Safe practice and environment

A. Patient and Staff Safety standards

Patient Safety

Defined as those that reduce risk of adverse events related to exposure to

medical care across a range of diagnoses or conditions

Practices: (evidence-based practice)

Appropriate use of prophylaxis to prevent venous thromboembolism in patients at risk

Use of perioperative beta-blockers in appropriate patients to prevent perioperative
morbidity and mortality
Use of maximum sterile barriers while placing central intravenous catheters to prevent
infection
Asking that patient recall and restate what they have been told during the informedconsent process to verify their understanding
Continuous aspiration of subglottic secretions to prevent ventilator-associated pneumonia
Use of pressure-relieving bedding materials to prevent pressure ulcers
Use of real time ultrasound guidance during central line insertion to prevent
complications
Patient self-management for warfarin to achieve appropriate outpatient anticoagulation
and prevent complications
Appropriate provision of nutrition, with a particular emphasis on early enteral nutrition in
critically ill and surgical patients, to prevent complications
Use of antibiotic-impregnated central venous catheters to prevent catheter-related
infection
Environmental Safety Standards according to Association of Nursing Service
Administrators of the Philippines, Inc. (ANSAP), Committee on Nursing Practice
The Nursing Services Department actively participates in the planning, implementation
and evaluation of hospital wide programs to provide a safe and secure physical
environment.
Measurable Elements
There is a written and up-to-date plan, implementation and evaluation of
programs/activities to manage the risks within the environment which includes but is
not limited on the following:
1.1. Safety and Security
There is an existing provision for the identification of patient and their
families, visitors, staff and others.

 Monitoring mechanism of all risk areas is in place and kept secure to

patient from unauthorized access or use, tampering, destruction or loss.
(e.g. Medication Room)
In 2006, the State of Washington legislature passed Engrossed Substitute House Bill
(ESHB) 1672 for safe patient handling which requires:
A safe patient handling committee, with at least half the members being in frontline non-managerial employees who provide direct patient care
A safe patient handling program with a policy that covers all units and shifts,
includes a patient handling hazard assessment, and conducts an annual evaluation
At least one patient handling lift per acute care unit, or one lift for every 10 acute
care inpatient beds, or lift equipment for use by lift teams
Procedures that give an employee the right to refuse performing a patient handling
task that may pose an unacceptable risk of injury to the patient
Training for staff on policies and equipment atleast annually
Patient Care Ergonomics Resource Guide: Safe Patient Handling and Movement,
developed by the Patient Safety Center of Inquiry (Tampa, FL), for injury prevention:

Air assisted lateral sliding aids

Friction reducing lateral sliding aids
Mechanical lateral transfer aids
Transfer chairs
Powered full body swing lifts
Powered standing assist and repositioning lifts
Standing assist and repositioning aids
Bed improvements to facilitate transfer or repositioning
Sliding boards
Gait/transfer belt with handles

The American Association of Critical-Care Nurses recognizes the inextricable links among
quality of the work environment, excellent nursing practice and patient care outcomes. The
AACN Synergy Model for Patient Care further affirms how excellent nursing practice is that
which meets the needs of patients and their families.
The standards for establishing and sustaining healthy work environments are:
Skilled Communication
o Nurses must be as proficient in communication skills as they are in clinical skills.
True Collaboration
o Nurses must be relentless in pursuing and fostering true collaboration.
Effective Decision Making
o Nurses must be valued and committed partners in making policy, directing and
evaluating clinical care and leading organizational operations.
Appropriate Staffing

o Staffing must ensure the effective match between patient needs and nurse
competencies.
Meaningful Recognition
o Nurses must be recognized and must recognize others for the value each brings to
the work of the organization.
Authentic Leadership
o Nurse leaders must fully embrace the imperative of a healthy work environment,
authentically live it and engage others in its achievement.
UVAHS (University of Virginia Health System) structures ensure that nurses are working and
caring for patients in a safe practice environment. Many of the activities to assure a safe and
secure environment of care for patients also support a safe environment for their staff.
Here are their policies regarding patient and staff safety:

Empowered Staff, Superior Safety: UVAs Executive Vice President for Health Affairs,
Richard P. Shannon, MD, has introduced Be Safe, a shared methodology focused on
creating an environment of unmatched patient and team member safety. Be Safe trains
and empowers all front-line staff to call out issues that affect safety, workflow and
outcomes. This triggers a systematic, real-time problem solving process that quickly
involves leadership support and other organizational resources, as needed, to effect
changes.
Safe Patient Handling: UVAHS has invested in a wide variety of minimal lift equipment
since 2003 to support safety for both caregivers and patients during repositioning and
mobility. Local Transfer Mobility Coaches help staff optimize their safe patient handling
techniques.
Exposure Control and Sharps Injury Prevention Program: Safety systems minimize staff
risk for exposure to blood and body fluids in all patient care areas. Whenever staff
experience an exposure, expedited care is delivered to support rapid treatment and peace
of mind for our staff. Any exposures and sharps injury events are closely studied to
determine whether processes or products can be changed to enhance safety.
Slips, Trips and Falls: UVAHS has a robust nurse-led Falls Prevention program that
drives proactive safety measures, such as yellow identifiers for patients with high fall
risk. They investigate the contributing factors when a fall does occur, to further improve
safety. Any staff encountering an environmental hazard that poses a fall risk can take
immediate action such as pop up cones and pads to soak up hallway spills; calling
Facilities hotline to promptly fix a broken tile or uneven sidewalk.
Preventing Violence: Several safety programs help identify the potential for violence in
the healthcare setting, prevent it from escalating, and provide security and support for
patients, families and staff should an incident occur. Emergency Room staff, Security, and
many others receive specialized training in de-escalation of intense situations. Patients at
risk for delirium have preventative care plans in place. A rapid response team assists in
the event of a behavioral emergency.