Safety

Question 0

What 4 things contribute to a patient safe environment

Answer 0

1. Organization has clearly defined patient safety policies
2. All people can explain the organization’s patient safety policies
3. All people are actively involved in identifying and resolving patient safety concerns
4. All people are empowered to correct patient safety hazards as they are identified

Question 1

which drug would you avoid due to its potential anticholinergic side effects in older adults?

Answer 1

Benadryl. Never give highest dose possible. Give smallest dose

Question 2

What is polypharmacy?

Answer 2

simultaneous use of 2 to more than 10 drugs at once. Increases the risk of major complications with heart and lung disease

Question 3

Disadvantages of polypharmacy in the elderly

Answer 3

Increases the risk of complications in the heart and lungs. elderly are 7 times more likely to experience side effects from drugs.

1. increased number of ADEs, which can lead quickly to death
2. Behavioral/cognitive changes show up first when it comes to ADEs (these changes are subtle and you need to know patients baseline so you can pick up on subtle symptoms
3. Increase incidence of falls (complications cause 25% to die within 6 months typically being pneumonia)
4. Inappropriate medications prescribed
5. Heightens the risk of drug drug interactions
6. increased urinary incontinence episodes

Question 4

What are the reasons for polypharmacy?

Answer 4

For every comorbidity a patient has there is a doctor attached to it. each physician is just looking at this treatment. This leads to the patient having many physicians and pharmacists who are only focusing on the drugs they are prescribing and not looking at the whole picture. Also, many physician appointments are just 15 minutes long which does not give enough time to go over medications carefully. OTC and herbal medications are not considered. sharing medications

Question 5

What are the 3 essential nursing competencies needed to increase patient safety?

Answer 5

1. Critical thinking
2. Communication
3. Teaching

Question 6

When are ADEs most likely to occur?

Answer 6

immediate post hospitilization phase

Question 7

Why are the elderly at an increased risk for ADEs (Pharmacokinetics)

Answer 7

1. gastric acid is decreased d/t use of antacids
2. blood flow is decreased which leads to less absorption
3. altered GI blood flow
4. Hypo/hyper motility of the GI tract
5. Elderly patients usually don’t have a lot of muscle mass so parenteral injections can lead to poor absorption
6. Drug absorption through the skin is affected by skin hydration and microcirculation. (absorption is not very good such as nitroglycerin patch. the worst form of me administration you can give to an elderly patient)

Question 8

Reasons for increased ADEs in the elderly (Drug Distribution)

Answer 8

1. If you do not have protein in your body for the drug to bind to the drug will not work. Nurses need to be aware of total protein and albumin levels. If drug is not bound to protein it is floating around in the bloodstream causing toxicity and with elderly patients their blood flow/liver is not the best and toxicity can become a serious problem quickly.

Question 9

Reasons for increased ADEs in the elderly (Drug Metabolism)

Answer 9

1. Drugs are primarily broken down in the liver

2. Hepatic blood flow is diminished with aging. disease such as heart failure can cause hepatic congestion

Question 10

Reasons for increased ADEs in the elderly (Pharmacodynamics)

Answer 10

1. Aging or disease related changes in organs, organ systems and tissues may negatively affect drug actions at these sites
2. the presence of other competing drugs may also influence drug activity
3. Altered pharmacodynamics can put patients at risk for delirium, orthostasis, and falls

Question 11

Drugs most commonly causing ADEs

Answer 11

among elderly people insulin, warfarin, and digoxin cased the majority of adverse drug events.

Question 12

What are the most common ADEs that occur?

Answer 12

falls, orthostatic hypotension, heat failure, and delirium. The most common causes of death are GI or intracranial bleeding and renal failure.

Question 13

Close calls/ near misses

Answer 13

things that would result in an accident if it didn’t get caught.

Question 14

Sentinel Event

Answer 14

unexpected occurrence or variation that involves death or serious physical/psychological injury

Question 15

If a doctor gives you an order over the phone what should you do?

Answer 15

1. If possible, have a second nurse listen on an extension
2. read back to the provider the client’s name, name of med, dosage, time of administration, frequency, and route.
3. Remind the provider the prescription must be signed within 24 hours

Question 16

What are the 6 rights of medication administration?

Answer 16

Right client, right medication, right dose, right time, right route, right documentation

Question 17

Who do you notify if a doctor is telling you to give a medication that you feel would harm the patient?

Answer 17

the charge nurse or supervisor

Question 18

What doses would you question?

Answer 18

doses are usually one to two tablets or one single dose vial. Question multiple tablets or vials for a single dose. If your client questions the size of a dose or appearance of a medication omit or delay the dose.

Question 19

What information should be obtained prior to the initiation of medication therapy?

Answer 19

1. Age
2. Diagnosed health problems and current reason for seeking care
3. All medications currently being taken (name, dose, route, and frequency of each medication)
4. Use of herbal or natural products for medicinal purporses
5. Use of caffeine, tobacco, alcohol, and/or street drugs
6. Client’s understanding of the purpose of the medications along with the client’s beliefs, feelings, and concerns
7. All known medication and food allergies

Question 20

What needs to be implemented within the nurses work environment in order to improve patient safety?

Answer 20

1. Transformational leadership and EBP are needed
2. Maximize workforce capability (know your staff well help weaknesses become strengths)
3. Redesign of work process (Example, when you are in the red zone don’t let anyone talk to you. nurse patient ratio. nurses working more than 12 hours in a 24 hour period or 60 hours in a 7 day period)
4. Create and sustain a culture of safety

Question 21

What are some current issues affecting patient safety?

Answer 21

long work hours, high nurse to patient ratio

Question 22

What are some solutions to increasing patient safety?

Answer 22

Red zone

Question 23

How can we create and sustain a culture of safety? (SCIECII)

Answer 23

1. Specify short and long term safety objectives
2. Continually review success in meeting these objectives and provide feedback at all levels
3. Conduct an annual confidential survey of nursing and other health care workers to assess the extent to which a culture of safety exists
4. Institute a fair, just, and blameless reporting system for errors and near misses
5. Engage in ongoing employee training in error detection, analysis, and reduction
6. Implement procedures for analyzing errors and providing feedback to direct care workers
7. Institute rewards and incentives for error reduction

Question 24

What are behaviors that can undermine a culture of safety?

Answer 24

1. Intimidating or disruptive behavior 2. organizations that fail to address unprofessional behavior 3. those resistant to change 4. those that refuse to complete assigned tasks 5. passive behaviors 6. uncooperative behaviors 7. high stress 8. fatigue 9. immature/defensive people

Question 25

Interventions to reduce ADEs (from article)

Answer 25

1. Obtain a comprehensive medication hx on admission 2. collaborate w/interdisciplinary team 3. D/C unnecessary therapy 4. Attempt a trial of non pharmacological interventions first 5. Assess renal function 6. Avoid the prescribing cascade ( first consider any new symptoms as being an adverse effect of a current med prior to adding a new med) 7. Reconcile medications at discharge

Question 26

What is the problem with herbal supplements?

Answer 26

they fall under the dietary supplement category and dietary supplements do not have to have FDA approval for being put on the market

Question 27

Reasons for increased ADE in elderly (Drug Elimintaion)

Answer 27

Drugs are primarily eliminated through the kidneys. kidneys are not working at 100% in the elderly (decreased blood flow, decrease GFR, decrease tubular excretion and reabsorption).

Question 28

Why can you not trust creatinine levels in an elderly patient?

Answer 28

Creatinine levels decrease due to loss of muscle mass and elderly usually don't have a lot of muscle mass. (to find out if kidneys are functioning in elderly look at GFR and creatinine clearance)

Question 29

Why can you not trust BUN levels in the elderly

Answer 29

Because BUN is supported by good nutrition status. To monitor nutrition status you need to look at protein and albumin levels and elderly usually don't have the highest protein level. For elderly look at Na and Cl for dehydration.

Question 30

National patient safety goals for home care, hospital, & LTC (9 things)

Answer 30

1. ID patients correctly w/2 identifiers 2. Make sure patient gets correct blood transfusion 3. Label meds before a procedure that aren't labled 4. Take extra care w/pts on blood thinners 5. med reconcilitation 6. hand washing 7. identify which patients are most likely to commit suicide 8. use proven guidelines to prevent infection from central lines 9. Make sure surgery is performed on the right patient and the right site

Question 31

National patient safety goals for LTC (7 things)

Answer 31

1. identify residents most likely to get bed sores. take action to prevent 2. find out which residents are most likely to fall. are they on meds that make them sleepy, dizzy, etc. 3. ID patients correctly w/2 identifiers 4. take extra care of patients on blood thinners 5. hand washing 6. use proven guidelines to prevent infection from central lines 7. med reconciliation.

Question 32

National patient safety goals for home care (5 things)

Answer 32

1. find out which residents most likely to fall, are they on meds that make them dizzy, sleepy, weak? 2. ID patients directly w/ 2 identifiers 3. hand washing 4. find out if there are any risks for patients on oxygen 5. med reconciliation

Question 33

How can we prevent med errors in prone/special populations (infants/children, edlerly, non english speaking, cognitively impaired, visually impaired, physically impaired)

Answer 33

1. close visual observation 2. picture boards 3. pictured pain scales (FLACC, CNPI) 4. family involvement enouraged 5. double check dosage/calculations

Question 34

benchmark

Answer 34

an attribute or achievement that serves as a standard for providers or institutions to emulate

Question 35

just culture

Answer 35

organizational culture that promotes pt safety by acknowleding that competent HCP may make mistakes but should not be held accountable for system failings over which that have no control. However, just culture does no tolerate reckless behavior or conscious disregard of risk to patients, thus it is NOT considered a "no blame" culture

Question 36

adverse drug event

Answer 36

injury occurring during the patients drug therapy

Question 37

iatrogenic ADE

Answer 37

any undesirable condition in a patient occurring as the result of treatment by a health care professional; pertaining to an illness or injury resulting from a medication

Question 38

adverse drug reaction

Answer 38

any unintended and undesired effect of a drug that occurs at normal human doses