Patient’s Fall Risk Assessment

One of the common risk to safety of patients in hospital is the risk of fall. Several epidemiological studies has found that on an average 3 to 5 patient fall incidence occur in every 1000 bed-days. It is also estimated that a third of fall results into injuries which could be severe such as fracture. Due to the widespread prevalence and resulting harm, prevention of patient fall is included as one of the International Patient Safety Goals (IPSG) of JCI standards for hospitals.

The first step to prevention of fall is identifying patient who is at a risk of fall. Most accreditation bodies, including NABH and JCI expects hospital to undertake a fall risk assessment of all admitted patient and take preventive measures for those who are at a higher risk of fall.

The table below describes the points that should be used for assessing risk of fall, and classifies features into very high, high, moderate and low risk categories.

Code Pink system in hospital

Code pink is an emergency code which is used to activate a set of action in case a child/baby is missing from the ward/room. As there is a fair possibility that the missing child/baby is abducted, it is considered as an emergency situation and a predefined set of actions are taken on an urgent basis to safeguard the missing child/baby. The entire system of coordination, communications, decisions and actions followed during such situation is called as a code pink system. (Also check Code Blue, Code Red)

Depending upon how a hospital is structured and organized the code pink system may vary from one hospital to another. The objective, however, remains the same, i.e. ‘Find the missing child as soon as possible’. The objective should be achieved in a manner that other critical activities in the hospital do not get hampered and that unnecessary scare or commotion of public be avoided. An illustrative code pink system has been described below. This can be taken as a reference for developing code pink system by various hospitals. 

Critical findings in Imaging – Policy and procedure

Imaging and Medical laboratory frequently come across critical results or finding of a patient’s diagnostic tests which requires immediate intervention from the doctor to bring the patient out of the criticality. Hence, a hospital must have a policy and procedure in place for identification and quick communication of such results. This posts describes critical findings in imaging (Check critical test results in laboratory –policy and procedure).

Standard Precautions for Infection Control in Hospitals

Standard precautions are the basic infection control practices which must be adhered to while caring any patient in hospital. If fully implemented, standard precaution can drastically reduce the risk of infection to healthcare providers and patients. They are minimum level of precaution and may not be sufficient for special situations which requires special precautions. As these precautions should be taken in all kinds of patient care process they are also called as universal precautions.

Elements of standards precautions are as follows

      

Critical test results in laboratory – Policy and process for identification and communication

Medical laboratory and Imaging frequently come across critical results or finding of a patient’s diagnostic tests which requires immediate intervention from the doctor to bring the patient out of the criticality. Hence, a hospital must have a policy and procedure in place for identification and quick communication of such results. This posts describes critical test results in medical laboratory (Check critical findings in imaging–policy and procedure). 

Critical test results in laboratory are the findings in the lab tests of a patient which indicates that condition of the patient may be critical or even life-threatening.  Such results, when found shall urgently be informed to the treating physician of the patient so that required interventions can be carried out on time and patient can be saved from any possible adversities. To be able to do so, a hospital needs to have a well-developed process of ‘identification and urgent communication of critical test results in lab’. The process should be able to achieve following objectives.

1. Critical test results gets identified within the lab as soon as the test results are obtained
2. No critical test results gets missed from identification
3. Non-critical test results do not get identified as critical
4. The treating doctor of the concerned patients gets to know about the critical test result on an urgent basis

Any lapses in identification and/or communication of critical test results to concerned doctor may lead to severe consequences for patient, including death. Hence, in addition to the process, hospitals must have a policy that mandates compliance to this process by laboratory staff. Following points shall be taken into consideration for policy and system on identification and communication of critical test results in laboratory.

Patient identification Policy and Procedure

One of the most common causes of medical errors in healthcare is the incorrect identification of patients. The error can lead to potentially serious consequences such as surgery of a wrong patient or transfusion of wrong blood into a patient. It is vital that hospitals must put into place an effective policy and procedure for identifying a patient. Below are the internationally recommended practices for accurately identifying a patient.

Safe transfer of unstable patient from hospital

One of the critical task that hospitals have to frequently undertake is to transfer a critically ill or unstable patient from one hospital to another. Transfer of such patient are likely to induce various physiological changes, which may adversely affect the health of patient even leading up-to death. Hence, such transfers shall be undertaken with great care and as per evidenced-based guidelines. Following are the key elements and guidelines for safely executing transfer for an unstable patient.

List of medical errors leading to patient harm

(Also check 'Patient Identification Policy and Procedure)

Medication related

1.       Administration of wrong medicine

2.       Administration of medicine to a wrong person

3.       Administration of wrong dose of medicine

4.       Administration of medicine through wrong route

5.       Administration of medicine at wrong time

6.       Administration of medicine with wrong rate of administration

7.       Administration of expired medicine

Taking Care of Vulnerable Patients

Vulnerable patients are those patients who, for any reason, are not able to protect or take care of himself/herself, against exploitation or harm. Such patients are prone to various risks within the hospital, such as fall, injury, neglect, abuse, medical errors and acquiring of infections. Vulnerability of a patient may be due to his/her age, physical or mental condition. It is the duty of the hospital to identify such patients and provide them with necessary support so that they are safe in the hospital surroundings.

Following type of patients can be identified as vulnerable

      1.       Patients who are old (above 65 or a certain age, as decided by the hospital)

      2.       Patients who are of minor age (Patients below 12 years or as decided by the hospital)

      3.       Patients with physical problems, such as limited mobility, blindness, deafness, speech limitations etc.

      4.       Patients with mental problems, such as depression, mental retardation, forgetfulness etc.

      5.       Patients who are unconscious or in semi-conscious stage

      6.       Patients who are illiterate and have difficulty in understanding written instructions

Code blue system in hospitals

Code blue is perhaps the most popular codes used in hospital for managing emergency situation. Code blue is a code given to identify and communicate that a medical emergency, of the nature of cardiac arrest, has occurred and the patient needs to be attended immediately for life saving measures. (Other codes - Code Pink, Code Red). Since it deals with the life threatening situation, swift and coordinated action by a team of professionals is of paramount importance. This calls for designing and implementing a highly efficient system, which can work in round the clock and can cover entire hospital. This posts elaborate on all considerations that should be made while designing a code blue system. Also check code blue form and crash cart checklist along-with this post.

Checklist of facility safety inspection for NABH accreditation preparation

NABH puts high importance to safety in hospitals and ask the preparing hospitals to ensure that the facility is safe for patients, staff and visitors. As per one of the objective elements (FMS.1 e. of NABH 4^th edition), the preparing hospital is required to conduct facility inspection rounds to ensure safety. Further, it also states that the round should be conducted at-least twice in patient care areas and once in non-patient care areas. In-order for these rounds to be effective, it is important that a comprehensive checklist be used so that common safety hazards and potential risks could be checked and necessary remedial measures be taken. Below, I have prepared a checklist of points that could be used for such rounds. The checklist also addresses various other safety parameters that has been asked in different standards and objective elements of NABH standards book.

This checklist would be of much more value if used along-with the Infrastructure checklist for NABH accreditation preparation.