Quality Assurance and Safety Practices

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Quality Assurance and Safety Practices

• Chapters 6 and 7

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Quality Control

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

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Reasons for this concern include

• Recognition that Total Quality Management (TQM)
  principles have dramatically increased the
  quality of products manufactured in the United
  Statesthey should be able to do the same in
  healthcare.
• Greater visibilitythe public is demanding more
  information on the quality of care they receive.

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What are some of the top risks that patients face?

• Misdiagnosisprimarily a physician problem, but
  hospitals play a part.
• Failure to adequately monitor the
  patientprimarily a hospital problem often caused
  by shortages in staffing.
• Failure to appropriately use the chain of command.

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What are some of the top risks that hospitals
face?

• Falls and injuriespreventable by the hospital
  staff.
• Medication errorsa problem caused by doctors
  and/or pharmacies.

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What are some of the top risks that hospitals
face?

• No response by hospital personnel to abnormal
  diagnostic testing values.
• Misread radiology tests.

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What are some of the top risks that hospitals
face?

• Infectionsmany of these arise in the hospital.
• Exposure to hazardous materialsfailure to follow
  prescribed procedures.

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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

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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
• Monitoringgathering and acting on data

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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

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Medical Staff Membership

• Allows doctors to admit patients to the hospital
• Is granted by the hospitals board of trustees
  upon recommendation from the medical staff

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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.

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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

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Credentialing of Hospital Personnel

• As mentioned in an earlier chapter,
  credentialing includes
• Accreditationan evaluation that assures that an
  organization meets minimum standards
• Certificationrecognition by a non-governmental
  regulatory body that an individual meets
  standards
• Licensurerecognition by a governmental body that
  an individual meets minimum educational
  requirements, and has the knowledge and skill to
  practice a specific profession

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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

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Employee Training

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

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Monitoringgathering 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.

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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.

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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.

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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.

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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.

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Quality Control at Brannan Community Hospital
23
Lets talk a little more about hospital infections

• What causes infections?
• Pathogens
• Microorganisms that causes disease. Common
  pathogens include bacteria, viruses, and fungi

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Bacteria

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

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Reaction to gram stain

• Gram-positive bacteria 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.

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Virus

• The smallest of the infection agents, with few
  exceptions, 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.

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Fungi

• Plantlike pathogens (molds and yeasts).

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Good Website

• Medical and surgical asepsis
• http//www.cdc.gov/ncidod/hip/a_z.htm
• See Isolation Guidelines and Infection
  Guidelines.

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Principles of Body Mechanics and Ergonomics
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Ergonomics

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

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Body mechanics

• Using the bodys 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.

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Advantages Of Proper Body Mechanics

• Prevent injury
• Reduce energy consumption

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Components Of Good Body Mechanics

• Posture
• The alignment of head, trunk, arms, and legs
• The proper alignment of the body
• Coordination of body movement

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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.

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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.

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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.

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The End