NPSG compliance

[wndblws]

I have been concerned with patient safety and compliance with NPSG's. In the ED I currently work in I find that it is common practice to carry unlabel med filled syringes to pt bedside, lab tubes are not labeled at the bedside causing many errors and write up's from labs (on pt was treated as if he had an elevated troponin but later realized no cardiac enzymes had been ordered on him,the specimens had been mislabled). Handwashing/hygiene is also not commonly done upon leaving a pt room. Handhygiene, labeling specimens, and not drawing up medications until at the bedside and comparing pt identifiers with the orders had been emphasized in the previous ED I worked at. No one is taking my concerns seriously and we have had a few close calls that I know of. My question to you all is what was done in your departments to encourage complience with these patient safety issues? Knowing these issues are joint commission standards doesn't help becuase they have been joint commission standards for several years and if this department had any visitors from JC during their last visit no problems were noted. I am just afraid something worse will happen to our patients than already have. Any advice or suggestions will be appreciated.

[hamartin1515]

Hi, I oversee the quality and safety for our pediatric ED and for the EM Providers. These are huge areas of non-compliance for us as well. We are trialing different colored labels to go on blood specimens and also use a log book that all muct document the labs they send and need to have the labs and req verified. The log helped us out a lot. Hand washing--all nurses are required to audit at least 3 random people every month, but our compliance is "100%", which is highly doubtful. You almost need a secret shopper to do this audit. Unlabeled syringes jsut caused us a huge near miss and they are starting to come down hard on nurses. Can I ask where you work and what has worked in the past for you? Always looking for colleagues in quality and safety.

[LLLLiiiFFEsaveer]

Those are HUGE concernes! Plus, an increadible liability issue for all involved.

I would think that motivation for change should come from within. The people working there need to watch out for each other, and take some pride in using best practice whenever possible. Enforceing it amoungst one another would probably be a good place to start. It should only take one good person with the right attitude to get the information out for just how dangerous of a game they are playing, or maybe that one time when any one of them may cause serious harm to another (maybe even more than one patiend would be involved too) patient, and pays the consequences? Then, they may change their ways...

One thing though, I always have that clear tape on me... So, I just draw it up and tape that vial to the side of the syringe. Pretty simple. As primary during an RSI, start drawing them up and taping, then hand em off to the L side nurse.

I know, I know.. Don't give any meds that you have not personally drawn up... Or can you?

I hope somehow I've helped?

[wndblws]

We have decided to implement a sign off sheet by the person taking the specimen to the lab that the specimen was drawn and labeled at bedside using patient identifiers. We are taking a lot of flack from this but due to a mislabeled specimen a few weeks ago we missed a positive troponin and treated and negative troponin as if it were positive. Of course tied that in with the other things like a flu label on a green tube ...

[northshore08]

One thing though, I always have that clear tape on me... So, I just draw it up and tape that vial to the side of the syringe. Pretty simple.

From what I've read, this is not considered acceptable labeling. In my book it is, but according to JCAHO, this method is not what they want. A good example of what they want is posted on the last premixed med your inpt pharmacy delivered to your department. I can't see writing all that information on every syringe of Zofran I have to administer.

I really believe all these med standards (current and future) will never be met until every medication is prepared and labeled by a pharmacist on site before it is delivered to the staff nurse on site for administration. From what I have read about the pharmacy world, they are less than prepared to fulfill this role.

In the last 50 years or more, I am surprised nurses have not killed off more of the population. I'm sorry, but IMHO these "national patient safety goals" continue to be someone's way to keep their administrative position. Requiring increasing mandates of every move workers make will not ensure the safety of patients. More staff and the time/freedom to do the work results in less safety problems.

I feel a little bit of environment change could help with many of these safety issues. If you are so concerned with handwashing, install sinks in my rooms; the sanitizer you have so nicely provided doesn't clean pee, poo or the C. Dificile off my hands. If you want all specimens labeled at the bedside, provide pre-printed labels for me to use; the lab has them, why can't we?

Just a few ideas....Okay, I'm better now, and ready to follow my scripting for phone calls and patient contacts!

[LLLLiiiFFEsaveer]

Requiring increasing mandates of every move workers make will not ensure the safety of patients. More staff and the time/freedom to do the work results in less safety problems.

I feel a little bit of environment change could help with many of these safety issues. If you are so concerned with handwashing, install sinks in my rooms; the sanitizer you have so nicely provided doesn't clean pee, poo or the C. Dificile off my hands. If you want all specimens labeled at the bedside, provide pre-printed labels for me to use

Yea! What you said...

I am suprised though, our ED does have sinks in every room. I also always have pre-printed patient labels for every one of my patients on me. Sticky the label on all the bloods right there next to the patient, being sure to verify with them, if they are who we think they are?

Tell the Docs to start washing their hands after every time they leave the room. That is unless they are hands-off on their approach. Watch them start the trend...