Time Out–Make it Safe
Aug 14, 2019
By Karen Wilkinson, RN, NHA, CLNC – CareerSmart® Learning Contributor
This time of year we gear up for the changes that are coming to our schedules as summer ends and fall approaches. Hopefully, a quick review of the summer months brings to mind good memories of time away on vacation or at least a few days off for planned fun, rest, and relaxation. These “time-outs” help us disconnect from our usual routines of life, recharge our batteries, and return home with a fresh perspective and renewed focus.
It’s no different for us at work; we need “time-outs” there as well. Every healthcare professional has a lengthy list of routine tasks and procedures that fill each day but lull our senses with their “routine-ness.” But we also have many “interrupters” in our day that divert our attention, and when our attention is interrupted, the chance for medical error increases. If you have ever made a medication error of commission as a nurse, you understand how easy it is to miss a step in the “rights” of safe medication administration, even though you are usually very careful. Although it is relatively uncommon, with only one in 112,000 surgical procedures implicated, wrong-site, wrong-procedure, and wrong-patient surgery continue to make headlines.
One way to consistently build “time-outs” in our practice is through National Patient Safety Goals® (NPSGs) established by The Joint Commission (TJC). NPSGs have evolved over the years as safety concerns have changed, and they are currently available for ambulatory care, behavioral care, hospitals, home care, nursing care centers, laboratories, and office-based surgery. Typically, NPSGs are specific to the healthcare setting; however, one particular goal that is found across all settings is the use of at least two patient identifiers when providing care, treatment, and services. No matter the setting or circumstance, a problem with patient identification can lead to medical error. Let’s examine this particular safety goal a little closer across several settings. The purpose of this goal in Nursing Care Centers is to identify the correct patients or residents before administering medications or treatments and therefore lessen the chance of error. According to TJC, “acceptable identifiers may be the individual’s name, an assigned identification number, telephone number, or other person-specific identifier.” However, each facility or setting may have different methods for accomplishing the same goal. For example, many nursing centers use a photograph of the resident in the medical record and/or the medication administration record as an identification tool. Because error in patient identification is less likely to occur in the Home Care setting than in other settings, the patient’s confirmed address is acceptable when used with another patient-specific identifier. Facial recognition is also considered an acceptable identifier when the clinician regularly sees the patient and “knows” them. In the hospital setting, proper patient identification can prevent a myriad of medical errors. TJC recognizes that “well-known misidentification errors such as wrong patient/wrong procedure” occur, as well as there being a higher risk of misidentification for newborns “due to their inability to speak and lack of distinguishable features.” Additional information on the National Patient Safety Goals can be access here. https://www.jointcommission.org/assets/1/6/NPSG_Chapter_NCC_Jan2019.pdf
Although “time-outs” may be thought of more traditionally in the pre-surgical or pre-procedural hospital setting, stopping to properly identify a resident is a “time-out” in its simplest sense. It is a break in routine that allows a clinician to stop and disconnect from a repetitive task or an interruption and then clearly refocus on the task at hand. The refocusing process protects us from the liability of medical errors and keeps our patients and residents safe. Become familiar with all of the NPSGs for your healthcare setting, and remember that a “time-out” is a good thing. Consider it a mini-vacation during your hectic day!
For more information about the impact of medical errors, please visit CareerSmart Learning (www.careersmart.com) and check out the following courses:
Medical Errors: The Healthcare Provider Perspective; and,
Medical Errors: The Financial Impact on the Healthcare Industry.
Person-Centered Care: An Overview
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1Agency for Healthcare Research and Quality/PSNet (2019). Wrong-Site, Wrong-Procedure, and Wrong-Patient Surgery. Retrieved August 11, 2019 from https://psnet.ahrq.gov/primers/primer/18/wrong-site-wrong-procedure-and-wrong-patient-surgery
2The Joint Commission. (2019). National Patient Safety Goals®. Retrieved August 12, 2019 from https://www.jointcommission.org/standards_information/npsgs.aspx
3The Joint Commission. (2019). 2019 Nursing Care Center National Patient Safety Goals. Retrieved August 11, 2019 from https://www.jointcommission.org/assets/1/6/2019_NCC_NPSGs_final.pdf
4The Joint Commission. (2019). National Patient Safety Goals Effective January 2019, Nursing Care Center Accreditation Program, Goal 1. Retrieved August 12, 2019 from https://www.jointcommission.org/assets/1/6/NPSG_Chapter_NCC_Jan2019.pdf
5The Joint Commission. (2019). National Patient Safety Goals Effective January 2019, Home Care Accreditation program, Goal 1. Retrieved August 12, 2019 from https://www.jointcommission.org/assets/1/6/NPSG_Chapter_OME_Jan2019.pdf
6The Joint Commission. (2019). 2019 National Patient Safety Goals Effective January 2019, Critical Access Hospital Accreditation Program, Goal 1. Retrieved August 12, 2019 from https://www.jointcommission.org/assets/1/6/NPSG_Chapter_CAH_Jan2019.pdf