Safety in hospital settings is not only essential for patients but also for the healthcare providers and the visiting relatives. It is important to maintain the utmost degree of care and apply safety measures to facilitate recovery of the patient and prevent the development of complications due to the disease or the treatment that the patient may be receiving. This also safeguards against the transmission of infection to the rest of the ward dwellers and the medical care providers. Safety control and implementation of the precautions calls for collaborative efforts of members of the healthcare fraternity. To improve quality in the provision of health care and foster safety to patients, The Patient Safety Advisory Committee in 2002, composed the goals and measures to ensure patient safety. The compiling of these goals involves consultations from advisory boards of pharmacists, medical doctors, nurses and other health stakeholders. The application of the first goals designed was in 2003, and the latest update of the same that is currently in use is the National Patient Safety Goals 2016, which outlines several items. Health institutions also update alarm systems for alerting the caregivers and the patients about errors in the systems.
The first goal of the commission laid out is on the importance of keeping accurate patient identification information. This is useful in developing of diagnoses, formulation of medication plans and carrying out procedures. It prevents the healthcare giver from performing procedures on the wrong patient. The target of this goal is also to eradicate the likely hood of transfusion-related complications such as anaphylaxis. Grouping and cross matching is a compulsory step in the process of blood transfusion to avoid ABO blood type incompatibility. For instance, two healthcare givers are essential in the presence of a patient for transfusion for the performance of a transfusion procedure. A third party in the procedure ensures that the identification of the patient is accurate. Implementation of this goal would help improve the outcomes of procedures as well as minimize the chances of healthcare litigations on healthcare givers. The guidelines for patient identifications clarify that a health provider should at least verify two of patient identity documents to avoid confusion. Clear record keeping is crucial in the process of patient identification.
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The goals also stipulate the importance of maintaining an open communication channel between the caregiver and the patient. To achieve safety, the caregivers should also share information about the patient between themselves in an effective and ethical manner that promotes professionalism. This communication should aim at delivery of information about the diagnostic tests, the condition that the patient is ailing from and the procedures. The purpose of this consultation and collaborative effort in designing the care plans the patient may need. Informing an individual of their condition, its prognosis, and the interventions that the patient requires is a core component of implementing communication(Joint Commission Resources, 2012.
Safe application of medications is the third goal. The attending caregiver should follow the rules of drug administration, which describe the delivery of the right medication, at the right dose, using the correct route at the right time. This involves appropriate labeling of medications during procedures. This also applies to the operating rooms as well, whereby the medications used in anesthesiology contain designated labels. Medical containers should be easily identifiable regarding the medication they contain. Safe use of medications also targets cutting down on the side effects associated with anticoagulant therapy. To prevent anticipated adverse effects, the caregiver in charge should provide education on the use of anticoagulants such as warfarin. Knowledge of the likelihood of development of a bleeding diathesis helps the patient maintain compliance and report any undesired properties of the drug. Appropriate use of medications also involves developing a care plan for the patient with clear documentation of the regimens, to whom they belong and the times of their administration. Individualized treatment sheets offer the best way of addressing the needs of each patient. The caregiver should also monitor drug-drug interactions for those patients receiving different medications. Health providers should also take precaution when giving intravenous medications to ensure that complications related to injection of drugs into the veins such as thrombophlebitis.
Installation of alarms and their maintenance in the correct working order is the sixth goal. Appropriate alarm responses help caregivers in identifying flows in the systems. Such alarms improve the response time to flaws that may occur during procedures. For example in the theater, the anesthesia machine used has alarms that notify the medical provider on oxygen delivery to the patient, carbon dioxide changes and the flow of the anesthetic gas. In the intensive care unit, the mechanical ventilator has several safety installations that monitor the respiratory rate of the patient, the tidal volume, and minute breathing. The alarms installed in the machine sense variations in the patient parameters, which enable the caregiver to deliver the corrective measures(Joint Commission Resources, 2012).
Health- Care acquired infections, or nosocomial infections are infections that patients acquire from a hospital facility. These infections must not be the ones that the patient presented with during admission to hospital. Poor hospital hygiene is the cause of nosocomial infection. The WHO in collaboration with CDC provides continuous medical educations on the importance of hand washing in hospitals. The WHO strives to update the hand-washing chart to attain maximum reduction of nosocomial infection. The common causes of nosocomial infections include Methycilin Resistant Staph Aureus, Pseudomonas aeruginosa and actinetobacter species. Broad-spectrum antibiotics are the treatment of choice for nosocomial infection. A combination of amoxicillin and clavulinic acid suffices. Other preventive measures include proper hygiene in the hospital facility and timely discharge of stable patients. Nosocomial infections occur in long-staying patients with deteriorating health status despite proper management (Hammond, 2013).
Central line associated blood stream infections are common in in-patients. Early removal of the central lines is the surest regimen to control such infections. Patients receive broad-spectrum antibiotics after fixation of central venous catheter. Also, the procedure happens in the critical care unit where the rate of infections is minimal. Broad-spectrum antibiotics suffice in the prevention of surgical site associated infections. Surgical safety is one of the top concerns for World Health Organization (WHO) consideration the uprising need for efficiency in surgical care. The initiative for emergency and crucial operational care and regulations for trauma care have focused on the use of a checklist. Sterile instruments in the operating room such as sterile gloves and gauze supplement the antibiotics in the prevention of the same Indwelling catheters cause urinary tract symptoms. Besides making patients feel very sick, indwelling Foley’s catheters are sources of infection in post-operative patients. Early removal of the Foley’s catheter prevents health care-associated infections.
The National Patient Safety Goals (NPSG) also outlines a goal on the prevention of errors occurring during surgery. Regarding this, the commission advises health care providers to evaluate the information about the patient, the surgical site, and the procedure. This eliminates the possibility of a surgeon operating on the wrong patient or the wrong site. A theater checklist that the in-charge fills up ascertains the information contained about the patient. Nurses and other professionals in theater also check the working condition of the equipment before the commencement of procedure. This prevents undue stoppage of the procedures to look for tools or drugs whenever required. The anesthetist also should carry out a complete assessment of the patient to determine fitness for surgery and classify the patient according to the American Association of Anesthesiologists (Joint Commission Resources, 2012).
The prior setting of the surgical tray forms the baseline of the patient’s safety; leave alone the antiseptic techniques, which are inevitable. Having a checklist in surgical care rooms ensures that the caregiver controls the mismatches and thus wholesomely minimizing mortality cases in surgical departments. (Hammond, 2007) This practice will cover a broad spectrum of safety meridians such as minimizing infections, improved anesthetic care value, minimizing delays of operations, and step up communication between the sub-ordinate and clinical personnel in care hospital facilities.
Health Care Institutions that provide surgical care should ensure that identification of and implementation of safety measures. They also make certain that the nurse in-charge enters note into the checklist for future reference. The National Patient Safety Agency (NPSA), in conjunction with other expert agencies, has adopted the checklist for use in various nations outside the United States. The checklist has core components although it can be alterations in it may suit the local hospital requirements.
Checklists assure quality control through preparedness for emerging complications hence urgent reconciliation to standard. Use of checklists in theater prevents health care provider negligence as they comply with the list that is following standard guidelines. They also help during the evaluation as nurses and physicians countercheck achievements and failures. Checklists help nurses and physicians to prepare mentally for the operation since they orient themselves for the task ahead by confirming equipment and other needed tools on the checklist. Additionally, a checklist is the basic tool for a surgical procedure. A checklist also increases efficiency in the operating room by eradicating errors caused by forgetting equipment or skipping crucial steps.
In the column of time out, the surgeon should identify with the teammates and all the required staff members present before the operation. Surgical equipment must be present too. For the sign-out, the amount of blood loss should be recorded and a sample of the tissue taken for histology if necessary. It is important to note that the type of surgery done determines the outcome and hence recovery of the patient (Bailys, 2012).
The goal of ensuring the safety of a patient while in the wards plays a crucial role in preventing suicide attempts by patients. This is especially essential for those patients in the psychiatric wards who may be afflicted by depressive disorders. Alertness in this field is necessary as it enables early identification of the needs of the patient and intervening appropriately in anticipation of the likelihood of suicide. Provision of safety to patients in this area involves admitting them into private rooms, provision of therapy such as mood stabilizers to curtail the unfortunate events of suicide.
In conclusion, patient safety remains a key component in the management of conditions. Application of the goals outlined in the National Patient Safety Goals such as accurate identification of patients before the procedure, medication safety, and prevention of nosocomial infections and guarding against suicide is an essential component of healthcare delivery. Elimination of errors during surgery through checklists and patient assessment to ensure that the procedure occurs to the right patient at the right site is crucial in patient management.
References
Joint Commission Resources, Inc. (2012). Patient Safety Pocket Guide . Joint Commission Resources.
Norman S. Williams (2012). Baileys and Love Short Practice of Surgery. London:Hodder Education and Hachette UK Company.
Hammond, J.S., Eckes, J.M., Gomez, G.A. and Cunningham, D.N. (2013) HIV, trauma, and infection control: universal precautions are universally ignored. London: Oxford University Press.
