Management in The Nursing Care

The Management in the Delivery Nursing Care
Hospital Nursing Service Administration Manual

11 SAFETY IN HEALTH
CARE
Introduction
Safety in healthcare organizations aims to prevent harm to patients their

families and friends, healthcare professionals, contract of service workers,
volunteers, and the many other individuals whose activities bring them into a safe
environment.
Safety is one aspect of quality that includes not only avoiding preventable
harm, but also making appropriate care available-providing effective services to
those who could benefit from them and not providing ineffective or harmful services.
In response to the call of the World Health Assembly (WHA), the

Department of Health has issued Administrative Order No. 2008-0023 which
mandates the reinforcement and institutionalization of the implementation of quality
assurance for patient safety where it is regarded as one of the dimensions of quality
care (Institute of Medicine, 2000). In 2019, the Administrative Order on National
Policy on Patient Safety in Health Facilities was updated.
Definition of Terms
Patient Safety is defined as "the prevention of harm to patients through avoidance

and amelioration of risk, adverse outcomes, or injuries stemming from the
processes of healthcare. It is the degree to which the risk of an intervention
and risk in the care environment are reduced for a patient and other persons,
including healthcare providers.
Prevention of harm to patients it is freedom from accidental injury and ensuring
the establishment of operational systems and processes that minimize the
likelihood of enors and maximize the likelihood of intercepting them when
they occur.
Patient—Centered is providing care that is respectful of and responsive to patient
preferences, needs, values and ensuring that patient values guide all clinical
decisions.
No Blame Culture a non-punitive culture encouraging voluntary reporting of
events.
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Safety in Health Care
Sentinel Event most serious adverse events which cause permanent harm, severe
or temporary serious injury or death. Timely means reducing waiting time
and sometimes harmful delays for both those who receive and those who give
care.
"f
Efficient means avoiding waste, including waste of equipment, supplies, ideas

and energy.
Equitable means providing care that does not vary in quality because of personal
characteristics such as gender, geographic location and socio economic status
(Institute of Medicine (IOM) 2001).
Key Elements of Patient Safety
Leadership. Leadership and political commitment are essential at the health

facility level where patient safety becomes an integral component of quality
care. The leadership shall address strategic priorities for institutional
development, its culture and infrastructure, engage its various stakeholders
communicate and build awareness.
Institutional Development. Refers to approaches to institutionalize patient safety
and quality in the health facilities will have to consider financial and human
resource; facility and equipment management; strengthen management
responsibility, authority and competency; formulate standards of what is
expected from health providers; communicates; provide training; enforce the
standards that comes with the policies and give the patients a voice through a
feedback system or a patient satisfaction survey.
Reporting System. The National Patient Safety Committee shall develop and
institutionalize a pro-active reporting and learning system that requires its
leadership to encourage reporting of events.
Feedback and Communication. Performance feedback and benchmarking
mechanism to communicate leadership responses to the reports shall be
established to demonstrate commitment to patient safety and ensure
continuous ilnprovement.
Adverse Event Prevention and Risk Management. Risk and reduction strategies
thorough patient risk assessment, patient feedback survey, health technology
assessment and safety assessment code.
Disclosure of Reported Serious Events. The reporting system ensures
confidentiality of individual cases. The events can be made
available to the public through disclosure of results of investigation, summary
reports or annual reports that summarize events and actions taken.
Professional Development. Training and supervision of the healthcare staff to
improve their decision and clinical judgments are imperative. It is necessary
to instill standard norms of behavior of courtesy, promptness and efficiency
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among the healthcare workers and improve the quality of service given to
patients.
Patient-Centered Care and Empowerment of Consumers. Patients must be at the
center of patient safety initiatives and must be paflners in all aspects of the
process. Patient-centered care and patient safety is a national priority and a
core agenda to improve quality care in all health facilities to protect patients
from faulty systems.
Ten (10) Reasons for Global Patient Safety

Patient safety is a serious global public health issue. There is now growing recognition
that patient safety and quality is a critical dimension of universal health coverage.
Since the launch of the WHO Patient Safety Program in 2004, over 140 countries
have worked to address the challenges of unsafe care.
One in 10 patients may be harmed while in the hospital. Estimates show that in
developed countries as many as 1 in 10 patients is harmed while receiving hospital
care. The harm can be caused by a range of errors or adverse events.
Hospital infections affect 14 out of every 100 patients admitted. Of every 100
hospitalized patients at any given time, 7 in developed and 10 in developing
countries will acquire health care-associated infections (HAIs). Hundreds of
millions of patients are affected worldwide each year. Simple and low-cost
infection prevention and control measures, such as appropriate hand hygiene,
can reduce the frequency of HAIs by more than 50%.
Most people lack access to appropriate medical devices. There are an estimated 1.5
million different medical devices and over 10,000 types of devices available
worldwide. The majority of the world's population is denied adequate access to safe
and appropriate medical devices within their health systems. More than half of low-
and lower middle-income countries do not have a national health technology policy
which could ensure the effective use of resources through proper planning,
assessment, acquisition, and management of medical devices. "While patient safety
and healthcare quality have certainly received substantial attention for more than 10
years now, the actual investments in patient safety still pale beside investments in
traditional biomedical research'
Unsafe injections decreased by 88 00 ./iwm 2000 to 2010. Key injection safety indicators
measured in 2010 show that important progress has been made in the reuse rate of
injection devices (5.5% in 2010), while modest gains were made through the
reduction of the number of injections per person per year (2.88 in 2010).
Delivery of safe surgery requires a teamwork approach. An estimated 234
million surgical operations are performed globally every year. Surgical care is
associated with a considerable risk of complications. Surgical care errors
contribute to a significant burden of disease despite the fact that 50% of
complications associated with surgical care are avoidable.
About 20%—40% of all health spending is wasted due to poor-quality care. Safety
studies show that additional hospitalization, litigation costs, infections acquired in
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hospitals, disability, lost productivity, and medical expenses cost some countries as
much as US$ 19 billion annually. The economic benefits of improving patient safety
are therefore compelling.
Healthcare has a poor safety record compared to other industries. Industries with a
perceived higher risk such as the aviation and nuclear industries have a much better
safety record than health care. There is a 1 in 1,000,000 chance of a traveler being
harmed while in an aircraft. In comparison, there is a 1 in 300 chance of a patient
being harmed during health care.
of
Patient and community engagement and empowerment are keys, People's experience and
perspectives are valuable resources for identifying needs, measuring progress, and
evaluating outcomes.
Hospital partnerships can play a critical role. Hospital-to-hospital partnerships to
improving patient safety and quality of care have been used for technical exchange
between health workers for a number of decades. These partnerships provide a
channel for bi-directional patient safety learning and the co-development of solutions
in rapidly evolving global health systems.(World Health Organization (2014)
Strategies that Promote Patient Safety
Health facility operations and management systems that promote Culture of

Safety
Leadership and Management commitment to patient safety
Patient safety as a strategic priority in health facility policies,
organizational structure, plans and health program
Promoting the use of checklists in patient care process
Establishing a clinical audit system for system improvement
Conducting regular patient safety executive walk-rounds to promote
Culture of Safety
Ensuring that hospital managers, clinicians, and all levels of healthcare
staff are responsible for patient safety at their levels and held
accountable
Ensuring a safe environment in the health facility

Compliance to environmental standards for health care
Displaying of warning signs marking unsafe areas and precautions on
safety issues (fall, medication alert, radiation, etc.)
Ensure there is appropriate and safe supply of food and drinks for
patients and staff
Conforming to guidelines on safe management of chemical and
radiologic waste
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Establish a preventive maintenance program for its physical
environment
Implement an emergency plan
Establishing systems to ensure standards of cleaning and sanitation
Health personnel safety established

Implementing occupational health program for all staff
Ensuring clinical staffing levels reflect patient needs at all times
Adherence to national labour laws
Screening before employment and regularly afterwards for transmissible infections
Protecting from health-care associated infections, including provision of vaccination
Medical records system is completed

Using standardized codes for diseases, diagnosis, and procedures •
Establishing and maintaining medical records archiving system o
Ensuring that each patient has a single completed medical record with
unique identifier o Developing the infrastructure and capacity to
introduce and strengthen information technology to minimize errors in
patient care
Patient-centered care
Obtaining informed consent for treatments and procedures carrying risk
to patients
Communicating and counselling patients and their families and also the
staff involved when an adverse event occur
Involving participation from patients and their respective families in
decisions regarding their care
Encouraging and setting up mechanisms for reporting of incidents by
patients and their families
Involving participation of patients and consumer advocates in patient
safety committees and patient safety initiatives
Assessment of the nature and scale of adverse events

Implementing a surveillance system for nature and scale of adverse events o
Conducting a baseline assessment of the overall burden of unsafe care in the
facility e Developing patient safety incident surveillance
Establishing a system of analyzing all reported incidents to guide
appropriate intervention at the institutional and health facility levels to
prevent their recurrence
Use of incident reporting system and risk mitigation strategies o Employ risk
mitigation strategies to manage the effects of adverse events
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Developing a system of reporting and disclosure for learning
from all adverse events, sentinel events, and near misses o Conduct
Patient Safety risk identification and management plan proactively (Root
Cause Analysis and /or Failure Mode and Effects Analysis)
Training and capacity building of health workforce sensitive to patient safety

Strengthening education, training and professional performance inclusive of
skills, competence and ethics of healthcare personnel o Developing standard
treatment guidelines and standard operating procedures for healthcare
practice and ensuring compliance
Establishing accreditation of healthcare professional education and training
for the improvement of standards
el
Identifying knowledge, skills, attitude gaps of health professional and

providing learning and development avenues to address
Improving the understanding and application of patient safety and risk

management
Addressing patient safety at the time of employment and induction and making it a
component of performance reviews
Conducting periodic assessments of healthcare staff on their understanding and
awareness of patient safety principles and practice Encouraging patient safety as
part of bedside teaching, onsite learning and field work
Reinforcing a Culture of Safety by advocacy, awareness, patient safety campaigns, and
behavior modification methods for involvement by all healthcare personnel
Preventing and controlling Healthcare-Associated Infection (HAI)

1. Strengthening the Infection Prevention and Control (IPC) Program across all
healthcare services
Establishing evidence-based IPC policies, technical guidelines, standard operating
procedures that are aligned with the national IPC policy
Creating the IPC committee or team that will oversee the Infection Prevention and
Control program of the health facility in all services Building awareness on the
principles of hygiene and sanitation for patients including visual reminders
Strengthening microbiology laboratory support
Implementing policies and procedures for rational use of
antibiotics Building the awareness and capacity of health-care workers,
sanitary and supervisory staff in cleaning and sanitation and occupational
safety
2. Employing a system to reduce HAI in the facility
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Improving hand hygiene practices using multimodal strategy for hand
hygiene
Undertaking surveillance, identification and prevention of significant
HAI
Utilizing effective barrier precautions and isolation procedures
Providing appropriately cleaned, disinfected or sterilized equipment for
patient care
Providing appropriate design and ventilation of health facility for infection
control, sinks and running water, supplies for hand hygiene and other
IPC practices, isolation facility and sterile supplies
Implementing of Patient Safety key priority areas

Patient Identification Procedures and Protocols o Standardizing patient
identification procedures to have at least two identifiers, including full name
and date of birth (room number is not
one of them), for all patient care processes (procedures, transfer, or

administration of medication and blood or blood components) Providing
clear protocols for maintaining patient sample identities throughout pre-
analytical, analytical, and post-analytical processes Using of biometric
technologies or bar coding with check digits for patient identification
Providing clear protocols for identifying patients who lack identification
and for distinguishing the identity of patients with the same name
Developing non-verbal approaches for identifying comatose or confused
patients
Developing and implementing a process to improve the accuracy of patient
identification and confirmation prior to procedures
2. Effective Communication
Creating policies against use of abbreviations in medical orders and in patient charts
Developing and implementing a process to improve the effectiveness of verbal and/or
telephone communication among caregivers (i.e, reading back)
Implementing a process and protocol for reporting critical results of diagnostic test
Use of standardized methods, fonns, or tools to facilitate consistent and complete
handovers and referral of patient care (SBAR, IPASS the BATON)
a. SBAR-standardized technique to facilitate communication during

transitions of care
S Situation: What is the situation?

o identifying self, the unit, and the patient (by using
two patient identifiers-name and birth date) briefly state the
problem: what it is, when it started, and the severity
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B Background: Provide background information relevant to the
situation (i.e. admitting diagnosis, list of medications, allergies,
most recent vital signs, other clinical information)
A Assessment: What is your assessment of the situation?
R Recommendation: What is your recommendation of the situation (i.e..

patient to be admitted, to be seen now, or an order to be changed)
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The Management in the Delivery ofNursing Care
b. I PASS THE BATON — an effective tool of a hand-off checklist of critical

information
1 Introduction of self and your role
P Patient-name, identifiers, age, gender, location
Assessment-presenting chief complaint, vital signs, symptoms diagnosis
S Situation-current status/circumstance, level of uncertainty, recent changes,

code status
S Safety Concerns-critical lab values/reports, socio-economic factors,

allergies, and alerts (falls, isolation, etc.)
[THE]
Background-comorbidities, previous episodes, current medications, family

history
A Actions-what actions were taken or are required?
T Timing-level of urgency and explicit timing and prioritization of

actions
O Ownership-who is responsible (nurse, doctor/team)? Include

patient/family responsibilities
N Next-what will happen next? Anticipated changes? What is the

plan?
Types of Errors
Adverse Health Care Event is n event or omission arising during clinical care and
causing physical or psychological injury to a patient.
Error is failure to complete a plan action as intended, or the use of an incorrect plan of
action to achieve a given plan.
Health Care Near Miss refers to a situation in which an event or omission (or sequence)
arising during clinical care fails to develop further whether or not as the result of
compensating action, thus preventing injury.
Adverse Drug Reaction is any response to a drug which is noxious, unintended and
occurs at doses used for prophylaxis, diagnosis or therapy
(Predictable/Unpredictable).
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Medication Error refers to any preventable event that may cause or lead to inappropriate
medication use or patient harm while the medication is in the control of health
professional, patient or consumer.
Sentinel Error refers to a surgery on the wrong body part, surgery on the wrong patient,
patients receiving the wrong medication.
Medication Errors
A medication error is broadly defined as dose of medication that deviates
from the physician's order as written in the patient's chart or from standard hospital
policy and procedures, except for errors of omission. The medication dose must
actually reach the patient; that is, a wrong dose that is detected and corrected before
administration to the patient is not a medication error. Prescribing errors (e.g.,
therapeutic inappropriate drugs or dose) are excluded from this definition.
In the medication area, vigilance, accuracy, careful attention, and

meticulous knowledge of medications and their administration are also needed. In
addition, nurses should conduct clinical research that examines modes of delivering
medications to patient in order to answer the following:
Do error rates differ when one nurse per unit is responsible for administering medications,
as opposed to several nurses administering medication to their assigned patients in
one unit?
Are there safer ways of giving medications?
Another strategy for minimizing risk of injury by medication error is to evaluate labeling,
packaging, coding and other aspects of medicine identification. Encourage all
members of the nursing staff to notify the Supervising Nurse, the hospital therapeutic
committee, and the manufacturer, in-writing, of any problems, questions, or concern
about the administration of medications.
If a medication error is detected, the patient's physician must be infornned
immediately.
An incident report should be prepared describing any medication error observed in the
administration of a medication. This report should be prepared and sent to the
Nursing Service Office within 24 hours. This report should be analyzed and any
necessary action taken, to minimize the possibility of their recurrence. Properly
utilized, this incident report will help ensure optimum drug use control.
Medication Error Policy
Appraisal. The merits of a medication error policy or any policy can only be
measured in terms of results.
Are medication errors being reported promptly?
Did the nurse act properly and procedurally?
Is there a marked decrease in repeat offenders?
Are the educational and corrective measures reviewed constructively?
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Have grievances as a result of corrective measures decreased?

What seems to be the overall feeling of the staff towards the medication error policy?
Nine Categories ofMedication Error
Omission error: the failure to administer an ordered dose. However, if the patient refuses
to take the medication, no enor has occurred. Likewise, if the dose is not administered
because of recognized contraindications, no error has occurred.
Unauthorized-drug error: administration to the patient of a medication dose not authorized
for the patient. This category includes a dose given to the wrong patient, duplicate
doses, administration of an unordered drug, and a dose given outside a stated set of
clinical parameters (e.g., medication order to be administered only if the patient's
blood pressure falls below a predetermined level).
Wrong dose error: any dose that is wrong number of ordered units (e.g., tablets) or any
dose above or below the ordered dose by a predetermined amount (e.g., 20 percent).
In the case of ointments, topical solution, and sprays an error occurs only if the
medication order expresses the dosage quantitatively (e.g., 1 inch of ointment or two
1 second sprays).
Wrong-route error: administration of a drug by a route other than that ordered by the
physician. Also included are doses given via correct route but a wrong site (e.g., left
eye instead of right).
Wrong-rate error: administration of a drug at the wrong rate, the correct rate being that
given in the physician's order as established by hospital policy. Wrong-dosage form
error: administration of a drug by the correct route but in different dosage form than
that specified or implied by the physician. Examples of this el-ror type include use of
an ophthalmic ointment when a solution was ordered. Purposeful alteration (e.g.,
crushing of a tablet) or substitution (e.g., substituting liquid for a tablet) of an oral
dosage form to facilitate administration is generally not an error.
Wrong-time error: administration of dose of a drug greater than ± X hours from its
scheduled administration time, X being as set by hospital policy.
Wrong preparation of a dose: incorrect preparation of the medication dose. Examples are:
incorrect dilution or reconstitution; not shaking a suspension; using an expired drug;
not keeping a light-sensitive drug protected from light; and mixing drugs that are
physically/chemically incompatible.
Incorrect administration technique: situation when the drug is given via the correct route,
site, and so forth, but improper technique is used. Examples are: not using the Z-track
injection technique when indicated for a drug; incorrect instillation of an ophthalmic
ointment; and incorrect use of an administration device.
Oftentimes, medication enor occurs due to the system of applying standards

of care. A review of the system with the personnel involved would pinpoint the cause
of error that, otherwise, could have been prevented.
The Nurse's Responsibility for the Patient's Safety
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Nurses are responsible for providing safe care both physically and
psychologically. Equipment, such as stretchers, wheelchairs and beds should likewise
promote an environment conducive to recovery.
Restraints like confining a person in bed can be misinterpreted as a form of

punishment, therefore, it cannot be instituted without a doctor's order. However, in
case where a patient is in danger of hurting himself and others, the nurse can apply
the necessary restraint provided that an accurate documentation is made.
Emergency Care
When a patient is brought to the Emergency Room (ER) for treatment, it is

implied that he/she is consenting to the measures the physician deems
necessary for his/her condition.
Nurses should observe and properly record the patient's condition and the
treatment he/she received. In many cases, patients brought to the ER are
medico-legal cases and the nurses must be conscious of its legal implications
to them and the hospital.
A written consent should be obtained from the patient or in cases of children,
from their parents. It is to be noted, however, that in emergency cases,
treatment may be instituted as a means to save life. The doctor attests to this
and the patient signs it. This is called therapeutic privilege on the part of the
doctor.
Consent (Right to Informed Consent)
Patients have the right to choose whether they desire medical care or not. A
consent signed by the patient should be obtained before beginning any
treatment or care. The patient must be aware of the treatment that would be
given to him/her, the possible complications, danger and risks that may take
place and other alternatives to the proposed therapy or treatment which may
be considered. The patient has the right to consent or refuse such treatment.
The general consent taken upon admission is for initial treatment. Special
procedures, such as: surgery, biopsy, spinal puncture, blood transfusion and
xray procedures necessitating the administration of dyes, would require
another consent. A patient who consent must have the legal capacity to do so,
meaning he is of legal age, and knows what he is consenting to. Patients who
are sedated, distraught, or who cannot comprehend cannot give an informed
consent.
No consent is necessary for emergency cases where a patient's life is at stake.
However, this should be properly witnessed and the doctor should make the
necessary notation on the chart.
When a patient refuses to give his/her consent, verify his/her reason, he may just
need further explanation. However, should the patient still refuse, he
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cannot be forced to sign the consent. This reaction should be

properly noted on the patient's chart through a waiver.
Therapeutic Orders
Therapeutic orders should be legal, written, clear, timed and signed by the
ordering physician. Signing an order is the legal proof that such an order has
been made. If the order is unclear, verify from the ordering physician. Do not
risk the patient's life with an incorrect or an unclear order.
Medicine administration is a high risk area because errors may be fatal. Nurses
should be familiar and kept updated with drug preparation, dosage, action,
route, frequency, side effects and adverse reactions.
Since the quality of care given to patients is reflected in their charts, it is
imperative that the nurses' notes be clear, accurate and up-to date. What is not
charted has not been observed, nor administered nor done.
There are occasions when nurses give telephone reports to physicians about
changes in the patients' conditions. Information given through telephone
should be accurately transcribed by the receiving nurse in written form
especially if this pertains to medications, or if significant events or changes in
client's condition have occurred.
There are legal risks in telephone orders. These may be understood or

misinterpreted by the receiving nurse. They may sound unclear because of some
trouble in the telephone line. Most importantly, if the signature of the ordering
physician was not present and this order may be denied in case errors exist or when
court litigations arise.
Only in an extreme emergency and when no other physician is available should a

nurse receive telephone orders. The nurse should read back such order to the
physicians to make sure the order has been correctly received. The nurse
should note the date and time when the order was made, the name of the
physician making the order, then sign his/her own name including
designation. The ordeHng physician should sign the order as soon as he
arrives in the unit. Clear hospital policies with regards to receiving telephone
orders should be established to avoid misunderstanding and legal risks.
The Generics Act Law (RA 6675)
An Act to promote, require and ensure the production of an adequate

supply, distribution, use and acceptance of drugs and medicines identified by their
generic names.
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A prescription and orders for drugs and medicines in DOH facilities shall be
specified in generic terminology. In all written orders, the generic name of the drugs,
active ingredients shall be stated. All orders shall use generic names exclusively. The
role of the nurse in relation to genelics is not only as a drug administrator but also as
an educator, a motivator, a coordinator and an evaluator of the efficacy of such drugs.
Medication Rights
Observation of the Medication Rights will prevent Medication errors

legally ordered by a physician.
Right Order is always written, dated and signed by the ordering physician. Right
Medicine. Medicines may have similar names. Be careful in examining the label.
Right Dose. When in doubt, double check with the physician. It is better to be safe than
to be sorry.
Right Patient. There are times that patients have the same name and surname. Verify the
middle initial. Ask the patient to state his/her name.
Right Route and Frequency. Some procedures are given orally or parenterally. Check
several times to prevent enors.
Right Assessment. Assess whether patient has any allergies, have been previously
administered, or any information that is significantly relative to administration of
drugs.
Right Approach. Patients who are having problems with diug administration especially
children, will be more cooperative if approached in gentle, persuasive manner that
builds trust and confidence in the patient.
Right Feedback to the ordering physician, is important so he will know the patient's
progress.
Right Observation. Patient should be regularly visited, to detect if there are any
symptoms of reactions.
Right Documentation. This is a legal requirement. What is not documented has not been
observed nor given.
Indicators and Parameters of Safety
The Patient Safety Indicators (PSIs) are a set of measures that screen for
adverse events that patients experience as a result of exposure to the health care
system. These events are likely amenable to prevention by changes at the system or
provider level.
(P SIS) are a set of indicators providing införmation on potential in hospital

complications and adverse events following surgeries, procedures, and childbirth.
The PSIs were developed after a comprehensive literature review, analysis of ICD-9-
CM codes, review by a clinician panel, implementation of risk adjustment, and
empirical analyses.
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The PSIs can be used to help hospitals identify potential adverse events that
might need further study; provide the opportunity to assess the incidence of adverse
events and in hospital complications using administrative data found in the typical
discharge record; include indicators for complications occun•ing in hospital that may
represent patient safety events; and, indicators also have area level analogs designed
to detect patient safety events on a regional level.
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Medication error
Falling incident
Needle stick injury
Splash/spills incident
Hospital acquired infection like CLABSI, CAUTI, VAP, HAPU / healthcare associated
infection
Blood and blood component transfusion error
Intravenous Therapy complications like infiltration, extravasation and phlebitis
Hazardous materials exposure
Benefits of Checklists in Health Care
Checklists used in the medical setting can promote process improvement and increase patient
safety.
Implementing a formalized process reduces errors caused by lack of information and inconsistent
procedures.
Checklists have improved processes for hospital discharges and patient transfers as well as for
patient care in intensive care and trauma units.
Along with improving patient safety, checklists create a greater sense of confidence that the
process is completed accurately and thoroughly.
Checklists can have a significant positive impact on health outcomes, including
reducing mortality, complications, injuries and other patient harm. Clinical quality.
This guide includes checklists, developed by Cynosure Health, fbr thesel() areas:
l . Adverse drug events (ADEs)
Catheter-associated urinary tract infections (CAUTIs)
Central line-associated blood stream infections (CLABSIs)
Early elective deliveries (EEDs)
Injuries from falls and immobility
Hospital-acquired pressure ulcers (HAPUs)
Preventable readmissions
Surgical site infections (SSIs)
Ventilator-associated pneumonias (VAPs) and ventilator associated events (VAEs)
Venous thrombo embolisms (VTEs) to prevent process breakdowns due to human factors, each
checklist identifies the top evidence-based interventions that health care organizations can
implement and test to reduce harm
Nursing Actions to Improve Patient Safety
Knowledge and implementation about healthcare policies and procedures.

Open communication and teamwork among all other healthcare providers.
Review the medication rights before giving the medications.
Engage in creating and updating reporting systems to avoid a blaming culture.
Involve in research and evidence-based activities for better decision making.

Be updated on all lifesaving certification like CPR, BLS, ACLS, PALS, NALS and other
Nursing Specialty Certification Programs.
Engage in hospital committees to make the healthcare system safe effective and patient-
centered.
Be responsible in reporting all errors and near misses not only for the patient to prevent
sentinel and adverse events to happen again.
Ensure better lighting and less clutter in the work areas.
Ensure the staffs are trained to operate the medical equipment like ventilator, infusion
pump, and warmer.
Nurses were asked to engage in the following activities:
Promote awareness about changes in the healthcare system that undermine quality and safety of
patient care.
Support the development of a National Center for Patient Safety and the establishment of a
nationwide mandatory state-based error reporting system.
Support the development and implementation of performance standards by regulators and
accrediting agencies that require health care institutions and systems to implement patient
safety programs and processes with defined executive responsibility.
Support the implementation of proven medication safety systems and practices by healthcare
organization.
Promote passage of whistle-blower legislation that protects the essential role of nurses in efforts
to correct system errors.
Denionstrate the improvement of quality of care and reduction of errors through
collection of data using nursing quality indicators.
Promote nursing research on patient safety and educate nurses in the science of system safety
issues.
Tips on How to Improve the System and Prevent Future Errors from Occurring
Adapt a culture of safety in the workplace
Focus on the task at hand
Reduce distracting noise to prevent accidents/errors
Develop a personal note-taking system
Implementing Policies on Accidents
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Standard O eratin Procedure Person/s Res onsible
When a patient had an accident e.g., fall:

Bring the patient back to bed if his condition permits.
Notify the Supervising Nurse on duty and ROD. Inform Assigned nurse or whoever
them of the accident. saw the patient
Do physical assessment. Check for any injury and extent of Nurse on duty
injury.
Get neurological vital signs. Assigned nurse and ROD
Render emergency care and carry out doctors' orders such
as cold compress application, IV fluids insertion, 02 Assigned nurse
inhalation etc. Assigned nurse and ROD
Standard O eratin Procedure Person/s Res onsible
Accomplish an accident report in duplicate copy with Assigned nurse
the medical examination report of the doctor who
examined the patient.
Submit two copies of the report to the Nursing Office Senior nurse/Charge nurse
thru channel, within 24 hours after the accident.
When the visitor or watcher had an accident:

• Render emergency care on the spot. Nurse on duty and ROD
Inform Supervising Nurse on duty Senior nurse/Charge nurse
Send the visitor or watcher to ER for treatment if Senior nurse/Charge nurse
condition permits.
Report to Securit Guard for medico-legal purposes. ER nurse
When nursing personnel had an accident during his/her
tour of duty:
Render emergency care on the spot
Notify ROD / Medical Specialist
Notify Supervising Nurse on duty
Send the personnel to ER for treatment if
condition permits
Nurse on duty and ROD
Accomplish an incident report in duplicate copy
Senior nurse/Charge nurse
Accomplish a medical exammation
Senior nurse/Charge nurse
report/medical certificate
Senior nurse/Charge nurse Senior
Submit 2 copies of the accident report with the
attached medical examination report to the Nursing
nurse/Charge nurse ER ROD
Office thru channel within 24 hours after the
accident Senior nurse/Charge nurse
Give two copies of the accident report and the
medical exannnation report to the personnel
concerned for future reference (Employment
Compensation or Disability Claims) Senior nurse Charge nurse
Patients ' Safety Implementing Policies
Bedside rails and/or restraints should be used routinely for children, restless patients, the aged,
those under sedation and unconscious patients.
Suicidal patients should always be provided with a 24 hour watcher. Alert other caregivers of
patients' suicidal tendencies.
Strictly "No Smoking" within hospital premises is enforced.
19
Make sure floors are free of debris that might cause patients to slip and fall. Spilled liquids
should be wiped immediately. Encourage janitors to use dry mops for slippery/wet areas.
Patient's unit and hallway should be neat and free from hazardous equipment, footstools,
electrical cord, slippers, shoes, IV stand, etc.
Place articles such as call light, cups etc. within the patient's reach.
Nurses should take turns in making rounds, checking patient's condition at least every hour and
more frequently to high-risk patients.
Stretchers, wheelchairs and beds' wheels should be locked when not in use. Security guard on
duty should be notified of any suspicious strangers loitering in the patient's unit/ward.
Unsafe and defective equipment and devices should be reported or turned over to the
Maintenance/Engineering Department for repair or condemnation.
Fire extinguishers available in the unit should be changed annually with the
Maintenance Personnel. Fire exits are checked for safety purposes.
On admission, patient's condition is assessed. Proper documentation should be

made on the patients' chart.
Example: The patient taking drugs that would affect movement or ambulation. He/she
may need help in getting out of bed or walking.
Nursing Actions That Improve Patient Safety
Nurses need to be knowledgeable about their healthcare facility policies and procedures and
always follow them.
Nurses should have open communication with one another as well as other healthcare
professionals. They should not be afraid to question orders or medications that seem out of
the ordinary.
Nurses must ALWAYS review the medications rights before giving medications.
Nurses need to be involved in creating and updating reporting systems that avoid blaming
individuals but rather encourage learning from the error, so that it can be prevented in the
future.
Nurses should stay current with research that affects their area of practice, so that they can be
involved in evidenced- based decision making when taking care of patients.
Nurses should stay current on all lifesaving certifications, such as BLS, ACLS, PALS and IV
therapy to avoid missing information that could affect patient safety.
Nurses ought to be part of hospital committees that focus on making the healthcare system safe,
effective, patient-centered and timely.
Nurses must report all unsafe care, errors and "near miss" not only for the patient it
affects but to prevent it from happening again.
Patients are given identification bracelets showing their names and allergies. Better lighting and
less clutter in work areas where medications are prepared, keeping distractions to a
minimum and keeping noise levels down.
20
Drug companies and health care facilities are also standardizing medication labels and
packaging.
Medications that can have a particularly dangerous effect are being mark as "high alert".
Many hospitals are investing in technology to minimize errors such as machines that dispense
medication for just one patient at a time.
21
The Management in the Delivery Care
o_fNursing
Occupational and Environmental Health Nursing
Is the specialty practice that provides for and delivers health and safety
programs and services to workers, worker populations and community groups. The
practice focuses on promotion and restoration of health prevention of illness and
injury and protection from work related and environmental hazards.
Role of Occupational Health Nurses
Case Managenwnt refers to providing treatment, follow up and refenals and emergency
care for job related injuries and illnesses. Occupational health nurses act as
gatekeepers for health services, rehabilitation, retum to work and case management
issues, and are keys to employers' health care quality and cost containment strategies.
Counseling and Crisis Intervention involves counseling workers about workrelated illness
and injuries, substance abuse and emotional and/or family problems. They handle
referrals to employee assistance programs and/or other community resources and
coordinate follow up care.
Health Promotion is the teaching of skills and developing health education programs that
encourage workers to take responsibility for their own health. Smoking cessation,
exercise, nutrition and weight control, stress management, control of chronic services
are just a few of the preventive strategies to keep workers healthy and productive.
Worker and Work Place Hazard Detection Includes monitoring the health status of
workers by conducting research on the effects of workplace exposures, gathering
health and hazards data, and using the data to prevent injury and illness.
Personnel Safety Implementing Policies
Always observe necessary safety measures when using wheelchairs, stretchers, beds and
other equipment available for the patient. Never operate electrical equipment with
wet hands.
Do not attempt to use an equipment unless, you are familiar with its operation.
Be sure that the electrical equipment is plugged into the proper type of outlet.
Never smoke or allow anyone to smoke in a room where oxygen is in use. This is
a "No Smoking" hospital.
Report any unsafe conditions such as following to the janitorial supervisor or
Supervising Nurse :
Wet and slippery floors
Defective equipment
Inadequate lighting
Fire drills are conducted so that employees know how to act during emergencies.
Needlestick injuries surveillance. Recommend staff for immunization on the following:
Flu Vaccination, Pneumonia, Rabies, Hepatitis B and C.
22
Infection Prevention and Control (IPC)
The goal of an organization's infection and control program is to identify

and reduce the risk of acquiring and transmitting infections among patients, staff,
health care professionals, contract workers, volunteers, students and visitors.
The infection risks and program activities may differ from organization to
organization depending on their clinical activities and services, patient's population
served, geographic location, patient volume and number of employees.
Effective infection prevention and control program commonly have

identified leaders, well-trained staff, methods to identify and proactively address
infection risks, appropriate policies and procedures, staff education and coordination
throughout the organization.
It has become clear that countries should be prepared in meeting the

challenge of emerging and re-emerging diseases. Critical to country preparedness is
an existing National Standard on Infection Control that will be followed and
implemented by all health facilities to ensure that transmissible infection are
prevented and/or contained.
The Department of Health, through the Health Facility Development Bureau,

in collaboration with active partners from both the public and private sectors,
developed the National Standards in Infection Prevention and Control for Healthcare
Facilities. These standards will forin the basis for future policies and progranos that
shall help healthcare facilities establish a strong, effective and relevant hospital
infection control network in the country (Department Q/ Health-Health Facility
Development Bureau(DOH-HFDB) and the Philippine Hospital lufection Control
Society, Inc. (PHICS) National Standards in Infection Prevention and Control for
Healthcare Facilities, 2009).
Importance ofInfection Prevention and Control
1. Maintain a safe environment for patients and staff by reducing the risk of
acquiring the healthcare-associated infections.
Prevent spread of transmissible diseases in healthcare settings through evidence
based-control measures.
Learn the multidisciplinary approach in infection prevention and control practices
particularly for the emerging and non-emerging infections.
Develop strategies to reduce hospital and community acquired infections through
evidence-based research.
Respond effectively and efficiently to outbreak of infections within the healthcare
facility community.
23
Provide support for infection control preparedness and response to public health
emergencies of potential international concern.
Reduce patients' length of stay and cost of confinement through stringent
implementations of prevention and infection control policies and protocols.
of
Prevent complaints and litigations related to healthcare associated infections that

can potentially incurred by patients, significant others, and staff.
Purpose
To coordinate, evaluate, and support the activities of the Infection

Prevention and Control Program and to communicate with all departments of the
healthcare facility to ensure the engagement and full support to the program by all
stakeholders. The IPC advocates for the program shall ensure all resources needed
are available.
General Duties and Responsibilities (Infection Prevention and Control

Nurse)
Acts as coordinator to all hospital staff relevant to infection control.

Identifies healthcare-associated (nosocomial) infections.
Investigates type of infection and infecting organism.
Participates in outbreak investigation.
Conducts of surveillance of hospital infection.
Participates in training of personnel.
Assists in the development of infection control policies, reviews and approves
patient care policies relevant to infection control.
Ensures compliance with local and national regulations.
Serves as liaison with other departments of the hospital.
Provides expert consultative advice to staff health and other appropriate hospital
program in matters relating to transmission of infections.
Attends professional meetings and conferences on matters related to infection
control. Regularly monitors infection control practices and compliance of
health care worker.
Monitors staff health in collaboration with the Employee Health Services
Department to prevent hospital related infection among hospital staff.
Serves as preceptor in nursing training program.
Conducts research studies relevant to infection control.
The committee consists of multidisciplinary team members. Membership

includes representation from the different services. Special meetings will be called by
24
the Chair when circumstances dictate. (Refer to National Standards in Infection
Control for Healthcare Facilities, 2009)
All matters to be addressed by the committee should be brought to the

attention of the chairperson, and/or the appropriate committee members.
Documentation, discussions, conclusions, recommendations, assignments, actions,
and approvals are documented in the minutes of the Committee meetings. Minutes are
distributed to each Committee member and are forwarded to other appropriate staff
The program is executed by the Infection Prevention & Control (IPC) Department
supported by the Infection Prevention Control Committee (IPC) through the following
services:
Surveillance of healthcare-associated infections (HAIs)

Education
Consultation
Outbreak and exposure investigation
Environmental health
Occupational health and safety (Employee Health)
Infection control is Everyone's Responsibility, but the scope and magnitude

encompassed by Infection Control requires a "key person" to coordinate the activities
of the program. The Infection Prevention Chair is that "key person." In some
hospitals, Environmental Health is a complementary service to the IP&C Department
depending on its size. The Environmental Health personnel assigned to the IP&C
Department would be the appropriate person to report any environmental-health
related infection concerns.
Any staff, patient, and/or visitors of the healthcare facility may request
infection control review and consultation as they relate to infection prevention and
control activities, such as: • Surveillance • Investigation ' Research • Statistics •
Education
Standard Precaution — Infection Prevention and Control (Rcfer to National
Standards in ]u/ection Control for Healthcarc Facilities, 2()()9)
Standard precautions are meant to reduce the risk of transmission of blood

borne and other pathogens from both recognized and unrecognized sources. They are
the basic level of infection control precautions, which are to be used as a minimum in
the care of all patients.
The nurses play a critical role in preventing and controlling hospital

infections. Thus, nurses' actions for infection prevention and control are the
implementation of universal standard precautions.
Nurse's Role
25
Nurses as the largest group of healthcare service providers in the nation, are
vital members of this team. The IOM (Institute of Medicine) report on keeping
patients safe: Transforming the Work Environment of Nurses made it explicit that
nurses are the healthcare service professionals most likely to intercept errors and
prevent harm to patients.
Given the role that nurses play in care and quality improvement, it is
important for nurses to know what proven techniques and interventions they can use
to enhance patient and organizational outcomes.
of
The Department of Health, through the Health Facility Development

Bureau, in collaboration with active partners from both the public and private sectors,
developed the National Standards in Infection Control for Healthcare Facilities-DOH.
These standards will serve the basis for healthcare organizations to establish a strong,
effective and relevant hospital prevention and infection control program. The other
references that can be utilized are materials from refutable related organizations like
the Philippine Hospital Infection Control Society, Inc. (PHICS) and Disease
Prevention and Control Bureau (DPCB).
The primary role of a nurse is to advocate and care for individuals of all
ethnic origins and religious backgrounds and support them through health and illness.
However, there are various other responsibilities of a nurse that form a part of the role
of a nurse, including to:
Record medical history and symptoms

Collaborate with the team to plan for patient care
Advocate for health and wellbeing of patient
Monitor patient health and record signs Administer medications and treatments
Operate medical equipment
Perform diagnostic tests
Educate patients about management of illnesses
Provide support and advice to patients
Multi-Drug Resistant Organisvns (MDROs) are bacteria that are resistant to

many or all available antibiotics. Methicillin-Resistant Staphylococcus Aureus
(MRSA) and 2 Vancomycin-Resistant Enterococci (VRE) are important resistant
microorganisms encountered in the hospital; Methicillin-Resistant Staphylococcus
Aureus Management Vancomycin- Resistant Enterococcus Management.
Extended Spectrum Beta-lactamases (ESBLs) and Carbapenem-Resistant

Enterobacteraceae (CRE) are among primary resistant microorganisms of significant
concern in the healthcare setting and are endemic in many hospitals of the GCC
26
countries. Proper attention to these pathogens is critical to curtail further emergence
of these highly resistant organisms.
Standard Precautions Must Be Observed For All Patient Care Procedures
Notification of the MDRO

The microbiology lab will notify the ward and Infection Prevention and Control (IPC)
Department ofthe MDROs.
Patients previously discharged MDRO positive are flagged and documented by IPs.
Only IPS can de-flagged / remove MDRO alerts.
Management of MDRO-Positive Patients

1. Initiate contact precautions in addition to standard precautions.
Patient must be in a single room or can be cohorted with another patient with the
same organism.
MDRO-positive patients who are in multi-bed rooms can be managed temporarily
while waiting to be transferred to a single room or an appropriate cohort.
Place a sign on the cubicle or curtain of the patient's bed.
Ensure easy access to PPE and alcohol-based hand rub.
Practice strict standard precautions between interactions with patients in the room.
Transfer to a single room or cohort with another patient with the same organism as
soon as possible.
Place a contact isolation sign on the outside of the isolation room door.
Practice strict hand hygiene.
Cohort non-critical items such as stethoscopes and pressure cuffs with the patient.
Store minimum amount of supplies in the patient's room.
Use an isolation cart for extra supplies (kept outside the room).
Ensure that all staff understand and comply with the isolation precautions and
hand hygiene protocol.
Limit the patient's activity outside the room to treatments or tests.
1 1. Notify receiving depaltments/wards (e.g., Radiology, Endoscopy, Clinics,
OR) of the patient's isolation status when the patient must be transported for
treatment/tests.
Ensure concurrent and terminal cleaning of the isolation room and equipment as per
housekeeping procedure.
Handle/discard contaminated items as per Standard Precautions.
2. Medical
a Request Infectious Diseases consultation as needed.
b Discharge the patient from the hospital once his/her medical condition
allows.
c If the patient is being transferred to another hospital or healthcare
facility while still colonized or infected with an MDRO, the
27
transferring hospital is obliged to inform the receiving hospital of the
details of the MDRO in order to ensure proper isolation. Emergency
Medical Services (EMS) and other healthcare providers involved in
transferring such a patient need to be made aware of the status of the
patient and advise on proper Personal Protective Equipment (PPE), as
well as, disinfection of the ambulance, as deemed necessary.
3. Clearance/Discontinuation of Isolation
a Discontinue isolation of MDRO-positive patient after consultation.
4. Screening of Healthcare Workers (HCWs) and the Environment.

▪ Do not screen HCWs or the environment because it is not
typically indicated and incurs unnecessary costs.
▪ IPC may initiate such measures when indicated.
5. Outbreak Management
1. Management of outbreaks will be coordinated by the IPC and will require
the cooperation of medical, nursing, laboratory and other departments.
6. Cleaning of the Patient's Room

1. Perform regular or terminal cleaning.
7. Linen
1. Keep a linen hamper in the isolation area.
This policy describes the steps needed to prevent the spread of Methicillin-
Resistant Staphylococcus Aureus (MRSA) to patients, staff, and visitors.
Management of Patients with Suspected MRSA Infection or Colonization

1. Initiate empiric contact isolation precautions during the screening procedure, if
possible.
a. Screen all patients who are:
1. Admitted to the intensive care units (ICU).
2. Transferred from other hospitals or have been treated in.
Needlestick Injury
In response to the risk of exposure, institutions have focused on primary

prevention as a means of reducing the incidence of needlesticks and thereby
decreasing the number of blood borne pathogen transmissions. Needlestick injuries
still occur, however, and it is important that individuals in the health care field
become well informed about the exposure risks and educated regarding the
appropriate response.
28
Needlestick injuries are wounds caused by needles that accidentally puncture
the skin. Needle stick injuries are a hazard for people who work with hypodermic
syringes and other needle equipment. These injuries can occur at any time when
people use, disassemble, or dispose of needles.
What are the primary pathogens transmitted?

Human Immunodeficiency Virus (HIV). The average risk of sero conversion after a
needle stick injury from a confirmed HIV source is approximately 0.3 percent without
post-exposure therapy. Certain factors contribute to elevated risk:
Increased depth of the puncture wound
Visible blood on the needle o Needle
used in the vein or artery of the patient o Patient
with terminal HIV as source of the fluid
Hepatitis B Virus (HBV). The risk of acquiring hepatitis secondary to HBV percutaneous
exposure varies based on the serological status of the patient. In the worst case
scenario, if the patient has active replication of the virus (indicated by HBeAg-
positive blood then the risk of developing clinical hepatitis is as high as 31 percent.
When the patient has HBsAg-positive blood but is HBeAg-negative (indicating a less
infective state), the risk is significantly lower, about 1 to 6 percent.
Hepatitis C Virus (HCV). The risk of HCV seroconversion after a needle stick injury
from a patient infected with HCV is approximately 1.8 percent. Unfortunately, there is
little evidence to support post exposure treatment as a means to decrease the risk of
infection.
What protocol should be followed after any

needlestick? e First, do not panic.
Protocols are in place to minimize the risk of infection after
exposure.
Second, do not ignore the exposure. Acting within outlined timeframes can lead to a
significant decrease in the transmission rate of certain infections.
The following measures also should be taken:

The site should be immediately washed with soap and water. o The incident should be
reported and an exposure report sheet completed.
The exposure should be assessed (type of fluid, type of needle, amount of blood on the
needle, etc.)
The exposure sources should be evaluated:

HIV, HBV, and HCV status of the patient;
Consent and testing of the patient for these diseases if the status is unknown;
Likelihood of infection based on the community served by the hospital if the patient is not
available to be tested.
29
Appropriate management of any positive exposure is necessary
Policies on Needle Stick Injury

All health care workers who handle sharps should be properly oriented in its safe use and
disposal.
All health care workers should handle needles, blades/lancets and sharp instruments
carefully so that accidents can be prevented.
All used needles, blades/lancets and other sharp instruments should be disposed to
punctured proof resistant container immediately after use. Punctured proof resistant
container should be accessible so that the operator can dispose immediately the sharp
and avoid mixing it with other wastes. All health care workers should practice safety
techniques in handling sharps from use until disposal.
"f
DO NOT RECAP NEEDLES. If recapping is necessary, USE SINGLE HAND

TECHNIQUE or USE MECHANICAL DEVICE (forceps).
Always seek orientation on how to properly manipulate new gadget using sharp (e.g.
CBG lancets).
Do not bend needle. Do not manipulate the capped needle. If needle should be removed
from the syringe, always use forceps. o Use forceps in picking sharps debris or any
equivalent.
Sharps should be pointing away from the operator when manipulated but
not facing anybody and be aware of the persons beside you.
Do not overfill sharp containers and seal properly if ready for disposal.
Puncture proof resistant container should be available in the following areas at all
time:
Medication room/IV trays o Laboratory o Procedure/treatment room o Anywhere sharps
are used
All needles/sharp injuries should be reported for evaluation and management.
Safe Transfusion of Blood and Blood Component
Nurses are integral to the Blood Transfusion Process. Blood transfusion

practice is the administration of a blood component or plasma-derived product to the
patient, relative to the cunent requirements of national guidelines.
Blood transfusion is concerned with ensuring that at a time when transfusion

is clinically indicated, the patient receives the correct blood safely. Nurses have a
responsibility to provide the highest standard of care and all patients have the right to
expect this. Nurses are often involved in pre-transfusion sampling, provision of
patient infonnation, requesting blood from laboratory, collecting blood, administration
of the transfusion and monitoring the patient's responses during and after the
transfusion event. As practitioners they are personally accountable for their practice
and for ensuring that it is based on sound evidence to minimize the risk to which
30
patients are exposed. Current emphasis in health care requires practice to be evidence-
based rather than based on ritual or tradition. (Wilkinson, 2001).
Blood is a body fluid in humans and other animals that delivers necessary
substances such as nutrients and oxygen to the cells and transports metabolic waste
products away from those same cells. In vertebrates, it is composed of blood cells
suspended in blood plasma.
A blood transfusion is a safe, common procedure in which blood is given to

you through an intravenous (IV) line in one of your blood vessels. Blood transfusions
are done to replace blood lost during surgery or due to a serious injury.
Good Practice in Blood Transfusion

Procedure Rationale
31
To minimize delay and risk to the patient.
Ensure availability of competent and trained staff.
Explain to the patient and family the reasons for To ensure that the patient understands the
the transfusion and secure valid consent. . Provide procedure
supporting written information and answer
questions.
Ensure that the patient is wearing a correctly

completed identity wrist band. To ensure positive identity.
Check the blood component that has been

prescribed and the correct documentation. To mnimize delay and risk to the patient and avoid
wastage of blood
See to it that all required equipment is available,
functional and suitable for the procedure. To minimize delay and risk to the patient.
Ensure that the cannula intended for administration

of the component is patent. To minimize delay and risk to the patient.
Ensure correct blood compatibility documentation.

To minimize delay and risk to the patient.
Confirm that the blood component is for the
intended patient. To maximize patient safety and minimize wastage
if an incorrect unit has been collected and is to be
returned to the blood bank.
Take all equipment and documentation to the
patient bedside. To enable correct pre-transfusion checking
procedure.
Ask the patient to state full name and date of birth,
To confirm patient identity.
Compare verbal identifiers with identity wrist band.
To confirm positive identifier.
Check the blood component expiry date and quality
in particular looking for signs of leakage or To ensure the blood meets any special
deterioration. requirements of the patient.
Check that the details on the label attached to the

bag are identical to those of the original bag To ensure that the correct compatibility label is
label, that is, serial number and blood group. attached to the bag.
Perform pre-transfusion observation of

temperature, pulse and blood pressure and To establish baseline levels so that any potentially
document on the observation chart or transfusion transfusion related deviations will be recognized.
record.
Run the blood component at the prescribed rate. To ensure safety and well-being of the patient.
Document the exact time ofblood transfusion. To maintain accurate documentation label.
Ensure that the patient has a call bell and knows To aid early recognition.
how to call for assistance in the event of any
potentially related symptoms.
Procedure Rationale
32
Maintain visual observation of the patient for the To aid early recognition of a transfusion reaction.
first fifteen minutes.
Repeat and document observations ofTPR 15 To aid early recognition of a transfusion reaction.
minutes after commencement transfusion.
Maintain additional observation according to
policy.
To aid early recognition of a transfusion reaction.
Continue transfusion at the correct rate until
completed. To maintain accurate documentation.
If another unit is not required, disconnect and

record the stop time. To aid in recognition of transfusion reaction
Repeat and document observation of temperature,

pulse, respiration and blood pressure.
(Refer to Appendix S, National Voluntary Blood Services Program,
Transfusion Standard Operating Procedures)
33
34

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The Management in the Delivery Nursing Care

Hospital Nursing Service Administration Manual

Safety in healthcare organizations aims to prevent harm to patients their

In response to the call of the World Health Assembly (WHA), the

Patient Safety is defined as "the prevention of harm to patients through avoidance

Efficient means avoiding waste, including waste of equipment, supplies, ideas

Key Elements of Patient Safety

Leadership. Leadership and political commitment are essential at the health

Ten (10) Reasons for Global Patient Safety

Strategies that Promote Patient Safety

Health facility operations and management systems that promote Culture of

Ensuring a safe environment in the health facility

Health personnel safety established

Medical records system is completed

Assessment of the nature and scale of adverse events

Training and capacity building of health workforce sensitive to patient safety

Identifying knowledge, skills, attitude gaps of health professional and

Improving the understanding and application of patient safety and risk

Preventing and controlling Healthcare-Associated Infection (HAI)

2. Employing a system to reduce HAI in the facility

Implementing of Patient Safety key priority areas

one of them), for all patient care processes (procedures, transfer, or

a. SBAR-standardized technique to facilitate communication during

S Situation: What is the situation?

A Assessment: What is your assessment of the situation?

R Recommendation: What is your recommendation of the situation (i.e..

b. I PASS THE BATON — an effective tool of a hand-off checklist of critical

1 Introduction of self and your role

P Patient-name, identifiers, age, gender, location

Assessment-presenting chief complaint, vital signs, symptoms diagnosis

S Situation-current status/circumstance, level of uncertainty, recent changes,

S Safety Concerns-critical lab values/reports, socio-economic factors,

Background-comorbidities, previous episodes, current medications, family

A Actions-what actions were taken or are required?

T Timing-level of urgency and explicit timing and prioritization of

O Ownership-who is responsible (nurse, doctor/team)? Include

N Next-what will happen next? Anticipated changes? What is the

In the medication area, vigilance, accuracy, careful attention, and

Medication Error Policy

Have grievances as a result of corrective measures decreased?

Oftentimes, medication enor occurs due to the system of applying standards

Restraints like confining a person in bed can be misinterpreted as a form of

When a patient is brought to the Emergency Room (ER) for treatment, it is

Consent (Right to Informed Consent)

cannot be forced to sign the consent. This reaction should be

There are legal risks in telephone orders. These may be understood or

Only in an extreme emergency and when no other physician is available should a

The Generics Act Law (RA 6675)

An Act to promote, require and ensure the production of an adequate

Observation of the Medication Rights will prevent Medication errors

Indicators and Parameters of Safety

(P SIS) are a set of indicators providing införmation on potential in hospital

Benefits of Checklists in Health Care

Nursing Actions to Improve Patient Safety

Knowledge and implementation about healthcare policies and procedures.

Hospital Nursing Service Administration Manual

Nurses were asked to engage in the following activities:

Implementing Policies on Accidents

Standard O eratin Procedure Person/s Res onsible