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 nonradiologists.
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/nci
dod/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