Module 50 and 51: Quality Improvement and Safety (NURS2700)

colleagues examine each other's work. For example, nurses could look at their adherence to medication administration timing or documenting effectiveness of pain relief measures. The key characteristic is that of mutual learning in a safe, nonpunitive environment.

A peer review happens when...

Malignant cancers Heart disease Suicides and homicides

Additional causes of death in young adults include:

1. Client care 2. Client outcomes 3. Client satisfaction 4. Clinician satisfaction 5. Resource utilization

After new processes are implemented in a clinical setting, five results need to be evaluated for impact:

On the wrong client On the right client, but the wrong body part On the right client, but the wrong surgery

Another injury that can occur in the clinical setting is wrong-site surgery (WSS). This injury refers to surgery performed:

no

Are quality improvement and quality management the same things?

trained individuals either inside of or outside of the clinical area. They can examine either financial or medical records with different timelines.

Audits can be performed by...

Patient Centered Care Rationale In​ patient-centered care the​ client's perspectives,​ beliefs, and culture are taken into consideration for all aspects of care. In quality​ improvement, adverse outcomes are studied to improve client safety and the quality of care provided.​ Evidence-based practice is the use of research to guide clinical care. Teamwork and collaboration is working effectively with other departments and​ shifts, being accountable for participation as a team​ member, and engaging in conflict resolution as needed.

Before planning​ care, the nurse asks the client to identify goals and any cultural aspects that should be taken into consideration when providing nursing care. Which competency is this nurse​ demonstrating? Teamwork and collaboration Quality improvement ​Patient-centered care ​Evidence-based practice

looking back at the actual performance of an activity and comparing its results to a chosen standard. The statistics that are produced are called indicators, since they show how closely the activity compared to the set standard.

Benchmarking is...

Unintentional injury from motor vehicle accidents Poisoning from drug overdose Drowning Suicides

Causes for fatal injuries in the adolescent are, in the order of prevalence:

Unintentionally being struck or being hit up against something Unintentional falls Overexertion Occupant of a motor vehicle Cut or puncture Nonsexual assault

Causes for nonfatal injures in the adolescent include:

Unintentional falls Overexertion Accidental striking by or against something Unintentional cuts or piercings

Causes for unintentional injuries in young adults include:

Recognizing individual knowledge limits Knowing how to access current evidence to supplement knowledge

Characteristics of evidence based practice include:

Needlesticks Latex allergies Musculoskeletal injuries Stress Violence from clients

Even though hospitals and other healthcare organizations are places where individuals receive care to improve health, these facilities can be very dangerous places to work. There are more than 18 million healthcare workers who face safety hazards while caring for others, and these workers experience the highest percentage of nonfatal occupational injuries and illnesses than any other industry. Some of these safety hazards include:

Medical errors causing an increased length of stay (LOS) in an inpatient facility Additional clinical visits for client education Lost time due to the condition of supplies, equipment, or documentation

Examples of waste that nurses can prevent are:

Deficits in treatment and care management Medication administration Assessment Professional conduct Monitoring

Five high-risk situations associated with such breach of duty are:

Informatics Demonstrating the ability to use electronic client records is a skill within the QSEN competency of informatics. The competencies of quality​ improvement, teamwork and​ collaboration, and​ patient-centered care do not address the use of technology for documenting in the client record.

For which QSEN competency should the nurse demonstrate the ability to use electronic client​ records? Informatics Teamwork and collaboration Quality improvement ​Patient-centered care

Miscarriage

Health risks to the developing fetus can begin before conception and may result in?

All restraints must be removed regularly to allow for cleansing and exercising of the restrained limb.

How frequently must physical restraints be removed?

Use information and technology to further client care and safety efforts Ensure client information is protected by using appropriate system safeguards and practices

Information technology is playing a larger role in health care, and nurses are needed to assist with the design and use of these communication systems. Nurses with expertise in this competency will:

Transportation accidents Workplace violence Trauma from objects or equipment Falling or tripping Exposure to dangerous environments or substances Explosions or fires.

Injuries are either fatal or nonfatal with the majority of fatal injuries involving males. The categories of injuries that result in fatalities include, in the order of prevalence:

collects data from nurses about nursing activities. The data can come from either peer reviews or audits. Both examine documentation to verify that standards of care are met.

Intradisciplinary assessment

Infection Premature birth Asphyxia

Neonatal death accounts for nearly 40% of deaths of all children age < 5 years old. Cause of neonatal deaths worldwide include:

Needles Latex Blood Wound drainage Other infectious materials.

Nurses are expected to actively prevent injuries while providing client care. Healthcare organizations have policies and procedures to prevent injuries; however this might not be enough. Nurses need to be aware of actions to prevent injuries when working with:

Football Hockey Soccer Boxing Wrestling

Sports that have the highest risk for head injuries are:

Appropriate hand hygiene Use of personal protective equipment Safe injection practices Managing contaminated surfaces and equipment.

Standard precautions are actions taken to reduce the transfer of infectious agents between nurses and clients. Most organizations expect nurses to follow standard precautions when providing client care. Measures taken when implementing standard precautions include:

"breach of care" or "breach of duty"

The legal term for a deviation from a standard of care is...

hand hygiene

The major preventive measure that all nurses can take to limit the spread of common illnesses is....

Falls Improper use of restraints Healthcare-associated infections Wrong-site surgery Medication errors Hospital readmissions Diagnostic errors

The most common adverse events in healthcare include:

lifestyle choices

The risk for injury and death related to unintentional injuries decreases as individuals age. So what risk factors most contribute to adult health and safety?

Cancer Heart disease Infection However, these risks will vary depending upon the age of the individual. For example, an older client may have a higher risk for cancer or heart disease, whereas a child or adolescent may have a higher risk for infection.

The risk for safety issues change throughout an individual's lifespan. In the United States the majority of health risks fall into the categories of:

Occupational Safety and Healthcare Administration (OSHA) National Institute for Occupational Safety and Health (NIOSH).

This Act also created two safety regulatory bodies, which are:

Overuse: Using a resource when it is not necessary. An example would be performing every type of laboratory test to rule out every kind of possible physiological imbalance. Misuse: Using a resource in the wrong way. An example would be diverting donated funds meant to help discharged clients transition home to another use. Underuse: Not using a resource when it is clinically indicated. An example would be inadequate staffing levels on weekend shifts or in satellite clinics. Not having systems in place to make sure children are vaccinated or that older adults receive annual flu shots would be other examples.

Three kinds of problems might be identified by utilization review efforts:

Teach clients who participate in sports, strenuous exercise, or any athletics about the danger of not reporting a head injury. Counsel clients who have sports injuries about the risk of unreported concussions. Teach adolescents the dangers of unreported head injuries during routine sports physicals.

To help increase the reporting and reduce the long-term effects of head injuries, nurses should be prepared to:

Physical Chemical Other devices

What are the different types of restraints?

Needlestick injuries Exposure to airborne pathogens

Workplace safety is of paramount importance in health care. Incidents can and do occur in health care that should be reported to ensure safety of other employees as well as clients. Examples of incidents that impact both healthcare workers and clients include:

Each nurse needs to be aware of reporting expectations for the state of residence.

Nurses must be alert for clients who are unable to address safety issues because of others' actions. There are certain situations in which nurses must report unsafe or injurious behaviors, such as exposure to violence. What must the nurse be aware of in order to report appropriately?

Report problems to supervisors. Keep current in skills and education. Base all care on the nursing process model. Document the care plan and the client's response.

Four methods can help nurses reduce the risk of committing a breach of care:

Physical restraints are any manual method, material, device, or equipment attached to the body to limit free movement of the head, arms, legs, or body.

What are physical restraints?

ideal achievable level of care delivery.

In health care, "standards" are statements of the...

Done while a client is still undergoing care. It can make timely changes to the client's care before discharge.

When is a concurrent audit completed?

include Safety Data Sheets that provide information as to safe handling of the chemical and measures to limit exposure in the event of a spill. If not handled correctly, many chemicals can cause both injury or illness if spilled or ignited

Another concern is exposure to hazardous and toxic substances. Chemicals such as cleaning supplies, paints, and other forms of air pollutants can be dangerous. Healthcare organizations have Hazard Communication standards to help regulate the exposure to hazardous chemicals. These standards include:

Individuals can report errors or near misses without fear of punishment.

Blame-free environment is a facility approach to human errors. What is a blame-free environment?

Catheter-related bloodstream infections (CRBIs) Healthcare-associated pneumonia (HAP) Ventilator-associated pneumonia (VAP) Surgical site infections (SSIs) Central line-associated bloodstream infections (CLABSIs) Clostridium difficile-associated infection (CDIs)

Diseases or conditions caused by HAI microorganisms include:

Age Lifestyle choices Environmental exposures Development

Each age group has a set of common injuries. These injuries vary depending upon:

Measurable Objective Sensitive to changes in performance

Indicators for benchmarking must be...

a way to balance both accountability and blame-free environment. It focuses on correcting system problems that produce unsafe activity. It has zero tolerance for reckless behavior.

Just culture is a facility approach to human errors. What is a just culture environment?

Improve current methods being used in practice Impact physiologic outcomes for the client Have a positive influence on legal and ethical issues

Monitoring quality can:

These goals are developed and updated by a group of nurses, healthcare providers, pharmacists, risk managers, engineers, and other professionals who make up the Patient Safety Advisory Group (PSAG)

National Patient Safety Goals are developed by members of what profession(s) and what group are they apart of?

Establishing an identify separate from parents\ Increasing peer pressure Receiving a driver's license Playing contact sports Experimenting with drugs and alcohol

The adolescent period is one of discovery and risk taking. Injuries in this age group are due to:

Retrospective Audit Retrospective audits take place after clients are discharged. Concurrent audits take place while clients are still hospitalized. Utilization review is about the use of​ resources, rather than about client outcomes. Benchmarking compares data with​ pre-set standards, rather than exploring new territory.

The oncology nurse interviews all the mastectomy clients 2 weeks after they leave the hospital. Before​ discharge, clients gave their consent to be contacted. The interview consists of ten exploratory questions about factors in their satisfaction before and after surgery. What kind of assessment is going​ on? Benchmarking Utilization review Retrospective audit Concurrent audit

requires that specific criteria are met that clearly demonstrate the potential for self-harm or harm to others.

The use of any restraint requires what?

Increases client comfort Decreases falls Decreases skin injuries Increases rehabilitation efforts Promotes client safety Promotes staff safety.

The use of mechanical aids to move clients:

scratched, hit, kicked, beaten, and bitten. Within healthcare organizations, the areas in which violence is most likely to occur are psychiatric units and emergency departments.

Violence is considered as being any physical assault, threatening behavior, or verbal abuse that occurs in the workplace. The healthcare industry ranks the highest in workplace violence incidence with injuries being caused by being:

promoting wellness, providing client teaching, and conducting safety screenings.

When providing care to address potential or actual safety issues, implementation focuses on:

Contact with clients with contagious illnesses that are or have yet to be diagnosed Bloodborne pathogens caused by needlestick or other sharps injury.

By virtue of the environment, work-related illnesses occur in nursing. Reasons for these illness include:

dissatisfied clients are higher risk for liability

Client satisfaction is an important factor because....

hazards, prevention of injuries from hazards, and treatment of injuries from hazards.

Client teaching should focus on age-appropriate safety issues and should include avoidance of:

With impaired memory and muscle weakness Who use assistive devices such as canes or walkers Who use multiple prescription and over-the-counter medications

Clients at high risk for falls include those:

Complicated care Treatments occur anytime of the day or night and across several shifts Coordinating care among healthcare providers, nurses, and specialists who work in a team Complicated and time-sensitive treatment protocols Medicine and nursing are constantly evolving Multiple clients needing care at the same time Clients unable to follow complicated treatment plans and medical terminology

Despite the best intentions of healthcare professionals, adverse events when providing client care continue to occur. Reasons for these events include:

Home swimming pools lacking​ four-sided barriers Rationale The risk of​ water-related injuries is greater when home swimming pools do not have​ four-sided barriers. The presence of life​ preservers, lifeguard​ classes, and adults in attendance while children are in water or swimming pools would prevent​ water-related injuries.

During a recent community survey on local swimming​ pools, the public health nurse becomes concerned about the risk of​ water-related injuries for community members. Which survey result led the public health nurse to have this​ concern? Life preservers available at each pool side ​School-age children swimming with several adults in attendance Life guard classes occurring at the community pool Home swimming pools lacking​ four-sided barriers

Poor prenatal care Poor maternal nutrition Tobacco use Pollution exposure Pathogens

Factors that affect birth weight include:

Right drug Right dose Right client Right route Right time Right documentation *The right documentation is particularly important since this action can help prevent accidental duplication of a medication dose.

Medication errors cost healthcare organizations approximately $3.5 billion extra healthcare dollars each year. This type of safety issue can be prevented if the six rights of medication administration are followed, specifically:

address client safety issues.

National Patient Safety Goals is a program from The Joint Commission that started in 2002 to help organizations do what?

Bar coding both clients and medication Regulating similarly-named drugs Using computerized healthcare provider order entry systems.

National- and facility-implemented interventions to reduce medication errors include:

Job satisfaction Employee retention rates.

Nursing has been addressing workplace safety over the years by establishing protocols for safety promotion and injury prevention. These protocols are intended to protect both the healthcare worker and clients receiving care. Workplace safety impacts:

Risk of falling due to medication, age, or activity level Prevention of motor vehicle accidents Avoidance of heart disease and cancer

Other areas for consideration when instructing clients on safety include:

Six Sigma Rationale Six Sigma considers factors leading to client dissatisfaction as open double quote"defects.close double quote" Disrupted sleep qualifies as a defect. Defect is not a concept used in continuous quality improvement or performance improvement. Benchmarking uses industry​ standards, which do not exist for disrupted sleep.

The nurse manager complimented the night staff on recent data about reducing noise. The day shift nurses asked each client about obstacles to sleep the previous night. They recorded the clients​' responses as either achieving the goal of sleep or being disrupted by the defect of loud sounds or other obstacles. Which kind of quality improvement activity is taking​ place? Performance improvement Continuous quality improvement Benchmarking Six Sigma

Transport the resident in a wheelchair to the dining hall for meals. Find out what activities the resident enjoys and ensure the resident attends. Introduce the resident to other residents. Rationale For older residents and those requiring​ long-term care, the nurse should encourage social contact to reduce the risk for​ isolation, which contributes to functional decline and mortality. The nurse could transport the resident to the dining hall for​ meals, assess the resident to learn activities that the resident​ enjoys, and introduce the client to other residents. Spending time in bed after meals would potentiate social isolation and increase the risk of unintentional injuries. The resident may or may not need a psychology consultation. This​ action, however, would not reduce the risk of unintentional injuries in the resident who is socially isolated.

The nurse notes that an older resident of a​ long-term care facility is not eating in the dining room with other residents and does not participate in group activities. Which nursing interventions can minimize this resident​'s risk for unintentional​ injuries? ​(Select all that​ apply.) Transport the resident in a wheelchair to the dining hall for meals. Find out what activities the resident enjoys and ensure the resident attends. Suggest the resident have a consultation with a psychologist. Encourage the resident to spend time in bed after meals. Introduce the resident to other residents.

Screen for risks of injury. Teach use of seatbelts and helmet use. Discuss drug and alcohol use and risk for suicide if applicable. Discuss risk for traumatic brain injury if applicable.

What are some nursing actions that reduce risk for injury in adolescents?

Wheezing Nonproductive coughing Dyspnea (labored breathing) Cyanosis (abnormal discoloration of skin) Diminished breath sounds Crackles

What are some symptoms of foreign body aspiration?

low birth weight

What is a major risk for fetal mortality or still birth?

Falls

What is the leading cause of death and injury in older adults?

Done after client discharge. It compares one client's outcome to that of clients with similar conditions, and can recommend future changes to procedures.

When is a retrospective audit completed?

10 to 19 year olds. These injuries are caused by football or cycling in males and soccer or basketball in females.

Which age range has the highest rate of TBI?

Serve a medically underserved area or population Provide comprehensive primary care services Offer services at reduced cost Choose over half of their governing board from the served population

states or the federal government can fund community health centers (CHCs). These nonprofit facilities provide health care to uninsured and underinsured populations. They comply with regulations to:

Previous three months of work schedules Number of reports of verbal abuse New policies about calling off and use of paid time off Rationale One topic in which NIOSH focuses research is that of workplace stress. Stress is common in healthcare primarily because of the nature of the work. When studying workplace​ stress, NIOSH focuses on the impact of work​ schedules, the impact of new policies and​ practices, and emotional abuse in the workplace. The number of employees hospitalized with​ work-related injuries and the number of employee​ cuts, sprains, and fractures would be reported to OSHA.

A NIOSH representative is scheduled to tour a care area as part of a study on workplace stress. What should the manager prepare to share with the representative who visits the care​ area? ​(Select all that​ apply) Previous three months of work schedules Number of reports of verbal abuse Number of employee​ cuts, sprains, and fractures Number of employees hospitalized with​ work-related injuries New policies about calling off and use of paid time off

Risk management Rationale Risk management could add this complaint to its data about client​ satisfaction/outcomes, and work with the relevant clinical unit about prevention. A skin infection is not a sentinel​ event, so no root cause analysis needs to be initiated. An isolated event would not prompt peer review. Utilization review looks at resource​ use, not postdischarge outcomes.

A client called Patient Relations after being discharged to report that a skin infection developed around the IV catheter insertion site on the client​'s right arm. Which process would likely prevent a similar recurrence in the​ future? Root cause analysis Peer review Utilization review Risk management

diazepam​ (Valium) Rationale Pharmacologic agents are used to control hyperactive behavior in agitated clients. Commonly used medications include​ sedatives, hypnotics,​ neuroleptics, and antianxiety medications. Diazepam​ (Valium) is a​ benzodiazepine, which can be prescribed as a sedative or antianxiety medication. Amoxicillin​ (Amoxil) is an antibiotic. Warfarin​ (Coumadin) is considered an anticoagulant. Digoxin​ (Lanoxin) is a cardiac glycoside antiarrhythmic medication.

A client is prescribed a chemical restraint for aggressive behavior. When reviewing the client​'s medication administration​ record, which medication should the nurse use to prevent the client from causing harm to self or other staff​ members? digoxin​ (Lanoxin) warfarin​ (Coumadin) amoxicillin​ (Amoxil) diazepam​ (Valium)

Identify the medication to obtain a safety data sheet Rationale Healthcare organizations have Hazard Communication standards to help regulate the exposure to hazardous chemicals. These standards include safety data sheets that provide information as to safe handling of the chemical and measures to limit exposure in the event of a spill. If not handled​ correctly, many chemicals can cause both injury and illness if spilled or ignited. The nurse should identify the medication so that a safety data sheet can be accessed to properly address the spill. Covering the medication with a towel might not be the correct way to clean the spill. Asking the environmental services team to clean the floor does not address exposure to the medication that has spilled. Applying gloves and wiping the medication with clear water might not be the correct way to handle the spill to prevent injury to the​ nurse, client, or other staff.

A client​'s chemotherapy medication becomes disconnected and fluid is running down the hospital bed onto the floor. What action should the nurse take regarding the spilled​ substance? Identify the medication to obtain a safety data sheet Apply gloves and wipe the medication with clear water Ask environmental services team to clean the floor Cover the spilled medication with a towel

Witnessing a nurse recapping used needles Finding used syringes and needles on top of medication carts Rationale The educational campaign STOP STICKS was created to remind hospital staff of the ways to prevent and report needlestick injuries. This campaign specifically provides resources for exposure prevention​ methods, equipment​ evaluations, and requirements for sharps disposal containers. Nursing staff recapping needles and finding used syringes and needles on top of medication carts indicate that additional training is needed on exposure prevention methods. Changing sharps containers when​ ¾ full and ensuring that sharps containers are at the head of every​ client's bed space would indicate that training has been effective. Providing all staff with blunt edged scissors would not support the STOP STICKS program.

A healthcare organization implemented the STOP STICKS program on all client care areas. Which observations by the nurse manager indicate the need for additional education about the​ program? ​(Select all that​ apply.) Finding sharps containers at the head of every​ client's bed space Supplying nursing staff with blunt edged scissors Witnessing a nurse recapping used needles Changing sharps containers when​ 3/4 full Finding used syringes and needles on top of medication carts

Exposure to toxins Rationale An area that has the potential to impact the safety of all age groups is the risk for exposure to toxins. These toxins include​ tobacco, illicit​ drugs, and alcohol. The risk for head injuries would be appropriate for community members who participate in​ football, soccer,​ hockey, boxing, and wrestling. Participating in these sports would most likely be limited to​ school-age, adolescents and young adults. The older community members would not benefit from this information. Polypharmacy would be appropriate for older community members who might have several health problems. This topic would most likely not be applicable to younger community members and those with young children. Car safety seats would be applicable to community members with small children. This topic would not be applicable to the largest number of community members.

A local hospital is planning a health fair for community members. Which topic should the nurse suggest be included to address a potential health problem that can affect the greatest number of community​ members? Polypharmacy Car safety seats Risk for head injuries Exposure to toxins

Blame-free environment Rationale In a​ blame-free environment, errors or near misses can be reported without fear of punishment. Just culture balances accountability with correcting system problems. Responsibility and accountability both call for admitting​ mistakes, but without guarantees of how they will be handled.

A newly hired nurse made a medication error in her first week on the job. The nurse soon learned that her facility had a strong policy in which errors or near misses could be reported without the fear of punishment. Which concept supports this attitude toward​ mistakes? Just culture ​Blame-free environment Responsibility Accountability

Training videos Safety information Results of workplace safety hazard evaluations Recommendations for safety procedures NIOSH conducts research studies with the intention of improving safety in the workplace and the general population. NIOSH also develops recommendations for safety​ procedures, distributes​ information, provides training​ videos, and evaluates workplace health hazards. OSHA would have the statistics about the number of organizational injuries.

A representative from NIOSH is scheduled to visit a healthcare organization. What should the staff expect to receive from the representative during the​ visit? ​(Select all that​ apply.) Results of workplace safety hazard evaluations Report of the number of organizational injuries Safety information Training videos Recommendations for safety procedures

Soccer Coach Wrestling Coach Football Coach Rationale Sports that have the highest risk for head injuries include​ football, soccer, and wrestling. The​ football, soccer, and wrestling coaches should be members of the task force. Although there may be a risk for head injuries for students who participate in marching band or​ gymnastics, these employees would not need to be members of the task force because the risk for their students is significantly lower.

A school nurse is creating a task force to identify ways to reduce the risk of head injuries when students participate in​ school-sponsored activities. Which school employees are most appropriate for the nurse to recommend as members of this task force because of the high risk for head injuries for the students they​ supervise? ​(Select all that​ apply.) Gymnastics coach Soccer coach Wrestling coach Marching band instructor Football coach

Anonymously report the practice to OSHA Rationale The Occupational Safety and Health Act was enacted to improve job safety. This act allows employees to anonymously report hazardous work conditions. Needlestick injuries are a safety hazard to both staff and clients. This practice needs to be reported. Wearing gloves might reduce the risk of infection but will not prevent an accidental needlestick. NIOSH conducts research studies with the intention of improving safety in the workplace and the general population. Counting the number of needlestick injuries that occurred because of an unsafe practice will not help stop the practice.

A staff nurse is assigned to provide client care on a different care area for one shift. While providing​ care, the nurse notes the inappropriate disposal of used needles and syringes. When asking a staff member about this practice the response was open double quote"this is how it is done here.close double quote" What is the most appropriate action by the nurse in this​ situation? Collect data on the number of needlestick injuries that occurred during the shift Anonymously report the practice to OSHA Anonymously report the practice to NIOSH Wear gloves while providing all care

Individuals, groups, and organizations are responsible for their care delivery.

Accountability is a facility approach to human errors, and also a responsibility of the nurse. What is accountability?

Knowing the prescribed treatment and recovery plan Controlling blood glucose levels Losing weight prior to surgery Quitting smoking

Actions clients can take to prevent HAI's:

Use of powderless gloves Use of hypoallergenic gloves that are latex-free Washing hands after removing gloves. *Using powderless gloves is important because the powder can absorb the latex from the gloves and then spread when the gloves are removed. Powder particles can enter the air and affect individuals with a severe allergy to latex.

Actions that nurses can take to reduce the risk of developing a latex allergy include:

Question the need to recap used needles Dispose of used needles in the appropriate sharps container Ensure disposal containers are puncture resistant and leak proof on the bottom and all sides Recap needles using forceps or tongs or use the scoop method Never recap a needle by holding the cap in one hand while guiding the needle into the cap Never pick up broken glass by hand Pick up broken glass with a broom, dustpan, or forceps.

Actions that nurses can take when working with used or contaminated sharps include:

Clinical Decision Making: Nurses consider safety of the client and colleagues at all points of the nursing process. Infection: The spread of infection within healthcare settings is a danger to clients and all healthcare staff. Perioperative Care: Surgery increases the risk to the client of being exposed to infections, wrong-site surgery, and issues related to anesthesia. Quality Improvement: Improving the quality of care for clients involves the safety of clients at all times.

Almost all concepts in nursing relate to the concept of safety. Examples include:

lifting heavy objects Nurses can experience back, shoulder and knee injuries through common activities such as moving clients from one location to another, relocating equipment, or carrying client-care objects to the bedside.

Although every occupation has risks for injuries, the most common are sprains and strains to the back followed by injuries to the shoulder and knee. Another injury common to the workplace is fractures. The most common cause of these injuries is from what?

Gloves Blood pressure cuffs Intravenous tubing Bandages Syringes Catheters

An allergy to latex is becoming more common in health care. Continuous use of products and items that contain latex increases an individual's risk of developing a reaction. Some reactions are mild and cause skin irritation whereas others can be severe and cause asthma, hives, and possibly shock. Common items used in healthcare that can contain latex include:

The dangers associated with these substances The potential long-term effects such as cancer, asthma, liver damage, addiction, and organ failure

An area that has the potential to impact the safety of all age groups is the risk for exposure to toxins. The age group that is the most likely to experiment with tobacco, alcohol, and illicit substances is adolescence. When teaching this age group of clients, the nurse should include information about:

plan The Plan phase includes data collection. The Do phase implements a pilot program. The Study phase analyzes the outcomes of the Do phase. The Act phase plans future steps.

An emergency department nurse found the following waiting times for the last five clients admitted from the ED to the cardiology ​unit: 20 minutes at 2 p.m. 40 minutes at​ 3:30 p.m. 60 minutes at 4 p.m. 20 minutes at​ 7:30 p.m. 10 minutes at​ 9:15 p.m. What phase of the TQM process is the nurse engaged​ in? Study Act Do Plan

Generate new knowledge about occupational safety and health Transfer the knowledge into practice for the betterment of workers.

Another organization created to support the Occupational Safety and Health Act of 1970 is the National Institute for Occupational Safety and Health (NIOSH). The mission of NIOSH is to:

"Illnesses are more likely related to lifestyle choices in adults." Rationale In​ adults, injuries and illnesses are more likely related to lifestyle​ choices, such as​ smoking, consuming a​ high-fat diet and inactivity. There is no evidence to support that failing to finish prescribed antibiotics can cause chronic health conditions. Having childhood injuries does not predispose an adult to develop a chronic illness. There is no evidence to support that exposure to the elements at an early age will predispose a person to develop a chronic illness as an adult.

A​ 55-year-old client is diagnosed with a chronic illness and asks the nurse how this could have occurred. What is the most appropriate response by the​ nurse? "Illnesses are more likely related to lifestyle choices in adults." "Too many childhood injuries can affect you as an adult." "Failing to finish prescription antibiotics can affect your health as an adult." "Exposure to the elements at an early age leads to these illnesses."

One way to improve the reporting of head injuries is to teach those most likely to experience the injury about concussions. Research has shown that those who learn about potential long-term effects of head injuries are also more likely to report the injury.

Because head injuries do not always lead to a loss of consciousness, many individuals with these injuries return to the sport without medical treatment. The severity of the injury is not always noticed by coaches, parents, or others within the injured individual's environment. What is one way to improve under-reporting of head injury?

​"Children should learn how to​ swim." To support water​ safety, all children should learn how to swim through formal training. A bump on the head could lead to a concussion. The use of foam or​ air-filled flotation devices as replacements for life jackets should be avoided. Head gear should be worn while participating in contact sports to prevent head injuries.

Bill Jolent is a nurse who provides a program on summer safety for families of a residential community. Which participant statement indicates that teaching has been​ effective? ​"Head gear while playing touch football is not​ necessary." ​"Air-filled floats should be kept around the​ pool." ​"Children should learn how to​ swim." ​"A bump on the head is nothing to be concerned​ about."

Sedatives Hypnotics Neuroleptics Antianxiety medications

Chemical restraints are pharmacologic agents used to control hyperactive behavior in agitated clients. Commonly used medications include:

Smoking Consuming high-fat diet Inactivity

Children's injuries are most likely related to play, such as riding a bicycle or falling while climbing a tree. Illnesses in children may be related to genetics or environmental exposure. In adults, injuries and illnesses are more likely related to lifestyle choices such as:

Pneumonia Bloodstream infections Urinary tract infections Surgical site infections

Common causes of death related to HAI's include:

is another way to make sure the quality of care in a clinical setting is measured, improved, and monitored. It consists of "a structured organizational process for involving personnel in planning and executing a continuous flow of improvements ... that meets or exceeds expectations." CQI is a client-driven process. The expectations in the definition of CQI come from clients who can be: Internal clients, who are employees of the healthcare organization, OR External clients, who are individuals seeking health care, and their family and friends. Also included are other entities, such as insurance companies, managed care organizations, vendors, social service agencies, and law enforcement officials.

Continuous Quality Improvement

Physical therapist Head of Management of Information Systems​ (MIS) department Clinical nurse specialist Rationale Internal clients are employees of the rehabilitation facility. They could be a physical​ therapist, the head of the MIS​ department, and a clinical nurse specialist. External clients include a client after hip​ replacement, and parents of a child with spina bifida.

Continuous Quality Improvement​ (CQI) is a​ client-driven process. In a rehabilitation​ facility, which individuals are examples of internal clients who drive the CQI​ process? ​(Select all that​ apply.) Parents of a child with spina bifida Client after hip replacement Physical therapist Head of Management of Information Systems​ (MIS) department Clinical nurse specialist

Make a list of water safety devices and vendors of the devices to be kept at the pool. Suggest swimming lessons be provided for community members when the pool opens. Recommend cardiopulmonary resuscitation classes be provided for community members. Rationale ​Water-related injuries are a common occurrence in children. The nurse can help reduce these types of injuries by encouraging community members to learn cardiopulmonary resuscitation​ (CPR), recommending that all children learn how to swim through formal​ training, and using​ life-jackets or devices designed to promote water safety. It is unreasonable to expect all community members to attend lifeguard classes. Children can use a swimming pool if they are unable to​ swim, however, these children should not be left unattended.

During a city planning​ meeting, the nurse learns that a new swimming pool is being built in the community. Which recommendations should the nurse make to the planning committee to ensure water safety for community​ residents? ​ (Select all that​ apply.) Discuss having children prove evidence of ability to swim before being permitted access to the pool. Insist community residents attend lifeguard classes at the community college. Make a list of water safety devices and vendors of the devices to be kept at the pool. Suggest swimming lessons be provided for community members when the pool opens. Recommend cardiopulmonary resuscitation classes be provided for community members.

​Age-appropriate car seat installed in the family car Plastic trash bags replaced with paper Safety latches secured over gas range controls ​Four-gallon drum to accumulate rain water removed Rationale Accidental injuries in the preschooler include motor vehicle​ accidents, drowning, fires and​ burns, suffocation, and aspiration of foreign bodies. Evidence that safety teaching was effective would be an​ age-appropriate car​ seat, safety latches over range​ controls, removal of items that could cause accidental​ suffocation, such as plastic trash​ bags, and removal of containers that could cause​ drowning, such as a​ four-gallon drum. Playing with small buttons could increase the​ child's risk of aspiration and indicates additional teaching is needed.

During a home​ visit, the nurse teaches a family with a​ preschool-aged child about accidental injury prevention. Which observations indicate that teaching has been​ effective? ​(Select all that​ apply.) ​Age-appropriate car seat installed in the family car Box of small buttons available for play Plastic trash bags replaced with paper Safety latches secured over gas range controls ​Four-gallon drum to accumulate rain water removed

Individuals responsible for implementing and overseeing improvements Pilot testing to ensure successful changes Timelines for implementing changes Strategies for measuring the effectiveness of changes

During a root analysis, multidisciplinary team looks at the unwanted situation, focusing on systems and process, not on individual performers. The team analyzes what caused the problem and how it can be prevented in the future by using a plan that identifies:

Quality improvement Rationale A skill associated with the competency of quality improvement is studying the outcomes of quality improvement reports. The competency of informatics uses information and technology to further client care and safety efforts. The competency of safety minimizes the risk of dangerous or harmful situations with clients and other healthcare​ professionals, reduces​ healthcare-associated infections, and decreases the possibility for errors in client care. The competency of teamwork and collaboration means that the nurse works effectively with other departments and​ shifts, is accountable for participation as a team​ member, and engages in conflict resolution as needed.

During a staff meeting the nurse manager provides information about the client care studies conducted on the​ medical-surgical unit. Which competency is the manager helping the staff​ achieve? Informatics Quality improvement Safety Teamwork and collaboration

Not following proper disposal techniques Bumping into an uncapped and used needle Contact with a used scalpel or broken glass.

Even though the safe handling of sharps and needles is an expectation for every healthcare professional, accidents can occur because of:

1. total quality management 2. continuous quality improvement 3. Six Sigma 4. Lean Six Sigma

Four quality improvement programs are commonly utilized, including:

Inability to complete activities of daily living Impaired mobility Decreased musculoskeletal strength Reduced physical stamina or endurance Precautionary measures need to be taken during this age range to protect them from injury

Functional decline of older adults contributes to risk, such as:

The client will seek medical attention upon receiving an injury. The client will report health status changes to a medical professional. The client will articulate common safety hazards within specific age group. The client will explain ways to eliminate or reduce exposure to specific safety hazards.

Goals to address potential or actual safety issues include the following:

Allowed employees to anonymously report hazardous work conditions Required workers to wear specific protective equipment and follow safety procedures Mandated workers to report work-related illnesses and injuries.

In 1970, the Occupational Safety and Health Act was passed by the federal government with the purpose to improve job safety. This act:

Malignant cancers account for one-third of deaths followed by heart disease, due to age and obesity.

In middle aged adults, unintentional injuries are not the leading cause of death. Instead the leading causes of injury include:

Diseases that impact cognition and mobility increase the risk for injuries and death.

In older adults, what is a major risk factor for injury and death?

Structure standards, relating to material resources, human resources, and general organizational structure. It can be thought of as an organizational chart brought to life with assets and individuals. Process standards, relating to the steps that produce a particular clinical outcome Outcome standards, relating to the results of a clinical process, in terms of the client's health status

In physician Donabedian's model of quality improvement, high-quality care has three dimensions:

Congenital malformations, deformations, and chromosomal abnormalities Disorders related to short gestation, preterm delivery, or low birth weight Maternal complications of pregnancy Complications related to the placenta, cord, and membranes

In the United States, causes of neonatal deaths include:

from different disciplines. It could include chart audits. More frequently it is composed of utilization review information.

Interdisciplinary assessment collects data from where?

Risk management Risk​ management, which looks at past adverse​ events, would most likely be used to collect data. With no evidence of​ overuse, misuse, or​ underuse, the data would not be flagged for utilization review. Even with​ complications, Ms.​ Jones-March did not have a sentinel​ event, so no root cause analysis would be initiated. The events might or might not take place in a​ blame-free environment, but no errors or near misses are part of the known story.

Julia​ Jones-March, a​ 58-year-old female real estate​ agent, was admitted to the hospital 3 days ago for treatment of Chronic Obstructive Pulmonary Disease​ (COPD). She has had a hospital stay full of negative events. She fell in the shower on her first night. She had an allergic reaction to her hospital gown fabric by the second night.​ Now, as she is about to be​ discharged, she has spiked a high temperature. What type of assessment would most likely be used to collect data about the three complications Ms.​ Jones-March experienced during her​ visit? ​Blame-free environment Utilization review Root cause analysis Risk management

K: Knowing the impact of nursing care on client outcomes S: Performing root cause analyses of sentinel events or studying the outcomes of quality improvement reports A: Valuing the importance of nursing care to client outcomes

KSA examples of addressing quality improvement include:

K: Knowing the individual roles of team members S: Performing the role of a nurse and being able to ask for help A: Respecting the views and skills of all team members along with valuing the client and family as team members

KSA examples of competencies of teamwork and collaboration include:

K: Knowing scientific methods and processes S: Participating in research activities and planning care based upon research evidence A: Valuing research in nursing practice and supporting ethical research approaches

KSA examples of competency in evidence-based practice include:

K: Understanding the benefits of information technology S: Demonstrating the use of information systems when providing safe client care A: Valuing the ongoing need for information technology

KSA examples of competency in informatics include:

K: Knowing common safe and unsafe practices S: Implementing appropriate safety protocols A: Valuing safety standards and practicing within the limits of professional performance

KSA examples of competency in safety include:

K: Demonstrating knowledge of the client's health problem S: Implementing skills to address the problem A: Demonstrating the appropriate attitude when working with the client on the particular health problem

KSA examples of focusing on patient-centered care include:

​Long-time unemployment Mr.​ Nikkelson's long-time unemployment and his being unable to afford medications would make him likely to be in the unserved or underserved population. The fact of his asthma attacks having a​ pattern, his dislike of ED​ delays, or an ED nurse referral would not be enough. Next Question

Mikel​ Nikkelson, a​ 60-year-old long-time unemployed​ plumber, has asthma attacks that flare up on a regular basis in the fall. He cannot afford some of the medications that have been prescribed for him. The last time he went to the Emergency​ Department, the nurse recommended that he explore getting his care at a local community health center​ (CHC). What characteristic would likely qualify him for that​ care? Asthma attacks with a recurring pattern ​Long-time unemployment Dislike of long waits at the emergency department Referral from an emergency department nurse

Include a new process for changing a wound dressing into a​ client's care plan. Skills that demonstrate the competency of​ evidence-based practice include integrating new techniques into practice. Meeting with other disciplines supports the competency of teamwork and collaboration. Documenting care immediately after providing it supports the competency of safety. Completing a root cause analysis supports the competency of quality improvement.

Molly Cantrell is a nurse who is planning to incorporate skills that support the competency of​ evidence-based practice when providing client care. Which action supports this​ competency? Complete a root cause analysis after a medication error occurs. Document care immediately after providing it. Include a new process for changing a wound dressing into a​ client's care plan. Meet with physical therapist to discuss a​ client's mobility needs.

Develops recommendations for safety procedures Distributes information Provides training videos Evaluates workplace health hazards.

NIOSH conducts research studies with the intention of improving safety in the workplace and the general population. NIOSH also:

an accident or while trying to help a confused or violent client.

Nurses can experience back and shoulder injuries when helping to move or support clients. Falls and trauma from being forced into objects or equipment can occur as a result of what?

Regularly assessing client medication lists Evaluating treatment options Examining the name and function of medications Teaching when and how medication should be taken Emphasizing common side effects and how to address them Discussing drug interactions with other drugs, food, and diseases Examining the client's role in using medication appropriately Evaluating the purpose of the medication in the client's treatment plan

Nurses can proactively help prevent medication errors by discussing medications with clients. Actions to take include:

Removing obstacles from walking paths Keeping frequently used items in reach Ensuring client rooms are well lit Making sure clients wear shoes with soles that provide adequate traction Ensuring prescription eyewear is being used Utilizing side rails on client beds Applying physical restraints when necessary for client safety and only when ordered by the healthcare provider

Nursing strategies to prevent falls include:

Be alert for improperly disposed sharps such as in wastebaskets or on tables and furniture Instruct clients about safe disposal of sharps Teach clients infection control practices Develop coping skills to manage stress such as relaxation techniques, adding extra time for travel, and attend training on safety in the home setting Recognize the signs of escalating violent behavior Report all incidents of violence in the home Leave the home in the event of violence or an unsafe condition, such as aggressive pets, and notify the local police Report unsafe home conditions, such as extreme heat, cold, unsanitary conditions, and lack of clean water, to the employer and contact social service agencies to intervene in the situation.

Of particular concern to nurses is the potential for violence when providing care to clients in the home. Nurses can face particular dangers when providing home care such as stress, exposure to guns and knives, unsanitary conditions, needlesticks, bloodborne pathogens, aggressive pets, and driving risks. Actions that nurses can take to minimize these risks are:

Use of gloves when caring for clients Compliance with hand hygiene procedures Presence of​ puncture-resistant sharps containers When conducting an inspection within a healthcare​ organization, OSHA will focus on preventive measures such as hand hygiene​ procedures, use of gloves when caring for​ clients, and the presence of​ puncture-resistant sharps containers. OSHA does not address location of staff break room or staffing levels.

On which preventive measures should an OSHA reviewer focus when conducting a site​ inspection? ​ (Select all that​ apply.) Ratio of nursing staff to assigned clients Location of staff break room Use of gloves when caring for clients Compliance with hand hygiene procedures Presence of​ puncture-resistant sharps containers

Importance of and features of the new process Steps to accomplish the new process Associated reporting or documentation procedures Need for personal responsibility for action

Once managers begin to implement a new process in a clinical setting, nurses and other clinicians must be educated about:

Injury Trauma Knowledge Deficit Developmental Delay

Once the assessment is complete the nurse can then identify diagnoses to address actual or potential health problems. Since safety hazards can occur at any time through the life span, the list of potential diagnoses can be sizable. Even so, there are a few diagnoses that are common for the majority of the age groups. These diagnoses include being at risk for:

Main factors that influence feelings of stress on the job Impact of work schedules Impact of new policies and practices Depression Emotional abuse in the workplace.

One topic in which NIOSH focuses research is that of workplace stress. Stress is common in healthcare primarily because of the nature of the work. When studying workplace stress NIOSH focuses on:

wheelchairs with lap trays, bed rails, and geri-chairs. Infant and child restraints include crib nets, elbow restraints, and mummy restraints.

Other devices that may be considered as a form of restraint include:

genetics, environmental factors, and lifestyle choices.

Parents may unknowingly expose their baby to prenatal risks through what factors?

Receives the wrong medication Receives the wrong dose Receives the wrong formulation Receives the right medication at the wrong time

Probably the most familiar safety issue to nurses is that of medication errors. A medication error occurs when a client either:

Ethics: Clients have the right to the best quality of care. Informatics: Electronic health records can be used at the point of care and can be easily transmitted to collaborating healthcare workers to improve continuity of care Legal Issues: Consistently following federal and state laws will improve the quality of client care.

Quality care is an important part of the nursing process. What are some related nursing concepts to quality management?

according to the Health Resources and Services Administration (HRSA), quality improvement consists of "systematic and continuous ACTIONS that lead to measurable improvement in healthcare services and the health status of targeted patient groups." This involves: Physiological outcomes Legal issues Ethical issues Informatics systems

Quality improvement is considered an integral part of nursing care. What is quality improvement?

Inadequate client assessment and care planning Failure to communicate Insufficient review of medical records Multiple procedures on multiple parts of a client performed during a single operation Failure to include the client and family when identifying the correct operation site Failure to clearly mark the correct operation site Failure to recheck information before starting the operation

Reasons for WSS events include the following:

Chromosomal and other genetic errors Environmental exposure to teratogens Anatomical problems in the cervix or uterus Rh factor incompatibility Lifestyle and behavior Exposure to pathogens Use of prescription and over-the-counter medication Caffeine intake Illegal drug usage Tobacco usage Environmental pollution exposure and lead Older maternal age

Reasons for miscarriage include:

Lack of education about the long-term effects of the injury Desire to "tough out" the injury

Reasons for under-reporting head injuries include:

Total Quality Management (TQM) Continuous Quality Improvement (CQI) Six Sigma Lean Six Sigma

Responding to the needs of their clients and focusing on their specialty areas, different healthcare organizations will use different approaches to establish their unique quality management programs. Commonly used methods include:

Restrains can both partially and fully limit client mobility

Restraints are devices or medications that are used to protect a client from self-injury or injury to others. Do restraints fully or only partially limit mobility?

Obesity Advanced age Rh factor incompatibility Diabetes Preeclampsia Placental complication Fetal malformation Maternal injury to the abdomen

Risk for stillbirth or newborn illnesses may be due to the mother's health including:

Prospectively, it identifies areas that can lead to client or staff injury or financial loss. Retrospectively, it looks at the frequency, severity, and causes of past adverse events.

Risk management has both retrospective and prospective aspects to prevent errors and lawsuits. What aspects does risk management look at?

Congenital anomalies Short gestation Sudden infant death syndrome (SIDS) Complications during delivery Unintentional injuries such as suffocation from co-sleeping, falls leading to traumatic brain injuries, bites, stings, and child abuse

Risks for infant mortality include:

Active living Healthy eating Neighborhood, school, and workplace safety

Safety extends beyond the walls of healthcare organizations. Community-organized health and safety programs are often supported by healthcare organizations. These programs contribute to healthier communities by advocating for:

​Reduce the number of bicycle and pedestrian injuries caused by motor vehicles. Community-organized safety programs contribute to healthier​ communities, emphasizing active living and neighborhood safety.​ Community-organized health promotion programs also contribute to healthier​ communities, and emphasize initiatives to increase​ activity, reduce​ high-calorie snacks, and promote community activity through a sports facility.

Sam Woods is a registered nurse working with city council members to create a program that supports community safety. What would be a goal of this​ program? Reduce the number of​ high-calorie snacks in school vending machines. Reduce the number of bicycle and pedestrian injuries caused by motor vehicles. Advocate for the opening of a community sports facility for children. Increase the number of​ after-school organized activities for community children.

3 incidences of intravenous poles collapsing on nurses necessitating stitches to close arm wounds 1 incidence of employee sprained ankle after falling on a wet floor The OSHA guidelines mandate that specific safety issues are reported such as any​ work-related injury that results in days off from​ work, treatment of an injury beyond first​ aid, any loss of consciousness or​ death, hospitalization of 3 or more employees with​ work-related injuries, any cases of poisoning or respiratory illnesses as a result of working​ conditions, and injuries including​ cuts, fractures,​ sprains, or amputations. Incidents where client aggression was averted would not be included in the safety report. Staff overtime or staff inoculation of the flu vaccination would also not be a part of the OSHA report.

Sue​ Nguyen, a nurse in the Employee Health​ Department, is reviewing information to submit to OSHA for the monthly report. Which information about employee health and injuries should the nurse include in this​ report? ​(Select all that​ apply.) 6 incidences when staff nurses worked overtime 5 incidences in which client aggression was averted 3 incidences of intravenous poles collapsing on nurses necessitating stitches to close arm wounds 1 incidence of employee sprained ankle after falling on a wet floor 8 incidences where staff nurses left the unit to obtain flu vaccinations

His dissatisfaction with his extended hospital stay In a Six Sigma​ program, a defect is defined as a situation leading to client dissatisfaction. Mr.​ Gupta's unhappiness at his extended length of stay qualifies as such a defect. His unrelieved stomach​ pain, his choice of an​ intervention, and his response to meds would not be seen as defects.

Sunil​ Gupta, a​ 30-year-old international​ student, was admitted to the hospital with excruciating stomach pain. He experienced a longer length of stay​ (LOS) than usual after his ulcer surgery. His stay was extended due to a wound infection that responded well to antibiotics. He expressed his displeasure at missing so many of his academic commitments. Which characteristic of Mr.​ Gupta's care would be seen in a Six Sigma program as a​ defect? His choice of​ surgical, rather than​ medical, intervention His dissatisfaction with his extended hospital stay His unrelieved stomach pain His response to prescribed antibiotics

Developing new healthcare delivery models Reducing harm Engaging individuals as partners in their care Promoting best practices for healthy living Reducing​ harm, engaging individuals as partners in their​ care, developing new healthcare delivery​ models, and promoting best practices for healthy living are priorities of the National Quality Strategy. Supporting new cancer clinical trials is not part of that strategy.

The Department of Health and Human Services developed a National Quality Strategy to prioritize quality improvement activities. Which activities are part of that​ effort? ​(Select all that​ apply.) Developing new healthcare delivery models Supporting new cancer clinical trials Reducing harm Engaging individuals as partners in their care Promoting best practices for healthy living

Safe Effective Client-centered Timely Efficient Equitable

The IOM instituted six aims for improving the American healthcare system. They described the ideal system as being:

Correct client identification Staff communication improvements Medications Infections Surgical errors Clients at risk for suicide

The Joint Commission creates safety goals for every care delivery setting. These goals focus on specific areas in which safety issues arise while delivering client care. For acute care hospitals, these goals focus on?

"an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof." All sentinel events have to be thoroughly investigated by a team of internal experts.

The Joint Commission defines a sentinel event as....

Any work-related injury that results in days off from work Treatment of an injury beyond first aid Any loss of consciousness or death must be reported within 8 hours of the incident. Hospitalization of three or more employees with work-related injuries Any cases of poisoning or respiratory illnesses as a result of working conditions Injuries including cuts, fractures, sprains, or amputations

The OSHA guidelines mandate that the following are reported:

Support the guidelines within the Occupational Safety and Health Act of 1970 Consult with employees and employers on methods to prevent injuries and illnesses Inspect workplaces to ensure employee and employer compliance with standards.

The Occupational Safety and Health Administration (OSHA) was created to:

Evaluating safety concerns Evaluating goals that would have the most impact and use at the least cost

The PSAG determines topics for the goals by:

Minimize the risk of dangerous or harmful situations with clients and other healthcare professionals Reduce healthcare-associated infections Decrease the possibility for errors in client care

The QSEN competency of safety focuses on sharing knowledge and reporting errors to help improve client safety. This competency enables the nurse to:

Performance improvement Performance improvement links quality improvement data to the performance of a unit. Benchmarking takes data and compares it to a standard. Effectiveness evaluation looks at changes made in care delivery. Asset allocation is part of the​ financial, not the​ clinical, activities.

The Quality Improvement Committee is looking at the pattern of medication errors committed by nurses from the​ medical-surgical hospital unit. What kind of activity is being​ conducted? Performance improvement Effectiveness evaluation Benchmarking Asset allocation

Define the problem, determine a goal, and form a team. Measure: Obtain data. Analyze: Look at the data to find cause-and-effect relationships. Improve: Develop and implement solutions. Control: Sustain positive changes and continuously monitor the ongoing process.

The Six Sigma method to approach problem-solving is called the DMAIC system:

Client who is scheduled for an amputation of the right foot Client with burning and pain when urinating Client who is depressed and refused antidepressant medication the previous evening Rationale Clients at risk for safety issues based on the National Patient Safety Goals include the​ following: The client with depression could be at risk for​ suicide; the client with pain and burning with urination could have a urinary tract​ infection; and the client scheduled for an amputation could be at risk for a surgical error if the wrong limb is amputated. The client being discharged after having abdominal wound stitches removed and the client recovering from a stroke who is scheduled for physical therapy are not at risk for a National Patient Safety Goal issue.

The nurse team leader for a​ medical-surgical unit is reviewing client assignments made for the staff nurses. Based on the National Patient Safety​ Goals, which clients will the team leader identify as being at risk for safety​ issues? ​(Select all that​ apply.) Client who is scheduled for an amputation of the right foot Client recovering from a stroke who is scheduled for physical therapy in the afternoon Client scheduled for discharge after abdominal wound stitches are removed Client with burning and pain when urinating Client who is depressed and refused antidepressant medication the previous evening

Conduct a root cause analysis The Joint Commission would require them to conduct a root cause analysis to compose an action plan to prevent future problems. The Joint Commission is interested in system improvements and not pointing fingers at poor performers. A breach of duty might have​ occurred, but no reason exists to change the response from exploring improvement to filing a legal document. They might or might not have to change their clinical​ procedures; it could be that effective procedures were not followed. Next Question

The nurses on the orthopedic surgical unit have collected data on correct surgical site operations on a routine basis. If they find an exception to following their procedures for identifying the intended​ limb, what would The Joint Commission require them to​ do? Conduct a root cause analysis Change their​ pre-operative preparation procedure File a breach of duty report Identify the responsible​ individual(s)

Reliable Safe Accessible Rationale The HHS criteria expect the healthcare system to be​ client-centered, reliable,​ accessible, and safe. The HHS does not discuss compliance or sensitivity.

The oncology nurse is reviewing the Department of Health and Human Services​ (HHS) National Strategy for Quality Improvement in Health Care. In evaluating the nurse​'s cancer center​ facility, which descriptions of that healthcare system fit the HHS​ criteria? ​(Select all that​ apply.) Sensitive Compliant Reliable Safe Accessible

Importance of crossing the street at traffic signals Protective equipment to use when playing How to avoid and report strangers in the community Reporting burned out street lights to the municipal building Rationale Safety extends beyond the walls of healthcare organizations.​ Community-organized safety programs are often supported by healthcare organizations. These programs contribute to healthier communities by advocating for​ neighborhood, school, and workplace safety. Topics that promote child safety include avoiding and reporting​ strangers, using protective equipment while at​ play, reporting burned out street​ lights, and crossing the street at traffic signals. Packing fresh fruit and vegetables supports a healthier a community.

The school nurse is preparing a program on child safety for community members. Which topics are the most appropriate for the nurse to include in this​ program? ​(Select all that​ apply.) Importance of crossing the street at traffic signals Protective equipment to use when playing How to avoid and report strangers in the community Reporting burned out street lights to the municipal building Reminding to pack fresh fruit and vegetables in school lunches

"I can talk to a teacher if I am faced with peer pressure to use drugs." "I hate​ it, but I will wear a helmet when riding my bike." "I should not get into a car when the driver has been drinking." "If I feel really​ down, I need to talk to my parents about it." Rationale Nursing actions to reduce the risk for unintentional injury in the adolescent include teaching on the use of seatbelts and​ helmets, discussing drug and alcohol use and risk for​ suicide, and discussing the risk for traumatic brain injury. The student who states there is no need to wear a seatbelt as a passenger in a car would require further teaching. The statements of the other students indicate teaching has been effective.

The school nurse provides a health seminar for high school students on actions to prevent injury. Which student comments indicate that the teaching has been​ effective? ​ (Select all that​ apply.) "I can talk to a teacher if I am faced with peer pressure to use drugs." "I hate​ it, but I will wear a helmet when riding my bike." "I should not get into a car when the driver has been drinking." "I do not need to wear a seatbelt as a passenger in a car." "If I feel really​ down, I need to talk to my parents about it."

Retrospective Audit Rationale The nurse is conducting a retrospective​ audit, looking back in time. A concurrent audit takes place when clients are still hospitalized. Utilization review looks at use of​ resources, not documentation. A root cause analysis is triggered by a sentinel​ event, rather than by routine client care documentation.

The urology nurse is reviewing medical records of the last five clients discharged after transurethral resection of the prostate​ (TURP). The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief. Which activity is the nurse participating in with this review​ process? Retrospective audit Utilization review Root cause analysis Concurrent audit

Accidental client injury or death Psychosocial effects, such as depression and dehumanization

The use of restraints can lead to:

TQM aims to improve quality and productivity by using data and statistics to improve the way systems operate. TQM involves teamwork throughout the entire organization. It involves the full spectrum of departments and employees, including suppliers and customers. Plan: Define the goal, collect data, and design a strategy. Do: Try out the plan on a small scale, piloting the process. Study: Look at the outcome of the pilot and compare it with the desired result. Act: Decide if the goal is accomplished and plan the next steps to take. The acronym for the circular process of PDSA comes from the initials of the Plan-Do-Study-Act process.

Total Quality Management (TQM)

Limb: Made of cloth and used to immobilize a limb for a therapeutic purpose such as preventing dislodgement of endotracheal tubes Belt: Used to ensure safety when transporting on a stretcher or wheelchair; may also be used to protect clients confined to a chair or bed Mitt or hand: Used to prevent confused clients from self-inflicted skin injuries or to prevent accidental dislodgement of intravenous catheters or endotracheal tubes; the mitt must be removed periodically to assess hand circulation.

Types of physical restraints include:

Poisoning from drugs, narcotics, medicines, or biologic agents Motor vehicle accidents Falls Suicides

Unintentional injury in middle-aged adults include:

Organize an influenza vaccination clinic at the local community center. Rationale As a member of the​ community, the nurse should plan an influenza vaccination clinic at the community center to help reduce the risk of an outbreak of influenza in the community. The community does not have an outbreak of the​ flu, so telling the school to expect student absences is premature. A curfew would be needed if community safety is at risk. Distributing​ over-the-counter cold and flu medication during a community meeting is also premature and might be unnecessary if community members receive the flu vaccination.

The community nurse receives a report from the Department of Public Health about an outbreak of influenza in neighboring counties. Which nursing intervention is appropriate to reduce the risk of a similar outbreak in the​ community? Notify the school to expect a high number of student absences due to influenza. Discuss implementing a community curfew to curtail spread of influenza. Organize an influenza vaccination clinic at the local community center. Distribute​ over-the-counter cold and flu medication during the next community meeting.

Quality management Rationale Quality management compares specific nursing​ processes, like​ sterilization, to accepted standards of care. Quality improvement is one method of improving the processes of care. Performance improvement matches positive changes with participating staff. Process standards record​ step-by-step client care activities.

The dialysis nurse manager decides to evaluate the sterility processes the renal unit staff​ follows, compared to accepted standards of care. Which term best describes that​ effort? Quality improvement Process standards Performance improvement Quality management

PSDA Rationale TQM uses the PDSA approach of​ Plan-Do-Study-Act. The DMAIC and the DMADV methods are used in Six Sigma. LEED is not a QI method.

The emergency department nurse manager is sharing the most recent client satisfaction data and statistics with the evening shift staff. As a​ team, they are using the total quality management​ (TQM) approach. Which process organizes their​ efforts? LEED PDSA DMADV DMAIC

A nurse who lost three days of work because of tripping over a cord in the hallway Rationale The incident involving the nurse losing three workdays due to an on the job injury is reportable to OSHA. OSHA mandates that injuries that result in loss of workdays must be reported. The nurse who experienced a needlestick injury which required first​ aid, the client who developed a​ healthcare-associated urinary tract​ infection, and the client who received a medication at the wrong time would not be reported to OSHA.​ However, all these incidences require proper documentation according to hospital policy.

The employee health nurse is preparing a presentation for new hires at a local hospital and wants to provide education on injuries that must be reported to OSHA. Which reportable injury would the nurse include in the​ presentation? A nurse who experienced a needlestick requiring first aid A nurse who lost three days of work because of tripping over a cord in the hallway A client who developed a​ healthcare-associated urinary tract infection A client who received the correct medication at the wrong time

Unnecessary and potentially severe client trauma Negative morale of operative team Lack of insurance payments for events Malpractice claims Licensing boards' disciplinary action

WSS events can lead to:

"The lift protects both the client and the staff during transfers." Rationale The use of mechanical aids to move clients promotes client and staff safety. Responding that the mechanical aid is used because the client cannot walk fast enough to the bathroom could support the​ family's concern that the client is deteriorating. Responding that the lift is used because of limited staff could be interpreted that the client is receiving​ sub-standard care or the​ client's condition is deteriorating. The use of a lift will not improve the​ client's circulation although one purpose of its use is to increase rehabilitation efforts.

The family of a client in a skilled care facility is concerned that the client​'s condition is deteriorating because a mechanical lift is being used to transport the client to the bathroom. Which explanation by the nurse is most​ appropriate? "The lift is used because there isn​'t enough staff to help move the client." "The client cannot walk as fast as necessary to make it to the bathroom without having an accident." "The lift protects both the client and the staff during transfers." "The client is weaker and the lift helps improve circulation.close double quote"

Client perspectives, beliefs, and cultures are taken into consideration for all aspects of care. Client experiences and expertise are respected, which is particularly important when caring for clients with chronic illnesses or with exacerbations of existing illnesses.

The first QSEN competency is patient-centered care. In this competency, clients are partners in their care. This means that:

Types of injuries from falls include fractures, bleeding, traumatic brain injury, and death.

The first type of injury that commonly occurs in healthcare settings is falls, and more than half a million falls occur in hospitals. What are some types of injuries that result from falls?

Exposure prevention methods Equipment evaluations Requirements for sharps disposal containers.

The frequency and number of needlestick injuries is believed to be underreported. The hazards associated with needlestick injuries is so severe that the NIOSH created the educational campaign STOP STICKS to constantly remind hospital staff on ways to prevent and report these injuries if they occur. This campaign specifically provides resources for:

Review the client​'s list of prescribed medications. Teach how prescribed medications are to be taken. Review potential drug interactions with food. Study the name and purpose of each prescribed medication. Rationale Nurses can proactively help prevent medication errors by discussing medications with clients. Actions to take include regularly assessing client medication​ lists, examining the name and function of​ medications, teaching when and how medication should be​ taken, emphasizing common side effects and how to address​ them, and discussing drug interactions with other​ drugs, food, and diseases. Skipping a medication dose is beyond the scope of practice for the nurse. This action would not prevent a medication error at home and might cause an error if the client is instructed to skip certain medications.

The home care nurse is visiting an older client with heart failure. Which interventions are appropriate for the nurse to implement in order to prevent medication errors at​ home? ​(Select all that​ apply.) Review the client​'s list of prescribed medications. Explain when to skip medication doses. Teach how prescribed medications are to be taken. Review potential drug interactions with food. Study the name and purpose of each prescribed medication.

Recognize that all water sources such as swimming pools, ponds, bathtubs, buckets, and pails are potential water safety hazards. Encourage all family members who are capable and eligible to learn (CPR) Urge constant supervision of children in water-related environments. Recommend that all children learn how to swim through formal training. Use life-jackets or devices designed to promote water safety. Avoid the use of foam or air-filled flotation devices as replacements for life jackets. If a swimming pool is at home, have a four-sided barrier to prevent unintentional pool access. Home pool barriers should not have footholds, handholds, or openings.

Water-related injuries are a common occurrence in children. The nurse can help reduce these types of injuries by instructing children, caregivers, and family members on the following:

The number of expired sterile instruments Lean Six Sigma looks for waste in care delivery. Expired sterile instruments might be due to wasteful procedures or overuse of sterilization. The number of I and O records not completed correctly is a clinical​ matter, not a open double quote"leanclose double quote" concern. The number of admissions asking about​ pain, the fifth vital​ sign, is a similar clinical matter. The number of clients discharged on weekends might be collected in a utilization​ review, but not as part of a open double quote"leanclose double quote" effort.

The hospital quality improvement​ committee, which had been using the Six Sigma approach to quality​ improvement, added a open double quote"leanclose double quote" component. After the​ change, what new data would be most likely to be​ collected? The number of I and O records not completed correctly The number of admissions asking about the fifth vital sign The number of expired sterile instruments The number of clients discharged on weekends

Attach a mechanical device The Nurse and Health Care Worker Protection Act of 2009 is intended to prevent injuries to​ nurses, other healthcare​ workers, and clients through the use of mechanical devices to move clients unless contraindicated for the client. Asking others for help will not ensure safety for the client or all workers. Using a slide board may or may not be appropriate for the​ bed-bound client. Pivoting from the bed to the chair will not ensure safety for the client or nurse.

What action should the nurse take to transfer a​ bed-bound client from the bed to a​ chair? Ask for assistance by other staff members Pivot to the chair from the side of the bed Use a slide board Attach a mechanical device

Place used needles in sharps containers Ensure sharps containers are puncture resistant Actions that nurses can take when working with used or contaminated sharps include disposing of used needles in the appropriate sharps​ container, ensuring that disposal containers are puncture​ resistant, recapping needles using forceps or tongs or the scoop​ method, never recapping a needle by holding the cap in one hand while guiding the needle into the​ cap, never picking up broken glass by​ hand, and picking up broken glass with a​ broom, dustpan, or forceps and not a damp paper towel. Next Question

What actions should the nurse take to reduce the risk of an injury when handling​ sharps? ​(Select all that​ apply.) Pick up broken glass with a damp paper towel Place used needles in sharps containers Recap all needles before disposing Recap used needles by guiding the needle into the cap Ensure sharps containers are puncture resistant

Male client being treated for diarrhea after receiving antibiotics for pneumonia Female client with an indwelling urinary catheter being treated for a urinary tract infection Male client with sepsis after receiving hyperalimentation infusions Rationale Diseases or conditions caused by​ healthcare-associated infection microorganisms include​ catheter-related bloodstream infections​ (CRBIs), healthcare-associated pneumonia​ (HAP) or​ ventilator-associated pneumonia​ (VAP), surgical site infections​ (SSIs), central linedash-associated bloodstream infections​ (CLABSIs), and Clostridium difficiledash-associated infection​ (CDIs). The client with a leg wound after a motor vehicle accident most likely received the infection as a result of the accident and not hospital care. The client with sepsis after receiving hyperalimentation should be investigated as having a​ central-line associated bloodstream infection. The client with the urinary tract infection should be investigated as having a​ catheter-related infection. The client receiving antibiotics after total knee replacement surgery is most likely receiving the antibiotics to prevent a​ post-operative infection. The client being treated for diarrhea after receiving antibiotics should be investigated for a Clostridium difficile infection.

The infection control nurse is reviewing a monthly status report of all clients who were treated for infectious diseases in the organization. Which clients require further investigation to determine whether they have a​ healthcare-associated infection? ​(Select all that​ apply.) Male client being treated for diarrhea after receiving antibiotics for pneumonia Female client receiving antibiotics after having total knee replacement surgery Female client with an indwelling urinary catheter being treated for a urinary tract infection Male client with sepsis after receiving hyperalimentation infusions Male client with a leg wound from motor vehicle accident that became infected

Healthcare-associated infections are those that occur while a client is receiving treatment for another health problem

What are HAI's?

KSA's stand for Knowledge, Skills, and Attitudes that all graduating nurses are expected to have learned, and are associated with the Quality and Safety Education for Nursing competencies.

What are KSA's and what are they associated with?

Slower healing process, chronic illnesses, and less activity are risk factors.

What are risk factors for middle aged injury?

Similar injuries to the toddler, but fewer in number because of improved mobility and coordination at this age Unintentional injuries from motor vehicle accidents and drowning account for the greatest number of injuries Fatalities also caused by fires, burns, and suffocation Use of booster seats with proper belt positioning is needed to reduce injuries and fatalities from motor vehicle accidents. Additional injuries caused by falls, unintentionally being struck by or against something, bites or stings, and foreign body aspiration Foreign body aspiration due to the tendency to place objects in the mouth at this age

What are risks for unintentional injuries in preschool children?

Injuries from motor vehicle accidents because of small size and developing bones Injuries from being hit, pushed, or shaken due to smaller size Drowning in swimming pools Fires leading to burns or suffocation

What are risks for unintentional injuries in toddlers?

Before using any restraint federal laws mandate that less restrictive measures are attempted and found to be ineffective. There are also state laws that mandate the correct use of restraints. Nurses need to be aware of laws in their state of practice. Each organization's policies on restraint use must be followed when implementing restraints. Restraints are not used as a form of punishment or as a convenience measure. Any improper use of restraints can constitute false imprisonment. And any use of restraints on a competent client who refuses to adhere to the plan of care can be viewed as assault and battery in addition to false imprisonment.

What are some important considerations for the nurse regarding restraints?

Screen families for risks to their children. Teach use of car safety seats, booster seats, bicycle helmets. Look for signs of abuse and neglect. Focus teaching and interventions on caregiver and family.

What are some nursing actions that reduce risk for injury in children?

Nursing assistant independently repositioning and pulling a client up in a hospital bed Rationale The most common injuries in nursing are sprains and strains to the back followed by injuries to the shoulder and knee. The most common cause of these injuries is from lifting heavy objects. Healthcare staff can experience​ back, shoulder and knee injuries through common activities such as moving clients from one location to​ another, relocating​ equipment, or carrying​ client-care objects to the bedside. Pulling a client up in bed without assistance could cause a back or shoulder injury. Using a medication cart for intravenous fluids would not lead to an injury. Removing the breaks on a stretcher before moving a client would not lead to an injury. Using a cart to distribute filled water pitchers would not lead to an injury.

The manager is evaluating the impact of an educational program on the frequency of​ work-related injuries experienced by the nursing staff. Which observation indicates that additional training is​ necessary? Nursing assistant using a cart to distribute newly filled water pitchers to clients Staff nurse releasing the breaks on a stretcher before transporting a client to the elevator Staff nurse placing intravenous fluids on the medical cart to use while passing medications Nursing assistant independently repositioning and pulling a client up in a hospital bed

Comprehensive Primary Care Rationale The regulations for CHCs require that they provide comprehensive primary care. They are not required to have an​ ED, offer​ chemotherapy, or stock an​ on-site pharmacy.

The mental health nurse enjoys working at a community health center​ (CHC). Part of the nurse​'s satisfaction comes from helping provide the required services for CHC facilities. Which services are​ required? Emergency Department​ (ED) ​On-site pharmacy Chemotherapy Comprehensive primary care

Unintentional injuries account for the greatest number of injuries in this age group. Reasons for injuries include more active play further from home without supervision, less dependency on parents, and faster movements on foot and bicycles Motor vehicle accidents are the number one cause of injuries followed by drowning, fires or burns, and suffocation. Most common cause of nonfatal injuries is unintentional falls.

What are some risks for unintentional injuries in school age children?

Heart disease is the major cause of fatalities Malignant cancers Cerebrovascular illness Chronic respiratory disease Alzheimer disease Diabetes

What are the major fatality causes in older adults?

(1) Patient-centered care (2) Teamwork and collaboration (3) Evidence-based practice (4) Quality improvement (5) Safety (6) Informatics

What are the six QSEN competencies?

It examines the use of resources in clinical settings (inpatient or outpatient) and in community settings. The process is required by Medicaid for facilities to receive reimbursement for specific services and by The Joint Commission for continued facility accreditation.

What do interdisciplinary assessments/utilization reviews examine and who requires them?

Quality and Safety Education for Nurses

What does QSEN stand for?

In an effort to even more dramatically improve the effectiveness and efficiency of healthcare organizations, it combines the efforts of LEAN and SIX SIGMA, and uses either the DMAIC or DMADV system of Six Sigma as an operating method. The benefit that the Lean method adds to the Six Sigma approach is its focus on eliminating waste while improving value. Waste is defined as any asset or activity that does not bring value to the client. Again, the insistence on maximal client satisfaction is reinforced.

What is Lean Six Sigma?

Nurses and other healthcare professionals can be exposed to hazardous and toxic substances while providing client care. Examples of these chemicals include chemotherapeutic agents and chemicals used to clean hemodialysis machines, ventilators, and infusion pumps.

What is an example of a toxic substance that nurses can be exposed to?

is a retrospective activity. It assesses clients' experiences by looking at links between medical interventions and health outcomes or links between health outcomes and cost of care. The data can identify both areas needing improvement and those excelling in results.

What is outcomes management?

Involves evaluating: data related to the original problem is collected and analyzed to determine whether the new standards are being met. If standards are not being met, further changes are indicated.

What is quality assurance?

the EVALUATION of health care and nursing processes. This involves: - looking at the quality and effectiveness of these processes compared to accepted standards - correcting problems before clients are harmed and to prevent treatment mistakes. - keeping facilities cost-conscious. It keeps cost effectiveness of medical resources in mind, eliminating their overuse, misuse, and under-use.

What is quality management?

Complete a thorough assessment of the client's physical, functional, and psychosocial status upon admission. Communicate physical, functional, and psychosocial status changes to the client's care team or primary care provider. If the client's health status permits, promote activities that improve the client's physical status in conjunction with prescribed therapies. Encourage the client to use all assistive devices. Instruct clients on the use of appropriate footwear to prevent falls and mobility-related injuries. Eliminate clutter and obstacles in walkways. Teach clients to use devices such as elevated toilet seats, handrails, and easy-to-grip door levers. Know side effects of medications that impact mobility or cognition. Evaluate clients' responses to medications and communicate impairments to the healthcare provider. Encourage social contact to reduce the risk for isolation, which contributes to functional decline and mortality. Know the manifestations of deterioration in clients with health problems that increase the risk for functional decline.

The nurse can minimize or eliminate these safety hazards by focusing on the following actions:

Six Sigma is another way to make sure the quality of care in a clinical setting is measured, improved, and monitored. It is a long-standing quality improvement approach that healthcare organizations have borrowed from other industries, mainly in the manufacturing sector. The idea is to reduce variation, so that every time a process is initiated, it has the same positive result, a near-perfect product. It uses the word "defects," when clinical staff would usually classify the situation as having "errors or mistakes."

What is six sigma?

Lean Six Sigma Rationale The objective of Lean Six​ Sigma, the QI method used by the blood bank​ team, is to reduce waste. Quality assurance determines whether standards are met. Root cause analysis explores a sentinel event. Utilization review collects data about resource use.

The nurse in the blood bank is part of a team effort to reduce the costs of collecting and storing blood components. The nurse conducts an inventory to check for expired sterile supplies. In seeking to reduce​ waste, which quality improvement​ (QI) method is the team​ using? Utilization review Lean Six Sigma Root cause analysis Quality assurance

Ensuring a dressing change is completed according to established protocols Rationale The purpose of the competency​ evidence-based practice is to ensure that nurses have the most current information to improve or provide quality care. An example of an attitude for this competency would be planning care based upon research evidence. Changing a dressing using the established protocol is an attitude associated with​ evidence-based practice. Explaining the pathophysiology of a​ client's disease process is demonstrating knowledge for the competency of​ client-centered care. Reviewing the results of a root cause analysis is a skill associated with the competency of quality improvement. Asking for help is a skill associated with the competency of teamwork and collaboration.

The nurse is adhering to the competency of​ evidence-based practice while providing client care. Which nursing intervention is an appropriate demonstration of this​ competency? Ensuring a dressing change is completed according to established protocols Explaining the pathophysiology of a client​'s disease process Asking a nursing assistant to help turn and reposition a client in bed Reviewing the results of a root cause analysis of wound infections

During routine sports physicals To help increase the reporting and reduce the​ long-term effects of head​ injuries, nurses should be prepared to teach adolescents the dangers of unreported head injuries during routine sports physicals. Although teaching about​ under-reported head injuries is​ essential, the times to teach must be linked to when the injuries are most likely to occur. Head injuries are not associated with influenza vaccinations nor does this information need to be provided daily while in school. Teaching about head injuries before the school summer break depends on the sports in which the students plan to​ participate, and this does not apply to all students.

What is the best time the nurse should instruct high school students about the dangers of​ under-reporting head​ injuries? During routine sports physicals While providing the annual influenza vaccination Before the school summer break Daily during home room period in school

Wash hands before and after providing care to the client Double bag reusable client care equipment before sending out for sterilizing Rationale The major preventive measure that all nurses can take to limit the spread of common illnesses is hand hygiene. Thorough sanitation of​ client-care equipment is another action to reduce the spread of highly contagious illnesses.​ Double-bagging the equipment before sending it for sterilization would help reduce the spread of the virus throughout the hospital during transport. Rubbing alcohol might not be effective to disinfect tables and counter tops. Removing unneeded care items from the​ client's room to decrease clutter does not limit the spread of​ infection, but may reduce the risk for falls. Covering a bedpan with a sterile towel is not sufficient to limit the spread of the virus to other clients and nursing staff.

The nurse is caring for a client recently admitted with a stomach virus. Which actions should the nurse take to limit the spread of this infection to other clients and nursing​ staff? ​ (Select all that​ apply.) Wash hands before and after providing care to the client Cleanse bedside tables and counter tops with rubbing alcohol Cover the client​'s bedpan with a sterile towel and place in the bathroom Remove unneeded care items from the client​'s room to decrease clutter Double bag reusable client care equipment before sending out for sterilizing

The end goal of CQI is both internal and external client satisfaction. To get this thumbs-up response to care, the organization must focus on system errors rather than on individual shortcomings. Another characteristic is to insist on involvement by everyone in the system, from senior management to front-line employees.

What is the end goal of Continuous Quality Improvement?

unintentional injury

What is the leading cause of death in children of all ages?

Heating the environment with a kerosene heater Rationale When a nurse conducts a home​ visit, it is important to assess the home for safety issues. Heating the environment with a kerosene heater may indicate the home is not properly heated and is a safety concern. The use of well water for cleaning and​ cooking, disposing of needles in a plastic container labeled open double quote"​sharps,close double quote" and finding prescription drugs in several locations of the home are not safety concerns that the nurse would have to report.

The nurse is completing an initial home visit for a client who was recently discharged from the hospital. Which home condition would the nurse report due to client safety​ concerns? Finding prescription drugs in several locations of the home Using well water for cleaning dishes and for cooking Heating the environment with a kerosene heater Disposing of needles in a plastic container labeled open double quote"sharpsclose double quote"

to ensure that nurses have the most current information to improve or provide quality care.

What is the purpose of the QSEN competency of evidence based practice?

Clinical information is available to collaborating healthcare providers. Rationale Entering data into an EHR makes clinical information available to collaborators. It is not important that the software corrects grammatical errors. The EHR documents actions at the point of care.​ However, it is the availability of that information to others that affects the continuity of​ care, not its being recorded. Support for continuity of care is one​ reason, but not the only​ one, for encouraging the use of EHRs.

The nurse is discharging a client who has had an organ transplant. To accurately summarize the client​'s complex​ treatments, the nurse is carefully entering data into an electronic health record​ (EHR). How does that activity affect continuity of​ care? The nurse follows guidelines encouraging use of EHRs. The EHR documents actions at the point of care. The software will scan for grammatical errors. Clinical information is available to collaborating healthcare providers.

​Create healthier individuals. Community-organized health and safety programs are often supported by healthcare​ organizations, as these programs contribute to healthier communities. Reduction in healthcare costs might occur if a community is healthier.​ However, this is not identified as the purpose of a​ community-based safety program. The purpose of​ community-based safety programs is not to improve employment opportunities or to establish community gardens.

What is the purpose of​ community-based safety​ programs? Establish community gardens. Reduce healthcare costs. Improve employment opportunities. Create healthier individuals.

They require an order from the healthcare provider or independent licensed practitioner. If used in an emergency, the healthcare provider must be notified as soon as possible after their use. Standing or PRN orders for restraints are against federal regulations.

What must be in place before physical restraints are utilized?

root analysis

What response is required by the joint commission to a sentinel event that involves a team effort?

Be aware of the client's development according to age group Understand the client's lifestyle choices Recognize the impact of the client's culture Conduct a complete client history including past injuries and illnesses

When assessing for safety the nurse should:

Hand hygiene procedures Use of gloves when caring for clients Presence of puncture-resistant sharps containers.

When conducting an inspection within a healthcare organization, OSHA will focus on preventive measures such as:

Matching the name on the client​'s wrist band with the medical administration record Rationale The Joint Commission creates safety goals for every care delivery setting. These goals focus on specific areas in which safety issues arise while delivering client care. One area of focus for acute care hospitals is correct client identification. Placing the​ client's name on the room door is not an acceptable way to identify a​ client, as this violates privacy. Asking the client to state their middle name and writing the​ client's first name on a staff assignment sheet are not acceptable ways to correctly identify a client. The acceptable way to identify a client is to match the name on the​ client's identification band with the name on the medication administration record.

The nurse is planning interventions to address the National Patient Safety Goal of correct client identification. Which nursing action supports this​ goal? Asking the client to state their middle name Placing the client​'s name on the room door Writing the client​'s first name next to the assigned staff on the assignment sheet Matching the name on the client​'s wrist band with the medical administration record

performance improvement

When quality improvement is directly linked to the performance of an individual, team, unit, or organization, the result is called...

Teamwork and collaboration Within the competency of teamwork and​ collaboration, the nurse is expected to work effectively with other departments and​ shifts, and engage in conflict resolution as needed. Within the competency of​ evidence-based practice, the nurse recognizes individual knowledge limits and knows how to access current evidence to supplement knowledge. Within the competency of quality​ improvement, adverse events are monitored and reported so safety and quality of care can be improved. The competency of safety focuses on sharing knowledge and reporting errors to help improve client safety.

Which QSEN competency is exemplified when nurses work with individuals from other departments and disciplines to address conflict​ situations? ​Evidence-based practice Safety Teamwork and collaboration Quality improvement

Wash hands before and after providing client care Apply gloves before emptying urinary catheter drainage bags Place used syringes and needles in the sharps container Measures taken when implementing standard precautions include appropriate hand​ hygiene, use of personal protective​ equipment, safe injection​ practices, and managing contaminated surfaces and equipment. Masks and gowns do not need to be worn upon entering the care area. Blood is a contaminant and would be cleaned with something other than cold water.

Which actions should the nurse perform when implementing standard​ precautions? ​(Select all that​ apply.) Wash hands before and after providing client care Apply gloves before emptying urinary catheter drainage bags Place used syringes and needles in the sharps container Cleanse blood spills with cold water Wear a mask and gown upon entering the care area

adolescents between 10-14

Which age range has the highest rate of injury during play and sports?

Prevent surgical site errors. Identify clients correctly. Document client care correctly. Prevent medication errors. Examples of NPSGs for acute care facilities include identifying clients correctly and preventing surgical site and medication errors. Correct documentation is implied to support identification of clients and preventing surgical site and medication errors. Using​ evidence-based guidelines are not NPSGs for an acute care facility.

Which goals are included in the National Patient Safety Goals​ (NPSGs) for an acute care​ facility?​(Select all that​ apply.) Prevent surgical site errors. Use​ evidence-based guidelines. Identify clients correctly. Document client care correctly. Prevent medication errors.

Ensuring all pool barriers have handholds The nurse providing education to​ children, family​ members, and caregivers regarding child pool safety understands that prevention of drowning is the priority. Educating about the use of​ life-jackets, formal swim​ training, as well as CPR training should be included in teaching. All pool barriers should be free from handholds in order to ensure pool safety.

Which subject is not appropriate for the nurse to include when teaching​ children, family​ members, and caregivers about​ water-related injuries among​ children? Encouraging all eligible family members to learn cardiopulmonary resuscitation Ensuring use of​ life-jackets or devices designed to promote water safety Ensuring all pool barriers have handholds Recommending that all children learn how to swim through formal training

Occasionally smokes marijuana Immigrated to the United States 5 years ago Sustained a fractured arm and leg during a motor vehicle accident 2 years ago Drives a motorcycle as recreation on the weekends Rationale When assessing for​ safety, the nurse should be aware of the​ client's development according to age​ group, understand the​ client's lifestyle​ choices, recognize the impact of the​ client's culture, and conduct a complete client history including past injuries and illnesses. Recreational driving of a motorcycle could lead to unintentional injuries. The client has a history of fractures sustained during a motor vehicle accident. The use of substances could alter reflexes and increase the risk of unintentional injuries. Being a recent immigrant to the United States could indicate a knowledge deficit of safety actions and U.S. safety laws. Participating in a sport with friends does not increase this​ client's risk for unintentional injuries.

While analyzing data collected during a client​ assessment, the nurse sees a need to include interventions to reduce the risk of injury. Which assessment findings support the nurse​'s ​decision? ​ (Select all that​ apply.) Occasionally smokes marijuana Immigrated to the United States 5 years ago Plays tennis with friends after work several evenings a week Sustained a fractured arm and leg during a motor vehicle accident 2 years ago Drives a motorcycle as recreation on the weekends

Client consumes black coffee and cola drinks. Client​'s husband uses marijuana in the home. Client smokes one pack of cigarettes per day. Client has two children and is over 40 years of age. Rationale Reasons for miscarriage include lifestyle and behavioral​ factors, caffeine​ intake, illegal drug​ usage, tobacco​ usage, and older maternal age. The​ client's specific factors would include​ smoking, older maternal​ age, exposure to marijuana smoke in the​ home, and ingestion of caffeine in black coffee and cola drinks. Having two other children does not increase the risk for miscarriage. Ingesting fresh fruits and whole grain products are positive health choices and would not adversely affect the developing fetus.

While completing a health history for a pregnant​ client, the nurse becomes concerned that the fetus is at risk for miscarriage. What information in the client​'s history is causing the nurse to have this​ concern? ​(Select all that​ apply.) Client consumes black coffee and cola drinks. Client​'s husband uses marijuana in the home. Client ingests fresh fruits and whole grain products. Client smokes one pack of cigarettes per day. Client has two children and is over 40 years of age.

Knowledge deficit Rationale The mother may not be aware that the baby can drown in a sink full of​ water, so the topic of knowledge deficit is correct. The nurse would need to teach the mother about water safety for the infant. The infant is not having thermoregulation​ issues, so this topic would not be applicable at this time. Neither the mother nor the infant has sustained a head​ injury, so the risk for developmental delays is not applicable at this time. There is no evidence to suggest that the mother is at risk for coping issues.

While conducting a home​ visit, the nurse observes a new mother place the infant in a sink full of water for a morning​ bath, and then walk away to collect towels and soap. Which topic should the nurse use to guide teaching for this​ mother? Risk for coping issues Knowledge Deficit Thermoregulation issue Risk for developmental delays

Change the catheter using one without latex An allergy to latex is becoming more common in healthcare. Continuous use of products and items that contain latex increases a​ person's risk of developing a reaction. Some reactions are mild and cause skin irritation. Common items used in healthcare that can contain latex include catheters. The nurse should change the catheter using one without latex. Cleansing the skin with soap and water will not prevent further irritation from the latex. Dusting the skin with cornstarch could spread the latex to other body areas. The​ client's skin is not breaking down because of high urine acidity. The catheter needs to be replaced with one that does not contain latex.

While performing client​ care, Amanda​ Graham, the​ nurse, notes an area of skin breakdown and excoriation along the area where the indwelling urinary catheter is affixed to the​ client's inner thigh. What should the nurse do to help the​ client? Dust the skin with cornstarch Change the catheter using one without latex Check the acidity level of the​ client's urine Cleanse the skin with soap and water

Unable to lift legs onto the bed Use of a cane to ambulate Fatigue when bathing Short of breath when walking 15 feet Rationale In the older​ client, functional decline contributes to the risk for unintentional injuries. Functional decline includes the inability to complete activities of daily​ living, impaired​ mobility, decreased musculoskeletal​ strength, and reduced physical stamina or endurance. Being able to button clothing does not contribute to the risk for an unintentional injury in the older adult.

While planning care to promote safety for an older​ client, the nurse includes specific interventions to prevent unintentional injury. Which assessment findings support the necessity of these​ interventions? ​ (Select all that​ apply.) Unable to lift legs onto the bed Use of a cane to ambulate Buttons shirt with left hand Fatigue when bathing Short of breath when walking 15 feet

Appropriate disposal of used sharps Rationale Even though the safe handling of sharps and needles is an expectation for every healthcare​ professional, accidents can occur because of staff not following proper disposal techniques. The issue was a needle placed in regular trash. A technique to remove biohazard trash from a​ client's room will not address the problem. Reviewing personal protective equipment to wear when disposing of trash will not address the problem. Actions to take when exposed to contaminated sharps would not be necessary if all staff disposed of sharps appropriately.

While removing a trash bag from the room of a client in protective​ isolation, the nurse sustains a needlestick to the leg. Which educational topic is a priority for the nurse manager to discuss during the next staff​ meeting? Technique to remove biohazard trash from isolation rooms Actions to take when exposed to contaminated sharps Personal protective equipment to wear when disposing of trash Appropriate disposal of used sharps

84-year-old male with chronic renal failure and macular degeneration ​70-year-old female prescribed three blood pressure medications ​55-year-old female who lives alone and walks with two canes Rationale Clients at high risk for falls include those with impaired memory and muscle​ weakness, those who use assistive​ devices, such as canes or​ walkers, and those who use multiple prescription and​ over-the-counter medications. The client with renal failure and macular degeneration is at risk for falling because of electrolyte imbalances and a vision disturbance. The client taking three blood pressure medications is at risk for falling because of the potential for hypotension. The client who walks with two canes is at risk for falling because of the use of assistive devices. The clients recovering from breast cancer surgery and a broken arm are at the least risk for falling.

While reviewing the health histories for a group of​ clients, the case manager becomes concerned that several clients are at risk for falls. Which clients would benefit from fall prevention​ interventions? ​(Select all that​ apply.) ​47-year-old male recovering from a fractured arm ​84-year-old male with chronic renal failure and macular degeneration ​55-year-old female recovering from breast cancer surgery ​70-year-old female prescribed three blood pressure medications ​55-year-old female who lives alone and walks with two canes

This competency is important because adverse events must be monitored and reported so safety and quality of care can be improved. These adverse events can be tools for learning to prevent similar situations in the future.

Why is the QSEN competency of Quality important?

Needlesticks Bloodborne pathogens Client aggression

Within nursing, OSHA expects preventive measure to address:

Work effectively with other departments and shifts Be accountable for participation as a team member Engage in conflict resolution as needed

Within the QSEN competency of teamwork and collaboration the nurse is expected to:

Poisoning by drugs, narcotics, medicines, or biologic agents Motor vehicle accidents

Young adults major cause of death is unintentional injuries, in the order of prevalence:

Outcome standard Rationale The nurse is examining data about an outcome​ standard, pressure​ ulcers, which is a negative result of the care process. A process standard would look at steps to achieve a positive result. A structure standard would look at the organization. There is no decubiti standard.

he nurse working in the assisted living facility is reviewing the weekly report of the number of bedridden clients who developed pressure ulcers. The facility uses the Donabedian model of QI. Which standard is the nurse using with this data​ review? Decubiti standard Process standard Structure standard Outcome standard

Applying gloves before emptying a client​'s wound drainage device Notifying the environmental services team about a leaking sink in a client​'s bathroom Washing hands before and after providing care to a client with an infection Following the identified rights of medication administration before giving a client a pain medication The QSEN competency of safety focuses on sharing knowledge and reporting errors to help improve client safety. This competency enables the nurse to minimize the risk of dangerous or harmful situations with clients and other healthcare​ professionals, reduce​ healthcare-associated infections, and decrease the possibility for errors in client care. This would be exemplified by notifying someone of a leaking bathroom​ sink, washing hands before and after providing​ care, wearing​ gloves, and following the rights of medication administration. Entering​ log-in and password information before documenting in a​ client's medical record is a skill associated with the competency of informatics.

The nurse manager determines that a staff nurse is demonstrating the​ knowledge, skills, and attitudes for the competency of safety. Which skills did the manager observe the nurse​ perform? ​ (Select all that​ apply.) Applying gloves before emptying a client​'s wound drainage device Notifying the environmental services team about a leaking sink in a client​'s bathroom Washing hands before and after providing care to a client with an infection Following the identified rights of medication administration before giving a client a pain medication Entering​ log-in and password information before documenting in a client​'s medical record

​Puncture-resistant containers for used sharps are appropriately mounted. ​Water, soap and hand hygiene disinfectant is available at all client bedsides. Glove boxes are filled and placed at each point of client access. Rationale When conducting an inspection within a healthcare​ organization, OSHA will focus on preventive measures such as hand hygiene​ procedures, use of gloves when caring for​ clients, and presence of​ puncture-resistant sharps containers. NIOSH distributes safety information and provides training material.

The nurse manager is preparing the care area in anticipation of a scheduled OSHA inspection. Which particular areas should the nurse manager focus on in order to prepare for this​ visit? ​ (Select all that​ apply.) Schedule for staff to view the DVD on safety issues is posted. ​Puncture-resistant containers for used sharps are appropriately mounted. ​Water, soap and hand hygiene disinfectant is available at all client bedsides. Safety information is posted in the staff lounge. Glove boxes are filled and placed at each point of client access.

Explains that musculoskeletal injuries are often the result of moving, lifting, or repositioning clients Supports the use of mechanical devices to move clients unless contraindicated for the client Focuses on how the use of mechanical devices avoids musculoskeletal injuries for nurses and other healthcare workers Establishes training in safe client handling methods for all nurses

The nurse must ensure safety for both clients and staff when providing care. Because of this, the Nurse and Health Care Worker Protection Act of 2009 was proposed. This Act is intended to prevent injuries to nurses, other healthcare workers, and clients and highlights the following areas:

Use a​ latex-free syringe for the next injection Rationale Continuous use of products and items that contain latex increases a​ person's risk of developing a reaction. Some reactions are mild and cause skin irritation. Common items that can contain latex are syringes. The nurse should use a​ latex-free syringe to determine if the areas of skin irritation are being caused by latex. Wearing gloves should be done whether or not the client is experiencing skin irritation at the site of previous injections. Cleansing the skin with soap and water before the next injection or applying a topical antibiotic to the site after the next injection will not help prevent future irritation if it is being caused by a latex allergy.

The nurse notes skin excoriation on the client​'s abdomen at previous injection sites. Which nursing action is a priority when administering the next dose of​ medication? Wear gloves when performing injection Cleanse the skin with soap and water before the injection Apply topical antibiotic at the site after the injection Use a​ latex-free syringe for the next injection