Safety And Hygine Flashcards
(25 cards)
Fall risks for elderly
Medications: antidepressants- 68% increased risk
Neurleptics/ antipsychotics-59% increased risk
Sedatives/hypnotics- 47% increased risk
Antihypertensive- 24% increased risk
NSAIDS- 21% increased risk
Elderly falls
30-40 % of people over age 65 have a fall each year
In an elderly patient who has fallen, the risk of having a second fall within a year rises to 60%
Hospital falls
2-12% of patients will fall in hospital
Circumstances 20% with toieleting
34% from bed
38% while ambulating
10-20% of in hospital falls are recurrent events
Fall risk scoring tools
Morse fall scale-MMMC
Medication fall risk scale
Predictive accuracy 43.2-60%
Medication fall risk scale
3- high , 2 medium, 1- low( diuretics)
>6- high risk for falls
Morse fall scale
Hx of falls- 25 score Secondary diagnosis-25 score Ambulatory aid- furniture- 30, crutches, 15 Iv-20 score Gait/transferring- impaired -20, weak 10 Mental status, forgets limitations- 15
Best indicator of falls
Hx of a fLl
Interventions for falls
Ambulation aids- eye glasses, modified footwear, exercise/ balance training, referral to pt, hip protector use, evaluation and treatment of postural hypotension
Interventions for falls
Modification of bedside environment Modification of drug regimen Posted alerts to staff on patient fall risk Scheduled toileting Bedside commode Screening for urine infection Beds placed in lowest position
Intervention for falls
Staff education Patient and family education Increased supervision Bedside sitter Bed and chair alarms High risk patients moved to close proximity to nursing station Staff assistance with transfers
Orange star
Posted on the patients door frame and on the activity section of the patients kardex.
Intentional rounding
Research shows specific nursing actions performed at set intervals were associated with statistically significant reduced patient use of the call light overall, as well as a reduction of patient falls and increased patient satisfaction
Intention rounding
4 ps Positioning Personal needs Pain Placement
Braden scale
MMMC guidelines: score < 12= wound care consult
Braden scale
Sensory perception Moisture- 1 constantly moist, 2- moist, 3-occasionally 4- rarely Activity Mobility Nutrition Friction and shear Higher the score, the lower the risk <12 = wound care consult
Pressure ulcer consequences
CMS: pressure ulcers: No pay if acquired in healthcare setting
# affected: 2.5 million patients per year
Cost: ulcers cost 9.1-11.6 billion per year and each pressure ulcer adds 43,180 in costs to a hospital stay.
Death: about 60,000 patients die as a direct result of a pressure ulcer each year
Infection control
Airborne precautions- measles, chicken pox (varicella), tb private room, neg- pressure airflow of at least 6 to 12 exchanges, mask or resp. Protection device n95 respirator
Droplet precaution- influenza, streptococcal pharyngitis, rubella, mumps
( being within 3 feet of patient)
Private room or cohort patients, mask or repirator required depending on condition
Contact-‘colonization or infection with multi- drug resisten organisms, such as VRE and MRSA, major wound infections, herpes simplex, scabies
Private room, or cohort patients, gloves, gown
Patient safety goals
Goal 1: improve accuracy of patient identification
Goal 2: improve effectiveness of communication amount caregivers
Hand off communication- follow 5ps and include time to ask and answer questions
5 ps: patient, plan, purpose, problem, precautions
Patient safety goals
Goal 3 improve the safe use of medications
Goal 7 reduce the risk of health care acquired infections
Comply with hand- hygiene guidelines
It is considered a sentinel event if a health care acquired infection (HAI) leads to death or major permanent loss.
Patient safety goals
Goal 8: accurately and completely reconcile medications across the continuum of care
Process of verifying patient medication
Can reduce errors by 46%, can reduce adverse drug effects up to 20%
Needs to be done upon admission, transfer and discharge
Patient safety goals
Goal 9: reduce the risk of patient harm resulting from falls
Number one nursing liability to patient safety
Patient safety goals
Goal 13 Encourage patients active involvement in plan of care
Goal 15 risk for suicide
Goal 16- improve recognition and response to changes in a patients condition
National patient safety goals - JCAHO
Universal protocol #1, elimination wrong sire, procedure, person, surgery
Timeouts, everyone participates.
Site marking
Advocates red rule- time out
Time out applies to procedures outside the OR as well. Rule of thumb: anything that may require a consent and/or is a high risk procedure and requires a time out.
National patient safety goals - JCAHO
Universal protocol #1, elimination wrong sire, procedure, person, surgery
Timeouts, everyone participates.
Site marking
Advocates red rule- time out
Time out applies to procedures outside the OR as well. Rule of thumb: anything that may require a consent and/or is a high risk procedure and requires a time out.
RACE
Rescue
Alarm
Contain
Extinguish
