Chapter 27 Patient Safety

Question 1

Define safety:

Answer 1

often defined as freedom from psychological and physical injury, is a basic need

Question 2

Safety in Health Care Organizations:

Answer 2

Performance Improvement
Risk management and safety reports
Current reliable technology
Evidence-based practice
Safe work environment
Adequate staff education

Question 3

QSEN

Answer 3

Quality and Safety Education for Nurses

Question 4

Future Nurses need what to promote safety?

Answer 4

knowledge, skills, and attitudes

Question 5

What is essential for QSEN?

Answer 5

continuous improvement

Question 6

QSEN minimizes risks of harm to

Answer 6

-patients and providers by:
system effectiveness
individual performance

Question 7

In patient safety, critical thinking is a

Answer 7

on going process

Question 8

Standards of critical thinking have been developed by

Answer 8

ANA and TJC

Question 9

Use of what is important when planning care that promotes safety?

Answer 9

Nursing process

Question 10

Safety in Health Care Settings:

Answer 10

1. reduce incidence of illness and injury
2. prevents extended length of treatment/stay
3. improve or maintain functional status
4. increases patient’s senses of well-being

Question 11

A Safe Environment includes meeting patient’s

Answer 11

physical and psychosocial needs

patient’s and health care provider’s well being

Question 12

The environment applies to

Answer 12

all places where patients receive care

Question 13

The environment reduces

Answer 13

risk of injury and transmission of pathogens

and maintains sanitation and reduces pollution

Question 14

Basic Human Needs

Answer 14

Oxygen
Nutrition
Temperature

Question 15

Oxygen:

Answer 15

Low concentration: hypoxia
High concentration
Carbon monoxide

Question 16

Nutrition:

Answer 16

Proper Storage
Proper refrigeration: FDA
Preparation area
5,000 deaths per year

Question 17

FDA

Answer 17

Food and Drug Administration

• regulations for food producers
• US most safest of foods but still deaths

Question 18

Temperature:

Answer 18

Normal: 65 and 75 F comfort zone
Hyperthermia
Hypothermia: core temp is 35 C (95 F)
Frostbite

Question 19

Physical Hazards

Answer 19

Motor vehicle accidents
Poison
Falls
Fire
Disasters: natural or man-made

Question 20

Poison

Answer 20

any substance that impairs health or destroys life when ingested, inhaled, or absorbed by the body

Question 21

Transmission of Pathogens:

Answer 21

pathogens and parasites passed by through contact

most common is by hands

Question 22

pathogen:

Answer 22

any microorganism capable of producing an illness

Question 23

Immunization:

Answer 23

reduces and some cases prevents the transmission of disease from person to person

Question 24

Pollution has

Answer 24

pollutants

Question 25

Pollutants

Answer 25

harmful chemical or waste material discharged into the water, soil, or air

Question 26

Risks at Developing Stages:

Answer 26

``` 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 ```

Question 27

Individual Risk Factors:

Answer 27

Lifestyle Impaired Mobility Sensory or Communication Impairment Lack of Safety Awareness

Question 28

The Joint Commission Patient Safety Goals for Hospitals:

Answer 28

1. Identify patients correctly 2. Improve staff communication 3. Use medicines safely 4. Reduce the risk of health care-- associated infections 5. Check patient medicines 6. Identify patient safety risks

Question 29

NQF

Answer 29

National Quality Forum: procedure to report an event | improves quality of care by building consensus, endorsing national standards, promoting goals

Question 30

NQF also lists serious re-portable events (SREs):

Answer 30

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

Question 31

CMS list of "Never Events"

Answer 31

The Centers for Medicare and Medicaid Services - "never events" should never occur - denies hospitals higher payments resulting from by a never event

Question 32

Risks in Health Care Agencies:

Answer 32

Falls Patient-inherent accidents: self-harm Procedure-related accidents: caused by providers Equipment-related: malfunction, misuse

Question 33

Other risks in agencies:

Answer 33

``` Chemical use (Material Safety Data Sheets MSDS) Medical Errors ```

Question 34

Medical errors include:

Answer 34

infection | bed sores failure to diagnose and treat in time

Question 35

Assessment:

Answer 35

Through the patient's eyes Patient's home environment Nursing History

Question 36

Assessment questions:

Answer 36

activity and exercise medication history history of falls home maintenance and safety

Question 37

health care environment:

Answer 37

risks in immediate environment risks for falls risk for medication errors disaster preparedness: disease, not epidemic

Question 38

Diagnosis:

Answer 38

``` risks for falls impaired home maintenance risk for injury deficient knowledge risk for poisoning risk suffocation risk for trauma ```

Question 39

Planning:

Answer 39

Goals and outcomes setting priorities teamwork and collaboration

Question 40

Goals and outcomes:

Answer 40

prevent and minimize safety threats measurable and realistic may include active patient participation

Question 41

Setting priorities:

Answer 41

plan based on developmental stage, level of health, lifestyle, and cultural needs

Question 42

Teamwork and collaboration:

Answer 42

with coworkers, patient, family

Question 43

Implementation: QSEN

Answer 43

demonstrates effective use of technology and strategies to reduce risk of harm of others, strategies to reduce reliance on memory

Question 44

Implementation: Health promotion

Answer 44

individualization of implementation: - developmental stage - life style - environment: basic needs - general preventive measures

Question 45

General preventive measures:

Answer 45

lighting changing the environment organization

Question 46

Acute care safety:

Answer 46

``` Fall risk prevention: canes, walkers Restraints are last resort Restraint alternatives Seizures Poisoning Electrical hazards Radiation Disasters ```

Question 47

Restraint:

Answer 47

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

Question 48

Alternatives to restraints:

Answer 48

``` 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 ```

Question 49

Hospitals must have an

Answer 49

emergency management plan

Question 50

Seizure:

Answer 50

hyper-excitation and disorderly discharge of neurons in the brain leading to a sudden, violent, involuntary series of muscle contractions that is episodic

Question 51

Aura:

Answer 51

bright light, smell, or taste during a seizure

Question 52

Status epilepticus:

Answer 52

prolonged or repeated seizures

Question 53

Seizure precautions:

Answer 53

encompass all nursing interventions to protect patient form traumatic injury

Question 54

RACE:

Answer 54

Rescue patients Activate alarm Confine fire Extinguish

Question 55

PASS:

Answer 55

Pull Aim Squeeze Sweep

Question 56

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:

Answer 56

use an electronic bed monitoring device

Question 57

Evaluation:

Answer 57

Through the patient's eyes | Patient outcomes

Question 58

Evaluation: through the patient's eyes:

Answer 58

are the patient's expectations met? | are the family's met?

Question 59

Evaluation: patient outcomes:

Answer 59

monitor care by the health care team measure outcomes for each diagnosis continually assess needs for additional support

Question 60

A nurse floats to a busy surgical unit and administers a wrong medication to a patient. This error can be classified as:

Answer 60

A procedure related accident

Question 61

expected outcomes:

Answer 61

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