Safety Flashcards
Fall: trigger
Morse scale
History of falling: 25
- Secondary diagnosis: 15
- Ambulatory aid
None/bed rest/nurse assist: 0
Crutches/cane/walker: 15
Furniture: 30
- Intravenous therapy/saline lock: 20
- Gait
Normal/bed rest/wheelchair: 0
Weak: 10
Impaired: 20
- Mental status
Oriented to own ability: 0
Overestimates/forgets limitations: 15
Morse scale
- history of falling,
- presence of 2 or more medical conditions,
- intravenous medications,
- gait assessment,
- ambulatory aid, and
- mental status. Patients are then classified into low-, moderate-, and high-risk categories.
Delirium: risk factors
Age older than 70 years, cognitive impairment, sensory impairment such as vision or hearing loss, and functional dependence
physical comorbidity, psychiatric comorbidity, dehydration and malnutrition, and drug dependence
CAM: specificity, sensitivity
sensitivity of 94 to 100 percent and a specificity of 90 to 95 percent
Suspected Delirium: trigger
Compute CAM score
- Acute and fluctuating course
- Inattention
- Disorganized thinking:
“rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?”
- Decreased LOC: “Overall, how would you rate this patient’s level ofconsciousness?”
- Normal = alert
- Hyperalert = vigilant
- Drowsy, easily aroused = lethargic
- Difficult to arouse = stupor
- Unarousable = coma
CAM: Level of consciousness component
Normal = alert
Hyperalert = vigilant
Drowsy, easily aroused = lethargic
Difficult to arouse = stupor
Unarousable = coma
CAM: positive when
- Acute onset, fluctuating course
- Inattention
- Disorganized thinking
- Decreased LOC
The diagnosis of delirium requires the presence of features 1 AND 2 plus either 3 OR 4.
Stress ulcer prophylaxis: indications
critically ill patients at high risk of bleeding:
- coagulopathy (platelet count <50 × 103/µL, INR >1.5),
- prolonged mechanical ventilation (more than 48 hours),
- gastrointestinal ulcer or bleeding within the past year, or
- severe burn injury and 2 or more minor criteria including sepsis,
- stay longer than 1 week in the intensive care unit,
- occult gastrointestinal bleeding for 6 or more days,
- steroid therapy with more than 250 mg of hydrocortisone daily
Braden scale
The Braden scale rates patients in six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction and shear using scores ranging from 1 to 3 or 4.
The maximum score is 23; a score ≤18 is indicative of high risk.
Non-blanching erythema on buttocks: Trigger
Pressure ulcer precautions
Pressure ulcer risk mitigation
advanced static or dynamic support surface
if “high-risk,” regardless of whether the assessment was made clinically or with a structured scoring scale.
Development of Stage 3 ulcer after admission: Trigger
considered a “never event” that must be reported to the Joint Commission.
Pressure ulcer prevention: minimum strategies
- formal institutional multicomponent strategy
- protocols for scheduled turning and mobilization of at-risk patients,
- education of physicians and nurses on recognition of early-stage ulcers,
- designated “skin champion” who regularly evaluates patients and makes specific recommendations
- regular audit and feedback of pressure ulcer rates.
Less evidence:
- use of special mattresses and overlays to reduce skin pressure
- championing by hospital leadership, although these strategies have less supporting evidence.
- close attention to nutrition and hydration is important to prevent ulcers, no clear data show that targeting a specific serum albumin level is beneficial.
Hypotension, tachycardia, mild abdominal/groin tenderness the day after cardiac cath
RP bleed
CT abdomen is the best test
High Risk Meds
- IV Adrenergic agonists
- IV Adrenergic antagonists
- Anesthetics, general + IV
- IV antiarrhythmics
- Anti-coagulants
- thrombolytics (e.g., alteplase, reteplase, tenecteplase)
- glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide)
- Cardioplegics
- Chemotherapy agents
- Dextrose 20% or higher
- Dialysis solutions, peritoneal and hemodialysis
- epidural or intrathecal medications
- hypoglycemics, oral
- inotropic medications, IV (e.g., digoxin, milrinone)
- insulin, subcutaneous and IV
- liposomal forms of drugs (e.g., liposomal amphotericin B) and conventional counterparts (e.g., amphotericin B desoxycholate)
- moderate sedation agents, IV (e.g., dexmedetomidine, midazolam)
- moderate sedation agents, oral, for children (e.g., chloral hydrate)
- narcotics/opioids
- neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium)
- parenteral nutrition preparations
- radiocontrast agents, IV
- sterile water for injection, inhalation, and irrigation (excluding pour bottles) in containers of 100 mL or more
- sodium chloride for injection, hypertonic, greater than 0.9% concentration
