paentsafetyandinfeconprevenonin electroneurodiagnoscs · paentsafetyandinfeconprevenonin...

Pa#ent Safety and Infec#on Preven#on in Electroneurodiagnos#cs

Alison M. Canto, RN, BSN, MBA,

Associate Director, Diagnos7c Imaging Services Rush University Medical Center

Hand Hygiene One of the most important things you can do to protect pa7ents is also one of the easiest — clean your hands using soap and water or an alcohol-‐based hand sani7zer. Hand hygiene compliance is crucial in helping to prevent the spread infec7ons. Clean In and Clean Out.

2

TAKE FIVE TO HELP KEEP PATIENTS SAFE

Adapted from American Society for Healthcare Risk Management (ASHRM)

Health Care Worker Safety We need to take care of ourselves. A healthy lifestyle including diet, exercise, preventa7ve health care and adequate sleep promotes a safer work environment. A healthy, well-‐rested healthcare worker is a safe healthcare worker.

3



Handoff Communica8on Good handoff communica7on is cri7cal in preven7ng medical errors and keeping pa7ents safe. Targeted and effec7ve communica7on at change of shiR, transfer, and discharge promote teamwork and helps keep pa7ents safe.

4



Building a Culture of Safety Speak up if you see something that isn’t right. Every employee has a voice. Encourage input from team members. Report events and opportuni7es for improvement as an Unusual Occurrence or Safety Event report.

5



Pa8ent and Family Involvement Medical errors, such as wrong-‐site surgeries, are less likely to occur when pa7ents confirm their iden7fica7on and treatment. Engage pa7ents and families in their care, discharge planning and educa7on. Remember, involved pa7ents and families are our partners for safe care.

6



Safety Culture

•  No one is ever hesitant to voice a concern about a pa7ent

•  Skilled caregivers playing by the rules feel safe to discuss and learn from errors

•  Concerns raised by front line caregivers are taken seriously

•  Ac7on is taken, feedback reliably provided, changes are visible for staff & pa7ents

Michael Leonard Kaiser Permanente

7

Safety Culture

•  Senior Leadership Support •  Safety Champion

– Can resolve problems quickly – Provide solu7ons – Works best with commi^ee of front line staff

8 Buelow, J. Neurodiagn J. 53:104–113, 2013

Safety Culture

•  Safety briefings – Huddles to start the day – Debrief aRer an event

•  No Blame / Non-‐puni7ve repor7ng –  Include in Evalua7ons safety repor7ng and/or par7cipa7on in safety ac7vi7es (engagement)

– Human factors / System failures


Safety Culture

Get out of working in silos and communicate

•  Lines of communica7on –  Iden7fy chain of command for problems – Does staff know who to no7fy in an event and what needs to be reported

– Checklists – Handoffs and shiR reports – No fear of repor7ng 10 Buelow, J. Neurodiagn J. 53:104–113, 2013

Safety Culture

•  Orienta7on & On-‐going Training •  Staff Awareness of harm and how to prevent

– Know what to do in the event •  Document and track errors and near misses

– Analyze processes


Just Culture

It’s about trust... A learning environment based on respect, trust, and fairness to achieve safer, more reliable care •  Where staff feel are empowered and feel safe to speak up about concerns

and errors •  Where learning from system flaws and mistakes is part of ‘how we do

things here’ •  Where safety science is used to understand human fallibility and design

systems to mi7gate that fallibility •  Where leaders con7nually seek to differen7ate between human error in

unreliable systems and inten7onal unsafe acts; •  Where accountability is clear for all roles Barbara Balik [email protected]

12

The Just Culture Algorithm in 4 steps:

1.  Iden7fy malicious behavior and those with

altered mental states. 2.  Characterize ac7ons as reckless, risky, error 3.  Apply the Subs7tu7on Test: Would others

with similar skills have performed similarly? 4.  Evaluate individuals for recurrent

problema7c behaviors

13

PaIent IdenIficaIon and Order VerificaIon

•  Before performing your exam, ask the pa7ent to state their name and date of birth.

•  Validate pa7ent iden7fica7on against the order. Re-‐verify by matching against the pa7ent's ID band.

•  Whenever possible look at the order to verify the exam you’re doing. If you have a scheduling department the schedulers may not have the knowledge base to interpret all of the comments.

14

PaIent safety with InpaIents

•  Get to know the nurses you work with –  A collabora7ve rela7onship breeds communica7on

•  No7fy the nurse when you arrive to the unit –  They may need to explain the exam to new pa7ents

•  If your hospital has a Child Life representa7ve, enlist their help on the pediatric units –  They oRen have useful distrac7on techniques

15

PaIent safety with InpaIents •  Cover pa7ent’s eyes when removing and applying gel •  Electrode gel on skin, look for skin breakdown •  MRI compa7ble electrodes

–  No7fy nurses of difference –  Review skin when reconnec7ng

•  On the intensive care units have the nurse posi7on your pa7ents –  EVD leveling, vented pa7ents, hemodynamically unstable

16

Hypoglycemic PaIents

17

Symptoms of low blood sugar Can affect your EEG

§  Ji^eriness, tremors. §  Cyanosis, grey shock-‐like state. §  Convulsion, localized seizures. §  Apnea. §  Irregular respiratory rate. §  Apathy, lethargy. §  High pitched, week cry. §  Limpness or change in muscle tone. §  Refusal to feed, poor feed. §  Eye rolling. §  Inability to regulate temperature.

Seizure Safety •  Remain Calm •  Call for assistance •  Note what pa7ent was doing prior to the seizure

•  Dura7on of seizure

•  Monitor movements –  Body part involved –  Type of motor ac7vity

18

Seizure Safety Ensure adequate ven7la7on.

–  Loosen clothing, postural support devices and/or restraints –  DO NOT try to force an airway or tongue blade through clenched teeth.

(Forced airway inser7on can cause injury.) –  Turn the person into a side-‐lying posi7on as soon as convulsing has stopped.

(This will help the tongue return to its normal front-‐forward posi7on and will also allow accumulated saliva to drain from the mouth.)

Protect the person from injury (e.g., help break fall, clear the area of furniture).

–  DO NOT restrain movement. (Trying to hold down the person's arms or legs will not stop the seizure. Restraining movement may result in musculoskeletal injury.)

–  Remain with the person and give verbal reassurance. (The person may not be able to hear you during unconsciousness but verbal assurances help as a person is regaining consciousness.)

Provide as much privacy as possible for the individual during and aRer seizure ac7vity.

19

Polysomnography Safety

•  Chest Pain & Arrhythmias

– Plan in place for response •  Falls

– Evaluate for Fall Risk

20

IONM Safety

•  Avoid contamina7on of sterile field •  Sharps safety

– Minimize risk with needle placement and removal – Plan for needle s7cks

•  Arrange cables and equipment to prevent injury

•  Electrical •  Sterile electrodes

21

TJC RecommendaIons Focus on cleaning, disinfec7on, and steriliza7on

•  Rou7ne surface disinfec7on of electrodes – Change to disposables if possible – Rou7ne surface disinfec7on of electrodes

•  Thorough documenta7on of process via logs. –  Solu7on according to manufacturer recommenda7ons and temperature documenta7on

•  Surveyor will ask to see these.

•  Use of Sani or Cavi wipes and let them air dry ⁻  Surveyor will ask drying 7me, don’t guess, refer to the container

22

TJC RecommendaIons

•  Minimize transmission of infec7on ⁻  Be mindful of containers of gel and collodion; use on mul7ple pa7ents.

⁻  You will have to show that it’s your prac7ce to not cross contaminate

⁻  Consider single use -‐ expensive op7on ⁻  Thorough cleaning of items used on mul7ple pa7ents (cables, headboxes, connectors, etc)

23

TJC RecommendaIons

Polysomnography Safety •  Mask cleaning

–  If you use Cidex there are many control requirements, consult your Infec7on Control Dept.

•  Must follow each manufacturer’s instruc7ons for cleaning of the masks

– Be mindful of recommended cleaning cycles for masks. Manufacturers may suggest limita7ons on cleaning, for example 15-‐20 cleaning cycles.

24

Modified CDC recommendaIons: Sequence for Removing PPE

1.  Gloves 1st pair (contaminated) 2.  Face shield or goggles 3.  Gown 4.  Mask or respirator 5.  Gloves 2nd pair 6.  Wash hands **Double gloving ini7ally, will allow you to follow the recommended sequence and s7ll move your dirty equipment out of the room. Most PPE sequences don’t have the technologist in mind. Ask your Infec7on control department to follow you and modify their instruc7on to include considera7on of your workflow.

25

26 http://app1.unmc.edu/nursing/heroes/pdf/heroesDonningDoffingYourHospitalPPE-Poster2012.pdf

EBOLA PPE Re-‐training is key •  Adhere to your hospital ini7a7ve on course of ac7on •  Best prac7ce – Follow the leaders h^p://www.emoryhealthcare.org/ebola-‐protocol/index.html h^p://www.who.int/csr/disease/ebola/protec7ve-‐measures-‐staff/en/ h^p://www.nebraskamed.com/biocontainment-‐unit/ebola h^p://www.cdc.gov/vhf/ebola/hcp/index.html

27

•  Acute onset; typically 8–10 days aRer exposure (range 2–21 days)

•  Signs and symptoms –  Ini7al: Fever, chills, myalgias, malaise, anorexia

–  ARer 5 days: GI symptoms, such as nausea, vomi7ng, watery diarrhea, abdominal pain

–  Other: Headache, conjunc7vi7s, hiccups, rash, chest pain, shortness of breath, confusion, seizures

–  Hemorrhagic symptoms in 18% of cases

•  Other possible infec7ous causes of symptoms –  Malaria, typhoid fever, meningococcemia, Lassa fever and other

bacterial infec7ons (e.g., pneumonia) – all very common in Africa

28

Early Clinical Presenta7on

Centers for Disease Control and Preven7on h^p://www.cdc.gov/vhf/ebola/ppt/ebola-‐101-‐cdc-‐slides-‐for-‐us-‐healthcare-‐workers.pptx

Resources •  Agency for Healthcare Research and Quality •  (AHRQ) www.ahrq.gov •  American Society of Healthcare Risk Management (ASHRM) www.ashrm.org

•  Ins7tute for Healthcare Improvement– www.ihi.org •  Na7onal Pa7ent Safety Founda7on – www.npsf.org •  Centers for Disease Control ww.cdc.gov h^p://www.cdc.gov/injec7onsafety/IP07_standardPrecau7on.htm

29

QuesIons??

Please feel free to contact me with quesIons. [email protected]

30

paentsafetyandinfeconprevenonin electroneurodiagnoscs · paentsafetyandinfeconprevenonin...

Documents