What
are
IPSGs?
The
are important guidelines developed by orld
ealth rganisation and
oint ommission
nternational to promote
in patient care.
NABH also has adopted it in its 5th Edition
Hospital Standards.
Patient safety is the responsibility of every
healthcare worker who is directly or indirectly
involved in patient care.
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What are IPSGs?
Why IPSGs?
• To promote specific improvements in patient safety and
minimize the error.
• To highlight problematic areas in healthcare and describe
evidence and expert based consensus solutions for these
problems.
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International Patient Safety Goals
Goal 1: Identify Patients Correctly
Goal 2: Improve Effective Communication
Goal 3: Improve Safety of High Alert Medication
Goal 4: Ensure Safe Surgery-Right Patient, Site & Surgery
Goal 5: Reduce the Risk of Healthcare Associated Infection
Goal 6: Reduce the Risk of Patient Harm Resulting from Falls
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Identify Patient Correctly
Why Identify Patients?
Prevent treating/caring for wrong
patients.
???Challenges:
 Patients with same name
 Too many patients
 High Turnover
 Habit of depending on memory
 Heavy workload
 Inadequate protocols
 Lack of appropriate understanding
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Identify Patient Correctly
How to Identify Patients?
Use full name and Unique Hospital
Number (UHID)
Place Id band with above info
Where?
Left hand wrist of the patient
Remember to involve the patient whenever possible
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Identify Patient Correctly
When to Identify Patients?
BEFORE Administration of any medication, IV fluids
 Administration of blood and blood products
 Shift hand over
 Serving food
 Receiving the patient
 Doing any procedure
 Extra attention when two patients have same
name
Read the name and UHID on Id band, countercheck with the
patient file, confirm with the patient whenever possible
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Goal 1: Identify Patients Correctly
Goal 2: Improve Effective Communication
Goal 3: Improve Safety of High Alert Medication
Goal 4: Ensure Safe Surgery-Right Patient, Site & Surgery
Goal 5: Reduce the Risk of Healthcare Associated Infection
Goal 6: Reduce the Risk of Patient Harm Resulting
from Falls
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Improve Effective Communication
 Hand over Communication
 Verbal / Telephone Order
 Reporting Critical Result
Handover Communication Verbal/Telephonic Order Reporting Critical Test Results
ISBAR
Shift Handover Template for
handing over from one shift to
next
Interdepartmental Transfer
Template for handover
“No Verbal Order” Policy
In Exceptions follow Read/
Repeat Back.
IDENTIFY the patient correctly
LISTEN to the result carefully
DOCUMENT - In the Critical Value
Register.
Read and Verify the Result Again
Inform the Clinician & get it endorsed
/signed in 24 hours
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Improve Effective Communication
The ISBAR framework
I
IDENTIFY
S
SITUATION
B
BACKGROUND
A
ASSESSMENT
R
RECOMMENDATION
SPECIFY
Who are you ?
Where are you ?
Patient’s name, age, gender and department
What is the PROBLEM / reason for contact ?
I am calling because………(describe)
I have observed major changes…….(ABCDE)
I have measured the following values……(RR, HR, rhythm, values, SPO2, BP, capillary refill time, temp etc)
I have received test results…….
If its urgent and / you are concerned – speak up.
Brief and relevant case history
Admission diagnosis and date
Previous illnesses of significance
Relevant problems and treatment / interventions to date
Allergies
Assessment (of the situation and background)
I think the problem / reason for the patient condition is related to (respiration, circulation, neurology).
I don’t know what’s the problem is but the patient’s condition has deteriorated
The patient is unstable, we need to do something
I am concerned.
Request specific advices and interventions, and clarify expectations
I suggest ……/what interventions do you recommend
Immediate intervention
Investigation / treatment
How often should I………
When should I make next contact ? when will you be here ?
Confirm messages and interventions with a closed loop.
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Improve Effective Communication
Improve Effective Communication
Verbal / Telephonic Order
Hospital Policy- “No Verbal Order to be followed”
In Exceptions follow Read / Repeat Back
Exceptions
eg. Insulin orders (sliding scale)
Resuscitation -ACLS protocol
Verbal/ Telephonic Orders Policy
Accepted only in exceptional cases as mentioned in
policy.
Follow below steps for telephone orders
1.Confirm patient identification using Two identifiers
2.Write the order as exactly as heard over the phone
including date and time, name of patient, the complete
order and sign at the end.
3.Read back what you have written.
4.Get confirmation from other end.
5.Sign off the document.
6.Get counter sign from the doctor within 24 hours.
7.Follow hospital policy; some institutions require
telephone orders to be reviewed and signed by twonurses.
For verbal orders:
1.Confirm patient identification using two identifiers
2.Repeat any prescribed orders back to the physician
while preparing and loading.
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3.Use clarification questions to avoid misunderstanding.
Goal 1: Identify Patients Correctly
Goal 2: Improve Effective Communication
Goal 3: Improve Safety of High Alert Medication
Goal 4: Ensure Safe Surgery-Right Patient, Site & Surgery
Goal 5: Reduce the Risk of Healthcare Associated Infection
Goal 6: Reduce the Risk of Patient Harm Resulting
from Falls
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Improve Safety of High Alert Medication
Prescription
Dispensing
Labeling
Storage
Preparation and Administration
Prescription Dispensing
Labeling
Storage
Preparation &
Administration
Legible
Allow only
approved
abbreviation
Red color pouch High alert sticker High alert
cupboard
Under lock and
key
*Store LASA drugs
on different shelves
physically apart
Double verification by self
Follow rights of
medication Administration
Independantly verified
and signed by 2 nurses
Appropriate monitoring
Narcotics
Triplicate prescription
*LASA-Look alike Sound alike
Store separately in double lock cupboard, key with two available designated staff
Maintain narcotic register, return of empty & broken ampules
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Improve Safety of High Alert Medication
Ensure High alert labels on medication, shelves etc.
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Improve Safety of High Alert Medication
You must comply to the following:
Know your hospital policy of medication
safety , High-Alert Drug List and protocol
for administration
You need privileging (permission to do)
for administering such medications to
patients.
Double check the “rights of medication
administration” with another nurse
Examples of High Alert Medications:
•Concentrated electrolytes Infusions
•3% Saline
•Potassium Chloride
•Muscle Relaxants
•Succinylcholene, Atracurium, Vecuronium,
Pancuronium
•Intravenous Anticoagulants
• Heparin
•Insulin
•Narcotics
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Improve Safety of High Alert Medication
Look Alike-Sound Alike (LASA) Drugs
Take extra care: Keep in physically apart shelves
Tallman Lettering
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Goal 1: Identify Patients Correctly
Goal 2: Improve Effective Communication
Goal 3: Improve Safety of High Alert Medication
Goal 4: Ensure Safe Surgery-Right Patient, Site & Surgery
Goal 5: Reduce the Risk of Healthcare Associated Infection
Goal 6: Reduce the Risk of Patient Harm Resulting
from Falls
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Ensure Safe Surgery-Right Patient,Site & Surgery
To prevent
 Wrong-Site
 Wrong-Procedure
 Wrong-Patient Surgery
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Ensure Safe Surgery-Right Patient,Site & Surgery
Protocols
Pre-Operative Check List
Pre-operative Site Marking
Surgical Safety Checklist Sign in, Time Out, Sign Out
Care Location
Responsibility
Ward/IP Unit/OT
Ward Nurse &
OT receiving Nurse
Ward/IP Unit
Operating Surgeon/
team doc
Operation Theatre
OT receiving Nurse,
Anesthetist, Surgeon, Scrub
Nurse
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Ensure Safe Surgery-Right Patient,Site & Surgery
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Goal 1: Identify Patients Correctly
Goal 2: Improve Effective Communication
Goal 3: Improve Safety of High Alert Medication
Goal 4: Ensure Safe Surgery-Right Patient, Site & Surgery
Goal 5: Reduce the Risk of Healthcare Associated Infection
Goal 6: Reduce the Risk of Patient Harm Resulting
from Falls
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Reduce the Risk of Health Care Associated Infections
Healthcare Associated Infection (HAI)
Any infection which was not present while coming to the hospital
and acquired by a patient while being in the hospital.
E.g.
Catheter Associated Urinary Tract Infection (CAUTI)
Ventilator Associated Pneumonia (VAP)
Central Line Associated Blood Stream Infection (CLABSI)
Surgical Site Infection (SSI)
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Reduce the Risk of Health Care Associated Infections
Hand Hygiene involves
 Hand washing using antimicrobial soap
 Use of antimicrobial hand rub agents
5 Moments of Hand Hygiene by WHO
When to do Hand Hygiene?
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Goal 1: Identify Patients Correctly
Goal 2: Improve Effective Communication
Goal 3: Improve Safety of High Alert Medication
Goal 4: Ensure Safe Surgery-Right Patient, Site & Surgery
Goal 5: Reduce the Risk of Healthcare Associated Infection
Goal 6: Reduce the Risk of Patient Harm Resulting
from Falls
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REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALLS
Factors causing Accidental patient fall:
 Patient factors: very old and very young age, gait
problems, sensory deficit- hearing / sight problems,
orthostatic hypotension
 Environmental factors: less light, cluttered room, loose
wires on floor, slippery floor etc.
 Equipment factors: Malfunctioning of stretcher, wheel
chair, bed etc.
 Effects of medications, medical conditions,
hypoglycemia etc.
 Human factors: e.g., forget to place safety belt, side rails
placement.
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REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALLS
Fall Risk Assessment on admission/every
shift/when condition / treatment changes
Fall Prevention Strategies
Involve Patient & Family
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REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALLS
Fall Risk Assessment
Fall risk assessment is carried out for all patients during
admission and the reassessment will be done and documented
in every shift and when ever health status of the patient
changes.
Risk for fall for a patient is measured by using
Fall risk assessment tool
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REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALLS
Fall Risk Assessment Tool
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REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALLS
Risk Reduction Activities:
• Identifying the vulnerable groups for fall.
• Assessment of Vulnerable patients within the turnaround
Time.
• Applying vulnerable patients colour band.
• Ensure lowest height of patient bed with side rails up.
• Applying breaks for all the beds.
• Patient warning card at the edge of the bed.
• Education to the relative /patient on fall risk prevention.
• Education of the staff on fall risk assessment & prevention.
• Importance of using appropriate safety belts on stretchers
and wheelchairs during transportation.
• Availability of disable friendly washrooms.
REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALLS
Risk Reduction Activities
• Hourly Rounding for high-risk patients.
• Use of grab bars and call bells.
• Ensure call bell is within reach of patient.
• Ensure night lamp in patient room.
• Use of assistive devices for patients.
• Ensure bed side table and belongings are with in reach of
patient.
• Patient without bystanders not to be admitted in single
room.
TELLING IS NOT ENOUGH
• Educate and update yourself regularly.
TEACH
BACK
• Report any fall immediately.
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REDUCE THE RISK OF PATIENT HARM RESULTING FROM FALLS
CONSEQUENCES OF FALL
Consequences of Fall
• Fractures of the hip, femur, humerus, wrist
• Soft tissue injuries
• Hematoma
• Neurological consequences
• Head Injury
• Increased length of stay
• Disability
• Death at times
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Goal 1: Identify Patients Correctly
Goal 2: Improve Effective Communication
Goal 3: Improve Safety of High Alert Medication
Goal 4: Ensure Safe Surgery-Right Patient, Site & Surgery
Goal 5: Reduce the Risk of Healthcare Associated Infection
Goal 6: Reduce the Risk of Patient Harm Resulting
from Falls
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POST TEST
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