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Get with the Guidelines: A Nurse's Quick-start Guide to Best Practices in Patient Safety

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January 14, 2010 - Nurses are familiar with evidence-based care and the importance of following specific procedures that are based on “best practices” in health care delivery.  But how can you keep up with all of the latest research, weed out the extraneous information and make sure you are following the most effective practices for you and your patients? 

To help you get started, NurseZone has put together a list of current care guidelines from some of the most influential health care organizations and governing bodies, highlighting those that are most important to nurses.

Use this as your “guide to the guidelines” that are most likely to impact your daily nursing activities:

1. National patient safety goals - updated 

The Joint Commission’s National Patient Safety Goals (NPSGs) for 2011 are now available on their web site.   The goals are differentiated for each area of medicine, including: Ambulatory Health Care ; Behavioral Health Care; Critical Access Hospital; Home Care; Hospitals; Laboratory Services; Long Term Care; Long Term Care (Medicare/Medicaid); and Office-Based Surgery. Additional resources include a list of “look alike/sound alike” medicines and an official “do not use” abbreviations list.

The Joint Commission 2011 National Patient Safety Goals 

2. Guidelines for hand hygiene

Several organizations have issued guidelines regarding hand hygiene for health care workers in recent years, including the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).  The CDC’s hand hygiene web page offers quick access to the original 2002 CDC Guideline for Hand Hygiene in Health-care Settings, the 2009 WHO Guidelines for Hand Hygiene in Healthcare, background information, training materials, posters and other campaign materials, measurement/adherence tools (including a free application for iPhones), and more.

CDC Hand Hygiene in Healthcare Settings 

3.  Guidelines for patient hand-offs 

In perioperative settings: The Association of periOperative Registered Nurses (AORN) and the U.S. Department of Defense collaborated on a comprehensive Perioperative Patient “Hand-Off” Tool Kit.  This web-based tool aims to standardize hand-off communications, and is based on the Department of Defense Safety Program TeamSTEPPS™ initiative.  It includes supporting research for the recommendations, sample checklists and forms, PowerPoint presentations, and an annotated guide to additional resources.

The AORN Perioperative Patient Hand-Off Tool Kit

Between long-term and emergency facilities:  The Emergency Nurses Association’s (ENA) Institute for Quality, Safety and Injury Prevention released its new Safer Handoff Guidelines in May 2010 to help facilitate safer transfer of patients between long-term and emergency care facilities through standardized communication processes. The guidelines include sample customizable forms, recommended data elements to include on a patient handoff form, best practices, a list of available resources  and more.  The publication is free to download for ENA members or can be purchased by non-members for $24.95.

ENA's Practical Guide to Safer Handoff of Older Adult Patients between Long-Term Care Facilities and Emergency Departments 

4. Guidelines for safe surgery 

The World Health Organization (WHO) published a comprehensive set of guidelines related to ensuring safe surgery in 2009, which has since been found to lower mortality and other risks in a variety of surgical settings.   This authoritative, 133-page publication looks at essential objectives for safe surgery, reviews the research evidence and recommendations, and includes a checklist (for use before, during and after surgery) with an implementation plan.  Many organizations, including the American College of Obstetricians and Gynecologists (ACOG), have incorporated this checklist and guidelines into their own recommendations and encourage all members of the healthcare team to be involved in their use.

WHO Guidelines for Safe Surgery (2009) 

5. Guidelines for patient discharge to avoid rehospitalizations 

Avoiding unnecessary hospital visits is one of the major goals of health reform, with an expectation that initiatives in this area will improve patient safety and save significant costs. One such initiative is Project RED, the Re-Engineered Discharge Program to Decrease Rehospitalization, developed by Boston University School of Medicine with support from the Agency for Health Research and Quality (AHRQ) and the National Heart, Lung and Blood Institute (NIH-NHLBI).  The project’s online toolkit and assorted resources help nurses provide guidance to patients regarding their discharge instructions and follow-up care in order to improve outcomes and avoid a return trip to the hospital. 

Project RED Toolkit: Re-Engineered Discharge for Avoiding Rehospitalizations

The Joint Commission also offers a helpful list of additional references on the subject.

The Joint Commission: Reducing Rehospitalizations, Selected References 

6. Guiding principles for nurse leaders regarding patient safety

The Association of Nurse Executives (AONE) has drafted a variety of guiding principles for nurse leaders, including a toolkit that looks at the nurse executive’s role in patient safety.  These guidelines show leaders how to manage patient safety initiatives such as leading cultural change, providing shared leadership, building external partnerships  and developing leadership competencies.

AONE Toolkit: Role of the Nurse Executive in Patient Safety Guiding Principles 

7. Guidelines for dealing with HAIs, MRSA 

The U.S. Department of Health and Human Services has developed an action plan to avoid hospital-acquired infections (HAIs)—based on the CDC’s recommendations—that is available for healthcare providers and other stakeholders on their web site. The plan includes lists of priority recommendations for each of the guidelines reviewed.

HHS Action Plan to Prevent Healthcare-Associated Infections: Prevention – Prioritized Recommendations 

The CDC has also posted a number of HAI prevention tools for health care providers on their web site:

CDC’s Prevention Tools for Healthcare-associated Infections 

And on January 4, 2011, an advance copy of the Infectious Diseases Society of America’s (IDSA’s) first-ever guidelines for the treatment of Methicillin-Resistant Staphylococcus Aureus (MRSA) was published online in Clinical Infectious Diseases, including recommendations to address the threat posed by MRSA-related skin and soft-tissue infections. Covering topics ranging from personal hygiene and wound care to antibiotic therapies for invasive MRSA, each section of the guidelines begins with a specific clinical question and is followed by numbered recommendations and a summary of supporting evidence.

IDSA's Practice Guidelines for the Treatment of MRSA Infections in Adults and Children – NEW

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