Exam 2 module 3 part 3 Flashcards
Chapter 21, Safety
What is the second basic human need after survival needs?
Safety
the first need is oxygen, nutrition and fluids.
Safety is fundamental to providing effective care.
How do nurses contribute to patient safety?
By coordinating and integrating the multiple aspects of quality into nursing care
This includes collaboration with other care providers.
What must nurses be concerned with regarding safety?
- Their own safety
- safety of other care providers
- safety of patients
Awareness of hazards is key to preventing injuries.
What are accidents, or unintentional injuries, ranked as a cause of death in the United States?
Third leading cause of deaths
This is according to the CDC.
How many people die each year from accidents in the United States?
Approximately 170,000 people or one person every 5 minutes
This statistic highlights the severity of unintentional injuries.
What is the leading cause of unintentional death? What is the 2nd, 3rd, 4&5
1) Poisoning
2) Motor vehicles
3) Falls
4) Drowning & Fires
Followed by motor vehicle accidents, falls, drowning, and fires.
What organization publishes National Patient Safety Goals?
The Joint Commission
Name one of the 2021 National Patient Safety Goals.
Improving the accuracy of patient identification
Other goals include medication safety and preventing surgical mistakes.
Fill in the blank: Millions of people receive injuries that ______ beyond the day of injury.
disabled them
This highlights the long-term impact of accidents.
Examples of healthcare organizations campaigning for safer patient care to reduce healthcare cost (and reduce suffering)
- The Joint Commission publishes national patient safety
- Institute of Medicine To Err Is Human: Building a Safer Health System
- ANA Patient Protection and Affordable Care Act
- QSEN
- Medicare “never events”
What report brought public attention to patient safety?
To Err Is Human: Building a Safer Health System
Published by the Institute of Medicine in 1999.
What is not acceptable according to the report ‘To Err Is Human’?
Patients being harmed by the healthcare system
The system is supposed to offer healing and comfort.
Name one of the five critical principles to ensure safe healthcare systems.
Provide leadership
Other principles include recognizing human limits, promoting effective team functioning, anticipating the unexpected, and creating a learning environment.
What does the ‘culture of safety’ in healthcare refer to?
An environment that prioritizes patient safety and learning
Refer to the Safe, Effective Nursing Care box for more details.
What organization advocates for healthcare reforms focusing on high-quality healthcare access?
American Nurses Association (ANA)
The ANA also emphasizes patient safety.
What is the main aim of the American Nurses Association?
To support patient safety
This is aligned with their advocacy for high-quality healthcare.
What act is the ANA committed to educating the public about?
Patient Protection and Affordable Care Act (PPACA)
The ANA addresses how changes influence patients’ lives and the nursing profession.
What is one of the six competencies identified by the QSEN Institute?
Safety
This competency is essential for nursing students by graduation.
What does Medicare identify as ‘never events’?
Hospital-acquired conditions (HACs)
These are costly errors that cause serious injury or death and are mostly preventable.
According to Medicare, what will they no longer pay for?
Care required to treat the effects of ‘never events’
This includes falls and injuries from restraints.
What does the chapter discuss regarding risk factors?
Specific risk factors and hazards in the home, the community, and the healthcare agency
These discussions help identify areas where safety can be improved.
What is noted about individual progression through developmental stages?
Individuals progress through developmental stages at their own pace
This means some individuals may not fit the group description closely.
What is the primary dependency of infants and toddlers?
Completely dependent on others for their care
What behavior do infants and toddlers exhibit that increases the risk of choking?
Putting objects in their mouths
At what age range is the incidence of choking highest?
Between 6 months and 3 years of age
What hazards do toddlers tend to explore as they gain mobility?
Cupboards, stairs, open windows, swimming pools
True or False: The healthcare industry has always prioritized patient safety.
False
What did the healthcare industry historically assume about mistakes?
That all dedicated practitioners would perform correct actions
What culture existed in healthcare regarding mistakes?
A culture of secrecy and blame
What has the Institute of Medicine (IOM) called for healthcare organizations to do?
Dismantle the culture of secrecy and blame and create a culture of safety
What role does the IOM suggest nurses should take in creating a culture of safety?
Be leaders in these efforts
What are SENC activities designed to prepare nurses for?
Roles in the new culture of safety
What baseline knowledge is required according to SENC?
Thinking in terms of systems
Fill in the blank: The types of errors that occur in your facility are part of understanding how __________ create a mistake-prone environment.
systems
What key point summarizes the relationship between people and systems in healthcare errors?
People make the mistakes. Systems set the stage for them.
What is the leading cause of death for children aged 1 to 4 years?
Motor vehicle accident
Followed by drowning.
What are some other critical safety concerns for young children?
Falls, choking, sudden infant death, ingesting poisons
These are significant safety issues beyond motor vehicle accidents.
How do preschoolers’ motor skills change after age 3?
They become less prone to falls due to improved gross and fine motor skills, coordination, and balance
However, safety concerns increase with outdoor play.
What are the major causes of accidental deaths in children?
Motor vehicle injuries, drowning, fires, poisoning
These are critical concerns for child safety.
What is the primary cause of nonfatal injuries in preschoolers?
Falls
Falls are a significant concern even with increased awareness of dangers.
True or False: Adult supervision is essential for preschoolers despite their increased awareness of dangers.
True
Adult supervision remains crucial for ensuring child safety.
Fill in the blank: After age 3 years, preschoolers become less prone to _______ due to improved motor skills.
falls
This improvement leads to fewer accidents in controlled environments.
What are two key physical developments in school-age children?
More refined muscle coordination and improved decision-making skills
These developments contribute to their ability to engage in more complex physical activities.
What are common causes of bone and muscle injuries in school-age children?
Sports, skateboarding, bicycle riding, and playground injuries
Increased involvement in activities outside the home raises injury risks.
How do school-age children generally approach new skills?
They are less fearful and ready to try new skills with or without practice or training.
What safety risks increase for school-age children due to exposure to the wider environment?
Risks from people outside the home, such as abduction.
What is a nonpunitive response to errors in a facility?
Using strategies like root cause analysis to identify system issues.
Describe one system that can break down and make errors more likely.
Communication systems within the care team.
What continues to be the leading cause of accidental deaths in school-age children?
Motor vehicles
This highlights the importance of safety education around transportation.
What is the leading cause of nonfatal injuries in school-age children?
Falls.
What peak abilities do adolescents experience?
Physical, sensory, and psychomotor abilities
These abilities contribute to a heightened sense of strength and confidence in teenagers.
What is a significant characteristic of adolescent decision-making?
Lack of wisdom and judgment of adults
This characteristic can lead to increased risk-taking behavior.
What feeling contributes to adolescents’ risk-taking behavior?
Feeling of being indestructible
This feeling makes teenagers more prone to injury.
What is the leading cause of accidental death in adolescents?
Motor vehicle accidents
These accidents are often associated with alcohol and drug use.
What is the second leading cause of accidental death in adolescents?
Unintentional poisoning
This cause is frequently linked to substance use.
What types of injuries are common among adolescents?
Sports and recreational injuries
These include diving and drowning incidents, especially when substances are involved.
Fill in the blank: Adolescents are more likely to participate in _______ behavior due to their peak physical abilities.
risk-taking
This behavior can lead to a higher incidence of injuries.
What are some common causes of adult workplace injuries?
Lifestyle factors, stress, carelessness, abuse, decline in strength and stamina
These factors contribute significantly to the risk of injuries in the workplace.
What is a leading cause of accidental death?
Unintentional poisoning
Unintentional poisoning causes more deaths than motor vehicle accidents (Kochanek et al., 2019).
True or False: Motor vehicle accidents are the leading cause of accidental death.
False
Unintentional poisoning surpasses motor vehicle accidents in causing deaths.
What increases the risk of musculoskeletal injury in adults?
Lack of regular physical activity due to work and family responsibilities
This phenomenon is often referred to as the risk faced by ‘weekend athletes.’
Fill in the blank: Accidental death from unintentional poisoning causes more deaths than __________.
motor vehicle accidents
What lifestyle factor is mentioned as a concern for adult injuries?
Excessive alcohol use
This factor can contribute to both workplace injuries and lifestyle-related injuries.
What type of athlete is at increased risk for musculoskeletal injury due to irregular physical activity?
Weekend athlete
This term describes individuals who engage in physical activity primarily on weekends due to their busy schedules.
What physiological changes occur in older adults?
Reduced muscle strength and joint mobility, slowing of reflexes, decreased ability to respond to multiple stimuli, sensory losses (particularly hearing and vision)
These changes can increase the risk of injuries.
What is the most common cause of accidental death in adults aged 65 years and older?
Falls
According to Kochanek et al., 2019.
True or False: All older adults experience significant sensory losses as they age.
False
Many older adults have intact senses and continue to enjoy life.
Fill in the blank: Physiological changes in older adults increase the risk for _______.
falls, burns, car accidents, and other injury
These risks are associated with the changes in muscle strength, reflexes, and sensory capabilities.
What are individual risk factors for unintentional injury?
Factors include lifestyle, cognitive awareness, sensoriperceptual status, ability to communicate, mobility status, physical and emotional health, and awareness of safety measures.
List lifestyle-related risks for unintentional injury.
- Smoking
- Alcohol abuse
- Risk-taking behaviors
How does cognitive status impact risk for injury?
Confusion due to stress and loss of short-term memory can increase risk.
What does impaired sensory and perceptual status refer to?
Loss of senses, such as vision and hearing, that provide the first line of defense.
What are the effects of impaired communication on injury risk?
Language barriers and hearing and speech impairments related to disease processes.
What does impaired mobility entail?
Impaired strength with accompanying problems in mobility, balance, and endurance.
How can physical and emotional health impact injury risk?
Reduced physical stamina and depression, leading to feelings of loss of control and helplessness.
What is the effect of reduced safety awareness in older adults?
Reduced cognitive awareness can increase the risk of unintentional injuries.
Fill in the blank: _______ behaviors include smoking, alcohol abuse, and risk-taking.
[Lifestyle-related]
True or False: Impaired mobility can affect a person’s balance and endurance.
True
What has happened to poisoning death rates in the past 20 years?
Poisoning death rates have more than quadrupled
This increase has been mainly among adults.
How many emergency department visits in the United States are due to poisoning exposure annually?
About 2 million emergency department visits per year
Source: CDC, 2017a.
Who are the most frequent victims of poisoning?
Young children
They are often poisoned by improper storage of household chemicals, medicines, vitamins, and cosmetics.
What was banned in 1978 that is still found in older homes?
Lead in paint
Lead-based paint can still be found in some toys produced in certain foreign countries.
Which populations are at higher risk for lead exposure in the United States?
Poor, urban, and immigrant populations
They experience higher risk compared to other groups.
How may older children and adolescents experience poisoning?
Through suicide attempts by overdosing or accidental poisoning while experimenting with drugs
This includes both recreational and prescription drugs intended for adults.
What types of drugs are commonly misused by adults and students?
Illegal drugs and prescription drugs, especially narcotic medications, tranquilizers, and antidepressants
Deaths from prescription analgesics have reached epidemic levels.
What has reached epidemic levels in the past decade?
Deaths from prescription analgesics
These deaths are greater than those from heroin and cocaine combined.
What is a significant issue regarding pain medication use?
Nonmedical use
This includes using pain medications without a prescription or using them for the high they cause.
How many current nonmedical users of painkillers are estimated?
4.3 million
Source: Substance Abuse and Mental Health Services Administration, 2017.
What determines the choice of treatment for poisoning?
The poison ingested
Different poisons require different treatment approaches.
What is the most effective intervention for most poisonings?
Professional administration of activated charcoal orally or via gastric tube
However, charcoal is not effective for certain substances.
List some substances for which activated charcoal is not effective.
- Ethanol
- Alkali
- Iron
- Boric acid
- Lithium
- Methanol
- Cyanide
Other medical treatments may include gastric lavage, dialysis, administration of antidotes, and forced diuresis.
What are some other options for medical treatment of poisoning?
- Gastric lavage
- Dialysis
- Administration of antidotes
- Forced diuresis
These options depend on the situation and the poison involved.
What is carbon monoxide (CO)?
A colorless, tasteless, odorless toxic gas
What are the initial symptoms of carbon monoxide exposure?
Headaches, weakness, nausea, and vomiting
What can prolonged exposure to carbon monoxide lead to?
Seizures, dysrhythmias, unconsciousness, brain damage, and death
Approximately how many unintentional deaths are caused by CO poisoning each year in the United States?
About 500 unintentional deaths
Where do most carbon monoxide exposures occur?
At home
Which demographics are most affected by carbon monoxide exposure?
Females, children under 17 years, and adults aged 18 to 44 years
What percentage of deaths at the scene of fires is attributed to CO poisoning?
The majority of deaths at the scene of fires
What is a relatively common method of suicide related to carbon monoxide?
Carbon monoxide poisoning
During which season do many CO deaths occur, particularly among older adults?
Cold weather
Who are particularly at risk for CO poisoning during cold weather?
Older adults and economically disadvantaged people
Fill in the blank: Many economically disadvantaged individuals may seek _______ to stay warm.
nonconventional heat sources (e.g., gas ranges and ovens)
What are the most common causes of scalds and burns in children younger than age 3 years?
Scald injuries from hot water, steam, or grease
Scalding burns should prompt an assessment for abuse, especially if they occur on both feet or both hands.
What can happen when warming food or formula in the microwave?
The food may become hotter than intended, leading to burns in infants and young children.
What types of burns can sunburn cause?
First- or second-degree burns.
What are contact burns and when do they occur?
Contact burns occur from contact with metal surfaces and vinyl seats when cars are parked in the sun.
What increases the risk of contact burns in all age-groups?
The presence of heating devices such as kerosene heaters, wood-burning stoves, and home sauna heating elements.
What are some examples of chemical agents that can cause burns?
Acid, alkali, or other organic compounds.
True or False: Scalding burns in vulnerable older adults should be assessed for abuse.
True.
Fill in the blank: _______ injuries are the most common cause of burns in children younger than age 3 years.
Scald
What demographic groups have the greatest risk of fire death?
Older adults and children under age 5 years
These groups are particularly vulnerable to fire incidents in the home.
When do most fatal home fires occur?
While people are asleep
This highlights the importance of fire safety measures during nighttime.
What is the leading cause of fatal home fires?
Smoking (e.g., cigarettes)
Smoking materials are a significant ignition source in home fires.
What is the second leading cause of fatal home fires during winter?
Heating equipment
This indicates the need for safe heating practices in colder months.
In what percentage of home fires involving oxygen is smoking the ignition source?
75%
Home oxygen administration equipment significantly increases fire risk when combined with smoking.
What are some common causes of fire in the home?
- Unsupervised children playing with matches
- Improper use of candles
- Faulty wiring
These factors can lead to potentially dangerous fire incidents.
What is the third leading cause of injury-related deaths?
Falls
Falls are particularly dangerous for older adults.
Where do more than half of all falls occur?
In the home
This statistic emphasizes the need for fall prevention measures at home.
What percentage of home falls involve people aged 65 years and older?
About 80%
Older adults are at a significantly higher risk for falls in their homes.
What happens to the fall rate for adults older than 75 years?
It triples
This indicates an alarming increase in fall risk with age.
What is a controversial issue regarding firearms?
Gun ownership
The debate around gun ownership involves safety, rights, and regulations.
Why do some people keep guns in their homes?
For protection and/or recreation
Recreational uses include hunting and target shooting.
What are firearms a source of?
Unintentional injury and death
This includes accidental shootings and related fatalities.
What risk factors are associated with household access to firearms?
- Youth suicide
- Domestic homicide
- Unintentional injury
Studies have shown these associations (Knopov et al., 2019; Monuteaux et al., 2019).
Who emphasizes the importance of gun safety and security?
American Academy of Pediatrics and other groups
They advocate for education on firearm safety, especially for households with children.
What is particularly important when there are children in the home?
Gun safety and security
Ensuring firearms are stored safely prevents access by children.
Fill in the blank: Household access to firearms has been implicated as a risk factor for _______.
youth suicide
This highlights the mental health risks associated with firearms.
True or False: The presence of firearms in a household can increase the risk of domestic homicide.
True
Research indicates a correlation between firearm access and increased domestic violence risks.
What efforts have been made to educate parents about firearm safety?
Mounting efforts by the American Academy of Pediatrics and other groups
These efforts focus on reducing unintentional firearm injuries involving children.
What is the leading cause of death for infants younger than 1 year?
Suffocation by smothering
Suffocation may be caused by drowning, choking on a foreign object, or inhaling gas or smoke.
What are common hazards in a crib that can lead to infant suffocation?
Excess bedding, pillows, toys hung from long ribbons, entanglement in cords from window blinds
Infants can also become entangled in ribbons or strings used to hang pacifiers.
What is a key risk factor for drowning in children aged 1 to 4 years?
Children up to age 4 years are especially at risk for drowning
Drowning is an important cause of accidental death in children aged 1 to 18 years.
What types of food items are most responsible for nonfatal choking incidents?
Hot dogs, raw vegetables, popcorn, hard candies, nuts, grapes
These food items are common choking hazards for children.
What nonfood items cause the majority of suffocation deaths in young children?
Latex balloons, plastic bags
These items are particularly dangerous and contribute significantly to suffocation deaths.
What are take-home toxins?
Hazardous substances transported from the workplace to the home
Which organization reported on take-home toxins?
National Institute for Occupational Safety and Health (NIOSH)
List three examples of take-home toxins.
- Pathogenic microorganisms
- Asbestos
- Lead
What are the primary means of transporting take-home toxins?
- On workers themselves
- On their clothing
- On objects brought from the workplace
How does contamination occur in the home from take-home toxins? Name one source.
Contamination occurs via three sources, one of which is direct skin-to-skin contact or direct contact with contaminated clothing
True or False: Take-home toxins can be transported by arthropod vectors.
True
Fill in the blank: Take-home toxins can also be present on dust particles that are _______.
inhaled
What year did NIOSH last review their report on take-home toxins?
2014
Name two toxic metals mentioned as take-home toxins.
- Lead
- Mercury
What type of products can be considered as take-home toxins besides metals?
Pesticides and caustic farm products
What is one potential health consequence of take-home toxins?
Significant morbidity and mortality
Fill in the blank: Take-home toxins may involve _______ spores.
anthrax
What is the significance of dust particles in relation to take-home toxins?
They can carry toxins that are inhaled
What are the four hazardous agents discussed in the context of safety hazards in the community?
Motor vehicle accidents, pathogens, pollution, and weather hazards
These agents contribute significantly to illness, disability, and death worldwide.
What is a leading cause of accidental death in the United States?
Motor vehicle accidents (MVAs)
MVAs are particularly prevalent among certain age groups.
Which age group accounted for 38% of emergency room visits for injuries from motor vehicle accidents?
Teens and young adults aged 15 to 29 years
This statistic highlights the vulnerability of this age group.
How many people over the age of 65 are injured in automobile accidents daily?
500
Older drivers are at a higher risk of injury or death in crashes.
What are the major contributing factors to motor vehicle accidents?
Failure to use seat belts and proper child car seats
Air bag deployment can also cause severe injuries if young children are improperly placed.
What is driver distraction primarily attributed to?
Cell phone use and texting
Distracted driving includes other activities such as eating or adjusting controls.
In 2017, what percentage of fatal MVAs were attributed to distracted drivers?
9%
This statistic underscores the dangers of driver distraction.
What percentage of MVAs resulting in injury in 2017 were due to distracted drivers?
15%
This indicates a significant impact on injury rates from distracted driving.
How many nonoccupants were killed by distracted drivers in 2017?
599
Nonoccupants include pedestrians and bicyclists.
List other contributing and risk factors for motor vehicle accidents.
- Speed
- Alcohol
- Nonuse of motorcycle helmets
These factors also increase the likelihood of accidents and related injuries.
What is a pathogen?
Any microorganism capable of causing an illness.
How can pathogens enter the body?
Through several sources in the environment:
* Food
* Mosquitoes and other insects
* Rodents and other animals
* Unclean water
What does food poisoning refer to?
Illness caused by ingesting bacteria and other microorganisms, or their toxins, in food.
What are major contributing factors to food poisoning?
Improper food storage and preparation.
Name some raw foods commonly associated with foodborne illness.
Raw meat, poultry, eggs, shellfish, raw fruits and vegetables, unpasteurized milk or fruit juice.
What can contaminate food with poisonous chemicals?
Environmental contaminants such as:
* Mercury
* Arsenic
* Zinc
* Potassium chlorate
Fill in the blank: A _______ is any microorganism capable of causing an illness.
[pathogen]
True or False: Foodborne pathogens only come from animal sources.
False
What are vectors?
Organisms that transmit pathogenic bacteria, viruses, and protozoa from one host to another
Name a disease transmitted by mosquitoes.
West Nile virus, malaria
What is the impact of mosquito bites?
Discomfort and potential transmission of diseases
What can infected mosquitoes transmit to domestic animals?
Dog heartworm, equine encephalitis
Which insects can transmit diseases and produce allergens?
Roaches, fleas, sand flies, lice, ticks
True or False: Ticks are classified as insects.
False
How does allergic sensitivity to cockroaches relate to asthma?
It is a predictive factor for asthma severity
What structural defects in buildings can permit the entry of vectors?
Defects in roofs and walls
Name a disease that can be spread through the bite of a rabid animal.
Rabies
What can spread some fungal diseases?
Inhalation of bird droppings
Which proteins have been implicated in asthma occurrence?
Mouse proteins
What does sanitation refer to?
Measures to promote and establish favorable health conditions, especially related to the community’s water supply.
Sanitation encompasses various practices aimed at maintaining health standards in communities.
What are common issues faced by people living in substandard housing?
Lack of safe drinking water, hot water for washing, and adequate waste disposal methods.
These deficiencies can lead to serious health risks and community health issues.
What do rural areas often depend on for their water supply?
Private wells.
These wells may not be adequately maintained or tested for pathogens.
Name three pathogens that may be found in inadequately maintained private wells.
- Giardia lamblia
- Cryptosporidium
- Escherichia coli
These pathogens can lead to significant health problems if ingested.
True or False: Waterborne pathogens are primarily an individual health problem.
False.
They are primarily community health problems.
Fill in the blank: People in rural areas often depend on _______ for their water supply.
private wells.
What is pollution?
Pollution is any harmful chemical or waste material discharged into the air, water, or soil.
Name three examples of pollutants.
- Gaseous fumes
- Asbestos
- Carbon monoxide
How much trash do Americans generate each year?
268 million tons
How much trash do Americans recycle or compost each year?
About 94 million tons
True or False: Air pollution occurs only outdoors.
False
What are two sources of outdoor air pollution?
- Motor vehicle emissions
- Emissions from factories
List three indoor pollutants.
- Radon
- Carbon monoxide
- Allergens from dust mites
What health issues are linked to passive exposure to tobacco smoke?
- Respiratory disease
- Cancer
Environmental air pollution is linked to which two health conditions?
- Cardiovascular disease
- Respiratory viral infection
What is water contamination?
Contamination in lakes, rivers, and streams affecting recreation and food production.
What causes pollution in water systems?
Inadequately treated or inappropriate quantities of human, industrial, or agricultural wastes.
Fill in the blank: Pollution occurs when _______ is released into the water systems.
[human, industrial, or agricultural waste]
What happens if pollution in water is severe enough?
The water may become unsafe for human consumption.
What health effects are associated with substantial exposure to noise?
Hearing loss, stress, elevated blood pressure, loss of sleep
These effects are linked to various sources of noise in society.
List some common sources of noise pollution.
- Road traffic
- Airplanes
- Garbage trucks
- Construction equipment
- Lawn mowers
- Loud music
These sources contribute to the pervasive nature of noise in our environment.
Who is at greater risk of noise-related health issues?
People living or working near major roads, bus depots, airports, trucking routes, and certain work environments such as railroad workers
Proximity to these noise sources increases the risk of adverse health effects.
What can contaminate soil?
Improper waste disposal and excessive use of pesticides
These practices lead to significant environmental contamination.
What types of waste can create soil contamination?
- Agricultural waste
- Industrial waste
- Manufacturing waste
- Animal waste
- Radioactive waste
- Medical waste
Each type of waste presents unique challenges in terms of contamination.
What household products can contaminate the environment when disposed of improperly?
- Paints
- Cleaners
- Oils
- Batteries
- Pesticides
These products often contain corrosive or toxic ingredients.
True or False: Excessive use of pesticides can lead to soil contamination.
True
Pesticides contribute to the degradation of soil quality.
Fill in the blank: Noise pollution is caused by various sources including _______.
[road traffic, airplanes, garbage trucks, construction equipment, lawn mowers, loud music]
This list highlights the diverse origins of noise pollution.
What is the leading cause of weather-related deaths in the United States?
Heat-related deaths
Heat-related deaths are the most common among weather hazards.
How many people die each year in the United States due to weather hazards?
More than 1,000
This figure highlights the significant impact of weather hazards on public safety.
What trend has been observed regarding deaths caused by lightning, tornadoes, and hurricanes in the 21st century?
The number of deaths has fallen steadily
This indicates improvements in safety measures and preparedness.
What has contributed to the decline in deaths related to floods?
Advances in technology and warning systems
These improvements enhance public awareness and response to flood risks.
True or False: Deaths from weather hazards have increased in recent years.
False
Deaths from many weather hazards have actually decreased.
What is the number of avoidable deaths that occur in U.S. hospitals each year according to Leap Frog Hospital Safety Grade (2019)?
More than 161,000 avoidable deaths occur each year in U.S. hospitals.
What are some safety hazards present in healthcare facilities?
Healthcare facilities embody several safety hazards for residents and workers.
What is the first National Patient Safety Goal for 2021 set by The Joint Commission?
Identify patients correctly.
What is the second National Patient Safety Goal for 2021?
Improve staff communication.
What is the third National Patient Safety Goal for 2021?
Use medicines safely.
What is the sixth National Patient Safety Goal for 2021?
Use alarms safely.
What is the seventh National Patient Safety Goal for 2021?
Prevent infection.
What is the fifteenth National Patient Safety Goal for 2021?
Identify patient safety risks (specifically, suicide risk).
What does UP 1 stand for in the context of patient safety?
Prevent mistakes in surgery.
What is the purpose of the Universal Protocol (UP 1)?
It is a preprocedure verification process to ensure that all documents, information, and equipment are available, and that the correct procedure is performed on the correct person and site.
What are some organizational factors that contribute to errors and safety problems in healthcare?
- Poor design
- Maintenance failures
- Unworkable procedures
- Shortfalls in training
- Less than adequate tools and equipment
- Inadequate staffing
- Disruptive behavior and intimidation in the workplace
- Culture of disrespect among healthcare professionals
These factors can lead to significant issues in patient care and overall healthcare quality.
True or False: The traditional healthcare culture places the physician at the top of the hierarchy.
True
This hierarchy can contribute to communication issues and a culture that discourages questioning.
What needs to be repaired in the healthcare culture according to the text?
Disrespectful behavior, staff reluctance to speak up about risks and errors, and disregard of expressed concerns
Addressing these issues is essential for improving patient care and safety.
Fill in the blank: The quality of _______ care affects patient health and outcomes.
[nursing]
Nurses are critical in providing quality care and ensuring patient safety.
According to research, what is associated with greater numbers of patient deaths?
Fewer nurses to provide care
Studies have shown a direct correlation between nursing staff levels and patient mortality.
What are some negative outcomes associated with less nursing time provided to patients?
- Higher rates of infection
- Gastrointestinal bleeding
- Pneumonia
- Cardiac arrest
- Death from various causes
Adequate nursing time is crucial for preventing these adverse health outcomes.
What is the relationship between nursing time and patient safety?
Less nursing time is associated with higher rates of negative patient outcomes
This highlights the importance of adequate nurse staffing and time for patient care.
What are never events?
Healthcare-acquired complications that can cause serious injury or death to a patient and should never happen in a hospital.
List the three characteristics of never events.
- Clearly identifiable and measurable
- Serious
- Usually prevented
True or False: Never events can occur in a hospital setting.
False
Fill in the blank: Never events are also known as _______.
[serious reportable events (SREs)]
What is one example of a never event?
Foreign object (such as a sponge) left in patients after surgery
What is an air embolism?
A never event involving air bubbles entering the bloodstream.
What can happen if the wrong type of blood is administered?
It constitutes a never event.
What are severe pressure injuries?
A type of never event that can lead to serious patient harm.
What types of infections are considered never events?
- Infections associated with urinary catheters
- Infections associated with IV catheters
What symptoms can result from poorly controlled blood sugar levels?
They are classified as a never event.
Which elective procedures are associated with surgical site infections as never events?
- Certain orthopedic surgeries
- Bariatric surgery for obesity
What conditions can lead to deep vein thrombosis or pulmonary embolism following surgery?
Total knee and total hip replacement procedures.
What is the primary goal of root cause analysis (RCA)?
To decrease the likelihood that the problem will recur
RCA focuses on identifying and correcting underlying causes rather than just addressing symptoms.
What does a root cause typically relate to?
A process or system that has a potential for redesign to reduce risk
Root causes are not typically linked to individual errors.
What are the three basic questions RCA is designed to answer?
- What happened?
- Why did it happen?
- What can be done to prevent it from happening again?
These questions guide the RCA process for thorough analysis.
True or False: RCA is primarily focused on preventing individual errors.
False
RCA aims to redesign processes or systems rather than focusing on individual error prevention.
What does the Joint Commission require healthcare agencies to perform RCA for?
All unexpected occurrences involving death or serious physical or psychological injury, known as sentinel events
This requirement emphasizes the importance of RCA in healthcare safety.
Fill in the blank: RCA provides an organized structure for analysis of _______.
[errors]
This structure helps in systematically addressing the problems.
What is a culture of safety in a nursing unit?
A way of thinking, behaving, or working that improves patient outcomes and encourages staff collaboration.
What is the key point of a culture of safety?
Nurses practice in an environment where all staff work together to create a safe unit, disclose errors without fear, and address safety concerns.
What is one key component of a culture of safety?
Team empowerment.
Define team empowerment in the context of a culture of safety.
Every individual has the opportunity to be heard, feel important, and be a valued team member.
What role does communication play in a culture of safety?
Open and honest lines of communication are needed between team members and from the team to other hospital units.
How does transparency contribute to a culture of safety?
Team members eliminate rumors and operate with only the facts, contributing to mutual team goals.
What does accountability mean in a culture of safety?
Staff claim ownership for human error and are willing to disclose it and help prevent similar errors.
Fill in the blank: In a culture of safety, team members work together to create a _______.
[safe unit]
True or False: In a culture of safety, staff are encouraged to hide errors to avoid repercussions.
False
List three key components of a culture of safety.
- Team empowerment
- Communication
- Transparency
What are common causes of equipment-related accidents?
Equipment malfunction or improper use
Examples include suction devices and infusion pumps not working properly, incorrect transport of oxygen cylinders, and wheelchairs or beds not locked during transfers.
What is the sixth highest-ranked patient safety risk according to the ECRI Institute?
Cognitive overload that can distract or desensitize clinicians or prompt them to use improper notification settings
What are the three common scenarios that lead to missed alarms?
- The medical device does not detect the alarm condition
- The alarm is not communicated to a medical practitioner
- The alarm is communicated but not adequately addressed
What is alarm fatigue?
When nurses become overwhelmed by the number of alarm signals and begin to ignore, delay response to alarms, or deactivate them
What serious consequences can result from missed alarms or delayed responses?
Sentinel events, including patient deaths
What has The Joint Commission named as a National Patient Safety Goal?
Alarm desensitization
Fill in the blank: Thousands of _______ go off every day in hospitals.
alarms
True or False: Alarm fatigue can lead to improved patient safety.
False
What does CUS stand for in the context of safety communication?
C—state your concern, U—say why you are uncomfortable, S—state ‘this is a safety issue’
CUS words are used to articulate concerns effectively.
What is meant by ‘stopping the line’?
Calling for a preprocedure ‘time-out’ when there is a concern
This is a critical safety step to prevent errors.
What should you do if a safety issue needs escalation?
Communicate through the appropriate chain of command
This ensures that the issue is addressed by the right individuals.
What is the importance of being open and transparent?
It fosters trust with patients, families, and colleagues
Transparency is vital for effective communication in healthcare.
What are safety huddles?
Quick conversations with a focus on safety
These discussions help reinforce safety priorities among staff.
What is the purpose of opening meetings with the topic of safety?
To allow time for stories and concerns
This practice encourages a culture of safety and open dialogue.
What does SBAR stand for?
Situation, Background, Assessment, Recommendation
SBAR is a structured communication tool used in healthcare.
What does validating and verifying involve?
Having a second nurse check when unsure
This practice enhances accuracy and reduces errors.
What is meant by 200% accountability?
Calling other nurses or healthcare disciplines on handwashing or use of personal protective equipment
This emphasizes the shared responsibility for safety.
What should be reported in a safety culture?
Both actual and ‘near miss’ medication errors, policy deviations, treatment and outcome variations, and adverse events
Reporting is essential for learning and improving safety.
What is the role of the Patient and Caregiver Safety committee?
Participating in your organization’s committee to enhance safety
Engaging in these committees helps drive safety initiatives.
What is the primary cause of fire in a healthcare agency?
Anesthesia or improperly grounded or malfunctioning electrical equipment
Smoking is less often the cause but still considered a hazard.
What policies do most healthcare agencies have in place?
Policies for preventing electrical hazards
These policies aim to mitigate risks associated with electrical equipment.
What role do patients and visitors play in fire hazards?
They may break the rules, contributing to hazards
This includes actions like smoking in prohibited areas.
What is typically announced when a fire occurs?
An announcement is made over the communication system
Common phrases used include ‘Code Red’ or ‘Code Yellow’.
What is the purpose of using codes like ‘Code Red’ or ‘Code Yellow’ during a fire?
To prevent panic among patients and visitors
These codes are designed to convey urgency without causing alarm.
What may the fire announcement ask visitors to do?
Leave the building
This is part of the emergency protocol to ensure safety.
What is a restraint?
A device or method used for the purpose of restricting a patient’s freedom of movement or access to his body, with or without his permission.
Restraints can include physical force, mechanical devices, or chemical restraints.
What are examples of mechanical restraints?
Examples include:
* Cloth vest
* Siderails
Mechanical restraints are physical devices used to restrict movement.
What is a chemical restraint?
Sedatives and psychotropic medications given to control disruptive behavior.
Chemical restraints are used to manage a patient’s behavior rather than a physical condition.
Are casts and traction considered restraints?
No, casts and traction are not considered restraints.
Restraints are specifically devices or methods that limit movement or access.
Is the physical holding of a patient always considered restraint?
No, physical holding of a patient is not always considered restraint.
It may be necessary for routine physical examinations or tests.
What are the two classifications of restraints?
Restraints are classified into:
* Medical-surgical restraints
* Behavior management restraints
These classifications are based on the reason for their use.
What are the Medicare guidelines regarding restraints?
Medicare has specific guidelines for each circumstance, with stricter guidelines for behavior management restraints.
Compliance with these guidelines is important for healthcare providers.
Who are traditionally restrained by nurses?
Highly dependent older adults, patients with poor mobility, impaired cognition, and others judged to be at risk for falls.
Nurses assess risk factors to determine the need for restraints.
What is the impact of restraints on care time?
Restraints make care more time consuming
Restraints do not reduce falls.
Do restraints reduce the likelihood of falls?
No, restraints do not reduce falls
Restraints can actually increase the likelihood of injury.
What are some potential physical effects of restraints?
Potential physical effects include:
* Pressure injuries
* Contractures
* Loss of strength
* Affects nearly every body system
Restraint-imposed immobility can lead to serious health issues.
What can happen to a restrained person due to their natural tendency to struggle?
They can become entangled, suffer nerve damage, circulatory impairment, or even suffocate
Struggling against restraints can lead to serious injuries.
What are some potential emotional effects of using restraints?
Potential emotional effects include:
* Anger
* Fear
* Humiliation
* Diminished self-esteem
Emotional distress can significantly impact the individual’s mental health.
True or False: Restraints enhance safety for patients.
False
Restraints are considered a safety hazard.
What is the impact of less restraint use according to research?
Saves time and money and reduces patient injuries
(Bauer & Weust, 2017; Chou et al., 2019)
What do the ANA and other healthcare organizations establish regarding restraint use?
Evidence-based guidelines that show a restraint-free environment is the standard of care
What must be provided when the decision is made to avoid restraints?
Alternatives for keeping the patient safe
What is a key point regarding restraints and patient behavior?
Restraints never resolve the underlying problem; addressing the reason behind the patient’s behavior is key to calming the patient
(Springer, 2015)
What does The Joint Commission encourage healthcare facilities to promote?
A commitment to reduce the use of restraints and seclusion among all direct-care staff
What should caregivers do before participating in any restraint-related activity?
Receive education
How should restraint episodes be documented?
Specifically and in detail
What is recommended for monitoring patients in restraint and seclusion?
Maintain one-to-one viewing of patients
Who should be included when deciding to explore new technology as an alternative to traditional restraint devices?
Staff members
What should facilities budget for regarding patient care?
An adequate number of qualified staff to attend to patients
What are the two main reasons for using restraints in a healthcare setting?
To support medical healing or for a behavioral health reason
What should be utilized instead of restraints whenever possible?
Technology (such as bed alarms) and better anticipation of patient needs
What is required for the use of restraints according to Medicare and The Joint Commission?
Restraints must be medically prescribed and all less restrictive interventions must be tried first
Fill in the blank: Restraints must be _______ prescribed.
[medically]
True or False: Restraints can be used without trying less restrictive interventions.
False
What does CMS stand for in the context of healthcare standards?
Centers for Medicare & Medicaid Services
According to CMS standards, how can siderails be classified?
As a restraint
When is a full-length siderail considered a restraint?
When it is used to prevent the patient from getting out of bed
What is the role of half- or quarter-length upper siderails when used by a patient?
Aid to independence
Under what condition are split rails not considered restraints?
If a patient requests them to feel more secure
How might older or cognitively impaired adults perceive siderails?
As a barrier rather than a reminder for assistance
What have several studies shown regarding the use of siderails?
They may lead to serious falls and injuries
What recommendation have healthcare providers made regarding the routine use of siderails?
That siderails not be used routinely
Fill in the blank: A full-length siderail is considered a _______ when used to prevent a patient from getting out of bed.
[restraint]
True or False: A half-length siderail is always considered a restraint.
False
What is mercury?
A heavy, odorless, silver-white liquid metal
Mercury is toxic in both acute and chronic exposure.
How can mercury be absorbed into the body?
Inhaled, ingested, or absorbed through the skin
Mercury accumulates in muscle tissue.
What disorders can mercury exposure cause?
Renal and neurological disorders
Especially harmful to fetuses and neonates.
Why is mercury appealing to children?
Its shiny color and ability to form beads or balls
This can lead to accidental exposure.
List some products that contain mercury.
- Thermometers
- Thermostats
- Batteries
- Fluorescent light bulbs
- Blood pressure devices
- Electrical equipment and switches
What program has been sponsored since 1998 to address mercury waste in healthcare?
A program by the American Hospital Association and the EPA to eliminate mercury-containing waste
Aims to prevent mercury from entering the environment.
Are mercury thermometers still being manufactured in the United States?
No
Some people may still have them in their homes.
What do some hospitals do with mercury thermometers?
Conduct thermometer exchanges, providing free or low-cost nonmercury thermometers
Encourages safe disposal of mercury thermometers.
What regulations must healthcare facilities follow regarding mercury spills?
Have policies and procedures for hazardous waste spills
Required by The Joint Commission, the EPA, and OSHA.
True or False: You are likely to encounter mercury exposure in acute care and ambulatory agencies.
False
Mercury exposure is not common in these settings.
What are the acute effects of mercury toxicity?
Symptoms include chills, nausea, malaise, chest tightness and pain, dyspnea, coughing, stomatitis, gingivitis, excess salivation, and diarrhea
High levels can cause severe respiratory irritation, digestive disturbances, and severe renal damage.
What specific health effects can result from inhalation of mercury?
Respiratory damage, wakefulness, muscle weakness, anorexia, headache, ringing in the ears, chest pain, inflammation of the mouth, and pneumonitis.
What are the potential effects of mercury exposure on the eyes?
Eye irritation and corrosion.
What skin-related issues can arise from mercury exposure?
Skin irritation and allergic dermatitis.
What is a potential gastrointestinal effect of mercury ingestion?
Intestinal obstruction.
What are the chronic effects of mercury exposure primarily affecting?
Nervous system.
List the symptoms of chronic mercury exposure.
Numbness or tingling of the hands, lips, and feet; behavior and personality changes.
What other chronic symptoms can result from mercury exposure?
Fatigue, weakness, anorexia, weight loss, and gastrointestinal disturbances.
What does OSHA require employers to do regarding workplace injuries?
Employers must show employees how to report a workplace injury and prohibit discrimination against employees who make such reports.
OSHA stands for the Occupational Safety and Health Administration.
Why is it important to report a workplace injury?
To help pinpoint trends and areas of need in safety and ensure necessary treatment and follow-up.
Reporting injuries can enhance workplace safety and employee health.
Which occupation is consistently listed among the top 10 for work-related musculoskeletal disorders (MSDs)?
Nursing personnel.
This is based on statistics from the Bureau of Labor Statistics.
What is the range of frequency of back pain in nurses according to a literature review?
Between 40% and 97.9%.
This statistic is cited from research by Tosunoz & Oztunc (2017).
What activities in nursing are most likely to cause back injuries?
Transferring patients, weighing patients, lifting patients in bed, repositioning patients, and changing bed linens.
These activities often involve bending and twisting of the torso.
Have healthcare facilities consistently implemented safe patient handling guidelines?
No, they have not consistently implemented these guidelines and laws.
What organization developed national standards for safe patient handling in healthcare agencies?
The American Nurses Association (ANA).
This was highlighted in a study by de Castro et al. (2006).
What is one goal of the ANA regarding workplace safety?
To create a culture of safety by requiring employers to develop a safe handling and moving program.
This includes policies, appropriate equipment, training, and accommodations for injured employees.
What does the ANA encourage nurses to do in relation to safe handling measures?
Actively participate in creating and implementing safe handling measures and promptly report hazards, incidents, and injuries in a blame-free environment.
Fill in the blank: Most often, the MSD in nursing involves the _______.
shoulders and back.
True or False: Reporting an injury can help identify safety trends.
True.
What should you always do after a needlestick injury?
Report the injury
Reporting helps pinpoint trends and ensures necessary treatment and follow-up.
Who primarily suffers from needlestick injuries in healthcare?
Healthcare workers, mostly nurses and housekeeping staff
Up to 1 million injuries occur per year.
What infectious diseases are healthcare workers at risk for due to needlestick injuries?
Hepatitis B and HIV
What percentage of sharps injuries are experienced by surgeons?
About a quarter
What federal act requires employers to maintain a log of sharps injuries?
Needlestick Safety and Prevention Act
What did the passage of the Needlestick Safety and Prevention Act result in?
Needlestick injuries declined by more than 36%
This decline occurred during the 3-year period following the law’s passage.
How many needlestick injuries and other sharps-related injuries occur each year, according to OSHA estimates?
385,000
What is the average number of sharps injuries per day in U.S. hospitals?
Approximately 1,000
List three risk factors that increase the likelihood of needlestick injuries for nurses.
- Working in stressful environments
- Working varying or long shifts
- Having a low skill level
What are other risk factors for needlestick injuries?
- Lack of protective equipment
- Recapping needles
- Working in areas with high needle use
True or False: Some employers have completely complied with OSHA regulations regarding needlestick injuries.
False
Fill in the blank: The risk of needlestick injury increases for nurses who work _______.
in stressful environments
What is radiation?
The process of emitting radiant energy in the form of waves or particles.
What type of radiation is used in CT scans?
Ionizing radiation.
In which medical fields is ionizing radiation used?
- Diagnostic radiology
- Radiotherapy
- Nuclear medicine
Why are patients exposed to radiation?
During diagnostic tests and certain medical treatments.
Are healthcare workers exposed to radiation?
Yes, they are unavoidably exposed to small doses of radiation.
What precautions should be taken during x-ray procedures?
Avoid excessive radiation exposure for the patient and yourself.
What are the principles to follow when caring for a patient with an internal radioactive implant?
- Time: Limit the amount of time with the patient
- Distance: Perform only necessary care near the patient
- Shielding: Wear protective shielding if available
What does the principle of ‘Time’ refer to in radiation care?
Organizing nursing care to limit the amount of time with the patient.
What does the principle of ‘Distance’ imply in radiation safety?
Perform near the patient only the nursing care that is absolutely necessary.
What is the purpose of wearing a lead apron?
To provide protective shielding from radiation.
What should healthcare workers wear if they deliver care that exposes them to radiation regularly?
A film badge to indicate any radiation exposure.
What is the impact of violent acts on healthcare workers?
Injuries, higher-than-average staff turnover, increased requests for medical leaves, unusually high levels of time-off and attendance issues, and stress-related illnesses
Yang et al., 2018
True or False: Hospital security is always sufficient to protect healthcare workers from injury during violent incidents.
False
Security may not be sufficient, especially during violent outbreaks among patients, visitors, and staff.
In which environment is the risk of violence particularly high?
Crowded or chaotic environments, such as the emergency department
The emergency department has 24-hour accessibility and can be crowded and chaotic.
What emotional states may lead to violence in healthcare settings?
Anxiety and anger
These emotions can arise from the stress of an acute illness.
What is a key point regarding the escalation of violence?
Violence typically begins with anxiety and escalates from verbal aggression to physical aggression
Relieving a patient’s anxiety may help halt the progression to physical violence.
What conditions can increase the risk for patient aggression?
Certain emotional and physical conditions
Refer to ‘Assessing the Risk for Violence’ for more details.
How does gang activity influence violence in healthcare settings?
Increases the likelihood that gang members will be treated in the emergency department or admitted to the hospital
Copeland & Henry, 2017
What is a common cause of accidents in the home?
Fire, poisoning
These are examples of environmental safety hazards that can occur in residential settings.
What is the purpose of a home safety checklist?
To identify potential hazards
Such checklists can be found through an Internet search for ‘home safety checklist’.
What does the safety assessment scale (SAS) evaluate?
Dangers for cognitively impaired individuals
It assesses risk for injury and the capability of the individual to perform activities of daily living independently.
What two key aspects does the SAS assess?
- Risk for injury
- Capability to take medications and perform ADLs
ADLs refers to activities of daily living.
What should be done as part of the routine assessment of older adults?
Ask about falls
This should include inquiries to both the patient and caregivers.
What test should be used if there is a history of falls?
Get Up and Go test
This test helps identify the need for further evaluation.
When should a Timed Up and Go test be referred to a practitioner?
If there is difficulty with ambulation or a history of falls
Practitioners should have advanced skills and experience for comprehensive fall evaluation.
What is the recommendation for primary care providers regarding the Timed Up and Go test?
Perform it annually for patients over age 65
This is to assess fall risk.
Fill in the blank: The safety assessment scale (SAS) is used to evaluate dangers incurred by people with _______.
[memory and cognitive deficits]
True or False: The SAS can be used to assess whether an individual can live independently.
True
It evaluates independence in performing activities of daily living.
What should you be prepared to do if you recognize risk factors for violence?
Intervene and perhaps prevent violence
Reference: Arnetz et al., 2015; Copeland & Henry, 2017
List factors that increase the risk for aggression.
- Mental disorders (dementia, delirium, schizophrenia, bipolar disorder)
- Influence of alcohol or drugs
- Withdrawal from alcohol or drugs
- History of violence
- Clinical conditions (high fever, epilepsy, head trauma, hypoglycemia)
These factors can significantly contribute to aggressive behavior.
What are signs of anxiety to assess for?
- Agitation and restlessness
- Pacing
- Talking loudly, speaking rapidly
- Gesturing widely
- Verbal aggression (threats, sarcasm, swearing)
Recognizing these signs can help in assessing the risk for violence.
True or False: A history of violence is a factor that increases the risk for aggression.
True
Fill in the blank: Clinical conditions such as high fever, epilepsy, head trauma, and _______ can increase the risk for aggression.
hypoglycemia
