Practices Chapters 6 and 7 Code Blue Health Science Edition 4

2. Quality Control Problems at Brannan Community Hospital • An 82-year-old physician who is no longer qualified to practice medicine. • Physicians performing procedures that they were not trained or qualified to perform. • The reading of x-rays by non-radiologists.

3. Quality Control Problems at Brannan Community Hospital • Poor maintenance on medical equipment. • The failure of Central Supply to restock the crash carts after cardiac arrests. • A high hospital infection rate.

4. Quality Control • Hospitals are becoming increasingly concerned with the quality of care they deliver.

5. Reasons for this concern include: • Recognition that Total Quality Management (TQM) principles have dramatically increased the quality of products manufactured in the United States—they should be able to do the same in healthcare. • Greater visibility—the public is demanding more information on the quality of care they receive.

6. What are some of the top risks that patients face? • Misdiagnosis—primarily a physician problem, but hospitals play a part. • Failure to adequately monitor the patient—primarily a hospital problem often caused by shortages in staffing. • Failure to appropriately use the chain of command.

7. What are some of the top risks that hospitals face? • Falls and injuries—preventable by the hospital staff. • Medication errors—a problem caused by doctors and/or pharmacies.

8. What are some of the top risks that hospitals face? • No response by hospital personnel to abnormal diagnostic testing values. • Misread radiology tests.

9. What are some of the top risks that hospitals face? • Infections—many of these arise in the hospital. • Exposure to hazardous wastes and materials • Failure to follow prescribed procedures.

10. Employees face hazards also • Blood and body fluid exposures (needle sticks, puncture wounds, broken glass vials) • Lifting injuries • Repetitive motion injuries • Falls by employees or patients

11. How do hospitals address these issues? • Proper credentialing of physicians • Peer review • Credentialing of hospital personnel • Establishment of hospital protocols, policies and procedures • Employee training • Monitoring—gathering and acting on data

12. Proper credentialing of physicians • When a physician enters the community and desires to practice at a hospital, he or she must apply for: • Medical staff membership • Hospital privileges

13. Medical Staff Membership • Allows doctors to admit patients to the hospital • Is granted by the hospital’s board of trustees upon recommendation from the medical staff

14. Hospital Privileges • These list the actual procedures the doctor is allowed to perform in the hospital. • Physicians must present proof that they have been trained and are qualified to perform the requested privileges. • As with medical staff membership, the board of trustees grants privileges upon recommendation from the medical staff.

15. Peer Review • Peer review committees: • Review cases to see that physicians are providing quality care • Review physician membership and privileges on a yearly basis for the purpose of recommending renewal by the hospital board of trustees

16. Credentialing of Hospital Personnel As mentioned in an earlier chapter, credentialing includes: • Accreditation—anevaluation that assures that an organization meets minimum standards • Certification—recognition by a non-governmental regulatory body that an individual meets standards • Licensure—recognition by a governmental body that an individual meets minimum educational requirements, and has the knowledge and skill to practice a specific profession

17. Establishment of hospital protocols, policies and procedures • A protocol is a procedure for handling a specific medical situation • Protocols are developed by medical schools, professional associations, and hospitals • Hospitals also develop policies and procedures for the delivery of care within their hospital

18. Employee Training • Training is a key component of quality control • Training is performed by: • Universities • Professional associations • In-service departments within hospitals

19. Monitoring—gathering and acting on data • A number of committees collect data on quality control indicators including • Hospital infection rates • Numbers of employee/patient falls • Medication errors • Adverse drug events • Needle sticks • Etc.

20. Committees Concerned with Quality Include: • Credentials Committee: a medical staff committee that advises the board of trustees on matters concerning medical staff membership, and privileges • Health Information Management Committee: the committee charged with seeing that health information is accurate and timely

21. Committees Concerned with Quality Include: • Infections Committee: the committee charged with investigating and preventing hospital-caused infections • Medical Executive Committee: the primary governing committee of the medical staff. The objective of the MEC is to conduct hospital business within the hospital for and in behalf of the medical staff

22. Committees Concerned with Quality Include: • Morbidity And Mortality Committee: a committee responsible for monitoring the quality of care provided to emergency center and trauma patients • Quality Assurance Committee: the committee charged with the responsibility of monitoring the quality of care provided by the hospital

23. Committees • Not every hospital has every committee, and committee tasks vary from hospital to hospital. • The organization of these committees at Brannan Community Hospital is shown on the next slide.

24. Quality Control at Brannan Community Hospital

25. Let’s talk a little more about hospital infections • What causes infections? • Pathogens: • Microorganisms that causes disease Common pathogens include bacteria, viruses, and fungi

26. Bacteria • These are classified according to: • Shape: Cocci (spherical), Bacilli (rod shaped), and Spirochetes (corkscrew) • Reaction to gram stain

27. Reaction to gram stain: • Gram-positivebacteria have thick walls that cannot be colorized, but are stained violet with a gram crystal violets stain. • Gram-negative bacteria can be decolorized with alcohol and is counterstained with safranin after decolorization, which imparts a pink or a red color. • Whether a bacteria is gram positive or gram negative is important information for a doctor prescribing an antibiotic. • Some antibiotics work only with gram positive bacteria while some (broad-spectrum) antibiotics work against several classifications or groups of bacteria.

28. Virus: • The smallest of the infection agents, with few exceptions, viruses are capable of passing through fine filters that retain most bacteria. • Viruses are not visible through light microscopes, and are incapable of reproduction outside of a living cell.

29. Fungi: • Plantlike pathogens (molds and yeasts)

30. Infection Control Procedures • Wash hands: • After patient contact • Before and after eating • After using the restroom • After handling money • After removing gloves • Whenever cleanliness of the hands is in question

31. Infection Control Procedures • Try to keep soiled items from touching the skin and clothing • Wear a gown, a mask, and eye protection or an eye shield when appropriate • Use care in handling equipment that may carry pathogens • Make sure reusable equipment has been sterilized before using it on another patient

32. Infection Control Procedures • Transport soiled items in a manner that prevents exposure to pathogens • Never place soiled items on the floor • Avoid activities that raise dust when handling patients or equipment • Follow procedures when handling needles, scalpels and other sharp instruments. Use biohazard containers to discard these used items.

33. Infection Control Procedures • Avoid having the patient cough, sneeze or breathe on others • Clean areas that are least soiled first, moving outward or forward • Dispose of soiled items in appropriate containers

34. Infection Control Procedures • When pouring liquids such as mouth rinse, bath water, etc., into the drain, avoid splattering • Clean and sterilize items suspected of having pathogens • Follow appropriate isolation procedures

35. Handling Sterile Forceps • Wash hands • Keep only one forceps in a container of clean germicidal solution • When removing forceps from a container, keep prongs together and facing downward; grasp handles and lift without touching any part of the container above the solution line

36. Infection Control Procedures • Tap prongs together gently over the container to remove excess solution • When using forceps, keep them in a downward position to keep the fluid on the prongs from running back to the handle. Use as required to handle, transfer, or assemble sterile supplies and equipment

37. Infection Control Procedures • After the procedure has begun, never touch the tip of the forceps to a sterile field when placing supplies on a sterile field • After use, return the forceps to the container without touching any part of the container • Sterilize the forceps and the container, and refill the container with fresh germicide weekly, or more frequently

38. Pouring Sterile Solutions • Always wash hands before pouring sterile solutions • Check the label before pouring sterile solutions • Unwrap the sterile container to be used for the sterile solution

39. Pouring Sterile Solutions • When removing the cap of the sterile solution, place the cap on a surface that is level • When pouring, see that the label is in the palm of your hand

40. Pouring Sterile Solutions • When pouring a sterile solution, hold the sterile solution bottle about six inches above the container • If you are required to pour a solution onto a sponge, first pick up the sponge with the forceps, then pour the solution on the sponge

41. Good Website: Medical and surgical asepsis: http://www.cdc.gov/ncidod/hip/a_z.htm See “Isolation Guidelines” and “Infection Guidelines.”

42. Principles of Body Mechanics and Ergonomics

43. Ergonomics: • The study of work. More specifically, the study of ways the workplace can be improved to minimize employee injury and fatigue.

44. Body mechanics • Using the body’s major moveable parts (head, trunk, arms, and legs) in an efficient manner to maintain balance, conserve energy, and avoid strain and injury while performing work.

45. Advantages of Proper Body Mechanics • Prevent injury • Reduce energy consumption

46. Components of Good Body Mechanics • Posture • The alignment of head, trunk, arms, and legs • The proper alignment of the body • Coordination of body movement

47. Principles of Body Mechanics • Avoid unnecessary bending • Avoid unnecessary lifting • Avoid twisting when lifting; face the object you are moving • When changing direction of movement, turn your whole body • Push, pull, roll or slide the object when possible

48. Principles of Body Mechanics • Use your strongest muscles to accomplish work • Use your thighs and hips by bending knees when lifting • Use both arms to lift • Move smoothly, avoid movements that are jerky • Hold heavy objects close to the body or stand close to the person or object being moved

49. Principles of Body Mechanics • If you hold the object away from the body, strain is placed on the muscles of the lower arms • Get assistance if the person or object is too heavy • Increase your base of support by placing your feet slightly apart (eight to ten inches works well for most people) • Avoid lifting heavy items above the head

50. Review Homework Questions