i: patient-centered standards

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I : Patient-Centered Standards By Dr.Ashraf Sobhy AL-Abasiry,MBBCh,MSc Internist,Aramco Unit Saad Specialist Hospital

What is accreditation? :

What is accreditation? Accreditation is a process in which an entity, separate and distinct from the health care organization, usually non governmental, assesses the health care organization to determine if it meets a set of requirements ( standards ) designed to improve the safety and quality of care. Accreditation standards are usually regarded as optimal and achievable. Accreditation provides a visible commitment by an organization to improve the : 1-Safety and quality of patient care, 2-Ensure a safe care environment, 3-Reduce risks to patients and staff.

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The J oint C ommission (U.S.A.) and its predecessor organization have been dedicated to improving the quality and safety of health care services For more than 75 years. JCI is the international arm of The Joint Commission (U.S.A.). The Joint Commission and JCI are both nongovernmental, not-for-profit United States corporations JCI ’s mission is to improve the quality and safety of health care in the international community. . What is JCI’s relationship to The Joint Commission?

What are the benefits of accreditation?:

What are the benefits of accreditation? The accreditation process is designed to create a culture of safety and quality within an organization that strives to continually improve patient care processes and results . Accreditation may benefit hospitals by accomplishing the following: 1- Giving hospitals a competitive advantage. 2-Strengthening community confidence. 3-Negotiate with sources of payment for care with data on the quality of care. 4-Validating high-quality care to patients. 5-Helping hospitals organize and strengthen their improvement efforts. 6-Enhancing staff education. 7-Improving risk management. 8-Facilitating staff recruitment. 9-Promoting team-building skills for staff.

Who Is Eligible for an International Hospital Accreditation Survey? :

Who Is Eligible for an International Hospital Accreditation Survey? Any hospital may apply for JCI hospital accreditation if it meets the following requirements: 1- The hospital is currently in operation as a health care provider in the country and is licensed (if required). 2- The hospital assumes, or is willing to assume, responsibility for improving the quality of its care and services. 3-The hospital provides services addressed by JCI standards.

How are the standards organized? :

How are the standards organized? The standards are organized around and grouped by the important functions common to all health care organizations. The standards are divided into two sections: patient-centered functions and organization functions.. These functions apply to the entire organization as well as to each department, unit, or service within the organization. The survey process gathers standards compliance information throughout the entire organization, and the accreditation decision is based on the overall level of compliance found throughout the entire organization .

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1- International Patient Safety Goals 2-Access to Care and Continuity of Care. 3-Patient and Family Rights. 4-Assessment of Patients. 5-Care of Patients. 6-Anesthesia & Surgical Care. 7-Medication Management and Use. 8-Patient and Family Education . Functional Section I : Patient-Centered Standards

Functional Section II: Health Care Organization Management Standards :

Functional Section II : Health Care Organization Management Standards 1-Quality Improvement and Patient Safety. 2-Prevention and Control of Infections. 3-Governance, Leadership, and Direction. 4-Facility Management and Safety. 5-Staff Qualifications and Education. 6-Management of Communication and Information .

International Patient Safety Goals :

International Patient Safety Goals International Patient Safety Goals, are required for implementation as of 1 st January 2011 in all JCI accredited organizations. The purpose of the International Patient Safety Goals is to promote specific improvements in patient safety. The goals highlight problematic areas in health care and describe evidence- and expert-based consensus solutions to problems related to patient safety .

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patient Medication errors Infections Identification errors Communication errors falls Needless operations

1- International Patient Safety Goals:

1- International Patient Safety Goals ► Identify Patients Correctly. ► Improve Effective Communication. ► Improve the Safety of High-Alert Medications. ►Ensure Correct-Site, Correct-Procedure, Correct-Patient Surgery. ► Reduce the Risk of Health Care-Associated Infections. ► Reduce the Risk of Patient Harm Resulting from Falls.

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The organization develops an approach to improve accuracy of patient identifications . Identify Patients Correctly .

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▲ Effective communication, which is timely, accurate, complete and understood by the recipient,reduces errors and results in improved patient safety. ▲ The organization develops an approach to improve the effectiveness of communication among caregivers. The most error-prone communications are:- - Verbal and telephonic orders. - Report back of critical test results.. Read back :- the receiver should listen carefully and write down what he listened then read it back,and the sender should confirm . verbal order not allowed for:- -chemotherapy. -TPN. -narcotics. -vasopressor. -muscle relaxants Improve Effective Communication .

Improve the Safety of High-Alert Medications:

Improve the Safety of High-Alert Medications ▲ High-alert medications are those medications involved in a high percentage of errors and/or sentinel events, medications that carry a higher risk for adverse outcomes, for example, potassium chloride [equal to or greater than 2 mEq/ml concentrated], potassium phosphate [equal to or greater than 3 mmol/ml], sodium chloride [greater than 0.9% concentrated], and magnesium sulfate [equal to or greater than 50% concentrated]). ▲ All high alert medication should be kept in pharmacy not in the care units. - Exception to some of patient care areas like ( ICU,OR ),but should be labeled with special labels and stored in away that it is not easy to access.

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The organization develops an approach to ensuring correct-site, correct-procedure, and correct-patient surgery . Wrong-site, wrong-procedure, wrong-patient surgery is an alarmingly common occurrence in health care organizations . Evidence-based practices are described in The (US) Joint Commission’s Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. The essential processes found in the Universal Protocol are: marking the surgical site; a preoperative verification process; and a time-out that is held immediately before the start of a procedure Ensure Correct-Site, Correct-Procedure, Correct-Patient Surgery

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▲ Infection prevention and control are challenging in most health care settings and rising rates of healthcare–associated infections are a major concern for patients and health care practitioner Infections common to all health care settings include catheter-associated urinary tract infections, blood stream infections, and pneumonia (often associated with mechanical ventilation). Central to the elimination of these and other infections is proper Hand Hygiene . Reduce the Risk of Health Care-Associated Falls Infections

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▲ The organization develops an approach to reduce the risk of patient harm resulting from falls. As falls account for a significant portion of injuries in hospitalized patients the organization should evaluate its patients’ risk for falls and take action to reduce the risk of falling and to reduce the risk of injury should a fall occur. ► The evaluation could include:- - Fall history. -Medications-and-alcohol-consumption review. - Gait and balance screening. - Aids used by the patient. ► The organization should establish a fall-risk reduction program based on appropriate policies and/or procedures. Reduce the Risk of Patient Harm Resulting from

2-Access to Care and Continuity of Care (ACC) :

2-Access to Care and Continuity of Care (ACC) ACC is a patient centered integrated system of services matching and co-coordinating an individual’s ongoing needs with the appropriate level and type of care, treatment, and service within a Health Care Organization (HCO), or outside the organization, including the plan of discharge, transfer, and follow up. The objectives are improved patient care outcomes and more efficient use of available resources .

Admission to the Organization:

Admission to the Organization ▲ Patients are admitted to receive inpatient care or registered for outpatient services based on their identified health care needs and the organization’s mission and resources - Patients with emergent, urgent, or immediate needs are given priority for assessment and treatment. - Patient needs for preventive, palliative, curative, and rehabilitative services are prioritized based on the patient’s condition at the time of admission as an inpatient to the organization. - At admission as an inpatient, patients and families receive information on the proposed care, the expected outcomes of that care, and any expected cost to the patient for the care. - The organization seeks to reduce physical, language, cultural, and other barriers to access and delivery of services. - Admission or transfer to or from units providing intensive or specialized services is determined by established criteria.

Continuity of Care:

Continuity of Care The organization designs and carries out processes to provide continuity of patient care services in the organization and coordination among health care practitioners . ◘ The organization identifies individuals responsible for coordinating services. ◘ These individuals may coordinate all patient care (for example, between departments)or may be responsible for coordinating the care of individual patients (for example, case manager). During all phases of inpatient care, there is a qualified individual identified as responsible for the patient’s care. ◘ This individual may be a physician or other qualified individual

Discharge, Referral, and Follow-Up:

Discharge, Referral, and Follow-Up There is a policy guiding the referral or discharge of patients . - The clinical records of inpatients contain a copy of the complete discharge summary. - The clinical records of outpatients receiving continuing care contain a summary of all known significant diagnoses, drug allergies, current medications, and any past surgical procedures and hospitalizations. - Patients and, as appropriate, their families are given understandable follow-up instructions. - The organization has a process for the management and follow-up of patients who L eave A gainst M edical A dvice .

Transfer of Patients and Transportation:

Transfer of Patients and Transportation - Patients are transferred to other organizations based on status and the need to meet their continuing care needs. - The referring organization determines that the receiving organization can meet the patient’s continuing care needs. - The receiving organization is given a written summary of the patient’s clinical condition and the interventions provided by the referring organization. - During direct transfer, a qualified staff member monitors the patient’s condition. -The transfer process is documented in the patient’s record -The process for referring, transferring, or discharging patients, both inpatients and outpatients, includes planning to meet the patient’s transportation needs

3-Patient and Family Rights (PFR):

3- Patient and Family Rights (PFR) ▲ Each patient is unique, with his or her own needs, strengths, values, and beliefs. Health care organizations work to establish trust and open communication with patients and to understand and protect each patient’s cultural, psychosocial, and spiritual values ▲ To promote patient rights in a health care organization, one starts by defining those rights, then educating patients and staff about those rights. ▲ Patients are informed of their rights and how to act on them. ▲ Staff are taught to understand and to respect patients’ beliefs and values and to provide considerate and respectful care that protects patients’ dignity.

3-Patient and Family Rights (PFR):

3- Patient and Family Rights (PFR ) Excellence , for a healthcare organization, starts with the patients and ends with the patients. The rights of the patients and their families are an integral part of all of the activities that SSH is involved with. (PFR) at SSH are carried out by defined processes, related to how the organization provides health care in a balanced manner.

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J oint C ommission International PFR standards are incorporated with the daily practice of SSH by: Hospital Management Committee monitoring performances of how the caregivers carry out processes. Processes addressed are:  Identify, protect, and promote patients' rights.  Inform patients of their rights.  Include the patient's family, when appropriate, in decisions regarding care.  Obtain informed consent.  Educate staff about patients' rights.

4-Assessment of Patients (AOP) :

4-Assessment of Patients (AOP) An effective patient-assessment process results in decisions about the patient’s immediate and continuing treatment needs for emergency, elective, or planned care, even when the patient’s condition changes. Patient assessment is an ongoing dynamic process that takes place in many settings and departments, and consists of : Three primary processes . ► Collecting information and data on the patient’s physical, psychological, social status, and health history ► Analyzing the data and information, including the results of laboratory and imaging diagnostic tests, to identify the patient’s health care needs ► Developing a plan of care to meet the patient’s identified needs

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▲ - Each patient’s initial assessment(s) includes an evaluation of physical, psychological, social, and economic factors, including a physical examination and health history. ▲ - The patient’s medical and nursing needs are identified from the initial assessments and recorded in the clinical record. ▲ - The initial medical and nursing assessment of emergency patients is based on their needs and conditions.

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▲ - All patients are reassessed at intervals based on their condition and treatment to determine their response to treatment and to plan for continued treatment or discharge by qualified individuals ▲ - Physicians, nurses, and other individuals and services responsible for patient care collaborate to analyze and to integrate patient assessments. ▲ - Assessments are completed in the time frame prescribed by the organization and documented in the patient’s record and readily available to those responsible for the patient’s care. ▲ - The initial medical assessment is documented before anesthesia or surgical treatment.

Guidelines for at Risk patients: :

Guidelines for at Risk patients: At-Risk Patients (By location & type) Initial Evaluation Subsequent Evaluations Emergency Department 30 minutes 2 per hour Intensive Care Unit 60 minutes Twice a day Coronary Care Unit 60 minutes Twice a day Post-Operative (non-critical care areas) 12 hours Daily Acute Psychiatric Patient 60 minutes Twice a day Neonatal ICU 60 minutes Twice a day

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▲ - Patients are screened for nutritional status and functional needs and are referred for further assessment and treatment when necessary. ▲ -All inpatients and outpatients are screened for pain and assessed when pain is present. ▲ -Dying patients and their families are assessed and reassessed according to their individualized needs. ▲ - Laboratory services are available to meet patient needs, and all such services meet applicable local and national standards, laws, and regulations. ▲ - Radiology and diagnostic imaging services are available to meet patient needs, and all such services meet applicable local and national standards, laws, and regulations .

5 -Care of Patients (COP):

5 -Care of Patients (COP) ◙ A health care organization’s main purpose is patient care. ◙ Providing the most appropriate care in a setting that supports and responds to each patient’s unique needs requires a high level of planning and coordination Certain activities are basic to patients care. These activities include:  Planning and delivering care to each patient.  Monitoring the patient to understand the results of care.  Modifying care when necessary.  Completing the care.  Planning the follow-up Many physicians, nurses, and allied health professionals carry out these activities. Each provider has a clear role in patient care.

Care Delivery for All Patients:

Care Delivery for All Patients The care provided to each patient is planned and written in the patient’s record . Requirements : The care for each patient is : 1- planned within 24 hours of admission as an inpatient. 2- individualized and based on the patient’s initial assessment. 3- written in the health record. 4- updated or revised as appropriate. 5-Procedures performed are written into the patient’s record. 6- Patients and families are informed about the outcomes of care and treatment, including unanticipated outcomes.

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Health care organizations provide a variety of services, some of which are considered high risk because of their age, condition, or critical nature of their needs. Requirements : Policies and procedures guide the use and care OF : *The emergency patient ,Resuscitation services. Patients on life support *Handling, use and administration of blood and blood products. . *Patients with communicable disease and immunosuppressed patients. *Patients on dialysis,Elderly patients, disabled individuals, children and populations at risk of abuse. *Patients receiving chemotherapy or other high-risk medications Care of High-Risk Patients and Provision of High-Risk Services

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Food and Nutrition Therapy: - A variety of food choices, appropriate for the patient’s nutritional status and consistent with his or her clinical care, is regularly available. - Food preparation, handling, storage, and distribution are safe and comply with laws, regulations, and current acceptable practices. - Patients at nutrition risk receive nutrition therapy. Pain Management: - Patients are supported in managing pain effectively.

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End-of-Life Care - The organization addresses end-of-life care. - Care of the dying patient optimizes his or her comfort and dignity . End-of-life care provided by the organization includes : (a) Providing appropriate treatment for any symptoms according to the wishes of the patient and family; (b) Respecting the patient’s values, religion, and cultural preferences; (c) Involving the patient and family in all aspects of care; and (d) Responding to the psychological, emotional, spiritual, and cultural concerns of the patient and family.

6-Anesthesia and Surgical Care:

6-Anesthesia and Surgical Care ► The use of anesthesia, sedation, and surgical interventions are common and complex processes in a health care organization. ► They require complete and comprehensive patient assessment, integrated care planning, continued patient monitoring, and criteria-determined transfer for continuing care, rehabilitation, and eventual transfer and discharge ► The intent of the Anesthesia and Surgical Care Standards is to ensure an even safer environment for every patient and a clear record of the entire surgical and anesthesia process .

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Anesthesia Care ► - A qualified individual conducts a preanesthesia assessment and preinduction assessment. ► - Each patient’s anesthesia care is planned and documented in the patient’s record. ► - The risks, benefits, and alternatives are discussed with the patient, his or her family, or those who make decisions for the patient. ► - The anesthesia used and anesthetic technique are written in the patient record. ► -Each patient’s physiological status during anesthesia is continuously monitored and written in the patient’s record.

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Surgical Care ► - Each patient’s surgical care is planned and documented based on the results of the assessment. ► - The risks, benefits, and alternatives are discussed with the patient and his or her family or those who make decisions for the patient. ► - There is a surgical report or a brief operative note in the patient’s record to facilitate continuing care. ► - Each patient’s physiological status is continuously monitored during and immediately after surgery and written in the patient’s record. ► - Patient care after surgery is planned and documented.

7-Medication and Management Use:

7-Medication and Management Use ►Medication management is an important component in symptomatic, preventive, curative, and palliative treatment and management of diseases and conditions. ► Medication use in the organization complies with applicable laws and regulations and is organized to meet patient needs. ► An appropriately licensed pharmacist, technician, or other trained professional supervises the pharmacy or pharmaceutical service . ► To ensure efficient and effective use of medication, annual reviews are done on formularies

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The Medication and Management Use include the Following Activities * Selection, procurement. * Storage. * Ordering and transcribing. * Preparing and dispensing. * Administration and monitoring of medications.

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Selection and Procurement ► - An appropriate selection of medications for prescribing or ordering is stocked or readily available. ► -There is a method for overseeing the organization’s medication list and medication use. ► - The organization can readily obtain medications not stocked or normally available to the organization or for times when the pharmacy is closed .

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Storage - Medications are properly and safely stored. - Organization policy supports appropriate storage of medications and applicable nutrition products. - Emergency medications are available, monitored, and safe when stored out of the pharmacy. Ordering and Transcribing -Prescribing, ordering, and transcribing are guided by policies and procedures. - The organization defines the elements of a complete order or prescription and the types of orders that are acceptable for use. - The organization identifies those qualified individuals permitted to prescribe or to order medications. -Medications prescribed and administered are written in the patient’s record.

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Preparing and Dispensing - Medications are prepared and dispensed in a safe and clean environment. -Medication prescriptions or orders are reviewed for appropriateness. Administration - The organization identifies those qualified individuals permitted to administer medications. - Medication administration includes a process to verify the medication is correct based on the medication order. - Policies and procedures govern medications brought into the organization for patient self-administration or as samples. Monitoring - Medication effects on patients are monitored.

8-Patient and Family Education (PFE):

- The organization provides education that supports patient and family participation in care decisions and care processes. - Each patient’s educational needs are assessed and recorded in his or her record. - The patient’s and family’s ability to learn and willingness to learn are assessed. - Education and training help meet patients’ ongoing health needs. ► Patient and family education includes the following topics, related to the patient’s care: -The safe use of medications, the safe use of medical equipment, potential interactions between medications and food, nutritional guidance, pain management, and rehabilitation techniques. - Education methods include the patient’s and family’s values and preferences and allow sufficient interaction among the patient, family, and staff for learning to occur. - Health professionals caring for the patient collaborate to provide education. 8-Patient and Family Education (PFE)

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J oint C ommission I nternational PFE standards are incorporated into the daily practices of SSH patient - centered environment and embedded in our policies and guidelines in alignment with our mission, vision, values, PR, QI, and patient safety statements. SSH has a well-defined Patient Education program that promotes holistic care through a coordinated network of patient and family educational activities to meet their specific needs.

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► SSH has identified in the job description of applicable healthcare providers (physicians, nurses, educators, etc.) that they are authorized to provide patient education within their specialty. ► Utilizing resources that had been made available through the organization (i.e. Patient and Family Information (PFI), booklets, brochures, videos, policies, leaflets, handbooks, and visual aids).

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► During the discharge plan, the physician will evaluate the patient’s need for follow-up appointment after discharge. ► When the patient goes home, there is a follow-up call process in which specific questions are asked by the healthcare provider to the patient or family to evaluate the effectiveness of discharge, which includes the effectiveness of patient and family education .

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Tahrir square Feb 11,2011

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Tahrir square Feb 18 ,2011

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THANK YOU!!