Risk Management Flashcards
What risks do the NSQHS standards aim to minimise by following proper admission procedure?
Pressure injuries Falls Poor nutrition Malnutrition Cognitive impairment Unpredictable behaviours
What are the common components of a patient’s medical record while in hospital?
Observation charts Progress notes Medication chart Pressure injury assessment Falls risk assessment Deep Vein Thrombosis (DVT) Assessment Investigation requests Referral requests
What are the goals of a successful patient discharge?
Avoiding readmission and smoothly transitioning the patient back into their life before their time in hospital
What are the components of a discharge summary function on a patient’s MyHealth record?
Current medication list
Summary of why they were admitted
List of investigations carried out and their results
Overview of treatment received
Recommendations for GPs and Allied health professional to follow up on
What is a pressure injury?
Localised injury to skin which usually occurs over a bony prominence due to pressure, shear and friction where this area has contact with a surface like a hospital bed.
What factors place patients in hospital at higher risk of developing pressure injuries?
Immobility Increased moisture (incontinence) Malnutrition Obesity Smoking
What are the possible effects of pressure injuries?
Increased morbidity Increased mortality Pain Reduced mobility Loss of independence Lost work time
Stage 1 pressure injury
Non blanchable erythema (redness) of intact skin
Stage 2 pressure injury
Partial thickness skin loss with exposed dermis. Viable pink or red wound bed that is moist. May be an intact or non-intact blister
Stage 3 pressure injury
Full thickness skin loss. Adipose (fat) tissue visible, granulation and rolled wound edges may be present. Depth of wound dependent on the location
Stage 4 pressure injury
Full-thickness loss of skin and underlying tissue. May expose connection tissue, muscle, ligaments, cartilage and bone
Unstageable pressure injury
Obscured full-thickness skin and tissue loss. The extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar (dead tissue)
Name the three scales for tracking and preventing pressure injuries
Braden Scale
Norton Scale
Waterlow Scale
What strategies can be implemented to mitigate the risk of pressure injury development
Regular skin inspections
Maintain skin hygiene
Avoid rubbing or massaging bony prominences
Prevent friction and shear
Monitor patient’s nutrition and hydration
Encourage patients to move every two hours redistribute their weight
Keep skin dry
Falls prevention in a patient with poor vision
Ensure they have functional glasses
Ensure appropriate lighting
Mark doorways and edges
Keep a tidy environment
Falls prevention in a patient with cognitive disfunction
Set safe limits to activities
Remove unsafe objects
Falls prevention in patients with impaired gait or balance
Wear well fitted shoes with non-slip soles
Use walking aids where necessary (walking stick, crutches etc.)
Assistance with ambulation
Monitor gait and balance
Adapt living arrangements
Encourage safe physical activity to maintain muscle strength
Ensure uncluttered environment
Falls prevention in patients who have trouble getting in and out of bed
Encourage them to request assistance
Keep the bed in low position
Install grab bars in bathroom
Provide raised toilet seat
Falls prevention in patients with orthostatic hypotension
Instruct patients to rise slowly from lying or sitting positions and wait several seconds before walking
Falls prevention in patients with urinary urgency or receiving diuretics
Provide bedside commode
Assist with voiding on a regular and scheduled basis
Falls prevention in patients with weakness from disease or therapy
Encourage them to request help
Monitor activity tolerance
Falls prevention in patients receiving sedatives, analgesics, tranquilisers and narcotics
Attach side rails to bed where appropriate
Keep bed in lowest position
Monitor orientation and alertness status
Discuss how alcohol relates to falls
Encourage review of contributing medications
What are the 6 P’s of falls prevention?
Pain Position (how far is toilet from bed?) Personal needs Pathway Possession (walking aids within reach) Plan
Why is it important to document both near misses and adverse events relating to falls?
Because all falls are considered to happen for a reason and near misses provide an opportunity to ensure that factors that contributed to the risk are minimised
