Ensuring Oxygen Safety in Healthcare: Regulations and Precautions

1. Chapter 13 Promotion of Safety

2. Oxygen • Oxygen is necessary for life • Some diseases and conditions cause the patient to be unable to take in enough oxygen • Doctors will usually order additional oxygen to be given by an oxygen delivery system

3. Oxygen • Oyxgen is: • a colorless, odorless gas • a medication prescribed by a doctor • highly flammable and feeds a fire, which can turn a small spark into a big flame • used by many people in healthcare facilities and in the community • represented by the chemical symbol of O 2.

4. Oxygen • Types of oxygen equipment (display pictures of equipment as each is explained • O 2 tank - holds limited amount of O 2, gauge shows how much is left • Wall Outlet -O 2 is piped into each patients unit. • O 2 concentrator - machine removes O2 from the air, power source is needed • Nasal Cannula - prongs are inserted into nostrils, tubing goes over ears and under chin to keep in place. • Simple Facemask - nose and mouth are covered. Carbon Dioxide CO 2 escapes from small holes in the sides. • Endotracheal tube and ventilator which supports breathing

5. Types of Oxygen

6. Oxygen Administration

7. O2 Precautions • O2 in use sign on patient door • No smoking sign • O2 tanks should always be in a carrier • Be mindful of oxygen extension tubing • Cotton clothing only • Avoid static electricity • No open flames

8. Regulatory Agencies • The Joint Commission • OSHA- Occupational Safety and Health Administration • WHO- World Health Organization

9. The Joint Commission (TJC) • The Joint Commission (TJC), formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) • An independent, not-for-profit organization • Certifies more than 20,000 health care organizations • Certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.

10. The Joint Commission • Annual National Patient Safety Goals- to improve patient safety in identified problematic areas • Patient falls • Patient identification • Improve communication • Medication safety • Health care associated infections • Reconcile medications • Reduce flu and pneumococcal disease • Surgical fires • Pressure ulcers • Risk assessment • Changes in patient condition • Universal/standard precautions

11. 13:2 Preventing Accidents and Injuries • Occupational Safety and Health Administration (OSHA) • Division of the Department of Labor • Establishes and enforces safety standards in the workplace • Two main standards that affect health care: • The Occupational Exposure to Hazardous Chemicals Standard • The Bloodborne Pathogen Standard (continues)

12. 1. Occupational Exposure to Hazardous Chemicals • The Standard requires employers to inform employees of all chemicals and hazards in workplace • All manufacturers must provide Material Safety Data Sheet (MSDS) with any hazardous product they sell • Specific information has to be provided on the MSDS • See MSDS on page 337 on DHO • Training for employees

13. Preventing Accidents and Injuries(continued) • Two standards that affect health care workers: • The Occupational Exposure to Hazardous Chemicals Standard • The Bloodborne Pathogen Standard

14. Bloodborne Pathogen Standard • Contains mandates to protect health care providers from diseases caused by exposure to body fluids • Diseases that can be contracted by exposure to body fluids include hepatitis B, hepatitis C, and HIV/AIDS

15. Ergonomics

16. Ergonomics • Applied science to promote the safety and well-being of a person by adapting the environment and using techniques to prevent injuries

17. Components of Ergonomics • Correct placement of furniture and equipment • Training in muscle movements • Efforts to avoid repetitive motions • An awareness of the environment to prevent injuries (continues)

18. Components of Ergonomics(continued) • Prevention of accident and injury • Centers around people and the immediate environment • Health care worker must follow safety regulations • Remember, health care workers have a legal responsibility to protect the patient from harm and injury

19. Equipment and Solutions Regulations • Do not operate or use any equipment until you have been trained on how to use it • Read and follow operating instructions • Report any damaged or malfunctioning equipment immediately • Do not use frayed or damaged electrical cords (continues)

20. Equipment and Solutions Regulations(continued) • Observe all safety rules • Read MSDSs • Never use solutions that are from unlabeled bottles • Read labels at least three times • Do not mix solutions together unless instructed to do so

21. Patient/Resident Safety Regulations • Do not perform any procedures on patients unless instructed and properly authorized • Provide privacy for all patients • Identify your patient • Explain the procedure (continues)

22. Personal Safety Regulations • Responsible to protect yourself and others from injury • Use correct body mechanics • Wear the required uniform • Walk; do not run • Report any injury or accident • Unsafe situations need to be reported (continues)

23. Personal Safety Regulations(continued) • Keep all areas neat and clean • Wash hands frequently • Dry hands thoroughly before handling electrical equipment • Wear safety glasses when appropriate • Observe all safety precautions (continues)

24. Personal Safety Regulations(continued) • If any solution comes in contact with skin or eyes, flush immediately with cool water and report • If particle gets in eyes, report immediately, do not try to remove or rub eye

25. Occurrence/ Incident Reports • Records details of an accident or unusual event of patient, visitor or employee within 24 hours of event • This report documents exact details of the occurrence • Useful when dealing with possible liability issues in the future • It never becomes a part of the patient medical record

26. Hospital Safety Informational Video • Hospital Workers Safety Video

27. Summary • Health care workers are legally responsible for familiarizing themselves with disaster policies • Preventing fires is everyone’s concern • Be alert to causes of fires and take measures to prevent them • Know policies to follow in case of fire

29. Sentinel Event

30. Sentinel Event • A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof.  Serious injury specifically includes loss of limb or function. 

31. Top Sentinel Events Reviewed by TJC in 2013 as compared to 2014 • Unintended retention of a foreign body — 56/112 • Fall — 48/91 • Suicide-82 • Other unanticipated event (includes unexpected additional care/extended care, and psychological impact) — 40 • Delay in treatment — 56/73 • Wrong-patient, wrong-site, wrong-procedure — 60/67 • Op/Post op complications- 52 • Criminal Event- 47 • Perinatal death or injury -32 • Infection related deaths-12

32. National Patient Safety Goals • Refer to handout • NPSG’s • You are expected to know all 7 NPSG’s

33. Groups • In your groups– • Research specific examples of interventions ( at least 2) which currently exist to help improve patient safety as outlined by the NPSG’s

34. What is your reaction?

35. Statistic • ***It is estimated that between 44,000 and 98,000 patients die each year as a result of medical errors in the USA • That is the equivalent of at least 4 jet liners crash landing every week for one year without any survivors!!

36. New Statistic • Now comes a study in the current issue of the Journal of Patient Safety that says the numbers may be much higher — between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death

37. Leading Causes of Death in the USA 2012 • Number of deaths for leading causes of death • Heart disease: 597,689 • Cancer: 574,743 • Chronic lower respiratory diseases: 138,080 • Stroke (cerebrovascular diseases): 129,476 • Accidents (unintentional injuries): 120,859 • Alzheimer's disease: 83,494 • Diabetes: 69,071 • Nephritis, nephrotic syndrome, and nephrosis: 50,476 • Influenza and Pneumonia: 50,097 • Intentional self-harm (suicide): 38,364

38. The Josie King Story

39. Josie King Story • Josie King

40. Josie King Journal about the what happened in this real life event • What factors contributed to Josie King’s death? • How could this have been prevented? • How does a break down  in communication affect patient care? • Think about a time when you or a loved one felt worried about the quality of care being provided. Did you feel empowered to express your concerns? What did your provider do (or what could he/she have done) to make you feel more comfortable speaking up? • In the case of Josie King, how could the hospital and its providers have given Sorrel King more power over how Josie was treated? Turn and share your thoughts with a partner