Safety Issues in the Endoscopy CenterNational Patient Safety Goals from The Joint CommissionEndoscopy Safety recommendations from: Occupational Safety and Health Administration The American Society for Gastrointestinal Endoscopy The Centers for Disease Control and Prevention The Joint Commission

Presented byBJ Garrett, MSN-NE, CGRNNurse EducatorAustin Endoscopy Centers

All endoscopy facilities are scrutinized by regulating/governing bodies

Medicare and Medicaid ServicesThe Joint CommissionAccreditation Association for

Ambulatory Health CareAmerican Association for

Accreditation of Ambulatory Surgery Facilities

State and Local Health Departments

Patient safety and patient privacy is the responsibility of every employee in all healthcare facilities

THE 2015 JOINT COMMISSION’S “NATIONAL PATIENT SAFETY GOALS” ARE DESIGNED TO ENHANCE PATIENT SAFETY AND ELIMINATE WRONG-PATIENT ERRORS.

Safety Issues inThe Endoscopy Center

GOAL ONE: IMPROVE THE ACCURACY OF PATIENT IDENTIFICATION.

GOAL TWO: IMPROVE THE EFFECTIVENESS OF COMMUNICATION AMONG CAREGIVERS.

GOAL ONE: IMPROVE THE ACCURACY OF PATIENT IDENTIFICATION.

“Staff must identify the patient using two identifiers, before any patient encounter” (Ragsdale, 2011, p. 218).

Goal One: Accurate Patient IdentificationStarts at the Front Desk

◦Administrative associates ask the patient to: State (spell) name, birthdate, physician,

procedure, and indications

◦Associate can assess patient ability to answer questions appropriately

◦Checkpoint for scheduled procedure, correct patient, indications, procedure, physician

◦Verify information on ID bracelet

Goal One: Accurate Patient IdentificationContinues in Pre-opPatient Privacy: Use either first or last name Privately ask the patient to state their nameVerify (again):

◦ Physician, procedure, indicationsVerify

Drug allergies, adverse reactionsFall risk status-falls are leading cause of death in elderly

Medication reconciliation mandatoryReview health historyExamine patientASK, is there anything else we should know in

order to keep you safe today?

Goal One: Accurate Patient Identification Follows the Patient into the Procedure Room

Joint Commission's Time-Out ◦Mandatory staff presence for Time-Out prior

to procedure and sedation:◦Physician◦Nurse◦Anesthesia provider◦Endoscopy technician

Patient should sate their name, birthdatePatient should agree with procedure,

indications, physicianSpecimen collection: discussed next

section

Goal One: Accurate Patient Identification After the Endoscopic Procedure into Post Op

Discharge paperwork matches patient

Review Fall risk identification◦Suspicious? Ask: do you have a

history of falls?◦Any employee can upgrade a patient

to being escorted out of the facility in a W/C

If a patient enters the center with a cane or walker, escort out in a W/C

House policy should reflect unable to ambulate independently as “Fall Risk”

GOAL TWO: IMPROVE THE EFFECTIVENESS OF COMMUNICATION AMONG CAREGIVERS.

Goal Two: Effective CommunicationStarts at the Front DeskAdministrative associates notice

vital information to assist in patient safety◦Patient responses inappropriate◦Lethargy, weakness, pain, nausea◦Responsible adult not present

Reach out to a nurse or physician for immediate assistance

Arrange for professional interpreter (Limited English Proficiency [LEP], 2012)

Goal Two: Effective CommunicationContinues in Pre-opCharting should “paint a picture”

◦Patient alert and oriented to person, place, time, and event

Document normal and abnormal findings◦Skin lesions noted on left shoulder◦Patient suffered a vasovagal event with IV

stickDocument medication administration

◦Need for medication (nausea)◦Drug administered, dose, route, time◦Effectiveness, “patient reports relief of

nausea”

Goal Two: Effective CommunicationFollows Patient into Procedure Information from pre-op

◦ Physical condition, Prep effectiveness◦ Specific patient requests: report, staff, PHI

Facility approved signs/stickers◦ Fall risk, diabetic stickers, fluid restriction, PHI

Valuable endoscopic biopsies◦ Repeat all physician statements◦ Label to include patient name and medical record

number, specimen type and location◦ Double-check specimen with second

employee/Endo tech - jars have correct patient label, specimen type and location, verify tissue is present (Ragsdale, 2011, p. 218)

Goal Two: Effective CommunicationAfter the Procedure in Post-OpFormal hand-off to appropriate

providerReport to a nurse or physician

◦Patient name, procedure performed, name and amounts of medications, time of last dose, diagnosis if appropriate

Do not report or accept report about unrelated patients◦Respond politely, I will join you in a

moment

Goal Two: Effective CommunicationFollow Up Phone CallConsidered a patient encounter, use two

identifiers before dispensing advice or information

Nurse to document all adverse eventsSerious events must be immediately

reported to the physician or representativeDocument nursing advice

◦ Advised patient to increase fluid intake todayFollow facility policy as to management

follow up on adverse eventsUse EMR when appropriate

◦ Prescription refills, patient requests

Goal Two: Effective CommunicationReview Facility standards communicate

information to all employees◦Signs, open curtains, initialing ID

braceletAsk for more information when

needed, give more information when appropriate

Request privacy when necessaryRespectfully-but immediately-stop

inappropriate communication

Recommendations for Infection Prevention by

The American Society for Gastrointestinal Endoscopy [ASGE], 2014

Infection Prevention Recommendations: Scope Processing

Follow accepted standards such as: SGNA’s “Guidelines for the Use of High-Level Disinfectants and Sterilants for Reprocessing of Flexible Gastrointestinal Endoscopes” (2013)

“Multi-Society Guideline for Reprocessing Flexible Gastrointestinal Endoscopes” (Nelson et al., 2003)

Infection Prevention

Ragsdale quoting Joint Commission standards reports:

“Hand hygiene is the single most effective means of preventing nosocomial infections” (2011, p. 220)

ASGE on Infection Prevention:Hand Hygiene need be implemented

Before and after every patient contactAfter contact with blood or body fluidsAfter contact with contaminated

surfacesBefore performing invasive procedures

◦Starting an IV, medication preparationAfter glove removal

◦Eating and toileting ◦Any time the hands are soiled

ASGE on Infection Prevention: Hand Hygiene, continuedAlcohol-based agents are

adequate for most hand hygieneUse soap and water when:

◦Hands are visibly soiled◦After caring for patients with

diarrhea, especially C diff

ASGE on Infection Prevention:Personal Protective EquipmentNo PPE for low-risk exposureGloves and impervious gowns for high-risk

exposure ◦Direct patient care with potential of contact with

contaminated scope, device, or body fluidsBecause of the potential for splash exposure

to the face, individual units should develop policies based on Occupational Safety and Health Administration and state-mandated recommendations for wearing face and/or eye shields or masks” (ASGE, 2014, p. 366).

Safety Issues in the Endoscopy CenterAccurate Patient IdentificationProtection of Patient PrivacyEffective Communication Infection Prevention

◦Scope Reprocessing◦Hand Hygiene◦Personal Protective Equipment

Everyone is always responsible - communicate, investigate, utilize best practice, follow policy-and update policy as needed

ReferencesLimited English Proficiency. (2012). Laws concerning language access for LEP individuals. Retrieved from http://www.lep.gov/faqs/faqs.

html#OneQ2Ragsdale, J. A. (2011). Validating patient safety in the endoscopy unit using the Joint Commission standards. Gastroenterology Nursing, 34(3), 218-223. http://dx.doi.org/10.1097/SGA.0b013e3181d6e4b1Society of Gastroenterology Nurses and Associates, Inc. (2013). Guideline for Use of High Level Disinfectants &Sterilants for Reprocessing Flexible Gastrointestinal Endoscopes. Retrieved from http://www.sgna.org/Portals/0/Issues/PDF/Infection-Prevention/6_HLDGuideline_2013.pdfThe American Society for Gastrointestinal Endoscopy. (2014). Guidelines f or Safety in the Gastrointestinal Endoscopy Unit . Gastrointestinal Endoscopy, 79(3), 363-372. http://dx.doi.org/10.1016/j.gie.2013.

12.015The Joint Commission. (2007). Meeting the Joint Commission’s national patient safety goals. Oakbrook Terrace, IL: Department of Publication, Joint Commission Resources.The Joint Commission. (2015). National Patient Safety Goals Effective January 1, 2015. Retrieved from http://www.jointcommission.

org/assets/1/6/2015_NPSG_HAP.pdfVera, M. (2012). The 10 rights of drug administration. Retrieved from http://nurseslabs.com/10-rs-rights-of-drug-administration/

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Thank you for your attention

today!