quality assurance and safety practices质量保证和安全措施

Quality Assurance and Safety Practices,Chapters 6 and 7,Quality Control,Hospitals are becoming increasingly concerned with the quality of care they deliver.,Reasons for this concern include:,Recognition that Total Quality Management (TQM) principles have dramatically increased the quality of products manufactured in the United Statesthey should be able to do the same in healthcare. Greater visibilitythe public is demanding more information on the quality of care they receive.,What are some of the top risks that patients face?,Misdiagnosisprimarily a physician problem, but hospitals play a part.Failure to adequately monitor the patientprimarily a hospital problem often caused by shortages in staffing.Failure to appropriately use the chain of command.,What are some of the top risks that hospitals face?,Falls and injuriespreventable by the hospital staff.Medication errorsa problem caused by doctors and/or pharmacies.,What are some of the top risks that hospitals face?,No response by hospital personnel to abnormal diagnostic testing values. Misread radiology tests.,What are some of the top risks that hospitals face?,Infectionsmany of these arise in the hospital.Exposure to hazardous materialsfailure to follow prescribed procedures.,Employees face hazards also,Blood and body fluid exposures (needle sticks, puncture wounds, broken glass vials)Lifting injuriesRepetitive motion injuriesFalls by employees or patients,How do hospitals address these issues?,Proper credentialing of physiciansPeer reviewCredentialing of hospital personnelEstablishment of hospital protocols, policies and proceduresEmployee trainingMonitoringgathering and acting on data,Proper credentialing of physicians,When a physician enters the community and desires to practice at a hospital, he or she must apply for:Medical staff membershipHospital privileges,Medical Staff Membership,Allows doctors to admit patients to the hospitalIs granted by the hospitals board of trustees upon recommendation from the medical staff,Hospital Privileges,These list the actual procedures the doctor is allowed to perform in the hospital.Physicians must present proof that they have been trained and are qualified to perform the requested privileges.As with medical staff membership, the board of trustees grants privileges upon recommendation from the medical staff.,Peer Review,Peer review committees:Review cases to see that physicians are providing quality careReview physician membership and privileges on a yearly basis for the purpose of recommending renewal by the hospital board of trustees,Credentialing of Hospital Personnel,As mentioned in an earlier chapter, credentialing includes:Accreditationan evaluation that assures that an organization meets minimum standards Certificationrecognition by a non-governmental regulatory body that an individual meets standardsLicensurerecognition by a governmental body that an individual meets minimum educational requirements, and has the knowledge and skill to practice a specific profession,Establishment of hospital protocols, policies and procedures,A protocol is a procedure for handling a specific medical situationProtocols are developed by medical schools, professional associations, and hospitalsHospitals also develop policies and procedures for the delivery of care within their hospital,Employee Training,Training is a key component of quality controlTraining is performed by:UniversitiesProfessional associationsIn-service departments within hospitals,Monitoringgathering and acting on data,A number of committees collect data on quality control indicators includingHospital infection ratesNumbers of employee/patient fallsMedication errorsAdverse drug eventsNeedle sticksEtc.,Committees Concerned with Quality Include:,Credentials Committee: a medical staff committee that advises the board of trustees on matters concerning medical staff membership, and privileges.Health Information Management Committee: the committee charged with seeing that health information is accurate and timely.,Committees Concerned with Quality Include:,Infections Committee: the committee charged with investigating and preventing hospital-caused infections. Medical Executive Committee: the primary governing committee of the medical staff. The objective of the MEC is to conduct hospital business within the hospital for and in behalf of the medical staff.,Committees Concerned with Quality Include:,Morbidity And Mortality Committee: A committee responsible for monitoring the quality of care provided to emergency center and trauma patients.Quality Assurance Committee: The committee charged with the responsibility of monitoring the quality of care provided by the hospital.,Committees,Not every hospital has every committee, and committee tasks vary from hospital to hospital.The organization of these committees at Brannan Community Hospital is shown on the next slide.,Quality Control at Brannan Community Hospital,Lets talk a little more about hospital infections,What causes infections?Pathogens: Microorganisms that causes disease. Common pathogens include bacteria, viruses, and fungi,Bacteria,These are classified according to:Shape: Cocci (spherical), Bacilli (rod shaped), and Spirochetes (corkscrew).Reaction to gram stain.,Reaction to gram stain:,Gram-positive bacteria have thick walls that cannot be colorized but are stained violet with a gram crystal violets stain.Gram-negative bacteria can be decolorized with alcohol and is counterstained with safranin after decolorization, which imparts a pink or a red color.Whether a bacteria is gram positive or gram negative is important information for a doctor prescribing an antibiotic.Some antibiotics work only with gram positive bacteria while some (broad-spectrum) antibiotics work against several classifications or groups of bacteria.,Virus:,The smallest of the infection agents, with few exceptions, are capable of passing through fine filters that retain most bacteria. Viruses are not visible through light microscopes, and are incapable of reproduction outside of a living cell.,Fungi:,Plantlike pathogens (molds and yeasts).,Infection Control Procedures,Wash hands: After patient contactBefore and after eatingAfter using the restroomAfter handling moneyAfter removing glovesWhenever cleanliness of the hands is in question,Infection Control Procedures,Try to keep soiled items from touching the skin and clothing.Wear a gown, a mask, and eye protection or an eye shield when appropriate.Use care in handling equipment that may carry pathogens.Make sure reusable equipment has been sterilized before using it on another patient.,Infection Control Procedures,Transport soiled items in a manner that prevents exposure to pathogens.Never place soiled items on the floor.Avoid activities that raise dust when handling patients or equipment.Follow procedures when handling needles, scalpels and other sharp instruments. Use biohazard containers to discard these used items.,Infection Control Procedures,Avoid having the patient cough, sneeze or breathe on others.Clean areas that are least soiled first, moving outward or forward.Dispose of soiled items in appropriate containers.,Infection Control Procedures,When pouring liquids such as mouth rinse, bath water, etc., into the drain, avoid splattering.Clean and sterilize items suspected of having pathogens.Follow appropriate isolation procedures.,Handling Sterile Forceps,Wash hands. Keep only one forceps in a container of clean germicidal solution. When removing forceps from a container, keep prongs together and facing downward; grasp handles and lift without touching any part of the container above the solution line.,Infection Control Procedures,Tap prongs together gently over the container to remove excess solution. When using forceps, keep them in a downward position to keep the fluid on the prongs from running back to the handle. Use as required to handle, transfer, or assemble sterile supplies and equipment.,Infection Control Procedures,After the procedure has begun, never touch the tip of the forceps to a sterile field when placing supplies on a sterile field. After use, return the forceps to the container without touching any part of the container. Sterilize the forceps and the container, and refill the container with fresh germicide weekly, or more frequently.,Pouring Sterile Solutions,Always wash hands before pouring sterile solutions. Check the label before pouring sterile solutions.Unwrap the sterile container to be used for the sterile solution.,Pouring Sterile Solutions,When removing the cap of the sterile solution, place the cap on a surface that is level.When pouring, see that the label is in the palm of your hand.,Pouring Sterile Solutions,When pouring a sterile solution, hold the sterile solution bottle about six inches above the container. If you are required to pour a solution onto a sponge, first pick up the sponge with the forceps, then pour the solution on the sponge.,Good Website:,Medical and surgical asepsis: /ncidod/hip/a_z.htmSee “Isolation Guidelines” and “Infection Guidelines.”,Principles of Body Mechanics and Ergonomics,Ergonomics:,The study of work. More specifically, the study of ways the workplace can be improved to minimize employee injury and fatigue.,Body mechanics,Using the bodys major moveable parts (head, trunk, arms, and legs) in an efficient manner to maintain balance, conserve energy, and avoid strain and injury while performing work.,Advantages Of Proper Body Mechanics,Prevent i