Efficiency counts in endoscopy, perhaps more so than in other specialties, but keeping your patients safe should always be the top priority. Here are five ways to do just that.
Identify patients. Before any patient encounter, staff must identify the patient using two identifiers, including patient name, medical record number and date of birth. Patients, or their family members, should state the patient's full name and DOB. Picture identification that verifies the patient's name and DOB can also be used. On placing an armband ID on a patient, or receiving a patient with an armband, the same verification should occur. Never state the patient's name or DOB; ask the patient to spell it out. If the patient is unable to do this, a family member can do so.
Once they confirm a patient's information, staff should initial the patient's armband so that each caregiver knows the correct identification procedure has occurred. Keep in mind that patients may find the repetitive questioning annoying and fail to pay attention to what you're asking them. I once cared for a woman who had endured four handoffs. Her first name had an unusual spelling and she knew people often misspelled it. Evidently, no one asked her to spell it out or listened carefully when she did. Her chart was noted with the wrong spelling of her name and we had to repeat the whole registration process when we discovered the mistake.
Identify specimens. A critically important facet of an endoscopy service involves the safe handling of lab specimens (see "How to Handle Specimen Handling Errors" on page 15). Mislabeling or mishandling specimens can lead to incorrect diagnoses and treatment, and can jeopardize patient lives and staff careers.
Pre-printed specimen labels are the safest and most legible, but handwritten tags are acceptable. All labels should include the patient's complete name and medical record number. Have the employee handling the specimen set up the containers after verifying the patient's identity. The physician obtains the specimens, places them in the containers and applies a patient label. A second staff member validates the patient's information and confirms that a specimen was collected and placed in a properly labeled container. Immediately discard any unused labels. In my facility, we label multiple specimen containers numerically (1, 2 and so on) and the physician completes the requisition, identifying each specimen's source. Nurses then document the specimen's source in their procedural charting or on the specimen information area in the patient's record.
Improve communication among caregivers. When receiving verbal orders or telephonic reporting of critical test results, the Joint Commission requires that you verify the patient using two identifiers, write down the complete order or read back the test's results. In my facility, we only accept verbal orders in emergency situations or in surgical or procedural settings where the physician can't physically write an order. When verbal orders must be used, we immediately document them on an approved form and keep them as part of the patient's permanent record.
Responding quickly to critical test results also improves patient safety. Do you have procedures in place to ensure a suitable response? Our nurses complete a "Test Results" form whenever they complete tests or X-rays or collect specimens. This form notes the test performed and the specimen type obtained (biopsy polyps, for example), the physician performing the test, date of the test and the patient's identification. We quickly process the form to ensure patients receive the results in a timely manner so they can schedule any necessary follow-up procedures.
Another aspect of safe patient care involves proper handoff communication between caregivers. In the endoscopy setting, the patient exchange may involve reports between nurses caring for patients before, during and after procedures. The Joint Commission recommends implementing a standardized approach that includes the opportunity to ask and respond to questions. In GI labs that care for hospital patients, the handoff process is more difficult. The patient may arrive with a paper chart or, in an increasing number of facilities, the patient's records are computerized. At my hospital, the handoff process is evolving. We currently use a form that each nurse completes as the patient moves to another caregiver. We place this form in the patient's paper chart and fax it to the receiving nurse. At each handoff between caregivers, and before the patient is transported to another area, a telephone call verifies that the faxed report has been received. We document that phone call.
Improve medication safety. Accurately and legibly label drug syringes and vials so that you can read the labels in dim procedure rooms. Using pre-printed labels that note the drug name and strength (such as midazolam 1mg/ml, or glucagon 1mg/ml) will eliminate errors. Compare and match pre-printed or handwritten labels on medications and solutions to the original source. Individuals who are involved in the passing of medications or solutions should verbally verify the medications or solutions during the pass. Immediately discard any unlabeled medications or solutions.
Encourage patients' involvement in their care. Patients and families play a part in preventing medical errors and maintaining their own safety. Encourage patients to ask questions about the care they're receiving. They should also pay attention to staff handwashing, patient identification and staff wearing identification badges. Discharge instructions are another essential way to promote patient safety. Staff should review these instructions with the patient or the patient's family before and after the procedure, answer questions and clarify concerns. Give patients a printed copy of post-op instructions at discharge as their designated driver escorts them from the GI unit.
Speed with safety
Even as GI facilities are hit with diminishing reimbursements that demand increased speed and case throughput, staff must ensure that they work with the correct patient, during the right procedure and with the proper equipment. And since so many endoscopy cases also involve the collection of specimens, your staff must ensure the samples are labeled correctly and match the correct patient's record.