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Fundamentals of Nursing > chapter 27: patient safety > Flashcards

chapter 27: patient safety Flashcards

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1
Q

AHRQ key features for a culture of safety

A
  • 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
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2
Q

Environmental safety

A
  • 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

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3
Q

Basic human needs

A
  • physiological needs which must be met before physical and psychological and security
  • includes Oxygen, Nutrition, and comfortable Temperature
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4
Q

Oxygen

A
  • 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
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5
Q

Nutrition

A
  • 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
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6
Q

Temperature

A
  • 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
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7
Q

Common Environmental Hazards

A
  • motor vehicle accidents, poison, falls, fire, disasters

- nurses need to educate on how to avoid these preventable injuries

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8
Q

Motor vehicle accidents

A
  • 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
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9
Q

Poison

A
  • 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
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10
Q

Falls

A

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
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11
Q

Fire

A
  • usually from cooking and heating (stoves and space heaters)
  • fires happen in health care facilities too
  • nurses need to be prepared and educate ppl
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12
Q

Disasters

A

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
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13
Q

Transmission of pathogens

-Immunization

A

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
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14
Q

Infant/ Toddler/ Preschooler dvlpmntl stage risk

A

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
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15
Q

School aged kids dvlpmntl stage risks

A
  • playing sports recklessly

- getting into fights at school

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16
Q

Adolescent dvlpmntl stage risks

A

-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

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17
Q

Adult dvlpmntl stage risks

A

linked to habits:
alc = car crash or injuries
smoking = CV or pulmonary disease
stress = headaches, GI issues, infections

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18
Q

Old adults dvlpmntl stage risks

A
  • interactions of multiple meds
  • cognitive changes (mind wandering increases fall risk)
  • chronic diseases

DEMENTIA –> esp wandering behavior

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19
Q

Individual risk factors

A

workplace culture, lifestye, impaired mobility, economic resources, lack of safety awareness, sensory, cognitive, or communication impairment

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20
Q

Factors that prevent adherance to PPE protocol at work

A

Individual factors: knowledge, beliefs, history, attitudes

Environmental factors: availability of stuff

Organizational factors: policies, training, and boss’s expectations

21
Q

Risks in health care agencies

A 
Procedure-related accidents
Equipment related accidents
Chemical exposure
Falls
Workplace safety

FILL OUT INCIDENT REPORTS TO PREVENT FURTHER MISTAKES

22
Q

chemical exposure

A

-if exposed to chemotherapeutic agent, higher risk for leukemia and other cancers as well as chromosomal damage

23
Q

Falls in hospital

A
  • 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
24
Q

Workplace safety

A

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

25
Q

Risk of medical error

A

increase if HCW is fatigues (working consecutive 12 hr shifts)

reduced if checking patient’s identity

26
Q

Home hazard assessment

A
  • 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
27
Q

Universal fall precautions

A

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.

28
Q

Diagnoses associated with patient safety

A 
Risk of fall
risk of injury
Impaired cognition: confusion
Lack of knowledge
Risk for Poisoning
29
Q

Outcome planning

A

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

30
Q

ISBAR

A 
Introduction
Situation
Background
Assessment
Recommendation/ Request/ Readback
31
Q

Safe nursing practices during direct care

A
  • 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
32
Q

Passive vs active health promotion

A

Passive: public health measures and govt legislative interventions

Active: changes in lifestyle and participation in wellness programs

33
Q

Interventions for infants, toddlers, preschoolers

A

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
34
Q

Interventions for school aged kids

A

Teach safety for at school and play

35
Q

Interventions for Adolescents

A
  • be prepped to teach them and parents about avoiding risks and injury (alc and drugs)
  • teach parents how to reduce risks of teen suicide
36
Q

Adult interventions

A
  • Teach safety risks of stress, inadequate nutritionm guns, alc, drugs, smoking
  • teach benefits of good diet, relaxation techniques, and good sleep
37
Q

Older adult interventions

A
  • 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
38
Q

what’s wrong with small area rugs

A

FALL RISK

39
Q

wrist band colors

A 
red = allergy
yellow = fall risk
purple = DNR
40
Q

When NOT to induce vomiting for accidental poisonings

A 
lye
cleaners
hair care products
grease or petroleum products
furniture polish
paint thinner
kerosene
41
Q

Postural hypotension safety measures

A

place bed at low position and dangle patient’s feet off side for 3-5 mins before walking
-bedside comode

42
Q

Wheelchair hazards

A

small, hard front wheels

falls, pressure injuries, choking on seatbelt

use anti-tip bars, brakes, and side rails

43
Q

chemical restraints and physical restraints

A

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

44
Q

Risks of restraints

A 
pressure injuries
pneumonia
constipation
incontinence
low self esteem
humiliation
agitation
45
Q

Side rails

A

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

46
Q

Seizures

A

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

47
Q

What to do during a seizure

A

Stay with person and time the seizure

Keep person safe

Turn person on side if not awake/aware

48
Q

COVID precautions

A

Isolate patient

Set up separate, ventilated triage areas

Use airborne isolation room

Standard precaution and face mask

49
Q

6 behaviors that predict patient violence

A 
get louder
irritable
glaring
mumbling
abusive language
pacing

Fundamentals of Nursing (13 decks)

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