Chapter 27 Patient Safety Flashcards
Define safety:
often defined as freedom from psychological and physical injury, is a basic need
Safety in Health Care Organizations:
Performance Improvement Risk management and safety reports Current reliable technology Evidence-based practice Safe work environment Adequate staff education
QSEN
Quality and Safety Education for Nurses
Future Nurses need what to promote safety?
knowledge, skills, and attitudes
What is essential for QSEN?
continuous improvement
QSEN minimizes risks of harm to
-patients and providers by:
system effectiveness
individual performance
In patient safety, critical thinking is a
on going process
Standards of critical thinking have been developed by
ANA and TJC
Use of what is important when planning care that promotes safety?
Nursing process
Safety in Health Care Settings:
- reduce incidence of illness and injury
- prevents extended length of treatment/stay
- improve or maintain functional status
- increases patient’s senses of well-being
A Safe Environment includes meeting patient’s
physical and psychosocial needs
patient’s and health care provider’s well being
The environment applies to
all places where patients receive care
The environment reduces
risk of injury and transmission of pathogens
and maintains sanitation and reduces pollution
Basic Human Needs
Oxygen
Nutrition
Temperature
Oxygen:
Low concentration: hypoxia
High concentration
Carbon monoxide
Nutrition:
Proper Storage
Proper refrigeration: FDA
Preparation area
5,000 deaths per year
FDA
Food and Drug Administration
- regulations for food producers
- US most safest of foods but still deaths
Temperature:
Normal: 65 and 75 F comfort zone
Hyperthermia
Hypothermia: core temp is 35 C (95 F)
Frostbite
Physical Hazards
Motor vehicle accidents Poison Falls Fire Disasters: natural or man-made
Poison
any substance that impairs health or destroys life when ingested, inhaled, or absorbed by the body
Transmission of Pathogens:
pathogens and parasites passed by through contact
most common is by hands
pathogen:
any microorganism capable of producing an illness
Immunization:
reduces and some cases prevents the transmission of disease from person to person
Pollution has
pollutants
Pollutants
harmful chemical or waste material discharged into the water, soil, or air
Risks at Developing Stages:
Children less than 5 years old: poisoning - don't know labels School Age Child: head injuries Adolescent: substance abuse Adult: usually due to lifestyle habits Older Patient
Individual Risk Factors:
Lifestyle
Impaired Mobility
Sensory or Communication Impairment
Lack of Safety Awareness
The Joint Commission Patient Safety Goals for Hospitals:
- Identify patients correctly
- Improve staff communication
- Use medicines safely
- Reduce the risk of health care– associated infections
- Check patient medicines
- Identify patient safety risks
NQF
National Quality Forum: procedure to report an event
improves quality of care by building consensus, endorsing national standards, promoting goals
NQF also lists serious re-portable events (SREs):
Surgical events
Product or device events
Patient protection events: wrong person discharged
Care management events:disability with medication reaction
Environmental events: o2, burns, restraints, electric shock
Criminal events: diagnosing breast cancer when healthy for money
CMS list of “Never Events”
The Centers for Medicare and Medicaid Services
- “never events” should never occur
- denies hospitals higher payments resulting from by a never event
Risks in Health Care Agencies:
Falls
Patient-inherent accidents: self-harm
Procedure-related accidents: caused by providers
Equipment-related: malfunction, misuse
Other risks in agencies:
Chemical use (Material Safety Data Sheets MSDS) Medical Errors
Medical errors include:
infection
bed sores failure to diagnose and treat in time
Assessment:
Through the patient’s eyes
Patient’s home environment
Nursing History
Assessment questions:
activity and exercise
medication history
history of falls
home maintenance and safety
health care environment:
risks in immediate environment
risks for falls
risk for medication errors
disaster preparedness: disease, not epidemic
Diagnosis:
risks for falls impaired home maintenance risk for injury deficient knowledge risk for poisoning risk suffocation risk for trauma
Planning:
Goals and outcomes
setting priorities
teamwork and collaboration
Goals and outcomes:
prevent and minimize safety threats
measurable and realistic
may include active patient participation
Setting priorities:
plan based on developmental stage, level of health, lifestyle, and cultural needs
Teamwork and collaboration:
with coworkers, patient, family
Implementation: QSEN
demonstrates effective use of technology and strategies to reduce risk of harm of others, strategies to reduce reliance on memory
Implementation: Health promotion
individualization of implementation:
- developmental stage
- life style
- environment: basic needs
- general preventive measures
General preventive measures:
lighting
changing the environment
organization
Acute care safety:
Fall risk prevention: canes, walkers Restraints are last resort Restraint alternatives Seizures Poisoning Electrical hazards Radiation Disasters
Restraint:
any manual method, physical, or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely
Alternatives to restraints:
Explain all procedures Use trained sitters Music Put near nurses station Simple calm statements Use time-out techniques Appropriate visual or audio stimuli remove cues that promote leaving promote relaxation techniques institute exercise schedules attend frequent to toileting, food, liquid camouflage intravenous lines with clothing ensure effective pain management reassess physical status and review lab findings
Hospitals must have an
emergency management plan
Seizure:
hyper-excitation and disorderly discharge of neurons in the brain leading to a sudden, violent, involuntary series of muscle contractions that is episodic
Aura:
bright light, smell, or taste during a seizure
Status epilepticus:
prolonged or repeated seizures
Seizure precautions:
encompass all nursing interventions to protect patient form traumatic injury
RACE:
Rescue patients
Activate alarm
Confine fire
Extinguish
PASS:
Pull
Aim
Squeeze
Sweep
A newly admitted patient was found wandering the hallways for the past two nights. The most appropriate nursing interventions to prevent a fall for this patient would include:
use an electronic bed monitoring device
Evaluation:
Through the patient’s eyes
Patient outcomes
Evaluation: through the patient’s eyes:
are the patient’s expectations met?
are the family’s met?
Evaluation: patient outcomes:
monitor care by the health care team
measure outcomes for each diagnosis
continually assess needs for additional support
A nurse floats to a busy surgical unit and administers a wrong medication to a patient. This error can be classified as:
A procedure related accident
expected outcomes:
a safe physical environment
a patient whose expectations have been met
a patient who is knowledgeable about safety factors and precautions
a patient free of injury
