chapter 27: patient safety Flashcards
AHRQ key features for a culture of safety
- acknowledge risk of environment and need to maintain safety
- blame-free environment where ppl feel ok to report errors
- encourage collab across levels of employment
- organize resources to address safety concers
Environmental safety
- includes physical and psychosocial factors
- Meets basic needs, reduces hazards, and reduces transmission of disease
-vulnerable populations at risk for no safety include: babies, kids, elderly, those with chronic disease, mental disability, issues with communicating, low income, and homeless
Basic human needs
- physiological needs which must be met before physical and psychological and security
- includes Oxygen, Nutrition, and comfortable Temperature
Oxygen
- Supplemental O2 is sometimes necessary, but be careful bc its super flammable
- Careful of CO poisoning from unvented furnace, fireplace, or stove’
- CO binds with hemoglobin, preventing O2 to bind and get to tissues
Nutrition
- Important to know healthy food and how to store
- lots of ppl get sick bc they don’t know how to store food and it causes illness (E. coli, Salmonella, Listeria)
- make sure enough water to drink, wash produce, and wash dishes
Temperature
- Hypothermia: old ppl, young ppl, those with heart probs, those who’ve had drugs/alc, and the homeless
- Extreme heat (heat stroke): old, young, chronically ill, marathon runners
Common Environmental Hazards
- motor vehicle accidents, poison, falls, fire, disasters
- nurses need to educate on how to avoid these preventable injuries
Motor vehicle accidents
- backwards til about 2 yrs old; booster til 4’9”; don’t ride in front until over 12 yrs old
- 16 to 19 yr olds get in the most accidents due to unsafe behavior
- old adults are at risk because of cognitive and vision changes –> should drive during the day, have eyes checked plan route b4 driving, don’t tailgate, avoid distractions, exercise regularly
Poison
- kids are particularly at risk: ingest cleaning supplies, meds etc…
- lead poisoning is a big one –> present in old houses, soil, and water –> fetuses, babies, and kids are more sucesptible to the neg effects
Falls
Old ppl have highest risk or serious injury or death from a fall
others at risk:
- working at elevated heights
- alc and drugs
- poverty, crowded house, single parent, young mom
- underlying med conditions
- meds
- inactivity and loss of balance
- poor mobility, cognition, and vision
- unsafe environments
- foot probs
Fire
- usually from cooking and heating (stoves and space heaters)
- fires happen in health care facilities too
- nurses need to be prepared and educate ppl
Disasters
Includes Bioterrorism
Hospitals have to be prepped and monitor these six factors:
- communication
- resources and assets
- safety and security
- staff responsibilities
- utilities management
- patient clincal and support acivities
Transmission of pathogens
-Immunization
WASH YOUR HANDS
- Some parents are worried ab autism; some are worried that 2 month and 4 month vaccines cause SIDS
- poor and black kids are least likely to be fully vaccinated
- Older adults should get influenza and pneumonia vaccine (possibly shingles)
- Health care workers at risk of exposure should get hep B vaccines
Infant/ Toddler/ Preschooler dvlpmntl stage risk
infants and toddlers put stuff in mouth –> poison and choking
- babies need to sleep on back in safe crib
- preschoolers are less reckless, but uncoordinated and prone to falling and drowning
School aged kids dvlpmntl stage risks
- playing sports recklessly
- getting into fights at school
Adolescent dvlpmntl stage risks
-experiment with substances –> increases risk of drowning and car crashes
Suicide
-risk factors: means, bullying, alc/drugs, psychiatric issues, recent loss, sexual identity stuff, neglect, fam history
Adult dvlpmntl stage risks
linked to habits:
alc = car crash or injuries
smoking = CV or pulmonary disease
stress = headaches, GI issues, infections
Old adults dvlpmntl stage risks
- interactions of multiple meds
- cognitive changes (mind wandering increases fall risk)
- chronic diseases
DEMENTIA –> esp wandering behavior
Individual risk factors
workplace culture, lifestye, impaired mobility, economic resources, lack of safety awareness, sensory, cognitive, or communication impairment
Factors that prevent adherance to PPE protocol at work
Individual factors: knowledge, beliefs, history, attitudes
Environmental factors: availability of stuff
Organizational factors: policies, training, and boss’s expectations
Risks in health care agencies
Procedure-related accidents Equipment related accidents Chemical exposure Falls Workplace safety
FILL OUT INCIDENT REPORTS TO PREVENT FURTHER MISTAKES
chemical exposure
-if exposed to chemotherapeutic agent, higher risk for leukemia and other cancers as well as chromosomal damage
Falls in hospital
- fall prevention is a priority
- risk of falls can be patient related (intrinsic) or hospital related (extrinsic)
- balance management of fall risk with patient mobility and infection prevention
Workplace safety
patients are sometimes violent both verbally and physically
-risk is higher: history of violence, poor lighting, crowded waiting area, isolated HCW, not enough security, transporting or lifting patients
Risk of medical error
increase if HCW is fatigues (working consecutive 12 hr shifts)
reduced if checking patient’s identity
Home hazard assessment
- assess all rooms and outdoor entrance areas
- special attn to where patient receives care
- adequate lighting, floor condition, presence of safety materials, possible barriers
- know where meds and cleaning supplies are
- review food storage
- review heating and cooking
- check for lead paint
Universal fall precautions
Familiarize the patient with the environment.
Have the patient demonstrate call light use.
Maintain call light within reach.
Keep the patient’s personal possessions within patient safe reach.
Have sturdy handrails in patient bathrooms, room, and hallway.
Place the hospital bed in low position when a patient is resting in bed; raise bed to a comfortable height when the patient is transferring out of bed.
Keep hospital bed brakes locked.
Keep wheelchair wheel locks in “locked” position when stationary.
Keep nonslip, comfortable, well-fitting footwear on the patient.
Use night lights or supplemental lighting.
Keep floor surfaces clean and dry. Clean up all spills promptly.
Keep patient care areas uncluttered.
Follow safe patient handling practices.
Diagnoses associated with patient safety
Risk of fall risk of injury Impaired cognition: confusion Lack of knowledge Risk for Poisoning
Outcome planning
If patient actively helps in reducing threats, they’re more aware of hazards
-outcomes should focus on removing risk and managing related factors
should have time limit
ISBAR
Introduction Situation Background Assessment Recommendation/ Request/ Readback
Safe nursing practices during direct care
- Proper use of tech and standard practices
- strategies to reduce risks of harm
- use strategies to avoid reliance on memory
- communicate observations or concerns related to safety
Passive vs active health promotion
Passive: public health measures and govt legislative interventions
Active: changes in lifestyle and participation in wellness programs
Interventions for infants, toddlers, preschoolers
make sure they get vaccinated
- use reminder/recall systems, outreach, case-management, home visits, in-home vaccines
- Also, listen to parents, don’t be confrontational, partner with parents in decision making, discuss benefits of vaccines, stress number of lives saved
Interventions for school aged kids
Teach safety for at school and play
Interventions for Adolescents
- be prepped to teach them and parents about avoiding risks and injury (alc and drugs)
- teach parents how to reduce risks of teen suicide
Adult interventions
- Teach safety risks of stress, inadequate nutritionm guns, alc, drugs, smoking
- teach benefits of good diet, relaxation techniques, and good sleep
Older adult interventions
- reduce risk of falls
- teach about safe driving –> counceling is needed when its time for them to stop driving
- reduce temp of hot water heater
- tell them to wear reflective gear when walking at night
what’s wrong with small area rugs
FALL RISK
wrist band colors
red = allergy yellow = fall risk purple = DNR
When NOT to induce vomiting for accidental poisonings
lye cleaners hair care products grease or petroleum products furniture polish paint thinner kerosene
Postural hypotension safety measures
place bed at low position and dangle patient’s feet off side for 3-5 mins before walking
-bedside comode
Wheelchair hazards
small, hard front wheels
falls, pressure injuries, choking on seatbelt
use anti-tip bars, brakes, and side rails
chemical restraints and physical restraints
anxiolytics and sedatives
ALL RESTRAINTS ARE A LAST RESORT
order for restraint can’t be older than 24 hr
- 4 hr limit for adults
- 2 hr for kids 9-17
- 1 hr for kids younger than 9
monitor restrained patient every 15 mins
Risks of restraints
pressure injuries pneumonia constipation incontinence low self esteem humiliation agitation
Side rails
Pose risk of falling if patient is difficult
NOT a restraint if patient has route to exit bed
NOT a restraint if being used to keep sedated patient from falling out of bed
Bed should be at lowest level when using side rails
Seizures
rapid fire neurons
-loss of consciousness, tonicity (rigid muscles), clonicity (jerking muscles), incontinence
a tonic-clonic or granmal seizure lasts 2 mins
Sometimes an aura preceeds a seizure
A postictal phase follows seizure where they forget what happened, are confused, and fall asleep
What to do during a seizure
Stay with person and time the seizure
Keep person safe
Turn person on side if not awake/aware
COVID precautions
Isolate patient
Set up separate, ventilated triage areas
Use airborne isolation room
Standard precaution and face mask
6 behaviors that predict patient violence
get louder irritable glaring mumbling abusive language pacing
