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NURS 305 > Chapter 27: Patient Safety And Quality > Flashcards

Chapter 27: Patient Safety And Quality Flashcards

1
Q

How is health care working to provide a safe environment for patients?

A
  • 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
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2
Q

Nurses have the responsibility to

A

Involve themselves in promoting a safe patient-centered culture.

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3
Q

QSEN

A

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
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4
Q

QSEN teaches students that as a nurse

A
  • you are responsible for critical thinking skills
  • utilizing the nursing process
  • assessing each patient and their environment for hazards
  • planning and intervening appropriately
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5
Q

Maslow’s Hierarchy of Needs

A

…

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6
Q

What safety risks are there for older adults?

A
  • elder abuse
  • multiple medications, acute/chronic disease, increase risk for falls, poor eyesight, slow response time, decreased sensory perception, decreased muscle mass
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7
Q

What safety risks are there for children/adolescents?

A
  • child abuse

- adolescent: risky behaviors

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8
Q

What safety risks are there for adults?

A

Lifestyle habits such as ETOH, smoking and stress

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9
Q

What other patients have safety risks?

A

Patient’s that are mentally challenged or have dementia.

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10
Q

What are the individual risk factors for safety?

A
  • lifestyle
  • impaired mobility
  • sensory or communication impairment
  • lack of safety awareness
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11
Q

National Quality Forum:

A
  • 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)
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12
Q

Never Events

A

(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

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13
Q

When an event (or near miss) occurs an

A

Incident Report (Unusual Occurrence Report is filled out

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14
Q

Reports help the organization by

A
  • Watching for trending of repeated issues
  • Initiating “Root Cause Analysis” to discover why the event occurred.
  • Promotes teaching and process improvement
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15
Q

What are the Inherent Safety Risks in the Health Care Environment?

A
  1. Falls
  2. Patient-inherent accidents
  3. Procedure related accidents
  4. Equipment-related accidents
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16
Q

Factors influencing an increased risk for falling:

A
  • 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.
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17
Q

Patient-inherent accidents:

A

accidents in which the patient is the primary reason for the accident.

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18
Q

Procedure related accidents:

A

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.

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19
Q

Equipment-related accidents:

A

result from malfunction, disrepair, misuse of equipment or from an electrical hazard.

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20
Q

Patients most at risk for injury from falls are

A

Those with bleeding tendencies resulting from: disease (clotting disorders), patients on anticoagulants (risk for intracranial bleed, subdural hematomas), and osteoporosis (increased risk for fractures).

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21
Q

Falls result in minor to sever injuries resulting in

A

Reduced mobility, independence and premature death. Ex) fractures, head trauma.

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22
Q

Material Safety Data Sheets (MSDS)

A

on every unit

-provides information on how to deal with chemical hazards: (ex. spills)

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23
Q

Hospital patients have inherent increased risk for falling R/T

A
  • unfamiliar environment
  • acute illness
  • surgery
  • mobility status
  • medications (diuretics, anxiolytics, antihypertensives)
  • treatments
  • placement of tubes and catheters
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24
Q

Assessment: Risk for Falls

A
  • 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.
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25
Q

When are fall risk tools used?

A

completed on admission, after a fall, when the patient’s condition changes and upon transfer to another unit.

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26
Q

What nursing measures can a nurse take to decrease this risk for falls?

A
  • 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
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27
Q

What are some examples of patient inherent accidents?

A
  • self-inflicted cuts/injuries
  • burns
  • ingestion or injection of foreign substances
  • self-mutilation
  • fire setting
  • pinching fingers in drawers or doors
28
Q

Seizures

A
  • disorderly discharge of neurons in the brain

- leads to sudden, sometimes violent, jerking, involuntary series of muscle contractions for around 2 minutes

29
Q

Seizures are usually accompanied by

A

incontinence, shallow breathing and cyanosis.

30
Q

Patients experience a _______ period after the seizure.

A

postictal

31
Q

postictal period

A

characterized by confusion and perhaps amnesia to the event (seizure)

32
Q

Patients general feel an _____ before the advent of a seizure.

A

aura (is often a bright light, smell, or taste

33
Q

Nurses can plan ahead if their patient is known to have seizures by…

A
  • 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
34
Q

Why should a nurse never restrain a patient as they are having a seizure?

A

may cause additional harm to the patient.

35
Q

Many procedure related accidents are preventable by

A

following organizational policy and procedures and standards of nursing practice

36
Q

What are tips to avoid procedure-related accidents?

A
  • avoid distractions and interruptions
  • avoid over-work and fatigue
  • use two patient-identifiers
37
Q

high-risk procedures include

A

medication administration, safe patient handling, and using sterile technique as directed

38
Q

All IV pumps need

A
  • to have Free-flow IV protection.

- Otherwise it could cause a malfunction resulting in equipment-related accidents

39
Q

When equipment is in disrepair,

A
  • tag and remove from service.

- Prevents equipment-related accidents.

40
Q

If a piece of equipment has frayed cords,

A
  • immediately take equipment out of service, tag it and report it to clinical engineering.
  • Can help prevent equipment-related accidents.
41
Q

Nursing Diagnosis: Patient Safety Quality

A
  • 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)
42
Q

Safety: Teamwork and collaboration

A
  • 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)
43
Q

What are the kinds of restraints?

A

Chemical and Physical

44
Q

Restraint

A

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)

45
Q

Chemical Restraint

A

medicating a person to the point of incapacitation

46
Q

Physical Restraints: 2 Types

A
  1. Behavioral Non-Violent

2. Behavioral Violent

47
Q

Behavioral Non-Violent Restraints

A
  • confused, disoriented patients
  • at risk for removing lines/tubes
  • patients that repeatedly fall
48
Q

Behavioral Violent Restraints

A

at risk to themselves or others

49
Q

Serious complications can result with the improper use and monitoring of patients in restraint including death due to

A

restricted breathing, and circulation

50
Q

Many institutions have eliminated the jacket or “posey” restraint because

A

it can cause strangulation due to patient trying to get out of restraint

51
Q

Evidence shows patient outcomes are worse when restraints are used. Use of restraints can cause

A
  • pressure ulcers
  • contractures
  • decreased ADL’s
  • Morbidity and Mortality
52
Q

Who orders the restraint?

A

a physicians order (face to face) is necessary for restraints.

53
Q

Physicians order for restrains must state

A

type, location and specify time and reason for restraint

54
Q

Why should a nurse check hospital policy for restrain order renewal?

A

the order is time limited and needs to be renewed every 24 hours, every 4 hours or perhaps sooner on younger populations.

55
Q

Time limitations for restraints are different for

A

non-violent vs violent restraint

56
Q

Orders are never

A

PRN (used as necessary)

57
Q

When might an RN, using hospital policy and procedure, be able to apply restraints without an MD order?

A

in the evidence of harm to self and/or others. However, it must be followed up with an MD order a.s.a.p

58
Q

Before applying a restraint, the nurse must

A

-always exhaust any alternatives.

59
Q

What are some restraint alternatives a nurse could use?

A
  • frequent observation
  • family involvement
  • frequent orientation to surroundings

-bed alarms and other electronic devices may be an alternative for physical restraint

60
Q

What should be included in documentation for restraints?

A
  • 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
61
Q

Restraints must be periodically removed to

A

allow hygiene, movement, toileting and to reassess the continued need for restraint

62
Q

In what case would the use of 4 side rails not be considered a restraint?

A

when using it to prevent patient from falling in the case of transportation, pre-op before surgery, and post-operative situations

63
Q

Side rails

A
  • 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
64
Q

Fires/Disaster Plans

A
  • 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
65
Q

During a fire/disaster (drill) you should

A

close all patient doors (fire doors will close automatically as they are held open with magnets.)

66
Q

During a fire/disaster, patients on life support are maintained by

A

manual ventilation techniques (bag-valve mask)

67
Q

To reduce exposure to radiation,

A

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

NURS 305 (30 decks)

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