chapter 27: patient safety

Question 1

AHRQ key features for a culture of safety

Answer 1

• 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

Question 2

Environmental safety

Answer 2

• 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

Question 3

Basic human needs

Answer 3

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

Question 4

Oxygen

Answer 4

• 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

Question 5

Nutrition

Answer 5

• 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

Question 6

Temperature

Answer 6

• 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

Question 7

Common Environmental Hazards

Answer 7

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

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

Question 8

Motor vehicle accidents

Answer 8

• 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

Question 9

Poison

Answer 9

• 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

Question 10

Falls

Answer 10

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

Question 11

Fire

Answer 11

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

Question 12

Disasters

Answer 12

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

Question 13

Transmission of pathogens

-Immunization

Answer 13

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

Question 14

Infant/ Toddler/ Preschooler dvlpmntl stage risk

Answer 14

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

Question 15

School aged kids dvlpmntl stage risks

Answer 15

• playing sports recklessly

- getting into fights at school

Question 16

Adolescent dvlpmntl stage risks

Answer 16

-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

Question 17

Adult dvlpmntl stage risks

Answer 17

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

Question 18

Old adults dvlpmntl stage risks

Answer 18

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

DEMENTIA –> esp wandering behavior

Question 19

Individual risk factors

Answer 19

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

Question 20

Factors that prevent adherance to PPE protocol at work

Answer 20

Individual factors: knowledge, beliefs, history, attitudes

Environmental factors: availability of stuff

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

Question 21

Risks in health care agencies

Answer 21

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

FILL OUT INCIDENT REPORTS TO PREVENT FURTHER MISTAKES

Question 22

chemical exposure

Answer 22

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

Question 23

Falls in hospital

Answer 23

• 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

Question 24

Workplace safety

Answer 24

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

Question 25

Risk of medical error

Answer 25

increase if HCW is fatigues (working consecutive 12 hr shifts) reduced if checking patient's identity

Question 26

Home hazard assessment

Answer 26

- 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

Question 27

Universal fall precautions

Answer 27

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.

Question 28

Diagnoses associated with patient safety

Answer 28

``` Risk of fall risk of injury Impaired cognition: confusion Lack of knowledge Risk for Poisoning ```

Question 29

Outcome planning

Answer 29

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

Question 30

ISBAR

Answer 30

``` Introduction Situation Background Assessment Recommendation/ Request/ Readback ```

Question 31

Safe nursing practices during direct care

Answer 31

- 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

Question 32

Passive vs active health promotion

Answer 32

Passive: public health measures and govt legislative interventions Active: changes in lifestyle and participation in wellness programs

Question 33

Interventions for infants, toddlers, preschoolers

Answer 33

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

Question 34

Interventions for school aged kids

Answer 34

Teach safety for at school and play

Question 35

Interventions for Adolescents

Answer 35

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

Question 36

Adult interventions

Answer 36

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

Question 37

Older adult interventions

Answer 37

- 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

Question 38

what's wrong with small area rugs

Answer 38

FALL RISK

Question 39

wrist band colors

Answer 39

``` red = allergy yellow = fall risk purple = DNR ```

Question 40

When NOT to induce vomiting for accidental poisonings

Answer 40

``` lye cleaners hair care products grease or petroleum products furniture polish paint thinner kerosene ```

Question 41

Postural hypotension safety measures

Answer 41

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

Question 42

Wheelchair hazards

Answer 42

small, hard front wheels falls, pressure injuries, choking on seatbelt use anti-tip bars, brakes, and side rails

Question 43

chemical restraints and physical restraints

Answer 43

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

Question 44

Risks of restraints

Answer 44

``` pressure injuries pneumonia constipation incontinence low self esteem humiliation agitation ```

Question 45

Side rails

Answer 45

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

Question 46

Seizures

Answer 46

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

Question 47

What to do during a seizure

Answer 47

Stay with person and time the seizure Keep person safe Turn person on side if not awake/aware

Question 48

COVID precautions

Answer 48

Isolate patient Set up separate, ventilated triage areas Use airborne isolation room Standard precaution and face mask

Question 49

6 behaviors that predict patient violence

Answer 49

``` get louder irritable glaring mumbling abusive language pacing ```