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Long-Term Care Survey Alert

Survey Management:

PREEMPT TOP F TAGS WITH PATIENT SAFETY ROUNDS

Published on Tue Apr 01, 2003

If a surveyor asked you how safe residents are from accidents and clinical shortfalls, what would you say? Considering that F tags for safety hazards, accidents and quality of care rank among the top 10 deficiencies, that's a good question for your facility staff to ask themselves and one that can be answered with relative assurance by performing daily patient safety rounds.

While the term safety conjures the image of fire codes and plant maintenance issues, the patient safety round is a horse of a somewhat different color.

The latter focuses on any thing that affects the resident's safety and well-being, which includes accident hazards, potential clinical mix-ups and quality of care issues, according to StephenTrosty, director of risk management at American Physicians Assurance Corp. in East Lansing, MI.

For example, as part of its new patient safety program, the Miami Jewish Home & Hospital for the Aged will be doing rounds looking at physical safety issues, such as how the facility deals with the temperatures of beverages, which can seriously burn residents' fragile skin if served too hot and spilled.

"We'll also look at near misses, such as where a resident almost fell," reports Leilani Kicklighter, director of risk management services for the facility.

But the focus will also encompass clinical issues, such as delays in how different departments respond to physician orders or report test results and changes in resident status. "This might involve departments such as the laboratory, radiology, dietary, pharmacy or rehabilitation therapy, "Kicklighter explains.

Follow This 8-Point Plan

A DON conducting a patient safety tour might also take steps to:

  • Ensure that essential safety features are working, such as proper alarms on all the doors and IV pump alarms. When performing patient safety rounds, former DON Laura Fain at Leesburg Regional Medical Center's nursing center says she would test the side rails and call lights to make sure they worked properly.

  • Check to see if patients' special dietary needs are being met. For example, the DON or other staff person might crosscheck the physician's orders and make sure residents actually get the right diet at meal times or supplements in between meals.

  • Compare the amount of meals consumed by residents with the CNAs' estimated percentages on the flow charts.

  • Make sure housekeeping staff keeps their cleaning carts secured as they work to prevent accidental poisoning.

  • Look for objects or exposed corners of furniture that would hurt a resident if he fell.

  • Check for potential elopement risks (alarms not working properly or lack of supervision).

  • Review pharmaceuticals to see how they are being dispensed and whether the facility has safe-guards to ensure residents are getting the right medications on time as ordered by the physician.

  • Audit charts to see if patients who require lab monitoring(such as those on Coumadin) are getting the testing and the appropriate follow-up.

    Tip: Develop parameters for the patient safety rounds so staff knows what to look for on a daily, weekly and monthly basis.

    Don't Be the Safety Police

    Trosty suggests that staff doing any type of safety reviews consult with department heads on a regular basis to find out what they see as the key safety and clinical concerns.

    But if administrators want staff to "come clean" about patient safety hazards and near misses, they can't appoint safety patrols who use the rounds to corral the suspects, Trosty warns.

    Kicklighter adamantly agrees: "At our facility, we ask staff about potential safety problems and the near misses in an environment of support."

    Follow Through With Changes

    The safety rounds and data reviews can red flag the potential safety issues. But administration has to commit to ensuring that the information makes its way to the right departments and people to implement proactive changes. Administrative involvement is especially critical to help prioritize changes that come with a price tag.

    Tip: If the safety rounds and data show that things are going well in a certain area, give people that feedback. In other words, you can also learn from what goes right.

     

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