HRM Week Tip Sheet: 5 Steps to Safe and Trusted Healthcare

During HRM Week, ASHRM is offering tips that risk managers and patient safety experts can employ to help eliminate some of the most common preventable serious safety events and assist your organization in "Getting to Zero™ through the Power of One."
 
1. Right Ways to Eliminate Wrong-site Surgeries
A simple solution for preventing wrong-site surgeries involves surgeons signing their initials to the patient's operative site using a permanent marking pen. The patient should confirm the operative site as the surgeon marks it. Members of the operative team also need to verify the site.
 
Other solutions for preventing wrong-site surgeries includes:

• Ensure that copies of the operative permit/informed consent form state the correct surgery.
• Have the surgeon verify  that X-rays and medical records are for the correct patient as well as confirm the identity of the patient before beginning the procedure.

2. Remember to Remove Foreign Items from Surgery Patients
Removing all foreign bodies from patients prior to finishing surgery will eliminate the need for patients to undergo a second surgery to remove the objects, and also lesson their risk of a surgical site infection. Follow these best practices:

• Perform procedures in facilities with established written protocols for counting sponges, sharps, and instruments that meet Association of Operating Room Nurses (AORN) standards and/or are accredited by The Joint Commission.
• Make certain that counts are performed and reported to surgeons as correct, both as the beginning and again, at the conclusion of every sirgical procedure
• Include one phrase-without fail-in every operation report: The sponge and needle counts were reported to be correct.
  
• Maintain a healthy level of suspicion that complicated wound healing might be caused by a retained foreign body.

3. Steps to Help Stop Death or Injury of Patient in Restraints
Restraint and seclusion are safety interventions of last resort, to be used only when an individual poses an imminent danger to someone's safety. Restraint and seclusion may be ordered only by a physician or a licensed independent practitioner (such as a physician's assistant or nurse practitioner who is licensed to deliver medical services without oversight). Follow these best practices for restraint use:

• Make sure restraint orders are time-limited-four hours maximum for adults, two hours for adolescents ages 9-17, and one hour for children under age 9-and the intervention is ended as soon as it is safe to do so.
• Prohibit certain risky practices, such as "basket holds" and applying back pressure to a person who is prone.
• Ensure that a physician or licensed independent practitioner conducts a face-to-face assessment of the individual as soon as possible, which cannot exceed one hour.
• Have appropriately trained staff continually assess, monitor and reevaluate individuals who are restrained or secluded.
• Hold debriefings with the individual and staff as soon as possible after each use of restraint or seclusion. 

4. Exchange, Educate Your Way to Eliminating Medical Errors
There's no panacea for eliminating mistakes, but a starting point is clearly communication. Better doctor-patient exchanges improve medical care. A well-designed system also can help prevent medical errors. For example, a seemingly simple task of dispensing a drug at a hospital is actually a complex process that requires five interdependent steps: ordering, transcribing, dispensing, delivering and administering. A poorly designed system can lead to an error in any of those steps which can lead to a serious adverse outcome or death of a patient.
 
- Some steps to reduce or prevent future medical errors include:
- Implement a patient's informed consent policy.
- Get a second opinion from another independent practitioner with similar qualifications.
- Voluntarily report errors.
- Conduct a root cause analysis to determine the cause of the error and to develop actions to prevent a similar event from occurring in the future.
 
5. Best Practice Pointers to Patient Suicide Prevention
There are three umbrella actions to take to prevent patient suicides: be direct, listen and observe, and safeguard the environment. The most simple, and perhaps effective, thing a healthcare worker can do to determine whether patients are at risk of committing suicide is to ask them directly.

- Ask follow-up questions, listen carefully to the patient, watch the patient's actions, and do not judge or criticize the person.
- Make sure a healthcare worker stays with the patient at all times, or checks on the patient every 5, 15, or 30 minutes, depending on the patient's condition. Put at-risk patients in hospital rooms designed to minimize suicide risk by containing no curtains, towels or sheets patients can use to hang themselves.