Every Day is Patient Safety Day

Claude Rector, MA, MLS(ASCP), ASCLS President

When I moved from education to management this past spring, I felt the reality of a heightened sense of awareness regarding patient safety. The laboratory results were live and in real time. I had been in the student education laboratory far too long. The response of the laboratory staff to the patients’ results is going to affect patient safety. I wanted to take advantage of this opportunity to share my new role in patient safety. The following outlines my laboratory role in everyday healthcare.

Our mission is to promote a culture of safety to end preventable patient harm by engaging, educating, and equipping patient-care teams to put evidenced-based leading practices in place across the organization. Please note the role the laboratory and the laboratory professional plays regarding patient safety committees and programs. Once again, this is an opportunity to spotlight our profession’s role in the safe delivery of healthcare delivered every day.

Performance Improvement Committee: Responsible for recommending and monitoring clinical performance initiatives; developing clinical care protocols, including the promotion of evidence-based medicine; developing clinical performance measurement definitions and methodologies; promoting patient engagement; and additional quality improvement responsibilities.

Laboratory

• Critical results to physician in less than one hour
• Emergency Department laboratory results report initial troponin to Emergency Department within one hour
• Proficiency testing success
• Sterility maintained in blood culture collection
• All Emergency Department patients with critical point-of-care glucose will have documentation of appropriate notification and/or action
• All inpatients with critical point-of-care glucose will have documentation of appropriate notification

Blood and Tissue

• Identification checked by two people (including the transfusionist) prior to issuing blood
• Identification checked by two people at beside before transfusion
• Vital signs assessed per policy during and after blood transfusion
• Transfused outpatients will receive post-transfusion instruction sheet
• Blood shortages assessed for effect on transfusion service
• Crossmatch to transfusion ratio
• Tissue report on patients’ record
• Surgical report matches pathology report
• Tissue reports receive appropriate follow-up
• Informed consent will be completed prior to blood administration

Infection Prevention Committee: Functions to prevent and control healthcare-associated infections by setting infection control policy and monitoring practices to reduce these risks.

Blood and Tissue

• Healthcare associated infections
• Methicillin Resistant Staphylococcus aureus cases
• C. difficile
• Extended Spectrum Beta-Lactamase + urine culture
• Sputum Extended Spectrum Beta-Lactamase + Klebsiella pneumoniae
• Haemophilus infection
• Pseudomonas – Multi-Drug Resistant
• Sexually Transmitted Diseases
• Streptococcus pneumoniae
• Flu A
• Streptococcus Group A
• Hepatitis C
• COVID-19 (+)

Employee Health Report

• Exposure to blood borne pathogens
• Reportable employee illnesses
• Employees off sick days
• TB test
• Hepatitis B vaccine

Good Catch Campaign: An incentive-based program that fosters a growing culture of safety by encouraging the recognition and reporting of risk before a patient is harmed.

Blood and Tissue Committee–Transfusion Safety

• Transfusion chart review
• Therapeutic phlebotomies review
• Surgical pathology report review

Hand Hygiene Initiatives

Pharmacy and Therapeutic Committee

• INR prior to admin of Coumadin
• Patients with blood sugar less than 50 mg/dL that receive insulin
• Patients on Warfarin experiencing INR greater than 6

Falls Prevention Program

Antibiotic Stewardship Team: The effort to measure and improve how antibiotics are prescribed by clinicians and used by patients.

Medication/Patient Scanning

Hand Off Communication

Patient Identifiers–Name and Birthday

Claude Rector is the Director of Laboratory and Respiratory Services at St. Bernards CrossRidge Community Hospital in Wynne, Arkansas.