ASHRM has provided important patient safety tips and information that are in alignment with the Hospital Engagement Network (HEN) program. The goal of this initiative is to assist hospitals in adopting practices that have the potential to reduce inpatient harm by 40 percent and readmission by 20 percent. ASHRM will continue to be a resource to help improve patient safety in these areas:
1. Adverse Drug Events
Most medications are beneficial, or at least cause no harm. Occasionally, drugs can injure patients. Some of these "adverse drug events" are unavoidable, such as an acute reaction. But errors in any of the following processes, or a combination of the processes, can cause patient harm:
Many of these errors are not caused by individual carelessness, but by faulty processes that lead to human errors or fail to prevent the mistakes from occurring in the first place.
Tips to preventing adverse drug events
Source: Institute for Safe Medication Practices: www.ismp.org
More tips for preventing adverse drug events are detailed in ASHRM Pearls for Medication Safety, available at the ASHRM online store. Click Here to order the booklet.
2. Catheter-associated Urinary Tract Infections (CAUTI)
The urinary tract is the most common site of healthcare-associated infection, accounting for more than 30 percent of infections reported by hospitals, according to the Centers for Disease Control and Prevention (CDC). Complications associated with CAUTI cause patient discomfort, prolonged hospital stay and increased patient mortality. Virtually all healthcare-associated urinary tract infections (UTIs) are caused by indwelling urinary catheters.
Tips for preventing CAUTI
The first and most important step nurses and other caregivers can take to prevent CAUTI is to wash their hands before inserting and managing indwelling urinary catheters. Other tips include:
Medscape Today: www.medscape.com/viewarticle/587464_4
Centers for Disease Control and Prevention: www.cdc.gov/nhsn/pdfs/pscManual/7pscCAUTIcurrent.pdf
3. Central Line-associated Blood Stream Infections (CLABSI)
A central line is a tube that is placed into a large vein in the patient's neck, chest, arm or groin and used to draw blood or give fluids and medications. It may be left in place for several weeks. A bloodstream infection can occur when bacteria or other germs travel down this tube and enter the blood. Patients who develop a central-line associated bloodstream infection may develop a fever and the skin around the catheter may become sore and red.
Tips for preventing CLABSI
Source: Centers for Disease Control and Prevention: www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf
4. Patient Falls
Falls occur in all types of healthcare institutions and to all patient populations. However, patients most at risk include the elderly and frail, and those on medication regimens such as anticoagulant therapy. Patient falls lead to obvious physical consequences such as fractures and soft tissue or head injuries. However, patients who fall also suffer emotional consequences such as fear, anxiety and depression. Some falls are difficult to prevent, such as those caused by intrinsic risk factors including:
Falls caused by extrinsic risk factors are easier to prevent. Common extrinsic risk factors include:
Tips for preventing patient falls
Once a patient is determined to be at risk of falling, it becomes a priority to communicate this risk to all staff, the patient, and the patient's family. This task can be accomplished through the medical record, handoff communications, signage (door, wall, wristband), and other methods that continue to alert staff to the patient's risk. Interventions to prevent injury in the acute and long-term care settings include limiting restraint use, lowering bedrails, frequent staff rounding, using hip protectors in long-term care, and prescribing calcium with vitamin D, and possibly bisphosphonates (a class of drugs that prevent the loss of bone mass, used to treat osteoporosis and similar diseases) to patients in long-term care.
Source: Joint Commission Resources: www.jcrinc.com/Preventing-Patient-Falls
5. Obstetrical Adverse Events: Perinatal Death or Loss of Function
A healthy and safe birth for the mother and infant is the goal for all labor and delivery units. A celebratory event turns to tragedy when a birth results in the newborn's death or permanent injury. The absence of early and regular prenatal care is a leading contributor to the risk of infant death. Other risk factors include maternal age, history of diabetes and substance abuse. Complications that can occur during labor include failing to recognize a non-reassuring fetal status on the fetal monitor. Complications during birth include placental abruption, ruptured uterus and breech presentation. Although some infant deaths cannot be prevented, breakdowns in care can contribute to birth complications. Some root causes of birth complications identified by The Joint Commission include:
Tips to prevent perinatal death or loss of function
The Joint Commission's "Sentinel Event Alert, Issue 30: Preventing infant death and injury during delivery" outlines strategies to reduce risk of perinatal death, including:
Source: The Joint Commission: www.jointcommission.org/assets/1/18/SEA_30.PDF
Risk management techniques to help prevent obstetrical adverse events are explained in ASHRM Pearls for Obstetrics, available at the ASHRM online store. Click Here to order the booklet.
6. Pressure Ulcers
Pressure ulcers, also called bed sores, are injuries to the skin and underlying tissues that result from prolonged pressure on the skin. Bedsores most often develop on the skin that covers bony areas of the body, such as the heel, ankles, hips or buttocks. People most at risk of pressure ulcers are those with a medical condition that limits their ability to change positions, requires them to use a wheelchair or confines them to a bed for prolonged periods. Left untreated, pressure ulcers can develop into:
Tips for preventing pressure ulcers
Bedsores can develop quickly and are often difficult to treat. Several care strategies can help prevent some bedsores and promote healing.
Source: Mayo Clinic: www.mayoclinic.com/health/bedsores/DS00570
ASHRM Pearls for Long-Term Care details best practices for preventing pressure ulcers in bedridden and wheelchair-confined patients. Click Here to order the booklet.
7. Surgical Site Infections
Recent research has found that surgical site infections (SSI) occur in 2 to 5 percent of patients undergoing inpatient surgery in the United States. Approximately 500,000 SSIs occur each year, with 75 percent of deaths among patients with SSIs directly attributable to the SSI.
SSIs are classified in three categories:
There are several strategies hospitals can adapt to prevent SSIs, the first being to follow existing guidelines, recommendations and requirements regarding SSIs, and develop new guidelines as needed. Other strategies include:
Source: Journal of Infection Control and Hospital Epidemiology, Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: www.wsha.org/files/82/HAI-SurgicalSiteStrategies.pdf
8. Venous Thromboembolism
A venous thrombosis is a blood clot (thrombus) that forms within a vein. In deep vein thrombosis (DVT) a clot breaks off and can become a life-threatening pulmonary embolism (PE). The conditions of DVT and PE are referred to collectively as venous thromboembolism. Thrombosis can occur when blood flow within the veins is slowed or blocked, the lining of the vessel wall is damaged (due to surgery or injury) or too many-blood clotting substances are present in the blood.
Most deep vein clots occur in veins of the leg or pelvis. Swelling, discomfort, redness, or warmth in the legs may be the first sign of a clot forming, although in many cases there are no initial symptoms. DVT itself is not life threatening. However, if part of a clot dislodges and blocks the flow of blood to the lungs, this may cause chest pain, shortness of breath and possibly haemoptysis (coughing up of blood). A large clot in the lungs may obstruct blood circulation, causing breathlessness, dizziness or shock, and may be life threatening.
Tips to prevent venous thromboembolism
There are a number of medicines, mechanical therapies and surgical procedures that can be used in both the prevention and treatment of deep vein thrombosis and pulmonary embolism:
Source: Agency for Healthcare Research and Quality: www.ahrq.gov/qual/vtguide/
9. Ventilator-associated Pneumonia
Pneumonia is a leading cause of death due to hospital-acquired infections. Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hours after patients have been intubated and received mechanical ventilation.VAP is caused by microorganisms invading the lower respiratory tract and lung parenchyma. The presence of an endotracheal tube provides a direct route for colonized bacteria to enter the lower respiratory tract.
Tips to prevent VAP
There are several interventions healthcare providers can use to prevent VAP. These interventions can begin before intubation and should be continued until extubation:
Sources: Medscape Reference: emedicine.medscape.com/article/304836-overview
Clinical Microbiology Reviews, Ventilator-Associated Pneumonia: Diagnosis, Treatment and Prevention: www.ncbi.nlm.nih.gov/pmc/articles/PMC1592694 Critical Care Nurse, Ventilator-Associated Pneumonia: http://ccn.aacnjournals.org/content/27/4/32.full
10. Preventable Readmissions
Hospital readmission rates can be an important indicator of quality of patient care. A readmission may result from incomplete treatment or poor care of the patient's underlying problem during the original/previous admission. Or it may reflect poor coordination of services at the time of discharge and an inadequate access to post discharge care.
Educating patients about their aftercare is key to keeping them healthy and in preventing them from returning to the hospital. Before discharging patients, healthcare providers should ensure that these patients:
Source: Centers for Medicare and Medicaid Services, Indentifying Potentially Preventable Readmissions: www.cms.gov/HealthCareFinancingReview/downloads/08Fallpg75.pdf