Patient Safety Universal Protocol and the National Patient Safety Goals

Patient Safety Coordinator
Students Name
Institution
Patient Safety Coordinator
Question 1: Universal Protocol
The Universal Protocol was implemented by the Joint Commission to reduce or eliminate the incidences wrong site surgeries. Wrong-Site surgery comprises of the following instances: surgery on the wrong side or site; on the wrong patient; or wrong surgical procedure. The Joint Commission defined wrong-site surgery as a sentinel event and is the third-highest ranking event. However, there are instances when medical staffs do not adhere to the procedures of the Universal Protocol (UP). In this case, a Patient Safety Coordinator (PSC) discovers that the UP is not being done during procedures in the Army Health Clinic. Among the responsibilities of the PSC is to assist the Patient Safety Program Manager (PSPM) with identifying clinical quality concerns that put patients at risk and also assist in planning, development, and implementation of clinically based programs designed to provide high quality, safe care. The following are the steps the PSC would take on this potentially identified risk of noncompliance to the Universal Protocol.
The PSF must understand that wrong-site surgery is a medical error that is preventable with implementation and compliance of standardized protocol among team members in the perioperative setting. Therefore, the Universal Protocol is a policy for the entire team, including the patient, to adhere to during the surgical procedure. The first step involves establishing evidence-based Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) as the AMEDD platform for training, implementation, skill building, and sustainment of teamwork initiatives (MEDCOM Regulation Memo 40-41, 2017).
Team STEPPS is within the MEDCOM Safety Program which is aimed at making healthcare teams that optimize process and patient outcomes. All staff must be well educated on teamwork and asked to embrace it. Patient safety is a team activity that involves coordination, cooperation, and synchronization of all activities necessary to support the needs of patients (TeamSTEPPS, 2006). All staff members including those that are not in direct contact with the patient play a role in making the healthcare environment safe. A patient’s life is dependent on effective teamwork.
The next step involves compliance with the UP. The PSC should assist the PSPM in retraining of the staff on the UP. It should be a continuous process that should be done regularly to ensure that all the staffs are up to date with the UP. Regular comparisons of compliance and procedure should be conducted to track the progress the progress made. The UP consists of the following three processes: a pre-procedure verification process, marking out the procedure site and a Time Out (final verification) (The Joint Commission, 2018). Improving team communication can facilitate patient safety in the pre-procedure verification as a lack of communication between team members leads to many clinical errors. To improve on marking out the site, a “wipe-proof” pen should be used to ensure that the mark is visible after skin preparation and draping. On Time Out Confirmation, the nurse (as the patient advocate) should lead ...