Safety And Hygine

Question 0

Fall risks for elderly

Answer 0

Medications: antidepressants- 68% increased risk
Neurleptics/ antipsychotics-59% increased risk
Sedatives/hypnotics- 47% increased risk
Antihypertensive- 24% increased risk
NSAIDS- 21% increased risk

Question 1

Elderly falls

Answer 1

30-40 % of people over age 65 have a fall each year

In an elderly patient who has fallen, the risk of having a second fall within a year rises to 60%

Question 2

Hospital falls

Answer 2

2-12% of patients will fall in hospital
Circumstances 20% with toieleting
34% from bed
38% while ambulating

10-20% of in hospital falls are recurrent events

Question 3

Fall risk scoring tools

Answer 3

Morse fall scale-MMMC
Medication fall risk scale

Predictive accuracy 43.2-60%

Question 4

Medication fall risk scale

Answer 4

3- high , 2 medium, 1- low( diuretics)

>6- high risk for falls

Question 5

Morse fall scale

Answer 5

Hx of falls- 25 score
Secondary diagnosis-25 score
Ambulatory aid- furniture- 30, crutches, 15
Iv-20 score
Gait/transferring- impaired -20, weak 10
Mental status, forgets limitations- 15

Question 6

Best indicator of falls

Answer 6

Hx of a fLl

Question 7

Interventions for falls

Answer 7

Ambulation aids- eye glasses, modified footwear, exercise/ balance training, referral to pt, hip protector use, evaluation and treatment of postural hypotension

Question 8

Interventions for falls

Answer 8

Modification of bedside environment
Modification of drug regimen
Posted alerts to staff on patient fall risk
Scheduled toileting
Bedside commode
Screening for urine infection
Beds placed in lowest position

Question 9

Intervention for falls

Answer 9

Staff education
Patient and family education
Increased supervision
Bedside sitter
Bed and chair alarms
High risk patients moved to close proximity to nursing station
Staff assistance with transfers

Question 10

Orange star

Answer 10

Posted on the patients door frame and on the activity section of the patients kardex.

Question 11

Intentional rounding

Answer 11

Research shows specific nursing actions performed at set intervals were associated with statistically significant reduced patient use of the call light overall, as well as a reduction of patient falls and increased patient satisfaction

Question 12

Intention rounding

Answer 12

4 ps
Positioning
Personal needs
Pain
Placement

Question 13

Braden scale

Answer 13

MMMC guidelines: score < 12= wound care consult

Question 14

Braden scale

Answer 14

Sensory perception
Moisture- 1 constantly moist, 2- moist, 3-occasionally 4- rarely 
Activity
Mobility
Nutrition
Friction and shear
Higher the score, the lower the risk
<12 = wound care consult

Question 15

Pressure ulcer consequences

Answer 15

CMS: pressure ulcers: No pay if acquired in healthcare setting
# affected: 2.5 million patients per year
Cost: ulcers cost 9.1-11.6 billion per year and each pressure ulcer adds 43,180 in costs to a hospital stay.
Death: about 60,000 patients die as a direct result of a pressure ulcer each year

Question 16

Infection control

Answer 16

Airborne precautions- measles, chicken pox (varicella), tb private room, neg- pressure airflow of at least 6 to 12 exchanges, mask or resp. Protection device n95 respirator

Droplet precaution- influenza, streptococcal pharyngitis, rubella, mumps
( being within 3 feet of patient)
Private room or cohort patients, mask or repirator required depending on condition

Contact-‘colonization or infection with multi- drug resisten organisms, such as VRE and MRSA, major wound infections, herpes simplex, scabies
Private room, or cohort patients, gloves, gown

Question 17

Patient safety goals

Answer 17

Goal 1: improve accuracy of patient identification
Goal 2: improve effectiveness of communication amount caregivers
Hand off communication- follow 5ps and include time to ask and answer questions
5 ps: patient, plan, purpose, problem, precautions

Question 18

Patient safety goals

Answer 18

Goal 3 improve the safe use of medications
Goal 7 reduce the risk of health care acquired infections
Comply with hand- hygiene guidelines
It is considered a sentinel event if a health care acquired infection (HAI) leads to death or major permanent loss.

Question 19

Patient safety goals

Answer 19

Goal 8: accurately and completely reconcile medications across the continuum of care
Process of verifying patient medication
Can reduce errors by 46%, can reduce adverse drug effects up to 20%
Needs to be done upon admission, transfer and discharge

Question 20

Patient safety goals

Answer 20

Goal 9: reduce the risk of patient harm resulting from falls

Number one nursing liability to patient safety

Question 21

Patient safety goals

Answer 21

Goal 13 Encourage patients active involvement in plan of care
Goal 15 risk for suicide
Goal 16- improve recognition and response to changes in a patients condition

Question 22

National patient safety goals - JCAHO
Universal protocol #1, elimination wrong sire, procedure, person, surgery
Timeouts, everyone participates.
Site marking
Advocates red rule- time out
Time out applies to procedures outside the OR as well. Rule of thumb: anything that may require a consent and/or is a high risk procedure and requires a time out.

Answer 22

National patient safety goals - JCAHO
Universal protocol #1, elimination wrong sire, procedure, person, surgery
Timeouts, everyone participates.
Site marking
Advocates red rule- time out
Time out applies to procedures outside the OR as well. Rule of thumb: anything that may require a consent and/or is a high risk procedure and requires a time out.

Question 23

RACE

Answer 23

Rescue
Alarm
Contain
Extinguish

Question 24

PASS

Answer 24

Pull
Aim
Squeeze
Sweep