Safety

Patient Safety

By: Nancy Burden

Published: 10/28/2008

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How to Create a Useful Safety Manual


Build your own safety manual? Sure, in all your spare time, right? It's not as difficult or as daunting as it might sound. Read on as I outline how to assemble a manual that will be easy for your OR team to read, understand and apply.

What's the purpose?
Put simply, a safety manual must communicate the essence of your safety policies and provide staff with clear descriptions of their roles in all types of emergencies. The manual must be useful in times of calm and crisis - as a part of your team's ongoing knowledge base to create a safe environment and as a tool for quick reference when a real emergency or safety issue arises (see sample below).

Management must lead the process and show support of the manual's usefulness. But it's certainly acceptable, and often desirable, to delegate the actual development of the manual to a staff member. Choose someone with a broad point of view, someone who's enthusiastic, knowledgeable of industry standards and self-motivated to complete the task. It's more important that the person have clinical expertise than writing skills (you can always edit). Give the person the time and resources to develop the manual.

Frontline team members frequently have the best ideas for approaching safety issues. Engage them in both business and clinical areas to ensure a number of desired outcomes, such as their buy-in to the value of the tool and their insights about the actualities of the practice setting. A manual full of instructions and actions that can't be easily applied to real-life settings is useless.

Consider the distinct needs of your environment, including the type of facility, patient population, staff mix and other concerns specific to your setting. For example, what are the options for communication during a telephone outage? Is your center contained on one floor? Are walkie-talkies available? Is there a logical central desk that should be considered a command center?

Next, investigate appropriate resources for standards and regulations that affect the safety plan. Hopefully you already did this when you developed your center's comprehensive safety plan, but it's always good to check for updates and clarifications. For example, accreditation organizations annually review and may update standards that apply to the environment of care. National, state and county regulations may change to accommodate recent updates from the National Fire Protection Agency, CMS, and local building and fire codes.

Short and to the point
For this type of publication, brevity wins over protracted descriptions and processes. Each topic should generally fit on one page. The use of graphics and color enhances a user-friendly appeal. Also include tabs for quick reference during emergencies (see "Example of a Safety Manual Outline").

What to Do in a Fire: Borrowing a Page from a Safety Manual

Each page of your safety manual should contain key points for the end user. For example, the page about "Code Red, Your Role in a Fire" should break down each employee's role.

TEAM MEMBER FINDING FIRE
1. Rescue and remove patients in immediate danger. Account for all patients. If a move is necessary, go to other side of a firewall.
2. Pull a fire alarm or call the emergency desk (use phone emergency button), announce "CODE RED" and location of fire.

TEAM MEMBER AT THE EMERGENCY DESK
1. Answer phone immediately, "Emergency desk."
2. Overhead page "CODE RED" and location 3 times in a row.
3. Call 911
4. Continue announcing "CODE RED" or any change in emergency.

TEAM MEMBERS RESPONDING TO THE FIRE PANEL
1. Immediately go to the closest fire panel.
2. Acknowledge/read fire panel and silence alarm only.
*** DO NOT RESET PANEL UNTIL VIEWED BY MAINTENANCE
3. Relay the information to the emergency desk.
4. Go to the main entrance and direct the fire department.

TEAM MEMBERS IN A NON-AFFECTED AREA
1. Close all doors and windows. If not giving patient care, turn off equipment. If performing procedure, complete procedure and then turn off equipment.
2. Designated individual(s) should take fire extinguisher to fire location to assist as needed. Always remain between any fire and an exit as an escape route. Do not enter any area of personal jeopardy.
3. Wait for further instructions on overhead page.
4. Assist affected department with any patient evacuation as needed.

TEAM MEMBERS IN CONTROL OF LOBBY
1. Assess location and number of people in the lobby.
2. Communicate and keep calm order.
3. Don't allow use of elevators until fire location is identified.
4. Have plans in place and prepare to evacuate the lobby upon the directive of the fire department.

TEAM MEMBERS WITH PATIENTS RECEIVING OXYGEN
1. RN to stand by with bag-mask-valve constantly with any patient on assisted ventilation until the "CODE RED ALL CLEAR" is announced. The physician will determine alternative methods for patients receiving other medical gases.
2. Turn off any O2 on patients who can do without.
3. Wait for further instructions on the overhead page.

- Nancy Burden, MS, RN, CPAN, CAPA

Excerpt the salient points from your existing safety policies and procedures. Other information that you may want to include in the manual may come from Web sites, industry news, healthcare literature and other sources. Such investigation will lead to the next step of making an outline for content.

After development, administration should review and approve the manual. Review by the facility's governing body and medical executive committee is appropriate as well. Orientation and annual staff updates are good opportunities to discuss the tool.

If you provide the manual electronically, make one hard copy available for access during unexpected computer downtimes. Remember to update that hard copy if you make changes to the electronic version. An annual review of content should identify any changes in regulations, organizational structure and telephone numbers, and the accuracy of current practices.

Example of a Safety Manual Outline

TAB 1 ORGANIZATIONAL INFORMATION
  -  Key Telephone Numbers
  -  Organization Chart & Telephone Tree

TAB 2 EMERGENCIES
  -  Alerts
  -  Bomb Threat & Room Checklist
  -  Code Blue - When to Call
  -  Code Blue
  -  Code Cart Inventory Adult & Pediatrics
  -  Communications Plan ? site-specific
  -  Emergency Medications
  -  Evacuation Process
  -  Fire Plan Code Red
  -  Fire - Your Role
  -  Fire Walls - Locations
  -  Infant Abduction - RAVE
  -  Rescue Carrying Methods
  -  Response Team & Domestic
  -  Severe Weather
  -  Utility Failure Plan

TAB 3 GENERAL SAFETY
  -  10 Outpatient Safety Tips
  -  Five Steps To Safer Health Care
  -  Kid Safe Environment & Checklist
  -  Medication Reaction Information Sheet
  -  Medication Use and Storage
  -  MRI Safety
  -  National Patient Safety Goals
  -  Patient Identification Talking Tips
  -  Prohibited Abbreviations
  -  Security and Safety
  -  Team Member Safety & Security

TAB 4 INFECTION CONTROL
  -  Blood Exposure
  -  Infection Control Plan
  -  Locations of PPE
  -  Standard Precautions
  -  TB Guidelines

TAB 5 HAZARDOUS AND BIOMEDICAL MATERIALS
  -  Biomedical Waste Plan
  -  Hazardous Material Management
  -  Hazardous Waste Explosion
  -  Hazardous Waste Roles
  -  Radiation Safety
  -  Spill Control
  -  Spill Equipment Locations

TAB 6 TEAM MEMBER HEALTH
  -  Proper Body Mechanics
  -  Eye Injury Treatment

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