Advances in health technology can save patients’ lives, but can also cause harm, as the recent Ecri Institute report, Top 10 Technology Hazards for 2012, reminds us. Here’s a snapshot of the hazards nurses should be focusing on, and some suggestions they give on how to prevent them.
1. Alarm hazards
The risk: With nurses being constantly bombarded by bells, it’s easy to see how alarm fatigue can set in, leading to desensitization, nurses being unable to distinguish the urgency level of alarms, and improper alarm adjusting.
Some suggestions: According to the report, a facility should look at the big picture, examining the entire alarm environment when setting up an alarm-management system. Alarm notification and response protocols should be developed to ensure that each alarm will be recognized, that the appropriate caregiver will be notified, and that the alarm will be promptly addressed. Policies should also be established to control alarm silencing, modification, and disabling.
2. Radiation exposure
The risk: High levels of radiation used during radiation therapy can cause serious harm if errors occur, including damage to normal tissue and organs. And despite radiation levels being lower in diagnostic settings, the increasing number of patients undergoing diagnostic radiography may reveal more risks in the future.
Some suggestions: The report suggests that adequate staffing levels may be a place to start. For radiation therapy, standard checklists should be developed for each step of patient treatment, and standard patient treatment procedures should be documented and followed. For CT scanning, radiation doses used should be as low as reasonably achievable while maintaining acceptable image quality.
3. Medication errors using infusion pumps
The risk: Mistakes such as mistyping data or entering it into the wrong field can have major adverse effects, including death. The use of “smart” pumps has helped, but preventable errors—such as misprogramming—can still occur.
Some suggestions: The report suggests hospitals should develop appropriate drug libraries for clinical areas that use infusion pumps, with standardized concentrations of drugs and solutions. Facilities should also get “buy-in” from staff members who will be using the system before and during purchasing of the system. Infusion pump technology safeguards should be emphasized, and noncompliance with safety systems should be addressed immediately. For more on smart pumps, read the CE feature “Increasing the Use of ‘Smart’ Pump Drug Libraries by Nurses: A Continuous Quality Improvement Project,” in AJN’s January issue (link pending in next day).
4. Needlestick and other sharps injuries
The risk: Exposure to bloodborne pathogens such as hepatitis B virus, hepatitis C virus, and HIV.
Some suggestions: Facilities are recommended to assess injuries and current practices to determine where and when these injuries occur most often. Using the data, an action plan should be developed and implemented. Some aspects of the plan could be ensuring adequate training of personnel and obtaining supplier support for in-service training on the use of protective devices.
5. Enteral feeding misconnections
The risk: Misconnection incidents can result in nutrients intended for the GI tract to end up elsewhere—potentially resulting in death by embolus or sepsis.
Some suggestions: The report suggests using enteral pumps for enteral feeding whenever possible. It also warns against using a standard Luer syringe for oral medications or enteral feedings and against modifying or adapting IV or feeding devices. Feeding tubes and connectors could be color-coded and labelled. Lines should also be traced from end to end when making an initial connection and any time there is a reconnection. Look for our upcoming February CE feature, “Bedside Assessment of Enteral Tube Placement: Aligning Practice with Evidence,” for more.
Other hazards that topped this year’s list include cross-contamination from flexible endoscopes, inattention to change management for medical device connectivity, surgical fires, anesthesia hazards due to incomplete pre-use inspection, and poor usability of home-use medical devices. Click here to request a copy of the full report.—Amy M. Collins, associate editor