How is health care working to provide a safe environment for patients?
- Performance Improvement (PI) analysis
- Risk Management findings
- Safety reports
- Integrating EBP into procedures
- Working o design safe work environments
- providing continuing education
- providing appropriate resources for staff
Nurses have the responsibility to
Involve themselves in promoting a safe patient-centered culture.
QSEN
Quality Safety Education for Nurses
- project design for student nurses to help prepare them with necessary tools to continuously improve the quality and safety of the healthcare system in which they work
- stresses system effectiveness and individual performance
QSEN teaches students that as a nurse
- you are responsible for critical thinking skills
- utilizing the nursing process
- assessing each patient and their environment for hazards
- planning and intervening appropriately
Maslow’s Hierarchy of Needs
…
What safety risks are there for older adults?
- elder abuse
- multiple medications, acute/chronic disease, increase risk for falls, poor eyesight, slow response time, decreased sensory perception, decreased muscle mass
What safety risks are there for children/adolescents?
- child abuse
- adolescent: risky behaviors
What safety risks are there for adults?
Lifestyle habits such as ETOH, smoking and stress
What other patients have safety risks?
Patient’s that are mentally challenged or have dementia.
What are the individual risk factors for safety?
- lifestyle
- impaired mobility
- sensory or communication impairment
- lack of safety awareness
National Quality Forum:
- publicly reporting patient safety information (events, indicators, measures)
- lists serious REPORTABLE events (box 27-3, pg 378)
- many are nurse-sensitive indicators (cause by poor nursing)
Never Events
(Box 27-4 p. 378) designated as serious adverse events that should never occur in the health care setting
-CMS denies hospitals higher payment for any hospital acquired condition resulting from or complicated by the occurrence of certain Never Events
When an event (or near miss) occurs an
Incident Report (Unusual Occurrence Report is filled out
Reports help the organization by
- Watching for trending of repeated issues
- Initiating “Root Cause Analysis” to discover why the event occurred.
- Promotes teaching and process improvement
What are the Inherent Safety Risks in the Health Care Environment?
- Falls
- Patient-inherent accidents
- Procedure related accidents
- Equipment-related accidents
Factors influencing an increased risk for falling:
- a history of falling
- being 65 years of age or older
- reduced vision
- effects of medication
- urinary incontinence
- use of walking AIDS
- effects of various medications
- orthostatic hypotension, gait, and balance problems.
Patient-inherent accidents:
accidents in which the patient is the primary reason for the accident.
Procedure related accidents:
caused by health care providers and include medication and fluid administration errors, improper application of external devices and accidents related to improper performance of procedures.
Equipment-related accidents:
result from malfunction, disrepair, misuse of equipment or from an electrical hazard.
Patients most at risk for injury from falls are
Those with bleeding tendencies resulting from: disease (clotting disorders), patients on anticoagulants (risk for intracranial bleed, subdural hematomas), and osteoporosis (increased risk for fractures).
Falls result in minor to sever injuries resulting in
Reduced mobility, independence and premature death. Ex) fractures, head trauma.
Material Safety Data Sheets (MSDS)
on every unit
-provides information on how to deal with chemical hazards: (ex. spills)
Hospital patients have inherent increased risk for falling R/T
- unfamiliar environment
- acute illness
- surgery
- mobility status
- medications (diuretics, anxiolytics, antihypertensives)
- treatments
- placement of tubes and catheters
Assessment: Risk for Falls
- observe patient’s posture, ROM, strength, balance and body alignment
- assess patient’s visual acuity, ability to read, identify distant objects
- complete a home hazard appraisal.
When are fall risk tools used?
completed on admission, after a fall, when the patient’s condition changes and upon transfer to another unit.
What nursing measures can a nurse take to decrease this risk for falls?
- thorough assessments
- communication about patient risks (yellow gown, yellow armband, footies)
- signage
- providing a safe, clutter free environment (call light & needed patient belongings within reach)
- teamwork
- patient & family involvement
What are some examples of patient inherent accidents?
- self-inflicted cuts/injuries
- burns
- ingestion or injection of foreign substances
- self-mutilation
- fire setting
- pinching fingers in drawers or doors
Seizures
- disorderly discharge of neurons in the brain
- leads to sudden, sometimes violent, jerking, involuntary series of muscle contractions for around 2 minutes
Seizures are usually accompanied by
incontinence, shallow breathing and cyanosis.
Patients experience a _______ period after the seizure.
postictal
postictal period
characterized by confusion and perhaps amnesia to the event (seizure)
Patients general feel an _____ before the advent of a seizure.
aura (is often a bright light, smell, or taste
Nurses can plan ahead if their patient is known to have seizures by…
- pad side rails
- bite blocks at bedside (NEVER put your fingers in a patients mouth)
- NEVER restrain a patient as they are having a seizure
Why should a nurse never restrain a patient as they are having a seizure?
may cause additional harm to the patient.
Many procedure related accidents are preventable by
following organizational policy and procedures and standards of nursing practice
What are tips to avoid procedure-related accidents?
- avoid distractions and interruptions
- avoid over-work and fatigue
- use two patient-identifiers
high-risk procedures include
medication administration, safe patient handling, and using sterile technique as directed
All IV pumps need
- to have Free-flow IV protection.
- Otherwise it could cause a malfunction resulting in equipment-related accidents
When equipment is in disrepair,
- tag and remove from service.
- Prevents equipment-related accidents.
If a piece of equipment has frayed cords,
- immediately take equipment out of service, tag it and report it to clinical engineering.
- Can help prevent equipment-related accidents.
Nursing Diagnosis: Patient Safety Quality
- Risk for Injury: call light in reach, orient to surroundings
- Altered Mobility: use of assist devices (ex. canes)
- Altered Mental status (What are some possible interventions?)
- Altered Sensory Perception: Visual (keep area well lit, free of clutter, call light in reach, orient to surroundings)
Safety: Teamwork and collaboration
- collaborate (patient, family to formulate a plan of care)
- physical therapy/occupational therapy (how does PT/OT help with patient safety?)
- communicate risk factors and plan of care with patient, family & other health care providers (SBAR - situation, background, assessment, recommended)
- patient teaching (ex. getting up slowly from sitting position, use of call light with return demonstration)
What are the kinds of restraints?
Chemical and Physical
Restraint
any means that deliberately reduces the ability of a patient to move his/her arms, legs, body, head, freely. (aside from orthopedic devices, dressings, protective helmets)
Chemical Restraint
medicating a person to the point of incapacitation
Physical Restraints: 2 Types
- Behavioral Non-Violent
2. Behavioral Violent
Behavioral Non-Violent Restraints
- confused, disoriented patients
- at risk for removing lines/tubes
- patients that repeatedly fall
Behavioral Violent Restraints
at risk to themselves or others
Serious complications can result with the improper use and monitoring of patients in restraint including death due to
restricted breathing, and circulation
Many institutions have eliminated the jacket or “posey” restraint because
it can cause strangulation due to patient trying to get out of restraint
Evidence shows patient outcomes are worse when restraints are used. Use of restraints can cause
- pressure ulcers
- contractures
- decreased ADL’s
- Morbidity and Mortality
Who orders the restraint?
a physicians order (face to face) is necessary for restraints.
Physicians order for restrains must state
type, location and specify time and reason for restraint
Why should a nurse check hospital policy for restrain order renewal?
the order is time limited and needs to be renewed every 24 hours, every 4 hours or perhaps sooner on younger populations.
Time limitations for restraints are different for
non-violent vs violent restraint
Orders are never
PRN (used as necessary)
When might an RN, using hospital policy and procedure, be able to apply restraints without an MD order?
in the evidence of harm to self and/or others. However, it must be followed up with an MD order a.s.a.p
Before applying a restraint, the nurse must
-always exhaust any alternatives.
What are some restraint alternatives a nurse could use?
- frequent observation
- family involvement
- frequent orientation to surroundings
-bed alarms and other electronic devices may be an alternative for physical restraint
What should be included in documentation for restraints?
- behaviors that necessitated the use of restraint
- procedure used in restraining
- condition of the body part restrained (circulation, movement, sensation (CMS))
- evaluation of patient response
Restraints must be periodically removed to
allow hygiene, movement, toileting and to reassess the continued need for restraint
In what case would the use of 4 side rails not be considered a restraint?
when using it to prevent patient from falling in the case of transportation, pre-op before surgery, and post-operative situations
Side rails
- two side rails help a patients mobility & stability when moving in bed or moving from bed to chair
- always keep the bed in low and locked position when not performing care or services
Fires/Disaster Plans
- every unit has a posted evacuation plan
- know where the fire extinguishers and gas shut-off valves are located
- know how to activate fire alarm
During a fire/disaster (drill) you should
close all patient doors (fire doors will close automatically as they are held open with magnets.)
During a fire/disaster, patients on life support are maintained by
manual ventilation techniques (bag-valve mask)
To reduce exposure to radiation,
Time: limit the time spent near the source
Distance: stay as far away from the source as possible
Shielding: use protective lead aprons and thyroid protection if exposure is unavoidable
