Safety Flashcards
Hand-off
Responsibility for care is transferred from one care provider to another
What are work-arounds? Provide Examples
- actions that bypass safety systems that can increase the risk of errors.
- Ex: Nuisance Alarms/ False alarms go off with no emergency present
-> Caused by damaging/removing wire/batteries to prevent false alarms - Ex: Bypassing/working around Barcode Medication Administration
-> Incorrect medication and/or wrong dose errors
How can dangerous abbreviations lead to error?
Minsterpretation of information can lead to medication errors (wrong dosages/wrong medication)
what is a culture of safety?
blame-free environment that improves care in high-risk healthcare settings through interprofessional collaboration
Describe how the following open communication strategies create a culture of safety:
SBAR
I-SBAR-Q/R
CUS
SBAR: (Situation, Background, Assessment, Recommendation) enhances clarity/efficiency of communication between health care team members
I-SBAR-Q/R: (Introduction, Situation, Background, Assessment, Recommendation, Questions) revised SBAR; identifies the nurse and PT when communicating PT care info/concerns to another healthcare provider
C.U.S: (Concern, Uncomfortable, Safety): consistent method to speak up about patient safety in an assertive manner that is clear, structured and easy to use.
What do the letters in SBAR mean?
- Situation: Complaints, diagnosis, treatment plan, and pt’s wants and needs
- Background: vital sign, mental and code status, list of medications, and lab results
- Assessment: assessment of the situation
- Recommendation: identify pending lab results and what needs to be done, and other recommendations for care
What do the I and Q/R stand for in I-SBAR-Q/R?
- Introduction: People involved in the handoff identify themselves, their roles and their jobs
- Questions/Readback: opportunity to ask and respond to questions
What do the letters in C.U.S. stand for?
C: I am concerned
U: I am uncomfortable
S: This is unsafe
What is “Just Culture”? How does it create a culture of safety?
Evaluates choices and processes that impact safety and quality, not the outcome of the event or assigning blame.
- Errors become opportunities for improvement instead of punishments
- Promotes open communication
How does teamworka dn collaboration create a culture of safety?
- Allows for open communication
- Mutual Respect
- Shared decision-making contributes to quality pt care
What is The Joint Commission? How did they make contributions to promote a culture of safety?
The Joint Commission is committed to improving safety in healthcare.
- Recommended SBAR to improve communication for hand-offs
- Require hospitals to implement fall prevention programs and report sentinel events
- Create National Patient Safety Goals
How does the Insitute of Medicine (IOM) contribute to a culture of safety?
Established 5 core competencies to sensure patient safety and quality care
QPIET
- quality improvement
- pt centered care
- informatics
- evidence based practice
- teamwork and collaboration
how does the Quality and Safety Education for Nurses (QSEN) Institute contribute to a culture of safety?
VIPPR
- Validated the IOM core competencies and added safety as a sixth competency.
- Identify quality and safety competencies
- Provides strategies/resources to assist nurse educators to meet the QSEN goals
- Prepare future nurses with the knowledge/skills/ attitudes to improve the quality/safety of health care
- Revised SBAR to I-SBAR-Q/R
How does the Center for Medicare & Medicaid Services (CMS) contribute to a culture of safety?
- Team surverys nursing home
- Set quality standards of practice
- Deems that falls should never occur (preventable injury)
- Set guidelines for use of restraints
How does the Agency for Healthcare Research and Quality (AHRQ) cotnribute to a culture fo safety?
- experts who develop clinical practice guidelines
- Provides resources and tools to improve healthcare and quality
How does the National Quality Forum contribute to a culture of safety?
- develop tools and resources to improve patient safety and reduce medical errors
What are Barcodes Points of care?
the use of barcodes to in healthcare setting for patient identification and medication administration.
- Alerts worker if there is an error
-> significantly reduces errors
What are smart infusion pumps?
Smart pumps with customized software that alert nurses of any complications
- reduces medication error
What are Computer Provider Order Entry (CPOE)?
Electronic systems for medical orders that improve efficiency
- Lab/Med/Procedure orders
- Radiology Orders
- Admission
What are automatic alerts/alarms?
Different alerts/alarms for different purposes
- EX: An elderly PT with dementia, who likes to wander, is given a position-sensitive electronic device to alert staff if they attempt to leave bed, instead of being restrained
Describe how the following materials/strategies help reduce reiance of memory:
Checklists:
Electronic Health Records:
Approriate electronic and paper resources:
Checklists:
- Structured and organized tools to reduce errors
Electronic Health Records:
- Used for documenting nursing and patient care
- Easy access to Medical Information
Approriate electronic and paper resources:
- Help ensure accurate and consistent care
- Standardized hand-off tools
- Documentation templates
Describe the type of fire:
Hospital Fire
(Common Cause of Fire, Prevention of fires, Type of Extinguisher used, STeps to take in an event of a fire)
Common Cause of Fire:
- Smoking
- Faulty electrical equipment
- Combustion of anesthetic agents
Prevention of Fire:
- Equipment properly maintained, stored and used
- periodic inspection of equipment
- Do not use damaged equipment
- Keep areas near electrical outlets or cords dry
Type of Extinguisher used:
ABC (universal,dry) fire extinguisher
How to use (PASS)
- PULL the pin
- AIM at the base of the fire
- SQUEEZE the handle
- SWEEP the nozzle side to side at the base of the fire
** Steps to take in an Event of a Fire:**
RACE
- Remove anyone in immediate danger
- Activate the fire code system and notify the appropriate person
- Confine the fire by closing doors and windows (prevention of smoke/fire spread)
- Evacuate patients and other people to a safe area (Extinguish)
Describe the type of fire:
House Fire
(Common Cause of Fire, Prevention of fires, Type of Extinguisher used, STeps to take in an event of a fire)
Common Cause of Fire:
- Smoking
- Faulty electrical equipment
- Grease
Prevention of Fire:
-Keep matches/lighters away from a child’s reach
- Cook on the back burner
- No smoking in doors
- Store oily rags/gasoline and other flammables away from heat source
- Be cautious around a fireplace.
Type of Extinguisher used:
ABC (universal,dry) fire extinguisher
How to use (PASS)
- PULL the pin
- AIM at the base of the fire
- SQUEEZE the handle
- SWEEP the nozzle side to side at the base of the fire
** Steps to take in an Event of a Fire:**
RACE
- Remove anyone in immediate danger
- Activate the fire code system and notify the appropriate person
- Confine the fire by closing doors and windows (prevention of smoke/fire spread)
- Evacuate people to a safe area (Extinguish)
Identify and Describe the following componet of QSEN:
Patient Centered Care
care based on respect for the pt’s preferences, values, and needs.
- Respect pts values, preferences, needs and wants
- Coordination and integration of care
- Information communication and education
- Physical comfort
- Emotional support and alleviation of fear and anxiety
- Involvement of family and friends
- Transition to continuity
- Access to care
What are the 6 components of QSEN?
- Patient-centered Care
- Teamwork and Collabortion
- Evidence-based Questions
- Quality Improvement
- Safety
- Informatics
Identify and Describe the following component of QSEN:
Teamwork and Collaboration
Achieve quality care by effectively communicating with others
- SBAR
- Teamstepps: communication approach that provides tools to enhance performance and patient safety.
- “Time Outs”
-> Moment of pause - Safe hand-offs:
-> RN-RN, one shift to the other: ensure theyre informed - Interdisciplinary/Interprofessional:
-> Work as a team
-> Don’t throw blame
-> Voices concerns about low quality care - Rapid Response Teams:
-> Respiratory
-> Rapid response nurse
-> Lab
-> Pharmacy
Identify and Describe the following componet of QSEN:
Evidence-Based Practice
Integrating current evidence with clinical expertise and deliver optimal healthcare
Identify and Describe the following componet of QSEN:
Quality Improvement
monitor the outcomes of care processes and improve the quality and safety of health care systems
- Culture of safety
- Report errors/adverse events
-> Root cause analysis: identifies the causes of adverse events and close calls to understand what happened, why, and how to prevent it in the future. - Participate in data collection
- Participate in improvement projects
- Performance improvement
Identify and Describe the following componet of QSEN:
Safety
minimize of risk of harm to patients through system effectiveness and individual performance
- Two patient identifiers: Name & DOB
- Medication reconciliation: What medications are used at home?
- Identify “workarounds”: ask for a permanent solution
- Barcode Point of Care: For pt & medication; Alert you automatically
- Smart pumps: Gives prompts & warnings
- Sentinel Events & “Never” Events:
- Failure to rescue (Rapid response teams)
Identify and Describe the following componet of QSEN:
Informatics
- uses information and technology to communicate, manage knowledge, mitigate errors, and support decision making
- Electronic Health Records (EHR)
- Computerized Provider Order Enrty (CPOE)
-> Order sets
-> Checklists
List some alternatives to restraints
- Reduce environmental stimuli
- Increased observation of pt
- Relocate patient for more frequent observation
- Divert attention
- Identify potential cause: hearing or vision impairment, hunger, pain, potty position needs
- Cover or tape tubing and line from sight or touch
- Mittens are also available
Name the different types of restraints
D, G, A, S, M
- Drugs: to control behavior (not included in PT normal medical regimens)
- Geriatric chairs with attached trays
- Applied wrists, ankles or waist
- Side rail (depending on situation and intent)
- Mittens: least restrive
What must be included in a restraint order?
CAN NEVER BE PRN
- Include type of restraint, justification, and criteria for removal
- Must be renewed ever 24 hours
-> Ordering practitioner must assess pt - Emergency restraint application require an order within 1 hour
When docutmenting restraints you must document…
- Alternatives used before restraints
- Assessment before, during and after restraints
- Proper orders
- Periodic removal of restraints
- Pts reactions to restraints
What are the negative outcomes of using restraints?
- Skin breakdown and contracture
-> Dmg to skin/tissue caused by the loss of blood flow - Incontinence
- Depression
- Delirium
- Anxiety
- Aspiration
- Respiratory difficulties
- Death
In the following scenario, could siderails be considered a restraint?
A student nurse is exhausted and nearing the end of their clinical day. In order to prevent anymore work for themselves, they decide to put all 4 side rails up on the bed of a patient with dementia. They decided to raise the side rails to prevent the patient from wandering the halls.
Yes, siderails would be considered restraints becuase they were all put up with teh intentin of preventing the pt from getting out of bed.
In the following scenario, could siderails be considered a restraint?
A student nurse is observing a sleeping elderly pt with their clinical instructor. They both notice that the pt tosses and turns a lot while they are sleeping. They have had multiple instance where the pt could have nearly fallen over and injured themselves. The clinical instructor decides to raise all for siderails for the safety of their pt.
No, the siderails would not be considered a restraint because they were raised with the intent of keeping the patient from inadvertently falling out of bed
T/F: If a pt lacks the ability to even attempt ot get out of bed, raising al 4 siderails would be a retraint.
False, siderails in this instance would not be a restraint.
T/F: If a pt request their siderails to be left raised, they must be able to raise and lower them on their own.
True.
When using restraints, try the ____ restrictive restraints first
least
How can restraints interfere with physiological function?
- Impair Circulation - skin breakdown
- Limit muscular activity -> immobilization
- Interfere with respiration
Describe the patient type who is at risk of injury:
Age
(Considerations, Cause of injury, Prevention)
Considerations:
- Risk of Fall
- Comorbidities
-> Osteoarthritis
-> Diabetes
-> Hypertension
-> Chronic pain
-> Depression
- Difficulty with ADL (activities of daily living)
-> Bathing - Gait
- Transferred from long term care
Cause of Injury:
Falling (at home)
- Poor lighting
- Clutter
- Improper fitting clothes
- Slippers
Prevention:
Falling (at home)
- Install Handrails
- Have good lighting
- Get rid of clutter
Falling
- Calcium and Vit D
-> promote skeletal health - Exercise
-> 🔼Bone, Muscle, Balance, Flexibility - Keep bed in low position
- Lock wheels on bed/chairs
Describe the patient type who is at risk of injury:
Altered Sensory Perception
(Considerations, Cause of injury)
Considerations:
Impairment in:
- Sight
- Hearing
- Smell
- Taste
- Touch
Cause of Injury:
- Unable to see
- Unable to hear sirens, alarms, nurse instructions
- Unable to smell smoke or gas leak
- Unable to tase tainted food
- Unable to perceive temperature changes
Prevention:
- X
Describe the patient type who is at risk of injury:
Altered Cognition
(Considerations, Cause of injury, Prevention)
Considerations:
-XDepression
- Stress
- Anxiety
Cause of Injury:
- Restraint injuries
- Violence
- Confusion and disorientation
Prevention:
- Provide a safe environment
- Compassionate care
- Restraint are last resort
Describe the patient type who is at risk of injury:
Altered Mobility
(Considerations, Cause of injury, Prevention)
Considerations:
- Paralysis or Spinal cord injury
- Recent or Prolonged Illness
Cause of Injury:
- Falling
Prevention:
Assistance with movement
- Allow them to maintain independence/foster self-esteem
Supportive devices
- Provide adequate education and instructions
Describe the patient type who is at risk of injury:
Ability to Communicate
(Considerations, Cause of injury, Prevention)
Considerations:
- Fatigue
- Stress
- Language Barriers
Cause of Injury:
- Minsterpreting nurse instructions
Prevention:
- Facilitate a positive communication experience
Describe the type of hazard:
Electrical Hazard
(Prevention/Reduction)
Prevention/Reduction:
- The third prong on the power plug is one of the most important safety features on some devices (DO NOT PLUG IN hospital equipment without a third prong)
- DO NOT USE extension cords except in an approved emergency
- DO NOT UNPLUG devices by pulling by on the power cord
- DO NOT USE obviously defective equipment or equipment marked not in working order
- NEVER USE a device that is or has been wet or gives off small shocks
Course of Action:
- X
Describe the type of hazard:
Radiation Hazard
(Prevention/Reduction, Course of Action)
Prevention/Reduction:
- Follow standards/policies; report to clinical coordinator
Course of Action:
- Do not enter room
- Wear Specific PPE,
-> Special gloves, Radiation shield
Describe the type of hazard:
Noisy Clinical Environment
(Prevention/Reduction)
Prevention/Reduction:
- Train staff in noise reduction
- Noise reduction programs (quiet times)
- Rethink/rework alarms (to decrease desensitization/alarm fatigue)
Course of Action:
- X
Describe the type of Hazard:
Earthquake
(Before, During, After)
Before:
- Secure heavy object to ensure sability adn prevent injury
During:
- Save yourself first
After:
- Assess PTs for new injuries
- Follow facilities emergency plan
A student nurse was tasked with gathering canisters of pressurized gas from the basement of the hospital. When transporting the gas canisters from the basement, the student accidentally causes a gas leak. This gas leak lead to the mass extinction of the entire human race on earth. What information should have been told to the student nurse before they performed their task?
A) If there’s a gas leak, take one for the team and inhale the gas.
B) Whenever you’re near or handling pressurized gases, proceed with caution and be careful
C) Shake the gas canisters to stabilize gas molecules inside.
D) Only be careful around gases that cause a foul odor
B) Whenever you’re near or handling pressurized gases, proceed with caution and be careful
A group of student nurses are in a drug preparation lab. They decide to take their lunch and smoke in this area. The student nurses’ actions lead to the contamination and destruction of all drugs in the facility. What safety precautions should be placed on the door to prevent more incidents like this?
A) Only chill people can eat in here
B) Drinking clear fluids is permitted in drug preparation labs
C) NEVER eat, drink, smoke, or apply cosmetics in drug preparation & non-designated areas
D) Farting is allowed if its not stinky
C) NEVER eat, drink, smoke, or apply cosmetics in drug preparation & non-designated areas
T/F: Some chemotherapy drugs require special precautions
True
