Safety

Question 1

What is the definition of safety?

Answer 1

Freedom from psychological & physical injuries
It is a basic human need that must be met.

Question 2

What are the safety risks for infants & children?

Answer 2

They like to explore (Ex. baby proofing); like to climb (fall risk); poisoning (eat whatever they can get their hands on); drowning (cannot be unsupervised); car seat safety

Question 3

What are the safety risks for adolescents?

Answer 3

Seeking independence & lack of fear (risk-taking behaviours); drowning; automobile accidents; substance abuse (vaping, smoking, drinking)

Question 4

What are the safety risks for adults?

Answer 4

Lifestyle habits (workplace hazards); alcohol & substance abuse

Question 5

What are the safety risks for older adults?

Answer 5

Lifestyle habits (workplace hazards); alcohol & substance abuse
Older adults – physiological & social changes; fall risk

Question 6

What is the focus of safety for infants & children?

Answer 6

Sleep position & safe supervision; child-proofing; toilet seat locks (drowning risk); poison prevention; bike helmet safety; water safety (Ex. life jackets); stranger danger; allergy awareness

Question 7

What is the focus of safety for adolescents?

Answer 7

Effects of alcohol & drugs; drivers education & car safety; safe sex & contraception, STI awareness; online media safety; mental health support

Question 8

What is the focus of safety for adults?

Answer 8

Workplace violence; smoking cessation & awareness; substance use & abuse; interventions for mental health

Question 9

What is the focus of safety for older adults?

Answer 9

Safe medication; falls; maintaining good health (physical & social activity)

Question 10

What are some risks to patient safety in a HC setting?

Answer 10

• Patient-inherent accidents
• Equipment-related accidents
• Procedure-related accidents
• Falls

Question 11

What are some workplace safety risks in a HC setting?

Answer 11

• Infectious agents
• Hazardous substances
• Violence

Question 12

What are the top 3 causes of death in Canada?

Answer 12

1. Cancer
2. Heart disease
3. Patient safety issue

Question 13

How often does someone die from a preventable patient safety issue in Canada?

Answer 13

Every 13 minutes

Question 14

What is the most prevalent patient safety incident in the acute care system in Canada?

Answer 14

Falls & infections

Question 15

What is a PSI (patient safety incident)?

Answer 15

PSI is a preventable unintended outcome of care caused by medical management or complication rather than by the underlying disease itself, resulting in prolonged healthcare, disability, or death

Question 16

What is a sentinel event?

Answer 16

Severely harmed psychologically or physically, or killed, due to an unintended outcome of care

Question 17

What is a preventable adverse event? Example?

Answer 17

An error that could cause harm that we know of
- Ex. vancomycin administered too fast = vancomycin reaction syndrome (red man syndrome – flushed, hypertensive); given antihistamines to correct

Question 18

Discuss the Swiss Cheese accident model.

Answer 18

Defences against incidents:
- procedures, physical barriers, information, decisions
Holes:
- poor protocols, faulty equipment, missing info, inadequate supervision

Question 19

Incidents related to medication often occur because of…

Answer 19

• Labels (similar labels, can run into trouble)
• Illegible writing
• Unapproved abbreviations
• Symbols

Question 20

What is a fall? What are the different types of ‘fallers’?

Answer 20

A fall is an abrupt, uncontrolled, downward change in position in which potential for injury exists or actual injury occurs
Near fall – potential fall that is prevented through purposeful actions
Repeat faller – has had 2 or more falls in the last 3 months

Question 21

What puts someone at risk for falls?

Answer 21

Physiological changes due to aging
Pt hospitalization; surgery, medication (side effects Ex. dizziness)
Disease processes
Vision & hearing changes

Question 22

What is the BEEEACH fall reduction model?

Answer 22

B = behaviour change
E = education
E = equipment
E = environment
A = activity
C = clothing & footwear
H = health management

Question 23

How do you determine safety in the assessment section of the nursing process?

Answer 23

Ask about…
- Health history
- Pt’s home environment
- Health care environment
- Risk for falls
- Pt expectations

Question 24

What are restraints?

Answer 24

Defined by CNO as physical, environmental, or chemical measures used to control the physical or behavioural activity of a person or a portion of their body

Question 25

Discuss the patient restraints minimization act.

Answer 25

Went through in June of 2001 (Bill 85) - Required HC facilities to establish policies with respect to restraining & confining pts, and the use of alternative methods to prevent serious bodily harm by a pt to themselves or to others - States that whenever possible, alternatives to restraints should be tried

Question 26

What are the differences between the different types of restraints?

Answer 26

Physical - Limits movement of client’s whole body or body part (Ex. fixed table or bed rail) Environmental - Control a client’s mobility (Ex. locked unit) Chemical - pharmacological intervention to control, inhibit, or restrict a person’s behaviour (Ex. psychoactive medication)

Question 27

What are mitts/double padded mitts used for? Pelvic holder?

Answer 27

Mitts - for when patients are picking at scars or tubing, helps keep them from taking things apart Pelvic holder - keeps patient in wheelchair, especially if they're continuously trying to stand when they shouldn't be

Question 28

Discuss the risks of restraints.

Answer 28

- Increased injury (Ex. falls - climbing over bed rails, strangulation) - Circulation impairment (Ex. cool extremities) - Skin breakdown, unable to reposition self - Confusion, agitation, loss of dignity, depression, fear - Incontinence, constipation - Loss of bone mass & muscle atrophy (Ex. lack of movement) - Loss of appetite & dehydration

Question 29

What assessments would you make before applying the use of restraints?

Answer 29

- Assess pt behaviour - Explore underlying causes/triggers & treat when possible - Consider alternative strategies - Collaborate with pt, family, and/or SDM when possible - Implement appropriate or preferred/individualized alternatives to assist the pt to manage the behaviour (if pt has capacity; can refuse care) - Document - If alternatives unsuccessful, review criteria for restraint

Question 30

When do we use restraints?

Answer 30

- Protection – when pt may cause serious harm to themselves or others - Maintaining treatment - Enhance freedom or quality of life - Pt meets criteria & consent is obtained *** ALWAYS as a last resort

Question 31

What are a nurse's responsibilities to a restrained patient?

Answer 31

- Check every hour - Release from restraint q2h - Provide opportunities for ambulation, toileting, exercises, and other care - Any member of pt’s care team can release/remove restraint for care - Discontinue restraint when pt no longer ‘meets criteria’ - Order required to apply restraint; MD or NP specific to agency policy (can apply in emergency situation, consult within the hour) - Assess all contributing factors - Consider alternatives first - Consent from pt or SDM

Question 32

What are the 3 main workplace safety risks in HC?

Answer 32

Infectious agents, hazardous materials, violence

Question 33

What is violence in HC?

Answer 33

Incidence where employees are abused, threatened, assaulted or subjected to other offensive behaviour in circumstances related to their work Threatening behaviour; physical attacks; bullying & harassment

Question 34

Why is there violence in HC?

Answer 34

Culture of acceptance; fear of reprisal/lack of support, policies; stress/high emotions/unpredictable environments; staffing; seeking control in environments

Question 35

Discuss violence in workplace recommendations.

Answer 35

Zero tolerance Education & training of HC professionals in the de-escalation of violence Undertaking violence risk assessments of HC organizations, departments, and individual pts Flagging of pts who pose a risk for violent behaviour Personal safety response system that allows HC providers to call for help Security personnel & protocols to respond to violence