Sixty ways to safety

Michael O’Connell has been interested in safety for years. It’s the way he was brought up by his parents. Today, as vice president of clinical/support services for Marymount Hospital, a Cleveland Clinic hospital, he’s steeped in it.

“Every day, the president of our organization, our chief nursing officer, quality director and myself review all of our safety events,” says O’Connell, who has a master’s in health administration, and who is a Fellow in the American College of Healthcare Executives as well as the American College of Medical Practice Executives. “We discuss how we can address the issue, as well as the bigger picture.”

The single most important ingredient for any successful patient-safety initiative is physician support, he says. “Physicians set the tone in the medical practice. If they aren’t committed to everything from reducing needlestick injuries to reducing slips, trips and falls, it won’t work.”

O’Connell presented 60 ways to create a safe medical practice at the recent MGMA 2013 Annual Conference. MGMA-ACMPE is a membership association for professional administrators and leaders of medical group practices. Here are a few:

  • Sprinkler heads: Keep them far from air vents, and clean. Don’t obstruct them; maintain an 18-inch clearance from the bottom of the sprinkler head
  • In case of fire, call Code RED first, then remember the acronym R.A.C.E. – “rescue, alarm, contain, extinguish.”
  • Code RED response: Keep in mind this acronym: P.A.S.S., for “pull the pin, aim nozzle, squeeze handle, sweep the base.”
  • Fire exits: Are exit signs pointing the right direction? Are fire exit paths clear? Are fire doors in working order?
  • Electrical outlets: Do not use power strips. Use items with a grounding conductor. Test sockets regularly. Unplug unnecessary items.
  • Personal appliances: They are not built for commercial use. All appliances within patient care areas must have a grounding conductor.
  • Improper item storage: Reduce clutter in hallways, patient rooms, storage areas and stations/desks.
  • Use fire-retardant furniture and curtains.
  • Educate employees annually on safety measures, code responses, and where to find more information on what to do in an emergency.
  • Disaster plan: Write it down, display it, update it annually, and make it easy to use.
  • Parking lots: Keep them well-lit.
  • Employee lockers: Insist that all employees lock their lockers.
  • Chemical storage: Differentiate between locked toxic/hazardous chemicals and others (i.e. formaldehyde vs. paint). Implement a safe storage policy/procedure based on category.
  • Chemical exposure: Reduce skin and respiratory irritation by using products with less odor; try to clean areas when patients are absent. Make sure cleaned area is dry before patients and employees enter.
  • Trash: All collection cans should have closed lids. Empty regularly. Separate items properly upon disposal (i.e. biohazardous waste vs. paper).
  • Red bags: Continually educate staff on items for red bag disposal. Use an approved vendor to remove biohazardous waste. Keep all bills of lading as documentation.
  • IT: Implement role-based access, audit trails, password protection, and data encryption. Continuously reassess and increase IT safety measures.
  • Implement a policy to stop cutting and pasting (without editing) of anything included in an electronic health record.
  • CPOE/alerts: Too many alerts can cause physicians to ignore allergies or drug interactions. Test and monitor the system often, work with other systems to develop best practices, remove “extra clicks”, and update often.
  • Handwriting: Establish a culture of legibility, to avoid incorrect prescription fills or incorrect medical records.
  • Abbreviations: Implement a hard-stop alert that appears when clinicians attempt to enter unapproved abbreviations.
  • Crash carts: Keep carts stocked, locked, checked, accessible, and plugged in. Store only full oxygen tanks on the carts.
  • Wheelchair lifting: Use lifting guidelines with bariatric patients. Educate staff on proper lifting procedures.
  • Footwear: Hazards include chemicals, bodily fluid spills, heavy objects being dropped. Create safe-footwear policies, such as no open-toed shoes and no shoes with holes in them.
  • Slips, trips and falls: Changes in elevation, spills, etc., can lead to falls. Use a comprehensive checklist for things to look out for. (See the Centers for Disease Control and Prevention booklet, “Slip, Trip, and Fall Prevention for Healthcare Workers,” at
  • Needles: Use blunt-tip or retractable needles. Use proper disposal methods for sharps.
  • Patient falls: Screen patients for risk and post alert on electronic health record; hourly rounding.
  • Patient refrigerators: Make sure they are labeled for patient food ONLY. Monitor temperature; maintain an alarm on the fridge in case temperature drops. Clean properly and often.
  • Salad (sound-alike, look-alike drugs): Write the purpose of the med on the Rx to prevent errors. Provide generic and brand names of drugs for med orders. Do not store meds alphabetically.
  • Oxygen tanks: Separate and properly label storage carts as “Full,” “Less than Full” and “Empty.”
  • Eye wash stations: Perform testing on stations to ensure proper functioning.
  • Medication rooms: Keep all medication and dirty utility rooms locked.
  • Error-reporting system: Have an error-reporting system to identify trends and system issues that could result in future patient harm.
  • Blanket warmers: Overheating is primary hazard. Test temperatures regularly and document.
  • Surgical sites and procedures: TIMEOUT checklist in the OR before procedure begins, so the whole operative team can confirm patient identity, correct side and site, and agree on procedure to be performed.
  • C. difficile patients: Use appropriate contact precautions and personal protective equipment, and monitor adherence. Isolate patient, transport only when medically necessary. Educate infected patients on proper hygiene.