Physical and emotional safety of the patient Flashcards
Pt post fall Rt #DR dun use a cane at home as their Rt hand is casted
lots of debris on floor
Identify the safety issue
- Hx of fall
- Clutter in the environment
- Difficulty walking without a cane
Respond to the safety issues
Take the necessary steps:
- Understand the Pt Hx of fall and provide specific strategies to address the reason
- Fall prevention: remove items off the floor to avoid tripping hazards
- Use the cane in their Lt hand/Gutter Crutch
Be transparent
Communicate effectively
- I would tell the Pt that I feel they are high risk for another fall and I am concerned about their welfore
- Any additional supports to rely on from others involved in care with whom I can liaise with
- Opportunity to ask questions
Document the safety issues
- Safety issue
- Plan of action
- Any non-compliance by Pt
Druing ambulation exercise, one of the horizontal bar of the parallel bars lossen
Safety issue:
- Equipment maintenance issue
- Failure to inspect the equipement before its tuse
Respond, communicate with Pt, Colleague
- Stop the Pt from using the parallel bars (WC to let the Pt sit down)
- Let the Pt know the parallel bars appear loose and cannot be used until they are serviced
PT should have inspect the equipment prior to its use (ensure good working order before being used in therapy)
- Liaise with team management imediately to let them know of the safety issue
- Place a sign on the bars stating ‘out of order’ to inform other PT who use the gym
Documentation
- Equipement safety issue, steps taken after identifying the issue
Mild dementia Pt return to long-term care home after THR.
When PT come to assess Pt, Pt is disoriented and in extreme pain, hip appears red and swollen but PT assume is normal post-op finding.
He decided to return later in the afternoon to see whether the Pt is feeling better.
Safety issue
- Failure to assess Pt & provide necessary care
- Failure to liaise with team member
The wrong action
- Should not simply assume that the Pt’s status was ‘normal’ post-op finding (imcompetent)
- Redness, swollen, extreme pain–>can be indicating an infection
Correct action
- Liaise with team member (physician/nurse) to report the finding
- Advise the team mebmers about the Pt’s extreme pain & red, swollen hip
call/request records form the hospital that the Pt was discharged from
- FU with the Pt and the team regarding investigation & outcomes
- PT should have documented all interactions
A PT colleauge did not follow contact precaution for a C.diff Pt, plus the label for contact precaution is not clear
Issue:
- Infection transmission
- Poor signage to identify ‘contact precaution’
- Lack of PT knowledge/insight (PT may be unaware that they are required to wear PPE, or don’t care (poor professionalism)
Respond, communicate
Infection transmission
- Stop the PT from entering the shared Rx room to ensure safety
- Advise them that they just worked with a Pt with C.diff and offer to grab them a set of scrubs–>change clothing to prevent any infection transmission
Poor Signage
- Advise the admin staff that there needs to be clear signage at the front of the private room when precautions are in place
Lack of PT knowledge and/or insight
- Talk to my supervisor and advise them of this situation–>to intervene if a Pt’s safety is in jeopardy
Communication
- Administrative staff regarding the issues
- Advise your manager of the issue
Documentation
- Follow the hospital’s policies and procedures with repect to documenting potential safety issues around improper signage and a potential breach of infection transmission policies
Pt say they want to suicide
Safety issue
- Pt’s wellbeing and potential for self-harm
Respond
- Take necessary steps
Address my Pt’s comments immediately
Ask some probing questions to determine the degree of danger
- Is this statement due to stress?
- Do you have a suicide plan?
- Is this something you have attempted before?
- Do you have anyone to talk to?
- I would let them know that I am concern about them
- I would encourage them to talk to someone and offer resources (beyond my SOP so I want to refer them to the proper services)
If imminent danger
- Break confidentiality out of duty to prevent harm and out of serious concern for their wellbeing
- Let them know that I was going to call a crisis line to create a plan of action
- Inform their family phyisican/family involved their care (within circle of care)–>shared with proper healthcare professional
If not imminent danger
- I will no break confidentiality based on a duty to prevent harm
–>Encourage the Pt to talk to someone and provide resources form professionals in the area
Documentation
Document all interactions and the actions tht were taken
Pt’s mother use yoga wedges to prop the Pt up by her armpits to encourage Pt sitting
Safety issue
- Potential injury to the child
*intentions are good, but not a safe option to promote sitting
Take action & communication
- Educate the mom on the reasons why she should not prop her daughter up by her armpits
(stress on nerves in armpit, no support in trunk and head, block could fall out and child could fall over and injuried)
- Alternative means of support: hands on cueing, proper sitting devices
Documentation
- the interaction and action taken
Pt almost fall during a virtual session, but the goal is to walk again.
Safety issue
- Poor balance and insistence on ambulation
- PT’s inability to provide necessary physical assistance
Respond
- Stop the Rx as safe delivery of care is a concern. Virutal session is not the best option.
- Although it is important to work toward my Pt’s goal, I must ensure the safety as the Pt is at high risk of falling
Be transparent
- Educate the Pt on the limitation of virtual practice and try to provide alternative to maximize the effectiveness of care and ensure safety
1. Continue but find another family member who can provide assistance during ambulation practice
2. If they have a family member/friend who can drive them to the clinic for in-person PT session. If not–>provide local ON transportation resources such as Handi-Transit
3. I would offer in-home PT service
4. If unable–>a list of options for home PT
Documentation
- Safety issue, discussion, options provided to the Pt, plan of action
Pt showing cancer red flag
Safety Issue
- cancer red flags in the Pt’s clincial presentation
Respond
- Instead of assess & treat this Pt–>assess and refer them back to their family physician
PT must be able to identify situations where there may be a need for a referral back to a family physician if suspected issue is beyond the PT SOP, critical for Pt safety
- Not medica emergency–>finish my PT Ax to ensure I am being thorough with my Ax and findings
- After Ax–>refer this Pt back to their family physician
- I would not attempt to Dx this Pt as this is beyond my SOP
Transparent
- I would advise the Pt to return to their family physician for more investigation as this may not a be a concern that can be treated by PT
- Send a letter to the Pt’s family phyisican highlighting my findings and reason for referral (Inform my Pt of the referral letter)
Documentation
- Document all my Ax findings, Pt recommendations, referral note, document when the referral back to family physician was made
PTA conduct bed and standing exercise, later on email PT about Pt reporting dizziness during standing exercise and can’t perform some of them
PT: allow rest during session, FU next week
PT ensured safe therapeutic environment for the Pt?
NO
- PTA is reporting issue with the current HEP due to Pt’s dizziness
- PT is required to properly supervise the PTAs that are working with them (now poor supervision)
PT should act immediately to provide effective direction for the PTA to discontinue all standing exercises until re-assessment
PT should also FU ASAP to re-assess the Pt and create a new & safer HEP
Failure to properly supervis PTAs and the Pt–>major safety concern
Pt under influence of drugs and want to drive back home
Refuse to treat
- Uncertain if they could provide informed consent if cognitively influenced by the drugs
- Not able to rely on the Pt’s feedback during Rx if they were under influence of drugs.
- I could potentially hurt the Pt by pushing an exercise too far if they were unable to give me reliable feedback.
Stop the Pt from driving
- Advise the Pt that they should not drive while under the influence and would request that they find an alternative way to get home (taxi)
- If Pt refuse, I would avoid any altercation and call the police as driving under a drug influence is illegal and puts lives in danger.
Abuse of a Pt of sound mind and independent in retirement home
- Pt is of sound mind but they reside in a retirement home
- Any know and suspected abuse in a retirement home, long-term care facility or nursing home must be reported–>to local authorities (e.g. police)
Document my observation and my actions
If the Pt is abused by her husband also lives in the retirement home
- Same action!!
- up to the authorities to investigate the matter to ensure the Pt’s safety moving forward (e.g. update policy to ensure safety of all resident
Adult Pt (independent): experiencing sexual abuse in their personal life, want to keep confidential.
Difficult situation
* Pt is capable or not? Yes
* Pt is at risk of immediate harm? No
Outcome: respect their wish
Offer the Pt some supportive resources within their community
If abused by a colleague
* Abuse by a regulated health professional
* Break confidentiality and make a mandatory report to the College
13 yo mature minor suspected abuse, request keep sercet.
All case of suspected/know abuse of a minor under age of 16 must be reported
- advise the Pt that I have a duty to disclose this situation to the proper authorities
- Any suspected abuse of a minor must be reported to ensure a minor’s safety
- Call proper authorities (e.g. social service, local police) to inform them of the situation
Document the interaction and all actions taken
16 yo mature minor, self harm due to stress, request keep sercet.
No need mandatory report as the Pt is 16 yo (only UNDER 16 yo is mandatory)
I am still allow to report this as the Pt is still a minor. For this reason and to ensure the safety of my Pt, I would choose to break confidentiality and disclose this information to their legal guardian/physician
- Regardless whether the Pt’s life was in imminent danger or not, I would break confidentiality and disclose this information as the Pt is a minor
Colleague Dx as Alzheimer’s and unsure how to open a 2 wheeled walker
Ask to keep confidential
Safety risks
- Suspected incapacity of my colleague due to cognitive changes
- Their health condition may affect their ability to provide safe Pt care
E.g. Put a Pt in a compromised position resulting in injury as they are unable to make informed decisions regarding their PT’s care
Direct report to College & supervisor
- act immediately and report my concerns to the College as well as the head of PT Dept.
Any know/suspected PT incapacity/incompetence must be reported to the provincial College under which the PT is registered
- Even though my colleague has requrested that I say nothing–>not safe to wait as Pt can be injured in the meantime
Document the situation and the actions I took
