Patient safety and quality
Discuss the importance of safety in the home and health care environment
- A safe environment reduces the risk for illness and injury and helps to contain the cost of health care by preventing extended lengths of treatment and/or hospitalization, improving or maintaining a patient's functional status, and increasing a patient's sense of well-being. - Nurses are responsible for incorporating critical thinking skills to promote patient safety, involves using the nursing process- assessing patient's risks for injury in their home or health care environment, assessing for hazards that threaten safety, accurately diagnosing problems, and the planning and intervening appropriately to maintain a safe environment.
Describe ways to prevent procedure-related accidents.
- Caused by health care providers and includes medication and fluid administration errors, improper application of external devices, and accidents related to improper performance of procedures such as dressing changes or urinary catheter insertion. - All staff need to be aware of distractions and interruptions contribute to procedure-related accidents and need to be limited, especially during high-risk procedures such as medication administration, another common is patients at risk for injury in transferring to a bed or chair. Correct use of safe patient handling techniques and equipment reduces the risk of injuries when moving and lifting patients.
Identify the factors to assess when a patient is in restraints.
Pressure ulcers, pneumonia, constipation, incontinence, breathing, circulation, behaviors that necessitated the application of restraints, procedure used in restraining, condition of the body part restrained, evaluation of the patient response.
Discuss the vulnerable populations most at risk for threats to safety.
Vulnerable populations are especially at risk for alternations in safety because of reduced access to health care, fewer resources, and increased morbidity. - These vulnerable groups most affected include infants, children, older adults, individuals who have difficulty communicating, and individuals who have a low-income or are homeless.
Discuss how to select environmental interventions for fall prevention for the home environment.
- Collaborate with patient and family caregiver to make changes based on their home fall risk assessment and the patient's risk factors. - Remove all obstacles from halls and other heavily traveled areas, be sure that end tables are secure and have stable, straight legs, place nonessential items in drawers to eliminate clutter, pts with stumbling or tripping should never have small area rugs in the home and if used secure them with a nonslip pad or skid-resistant adhesive strips, carpeting on the stairs is secured with carpet tacks, history of falling and live alone recommend wearing an electronic safety alert device. - Observe pts using assistive devices in the home to ensure the devices are held and used correctly and inform pt. about how to keep these devices in safe working order.
Discuss the key factors in patient-centered care that can improve patient safety.
- Engage in activities that support a patient-centered safety culture, by recognizing your patients or their designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient preferences, values, and needs. - Much of the force behind the focus on safety comes from regulatory and accrediting agencies: The joint Commission's 2020 National Patient Safety Goals are standards for all health care institutions and are specifically directed at reducing the risk of medical errors. (box 27.1) ~Identify patients correctly ~Improve staff communication ~Use medications safely ~Use alarms safely ~Prevent infection ~Identify patient safety risks ~Prevent mistakes in surgery The Agency for healthcare Research and Quality describes key features of a "culture of safety": ~Acknowledgement of the high-risk nature of an organization's activities and the determination to achieve consistently safe operations. ~A blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment. ~Encouragement of collaboration across levels of employees and disciplines to seek solutions to patient safety problems. ~Organizational commitment of recourses to address safety concerns.
Describe assessment activities that identify the physical, psychosocial, and cognitive status of a patient as it pertains to his or her safety.
- Identify patient's perceptions of safety needs and risks, identify actual and potential threats to the patient's safety, determine impact of the underlying illness on the patient's safety, Identify the presence of risks for the patient's developmental stage and patient's environment, Determine effect of environmental influence on the patient's safety.
Discuss how an individual's developmental age creates safety risks.
- In addition to being knowledgeable about the home and health care environment and the inherent safety risks, nurses need to know a patient's developmental level; mobility, sensory, and cognitive statue; lifestyle choices; and knowledge of common safety precautions. Developmental Stages and Risks Infant, Toddler, and Preschooler - Infants and toddlers explore the environment and, because of their increased level of oral activity, put objects in their mouths, this increases their risk for poisoning or aspiration and choking on foreign material such as toys. - A safe sleep environment for an infant involves the placement of the infant on his back on a firm mattress in a safety-approved crib that is free of pillows, toys, and blankets, as these are suffocation hazard. Instruct patients about the hazards of sleeping with an infant in bed, on sofa, or on the floor. - Limited physical coordination in preschoolers contributes to falls from riding bicycles and using playground equipment, other injuries include burns and drowning. - Accidents involving children are largely preventable, but accident prevention requires health education for parents and the removal of dangers whenever possible. School-Age Child - Enter a period of less intense emotions, secure in their dependency on parents and family and with self-confidence tempered by a more realistic perspective. - Have the energy to explore the environment beyond the home and gradually increase the scope of interpersonal interaction. - Learning how to perform more complicated motor activities and often are uncoordinated, also expand their cognitive and psychosocial skills. - School-agers are exposed to more environments in which they need protection, they have less supervision, and they take more responsibility as they participate in a more adult world. - Violence in any form disrupts a child's ability to learn and may have a negative effect on health throughout life. - School nurses are able to recognize the multiple factors that may increase or decrease a youth's risk of becoming a perpetrator or victim of school violence and may be able to identify students at risk. (box 27.2) ~History of victimization ~Disabilities ~Emotional problems ~Substance abuse ~Low IQ ~Authoritarian parenting ~Low family involvement and low income ~Gang involvement ~School failure ~Transient lifestyle ~Diminished economic opportunities Adolescents - They develop greater independence and a sense of identity, begin to separate emotionally from their families, and peer groups begin to have a stronger influence, have a wide variation that swing childlike to mature behavior. - Experimentation with the use of tobacco, alcohol, and other substances is common. Without appropriate health literacy skills, misinformed parents and students can overlook or downplay the risks of substance use. Environmental clues like the presence of drug-oriented magazines, beer and liquor bottles, or drug paraphernalia and the wearing of long-sleeved shirts in hot weather, and psychosocial clues are failing grades, change in dress, absenteeism from school, isolation, and changes in interpersonal relationships. - Risk for suicide with decreased self-worth and hopelessness, risk factors include: a recent loss or death, psychiatric disorder, prior suicide attempts, alcohol or substance abuse disorders, struggling with sexual orientation, family history of suicide, lack of social support, bullying, and access to lethal means(guns). Adults - Threats to an adult's safety are frequently related to lifestyle habits. People who drink excessively have a greater risk of motor vehicle accidents, those who smoke long term have a greater risk of cardiovascular or pulmonary disease, and people who experience a high level of stress is more likely to have an accident or illness such as headaches, GI disorders, and infections. Older adults - The physiological changes associated with aging, the effects of medications, psychological and cognitive factors , and the effects of acute or chronic disease increase an older adult's risk for falls and other types of accidents (burn injuries, vehicular crashes) , once a patient falls, the risk for a second time is increased. - Dementia - Mind wandering, involves engaging in task-irrelevant thoughts that can have negative functional consequences, such as falls, and impaired task performance.
Identify evidence-based alternatives to restraints for patients in physical restraints
- Orient patients and family members to the environment; explain all procedures - Provide companionship and supervision; use trained sitters; adjust staffing and involve family. - Offer diversional activities: music, puzzles, activity aprons, folding towels. Use ideas of the patient and/or family. - Assign confused or disoriented patients to rooms near nurses' stations, and observe frequently. - Use de-escalation, time-out, and other verbal intervention techniques when managing aggressive behaviors. - Provide visual and auditory stimuli (ex. Family pictures, a clock, music). - Remove cues that promote leaving the room (ex. Close doors to block view of stairs; do not allow inpatient to wear street clothes). - Promote relaxation and techniques and normal sleep patterns. - Institute exercise and ambulation schedules as allowed by patient's condition. - Attend frequently to patient's needs for toileting, food and liquid, and pain management. - Camouflage intravenous lines with clothing, stockinette, or Kling gauze dressing. - Evaluate all medication effects and ensure timely and effective pain management. - Discontinue bothersome treatments (ex. Nasogastric tubes or Foley catheter) as soon as possible. - Use protective devices such as hip pads, helmet, skid proof slippers, and nonskid strips near bed.
Explain the mobility alterations that pose risk for falling.
- The unfamiliar environment, acute illness, surgery, mobility status, medications, treatments, and placement of various tubes and catheters are common challenges that place patients of any age at risk of falling. - Muscle weakness, paralysis, abnormal gait, and poor coordination or balance. - In hospitals include sleep deprivation, a new environment, a change in medications, or deterioration in physical strength brought on by change in a disease process.
Identify basic nursing interventions to reduce the risk of falls, fires, medication errors, electrical hazards, and poisoning in the home and healthcare environments.
-School-Age Children: teach safe use of equipment for work and play, tell children not to operate electrical equipment while unsupervised -Adolescents: encourage adolescents to do community and school related activities; internet safety -Older Adults: encourage annual vision and hearing screening, teach pt safety tips for avoiding automobile accidents, provide adequate meaningful stimuli, teach families the importance of the safety techniques, assist elders when ambulating
Identify factors that affect safety and common manifestations of altered safety.
Being aware of factors that affect safety, such as developmental level, lifestyle, mobility, sensory perception, knowledge level, communication ability, physical health state, and psychosocial state allows nurses to identify potential hazards and promote wellness. Injuries and deaths from motor vehicle accidents, falls, fire, suffocation, and poisoning occur with alarming regularity across the lifespan. Many of these injuries and deaths can be prevented with appropriate safety awareness and precautions. Violent behavior and its aftermath has also become a significant factor that affects public safety.
Discuss common physical hazards and methods for preventing them.
Environmental Safety - A patient's environment includes physical and psychosocial factors that influence or affect the life and survival of that patient. - A safe environment meets basic needs, reduces physical hazards as well as the transmission of pathogens, and controls pollution. Basic needs - Physiological needs, including the need for sufficient oxygen, nutrition, and optimum temperature, influence a person's safety. - According to Maslow's hierarchy of needs, these basic needs must be met before physical and psychological safety and security can be addressed. Oxygen - Patients who require supplemental oxygen in health care settings are at risk because oxygen is highly flammable, fire can occur when the patient chooses to smoke or is exposed to a heat source. - Strict codes regulate the use and storage of medical oxygen in health care agencies, not the case at home environments; be sure to administer oxygen safely and provide patients and family caregivers the information needed to manage oxygen correctly in the home. - Oxygen can build up in at home and on a patient's clothing and hair; if a person smokes in an environment that has supplemental oxygen, such as a house, even a small spark can cause a fire that will spread very quickly, resulting in extensive burns and death. - Know factors that decrease the amount of available oxygen in a pt's environment: an improperly functioning heating system, a furnace, fireplace, or a stove that is not properly vented introduces carbon monoxide (CO) into the environment. - CO affects oxygenation by binding strongly with hemoglobin, preventing the formation of oxyhemoglobin and reducing the supply of oxygen delivered to tissues. - Low concentrations of oxygen cause nausea, dizziness, headache, and fatigue. - Unintentional, non-fire related (UNFR) carbon monoxide poisoning Nutrition - Meeting nutritional needs of patients requires knowledge about healthy food and food safety. - Health care agencies are required to meet State Board of Health regulations for the storage, preparations, and provision of food to patients. - When you care for patients returning home or if you work in home health, educate them about food principles, also a patient requires an adequate, clean water supply for drinking and to wash fresh produce and dishes. - If a patient does not prepare or store food properly, it increases the risk for infections and food poisoning from norovirus or bacteria such as Escherichia coli, Salmonella, or Listeria. Temperature - Temperature extremes that frequently occur during the winter and summer pose safety risks for vulnerable populations. - Exposure to severe cold for prolonged periods cause frost bite and accidental hypothermia. - Older adults, the young, patients with cardiovascular conditions, patients who have ingested drugs or alcohol in excess, and homeless are at risk for hypothermia. - Exposure to extreme heat changes the electrolyte balance of the body and raises the body core temperature, potentially resulting in heat stroke or heat exhaustion. - Chronically ill patients, older adults, and infants are at greater risk for injury from extreme heat. Physical Hazards - Physical hazards in the home and work environment threaten a person's safety and often results in physical and psychological injury or death. - Motor vehicle accidents, poisonings, and falls are the leading causes of unintentional injuries, fire and disasters are additional. - In the work setting, repetitive motion injuries, vehicle accidents, falling objects and falls are common causes of injuries. - A nurse's role is to educate patients about the common safety hazards in the home and at work, teaching them how to prevent injury and emphasizing the hazards to which patients are the most vulnerable. Motor Vehicle Accidents - State laws relating to licensing of young drivers, safety belt use, child restraint use, and motorcycle helmets exist for driver protection. - Children ride in child safety seats and booster seats appropriate for their age and weight and type of car. - The risk for motor vehicle accidents is higher among 16 to 19 year old drivers than any other age- group, with motor vehicle crashes being the leading cause of death. Teens often underestimate dangerous situations or are unable to recognize hazardous situations, lowest rate of seat belt use. - Elderly drivers have an age related decline in vision and cognitive functioning (ability to reason and remember) and physical changes affect driving abilities of some older adults. Poison - A poison is any substance that impairs health or results in death when ingested, inhaled, injected, or absorbed into the body. - Poisons often impair the function of every major organ system. - Sources of poison in the home includes: medicines, solid or liquid cleaning substances, gases, and vapors. - Toddlers, preschoolers, and young school-age children are at greater risk because of their curiosity, often ingesting household cleaning solutions, medications, or personal hygiene products. - Emergency treatment is necessary when a person ingests a poisonous substance or comes into contact with a chemical that is absorbed through the skin. - A poison control center is the best resource for patients and parents needing information about the treatment of an accidental poisoning. - Fetuses, infants, and children are more vulnerable to lead poisoning than adults because their bodies absorb lead more easily, and small children are more sensitive to the damaging effects of lead, a child's growth or causes learning and behavioral problems and brain and kidney damage. Falls - Falls have been a health problem, ranking as the second leading cause of accidental or unintentional injury deaths worldwide, falls contribute to disability, lost work time, and in the case of many older adults, long-term care and institutionalization. - Falls are multifactorial; numerous factors increase the risk for falls, risk factors include: older adults, occupations at higher elevation or hazardous, alcohol or substance abuse, socioeconomic factors including poverty, overcrowded housing, sole parenthood, or young maternal age. - Underlying medical conditions - Polypharmacy and side effects of medications - Physical inactivity and loss of balance - Poor mobility, cognition, and vision - Unsafe environments - Foot problems Fire - The leading cause of fire-related death is careless smoking, especially when people smoke in the bed at home, cooking equipment leading cause of home structure fire and home fire injuries and second leading cause of home fire deaths, heating equipment second most common cause of home fires and fire injuries and third leading cause of fire deaths. - Nurses play a role in educating the public about fire prevention measures. - Because patients in health care facilities are sick, disabled, or elderly, health care staff must know how to protect patients and respond to fires appropriately, have routine drills in place to measure staff responsiveness and understanding of fire safety protocols. Disasters - Natural disasters are a major cause of death and injury; leaves many people homeless. - Bioterrorism is another cause of disaster and refers to biological agents (microbes or toxins) used as weapons to further personal or political agendas, the agents of greater concern are anthrax (a bacterium) and smallpox (a virus). - Hospitals that are accredited by the Joint Commission must demonstrate they have proper plans and response mechanisms in place if a disaster occurs. The hospitals conduct annual disaster preparedness exercises and must monitor the following six critical factors: ~Communication ~Supplies ~Security ~Staff ~Utilities ~Clinical activity Transmission of Pathogens - Both patients and health care providers are at risk for exposure to pathogens, any microorganism capable of producing an illness. Most common means of transmission of pathogens is by the hands. - Nurses must educate patients about their unique risks for developing infection, such as immunosuppression from medications, chronic disease, or older age. - Health care facilities have standards for infection prevention in a variety of clinical situations, such as prevention of surgical site infections or catheter-associated urinary tract infections. - Limiting the transmission of pathogens in health care is the medically aseptic practice of hand hygiene, nurses must adhere to the practice of hand hygiene, follow standard and transmission-based isolation precautions, and educate patients, families, and caregivers about the importance of incorporating hand hygiene in all aspects of their lives. Immunizations - Reduces, and in some cases prevents, the transmission of disease from person to person. Children vaccinations has proven to be one of the most effective public health strategies to control and prevent disease. - Nurses play a role in informing parents about the importance of adhering to vaccination schedules for their children. - Adults require regular vaccinations depending on their age, job, lifestyle, travel, or health conditions. - Health care workers who are risk for being exposed to blood or other body fluids should receive the three-dose series of vaccinations for hepatitis B.