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Safety Counts! a newsletter highlighting safety at Hallmark Health System
Safety Counts October 2014 - Download entire PDF by clicking
Vol 2, No. 9, October 2014
Going back to basics prevents the spread of infectious diseases
At Hallmark Health System (HHS), education about preventing infectious diseases begins as soon as an employee is hired. And it continues on a daily basis. Preventing the spread of infectious diseases is particularly important during the fall and winter flu season and in summer and fall when enteroviruses are prominent. But media coverage of infectious diseases has heightened public awareness around preventing their spread year round.
HHS employs four main tactics to rein in infectious diseases:
Protocols. HHS adheres to the standard precautions protocol required by regulatory agencies. Standard precautions are based on the situation. “The employee assesses the task at hand and chooses protective equipment that fits the task,” said Elaine Boerger, RN, infection control nurse. “Interacting with a patient who is coughing, for example, dictates that the employee put on a mask.” The key to success with standard precautions is that “we use them with every patient, every time, with every interaction.” This includes hand hygiene, a simple yet highly effective way to prevent the spread of infectious diseases.
Education. Education begins at employee orientation and is particularly important for nurses, housekeepers and others who come into repeated contact with patients. Patients receive education as well, including printed materials specific to them. Signage around the hospital reminds visitors of proper infection control etiquette, such as not visiting if sick.
Vaccination. In addition to mandatory flu vaccines for staff, HHS offers combined Tetanus, Diphtheria and Pertussis (Tdap), hepatitis B and chickenpox vaccines to employees who request them.
Surveillance. Daily rounds on inpatient floors ensure that staff adhere to protocols and practice good hand hygiene, and monthly reports are sent to each nursing floor. “All these tactics allow us to protect our staff and our patients at the same time,” said Boerger.
Acting on ‘If you see something, say something’ may save lives
When phlebotomist Gina Bartsch went to labor and delivery at Melrose-Wakefield Hospital to draw a patient blood sample, she knew something wasn’t right. Then she did two things that may have helped save the life of a mother and her baby.
The first involved quick thinking. “The patient wasn’t very responsive when I asked her to confirm her date of birth for the two patient identifiers we need, and the nurses were very busy helping her,” Bartsch said. “I was pretty sure she was going to need more lab work than what I’d come there to do. So I drew what’s called a ‘rainbow’ – the equivalent of four samples rather than one.”
The second involved speaking up. She took the samples to the blood bank and talked with medical technologist Jesse Schacht. “I told him the patient had lost a lot of blood and I thought she might need a transfusion. He listened to what I said and prepared a transfusion even though we didn’t have an order for it.”
Schacht said “I developed a just-incase procedure for crossmatching blood – a way to anticipate orders that might come in. In this case, I crossmatched a couple of units of blood in anticipation of the call.” As it turned out, the patient did have a serious problem and was transferred to a Boston hospital for further care and the birth. Mother and baby are now home and doing well. Schacht said the patient’s doctor, Donald Monteiro, MD, “came down afterward to shake my hand and thank me, which really made me feel a part of the team.” This story illustrates a cornerstone of Hallmark Health System’s campaign to create a culture of safety – “if you see something, say something.” In this case, Bartsch spoke up. “Just as important, though, is that Jesse listened. With this level of teamwork and trust, we could anticipate what this patient needed and do the right thing for her and her baby.”
Cultural competence is an important patient safety tool
Cultural sensitivity is important to patient safety at all stages of care, from outpatient visits to hospitalization and even end-oflife care. “It’s well documented that when people have cultural or language barriers that prevent them from receiving and understanding basic health information, serious errors can and do occur,” said Johna Wasdyke, director of Human Resources Operations at Hallmark Health System.
- 1. knowing where patients are coming from – understanding cultural beliefs and values
- 2. finding the best way to communicate with patients about important health information, including trained interpreters
- 3. checking personal cultural stereotypes at the door.
In 2014, employees are participating in a series of lunchtime “Cultural Conversations” sponsored by the diversity steering committee and featuring presentations by local community advocates for underserved or immigrant populations. These sessions offer real-life examples of the importance of cultural competence. One example was that of a patient whose complaint of severe pain was disregarded because the caregiver believed that people of his ethnicity tended to be overly emotional and loudly expressive. Another example involved a patient with low English language proficiency who simply nodded when asked if she understood her medication instructions and then didn’t follow the regimen when she got home.
“It’s clear that awareness of language issues and cultural issues are crucial to safe outcomes,” said Wasdyke. “As our patient population becomes more diverse, we need to look beneath the surface and be aware of cultural practices and what role they play. We also need to ask the right questions, watch body language and expressions, and really listen.”
Proper equipment, training ensure safe lifting of patients
According to the National Institute for Occupational Safety and Health (NIOSH), health care workers experience musculoskeletal disorders at a higher rate than do those in construction, mining, manufacturing and other trades. NIOSH cites a number of factors, including the rising age of both staff and patients and the overall increase in weight of the patient population.
Hallmark Health System has invested in new equipment to safely move patients. Three main types of transfer devices are in use at HHS:
Hoyer lift. Either portable or ceiling-mounted, the Hoyer lift is a swing that enables a patient to be moved from a bed, wheelchair or other piece of equipment.
HoverMatt. This is an air mattress placed under the patient and inflated. “The mat has tiny perforations that allow air to escape gradually so the patient can glide along the mattress while moving from a bed to a stretcher, for example,” said Joy Gaviola, MSN, RN, CRRN, clinical nurse educator.
HoverJack. This is a tall air mattress that inflates from floor level to bed level. “Should a patient fall,” said Gaviola, “this is a way to safely return the patient to bed, minimizing the risk of further injury.”
Also at the disposal of staff are more traditional assistive devices such as sliding boards and gait belts. The equipment is used for any patient who needs moderate to complete assistance for mobility, including paralyzed and comatose patients, obese patients, and those with limited mobility who need transfer assistance. “Since acquiring this transfer equipment, our training has focused on its proper use,” said Gaviola. “If employees are picking up anything heavier than 30 pounds, they should find someone to help them or use one of the devices.” HHS’s Adult Day Health program also has a new standing and raising aid, called a Sara Lite lift, which helps raise and lower semi-dependent participants for transfers and toileting. This eliminates the need for three staff to assist in such transfers and increases safety for both clients and staff. Gaviola added, “When staff injuries are reduced, the quality of patient care improves. Safe nurses mean safe and satisfied patients.”
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Wednesday, November 12 2014 13:56