EXAM 2 Flashcards
Triage:
- Immediate (Red): life threatening injuries requiring immediate interventions to survive
- Delayed (yellow): serious injuries that aren’t immediately life threatening and can wait for treatment
- Minimal (green): minor injuries, not urgent
- Expectant (black): injuries so severe, not expected to survive
Smallpox aka variola:
- Remember that it’s not the same as chicken pox
- Contact and airborne precautions
- Treatment: supportive care, vaccine within 4 days of exposure
- S/S/: high fever, fatigue, severe headache, chills, vomiting, delirium, rash/lesions (vesicles) on face and extremities
Seclusions:
- Placing a patient in a safe room d/t violent behavior, danger to self or others, suicidal ideation, or escalation of a crisis situation
Risks associated with restraints:
Death from asphyxiation and pressure injuries
Guidelines for restraints:
- Explain the purpose
- Obtains a doctor’s order
- Prescription details -> reason, type, location, duration of restraint
- Neuro check every 2 hours
- Provide essential care and monitor vital signs
- Assess the need for continuation
- Document relevant data and interventions
- Easy knot, 2 fingers, tied to frame of bed NOT side rails.
Fire safety:
- RACE
Rescue, Alarm, Contain, Extinguish - PASS
Pull the pin, Aim at the base of fire, Squeeze handle, Sweep side to side
Quality improvement:
A way to advance the practice of healthcare through the use of objective, measurable information. The JOINT COMMISSION provides accreditation and they require standard to show evidence of a QI to maintain accreditation status.
Continuous quality improvement process models:
- Plan Do Study Act method
- The lean approach
- 6 sigma
QI process model questions:
- What are we trying to accomplish?
- How will we know that a change is an improvement?
- What changes can we make that will result in improvement?
PDSA method:
- Plan: choose the problem, decide what data to collect, and who will collect it.
- Do: make the change or take action
- Study: review and analyze the data collected
- Act: decide the next steps to take and implement
The lean approach:
- Focused on efficacy and decreasing the amount of waste
- Identifies values as a necessary characteristic, so anything that doesn’t add value to the process is removed
- Eliminates repeated or unnecessary steps
6 sigma:
- A business problem solving model to reduce variations in practice and reduce errors
- Define, measure, analysis, improvement, control
How to know if QI efforts are working?
- Audits
- Quality indicators
Audits:
STRUCTURE, PROCESS, OUTCOME.
1. Structure: focus on the setting and resources for care
2. Process: focus on how care is delivered
3. Outcome: focus on the results of care
Quality indicators:
- Structure indicators: reflect the setting in which care is provided r/t standard under review -> STAFFING
- Process indicators: reflect how care is provided and are establish by policies -> USE OF RESTRAINTS
- Outcome indicators: focus on results -> MORTALITY RATES, HOSPITAL READMIT RATES, INFECTION RATES, PATIENT SATISFACTION SURVEY
- Benchmark: are goals that are set to determine at what level the outcome indicators should be met
Risk management:
- Process of reducing the risk of errors
- RM gets involved when an error is made and an incident report gets filed
Incident reports:
- Record medical record number, names of all witnesses to incident, ID numbers of equipment, names and doses of meds, what the nurse witnessed, date, time, place, and actual facts
- Should be completed within 24 hours following incident
- Never include a note in medical record that incident report completed
Root cause analysis:
- Method used to find out why a problem happened so it can be prevented from happening again
- Should include sequence of events, what caused the incident, why did it happen, and what can be done to prevent the incident from recurring
- RM will use this tool to investigate reports, sentinel events, or never events
Sentinel event:
- Resulted in extreme harm, short term harm, permanent disability, or death
- May not always be preventable
- Examples -> suicide in a hospital, pressure ulcer acquired in health care facility, patient abduction, surgery on the wrong site, infant being DC to wrong family, death during or immediately after surgery or an invasive procedure
Never event:
Medical errors that are identifiable, preventable, and have potential for serious risks
Examples of quality improvements in nursing care:
- Reduce patient falls
- Goal -> reduce falls by 30% over 6 months by IMPLEMENTING prevention strategies; QI interventions that are EBP are applied
- Risk assessment (conduct a fall risk assessment upon admission and every shift), standardized protocols (bed alarm, non skid socks, frequent check ins), staff education, family and patient education on prevention
Unintentional torts:
- Negligence: not meeting expected standard of care, risking patient injury
Ex: failure to implement safety measures to a patient identified as a fall risk - Malpractice: professional negligence leading to harm or death of a patient
Ex: nurse administers a larger dose of medication d/t wring calculation, patient has a cardiac arrest and dies
QUASI intentional torts:
- Invasion of privacy: intrusion into private affairs
Ex: nurse releases medical information to the press - Defamation: false communication intending to harm reputation
Ex: Libel: written words or photos (nurse documents in patients record that a doctor is incompetent)
Ex: Slander: spoken words ( nurse tells a coworker she believes that the patient is being unfaithful to spouse)
Intentional torts:
- Assault: behavior causing fear
Ex: threatening to put a NG tube to a patient refusing to eat - Battery: intentional, wrongful physical contact resulting in injury
Ex: restraining a patient and administering an IM injection against their wishes - False imprisonment: confining a competent person against their will
Ex: using restraints on a competent patient to prevent them from leaving the facility
State laws:
- Regulation of nursing practice by state law:
Each state is different but the state board of nursing oversees and enforces laws - Standard and scope of practice:
The board of nursing sets standards for nursing programs and defines what tasks nurses at different levels are allowed to do - Variations in licensing requirements:
Varies by state
Behaviors consistent with substance use disorder:
- Smell of alcohol on breath
- Excessive use of mouth way
- Poor coordination, drowsiness, slurred speech
- Ignoring personal hygiene
- Taking too many sick days or being late, especially on the weekends/holidays/payday/Monday and Friday
- Frequently asking to leave the unit or ending shift early
- Forgetting a witness when disposing controlled meds
- Patient complains of not getting pain meds
- Falsely documenting giving pain meds
- Prefers shift with less supervision
Nurses role in organ donation:
Coordination, support, documentation, collaboration, advocacy
1. Coordination: with hospitals organ donation liaison or cali transplant network to facilitate the donation process when a patient is eligible for donation
2. Support: emotional support, address concerns, answer questions, offer comfort
3. Documentation: discussions, assessments, and actions r/t organ donation
4. Collaboration: physician, social worker, transplant coordination
5. Advocacy: for patient wishes regarding organ donation
Disruptive behaviors in nursing:
- Incivility: rude, intimidating, insulting
Ex: dirty looks, teasing, uninvited touching - Lateral violence: abuse between peers (nurse to nurse)
Ex: more experience nurse abusive to new nurse - Bullying: relentless abuse of power
- Cyberbullying: use online platform to bully
Purpose of QI and EBP:
Aim to improve patient care, safety, and outcomes. QI identifies needs and EBP guides actionable improvements
