Risk Management

Question 1

What risks do the NSQHS standards aim to minimise by following proper admission procedure?

Answer 1

Pressure injuries
Falls
Poor nutrition
Malnutrition
Cognitive impairment
Unpredictable behaviours

Question 2

What are the common components of a patient’s medical record while in hospital?

Answer 2

Observation charts
Progress notes
Medication chart
Pressure injury assessment
Falls risk assessment
Deep Vein Thrombosis (DVT) Assessment
Investigation requests
Referral requests

Question 3

What are the goals of a successful patient discharge?

Answer 3

Avoiding readmission and smoothly transitioning the patient back into their life before their time in hospital

Question 4

What are the components of a discharge summary function on a patient’s MyHealth record?

Answer 4

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

Question 5

What is a pressure injury?

Answer 5

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.

Question 6

What factors place patients in hospital at higher risk of developing pressure injuries?

Answer 6

Immobility
Increased moisture (incontinence)
Malnutrition
Obesity
Smoking

Question 7

What are the possible effects of pressure injuries?

Answer 7

Increased morbidity
Increased mortality 
Pain
Reduced mobility 
Loss of independence 
Lost work time

Question 8

Stage 1 pressure injury

Answer 8

Non blanchable erythema (redness) of intact skin

Question 9

Stage 2 pressure injury

Answer 9

Partial thickness skin loss with exposed dermis. Viable pink or red wound bed that is moist. May be an intact or non-intact blister

Question 10

Stage 3 pressure injury

Answer 10

Full thickness skin loss. Adipose (fat) tissue visible, granulation and rolled wound edges may be present. Depth of wound dependent on the location

Question 11

Stage 4 pressure injury

Answer 11

Full-thickness loss of skin and underlying tissue. May expose connection tissue, muscle, ligaments, cartilage and bone

Question 12

Unstageable pressure injury

Answer 12

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)

Question 13

Name the three scales for tracking and preventing pressure injuries

Answer 13

Braden Scale
Norton Scale
Waterlow Scale

Question 14

What strategies can be implemented to mitigate the risk of pressure injury development

Answer 14

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

Question 15

Falls prevention in a patient with poor vision

Answer 15

Ensure they have functional glasses
Ensure appropriate lighting
Mark doorways and edges
Keep a tidy environment

Question 16

Falls prevention in a patient with cognitive disfunction

Answer 16

Set safe limits to activities

Remove unsafe objects

Question 17

Falls prevention in patients with impaired gait or balance

Answer 17

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

Question 18

Falls prevention in patients who have trouble getting in and out of bed

Answer 18

Encourage them to request assistance
Keep the bed in low position
Install grab bars in bathroom
Provide raised toilet seat

Question 19

Falls prevention in patients with orthostatic hypotension

Answer 19

Instruct patients to rise slowly from lying or sitting positions and wait several seconds before walking

Question 20

Falls prevention in patients with urinary urgency or receiving diuretics

Answer 20

Provide bedside commode

Assist with voiding on a regular and scheduled basis

Question 21

Falls prevention in patients with weakness from disease or therapy

Answer 21

Encourage them to request help

Monitor activity tolerance

Question 22

Falls prevention in patients receiving sedatives, analgesics, tranquilisers and narcotics

Answer 22

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

Question 23

What are the 6 P’s of falls prevention?

Answer 23

Pain
Position (how far is toilet from bed?)
Personal needs
Pathway
Possession (walking aids within reach)
Plan

Question 24

Why is it important to document both near misses and adverse events relating to falls?

Answer 24

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