BACHELOR OF SCIENCE IN NURSING:

NCM 107A – NURSING LEADERSHIP

AND MANAGEMENT

COURSE MODULE COURSE UNIT WEEK

3 14 16
Standards of Nursing Practice, Management Creating a Patient Safety and
Culture

✓ Study the course and unit objectives

✓ Understand study guide prior to attending the class
✓ Read prerequisite learning resources
✓ Partake in classroom activity
✓ Be included in weekly discussion
✓ Answer and submit course unit task
At the end of this unit, the students are expected to:

Cognitive:

Affective:

1. Work effectively in collaboration with inter-, intra- and multi-disciplinary and multi-
cultural teams
2. Join actively in class discussions and group activities.
3. Appreciate and support one’s opinion and comments toward each other
4. Engage in life-learning with a passion to keep current with national and global
developments
5. Accept mutual responsibility for reaching predetermined supraordinate goals.

Psychomotor:

1. Demonstrate a professional attitude during the providing nursing to

patients regardless of the race, age sex, gender etc.

Introduction
Nurse as the largest group of healthcare service providers in the nation, are vital
members of this team. Keeping patients safe: Transforming the Work Environment of
Nurses made it explicit that nurses are the healthcare service professional most likely
to intercept errors and prevent harm to patients.

Given the role that nurses play in care and quality improvement, it is important for
nurses to know what proven techniques and interventions they can use to enhance
patient and organizational outcomes.
The Department of Health, through the Health Facility Development Bureau, in
collaboration with active partners from both the public and private sectors.

Safety in healthcare organizations aims to prevent harm to patients their families and
friends, healthcare, professionals, contract of service workers, volunteers, and the many
other individuals whose activities bring them into an environment.

Safety is one aspect of quality where quality includes not only avoiding, preventable
harm, but also making appropriate care available providing effective services to those
who could benefit from them and not providing ineffective or harmful services.

KEY ELEMENTS OF PATIENT SAFETY

1. Leadership
• Leadership and political commitment are essential at the health facility
level where patient safety becomes an integral component of quality care
• The Leadership shall address strategic priorities for institutional
development.
• Its culture and infrastructure, engage its various stakeholders
communicate and build awareness.

2. Institutional Development
• Approaches to institutionalize patient safety and quality in the health
facilities will have to consider the following:
➢ financial and human resource;
➢ facility and equipment management;
➢ strengthen management responsibility,
➢ authority and competency;
➢ formulate standards of what is expected from health providers;
communicates;
➢ provide training;
➢ enforce the standards that comes with the policies and give the
patients a voice through a feedback system or a patient
satisfaction survey
3. Reporting System
• The National Patient Safety Committee shall develop and institutionalize a
pro-active reporting and learning system that requires its leadership to
encourage reporting of events

4. Feedback and Communication

• Performance feedback and benchmarking mechanism
➢ to communicate leadership responses
➢ to the reports shall be established
➢ to demonstrate commitment
➢ to patient safety and ensure continuous improvement.

5. Adverse Event Prevention and Risk Management

• Risk and reduction strategies thorough patient
• Risk assessment,
• patient feedback survey health technology assessment and safety
assessment code

6. Disclosure of Reported Serious Events

• The reporting system ensures confidentiality of individual cases.
• The events can be made available to the public through
➢ disclosure of results of investigation,
➢ summary reports or annual reports that summarize events and
actions taken

7. Professional Development
• Training and supervision of the healthcare staff to improve their decision
and clinical judgments is imperative.
• It is necessary to instill standard norms of behavior of courtesy,
promptness and efficiency among the healthcare workers and improve the
quality of service given to patients.

8. Patient Centered care and Empowerment of Consumers

• patients must be at all center of patient safety initiatives and must be
partners in all aspects of the process.
• Patient centered care and patient safety is a national priority and a core
agenda
➢ to improve quality care in all health
➢ to protect patients, form faulty system
 Importance of Safety in Healthcare

1. Improve patient satisfaction and clinical outcomes.

2. Ensure accuracy of patient’s identification.
3. Enhance the effectiveness of communication among healthcare personnel.
4. Improve the safety of using medications.
5. Reduce the risk of healthcare associated infections
6. Reduce the risk of harm resulting from injuries.
7. Improve staff productivity and retention rate.
8. Increase awareness of occupational health and environmental control like
ergonomically- designed workplace.
9. Workers must be trained to. Workers also must be convinced why it is important
to pay attention to prevention and be educated about the benefits in terms of
reduced pain and discomfort of adopting good practices and work methods.
10. A strong ergonomics integration prevents injuries and increases productivity.
Together, they make the workplace safer and reduce costs.

5 Ways to Improve Staff Safety in Healthcare

Working in the healthcare profession is one of the most rewarding careers you can
choose, but working in healthcare also puts your own health at risk. Aside from the
physical demands of crowded hospitals and the stress that comes with long shifts
and treating serious ailments working with sick patients puts you at risk for the same
illnesses that brought them to the hospital.

1. Promote a culture of safety

• Company culture heavily influences the general attitude of a working
environment.
• Hospitals that place a big emphasis on staff safety are more likely to prevent
incidents because safety is aligned with professionalism in the workplace.

2. Measure the performance of safety protocols

• One of the fundamental practices that make hospitals as effective as they are
is the use of record keeping.
• Nurses and Doctors are bombarded with information and urgent tasks
throughout the day without checklist, scheduled, and other methods of
monitoring task, it would be nearly impossible to keep track of everything.
• Reporting incidents and learning form them is critical to implementing staff
safety.
For example unintentional exposure to aggressive substances is taken
less seriously than needle stick injuries (lick to previous blog:
http://www.infusesafety.com/preventing-needlestick-injuries-in-the-icu),
 3. Optimize staff scheduling
• Hospital management faces many challenged – two of the most areas, finding
enough qualified people to fill their teams.
• When hospital teams are understaffed,
employees are overworked,
and the risk of safety incidents increases.
While management needs to control labor costs for hospitals to remain
profitable, there needs to be a balance between minimizing cost and
maximizing staff safety.

4. Improve patient handling

• Moving and handling patients can be one of the most physically
demanding aspects of healthcare professions.
• Dependency of patients on nursing staff (2) increases and equipment
gest more complex, patient-handling methods form the past might not be
as effective today.

Nurses should be encouraged to always ask for help when they need it not just for
the sake of reducing injury to themselves, but also to ensure the safety and comfort
patients.
5. Use safer medical equipment
• Medical device is quickly improving, and recent innovations, eliminate health risks
that plagued staff and patients in the past.
• Improving Infection Control
• Helping prevent needlestick injuries
• Reducing medication errors (by reducing stopcock manipulations)
• Increasing protection against exposure to blood and drugs
• Minimizing disconnections, air embolism and misconnections
Ultimately, these serviced make hospitals safer for everyone and make it easier for
nurses and doctors to do their jobs effectively.
Resources:
1. OSHA:
http://www.osha.gov/dsg/hospitals/dpcuments/1.1_Data_highlights_508,pdf
2. http://www.scielo.br/scielo.php$pid=S141481452016000300205&script=sci_artte
xt&ting=en
Types of Errors
1. Adverse Health Care Event – event or omission arising during clinical care and
causing physical or psychological injury to a patient.
2. Error – failure to complete a plan action as intended or the use of an incorrect
plan of action to achieve a given plan.
3. Health Care Near Miss – situation in which an event or omission ( or sequence)
arising during clinical care fails to develop further whether or not as the result of
compensating action thus preventing injury.
4. Adverse Drug Reaction – any response a drug which is noxious, an intended and
occurs at doses used for prophylaxis, diagnosis or therapy (Predictable /
Unpredictable).
5. Medication Error – any preventable event harm may cause or lead to
inappropriate medication use or patient harm while the medication is in the
control of health professional, patient or consumer.
6. Sentinel Error – surgery on the wrong body part, surgery on the wrong patient,
patients receiving the wrong medication.

Indicators and Parameters of Safety

The Patient Safety Indicators (PSIs) are a set of measure that screen for adverse
events that patients experience as a result of exposure to the health care system.

(PSIs) are set of indicators providing information on potential in hospital complications

and adverse events following surgeries, comprehensive literature review, analysis of
ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and
empirical analyses.
1. Medical Error
2. Falling Incident
3. Needle Stick Injury
4. Splash / Spills Incident
5. Hospital acquired infection like CLABSI, CAUTI, VAP, HAPU/ healthcare
associated infection
6. Blood and blood component transfusion error
7. Intravenous Therapy complications like infiltration, extravasation and phlebitis
8. Nurse sensitive indicators namely
 9. Hazardous materials exposure
Benefits of Checklist Health Care
• Checklist used in the medical setting can promote process improvement and
increase patient safety.
• Implementing a formalized process reduces errors caused by lack of information
and inconsistent procedures.
• Checklist have improved processes for hospital discharges and patient transfers
as well as for patient care in intensive care and trauma units.
• Along with improving patient safety, checklist create a greater sense of
confidence that the process is completed accurately and thoroughly
• Checklist can have a significant positive impact on health outcomes, including
reducing mortality, complications, injuries and other patient harm. Clinical quality.

This guide includes checklist, developed by Cynosure Health for these 10 areas:
1. Adverse drug events (ADEs)
2. Catheter-associated urinary tract infection (CAUTIs)
3. Central line-associated blood stream infections (CLABSIs)
4. Early elective deliveries (EEDs)
5. Injuries from falls and immobility
6. Hospital-acquired pressure ulcers (HAPUs)
7. Preventable readmissions
8. Surgical site infections (SSIs)
9. Ventilator-associated pneumonias (VAPs) and ventilator- associated events
(VAEs)
10. Venous thromboembolism (VTEs) to prevent process breakdown due to human
factors, each checklist identifies the top evidence based interventions that health
care organizations can implement and test to reduce harm.
Nursing Actions to Improve Patient Safely
1. Knowledge and implementation about healthcare policies and procedures.
2. Open communication and teamwork among all other healthcare providers.
3. Review the medication rights before giving the medications.
4. Engage in creating and updating reporting system to avoid a blaming culture,
5. Involve in research and evidence-based activities for better decision making.
6. Be updated on all life-saving certification like CPR, BLS, ACLS, PALS, NALS and
other Nursing Specialty Certification Programs.
7. Engage in hospital committees to make the healthcare system safe effective and
patient-centered.
8. Be responsible in reporting all errors and near misses not only for the patient to
prevent sentinel and adverse events to happen again.
9. Ensure better lighting and less clutter in the work areas.
Ensure the staff are trained to operate the medical equipment like ventilator, infusion
pump, and warmer.
At the 2000 ANA House of Delegates, the nurses voted to support actions to build sage
health care system for patients.

Nurse were asked to engage in the following activities.

• Promote awareness about changes in the health care system that undermine
quality and safety of patient care.
• Support the development of a National Center for Patient Safety and the
establishment of a national mandatory state-based error reporting system.
• Support the development and implementation of performance standards by
regulators and accrediting agencies that require healthcare institutions and
system to implement patient safety programs and process with defined executive
responsibility.
• Support the implementation of proven medication safety system and practices by
health care organization,
• Promote passage of whistle blower legislation that protects the essential role of
nurses in efforts to correct system errors.
• Demonstrate the improvement of quality of care and reduction of errors through
collection of data using nursing quality indicators.
• Promote nursing research in patient safety and educate nurses in the science of
system safety issues.
Reference
American Nurses Association (2003b) Nursing: Scope and standards of practice. 3 rd
edition. Washington DC: ANA. (Available late October 2003).
 Tips on How to Improve the System and Prevent Future Errors from Occurring
1. Adapt a culture of safety in the workplace
2. Focus on the task at hand
3. Reduce distracting noise to prevent accidents / errors
Develop a personal note-taking system

Implementing Policies on Accidents

Personnel Safety Implementing Policies

• Always observe necessary safety measure when using wheelchair, stretcher,
beds and other equipment available for the patient.
• Never operate electrical equipment with wet hands.
• Do not attempt to use an equipment unless, you are familiar with its operation.
• Be sure that the electrical equipment is plugged into the proper type of outlet.
• Never smoke or allow anyone to smoke in a room where oxygen is in use. This is
a “No Smoking “Hospital.
• Report any unsafe conditions such as following to the janitorial supervisor or
Supervising Nurse:
o Wet and slippery floors
o Defective equipment
o Inadequate lighting
• Fire drills are conducted so that employees know how to act during emergencies
• Needle stick injuries surveillance
• Recommend staff for immunization on the following: FLU Vaccination,
Pneumonia, Rabies, Hepatitis B and C.
Occupational and Environmental Health Nursing

Is the specialty practice that provides for and health and safety programs and services
to workers, worker populations and community groups?
The practice focuses on promotion and restoration of health prevention of illness and
injury and protection from work related and environment hazards.

Role of Occupational Health Nurses

• Case management
Providing treatment, follow up and referrals and emergency care for job related
injuries and illnesses.
.
• Counselling and Crisis Intervention
Involves counselling workers about work related illness and injuries, substance
abuse and emotional and/or family problems.
They handle referrals to employee assistance programs and/or other community
resources and coordinate follow up care.

• Health promotion
Is the teaching of skills and developing health education programs that
encourage workers to take responsibility for their own health?
Smoking cessation, exercise, nutrition and weight control, stress management,
control to keep workers health and productive.
Worker and Work place hazard detection

Includes monitoring the health status of workers by conducting research on the effects
of the data to prevent injury and illness.

Infection Prevention and Control

The goal of an organization’s Infection and control program is to identify and reduce the
risk of acquiring and transmitting infections among patients, staff, health care
professionals, contract workers, volunteers, students and visitors.

The infection risk and program activities may differ from organization to organization
depending on their clinical activities and services, patient’s population served,
geographic location, patient volume and number of employees.

Importance of Infection Prevention and Control

1. Maintain a safe environment for patient and staff by reducing the risk of acquiring
the healthcare – associated infections
 2. Prevent spread of transmissible disease in healthcare settings through evidence
based-control measures.
3. Learn the multidisciplinary approach in prevention and infection control practices
particularly for the emerging and non-emerging infections.
4. Develop strategies to reduce hospital and community acquired infections through
evidence-based research.
5. Respond effectively and efficiently to outbreak of infections within the community
6. Provide support for infections control preparedness and response to public health
emergencies of potential concern.
7. Reduce patients’ length stay and cost of confinement through stringent
implementations of prevention and infection control policies and protocols.
8. Prevent complaints and litigations related to healthcare associated infections that
can potentially incurred by patients, significant others, and staff.

Standard Precaution Infection Prevention and Control

Standard Precaution are meant to reduce the risk of transmission of blood borne
and other pathogens from both recognized and unrecognized sources. They are the
basic level of infection control precautions, which are to be used as a minimum in the
care of all patients.
The nurses play a critical role in preventing and controlling hospital infections.
Thus, nurses’ actions for infection prevention and control are the implementation of
universal standard precaution such as:
• Hand Hygiene
- Perform hand hygiene by means of hand rubbing for 20-30 seconds using
enough hand disinfectant to cover all areas of the hand rub hands until dry or
- Perform hand washing for 40-60 seconds using soap and water and rinse and
dry hand thoroughly with a single towel.
- Perform hand hygiene or hand washing:
a. Before and after any direct patient contact and between patients, whether
or not gloves are worn,
b. Immediately after gloves are removed,
c. Before handling an invasive device,
d. After touching blood, body fluids, secretions, excretions, non-intact skin,
and contaminated items, even if gloves are warm,
e. During patient care, when moving from a contaminated to a clean body
site of the patient,
f. After contact with inanimate objects in the immediate vicinity of the patient.

• Personal Protective Equipment (PPE)

➢ PPE includes the use of gloves, impermeable gowns, face masks, eye shield.
Select PPE based on the assessment of risk.
➢ Assess the risk of exposure to body substance or contaminated surfaces before
any health-care activity. Make this a routine.

• Needle stick and sharps injury prevention

 ➢ Use care when handling needles, scalpels, and other sharp instruments or
devices, cleaning used instruments, and disposing used needles.
Example are:
Do not recap needles. If recapping is necessary use single hand
technique or use mechanism device like forceps.
➢ Establish engineering controls and safe injection practices.
➢ All used needles, blades/lancets and other sharp instrument should be
disposed to punctured proof resistant container immediately after use.
➢ Punctured proof resistant container should be accessible so that the
operator can dispose immediately the sharp and avoid mixing it with other
wastes.
➢ Do not overfill sharp containers and seal properly if ready for disposal.
➢ Report all needle and sharp injuries for evaluation and management.

• Cleaning and Disinfection

➢ Use adequate procedures for the cleaning and disinfection of
environmental and other frequently touched surfaces.
➢ Clean, disinfect, and reprocess reusable equipment appropriately
before use with another patient.
• Respiratory hygiene like cough etiquette
➢ Cover nose and mouth when coughing / sneezing with tissue or mask,
dispose of used tissue and mask, a perform hand hygiene after contact
with respiratory secretions.
➢ Place acute febrile respiratory symptomatic patients at least 3 feet
away from others in common waiting areas, if possible
➢ Post visual alerts at the entrance to health-care facilities instructing
persons with respiratory symptoms to practice respiratory hygiene /
cough etiquette.
➢ Consider making hand hygiene resources, tissues and masks
available in common areas and areas used for patients with respiratory
illnesses.

Waste Disposal
➢ Ensure safe waste management by following waste segregation
protocol
➢ Treat waste contaminated with blood, body fluids, secretions and
excretion as clinical waste, in accordance with local regulations.
➢ Discard single use items properly

Safe Injection Practices

➢ Prepare injections using aseptic techniques in a clean area.
➢ Disinfect the rubber septum on a medication vial with alcohol before
piercing
➢ Do not use needles or syringes for more than one patient. This includes
manufactured prefilled syringes and other devices such as insulin pen.
 ➢ Medication containers (single and multi-dose vials, ampules, and bags)
are entered with a new syringe, even when obtaining additional doses
for the same patient.
➢ Use single -dose vials for parenteral medication when possible
➢ Do not use single-dose medication vials, ampules, and bags or bottle of
intravenous solution for more than one patient.
➢ Do not combine the leftover contents of single-use vials for later use,
(Center for Disease Control and Prevention).

Guiding Principle

• Routine Practices must be incorporated into the culture of each healthcare

setting and into the daily practice of each healthcare provider.

• Routine Practices apply to all Body Fluids, Non-Intact Skin, Mucous Membranes
or Equipment Contaminated with Blood, Body Fluids or Tissues.

• A point a Care Risk Assessment must be done by healthcare providers before

each interaction with the patient or their environment to determine which
interventions are required to prevent transmission of microorganism during that
interaction.

• PPE is used to prevent transmission of infectious agents both from patient-to-

patient and from patient-healthcare provider. Healthcare settings must ensure
sufficient supplies of, and quick, easy access to PPE is provided.
• Routine practices are used by ALL healthcare providers for ALL
patients/residents/clients in ALL settings ALL of the time infection Prevention and
Control
• Preventing transmission of microorganism to other patients is a patient safety
issue, and preventing transmission to staff is an occupational health and safety
issue.

Procedure
• Point of Care Risk Assessment to be done before each interaction with a patient
or their environment.

Assess the patient for high risk of contaminating environment

➢ Uncontrolled diarrhea
➢ Uncontrolled draining wounds or skin lesions
➢ Uncontrolled respiratory symptoms
➢ Symptoms vomiting, fever, skin rash
➢ Inability to clean hands or cover cough

What type of environment is high risk for patient?

➢ Shared space (i.e.multi-bed room, shared bathrooms
➢ Crowded areas such as waiting rooms, hallways
➢ Shared equipment

• Use avoidance procedures that minimize contact with droplets (e.g. sitting next
to, rather than in front of, a coughing patient when taking a history or conducing
an examination).

• Hand Hygiene
• Personal Protective Equipment (PPE) Determine the appropriate PPE to use
that will decrease exposure risk and prevent transmission of infectious agents:
include gloves, mask, N95 respirators, eye protection, and gowns / aprons.

• Effective providing services based on scientific knowledge to all who could

benefit and refraining from providing services to those not likely to benefit.
• Efficient avoiding waste, including waste of equipment, supplies ideas and
energy
• Equitable providing care that does not vary in quality because of personal
characteristics such as gender, geographic location and socio-economic status
(IOM, 2001).
• Patient-Centered providing care that is respectful of and responsive to patient
preferences, needs, values and ensuring that patient values guide all clinical
decisions.
• Patient Safety is defined as “the prevention of harm of patients through the
prevention, avoidance of risk, adverse outcomes, or injuries stemming from the
process of healthcare.
It is the degree to which the risk of an intervention and risk in the care
environment are reduced for a patient and other person, including healthcare
provides.
• Safety avoiding injuries to patient from the care that is intended to help them.
• Timely reducing waiting time and sometimes harmful delay for both those who
receive and those who give care.
Marquis, Bessie & Huston, Carol Leadership roles and Management Functions in
Nursing, (2017)

Venzon, Lydia, Quality Management Towards Quality Care, (2016)

◦ Meador, Derrick. "The Purpose of Building a Portfolio Assessment."
ThoughtCo, Aug. 26, 2020, thoughtco.com/the-purpose-of-building-a-portfolio-
assessment-3194653.

IWorld Health Assembly (WHA), the Department of Health has issued Administrative
Order No. 2008-0023 which mandates the reinforcement and institutionalization of the
implementation of quality assurance for patient safety where it is regarded as one of the
quality assurance for patient safety where it is regarded as one of the dimensions of
quality care. As cited (Institute of Medicine. 2000).

Routine Practices and Additional Precautions for Preventing the Transmission of

Infection in Health Care: Public Health Agency of Canada: Sept 1, 2010 – Final Version.

Routine Practices and Additional Precautional in all Healthcare, Setting. Provincial

Infectious Disease Advisory Committee (PIDAC), Ontario: July 2011.

Best Practice for environment Cleaning for Provincial infectious Diseases Advisory
Committee (PIDAC), Ontario: May 2012