| One of the most important contributions those working in healthcare can make is to: | View Page |
| Laboratory Response The broad base of clinical laboratories in this country is an essential component of our nation’s public health and healthcare system and is an essential link in addressing biological and chemical terrorism. In 1999 the Centers for Disease Control and Prevention (CDC) initiated the concept of a Laboratory Response Network (LRN). The LRN is a network of local, state, federal, and military laboratories across the United States and internationally which work together in an integrated and coordinated way for a rapid response to public health emergencies. The LRN concept of operations is based on a system of safety and proficiency. | View Page |
| The Fear Factor in Bioterrorism As the term suggests, Terrorists excel at creating panic. What is so insidious about chemical and biological terrorism is that it involves agents that we can’t see. People don’t know how to react when they can’t see what is hurting them. There are several examples, from a commercial bus crash to someone who reported smelling gas in a school, where rumors that the incidents were caused by either biological or chemical terrorism triggered an “epidemic hysteria”. In both areas the local hospital’s emergency room was overwhelmed. In each of the incidents mentioned, State and Federal officials spent countless hours investigating and found no possible biohazard, but the panic was real. From these experiences we see more than ever that healthcare workers are not just the first line of defense in the event of an actual attack, they are who the public looks to for rationality and reliable information in an bioterrorism emergency. | View Page |
| What You Can Do to Prevent Panic The first step in minimizing hysteria is knowing what to expect and what to do in different circumstances. In other words, the single best agent to prevent or lessen hysteria is knowledge. Healthcare workers must not only be knowledgeable regarding what to do for themselves, but to help educate the general public as well so that everyone will respond to rumors or the real thing in a sane and rational manner. It is the responsibility of every healthcare worker to help provide information and resources, not only where they work, but also to their families and to their community so everyone can take care of events as they occur. | View Page |
| Your Response - Beyond the Workplace As a healthcare professional, your preparedness and response in the event of a terrorist attack is not limited to just your workplace. The following pages give a brief overview of what you can do to help protect yourself, your family, and your community. | View Page |
| Analysis of medical errors and adverse events creates opportunities to improve healthcare systems. True or false? | View Page |
| Near misses or "close calls" enable the healthcare community to discover new ways to prevent medical errors. True or false? | View Page |
| What does the JCAHO Speak UP campaign encourage? | View Page |
| The Joint Commission on Accreditation of Healthcare Organizations promotes improved patient safety through its programs and resources. True or false? | View Page |
| Medical Errors in the United States Most medical interventions produce positive outcomes. Everyone expects to give and receive effective medical care. These expectations are routinely met by the healthcare community.
However, a 2000 publication from the Institute of Medicine, the IOM, To err is human: Building a safer health system, reports that medical errors cause as many as 98,000 deaths every year in the United States. | View Page |
| The Joint Commission and Sentinel Events The Joint Commission learns about 80% of known Sentinel Events through healthcare organization reports and 20% through information from other sources, such as the media. In 1996, The Joint Commission implemented a "Sentinel Events Policy" for healthcare organizations. This policy requires organizations to monitor and report adverse events, explore their causes, and report on changes they make in response to the event. | View Page |
| The Joint Commission Sentinel Event Alert Since 1998, the Joint Commission has issued 25 Sentinel Event Alerts to the healthcare community. These publications include more than 50 evidence or expert-based recommendations for preventing adverse events. Sentinel Event Alerts address various error reduction topics: Transfusion reactions Inpatient suicide Infant abductions Wrong site surgery or other procedures Patient fallsLaboratory professionals can be involved in all of these types of Sentinel Events. The Joint Commission's first Sentinel Event Alert addressed the common practice of storing concentrated potassium chloride solutions in hospital nursing units. | View Page |
| Reporting Reluctance Errors must be identified before their number can be reduced.
Like most people, healthcare professionals are reluctant to admit mistakes. Guilt feelings, avoidance of punishment, and colleague disapproval feed this reluctance.
Fear of lawsuits silences discussion about error reduction. Most professionals work with the best of intentions and skills. Occasionally their efforts produce unintended results and they are forced to pay huge settlements to patients. These outcomes encourage the silence. | View Page |
| Culture of Secrecy People tend to look for someone to blame when medical mistakes occur. Victims and their loved ones find some satisfaction in blaming.
An environment of blame encourages a culture of secrecy about medical mistakes. Mandatory reporting laws have not overcome this secrecy, and they do not encourage efforts to find ways of avoiding errors.
Error reduction requires a commitment from the healthcare community to recognize and acknowledge that medical errors indicate systems problems, not people problems.
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| Observation and Review Human observation and record review help the healthcare community reduce errors several ways:
They indicate and signal system breakdowns.They create new reference points for quality improvement and best practices.They focus resources on error correction.They evaluate interventions.They provide examples for problem solving and continuing education.They focus on cause analysis.
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| Relevant Human Factors Human factors influence medical errors and their reporting.
Everyone involved in healthcare is human and inherently fallible.
Completely error-free medical care requires a knowledge base and performance level that exceeds human capability.
Healthcare providers must abandon the naming, blaming, and shaming of people that fosters reluctance to admit errors. | View Page |
| Failure Mode and Effect Analysis The Joint Commission, a voluntary hospital accreditation program, requires healthcare organizations that participate in its program to perform Failure Mode, Effect, and Criticality Analysis (FMECA) at least once each year. FMECA systematically identifies ways developing systems and processes might fail to eliminate the likelihood of failure. Its goal is preventing errors before they occur. | View Page |
| New Joint Commission Standards The healthcare community uses RCA to reduce medical errors, but it is reactive in nature. For this reason, Joint Commission collaborates with recognized patient safety experts to develop and implement additional patient safety standards. These new standards charge healthcare organization leaders to create cultures of patient safety. They emphasize the need for teamwork and effective communication. They are based on well-known experiences of the aviation industry and they reflect findings from Joint Commission's Sentinel Event Database. They identify communication breakdowns as the most common underlying factor in all types of Sentinel Events. | View Page |
| Joint Commission Patient Safety Goals Joint Commission adopted national patient safety goals for healthcare organizations, including specific goals for laboratories. 2009 Laboratory Services National Patient Safety Goals These goals are directly quoted. | View Page |
| American Society for Clinical Laboratory ScienceThe American Society for Clinical Laboratory Science, ASCLS, joins the leadership effort to prevent medical errors and increase patient safety. | View Page |
| Speak Up Campaign
JCAHO also encourages people to do things themselves to prevent errors.
It joined other groups in 2002 to launch the consumer Speak Up campaign. It encourages the public to become active participants in their healthcare and "speak up" when they have questions and concerns.
As a healthcare professional, you should be aware that JCAHO has started a program to encourage patients and their families to become more involved in their medical care. | View Page |
| Which of these actions can people do themselves to prevent medical errors? | View Page |
| Medical Negligence Unfortunately, adverse events do occur in healthcare situations. They may or may not be preventable and they may or may not involve medical negligence. Medical negligence is a legal term. It describes adverse events involving patient care that fails to meet specific, established standards. Medical negligence occurs when a medical professional does not perform the correct action, resulting in great patient harm (an adverse event). | View Page |
| You Are At Risk! As a healthcare worker, you come into contact with materials that may contain bloodborne pathogens. These are infectious organisms, usually viruses, which live in human blood and body fluids.The most important ones are: Hepatitis B Virus (HBV) Human Immunodeficiency Virus (HIV) Hepatitis C Virus (HCV) | View Page |
| Importance of Hand Hygiene Hand hygiene is the single most important method of preventing infections in the hospital and healthcare setting.It is expected of all healthcare workers by the public. | View Page |
| How common is HIV? There are approximately 1.1 million individuals in the United States who are estimated to have HIV/AIDS.Worldwide, it is estimated that there are over 33 million persons with HIV/AIDS, with most of these individuals living in sub-Saharan Africa.As of December 2001, there have been 57 documented cases of occupationally acquired HIV infection among healthcare personnel in the United States since reporting began in 1985 (CDC data).Considering the large numbers of HIV positive patients cared for, this is a very small number. | View Page |
| Sharps A sharp is any object which can penetrate the skin.Examples include: Needles Scalpels Broken glass About 800,000 needlestick and sharps injuries occur in the U.S. healthcare workplace each year! It is important to handle and dispose of sharps properly. | View Page |
| What is Venipuncture? Venipuncture is the collection of blood from a vein. The person having the responsibility for the performance of the venipuncture may be a phlebotomist who is a part of the laboratory staff, or he/she may be another healthcare professional that has been trained to perform this duty. In this course, we will refer to the person performing the venipuncture as the phlebotomist. | View Page |
| Venipuncture Procedure At a Glance Required Step Description Step #1 Wash your hands. Clean your hands with soap and water or gel cleanser. Step #2 Positively identify patient using unique identifiers. Ask the patient to state his/her first and last name; if the patient is unable to give you this information, ask the patient's caregiver to confirm the patient's name. A second unique identifier must also be used. Step #3 Special test requirements Determine if the test to be obtained has any special requirements. For example, should the patient be fasting? Is this a timed test? If any requirements are not met, consult with the caregiver to determine a course of action. Step #4 Prepare the patient Explain the procedure to the patient and obtain cooperation. Usually the patient will extend an arm. (This is a form of implied consent.) Position the arm for venipuncture; support the arm on a firm surface; the arm should be in a downward position. Step #5 Site determination The patient can make a fist, but should not pump the hand open and closed. Apply tourniquet Palpate the vein. Release the tourniquet and assemble appropriate equipment. Step #6 Aseptic technique Wear gloves that have not been altered in any way. Cleanse site with approved disinfectant. Allow the disinfectant to air-dry to avoid hemolysis of the specimen and discomfort to the patient. Step #7 Specimen collection Re-apply tourniquet about 3-4 inches above puncture site, insert needle, bevel-side up, at about a 30° angle, and collect specimens. Remove needle and immediately activate the safety device. Mix specimens by gentle inversion 5-10 times. Step #8 Patient care Apply direct pressure to stop bleeding at puncture site; do not have patient bend arm as this may cause a hematoma to form. After about 2 minutes, check the puncture site to verify that bleeding has stopped. Apply bandage if appropriate. Thank the patient for his/her cooperation. Step #9 Specimen labeling Label specimen(s) in the presence of the patient including all the information that is required by your facility. Check the labeled tubes a second time against the patient's wristband to verify labeling accuracy. A professional phlebotomist follows the procedure in the same way for every venipuncture. This ensures that none of the vital steps are omitted. The phlebotomist who is consistent in performance and who concentrates fully to obtain a quality specimen is an indispensable part of the healthcare team. | View Page |
| Don't Compromise Your Safety An important element of safety is personal protective equipment (PPE). This must be provided to phlebotomists by their facility and may include gloves, lab coats and protective eyewear. An N95 respirator (shown in the lower image) or other respiratory protection may be required to protect the phlebotomist from Mycobacterium tuberculosis or other airborne infectious agents. Phlebotomists and other healthcare workers must be medically cleared and fit-tested to wear N95 respirators. For the phlebotomist, gloves are required during every procedure. The gloves must remain totally intact. The gloves cannot be altered in any way as to expose the hand or fingers to potential bloodborne pathogens. Never remove all or part of the finger tip of the glove while performing venipuncture. | View Page |
| The Ongoing Problem Tuberculosis is an ongoing problem in the United States. As a healthcare worker, it is important for you to be informed about tuberculosis. It can affect your life, family and coworkers. | View Page |
| High Risk Infection Groups The following persons are at higher risk for exposure to and infection from Mycobacterium tuberculosis: Frequent travelers to tuberculosis endemic areas; Residents and employees of high-risk congregate settings such as correctional facilities, long-term care facilities, and homeless shelters; Healthcare workers who serve high-risk patients or have unprotected exposure; Medically underserved and low-income populations; Infants, children, and adolescents exposed to adults in high-risk categories. | View Page |
| Matching Facts | View Page |
| CDC Guidelines The Centers for Disease Control (CDC) issued Guidelines for Prevention of Tuberculosis in Healthcare Settings in 2005.These guidelines have broader applications than the Guidelines for Prevention of Tuberculosis in Healthcare Facilities issued by CDC in 1994. | View Page |
| CDC Risk Categories CDC has identified three risk categories in health-care settings: A low risk healthcare setting is one in which HCWs will most likely not be exposed to persons with TB disease or to clinical specimens that might contain M. tuberculosis. A medium risk healthcare setting is one in which the HCW will or might possibly be exposed to persons with TB disease or to clinical specimens that might contain M. tuberculosis. A potential ongoing transmission healthcare setting is temporarily applied to any setting if there is evidence of person-to-person transmission of M. tuberculosis in the past year. | View Page |
| Tuberculosis Exposure Control Plan The CDC Guidelines for Prevention of Tuberculosis in Healthcare Settings recommend that all healthcare facilities develop a TB exposure control. The plan should include an exposure determination at defined intervals for all employees who may have occupational exposure to tuberculosis. | View Page |
| Match the recommended frequency for TB screening of a healthcare worker with the risk category of the healthcare setting from the drop-down box: | View Page |
| Protect Yourself Healthcare workers must be alert for signs and symptoms of TB to protect themselves from inadvertent exposure.Help protect yourself, coworkers, patients, and visitors by: Having current TB screening according to the risk classification of your setting, Understanding the risks of TB in your work area, Practicing good infection control at work and at home. | View Page |
| References Pratt R, Robison V, Navin T. Trends in tuberculosis. MMWR/57(11);281 - 285; Centers for Disease Control and Prevention: March 21, 2008. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5711a2.htm Last accessed on May 23, 2008.Respiratory Protection in Health-Care Settings Fact Sheet. Available at http://www.cdc.gov/niosh/99-143.html. Last accessed May 23, 2008. Slide set - Guidelines for preventing the transmission of M. Tuberculosis in Healthcare settings, 2005. Available at http://www.cdc.gov/tb/pubs/slidesets/InfectionGuidelines/program.htm Last accessed on May 23, 2008.Tuberculin Skin Testing Fact Sheet. Available at http://www.cdc.gov/TB/pubs/tbfactsheets/skintesting.htm Last accessed on May 23, 2008. | View Page |