8

Harmonization – The Quality Choir

2010 NQF Safe Practices for Better Healthcare: A Consensus Report

34 Safe Practices

• Criteria for Inclusion

• Specificity

• Benefit

• Evidence of Effectiveness

• Generalization

• Readiness

9

33

Information Management and Continuity of Care

Medication Management

Healthcare-Associated Infections

Condition- & Site-Specific Practices

Consent & Disclosure

Culture

Workforce

Consent and Disclosure

CHAPTER 7: Hospital-Associated Infections• Hand Hygiene• Influenza Prevention• Central Venous Catheter-Related Blood Stream

Infection Prevention • Surgical-Site Infection Prevention• Care of the Ventilated Patient and VAP • MDRO Prevention• UTI Prevention

Information Management and Continuity of Care

Medication Management

Healthcare-Associated Infections

Condition-, Site-, and Risk-Specific Practices

Consent & Disclosure

Wrong-siteSx Prevention

Press. Ulcer Prevention

DVT/VTE Prevention

Anticoag. Therapy

VAP Prevention

Central V. Cath.BSI Prevention

Sx-Site Inf.Prevention

Contrast Media Use

Hand HygieneInfluenza

Prevention

Pharmacist Systems Leadership:High-Alert, Std. Labeling/Pkg., and Unit-Dose

Med. Recon.

Culture

CPOE

Read-Back & Abbrev.

Discharge System

PatientCare Info.

LabelingStudies

Culture Meas.,FB., and Interv.

Structuresand Systems

ID and Mitigation Risk and Hazards

Team Trainingand Team Interv.

Nursing Workforce

ICU CareDirect

Caregivers

Workforce CHAPTER 4: Workforce• Nursing Workforce• Direct Caregivers• ICU Care

CHAPTER 2: Creating and Sustaining a Culture of Patient Safety (Separated into Practices]

Leadership Structures and Systems Culture Measurement, Feedback, and Interventions Teamwork Training and Team Interventions Identification and Mitigation of Risks and Hazards

CHAPTER 5: Information Management and Continuity of Care

Patient Care Information Order Read-Back and Abbreviations Labeling Studies Discharge Systems Safe Adoption of Integrated Clinical Systems including

CPOE

CHAPTER 6: Medication Management Medication Reconciliation Pharmacist Leadership Role Including: High-Alert

Med. and Unit-Dose Standardized Medication Labeling and Packaging

CHAPTER 8:• Wrong-Site, Wrong-Procedure, Wrong-Person

Surgery Prevention • Pressure Ulcer Prevention• DVT/VTE Prevention• Anticoagulation Therapy• Contrast Media-Induced Renal Failure Prevention• Organ Donation• Glycemic Control• Falls Prevention• Pediatric Imaging

Informed Consent

Life-Sustaining Treatment

Disclosure

CHAPTER 3: Informed Consent and Disclosure• Informed Consent• Life-Sustaining Treatment• Disclosure• Care of the Caregiver

Consent and Disclosure

Care of Caregiver

MDROPrevention

UTIPrevention

FallsPrevention

OrganDonation

GlycemicControl

PediatricImaging

12

HAI GuidelinesHAI Guidelines

Before insertion:• Educate healthcare personnel involved in the insertion, care, and

maintenance of central venous catheters (CVCs).At insertion:• Use a catheter checklist at the time of CVC insertion.• Perform hand hygiene prior to catheter insertion or manipulation.• Avoid using the femoral vein for central venous access in adult

patients.• Use a catheter cart or kit with components for aseptic catheter

insertion. • Use maximal sterile barrier precautions.• Use chlorhexidine gluconate 2% and isopropyl alcohol solution as

skin antiseptic preparation in patients over two months of age and allow appropriate drying time per product guidelines.

After insertion:• Use a standardized protocol to disinfect catheter hubs, needleless

connectors, and injection ports before accessing the ports.• Remove nonessential catheters. • Use a standardized protocol for non-tunneled CVCs in adults and

adolescents for dressing care.• Perform surveillance for CLABSI and report the data on a regular

basis.

NQF CLABSI Prevention Safe Practice Specifications: 2010

Update

13

• Educate of healthcare professionals involved in surgical procedures.• Educate the patient and his or her family as appropriate about SSI

prevention. • Conduct periodic risk assessments for SSI.• Ensure that measurement strategies follow evidence-based guidelines.• Provide SSI rate data and prevention outcome measures to key

stakeholders.• Administer antimicrobial agents for prophylaxis.• When hair removal is necessary, use clippers or depilatories. • Maintain normothermia immediately following colorectal surgery. • Control blood glucose during the immediate postoperative period for

cardiac surgery patients. • Preoperatively, use chlorhexidine gluconate 2% and isopropyl alcohol

solution as skin antiseptic preparation, and allow appropriate drying time per product guidelines.

NQF SSI Prevention Safe Practice Specifications: 2010

Update

14

The Association for Professionals in The Association for Professionals in Infection Control & EpidemiologyInfection Control & Epidemiology

• Mission To improve health and patient safety by reducing the risks of

infection and related adverse outcomes.

• The preeminent voice in infection prevention Over 13,000 members worldwide with responsibility for infection prevention, control and hospital epidemiology in a variety of healthcare settings.

APIC Targeting Zero InitiativeAPIC Targeting Zero Initiative• Elimination Guides

Evidence-based strategies to implement CDC guidelines, NQF Safe Practices and recommendations from the SHEA-APIC-IDSA Compendium – Guides to the elimination of SSIs, CR-BSIs, Mediastinitis, C. difficile, VAP and MRSA

(hospital and long term care versions) help you bring science to the bedside– New guides in 2010 on A. baumannii, Hemodialysis and SSIs in orthopedics and oncology

• Research

2006 MRSA & 2007 C. difficile Prevalence Studies, 2010 MRSA II Study

• Education

The most comprehensive program of live and online education to reduce infection, meet new and emerging regulatory requirements and understand the changing legal standard in acute, ambulatory and long term care settings

Visit www.apic.org to learn more.

Visit www.apic.org/targetingzero to learn more about the initiative and to access resources and practical tools