Week 2 (09/02/15) - Standard Protocol and Basic Safety

Question 1

Patient identification

Answer 1

• Full name (some may have preferred nicknames)
• Date of birth (DOB)
• Medical record number (MRN)
• Pt. ID number

Question 2

QUESTION:

What are the five components to the Patient Safety Care Bundle?

Answer 2

CORRECT ANSWER:

Huddle, hourly rounding, Morse Scale, individualized care interventions, debriefing

Question 3

Huddle

Answer 3

• Beginning of every shift

- To discuss pts. at risk to fall

Question 4

QUESTION:

What is the color that signifies a fall risk pt.?

Answer 4

CORRECT ANSWER:

Orange (bracelet, socks, magnets (D = door bed, W = window bed, P = private room)

Question 5

Hourly rounding

Answer 5

• Systematicnursingbedsiderounds
• To prevent potential pt. problems or to keep actual problems from escalating
• 4 (sometimes 5) P’s: pain, potty, position, personal needs/items (sometimes patency = IV protocol)

Question 6

Morse scale

Answer 6

• An assessment tool that is individualized for each patient and involves a collaborative, multidisciplinary approach to treatment and falls-prevention care
• Pt. is assessed on: history of falls, secondary diagnosis, ambulatory aid, IVs/NS lock, gait/transfer, and mental status
• Three levels of risk interventions: high, moderate, and low

Question 7

Individualized care interventions

Answer 7

• Orange bracelet

- Morse Scale of 85 or higher = door magnet

Question 8

Debriefing

Answer 8

• Allowsindividualstodiscuss pt.-related events (i.e post falls)
• Identify errors
• Develop plan to improve

Question 9

Versa Care bed “need-to-know” information

Answer 9

• Must be plugged in to wall outlet and nurse call system (red outlets are hooked up to generator)
• Side rails, foot/head of bed, pt./nurse controls
• Brakes
• Bed should be in lowest position
• Foot pedals
• Foot of bed elongation
• “Zero” bed before pt. gets in it
• Bed alarms

Question 10

Standard protocol expectations

Answer 10

Before:
-Verify physician orders
-Gather equipment
-Hand hygiene
-Introduce self
-Identify client
-Explain procedure
-Assess the client
-Adjust the bed
-Adequate lighting
-Provide privacy
During:
-Patient independence
-Assess patient tolerance
-Ensure comfort and warmth
After:
-Assess client
-Call bell
-Side rails/bed position
-Soiled supplies/equipment
-Hand hygiene
-Documentation