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 Injection Safety
Nevada Sentinel Events Registry
Nevada Center for Patient Safety
Patient Safety Links
NSMA Executive Committee
A principal responsibility for organized medicine is to provide practicing physicians with tools to assist them in their practices. The NSMA is developing supporting materials to help members talk to their patients and their patients’ families about their concerns as a result of this crisis. Even if patients don’t bring the subject up, NSMA is encouraging every physician to say, “Please Ask Me” about the news stories regarding infection control.
The Nevada State Health Division has encouraged patients to ask several questions prior to a surgical procedure (http://health.nv.gov/docs/030308PressRelease.pdf):
- Can you assure me that I am safe in your facility from the transmission of communicable diseases?
- How does the staff at this facility conduct sterilization of diagnostic equipment after each patient use?
- Are single or multiple dose vials used at the facility? Are label instructions followed specifically?
- Are syringes and needles disposed of after each use?
- Has your facility ever received a complaint of the spread of an infectious disease to another patient as a result of staff practices?
NSMA encourages physicians to invite patients (and their families) to ask these or similar questions on the subjects that bother them based on the coverage of the issues and the releases from government agencies. Physicians are encouraged first make sure that they have reviewed the policies & practices. If the practice is in a licensed facility, physicians are encouraged to make sure that they have talked with the risk management department to clarify the facility’s position regarding disclosure and release of information including policies, plans and infection rates.
NSMA recommends that every physician should consider and adopt as appropriate in his/her practice the Centers for Disease Control and Prevention standards for preventing viral hepatitis transmission in ambulatory care settings (http://www.cdc.gov/ncidod/diseases/hepatitis/spotlights/ambulatory.htm).
“Injection safety” standards are presented at: http://www.cdc.gov/ncidod/diseases/hepatitis/spotlights/ambulatory.pdf). The key standards, which addresses the concerns raised in response to the Las Vegas hepatitis C outbreak, are:
- Use a sterile, single-use, disposable needle and syringe for each injection and discard intact in an appropriate sharps container after use.
- Use single-dose medication vials, pre-filled syringes, and ampules when possible. Do not administer medications from single-dose vials to multiple patients or combine leftover contents for later use.
- If multiple-dose vials are used, restrict them to a centralized medication area or for single patient use. Never re-enter a vial with a needle or syringe used on one patient if that vial will be used to withdraw medication for another patient. Store vials in accordance with manufacturer’s recommendations and discard if sterility is compromised.
- Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients.
- Use aseptic technique to avoid contamination of sterile injection equipment and medications.
The Association for Professionals in Infection Control & Epidemiology (APIC) advises (http://apic.informz.net/apic/archives/archive_272235.html) the following points to share with patients:
- The infection prevention & control professionals at our facility have designed a coordinated infection prevention & control program to protect everyone who comes into our facility, including patients, healthcare workers & the public.
- Our program incorporates evidence-based practices from leading authorities in infection prevention including the CDC. In addition, we comply with regulations from government agencies such as the state & local health departments, OSHA & the Centers for Medicare & Medicaid Services, as well as accrediting bodies, such as The Joint Commission.
- The essential elements of an infection prevention & control program include:
- Rigorous hand hygiene practices – that ensures healthcare providers clean their hands before & after giving patient care
- Monitoring the cleaning, disinfection and sterilization of instruments and equipment used for patient care
- An Exposure Control Plan that serves to minimize exposure to bloodborne pathogens such as Hepatitis B, C and HIV by patients and healthcare personnel
- As part of that plan, there are measures to prevent the re-use of items that are designed to be used only once then disposed of, such as needles and syringes
- Additionally, in order to ensure patient safety, our staff is trained to identify a breach in infection control practice and intervene if such practices are identified.
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Nevada Sentinel Events Registry
Since 2002 (as revised in 2005), health care facilities (acute care hospitals, ambulatory surgery centers, independent emergency room centers and obstetric centers) have been required to report “sentinel events” to the Nevada State Health Division. A “sentinel event” is defined (http://leg.state.nv.us/NRS/NRS-439.html#NRS439Sec800) as an unexpected occurrence involving facility-acquired infection, death or serious physical or psychological injury or the risk thereof, including, without limitation, any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. The term includes loss of limb or function. It is called a sentinel event because it signals the need for immediate investigation and response. Mandatory reportable sentinel events include events that have resulted in an unanticipated death or major permanent loss of function, not related to the natural course of the patient’s illness or underlying condition.
Forms for reporting sentinel events that include comprehensive definitions are available at: http://health.nv.gov/index.php?option=com_content&task=view&id=403&Itemid=689.
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Nevada Center for Patient Safety
NSMA is a founding member of the Nevada Center for Patient Safety (http://www.nvcps.org/), which was started in 2002. Participants include representatives of: the Nevada State Medical Association; the
Nevada Hospital Association; the Nevada Nurses Association; the Nevada Osteopathic Medical Association; and, HealthInsight, Nevada’s Quality Improvement OrganizationOn July 29th, the U.S. Senate passed “The Patient Safety and Quality Improvement Act” (S. 720).
Approved by voice vote, S. 720 must be reconciled by a Conference Committee with H.R. 663 before it can be signed into law. Both bills establish Patient Safety Organizations where physicians, nurses, hospitals, nursing homes and other health care professionals could confidentially report information about errors in patient care. Data about such occurrences would be analyzed and shared with health care professionals to prevent similar incidents -- a voluntary, non-punitive system that has been used successfully to enhance aviation safety.
"We look forward to a productive House and Senate conference and then President Bush's signature on this critically important legislation for the safety of our patients," said Dr. Palmisano. The Conference Committee is expected to meet this Fall.
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There are a growing number of web based resources regarding patient safety. Some of the most useful are the following:
- National Patient Safety Foundation (http://www.npsf.org/)
- National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP) (http://www.nccmerp.org/)
- Institute for Healthcare Improvement (http://www.ihi.org/IHI/)
- Institute for Safe Medication Practices (http://www.ismp.org/)
Memorandum
To: NSMA Executive Committee
From: Larry Matheis
Date: July 1, 2009
Subject: Safe Injection Practices Campaign-Nevada Pilot Revised Timeline
Based on today’s meeting with the national campaign and considerable assistance from the CDC, I developed the following revised summary for our continuing meetings as part of the national Safe Injection Practices Campaign. The next steps will be to pilot the training and educational materials in Nevada. We are partnering with the State Health Division in this effort. The Division has approved a $25,000 grant for our costs for this phase of the project and the CDC Foundation is prepared to provide for most other costs. Staff from the CDC and HONOReform will also be available to provide technical and operational assistance.
1. Send drafts of letters by July 2nd to: NSMA Executive Committee; SIP Steering Committee; Nevada Pilot task group; Richard Whitley-Administrator, Nevada State Health Division; Nevada State Health Officer Mary E. Guinan, MD; Southern Nevada Health District Chief Health Officer Lawrence K. Sands, DO; and, Washoe County District Health Department District Health Officer Mary A. Anderson, MD, MPH. These are being revised and should be complete by August 3, 2009.
2. Develop draft reporting form on educational and practice materials by July 30 including a knowledge pre-test for web site.
3. Identify professional association and related meetings and arrange presentations on Nevada Pilot through July and August. Conduct presentations August-end of year.
4. Develop PSA for local broadcast by August 7. Media contacts regarding Nevada Pilot starting August 10.
5. Letters to be sent during the week of August 24-28 to:
a. All Nevada health care facilities licensed or certified through the State Health Division (joint letter from NSMA President and State Health Officer)
b. All Nevada health care professional licensing boards (letter from NSMA President)
c. All Nevada health care professional associations (letter from NSMA President)
d. Every Nevada licensed physician (letter from NSMA President and President of each County/Local Medical Society)
e. Every Nevada licensed nurse (Letter from NSMA President and NNA?)
f. All public health clinics (or departments) (joint letter from NSMA President and State Health Officer)
g. All FQHC’s (letter from NSMA President)
6. Schedule report on campaign at 1st hearing of the Nevada Legislative Committee on Health Care.
7. Follow up phone calls to facilities and organizations. Follow up e-mails (if available) to professionals September 8-11.
8. Prepare materials for distribution to health professionals and facilities that volunteer to test the materials September 1-11. Distribute materials starting September 14.
9. Collect survey and comment forms, write summary report of Nevada Pilot and provide to Steering Committee and Nevada State Health Division September 14-October 30.
The following steps are proposed for NSMA followup after
initiation of the Nevada pilot.
10. NSMA provide web site CME program for members using these materials and certification for those professionals or facilities that complete the program.
11. Develop with Steering Committee a project summary with recommendations for national campaign.
12. Send project summary to Nevada Congressional delegation with suggestions for national policy changes.
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