Safety & Quality

Question 1

What is quality care?

Answer 1

Good care.

Question 2

What does TJC stand for?

Answer 2

The Joint Commission (regulatory agency)-They have national patient safety goals.

Question 3

What does safety mean?

Answer 3

Freedom from accidental injury & also fundamental. You keep them safe! It is very important and can cause an issue.
*100% is safe!

Question 4

What type of hazard is a fall?

Answer 4

Falls are one of the biggest safety hazards in the hospital.
*A lot of meds can cause dizziness and make you drowsy.

Question 5

What is a work around?

Answer 5

This is how you do it, but this is how I am going to do it.

Question 6

What is are operational systems?

Answer 6

Ex. Anderson Hospital has policies & procedures in place & tracking-keeps people responsible for their actions

Question 7

What is System Processing?

Answer 7

Trying to minimize incidence of errors to keep pt. safe for ex. certain arm bands for kidnapping of infants & it beeps when close to door. Also want to avoid injuries to patients while caring for them & follow the rules.

Question 8

How does EHR keep patients safe?

Answer 8

Before giving medications, the mar may alert you to go look at labs results to be sure you are not giving to much of the medication before you try to give another dose.

Question 9

Areas of safety concerns in the hospital?

Answer 9

*Surgical -Not being sterile or not having the right pt./Not doing right thing ( Removing wrong body part), Leaving instruments/sponges in pt. Gases can be flammable or Cautery when using it.
-Feelings getting in the way of dealing with pt. care-these are distractions & not being able to get things done
-Food safety, administration dosages & not charting medications, treatment, & diagnoses properly., side rails
-Be knowledgeable of precautions & ordered appropriately & following directions
-High fall risk (sign outside door)/leave door open/HIPPA Violation if chart open & safety concern because someone can easily chart
-Toileting/side rails down, malfunctioning equipment-tagged by biomed until fixed
-Aggressive pt. (sundowning)

Question 10

What is the scope of practice for safety & quality?

Answer 10

To go from no error to death-Trying to keep all patients safe from injury. There are different types of errors listed below.
*We want good safe and quality care for our patients.

Question 11

What happens if an error is made?

Answer 11

Errors should be reported& sent to a quality risk management department to review what happened to see why the error was made.
-There should be a system put into place or protocols to prevent this error from happening again.
*Busy, not enough staff, & not having the equipment can cause errors.
*The errors are reported, & they should be able to come up with ways to prevent these things from happening.

Question 12

What is an adverse event?

Answer 12

Results in unattended harm (Med errors (#1 error), allergic/anaphylactic response, Falls, Burn (heating pads), & Infection

Question 13

What is a near miss?

Answer 13

(3 levels of errors that almost happened but you caught the error)-Medication related (seen most-hydroxyzine/Hydroline), & wrong dosage-Need to report/learn from it & separate the drugs(improve processes)

Question 14

What are sentinel events or a Nevel event?

Answer 14

Should never happen-Reported national to Joint Commission that can result in some serious or death-Like Medication errors (giving potassium to fast through IV)
*Surgery-wrong limb taken off or surgical instrument left in pt.
*Drop baby or Infant abduction or something to cause the baby to die & fall result in serious injury or death
*Mismatched blood (infected blood)
*Losing a pt. (like a suicide pt). at risk
*Severe pressure ulcer injury or CAUTI

Question 15

What is a root cause analysis?

Answer 15

What really happened? (Was there not enough staff or wrong procedures)

Question 16

What are some types of errors?

Answer 16

*Diagnostic-Any error involving some type of testing (mislabeling specimen, follow up with test (High level of electrolyte balance like 6 of Potassium)
*Treatment Error-Delay of treatment (Nurse didn’t do her job)
*Preventative Error-Failure to provide prophylactically care (Access pt. for blood clots) could lead to sentinel event
*Communication Failure-Lack of good communication/Can lead to adverse event/sentinel event
Patient Transfer/Handoff report to another unit/Beside Reports are bad with communication.

Question 17

What are the placement of errors (What caused the error)?

Answer 17

*Active or Sharp Errors-(Pertaining to one person) Provider or nurse
*Latent (dull) Error-Flaw in the system (flaw in how call schedule with providers (wrong provider called) or the way medications are given
*Always access pt. first if an error is made. Then if problem with amount(twice dosage) of BP Medication-check another BP, Contact provider, Watch BP, Let charge nurse/supervisor, & chart. Take any orders given & do incident report in timely manner.
*Incident Report-Documentation of errors sent to error department/Very detailed of what happened (TIME,DATE, PT. & WHAT HAPPENED) & not part of Electronic Record but with facts in Electronic Record)
-Goal to change processes and look for opportunities to do better

Question 18

What is the most dangerous phrase in healthcare?

Answer 18

“We’ve always done it this way.”

Question 19

Attributes & Criteria-Knowledge, Skills, & Attitudes

Answer 19

*Knowledgeable of proper techniques, procedures, protocols (In service, Readings) benefits, & limitations to keep pt. safe. Keeps you away from taking care of your pt. (EHR.)
*Skills-(Inservice, checked off on monitors, IV pumps)
*Attitude for attribute of safety-Confident & caring, & compassionate, professional & collaborative attitude

Question 20

What is culture of safety?

Answer 20

Within organization begins from top to bottom (CEOs down to janitors)- They are on the same page related to safety. Management has money, enough staff, & things you need to take care of pts. & Communication of collaboration that is open & error reporting systems
-Open communication/error reporting systems/ (error reducing methods)
- “Just” Culture- Near Miss-Should never be afraid that you will get in trouble. Culture within an organization that does not penalize you.
*Be very transparent when making errors. Tell the error because it can cause serious injury/death. Never be afraid reporting injury and be accountable.
*You want to feel like you are accountable and able to admit you mistakes and hopefully there is a system in place to fix the flaw.

Question 21

What happens with quality? Errors with Abbreviations

Answer 21

There can’t be if a lot of infections or errors?
*Never use 10u write 10 units, Write International Unit
*Don’t use QD or qd in no form- Write “daily” or q6h, don’t use qod instead write “every other day”
*4.0 has trailing zero & can be mistaken for 40. 4.1 is ok. Just put 4 if 4.0.
*Lack of leading zero is .7 has to have a zero and be 0.7.
*Don’t use MSO4 AND mgSO4. Instead use “morphine sulfate” or “magnesium sulfate” & Look at other abbreviations
*Look & see what Hospital National Patient Safety Goals are, and things to reduce errors from happening.

Question 22

Why do falls happen?

Answer 22

*Unintentional inadvertent accident (can be small/big)
-Could be due to short staffage (Not enough people rounding)
*Forgetting to put up siderail, they are sick, need to go to bathroom, wrong foot wear, cognitive impairment, environment (torn rugs)
*Polypharmacy-Drug interactions between mixing up med, or new BP meds-dizziness, BP drops or hypotension occurs
*What is Gait/Parkinson’s shuffle-likely to fall/Can trip over cord or IV Pole
*Incontinent-Leaking urine/Sign most likely yellow indicating fall risk
*Know facility policy (Look over Fall prevention measures-Skill 27.1 in Fundamentals book
-Having quality care is having good care
*Males fall more than females
*High risk pt. should be near nurse’s station or have someone really close to them (One on one)

Question 23

How can you prevent falls from happening?

Answer 23

*Identify pt. as fall risk, place a fall mat, place a sign on door for high fall risk, Side rails up, bed alarms, pads in bed (weight shifts to alert staff of movement), & lots of pt. education
*Environment-You want some light & not in complete dark, place wet floor sign when floor is wet, keep pathway clear for pt., use grippy socks, place call bell within reach, & make sure the bed is locked in lowest position
*Can put up 2 or 3 siderails up /4 is used as a restraint & Cane should be within reach & on side of bed
*Elimination schedules (One of the best ways to prevent falls is purposeful rounding-Every hour or two hours to see if they need to potty if on high risk for falls)

Question 24

Fall Assessment: Morse Scale

Answer 24

*The higher the score the worse it is.
-Risk assessment (Done on admission), or change in level of care or condition, once a shift, and if they fall/Want to prevent a fall
-Can’t delegate/Can delegate the fall prevention-Help to bathroom, educate, use socks

Question 25

Restraints

Answer 25

*Chemical (Mental Health & Aggressive pts. hypnotic or anti-psychotic drugs) & Physical (Check your order-Good for only 24 hours/Relooked at start out using it 15 minutes & can go up to 2 hours), assess pt often, & take off every 2 hours for controlled movement (Seen mostly in hospital-Self harm/others/IV/Chest tube/Catheter- Removing)
-Joint Commission has standardized guidelines for use that hospitals use
-Temporary means of providing safety for pt.
*Always use the least restrictive restraint to get the job done & always try something else first. There is a lot of paperwork.
*ICU (Extubate, central lines)-Combative, Aggressive, & pulling stuff out (Foley’s ET Tube), and used everything that you can
-Box 27.12 Alternative to Restraints (Give them some else to do or hold to distract them) Frequent monitoring(rounding)/Move them close to you/Educate family.

Question 26

Types of Restraints/What should be done with them

Answer 26

*Soft limb Restraints on arms or legs-Just pulling things/Seen more of these
*Soft Mitten Restraint-Pulling out things
*Vest-Wraps around chair and pull back behind chair (people can slide down & choke themselves)
*Elbow Restraint (Keep arm straight)
-Important measures to check while in restraints
*Check vital signs, hydrate them, look at skin-if too tight, nutrition-feed them, hygiene, Assess circulation
*2 fingers should be able to fit in restraint make sure circulating, good color, cap refill, pulse, temp, nerve damage & movement
*Some have audio/video while in room
*Pressure injury (less mobility-laying still, increased risk for pneumonia, constipation, incontinence

Question 27

What all is involved in quality health care?

Answer 27

*Addresses safety & Addresses pt. satisfaction
-Monitor charts of pt. in hospitals to make sure that they get well.
*Processes
*Outcome (Star of quality)-Get better & don’t come back-Want good outcomes
*HAC-Healthcare Acquired Conditions-CAUTI, Ventilator Acquired Pneumonia
*CMS-Center for Medicare Services-No payment if pt. gets HAC
-Look at Healthcare Quality Diagram on lecture

Question 28

What are healthcare quality attributes?

Answer 28

*Safe-(Giving meds/treatment on time error free from injury)
*Timely-Meds given on time & treatments
*Effective- (Things working -Evidence based practices)
*Efficient (Don’t waste time or supplies)-Cluster Care (vital signs, Assessment all at one time)
*Equitable- (Care is equal-Everyone is treated the same)
*Patient Centered- (History, preference, likes, & involving family sometimes) Everything is about the patient!
*Performance Improvement/Quality Improvement (** Monitor processes & outcomes)-People in Quality work with people on the floor about falls for example because the number has gone up. Figure out ways to bring the number down.)

Question 29

Different types of Regulatory Agencies

Answer 29

Joint of Commission, Centers for Medicare Services, OSHA (Occupational Safety & Health Administration), U.S. Food & Drug Administration (FDA)

Question 30

Medication Administration: Pharmacokinetics

Answer 30

*Pharmacokinetics-What body does to drugs & how it affects it.
-Tylenol-30 min to hour, IV is the only one you give 100% of drug & goes straight to blood stream.
-Aspirin is coated

Question 31

What is the distribution of medications?

Answer 31

Distribution-The movement of drug from circulation to body tissues. Drugs carried by blood & tissue fluids through active sites, metabolism sites, & excretion sites. Highly perfused areas such as heart, liver, or kidney.
*Depends on adequacy of blood circulation.
*Bad perfusion includes the muscle, fat, peripheral organs.
-Pregnancy-drugs cross placenta & affects fetus & mother problems lead to spontaneous abortion, defects, fetal growth & development.
*PERFUSION Problems-Low BP, anemia, circulatory problems
*Warfarin regulated with lab levels. Check for protein in albumin levels.

Question 32

Medication Administration: Pharmacodynamics

Answer 32

*The study of the effects of drugs on the body. Some drugs can’t be taken together because there is an interaction between the drugs.
-Peak
-Onset
-Duration-Length of drug
*Therapeutic Index (Range in which effective) 1. Is with half life(time frame the drug’s active substances are reduced by half until it is fully eliminated), look at pt. & labs 2.Peak levels (Highest dose given after 2-3 hours) IV-6 hours & Trough (Right before next dose-30 minutes before next dose.) See if effective & therapeutic to not cause toxicity (to much drug/problems with diffusion/perfusion can cause it) HR may get to low
-Side effect of a drug-Predictable (headache)
-Undesired, unavoidable (Adverse drug affect)
-Tolerance-Amount of pain & you have to take more to get the same effect
*Agonist-Drug gets the desired effect
*Antagonist-blocks effect of drugs (Naloxone) reverses respiratory depression
*Primary effect of diuretic-getting rid of fluids/Secondary effect-Lowering BP
*Synergist Drug Interaction, Drug interaction (Can be drugs affecting labs)/Some have photosensitivity(Cautious of sunlight)

Question 33

Interrelated Concepts in Safety:
Healthcare Quality
Communication
Collaboration
Care Coordination

Answer 33

-Communicate with healthcare staff where they do like a morning huddle to address any issues along with everything that is going on with the on with the patient, discharge status, & what they need.
-Delegation involves knowing what you can do and can’t.

Question 34

What is a SMART Goal?

Answer 34

*SMART Goal
S-Specific
M-Measurable
A-Attainable
R-Realistic
T-Time-Sensitive
*The patient states a “0” on the pain scale after the medication was administered.
*You must follow up with documentation if the patient is in pain. Since that is considered an abnormal.

Question 35

What is the difference between the nursing process and the Clinical Judgement process?

Answer 35

Nursing process is Static in nature.
*ADPIE-Clinical judgement takes thinking & you pull from experience.

Question 36

How to look at the syringes & count the tick marks

Answer 36

*3ml syringe with-Don’t count the first tick mark & start counting at 0.1 & up.
*5ml syringe-Don’t count the first tick mark & start counting at 0.2 & by 2’s & up.
*The bigger the gauge, the smaller the needle.
*Bevel up for IV & Intradermal injection sites. Intramuscular site it doesn’t matter.