PRIORITIZATION, CARE OF SPECIMEN, AND

REPORTING ACCIDENTS & INCIDENTS

A Report

Presented to

Mrs. Emerita A. Dacanay, RN MAN

Assistant Chief Nurse for Patient Care

Department of Nursing Service

UERM Memorial Hospital

By

Johnasse Sebastian C. Naval, RN, MAN(og)

August, 2014

I. PrioritizationPrioritization is the essential skill that you need to make the very best use of your

own efforts and those of your team. It's also a skill that you need to create calmness

and space in your life so that you can focus your energy and attention on the things that

really matter.

It's particularly important when time is limited and demands are seemingly unlimited.

It helps you to allocate your time where it's most-needed and most wisely spent, freeing

you and your team up from less important tasks that can be attended to later... or quietly

dropped.

With good prioritization (and careful management of reprioritized tasks) you can

bring order to chaos, massively reduce stress, and move towards a successful

conclusion. Without it, you'll flounder around, drowning in competing demands.

a.) Simple Prioritization

At a simple level, you can prioritize based on time constraints, on the potential

profitability or benefit of the task you're facing, or on the pressure you're under to

complete a job: Prioritization based on project value or profitability is probably the most

commonly-used and rational basis for prioritization. Whether this is based on a

subjective guess at value or a sophisticated financial evaluation, it often gives the most

efficient results.

Time constraints are important where other people are depending on you to

complete a task, and particularly where this task is on the critical path of an important

project. Here, a small amount of your own effort can go a very long way.

And it's a brave (and maybe foolish) person who resists his or her boss's pressure to

complete a task, when that pressure is reasonable and legitimate.

b.) Prioritization Tools

While these simple approaches to prioritization suit many situations, there are plenty

of special cases where you'll need other prioritization and time management tools if

you're going to be truly effective. We look at some of these prioritization tools below:

c.) Paired Comparison Analysis

Paired Comparison Analysis   is most useful where decision criteria are vague,

subjective or inconsistent. It helps you prioritize options by asking you to compare each

item on a list with all other items on the list individually.

By deciding in each case which of the two is most important, you can consolidate

results to get a prioritized list.

d.) Decision Matrix Analysis

Decision Matrix Analysis   helps you prioritize a list of tasks where you need to take

many different factors into consideration.

e.) The Action Priority Matrix

This quick and simple diagramming technique asks you to plot the value of the task

against the effort it will consume. By doing this you can quickly spot the "quick wins"

which will give you the greatest rewards in the shortest possible time, and avoid the

"hard slogs" which soak up time for little eventual reward. This is an ingenious approach

for making highly efficient prioritization decisions.

f.) The Ansoff Matrix and the Boston Matrices

These give you quick "rules of thumb" for prioritizing the opportunities open to you.

The Ansoff Matrix   helps you evaluate and prioritize opportunities by risk. TheBoston

Matrix   does a similar job, helping you to prioritize opportunities based on the

attractiveness of a market and your ability to take advantage of it.

g.) Pareto Analysis

Where you're facing a flurry of problems that you need to solve, Pareto

Analysis  helps you identify the most important changes to make.

It firstly asks you to group together the different types of problem you face, and then

asks you to count the number of cases of each type of problem. By prioritizing the most

common type of problem, you can focus your efforts on resolving it. This clears time to

focus on the next set of problems, and so on.

II. Care of SpecimenMicrobiological and virological laboratory testing has a key role in the management

of children with infection. Accurate and rapid identification of significant micro-organisms

is vital for guiding optimal anti-microbial therapy, and improving outcome from infectious

disease. Laboratory diagnosis is also essential for effective infection control in both the

hospital and community settings, as well as providing invaluable epidemiological data.

Clinicians (including nurses, doctors and professionals allied to medicine) have

responsibility for the collection and safe transportation of samples to the laboratory. The

validity of test results largely depends on good practice in the “pre-test” stage and it is

essential that documentation is accurate and comprehensive (Higgins 1994).

Microbiological tests are not as standardised as some other lab tests; the way in

which a sample is processed and the results are interpreted depend heavily on the

information provided with the specimen.  Contamination of samples, especially those

from normally sterile sites such as blood or cerebrospinal fluid, leads to misleading

results, inappropriate antibiotic usage and unnecessary laboratory work.

Prolonged periods of storage at ambient temperature and delay in transport of

specimens to the laboratory may increase the number of contaminants present. It is

therefore essential that every effort should be made to avoid these problems.

a.) Rationale for specimen collection

Specimen collection is undertaken when laboratory investigation is required for

the examination of material, eg tissue, body fluid or faeces to aid diagnosis.  

b.) Preparation

Laboratory request forms are printed from the Patient Information Management

System (PiMS). Use the labels on the form to label the specimen accompanying the

form. These are bar coded to aid the audit trail. All specimens must be clearly

labelled to identify their source. DO NOT pre-label specimen containers as this

increases the risk of errors. The specimen must be labelled next to the child/patient

when the sample is taken.

A laboratory request form with the following information must accompany the

specimen. This aids interpretation of results and reduces the risk of errors.   

1.) Patient's name, DOB, ward/department and hospital number.  

2.) type of specimen and the site from which it was obtained.

3.) Date and time collected.

4.) Diagnosis with history and reasons for request such as returning from abroad

(specify country) with diarrhoea and vomiting, rash, pyrexia, catheters in situ or

invasive devices used, or surgical details regarding post-operative wound

infection.

5.) The question that needs an answer by having the sample tested. Any

antimicrobial drug(s) given.

6.) Consultant's name. Name/bleep number of the clinician who ordered the

investigation, as it maybe necessary to telephone preliminary results and discuss

treatment before the final result is authorised.

Hands should be washed before and after specimen collection (see our hand

hygiene clinical guideline). In line with standard precautions, appropriate personal

protective equipment should be worn when collecting or handling specimens.  

If an infection is suspected, eg when a patient has respiratory symptoms or loose

stools, the appropriate isolation precautions should be applied even before the

results of the specimen are available. The isolation precautions should be based on

the symptoms the child is presenting with. Once the result of the specimen is

available, the need and type of the isolation precautions can be re-assessed

according to the GOSH Standard and Isolation Precautions Policy (available to

GOSH staff internally on the GOSHweb intranet site). 

When collecting certain specimens, eg catheter urines and cerebro-spinal fluid,

every effort should be made to avoid infecting the child. An appropriate aseptic or

aseptic non-touch technique should be used.

All pathological specimens must be treated as potentially infectious and local

written laboratory protocols should be followed for the safe handling and

transportation of specimens (Health Services Advisory Committee 1986). Specimens

should be collected in sterile containers with close fitting lids to avoid contamination

and spillage. All specimen containers must be transported in a double-sided, self-

sealing polythene bag with one compartment containing the laboratory request form

and the other the specimen.

Ideally microbiological specimens should be collected before beginning any

treatment such as antibiotics or using antiseptics. However, treatment must not be

delayed in serious sepsis.

When collecting pus specimens obtain as much material as possible as this

increases the chance of isolating micro-organisms which maybe difficult to grow or

are minimal in number eg tuberculosis. Pus should be sent in a sterile specimen

container, not on a swab.

Transport medium may be used to preserve micro-organisms during

transportation. Charcoal medium improves the isolation of bacteria by neutralising

toxic substances such as naturally occurring fatty acids found on the skin.

As many viruses do not survive well outside the body special viral transport

medium is used. This is obtained from the Virology Department, Level 4 Camila

Botnar Laboratory (CBL). It may be stored at room temperature on ward, but should

only be used for viral investigation. The viral transport medium must not be used

after the expiry date.

c.) Equipment

This will vary according to the specimen required but must include: a.) disposable

gloves, b.) additional personal protective equipment (apron/gown, mask/respirator,

visor - where applicable), c.) a protective tray, a sterile container for the specimen,

d.) appropriate transport medium, if required, e.) laboratory specimen form,

a polythene transportation bag andf.) biohazard label, if required.

III. Reporting accidents and incidents

A brief guide to the Reporting of Injuries, Diseases and Dangerous Occurrences

Regulations 2013 (RIDDOR)

What is RIDDOR?

RIDDOR is the law that requires employers, and other people in control of work

premises, to report and keep records of:

a.) work-related accidents which cause death;

b.) work-related accidents which cause certain serious injuries (reportable injuries);

c.) diagnosed cases of certain industrial diseases; and

d.) certain ‘dangerous occurrences’ (incidents with the potential to cause harm).

This leaflet aims to help employers and others with reporting duties under RIDDOR, to

comply with RIDDOR and to understand reporting requirements.

Why report?

Reporting certain incidents is a legal requirement. The report informs the

enforcing authorities (HSE, local authorities and the Office for Rail Regulation (ORR))

about deaths, injuries, occupational diseases and dangerous occurrences, so they can

identify where and how risks arise, and whether they need to be investigated.

What must be reported?

Work-related accidents

For the purposes of RIDDOR, an accident is a separate, identifiable, unintended

incident that causes physical injury. This specifically includes acts of non-consensual

violence to people at work.

Not all accidents need to be reported, a RIDDOR report is required only when: the

accident is work-related; and it results in an injury of a type which is reportable. When

deciding if the accident that led to the death or injury is work-related, the key issues to

consider are whether the accident was related to: a.) the way the work was organised,

carried out or supervised; b.) any machinery, plant, substances or equipment used for

work; and c.) the condition of the site or premises where the accident happened.

If none of these factors are relevant to the incident, it is likely that a report will not be

required.

Types of reportable injury

Deaths

All deaths to workers and non-workers must be reported if they arise from a

work-related accident, including an act of physical violence to a worker. Suicides are not

reportable, as the death does not result from a work-related accident.

Specified injuries to workers

The list of ‘specified injuries’ in RIDDOR 2013 (regulation 4) includes: a.) a

fracture, other than to fingers, thumbs and toes; b.) amputation of an arm, hand,

finger, thumb, leg, foot or toe; c.) permanent loss of sight or reduction of sight; d.)

crush injuries leading to internal organ damage; e.) serious burns (covering more

than 10% of the body, or damaging the eyes, f.) respiratory system or other vital

organs); scalpings (separation of skin from the head) which require hospital

treatment;g.) unconsciousness caused by head injury or asphyxia; h.) any other

injury arising from working in an enclosed space, which leads to hypothermia, heat-

induced illness or requires resuscitation or admittance to hospital for more than 24

hours.