NUR 225: Chapter 27: Patient Safety and Quality

How do you avoid medical errors in the health care agency?

- Ask patient and confirm the location of surgery - Use 2 identifiers for patient when administering any medication - Never ask patient to sign anything after taking medication (could be drowsy) - ask patients to speak up/ask the nurse to do something (be approachable and available to your patient--- Patient should feel comfortable asking the nurse tow wash their hands) Health Care Agency Medical common Errors: - Huge, relevant problem - Anatomic position (mix up R/L) - administering the wrong medication to patient - Chemicals used for cleaning equipment got the patient sick

2 main ways to identify a patient

- Bracelet: Name, DOB

Adults are most at risk for:

- Lifestyle habits: smoking, drinking, hazardous work, drinking and driving Simply not taking care of yourself

Older adults are most at risk for:

-Aging process (polypharmacy- taking a ton of medications) -->Decreases heart rate, heart block, etc. -->Increased heart rate from meds mixing bad Hearing problems (loss of hearing)

Nursing Process:

1. Assessment: see though the patients eyes, assist them in any way possible, ask about home environment 2. Diagnosis: include any safety risks (risk for falls, risk for injury, risk for trauma, etc). 3. Planning: goals and outcomes for the patient. (make sure these are measurable and realistic-- may include active patient participation) Set priorities, and use teamwork collaboration. 4. Intervention 5. Evaluation: evaluate through the patients eyes. Ask the patient what their outcomes are and ensure all their expectations were met. Make sure they are gong home to a safe environment. Patient education is the most important!!!

A patient has been newly admitted to a medicine unit with a history of diabetes and advanced heart failure. The nurse is assessing the patient's fall risks. Which of the following is the proper order of steps for the "Timed Get-up and Go Test" (TGUGT)? 1. Have patient rise from straight-back chair without using arms for support. 2. Begin timing. 3. Tell patient to walk 10 feet as quickly and safely as possible to a line you marked on the floor, turn around, walk back, and sit down. 4. Check time elapsed. 5. Look for unsteadiness in patient's gait. 6. Have patient return to chair and sit down without using arms for support. A) 3, 1, 2, 5, 6, 4 B) 2, 1, 3, 5, 6, 4 C) 1, 2, 3, 6, 5, 4 D) 1, 2, 3, 5, 6, 4

3, 1, 2, 5, 6, 4 - Tell the patient the procedure you are about to time them on -Have the patient rise from straight-back cair without using arms for support -BEGIN TIMING -Look for unsteadiness in gait -Have patient return to chair without using arm support -Check time elapsed

The nursing assessment of an 80-year-old patient who demonstrates some confusion but no anxiety reveals that the patient is a fall risk because she continues to get out of bed without help despite frequent reminders. The initial nursing intervention to prevent falls for this patient is to: A) Place a bed alarm device on the bed. B) Place the patient in a belt restraint. C) Provide one-on-one observation of the patient. D) Apply wrist restraints.

A) Place a bed alarm device on the bed. Consider and implement alternatives as appropriate before the use of a restraint. A bed alarm is an alternative that the nurse implements independently.

At 12 noon the emergency department nurse hears that an explosion has occurred in a local manufacturing plant. Which action does the nurse take first? A) Prepare for an influx of patients B) Contact the American Red Cross C) Determine how to resume normal operations D) Evacuate patients per the disaster plan

A) Prepare for an influx of patients The emergency department nurse needs to prepare for the potential influx of patients first. Staff need to be aware of the disaster plan. Patients may need to be evaluated but not initially. The American Red Cross is not contacted initially. Determination of how to resume normal operations is part of the disaster plan and is determined before an actual event.

A nurse floats to a busy surgical unit and administers a wrong medication to a patient. This error can be classified as: A) A poison accident B) An equipment-related accident C) A procedure-related accident D) An accident related to time management

Administering the wrong medication to a patient is a procedure-related accident!!!! D) an accident related to time management is never an excuse for an accident. Slow down and take the time to prescribe the right medication.

Adolescence are most at risk for:

Adolescene are trying to be cool, drinking/driving, - Risk taking behavior, unsafe sex, smoking/drinking, suicide, social norms -Leading cause of injury and death is for MVA (Motor Vehicle Accidents)

School- aged children are most at risk for:

At risk for injury at home and now at school too (Important to teach kids stranger danger when they are entering school)

While caring for a child you identify that additional safety teaching is needed when a young and inexperienced mother states that: A) Teenagers need to practice safe sex B) A 3 year old can safely sit in the front seat of the car C) Children need to wear safety equipment when bike riding D) Children need to learn to swim even if they do not have a pool

B) A 3 year-old can safely sit in the front seat of a car This statement is the most alarming and incorrect.

You are caring for a patient who frequently tries to remove his intravenous catheter and feeding tube. You have an order from the health care provider to apply a wrist restraint. What is the correct order for applying a wrist restraint? 1. Be sure that patient is comfortable with arm in anatomic alignment. 2. Wrap wrist with soft part of restraint toward skin and secure snugly. 3. Identify patient using two identifiers. 4. Introduce self and ask patient about his feelings of being restrained. 5. Assess condition of skin where restraint will be placed. A) 4, 3, 5, 1, 2 B) 4, 3, 1, 5, 2 C) 3, 4, 1, 5, 2 D) 3, 4, 5, 1, 2

C) 3, 4, 1, 5, 2 These are the correct steps for applying a wrist restraint.

Infant, toddler, and preschoolers are most at risk for:

Children younger than 5 are at greatest risk for HOME ACCIDENTS for severe injury or death

A newly admitted patient was found wandering the hallways for the past two nights. The most appropriate nursing intervention to prevent a fall for this patient would include: A) Raise all 4 side rails when darkness falls B) Use an electric bed monitoring device C) Place in a room closest to the nursing station D) Use a loose-fitting vest-type jacket restraint

Correct: B) Use an electrical bed monitoring device!! This is the easiest and least invasive thing to apply tot he patient. Second best option: Place the patient in the room closest to nursing room. This way you can watch them, but this is not always an option due to availability of rooms. A) Using all 4 side rails is a restraint. You need a doctors order D) Avoid using a vest-type jacket restraint at all times, unless needed.

The nursing assessment of a 78-year-old woman reveals orthostatic hypotension, weakness on the left side, and fear of falling. On the basis of the patient's data, which one of the following nursing diagnoses indicates an understanding of the assessment findings? A) Activity Intolerance B) Impaired Bed Mobility C) Acute Pain D) Risk for Falls

D) Risk for Falls For adults age 65 and older, orthostatic hypotension, fear of falling, and weakness on one side are risks for the nursing diagnosis of Risk for Falls.

A parent calls the pediatrician's office to ask about directions for using a car seat. Which of the following is the most correct set of instructions the nurse gives to this parent? A) Only infants and toddlers need to ride in the back seat. B) All toddlers can move to a forward facing car seat when they reach age 2. C) Toddlers must reach age 2 and the height/weight requirement before they ride forward facing. D) Toddlers must reach age 2 or the height or weight requirement before they ride forward facing.

D) Toddlers must reach age 2 or the height or weight requirement before they ride forward facing. The American Academy of Pediatrics (2011a) recommends that all infants and toddlers ride in the back seat with a rear-facing-only seat and rear-facing convertible seat until they are 2 years of age or they reach the highest weight or height allowed by the manufacturer of the car safety seat.

A nurse is educating parents to look for clues in teenagers for possible substance abuse. Which environmental and psychosocial clues should the nurse include? (Select all that apply.) -Blood spots on clothing -Long-sleeved shirts in warm weather -Changes in relationships - Wearing dark glasses indoors - Increased computer use

Environmental and psychosocial cues: - Blood spots on clothing - Long-sleeved shirts in warm weather - Changes in relationships - Wearing dark glasses indoors Environmental clues include the presence of drug-oriented magazines, beer and liquor bottles, drug paraphernalia and blood spots on clothing, and the continual wearing of long-sleeved shirts in hot weather and dark glasses indoors. Psychosocial clues include failing grades, change in dress, increased absenteeism from school, isolation, increased aggressiveness, and changes in interpersonal relationships. (Indoor computer use does not serve as a cue for possible substance abuse)

A nurse is evaluating a patient who is in soft wrist restraints. Which of the following activities does the nurse perform? (Select all that apply.) - Check the patient's peripheral pulse in the restrained extremity - Evaluate the patient's need for toileting - Offer the patient fluids if appropriate - Release both limbs at the same time to perform range of motion (ROM) - Inspect the skin under each restraint

Evaluation of soft wrist restraints: - check the patients peripheral pulse in the restrained extremity - Evaluate the patients need for toileting - Offer the patient fluids if appropriate - Inspect the skin under each restraint (Release one limb at a time to perform ROM, not both at the same time) The nurse should evaluate patient for signs of injury every 15 minutes e.g., circulation, vital signs, ROM, physical and psychological status, and readiness for discontinuation. The nurse should evaluate patient's need for toileting, nutrition and fluids, hygiene, and elimination and release restraint at least every 2 hours but should do it one limb at a time.

A couple who is caring for their aging parents are concerned about factors that put them at risk for falls. Which factors are most likely to contribute to an increase in falls in the elderly? (Select all that apply.) - Inadequate lighting - Throw rugs - Multiple medications - Doorway thresholds - Cords covered by carpets - Staircases with handrails

Factors contributing to risk for falls in the elderly - Inadequate lighting - Throw rugs - Multiple medication - Doorway thresholds - Cords covered by carpets NOT stairways with handrails (this assist them and helps prevent falls) Falls most often occur while transferring from beds, chairs, and toilets; getting into or out of bathtubs; tripping over items such as cords covered by rugs or carpets, carpet edges, or doorway thresholds; slipping on wet surfaces; and descending stairs. Multiple medications also contribute to fall risk.

You are admitting Mr. Jones, a 64-year-old patient who had a right hemisphere stroke and a recent fall. His wife stated that he has a history of high blood pressure, which is controlled by an antihypertensive and a diuretic. Currently he exhibits left-sided neglect and problems with spatial and perceptual abilities and is impulsive. He has moderate left-sided weakness that requires the assistance of two and the use of a gait belt to transfer to a chair. He currently has an intravenous (IV) line and a urinary catheter in place. Which factors increase his fall risk at this time? (Select all that apply.) - Smokes a pack a day - Used a cane to walk at home - Takes antihypertensive and diuretics - History of recent fall - Neglect, spatial and perceptual abilities, impulsive - Requires assistance with activity, unsteady gait - IV line, urinary catheter

Factors that increase his fall risk at this time - Take antihypertensive and diuretics - History of recent fall - Neglect, spatial and perceptual abilities, impulsive - Requires assistance with activity, unsteady gait - IV line, urinary catheter (smoke a pack a day and using a cane to walk at home do not contribute to risk of falling) Smoking is not a risk factor for falls. Use of the cane at home is not a current risk factor for falls. Risk is determined by his current status

The nurse is caring for a patient who is having a seizure. Which of the following measures will protect the patient and the nurse from injury? (Select all that apply.) - If patient is standing, attempt to get him or her back in bed. - With patient on floor, clear surrounding area of furniture or equipment. - If possible, keep patient lying supine. - Do not restrain patient; hold limbs loosely if they are flailing - Never force apart a patient's clenched teeth.

Measure to protect the patient and nurse form injury : - With patient on floor, clear surrounding area of furniture or equipment - Do not retain patient; hold limbs loosely if they are flailing - Never force apart a patient's clenched teeth During a seizure, if a patient is standing, guide to floor. Do not try to place in bed. Do not position the patient supine; instead turn patient onto one side with head tilted slightly. When patient is on the floor, remove any furniture or objects that he or she could strike during tonic and clonic activity. Never force apart a patient's clenched teeth; you might be bitten. Do not restrain patient; hold limbs loosely if they are flailing. A postictal phase follows the seizure, during which the patient has amnesia or confusion and falls into a deep sleep.

A nurse knows that the people most at risk for accidental hypothermia are: (Select all that apply.) People who are homeless. People with respiratory conditions. People with cardiovascular conditions. The very old People with kidney disorders.

Most at risk for hypothermia: - Patients who are homeless - People with cardiovascular conditions - People that are very old Exposure to severe cold for prolonged periods causes frostbite and accidental hypothermia. Older adults, the young, patients with cardiovascular conditions, patients who have ingested drugs or alcohol in excess, and people who are homeless are at high risk for hypothermia.

What is your role as a nurse during a fire? (Select all that apply.) - Help to evacuate patients - Shut off medical gases - Use a fire extinguisher - Single carry patients out - Direct ambulatory patients

Role of a nurse during a fire: - Help evacuate patients - Shut off medical gasses - Use a fire extinguisher - Direct ambulatory patients Direct all ambulatory patients to walk by themselves to a safe area. If you have to carry a patient, do so correctly (e.g., two-man carry). After a fire is reported and patients are out of danger, nurses and other personnel take measures to contain or extinguish it such as closing doors and windows, placing wet towels along the base of doors, turning off sources of oxygen and electrical equipment, and using a fire extinguisher.

What kind of knot do you use when restraining a patient?

Slip knot! (easy one pull to release the restraint)

Temperature: -What brain structure regulates temperature? - Normal temp: 2 temperature extremems:

Temperature is regulated by the hypothalamus Normal temperature = 98.6 degrees F. ( If your temperature is under 101.5 or greater, your body is fighting off an infection, so let it be) Hyperthermia (high body temp) Hypothermia (low body temp)

What is the most common/ least restrictive restraint?

The use of side rails! - Having all 4 side rails on bed = a restraint!! (not common, you need a doctors order)

You are conducting an education class at a local senior center on safe-driving tips for seniors. Which of the following should you include? (Select all that apply.) - Drive shorter distances - Drive only during daylight hours - Use the side and rearview mirrors carefully - Keep a window rolled down while driving if has trouble hearing - Look behind toward the blind spot - Stop driving at age 75

Tips for safe-driving with seniors - Drive shorter distances - Drive only during daylight hours - Use the side and rearview mirrors carefully - Keep a window rolled down while driving if has trouble hearing - Look behind toward the blind spot - Do not recommend stop driving at the age 75 Educate patients regarding safe driving tips (e.g., driving shorter distances or only in daylight, using side and rearview mirrors carefully, and looking behind them toward their "blind spot" before changing lanes). If hearing is a problem, encourage the patient to keep a window rolled down while driving or reduce the volume of the radio or CD player. Counseling is often necessary to help older patients make the decision of when to stop driving.

The family of a patient who is confused and ambulatory insists that all four side rails be up when the patient is alone. What is the best action to take in this situation? (Select all that apply.) - Contact the nursing supervisor. - Restrict the family's visiting privileges. - Ask the family to stay with the patient if possible. - Inform the family of the risks associated with side-rail use. - Thank the family for being conscientious and put the four rails up. - Discuss alternatives that are appropriate for this patient with the family.

Yes: - Ask the family to stay with the patient if possible - inform the family of the risk associated with side-rail use - Discuss alternatives that are appropriate for this patient with the family The family is concerned about ensuring a safe environment for their loved one. The nurse should discuss their concerns, the risk of using restraints related to using four side rails, and safer alternatives such as the presence of a family member. If the family still insists on use of four side rails, you could contact the nursing supervisor to further discuss the situation with them. This is not a reason to restrict visitation; but, although you should appreciate their concern, the use of four side rails should be avoided. (Avoid contacting the nursing supervisor when possible)