Employee Center

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CGN Notes - Our Employee Newsletter

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• Volume 6, Issue 7 (June 2008)
• Volume 6, Issue 6 (May/June 2008)
• Volume 6, Issue 5 (May 2008)
• Volume 6, Issue 4 (April 2008)
• Volume 6, Issue 3 (March 2008)
• Volume 6, Issue 2 (February 2008)
• Volume 6, Issue 1 (Holiday Party Issue)
• Volume 5, Issue 13 (December 2007)
• Volume 5, Issue 12 (November 2007)
• Volume 5, Issue 11 (October 2007)
• Volume 5, Issue 10 (September 2007)
• Volume 5, Issue 9 (August-September 2007)
• Volume 5, Issue 8 (August 2007)
• Volume 5, Issue 7 (July 2007)
• Volume 5, Special Safety Issue (2007)
• Volume 5, Issue 6 (June 2007)
• Volume 5, Issue 5 (May 2007)
• Volume 5, Issue 4 (April 2007)
• Volume 5, Issue 3 (March 2007)
• Volume 5, Issue 2 (February 2007)
• Volume 5, Issue 1 (January 2007)

( Click here for archived newsletter issues )

Joint Commission Tips: Techniques to Improve Patient Safety

TIP 1: Creating a Culture of Safety - Encourage Communication Among Your Colleagues

In a culture of safety, patient safety is an integral part of everything the health care organization does. Clinicians and staff are empowered to ask questions and initiate change; organizational leaders demonstrate that safety is the organization's number-one priority; and patients and families are involved in the care process to ensure patients are receiving timely, safe, and effective care.

To help promote a passion for safety that is persistent and effective, you can do the following:

High levels of interpersonal trust and support are also crucial to create a culture of safety. Let your coworkers knows you perceive them to be competent, credible, and committed to quality care by using respectful language and behavior and by always expecting your colleagues to follow safety policies and protocols to the letter.

TIP 2: Cultural and Linguistic Competency and Patient Safety - Understanding the Cultures and Diversity of Patients

Joint Commission accreditation requirements directly address the need for health care organizations to ensure the provision of culturally competent care. Patients are more diverse than ever, and health care workers need to provide care in a way that is culturally and linguistically appropriate to their patients. Tips and strategies for enhancing cultural and linguistic competence may include the following:

Communication

• Use appropriately trained medical interpreters and translators.
  
• Use translators with extreme caution. Visitors in the waiting room, non-clinical staff members who speak the patient's language, and family members should not be used, if possible. Confidentiality and safety breaches could result.
  
• Listen carefully and respectfully to beliefs about your patient's illnesses and traditional cures. A patient's beliefs about the causes of illness will affect his or her future behavior. It is important to understand and explore such beliefs in order to develop plans that are likely to be followed by the patient. Evaluate technological solutions that provide translation and transcription services.
  

Care Provision

Treat your patients with the care they expect and deserve. Ask culturally related assessment questions:

• What do you think caused your problem?
• Why do you think it started when it did?
• What does your sickness do to you? How does it work?
• How severe is your sickness? How long do you expect it to last?
• What problems has your sickness caused you?
• What do you fear about your sickness?
• What kind of treatment do you think you should receive?
• What are the most important results you hope to receive from this treatment?

Clarify patient and family instructions through demonstration and visual aids. Request a return demonstration or explanation of the material taught to ensure the patient understood the instructions.

Never stereotype! Educational materials and "cultural tools" that provide snapshot information about belief practices, nutrition practices, communication issues, and so forth can be used only as a starting point in understanding cultural issues and common practices of populations. Do not assume that such descriptions apply to every individual in the population.

A system-wide effort to implement cultural and linguistic competency might include:

• Feedback from community groups at all stages of implementation
• Integration of cultural competency into all organizational systems, including quality improvement
• Ensuring manageability, measurability, and sustainability of proposed changes
• Understanding and making the long-term business case for linguistic and cultural competency initiatives
• Demonstrable commitment from leadership
• Ongoing staff training

Minnesota Home Care Hotline

Do you know what the Minnesota Home Care Hotline is and where to find it?

It is a toll free number located on the back of the home care bill of rights.  Clients and their families can call this number if they have an unresolved problem or complaint.

We strive to provide the best quality of care and ensure that all of our clients and their families are satisfied with our services. If a problem arises, it is our duty to assist in resolving it quickly, and in a professional manner.

We need to first ensure that the clients and their families are aware of the Minnesota home care hotline.  Then we need to encourage clients to speak with the following staff, in this order, before calling the hotline:

• Nurse on duty providing care
• Nurse managers
• Maria Dewey, RN, CNP, Vice President of Clinical Services
• Larraine O’Malley, RN, Chief Operating Officer

If the client and their family are not satisfied after all of the above steps were taken to resolve the problem, employees may suggest they call the Minnesota Toll Free Hotline at 1-800-369-7994.

Handwashing Techniques

Handwashing is the most effective way to prevent spread of infection.

However, there are times when using hand sanitizer is appropriate.

Reasons to use hand sanitizer:
     1.  If you cannot step away from your client right away.
     2.  Keep hands from becoming dry and cracked, from frequent handwashing, which can lead to open areas and increase your risk of infection.

Steps for using hand sanitizer:

    1. Apply about ½ tsp of the product to the palm of your hand.
    2. Rub your hands together, covering all surfaces of your hands, until dry.

You should use soap and water:

• When your hands are visibly dirty
• After using the restroom or changing a diaper
• After petting animals or handling animal waste
• Before handling food or eating
• After coughing, sneezing, or blowing your nose
• Before treating a cut or wound
• After handling garbage
• upon arriving and before leaving the client’s home

Seizures

Seizures differ in many ways, both in the form they take and the way they make the client feel.
Most epileptic seizures are either partial seizures, which affect just one part of the brain, or generalized, which affects both sides of the brain.

What is the difference between a seizure and epilepsy?

A seizure is a sudden alteration in behavior due to temporary change in the electrical functioning of the brain, in particular, the outside rim of the brain called the cortex.

An epilepsy is a neurological condition, which affects the nervous system.  Seizures that occur repeatedly is called epilepsy.

Types of Seizures

A partial seizure (also called focal seizures) affects one part of the brain and there are two types:

1) Simple Partial Seizure is the warning or aura that may or may not be followed by any other symptoms.  Other symptoms may include a sense of déjà vu, visions from the past, and extreme burst of emotion. Memory of this event may be quite clear.

2)  Complex Partial Seizure (also called temporal lobe or psychomotor epilepsy) may   begin with a blank stare and loss of consciousness, and movements uncontrolled.  Mumbling and talking makes no sense and no control of what is being said and done, crying out and disturbed reactions, and agitated motions are a part of this type of seizure.  After this seizure, there will be no memory of what has taken place.

Generalized Seizures affect both sides of the brain at the same time.  There are several types:

1)  Absence Seizures (also called petit mal and more common in children) can happen so quickly it  sometimes goes unnoticed and causes a sudden loss of awareness, sometimes accompanied by staring.
2)  Atonic Seizures (also called drop attack, astatic, or akinetic seizures) have no warning and cause some muscles to go limp.
3)  Myoclonic Seizures cause muscles to contract rapidly, for a brief time, causing sudden, jerking movements.
4)  Tonic-Clonic Seizures (also known as grand-mal seizures) is an epileptic seizure that causes generalized, involuntary muscle contraction, and cessation of respiration, followed by tonic and clonic spasms of the muscles.
5)  Tonic-Clonic Seizures are less traumatic than tonic-clonic seizures that cause increased muscle tension and sudden stiffening movements.  Consciousness is usually preserved and this seizure happens most often occurs during sleep. 

What causes seizures?

Some seizures may be the result of a medical problem such as low blood sugar, head injury, accidental poisoning or drug toxicity, and infection.  Some seizures may also be due to a brain tumor or other health problem affecting the brain.

Febrile seizures (common in children younger than 5) can occur when a child develops a high fever that is rapidly increasing.  These seizures are brief and rarely cause problems unless the fever is associated with a serious infection.

Diagnosing Seizures

 Patients who have at least two unprovoked seizures that occur a different times have a seizure disorder.  A diagnosis is made based on the patient’s history and observations of eye witnesses.  Seizures may be suspected if symptoms such as loss of consciousness, muscle spasms that shake the body, loss of bladder control, sudden confusion, and inability to pay attention occur.

To help diagnose a seizure disorder, doctors use electroencephalography (EEG), a painless and safe procedure that records electrical activity in the brain.  A computed tomography (CT) or magnetic resonance imaging (MRI) of the head may be performed to check for structural damage to brain tissue.  Sometimes a spinal tap (lumbar puncture) is performed to determine whether there is infection in the layer of tissue covering the brain or in the brain.  Positron emission tomography (PET) is a computerized, radiographic technique that uses very small amounts of radioactive substances to examine biochemical activity of the brain.  Neuropsychosocial studies may be done to assess for behavioral disturbances.

Treatment and Management of Seizures

If the cause can be identified and eliminated, no additional treatment is necessary.

Anticonvulsants may be needed to reduce the risk of having another seizure, and are not usually prescribed for patients who have had only one generalized seizure for which no cause can be found.  But they are necessary for patients who have had more than one seizure, unless the cause has been identified and completely eliminated.  Anticonvulsants are very effective and the doses are critical in treatment of seizures.  The best dose of anticonvulsant is the smallest dose that stops all seizures while causing the fewest side effects.
If all drugs are ineffective in controlling seizures or if drug side effects cannot be tolerated, brain surgery is a possibility.

Electrical stimulation of the vagus nerve (cranial nerve x- thought to have indirect connections to areas of the brain often involved in producing seizures) can reduce the number of partial seizures by one third.

If the patient is having a seizure for the first time or it is an unexplained seizure, the patient’s doctor or emergency services should be called for instructions.  The patient will need to be evaluated by a doctor as soon as possible.  A patient should never be restrained, nor should anything be put into the mouth of a patient during a seizure.  A patient should be placed on their side to prevent aspiration and their head should be protected by applying padding where it is needed, removing clutter, and placing bed in lowest position during the seizure.

Acceptable Medical Abbreviations

Our Acceptable Medical Abbreviations list has been updated.  Please note the following abbreviations must now be written out:

OD, OS, and OU are to be written out as “right eye”, “left eye”, and “each eye”.

H.S and hs is to be written out as “half strength” or “bedtime”.

OD is to be written out as “daily” or “once daily”.

+ can continue to be used for “positive” or “plus” but must be written out for “and”.

0 used to describe “hours” and “degrees” must now be written out as “hours” and “degrees”.

These are some of the most commonly used abbreviations that have been misinterpreted and involved in harmful medication errors, according to the Institute of Safe Medication Practices and Joint Commission.

Thank you for your cooperation in keeping all of our clients safe and ensuring the highest quality of care.

Safe Medical Device Act

Do you know what the Safe Medical Device Act is?

• It is an FDA regulation
• The Joint Commission requires a Medical Equipment Program to include a process for monitoring and reporting SMDA required events.
• The SMDA requires health facilities to report incidents involving medical devices that are reasonably believed to have caused or contributed to serious injury or death of a patient or employee.
• The intent of this law: Identify medical device problems that pose a threat to public health and safety.
• The use of safe equipment: Only use equipment that meets the manufacturer’s specifications for safe working conditions.  It is against policy to use any device, equipment, or product that is suspected or known to be unsafe, hazardous, malfunctioning, or defective.
• Reporting requirements are that within 10 working days of becoming aware of a reportable event, a Medical Device Report Form (form 3500A) must be filled out and sent to the FDA and manufacturer of equipment involved.


Review of the Joint Commission  2008 Home Care National Patient Safety Goals                               

Goal 1: Improve the accuracy of patient identification.  

•  Requirement1A: Use at least two patient identifiers when providing care, treatment or services.

Goal 2: Improve the effectiveness of communication among caregivers. 

• Requirement 2A: For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the information record and "read-back" the complete order or test result.
• Requirement 2B: Standardize a list of abbreviations, acronyms, symbols, and dose designations that are not to  be used throughout the organization.
• Requirement 2C: Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and  the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.
• Requirement 2E: Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.

Goal 3: Improve the safety of using medications. 

• Requirement 3C: Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used by the organization, and take action to prevent errors involving the interchange of these drugs.
• Requirement 3E: Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.

Goal 7: Reduce the risk of health care-associated infections. 

• Requirement 7A: Comply with current World Health Organization (WHO) Hand Hygiene Guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.
• Requirement 7B: Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-associated infection.

Goal 8: Accurately and completely reconcile medications across the continuum of care.  

• Requirement 8A: There is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.
• Requirement 8B: A complete list of the patient’s medications is communicated to the next provider of service  when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the organization.

Goal 9: Reduce the risk of patient harm resulting from falls.  

• Requirement 9B: Implement a fall reduction program including an evaluation of the effectiveness of the program.

Goal 13: Encourage patients’ active involvement in their own care as a patient safety strategy. 

• Requirement 13A: Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.

Goal 15: The organization identifies safety risks inherent in its patient population. 

• Requirement 15B: The organization identifies risks associated with long-term oxygen therapy such as home fires.

What is conflict of interest?

It is a situation which someone in a position of trust has competing professional or personal interests that can make it difficult to fulfill his or her duties impartially.

Examples:
1. Policing or self-dealing in which public and private interests collide;
2. Outside employment, in which the interests of one job contradict another, such as other home care agency management position;
3. Family interests, which a spouse, child, or other close relative is employed at a company from which CGN purchases goods and services;
4. Gifts from friends who also does business with the person receiving gifts.

What does CGN do about Conflicts of Interests?

All employees are educated about potential situations that could result in behavior that would violate this policy.  Also each employee acknowledges understanding of this information when signing the Work Environment acknowledgment Form annually.

Conflicts of interest are considered to be ethical issues and are addressed and documented by clinical management staff or Ethics Committee when they arise.  All situations of existing or potential conflicts of interest should be reported immediately for a full investigation.

CGN reviews the relationships of the agency and it’s staff with other care providers, educational institutions, and payers to ensure that those relationships are within the law and regulation, and will determine if conflicts of interest exist.

Strict confidentiality will be maintained and situations resulting in or judged to result in a conflict of interest may be grounds for dismissal for all employees involved.

What if I have more questions regarding Conflicts of Interest?

You may contact any clinical management staff or members of the Ethics Committee:
• Maria Dewey RN, CNP, Vice President of Clinical Services, Chairperson
• Kevin O’Malley, Chief Executive Officer
• Larraine O’Malley RN, BSN, Chief Operating Officer

Joint Commission standards for Medication Labeling

Medications are labeled in a standardized manner according to law or regulation and standard of practice.

Any time one or more medications or solutions are prepared but are not administered immediately, the medication container must be labeled with the client’s name and directions for use.  A storage container may include a plastic bag, syringe, bottle, box, med cup, or basin.

At minimum, all medications prepared by the pharmacy are labeled with the following:
• Drug name, strength, and amount
• Expiration date(and if needed to use within 24 hours)
• Date prepared and diluent for all compounded IV admixtures and parenteral nutrition solutions.

Scenario example:
Have you ever gone to draw up a medication and discover the label missing, the medication has been placed in a different container, or already drawn up but not labeled?

What you do is verify the unlabeled medication with previous nurses and parents.  Once verified, ask the parents if it is ok to give the medication to the client.

If the medication is not verified or not ok’d by the parents to give, it must be discarded.

If you discover that the wrong concentration is listed on the label, call the pharmacist and client’s doctor to verify the order.  If the order is correct, and the pharmacy made an error, request a new label for that medication.

Waived Testing

“Waived testing” is the lowest complexity of testing, of the four levels, with the Clinical Laboratory Amendments of 1988 (CLIA ’88).

What does this mean?

A “laboratory test” is any activity that evaluates any substance removed form a human body and translates that evaluation into a test result.

Blood glucose monitoring is one waived testing procedure approved by CGN clinical management and completed by CGN staff.  All staff working at the home of a client who requires waived testing, or have glucose monitoring on the Physician’s Plan of Treatment (PPT), will be oriented to the procedure and the manufacturer’s recommendations for monitoring use, including calibration and maintenance.

For clients with glucose monitoring, the clinical record, documentation (DAR notes), and glucose monitoring flow sheets are accompanied by reference ranges specific to the physician’s order or referenced source.  All nurse supervisors, case managers, and directors of clinical services will supervise testing.  Competency for waived testing procedure will be completed annually with performance assessments for all applicable staff.