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Change practice to comply with new 2008 safety goals
Only three new National Patient Safety Goals (NPSGs) were added this year by The Joint Commission, but all of them will have a big impact on emergency nurses.
"The biggest challenge in our ED will be getting staff educated about these new goals and also doing follow-up and monitoring to be sure we are in compliance," says Karen Shipman, RN, director of nursing for the ED at CJW Medical Center — Johnston-Willis Campus in Richmond, VA.
Here are the new goals, effective Jan. 1, 2008:
• Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.
At CJW's ED, evidence-based cardiac and noncardiac heparin protocols are used. "Right now we are looking at whether there is something else we need to be doing as an ED, to make sure that we are reducing harm," says Shipman. "We will be reinforcing education and ensuring that our patients are safely receiving heparin.
Currently, nurses have access to online calculators that compute the dosage of anticoagulant therapy, which is reviewed by a second nurse.
At the ED at Einstein at Elkins Park (PA), nurses are taking a closer look at the details of past incidents to determine if changes are needed, says Teri Jackson, RN, nurse manager of the ED. "We will be looking at historical data as to causes, processes, or analysis of previous episodes and seek to refine the process," she says.
• Comply with current World Health Organization (WHO) Hand Hygiene Guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.
Previously, hospitals had to adhere to the CDC guidelines, but now you have the option of using the WHO's guidelines instead. (For more information on the WHO hand hygiene guidelines, go to the Joint Commission International Center for Patient Safety web site at www.jcipatientsafety.org. Click on "WHO Collaborating Centre for Patient Safety Solutions" and "View Solutions.")
"Our nurses are all already in tune to hand hygiene, but continued reinforcement is in order," says Jackson. "We will give nurses friendly reminders with posters, newsletters, and quality data."
• Improve recognition and response to changes in a patient's condition: The organization selects a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patient's condition appears to be worsening.
At CJW, a rapid response team is being developed that will comply with this goal, says Shipman. "We are in the process of looking at who should respond from what unit," she reports. For example, if an inpatient nurse notices a patient's blood pressure is 70/40, the nurse can get a team to respond immediately so the patient can be treated before it becomes a critical event, says Shipman.
Currently, when a code blue occurs on a medical/surgical unit or other clinical area, both a nurse and physician respond from the ED. "Right now we are not sure if that practice will continue or whether we will pull staff from other areas," she says.
For more information on The Joint Commission's 2008 National Patient Safety Goals, contact: