Transcript Patient Safety Chapter 38

Patient Safety
Craven Chapter 22
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Safety
 High priority need
 Maslow basic need [safety/security]
 High Nursing Priority [ABC/Safety/Pain
 State of being free from harm or danger
 Unintentional Injury is 5th leading cause of
death in U.S.
 Results in disability, pain, emotional
distress, financial hardship
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Safety in Nursing
 Critical Thinking + Nursing Process
 Assess Patient and Environment
 Formulate Nursing Diagnosis/ Plan to provide
safe care
 Injury control/prevention
 3 levels:
 Individual: education about hazards and prevention
 Design phase: use of safety features in equipment,
products
 Regulatory Level: to ensure safe products and
environments
 Provide/ maintain a Safe environment
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Environmental Safety
A safe environment includes meeting basic
needs, reducing physical hazards, reducing
the transmission of pathogens, maintaining
sanitation, and controlling pollution.
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Safety regulations and guidelines
in healthcare
 Patient safety goals
 Joint Commission Hospital National Patient
Safety Goals [2010]
 Accurate Patient identification
 Effective Communication among caregivers
 Medication Safety
 Reduce HAI’s
 Medication Reconciliation
 ID suicide risk in patients
(The Joint Commission (2011). National patient safety goals)
 Sentinel Event: safety errors that result in
death or serious injury
 QSEN [Quality and Safety Education for
Nurses]:
 Provides framework for knowledge, skills,
attitudes
 Defines 6 competencies for entry into practice
Pt. centered care
Teamwork & Collaboration
EBP
Quality Improvement
Safety
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Informatics
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Characteristics of safety
 Pervasiveness
 Affects all aspects of life
 People assume or neglect responsibility for own
safety
 Perception and judgment
 Perception of danger influences safety practices
 Safety measures only effective if hazard is accurately
perceived and understood [e.g. smoking]
 Management
 Nursing responsibility to protect patients
 Safety practices to avoid /prevent danger
 Prevention is key
 Lifestyle & behavior affect risk for injury
Physical Hazards
 Lighting
 Obstacles
 Bathroom Hazards
 Security
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Lifespan Considerations
 Infant
 Falls, burns, choking, trauma
 Depend on caregivers to prevent injury
 Temperature, ID, airway, monitoring
 Toddler, Preschool
 Increasing mobility , curiosity
 Need modeling, caregiver awareness
 School aged child & Adolescent
 Better physical skills and communication of needs
 Wider world experiences, less supervision
 Risk-taking behavior – need education, example
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Lifespan Considerations
 Adult
 Home, work, recreation
 Safety habits self-enforced
 Alcohol use
 Older Adults
 Loss of physical function, sensory acuity,
judgment, slower reflexes increase risks
 Balance, temperature sensitivity, eyesight
 orthostatics
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Cultural Considerations
 Safety practices learned through
family/culture [risk tolerance]
 Socioeconomic status influences ability to
maintain safe environment, water, heat
 Higher rates/tolerance of high-risk lifestyle
behaviors [smoking, drinking, obesity, food
choices] in some areas increase risk
 Subculture [mountain biking/rock climbing]
brings specific risks
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Risks in the Health Care
Agency
 Falls
Confusion, dizziness, altered mobility,
unfamiliar environment
 Procedure-related Accidents
 ID check, IV lines
 Equipment-related Accidents
 Unlocked w/c, O2, electrical
 Medication errors
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Healthcare Worker Risks
 Exposure
 needle sticks
 Back injuries
 Lifting
 Infertility
 Exposure to antineoplastic
 Violence
 Patients, visitors
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Incident Report
 Required for any accident/injury in
healthcare setting
 NOT part of medical record
 Includes:
 What happened
 Patient assessment
 Interventions provided
 For internal use only
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Assessment [cont.]
 Changes in:
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Environment
Support system
Developmental status
Health status
 Perception, cognition, mobility, activity, sensation
 Functional status/ ability to do ADL’s
 Medications
 Medical conditions
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Assessment [cont.]
 Physical Assessment
 Neurological
 Alertness, orientation, judgment, cognition
 Sensory
 Visual, auditory, balance, sensation, taste, smell
 Cardiac/Respiratory: Activity tolerance,
orthostatics
 Skin integrity – assess past/present injuries
 Musculoskeletal – mobility, activity tolerance
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Nursing Diagnosis
 Risk for injury
 Related to:
 General weakness
 Right or Left sided weakness
 Side effects of medication
 Poor eyesight
 As evidenced by:
 Recent falls
 New CVA
 Confusion
 Macular degeneration
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Outcome Identification/Planning
 Focus on:
 Identification /avoidance of hazards
 Demonstration of safety habits
 Decrease/ absence in frequency/severity
of injury
 E.g. Pt. will not fall this shift
 Pt. will use call light each time he needs to
use BR this shift
 Pt will demonstrate proper use of car seat
prior to d/c
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Implementation
 Risk for injury related to (r/t) generalized
weakness as evidenced by recent falls
 Pt. will ask for help to the bathroom each
time this shift
 Call light will be in reach at all times
 Call light will be answered within 5 minutes this shift
 Pt will not fall this shift
 RN/CNA will collaborate to ensure patient is seen q
hour
 RN/CNA will Document on rounding sheet q 1 hr
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Evaluation
 Was goal met? AEB? Plan?
 Example: [Goal] Pt. will use call light each time
he needs to use BR this shift
 Evaluation:
 Goal partially met; pt. used call light 5/6 times to use BR,
but attempted to get up alone 1 time. Stated “ I couldn’t
wait any longer”. Revision: provide urinal for urgent need
and reinforce need to use call light. Reinforce need for
staff to respond within 5 minutes at shift report.
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Use of Restraints in the Health Care
Setting
 ANY Physical or chemical means of
stopping a patient from being free to
move.
 Used only in emergency situations to
ensure the patient’s safety.
 Restraint orders must be specific and
time-limited.
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Restraint Basics
 Try other options first
 Limit use – temporary solution
 Prescriber must evaluate [in person] within
1 hour for violent/self-destructive behavior
 Obtain consent before use; but if
necessary, explain reason to pt. and family
 Document behavior, interventions,
response, teaching
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Restraints & Alternatives
 Bed rails may be considered restraints
 Usually OK to have 2 up
 4 up considered a restraint
 Contributes to more frequent, severe injury
 Alternatives to restraints –
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Check on pt. at least hourly
Place close to nurse’s station
Control environment, re-orient pt frequently
Provide call light, personal needs, access to BR
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Other Mechanisms to
Prevent Falls
 Tab Alarms
 Arm Bands
 ID outside of Patient room
 Notice Inside the Patient room
 Colors of gowns, slippers, blankets
 Bed Alarms
 Chair Alarms
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Restraint Use
 Must have a physician order
 May apply in emergency, then get order
 Order must be rewritten every 24h.
 No automatic renewal, verbal order
 Restraint policies are specific to health
care setting
 Nursing documentation must occur at least
every two hours
 Including presence/type, need for continued use; skin
assessment; circulation, movement, sensation [CMS];
offer food/fluids if appropriate, offer toileting, ADL’s
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Complications from Restraints
 Skin breakdown
 Constipation
 Pneumonia
 Incontinence
 Urinary retention
 Nerve damage
 Circulatory damage
 Increased agitation
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Questions?
Discussion?
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