Performing Higher Acuity Cases Elevates Patient Safety at Ambulatory Surgery Centers As higher acuity cases such as total joint replacement continue to move from hospitals to ambulatory surgery centers (ASCs), patient safety is receiving more attention and becoming more closely monitored and scrutinized. An article recently published in Becker’s ASC Review lists the ten Ambulatory Care National Patient Safety Goals (NPSGs) released by The Joint Commission, effective January 2016. The goals focus on several aspects of patient safety including improving the accuracy of patient identification, improving the safety of using medications and reducing the risk of healthcare-associated infections. As Director of Clinical Operations for Regent, Amiee Mingus, RN, leverages her 20 years of healthcare experience and weighs in on the importance of safety at ASCs. “Since 2003, The Joint Commission has released NPSGs to help accredited organizations, in our case surgery centers, concentrate on specific patient safety concerns,” stated Mingus. “At Regent Surgical Health (Regent), we disseminate these goals to our 23 member centers and rigorously evaluate existing policies to make certain centers address every aspect of patient safety.” Mingus shares her expertise on the most recent Ambulatory Care NPSGs:
- Employ two or more ways to identify patients correctly, such as the patient’s name and birth date.
“We have a policy in every center that clearly and consistently defines how to identify patients,” said Mingus. “It begins by asking them questions as we greet them in the waiting room then it continues with a variety of questions, answers and various verifications leading up to surgery.” Mingus recognizes that surgery can be worrying and that patients can sometimes forget information such as the name of their surgeon. “We’re prepared for that and we plan around it,” stated Mingus.
- If the patient needs a blood transfusion, double check they receive the right blood type.
While transfusions are more common in a hospital setting, Regent is prepared and has a policy spelled out. “No matter where you treat patients, nurses know that blood type is something that gets double checked with another staff member before it gets transfused,” explained Mingus. “Our policies and procedures are aimed at protecting our patients and like all NPSGs, we take this one very seriously.”
- Label all medicines before the procedure, including those in syringes and cups.
Mingus recognizes that pre-drawing medications is standard practice but advises preparing medicines, syringes and cups as close to administration as possible. “When meds are pre-drawn, our policy states that they must be labeled with the name of the medication, strength, time of the draw, among other mandatories,” explained Mingus. “We err on the side of caution with all policies, and this one is no exception.”
- Pay extra attention to patients with blood thinning medications.
“Every Regent center conducts a medication reconciliation, also a Joint Commission standard, on every patient who comes into the facility,” said Mingus. “Aimed at preventing harm or adverse reactions, we pay close attention, in particular, to blood thinners due to excessive bleeding.”
- Record and communicate information about patient medications, and educate the patients about how to appropriately take new medications when they return home.
“The medication reconciliation extends from the time a patient arrives until the time they are released from care,” noted Mingus, “and this includes medication they will take when they are recovering at home. Preventing adverse drug events is a top priority for our centers.”
- Employ the CDC’s or World Health Organization’s (WHO) hand cleaning guidelines and set goals for improvement.
Regent centers follow CDC recommendations and protocols and conduct hand washing audits. “We’ve found that occasional audits are effective at keeping handwashing top-of-mind,” said Mingus. “While handwashing is very basic, it is incredibly important. We recognize that and we highly scrutinize this particular safety goal.”
- Implement proven infection prevention guidelines after surgery.
“Infection control is increasingly important now that we are doing more complicated procedures including total joint replacement (TJR),” said Mingus. Regent centers follow national guidelines – CDC, NIH, APIC – to maintain the highest standards of infection control in the healthcare industry.
- Develop a method to ensure the right surgery is done on the right patient at the correct surgical site.
Every single Regent center uses a safe surgery checklist recommended by the WHO to establish it is the correct patient, surgeon, body part and side of the body, taking time before and after procedures to make certain of this as well. “We are committed to creating a culture of safety,” stated Mingus, “and like the WHO, Regent upholds standards and develops policies that diminish injuries and save lives.”
- Mark the surgical site on the patient’s body.
“As an extension of the surgery checklist, surgical site marking is a key step in preventing error,” said Mingus. “The surgeon marks the site and that is the policy in every one of our centers. This is not the only step in preventing site errors but it is critical and works in tandem with preoperative checks and time out.”
- Take a pause before surgery to avoid mistakes.
“The surgical time out is universal protocol,” stated Mingus. “A designated team member starts the time out in the operating room prior to surgery. The process is standardized and provides the necessary checks and balances to avoid mistakes.” To learn more about how Mingus and her team support surgery centers with policies, procedures and ongoing education to ensure patient safety, call 708-492-0531.