Goal 1:Identify patient correctly

HOW?
1- Patient’s full name (3 names).
Room and /or bed number
2- PIN. are never used as patient
identifiers.

When?
• Before providing treatments
• Before Performing
procedures
• Before any diagnostic
procedures
• Serving diet tray
 Tools for patient’s Identification

In-patient & ER Out-patient

ID band Without
Procedure
procedure

ID band ID card
Colour of ID Bands
for patients>12y
for Boys <12y
for girls<12y
Special Situations
Identification of Comatose Patients :
for comatose patient without proper identification use temporary
identifiers as
• 1st Name: Unknown
• 2nd Name: ER
• 3rd Name: One
Identification of Newborn:
three (3) ID bands will be used
• Two ID bands (on the right and left ankles) containing the mother’s three full
names and mother’s PIN
• One ID band containing the gender of baby and mother’s three full names and
baby’s PIN on the baby’s right wrist. As BB/BG of (Mother name) until new name will
be nominated for baby
 Goal 2: Improve Effective
Communication

Reporting
Verbal/Telephone critical results
Hand Over
Order of diagnostic
tests
 1-Verbal/Telephone order
• When to use ?
only in Urgent/certain situation when patient is in need
to immediate intervention and documentation in file is
not applicable
• How to use ?
First: Make sure from patient identification
Then follow this mechanism:
write down -read back-confirm Authenticate
 Where to Document
Verbal/Telephone Order?

Medication Physician
Sheet Order
 Telephone orders NOT accepted under the
following circumstances:

• If the physician has not attended or assessed the patient before.

• Neonatal care and treatment
• Abortion inducing medications and labor inducing medications
• For administration of high-alert medications(including but not
limited to (Narcotics and other controlled substances)

Telephone orders accepted for :

• Analgesic-NSAIDs-Antispasmodic-Anti flatulent-Laxative-Cough
Syrup-Oral Anti hypertensive, Hypoglycemic-IV fluids-Changing
Insulin drip rate
 2. Patient’s Handover
• Handover: The transfer of
responsibility for a patient care
Critical Content
of Handover

• Diagnosis
• Significant clinical findings
• Significant Investigation
Handover
results(Critical results)
• Significant medications Unit to
Shift to
• Performed procedures unit/
shift hospital
• Special considerations and
recommendations
 Type of Healthcare
Unit Used Form
Handover Providers

General Ward Nurses Nursing Assessment & Re-assessment Forms

ER Nursing Assessment & Re-assessment

Emergency Room Nurses
Form
Critical Care Areas Nurses Critical Care Flow Sheets
Shift-to-shift
Labor & Delivery Unit Nurses L&D Handover Sheet
Nursery Nursing Assessment &
Nursery Nurses
Reassessment
Inpatient progress Notes, Endorsement
Inpatient units Physicians
Sheet
Nurses Nursing Transfer Summary
Within inpatient units
Physicians Internal Transfer Summary

To diagnostic units &

Nurses Temporary Nursing Transfer Summary
Physiotherapy & vice versa

Unit-to-unit Back from the diagnostic

units & Physiotherapy to the Nurses Temporary Nursing Transfer Summary
inpatient unit

To units providing surgical Temporary Nursing Transfer Summary + Pre-

Nurses
services (OR, Cath lab,..) operative Checklist
 Type of Healthcare
Unit Used Form
Handover Providers

From the operating theatre to

Nurses Nursing Surgical Record
the recovery room
Recovery Room
From Recovery room to
Nurses Post-operative Recovery Record
inpatient unit

Temporary Nursing Transfer Summary +

Nurses
Nursing Surgical Chart
In case of direct transfer of patient from
operating theatre to the SICU
Physicians Surgical Notes
3-Reporting critical results of diagnostic tests

• Critical Results: investigation results with a variance

from the normal that is life threatening which needs
an immediate and appropriate action

Investigations Include :
• Laboratory tests
• Radiology tests
• POCT(Glucometer,
Jaundice meter, ACT)
• ECHO,TEE,ECG,EEG,CTG
 Reporting Critical Results of Diagnostic Tests Flowchart
Critical result
Finding Critical result of diagnostic test
logbook/SHEET

Call the patient's nursing station immediately or

within max 15 minutes from finding the result

Report the critical results to the

Available Not available
attending physician

Physician Document the Test Type Charge Nurse will document

Nursing Notes
progress notes ,Result ,Date and Time of Test type,Result, Date and time of
receiving the result receiving the result

Physician Order
Take the appropriate action
communicate critical test results Attending
to stabilize the patient
Physician Care physician
condition
plan

nurse will document

1- Date and time of reporting to the attending
physician
2-Name and title of the attending physician who
received the result
 What is the definition of High Alert Medications ?

High alert Medications:Medications that bear a heightened risk of causing

significant patient harm when they are misuse

LASA Medications:Look a like , Sound a like Medications whose names confused

with other drug names ( sound alike )and similar product packaging ( lookalike )

Concentrated Electrolytes:medication is needed to be diluted before use.

Unintentional or incorrect administration of concentrated electrolytes may cause
patient harm.

How to reduce the risk of High Alert Medications?

 Using colour code labels

=High alert Medications
=Concentrated Electrolytes
 Blue =Look a like and Sound a like
 High alert Medication and Concentrate Electrolytes should be stored in locked
cabinets separately from the normal medications
 Concentrated electrolytes are not stocked up in the wards, only in critical areas as
needed.
 Independent Double check
Goal 4: Ensure correct-site, correct-procedure
and correct patient surgery
 Get Informed Consent
 Site Marking if (for all procedures
involving
• laterality(Left/right distinction)
• multiple structures (such as fingers, toes, kidneys)
• multiple levels (as in spinal procedures)
 Pre-Operative verification Checklist

 Sign IN(before the induction of anesthesia )

 Time Out (before the skin incision )
 Sign Out (before the patient leaves )
Goal 5: Reduce the risk of hospital-acquired infection
Goal : Reduce the risk of patient harm
resulting from falls
How to Know if patient is at risk for falls?
1-Screening For Outpatients by questions mentioned in OPD Nursing assessment.
2-Assessment For Inpatients by:
• Morse Fall Risk Assessment(Adults)>12 years
• Humpty Dumpty(Pediatric)<12 years

High Risk for fall He will be identified by Using (Green Wrist Band ,Fall Risk Sign)

Take care:
The following patient groups are considered High risk for falls without assessment:
1. Intensive care units’ patients.
2. Post-operative for 24 Hrs. Except for Local anaesthesia.
3. ER/Hemodialysis patients.
4. Patients undergoing procedural sedation.
5. Physiotherapy/Cardiology procedures.
When we will make Assessment &
Reassessment?
FACTS

• Following a Fall
• On Arrival or Admission to the facility
• Following any Change of status
• On any Transfer from one unit to
another within the facility or discharge
• Shift change
 Fall precautions
Fall risk interventions are applied and documented in the following forms:

Morse Fall risk assessment Humpty Dumpty Fall risk

assessment

OPD Nursing assessment