Chapter 27 - Patient Safety

Alternatives to restraints

-Bed alarm -Posey Bed -top side rails (considered a restraint if all 4 are up)

National Quality Forum has the mission of improving the quality of health care by

-Building consensus on national priorities and goals for the performance improvement and working in partership to achieve them -endorsing national consensus standards for measuring and publicly reporting on performance -promoting the attainment of national goals through education and outreach programs

Joint Commission National Patient Safety Goals for Hospitals

-Identify patients correctly -Improve staff communication -Use medicines safely -reduce the risk of health care -associated infections -check patient medications -identify patient safety risks.

Thorough hazard assessment for home includes

-adequacy of lighting (indoor and outdoor) -presence of safety devices -placement of furniture or other items that can create barriers - condition of flooring -safety in kitchen and bathrooms -knowledge of food preparation and storage and hand washing practices -heating and cooling systems and detectors GETTING A SENSE OF A PATIENTS ROUTINE WILL HELP YOU RECOGNIZE LESS OBVIOUS HAZARDS.

Most likely places for older adults to fall

-bathroom -bedroom -kitchen

Features that alert nurses to the possibility of a bioterrorism related outbreak

-disease or strain not endemic -unusual antibiotic resistance patterns -atypical clinical presentation -case distribution geographically (from same location) and/or temporally inconsistent -other inconsistent elements

Specific risks to a patient's safety within the health care environment

-falls -patient-inherent accidents -procedure-related accidents -equipment related accidents

Risk factors that pose threats to safety

-lifestyle -impaired mobility -sensory or communication impairment -lack of safety awareness -risks in the health care agency (med errors 8th leading cause of death)

Restraint Alternatives

-more frequent observations -involvement of family during visitation -frequent reorientation -introduction of familiar and meaningful stimuli

Falls can be decreased by...

-multiple-component group exercise -having a physician or pharmacist review all medications -having an eye exam annually -decreasing hazards in the home that increase falls

Use of restraints must meet one of the following objectives

-reduce the risk of patient injury from falls -prevent interruption of therapy such as traction, IV infusions, nasogastric tube feeding, or Foley catheterization -prevent patients who are confused or combative from removing life-suporrt equipment -reduce the risk of injury to others by the patient

Nursing diagnoses for patients with safety risks

-risk for falls -impaired home maintenance -risk for injury -deficient knowledge -risk for poisoning -risk for suffocation -risk for trauma

Group at highest risk for motor vehicle accidents

16-19 year olds

Comfort zone for a person's temperature

65-75 degrees F

Pathogen

Any microorganism capable of producing an illness.

Most common means of transmission of pathogens

By hands.

Leading cause of fire-related deaths

Careless smoking, especially when people smoke in bed at home.

Groups at the highest risk for food borne illnesses

Children, pregnant woman, older adults, people with compromised immune systems.

Food and Drug Administration

FDA- federal agency responsible for the enforcement of federal regulations regarding the manufacture, processing, and distribution of foods, drugs, and cosmetics to protect consumers against the sale of impure or dangerous substances.

Leading cause of death for adults 64 and older

Falls.

Group at highest risk for lead posining

Fetuses, infants and children- because their bodies absorb lead more easily and small children are more sensitive to the damaging effects.

Pathogens spread by blood and other bodily fluids

HIV, AIDS, Hep B

Pollution

Harmful chemical or waste material discharged into the water, soil, or air.

Most common injuries for school-aged children

Head injuries, bicycle accidents being one of the major causes.

Factors that increase the risk of falls

History of falling, being age 65 or over, reduced vision, orthostatic hypotension, gait and balance problems, urinary incontinence, use of walking aids, and various medications.

Common environmental hazard in home

Improperly working furnace- carbon monoxide poisoning. Low concentrations of carbon monoxide cause nausea, dizziness, headache and fatigue. Very high concentrations cause death after 1-3 minutes of exposure.

Safe environment

Includes: meeting basic needs, reducing physical hazards & the transmission of pathogens, and controlling pollution.

Most vulnerable groups

Infants, children, older adults, the ill, & the physically & mentally disabled

Leading cause of death in children over age 1

Injuries- cause more death and disabilities than do all diseases combined.

QSEN safety competency

Minimizes risk of harm to patients & providers through both system effectiveness & individual performance

Most common injuries for adolescents

Motor vehicle accidents and drowning- increased by the smoking, drinking and the use of drugs.

Hypothermia

Occurs when the core body temperature is 95 degrees F or below.

Groups at the highest risk for hypothermia

Older adults, the young, patients with cardiovascular conditions, patients who have ingested drugs or alcohol in excess, and homeless.

Basic Needs

Oxygen, Nutrition, optimum temperature. Must be met before physical & psychological safety & security can be addressed

Fire intervention guidelines

R-rescue and remove all patients in immediate danger (ambulatory patients 1st, patients on life support you need to maintain respiratory status manually) A- Activate the alarm C- Confine the fire by closing doors and windows and turning off oxygen and electrical equipment E- Extinguish the fire using an appropriate extinguisher (Pull pin, Aim at base of fire, Squeeze handles, Sweep from sided to side.)

Immunization

Reduces and prevents the transmission of disease from person to person. Individuals acquire active immunity by an injection of a small amount of attenuated (weakened) or dead organisms or modified toxins from the organism (toxoids) into the body.

Equipment Related Accidents

Result from the malfunction, disrepair, or misuse of equipment or from an electrical hazard. If faulty equipment is discovered place a tag on it to avoid being used. Facilities must report all suspected medical device related deaths to both the FDA and the manufacturer of the product if known.

Leading cause of burns, reported fires, deaths, & injuries involving home medical oxygen

Smoking

National Patient Safety Goals of TJC

Specifically directed to reduce the risk of medical errors. Goals are designed to promote specific improvements in patient safety and highlight ongoing problematic areas in health care.

Greatest risk for home accidental posioning

Toddlers, preschoolers and young school aged children who often ingest household cleaning solutions, medications or personal hygiene products.

Bioterrorism

Use of biological agents to create fear and threat. Most likely form of a terrorist attack to occur. Health officials are most concerned with biological agents such as anthrax, smallpox, pneumonic plague, botulism, tularemia, and viral hemorrhagic fevers.

Patient Inherent Accidents

accidents (other than falls) in which the patient is the primary reason for the accident. Include: self inflicted cuts, injuries, and burns; ingestion or injection of foreign substances, self mutilation or fire setting; pinching fingers in drawers or doors.

Physical Restraint

any manual method, physical, or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely. MUST HAVE AN ORDER

Procedure Related Accidents

caused by health care providers and include medication and fluid administration errors, improper performance of procedures such as dressing changes or urinary catheter insertion. Preventable by adhering to organizational policy and procedures and standards of nursing practice. Distractions and interruptions contribute to procedure related accidents and need to be limited, especially during high-risk procedures such as medication administration.

Exposure to extreme heat

changes the core body temperature, resulting in heatstroke or heat exhaustion.

Groups at highest risk for injury from extreme heat.

chronically ill patients, older adults, and infants.

Primary cause of air pollution at home, school, or workplace

cigarette smoke

Air pollution

contamination of the atmosphere with a harmful chemical. Prolonged exposure to it increases the risk of pulmonary disease.

Main source for in home fires and fire injuries

improper us of cooking equipment and appliances, particularly stoves.

Common physical hazards that lead to falls

inadequate lighting, barriers along normal walking paths and stairways, and a lack of safety devices in the home.

Most common injuries for infants, toddlers, and preschoolers

lead poisoning, chocking, fire injuries, falls.

Most effective methods for limiting the transmission of pathogens

medically aseptic practice of hand hygiene.

Chemical Restraints

medications such as anxiolytics and sedatives used to manage a patient's behavior and are not a standard treatment or dosage for the patient's conditions. MUST HAVE AN ORDER

Most common precipitating factor for a patient inherent accident

seizures

Quality & Safety Education for Nurses

(QSEN) developed to meet the challenge of preparing future nurses who will have the knowledge, skills, & attitudes necessary to continuously improve the quality & safety of the health care systems within which they work.

Complications resulting from restraints

- pressure ulcers -pneumonia -constipation -incontinence -in some cases death has resulted because of restricted breathing and circulations -loss of self-esteem -humiliations -agitation