Transcript Mock Stroke - University of Illinois at Chicago

Mock Stroke Code
Alice Liskay, RN, BSN, MPA, CCRC
Ohio Coverdell, Coordinator
Objectives

Describe a “mock stroke code.”
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List 2008-2009 patient safety goals.
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Implement a mock stroke code in their
hospital utilizing tools provided.
What is a
“Mock Stroke Code” ?
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Opportunity to:
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Improve care of patients with stroke
Access staff knowledge and educate
regarding current stroke protocols and
guidelines
Prepare staff for PSC Certification Site Visit
Review staff knowledge of 2008 National
Patient Safety Goals and revisions for 2009
Plan strategies for improvement as needed
Joint Commission NPSG and
Requirements

The National Patient Safety Goals (NPSG)
promote specific improvements in patient
safety by providing health care organizations
with evidence-based guidance on persistent
patient safety problems. Compliance with the
requirement is a condition of continuing
accreditation or certification for Joint
Commission-accredited and –certified
organizations.
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
New numbering
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New numbering for NPSG (part of the
JC’S Standard Improvement Initiative
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Allows electronic sorting and addition of
new requirements
Six digit no. “NPSG.01.01.01”
“Implementation Expectations” are now
called “Elements of Performance”
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 1: Improve the accuracy
of patient identification
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NPSG 01.01.01 - Use at least two
patient identifiers when providing care,
treatment, or services
Elements of Performance:
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Involve patient and family as needed
Two identifiers before administering meds
Two identifiers before drawing blood
Label blood in presence of patient
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 1: Improve the accuracy
of patient identification
NPSG 01.01.01
PSC Considerations:
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How do you identify patients with aphasia
Drawing labs
Administering tPA
Goal 2: Improve effectiveness
of communication among
caregivers

NPSG. 02.01.01- For verbal or telephone
orders or telephone reporting for critical test
results, the individual giving the order or test
result verifies the complete order or test
result by having the person receiving the
information record and “read back” the
complete order or test result.
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.01.01:
Elements of Performance:
 Those receiving the information writes
down the complete order/test result or
enters in computer
 Reads back order/test result
 Individual who gave order/result confirms
the read back
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.01.01
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PSC Considerations:
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Verbal orders for tPA
Critical lab results (may be asked to see
process)
Orders- (may be checked to insure these
are later signed-off by MD)
What is your protocol for having orders
signed-off?
Goal 2: Improve effectiveness
of communication among
caregivers

NPSG. 02.02.01 – There is a
standardized list of abbreviations,
acronyms, symbols, and dose
designations that are not to be used
throughout the organization.
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.02.01 –
Elements of Performance:
 Organization develops standardized list
 Refer to TJC list of those not to be used
 “Do not use” list added to orders that are
handwritten or entered as free text in computer
 Compliance also on preprinted orders
PSC considerations:
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Charts are checked for this during tracer
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.03.01 – The organization
measures, assesses, and, if needed,
takes action to improve the timeliness
of receipt of critical tests and critical
results and values by the responsible
licensed caregiver.
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.03.01
Elements of Performance:
Defines critical tests and critical results and values
 Defines acceptable length of time for reporting of
routine tests with critical abnormal values
 Defines the length of time of availability of results
and receipt by responsible licensed caregiver
 Collects data of timeliness
 Assesses data and determines if PI is needed
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.03.01
PSC Considerations:
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CT order to done- 25 min
CT order to report to MD- 45 min
Lab order to result- 45 min
ECG- order to result- 45 min
How are these reported?
Are they discussed in Stroke Committee?
Is Process Improvement needed?
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.05.01 – The organization
implements a standardized approach to
hand-off communication, including an
opportunity to ask and respond to
questions.
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Includes, but not limited to: Shift changes; transfer
to another unit or facility; on-call responsibility; meal
coverage; critical results sent to MD offices
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 2: Improve effectiveness
of communication among
caregivers

NPSG. 02.05.01 –
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Elements of Performance:
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Interactive communication that allows questions
between giver and receiver
Up-to-date information regarding condition, care,
treatment, meds, services, and anticipated
changes
Method to verify received information, including
read back techniques
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.05.01 –
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Elements of Performance Con’t:
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Opportunity for receiver to review relevant
patient historical data, which may include
previous care, treatment or services
Interruptions during hand-off are limited to
minimize errors
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.05.01
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PSC Considerations:
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Hand-off for tPA patients between ED and
MICU
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Where in process of VS assessment
Results of dysphagia screen
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Will need to chart results
Complications from tPA
Goal 2: Improve effectiveness
of communication among
caregivers
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NPSG. 02.05.01
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PSC Considerations:
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Hand-off for stroke MICU and medical unit
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Results of dysphagia screen
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Does it need to be re-assessed
Diet
Need for Modified Barium Swallow
Ambulatory status –DVD prophylaxis Day 2
Antithrombotics – Day 2
Medication reconciliation
Goal 7: Reduce the risk of
health care associated
infections
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NPSG.07.01.01- Reduce the risk of health
care associated infections
Elements of Performance:
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The organization complies with the World Health
Organization or Centers for Disease Control and
Prevention (CDC) hand hygiene guidelines.
Organizations are required to comply with 1A, 1B,
1C of the WHO or CDC guidelines.
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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NPSG.08.01.01 – A process exists for
comparing the patient’s current
medications with those ordered while
under the care of your organization.
Elements of Performance:
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At admission, a complete list of meds the patient
is taking at home (including dose, route and
frequency) is created and documented. Patient
and family as needed involved in process.
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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NPSG.08.01.01 –
Elements of Performance Con’t:
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Medications ordered are compared to preadmission list
Any discrepancies are reconciled and documented
When transferred within the organization, the
current provider informs the receiving provider
about the up-to-date medication list and
document
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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PSC Considerations:
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Attention to:
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Antithrombotics
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Antiplatelets
Anticoagulants
Cholesterol lowering (Statins)
Anti-hypertensives,
DM
Were they taken within the last week?
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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Pre-admission meds: Some elements that may be
captured in the reconciliation form to help with the
transitions of care
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Different times of day
OTC medications
Non-oral medications
Dosage
Indication
Length of therapy
Medication prescribed by different MD
Allergies
Compliance
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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NPSG.08.02.01 – When a patient is transferred
from one organization to another, the
complete and reconciled list of medications is
communicated to the next provider of service
and documented. When a patient leaves the
organization’s care directly to home, the list is
provided to the patient’s known PCP, or the
original referring provider, or a known next
provider of service.
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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NPSG.08.02.01
Elements of Performance:
 Most recent reconciled medication list is
communicated to the next provider of
service, either within or outside the
organization. Communication must be
documented.
 Transferring organization informs next
provider how to obtain clarification
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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NPSG.08.02.01
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PSC Considerations:
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Consider your processes for “Drip and Ship”
Consider your processes for IA patients
Who is responsible for making sure meds are
reconciled?
How is medication information communicated to
the next provider?
 In hospital system
 Not a network hospital
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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PSC Considerations con’t:
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Do you provide a guide for medication and
food interactions at discharge?
Do you call outside pharmacy to verify
meds if meds not typically filled at your
institution?
Do you have Pharmacist on your units to
contribute to discharge planning?
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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NPSG.08.03.01 (New 2009) when a patient
leaves the organization a complete and
reconciled list of medications is provided
directly to the patient, and patient’s family as
needed, and the list is explained to the
patient and/or family.
Elements of Performance:
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Patient and/or family reminded to discard old lists
and update records with PCP and Pharmacist
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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NPSG.08.04.01- (New 2009) In setting
where medications are used minimally,
or prescribed for a short duration,
modified medication reconciliation
processes are performed. There is a
caveat for some settings not needing
dose, route and frequency.
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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NPSG.08.04.01Elements of Performance:
 List of current medications and allergies to
prescribe setting-specific meds and assess for
allergic reaction and adverse reactions
 Short-term medication list. Not considered part of
original list. If patient confused need to give both
lists.
 New reconciliation list given to patient if new longterm medication is added or a change in their
current meds.
 Standard reconciliation process if patient is going
to be admitted to your organization
Goal 8: Accurately and
completely reconcile medications
across the continuum of care
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NPSG.08.04.01PSC Considerations:
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ED admission to floor
ED discharges (if TIA with outpatient
follow-up to PCP)
Goal 9: Reduce the risk of
patient harm resulting
from falls
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NPSG.09.02.01 – The organization implements
a fall reduction program that includes an
evaluation of the effectiveness of the
program.
Elements of Performance:
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Establishes a fall reduction program
Program includes evaluation appropriate to the
patient population, settings and services provided
Includes interventions to reduce fall risk factors
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 9: Reduce the risk of
patient harm resulting
from falls
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NPSG.09.02.01 –
Elements of Performance Con’t:
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Staff receive education and training
Educate patient and/or their family and any
individualized fall risk strategies
Evaluates the fall program to determine
effectiveness.
Outcome indicators can be used:
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Decreased number of falls
Severity of fall-related injuries
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 9: Reduce the risk of
patient harm resulting
from falls
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NPSG.09.02.01 –
PSC Considerations:
 Fall risk specific for patients with stroke
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Impulsiveness
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Patient’s with SCDs
Confused patient
Leg weakness
Patient with neglect
Be ready to explain your falls program
Goal 10: Reduce the risk of influenza
and pneumococcal disease in
institutionalized older adults
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NPSG.10.01.01- The organization
develops and implements protocols for
the administration of flu vaccine
Elements of Performance:
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Protocol to determine whether or not to
administer flu vaccine
Protocol implemented for patients
identified as high risk for influenza
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 10: Reduce the risk of influenza
and pneumococcal disease in
institutionalized older adults
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NPSG.10.02.01- The organization
develops and implements protocols for
the administration of pneumococcus
vaccine.
Elements of Performance:
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Protocol to determine whether or not to
administer pneumococcus vaccine
Protocol implemented for patients
identified as high risk for pneumococcus
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 10: Reduce the risk of influenza
and pneumococcal disease in
institutionalized older adults
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NPSG.10.03.01- The organization
develops and implements protocols to
identify new cases of influenza and to
manage outbreaks.
Elements of Performance:
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Protocol to identify new cases and manage
outbreaks
Protocol implemented to display signs and
symptoms of influenza
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 13: Encourage patient’s active
involvement in their own care as
a patient safety strategy.
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NPSG.13.01.01- Identify the ways in which the
patient and family can report concerns about safety
and encourage them to do so.
Elements of Performance:
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Educated on available Reporting methods
for their concerns regarding care,
treatment, services and patient safety
issues
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 13: Encourage patient’s active
involvement in their own care as
a patient safety strategy.
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NPSG13.01.01
Elements of Performance:
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Provide information regarding infection control
measures for hand and respiratory hygiene and
contact precautions according to their condition on
the day the patient enters the organization (can
be any media).
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Their understanding is evaluated and documented
Encourage reporting of concerns
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Goal 13: Encourage patient’s active
involvement in their own care as
a patient safety strategy.
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NPSG13.01.01
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PSC Considerations:
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Impulsive or Confused patient
Leg weakness - falls
Patient with neglect
Aphasic patient
Need for Dysphagia Screen
Universal Protocol
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UP.01.01.01- Conduct a pre-procedure
verification process
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All relevant documents and related information or
equipment are:
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Available prior to the start of the procedure
Correctly identified, labeled, and matched to the patient’s
identifiers
Reviewed and are consistent with the patient’s
expectations and with the team’s understanding of the
intended patient, procedure and site
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Universal Protocol
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UP.01.01.01
PSC considerations:
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tPA checklist to cover essentials
Consent /family permission/awareness
Transfer of patient to CT scanner and/or
angio suite
Radiology and lab results are available
Universal Protocol
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UP.01.02.01- Mark the procedure site.
Procedure site is marked by licensed
independent practitioner who is
privileged to perform the intended
surgical or non-surgical invasive
procedure.
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Universal Protocol
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UP.01.03.01- A time-out is performed immediately
prior to starting procedure.
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Final assessment that correct patient, site, position,
procedure are identified and all relevant documents, related
information and necessary equipment are available.
Elements of Performance:
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Time –out characteristics:
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Standardized
Initiated by a designated member of the team
Involves immediate members of the procedure team
Involves interactive verbal communication
Defined process for reconciling differences
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Universal Protocols
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UP.01.03.01
Elements of Performance con’t:
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During time-out, other activities are suspended to the extent
possible.
If two procedures are being performed on the same patient,
a time-out needed for each.
Time-out address: correct patient; correct site is marked;
consent form; agreement of procedure; position; relevant
images and results properly labeled and displayed; the need
for antibiotics or fluid as needed; safety precautions based
on history or medication.
The completed components of the Universal Protocol and
time-out are clearly documented.
The Joint Commission Disease-Specific Care Certification, 2009 Chapter: National Patient Safety Goals
Universal Protocols
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UP.01.03.01
PSC considerations
 Time-out before starting IV and IA tPA