1. Safety Issues in the Endoscopy Center National Patient Safety Goals from The Joint Commission Endoscopy 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 by BJ Garrett, MSN-NE, CGRN Nurse Educator Austin Endoscopy Centers

2. All endoscopy facilities are scrutinized by regulating/governing bodies Medicare and Medicaid Services The Joint Commission Accreditation Association for Ambulatory Health Care American Association for Accreditation of Ambulatory Surgery Facilities State and Local Health Departments

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

4. THE 2015 JOINT COMMISSION’S “NATIONAL PATIENT SAFETY GOALS” ARE DESIGNED TO ENHANCE PATIENT SAFETY AND ELIMINATE WRONG- PATIENT ERRORS. Safety Issues in The Endoscopy Center

5. GOAL ONE: IMPROVE THE ACCURACY OF PATIENT IDENTIFICATION. GOAL TWO: IMPROVE THE EFFECTIVENESS OF COMMUNICATION AMONG CAREGIVERS.

6. GOAL ONE: IMPROVE THE ACCURACY OF PATIENT IDENTIFICATION. “Staff must identify the patient using two identifiers, before any patient encounter” (Ragsdale, 2011, p. 218).

7. Goal One: Accurate Patient Identification Starts 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

8. Goal One: Accurate Patient Identification Continues in Pre-op Patient Privacy: Use either first or last name Privately ask the patient to state their name Verify (again): ◦ Physician, procedure, indications Verify Drug allergies, adverse reactions Fall risk status-falls are leading cause of death in elderly Medication reconciliation mandatory Review health history Examine patient ASK, is there anything else we should know in order to keep you safe today?

9. 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, birthdate Patient should agree with procedure, indications, physician Specimen collection: discussed next section

10. 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”

11. GOAL TWO: IMPROVE THE EFFECTIVENESS OF COMMUNICATION AMONG CAREGIVERS.

12. Goal Two: Effective Communication Starts at the Front Desk Administrative 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)

13. Goal Two: Effective Communication Continues in Pre-op Charting 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 stick Document medication administration ◦ Need for medication (nausea) ◦ Drug administered, dose, route, time ◦ Effectiveness, “patient reports relief of nausea”

14. Goal Two: Effective Communication Follows 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)

15. Goal Two: Effective Communication After the Procedure in Post-Op Formal hand-off to appropriate provider Report 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

16. Goal Two: Effective Communication Follow Up Phone Call Considered a patient encounter, use two identifiers before dispensing advice or information Nurse to document all adverse events Serious events must be immediately reported to the physician or representative Document nursing advice ◦ Advised patient to increase fluid intake today Follow facility policy as to management follow up on adverse events Use EMR when appropriate ◦ Prescription refills, patient requests

17. Goal Two: Effective Communication Review Facility standards communicate information to all employees ◦ Signs, open curtains, initialing ID bracelet Ask for more information when needed, give more information when appropriate Request privacy when necessary Respectfully-but immediately-stop inappropriate communication

18. Recommendations for Infection Prevention by The American Society for Gastrointestinal Endoscopy [ASGE], 2014 The American Society for Gastrointestinal Endoscopy [ASGE], 2014

19. 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)

20. Infection Prevention Ragsdale quoting Joint Commission standards reports: “Hand hygiene is the single most effective means of preventing nosocomial infections” (2011, p. 220)

21. ASGE on Infection Prevention: Hand Hygiene need be implemented Before and after every patient contact After contact with blood or body fluids After contact with contaminated surfaces Before performing invasive procedures ◦ Starting an IV, medication preparation After glove removal ◦ Eating and toileting ◦ Any time the hands are soiled

22. ASGE on Infection Prevention: Hand Hygiene, continued Alcohol-based agents are adequate for most hand hygiene Use soap and water when: ◦ Hands are visibly soiled ◦ After caring for patients with diarrhea, especially C diff

23. ASGE on Infection Prevention: Personal Protective Equipment No PPE for low-risk exposure Gloves and impervious gowns for high-risk exposure ◦ Direct patient care with potential of contact with contaminated scope, device, or body fluids Because 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).

24. Safety Issues in the Endoscopy Center Accurate Patient Identification Protection of Patient Privacy Effective 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

25. References Limited English Proficiency. (2012). Laws concerning language access for LEP individuals. Retrieved from http://www.lep.gov/faqs/faqs. html#OneQ2 Ragsdale, 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.0b013e3181d6e4b1 Society 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.pdf http://www.sgna.org/Portals/0/Issues/PDF/Infection- The 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. 12.015 The 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.pdf Vera, M. (2012). The 10 rights of drug administration. Retrieved from http://nurseslabs.com/10-rs-rights-of-drug-administration/

26. Questions? Comments? Thank you for your attention today!