QUALITY ASSURANCE AND SAFETY PRACTICES

CHAPTERS 6 AND 7

Code Blue

Health Science Edition 4

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.

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.

Quality Control

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

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.

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.

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.

What are some of the top risks that hospitals face?

No response by hospital personnel to abnormal diagnostic testing values.

Misread radiology tests.

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.

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

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

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

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

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.

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

Credentialing of Hospital Personnel

As mentioned in an earlier chapter, credentialing includes:

Accreditation—an evaluation 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

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

Employee Training

Training is a key component of quality control

Training is performed by:• Universities

• Professional associations

• In-service departments within hospitals

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.

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

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

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

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.

Quality Control at Brannan Community Hospital

Let’s talk a little more about hospital infections

What causes infections?• Pathogens:

• Microorganisms that causes disease Common pathogens include bacteria, viruses, and fungi

Bacteria

These are classified according to:• Shape: Cocci

(spherical), Bacilli (rod shaped), and Spirochetes (corkscrew)

• Reaction to gram stain

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.

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.

Fungi:

Plantlike pathogens (molds and yeasts)

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

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

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.

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

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

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

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

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

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

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

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

Good Website:

Medical and surgical asepsis:

http://www.cdc.gov/ncidod/hip/a_z.htm

See “Isolation Guidelines” and “Infection Guidelines.”

Principles of Body Mechanics and Ergonomics

Ergonomics:

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

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.

Advantages of Proper Body Mechanics

Prevent injury Reduce energy

consumption

Components of Good Body Mechanics

Posture The alignment of head, trunk, arms,

and legs The proper alignment of the body Coordination of body movement

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

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

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

Review Homework Questions

The End