chapter 21 of funds

joint commission

national patient safety goals

improving patient identification, communication, harm and risk

Institute of Medicines

building a safer health system

• provide leadership

• recognize human limits in process design

• promote effective team functioning

• anticipate the unexpected

American Nurse Association

advocates for healthcare reforms, with the priority of high quality health care

quality and safety education for nurses

task force to improve nursing education, identiffied and described six competencies that all nursing students should have by graduation

medicare

NEVER EVENTS

hospital acquired conditions

medicare will stop paying institutions for care required to reat the effects of error

developmental factors of infant/toddler

• drowning is leading cause of death for children ages 1 to 4

• falls, choking, SIDS, and ingesting poison

Dependent on care on others

developmental factors of preschoolers

• accidental deaths- vehicle, drowning, fires, and poisoning

• Nonfatal injuries-falls are primary cause of nonfatal injuries

gross and fine motor skills, and balance have improved

developmental factors school aged child

• accidental deaths- vehicles leading cause in this age grouo

• nonfatal-falls are the leading cause of non fatal injuries

developmental factors adolscents

• accidental deaths-vehicles are leading cause of death, suicide follows

• accidental injuries- sports.recreational injuries, diving, drowning, especially when drinking/drugs are involved

feel confidence but lack wisdom

development factors adult

• accidental death- unintentional poisoning followed by intentional self harm causes more deaths then vehicle accidents

• accidental injuries- no physical activity due to busy lives so weaker musculoskeletal injuries

development factors of an older adult

• FALLS!!65 and older

poisoning in young children

improper storage in house

poisoning of older children and adolescents

suicide by overdose

experimenting with drugs and accidentally

poisoning in adults

illegal use

misuse

abuse

of prescription or narcotics, tranquilizers, antidepressants

treatment for poisoning

activated charcoal orally or gastric tube

charcoal is not effective in ethanol, alkali, iron, boric acid, lithium, methanol, cyanide

depending on situation: gastric lavage, dialysis, antidotes like narcan, forced dieresis

carbon monoxide exposure

colorless, tasteless, odorless toxic gas

can cause headaches, weakness, and N & V

can cause seizures, dysrthmias, unconsciousness, brain damage, and death

• exposure at homes mostly

• most exposure females, children under 17 and adults 18-44 years

• majority of deaths at scene of fires (suicide)

• cold weather because of unconventional heat sources

scalds and burns

most common in children younger than 3

• warming food or formula in microwave- food becomes hotter than intended

• sunburn- first and second degree

• contact burns- metal surfaces or vinyl seats

• chemical agents- acid, alkali, or other organic compounds

Fires

major cause of death and injury in older adults and younger than 5

SMOKE INHALATION WILL KILL YOU FASTER

• smoking-fatal home fires

• heating equipment- usually during winter

• home oxygen administration equipment- oxygen or smoking materials

• other sources- children playing with matches, improper use of candles and faulty wiring

firearm injuries

• access to firearms a risk factor to youth and domestic homicide

• gun safety and security are important

• controversial so be careful what you say

• 
  

suffocation/asphyxiation

smothering is leading cause of death in infants younger than 1: drowning choking, inhaling smoke or gas

• infants- bed or crib, to many pillows or iteams

• ages 1 to 18- drowning especially after 4

• nonfatal incidents- food items

• fatal- balloons and plastic bags

take home toxins

workplace to home

• direct skin to skin with contaminated clothes

• arthropod vectors like ticks

• dust particles inhaled

SAFETY HAZARDS IN THE COMMUNITY

• Environmental hazards → agents that can cause illness, disability, or death

• Motor vehicle accidents, food poisoning, pathogens, pollution, and poisonous chemicals as major community hazards

Motor Vehicle Accidents

• Motor vehicle accidents (MVAs) are the second leading cause of accidental death in the United States

• Ages 16–24 → particularly high risk

• Drivers in this age group are more likely to be involved in a car crash

• Every day, over 500 people over age 65 are injured in automobile accidents

Motor Vehicle Accidents Contributing Factors

• Failure to use seat belts

• Failure to use proper child car seats

• Air-bag deployment

• Distracted driving

• Cell-phone use and texting

• Speeding

• Alcohol use

• Drug use

• Nonuse of motorcycle helmets

⭐ Especially know: seat belts, child car seats, distracted driving/texting, alcohol/drugs, and helmets.

Pathogens

any microorganism capable of causing an illness.

• Pathogens can enter the body through food, mosquitoes and other insects, rodents and other animals, and unclean water.

Food-Borne Pathogens

is a nonspecific term that describes illness caused by ingesting bacteria and other microorganisms, or their toxins, in food.

Contributing factors

• Improper food storage and preparation

• Raw/undercooked meat, poultry, eggs, shellfish, raw fruits and vegetables, and unpasteurized milk and fruit juice

⭐ Think: contaminated food + improper preparation/storage = foodborne illness.

Vector-Borne Pathogens

organisms that transmit pathogenic bacteria, viruses, and protozoa from one host to another.

Mosquitoes

• Mosquitoes can transmit pathogens that cause disease

• Examples include West Nile virus, malaria, and encephalitis

Other vectors:

• Ticks, fleas, lice, and other insects can transmit disease

• Animals can transmit pathogens through bites/scratches and contamination

• Rabies can be transmitted through the saliva of infected animals, usually through bites

⭐ TESTABLE: Vector = organism that carries/transmits a pathogen.

Water-Borne Pathogens

• Sanitation refers to measures to promote and establish favorable health conditions

• People who drink or use contaminated water are at risk for disease

• Poor sanitation can cause health problems

• Pathogens such as Giardia, Cryptosporidium, and Escherichia coli can cause illness

⭐ Know the connection: contaminated water → pathogens → illness.

Pollution

is any harmful chemical or waste material discharged into the air, water, or soil.

• Air, water, and soil pollution are major types

• Examples of air pollutants include gases, asbestos, carbon monoxide, and cigarette smoke

• Environmental Protection Agency (EPA) information on air pollution

Air Pollution

motor vehicle emissions, asbestos, tobacco smoke, and secondhand smoke.

• Indoor pollutants → carbon monoxide, radon, lead, pesticides, and allergens

• Indoor allergens can come from dust mites, cockroaches, mold, and pets

• Passive exposure to tobacco smoke is associated with respiratory disease and cancer

⭐ TEST TIP: Know indoor vs. outdoor sources of air pollution.

Water Contamination

• Contamination in lakes, rivers, and streams ultimately affects both recreation and food production

• Pollution occurs when inadequately treated or untreated waste enters water

• Water pollution can cause serious health problems

⭐ Main idea: Contaminated water can affect both people and the food supply.

Noise

• Substantial exposure to noise has been associated with a range of adverse health effects

• Effects include:

  • Hearing loss

  • Stress

  • Elevated blood pressure

  • Loss of sleep

  • Poor concentration

  • Anxiety

  • Depression

• Common sources include construction equipment, lawn mowers, music, and workplace noise

⭐ Remember: Noise pollution affects more than hearing—it can affect cardiovascular health, sleep, and mental well-being.

 Soil

• Improper waste disposal and excessive use of pesticides can contaminate soil

• Contaminated soil can contain:

  • Heavy metals

  • Radioactive materials

  • Medical wastes

  • Pesticides

  • Household products

  • Industrial toxins

• Contaminants can enter the environment when waste is disposed of improperly

Weather Hazards

• More than 1,000 people die each year in the United States due to weather hazards

• Heat-related deaths have increased

• Weather-related hazards include:

  • Lightning

  • Tornadoes

  • Hurricanes

  • Flooding

  • Extreme heat/cold

⭐ The main thing to know is that weather hazards can cause significant injury and death and that extreme temperatures are especially important health hazards.

SAFETY HAZARDS IN THE HEALTHCARE FACILITY

• Healthcare facilities have many safety hazards

• Healthcare facilities embody several patient safety risks

• The Joint Commission establishes National Patient Safety Goals.

THE JOINT COMMISSION — 2022 PATIENT SAFETY GOALS

Goal 1

Identify patients correctly

Goal 2

Improve staff communication

Goal 3

Use medicines safely

Goal 6

Use alarms safely

Goal 7

Prevent infection

Goal 15

Identify patient safety risks

UP 1

Prevent mistakes in surgery

Universal Protocol (UP 1)

Prevent mistakes in surgery by confirming the correct procedure, correct person, and correct site.

Memorize:

CORRECT PERSON + CORRECT PROCEDURE + CORRECT SITE

Organizational Factors Contributing to Safety Problems

• Poor design

• Inadequate staffing

• Short staffing

• Inadequate training

• Distractions

• Inadequate resources

• Disorganization and intimidation in the workplace

Healthcare Culture

• Healthcare has traditionally been hierarchical

• Errors should be reported rather than hidden

• Nurses should feel safe reporting errors and concerns

Just Culture

a culture that promotes reporting errors and safety concerns

·       Focuses on system problems, not simply blaming individuals

·       Encourages healthcare workers to report errors and near misses

What Are Never Events?

Never events are serious, preventable errors that should never occur.

• Wrong-site surgery

• Wrong patient

• Wrong procedure

• Patient death related to a fall

• Retained foreign object after surgery

• Air embolism

⭐ Think: serious + preventable + should never happen.

Understanding Errors in Healthcare — Root-Cause Analysis

• Root-cause analysis (RCA) → used to determine the underlying causes of an error

• Focuses on why the error happened, not simply who made it

• Used to prevent the error from happening again

1. What happened?

2. Why did it happen?

3. What can be done to prevent it from happening again?

Alarm Safety

·       Missed alarms can cause harm

·       Alarm fatigue occurs when healthcare workers become desensitized to alarms

·       Alarms must be recognized and responded to appropriately

⭐ Alarm fatigue = too many alarms → decreased attention/response.

Fires and Electrical Hazards

• Fires in healthcare agencies are often related to anesthesia or improperly grounded/malfunctioning electrical equipment

• Healthcare facilities must have policies for preventing electrical hazards

• Never smoke in a healthcare facility

Fire emergency

• “Code Red” or “Code Yellow” may be used to announce a fire

• Patients and visitors may need to leave the building

Restraints

a device or method used to restrict a patient's freedom of movement or access to their body.

• Physical restraints

• Chemical restraints

• Restraints should not be used for convenience

• Use restraints only when necessary

• Least restrictive intervention should be used first

Important:

• Cast and traction are NOT restraints

• Physical holding is not always considered a restraint

• Restraints can cause physical and emotional effects

Physical & Emotional Effects of Restraints

• Physical effects: decreased strength, contractures, injuries

• Emotional effects: anger, fear, humiliation, helplessness

Restraint-Free Environments

• Least restrictive interventions should be used

• Try alternatives before restraints

• Restraints should be used only as a last resort

Mercury Exposure

• toxic in both acute and chronic exposure

• Can be inhaled, ingested, or absorbed through the skin

• Can cause neurological and cardiovascular disorders

Mercury-containing products

• Thermometers

• Sphygmomanometers

Biological Hazards

• Nurses have a high priority for biological safety

• Potential exposure to infectious microorganisms

• Healthcare workers must follow infection-control procedures

Needlestick Injury

• Needlestick injuries can expose nurses to bloodborne pathogens

• Common causes include:

  • Recapping needles

  • Improper disposal

  • Handling sharps

• Never recap needles

• Dispose of sharps in the appropriate sharps container

⭐ Remember: Needlestick = bloodborne pathogen risk.

Back Injury

• Back injuries are common work-related musculoskeletal disorders

• Safe body mechanics and proper lifting techniques help prevent injury

• Risk increases with:

  • Improper lifting

  • Transferring patients

  • Repositioning patients

  • Long shifts

  • Inadequate equipment

Radiation Injury

• Radiation = energy emitted as waves or particles

• Sources include:

  • X-rays

  • Nuclear medicine

  • Radiation therapy

• Healthcare workers should minimize exposure

Radiation protection

• Time

• Distance

• Shielding

⭐ Think: T-D-S
Time ↓ + Distance ↑ + Shielding = ↓ radiation exposure

Violence

• Healthcare workers experience a high rate of workplace violence

• Risk factors include:

  • Crowded environments

  • Long waits

  • Anxiety and anger

  • Substance use

  • Mental illness

• Violence can be verbal or physical

Anxiety and anger

• often precedes violent behavior

• Warning signs include:

  • Agitation

  • Restlessness

  • Loud/rapid speech

  • Threats

  • Aggressive gestures

Assessing/Recognizing Cues for Violence

• History of violence

• Alcohol/drug use or withdrawal

• Mental disorders

• High fever

• Epilepsy

• Head trauma

• Hypoglycemia

⭐ Know that a history of violence is an important risk factor.

Falls

• Falls are a major patient safety concern

• Assess patients for fall risk

• Use appropriate fall-prevention interventions

Nursing Care in the Healthcare Facility

• Review medications, especially medications that may contribute to falls

• Call light within reach

• Orient patient to surroundings

• Place confused patients near the nurses' station

• Keep water, urinal, bedpan, and tissues within reach

• Provide a night-light

• Keep floors free of clutter

• Teach fall-prevention strategies

• For high-risk patients, use fall-risk identification

⭐ Think: environment + medications + orientation + accessibility.

Home Care — What to Do If a Fall Occurs

• Don't panic

• Stay still for a few minutes

• If okay, get up slowly

• If unable to move, call for help

Nursing Diagnosis/Analyzing Cues

possible safety diagnoses:

• Hyperthermia

• Hypothermia

• Swallowing impairment

• Falls Risk

• Risk for injury

• Poisoning Risk

• Suffocation Risk

• Trauma Risk

Planning/Prioritizing Hypothesis & Generating Solutions

• Nursing interventions should be based on the identified safety risk

• Goals/outcomes should be specific and measurable

Prevent Poisoning in the Home

• In suspected poisoning, call 911 or the local emergency number

• Do not induce vomiting unless instructed by Poison Control/emergency professionals

For Children Nursing Actions-POISON

• Children are especially vulnerable to poisoning

• Keep potentially poisonous substances out of reach

• Do not induce vomiting unless specifically instructed

• Keep Poison Control information available

For Adults-POISON

• Take medications only as prescribed

• Do not take larger/more frequent doses

• Keep medications in original containers

• Read medication labels carefully

• Avoid taking someone else's medication

POISONING IN THE HOME

Careful Words and Actions

• Never leave a small child unattended near household cleaners/medications

• Avoid taking medications in front of children

• Keep medications and chemicals out of children's reach

POISONING IN THE HOME-Careful Storage

• Store medications/chemicals in locked cabinets

• Keep chemicals in their original containers

• Never store chemicals in food containers

• Use child-resistant packaging

• Dispose of medications properly

POISONING IN THE HOME-Careful Disposal

• Do not flush medications unless instructed

• Follow appropriate medication-disposal guidelines

Prevent Carbon Monoxide Poisoning

• Install and maintain a home CO detector

• Vent gas appliances to the outside

• Repair defective vehicle exhaust systems

• Never use a gas/kerosene heater indoors

• Never operate gasoline-powered engines in enclosed spaces

⭐ CO = odorless and dangerous.

Prevent Home Fires

• Have a warning system/smoke alarms

• Change smoke-alarm batteries every 6 months

• Keep a phone near the bed for people who may have limited mobility

• Have a home fire-escape plan

• Practice the escape plan

Drowning

• Supervise children around water

• Never leave young children unattended near:

  • Pools

  • Bathtubs

  • Toilets

  • Buckets

• Use appropriate barriers around pools

• Do not rely on personal flotation devices as a substitute for supervision

Prevent Suffocation

• Inspect toys for small, removable parts

• Keep plastic bags away from children

• Keep window blind cords out of reach

• Avoid loose bedding

• Do not give young children hard candy, chewing gum, popcorn, grapes, or marshmallows

• Supervise children while eating

Choking Rescue

• Know the universal sign for choking

• Call 911 immediately if someone is choking

Choking Rescue Maneuver

• Used to remove a foreign object obstructing the airway

MOTOR VEHICLE SAFETY

• Always use seat belts

• Never drink alcohol and drive

• Avoid distractions such as:

  • Cell phones

  • Texting

  • Eating

  • Changing music

• Follow traffic laws

• Avoid driving when impaired

Older Adults

• Age-related changes can increase the risk for injury

• Vision, hearing, cognition, and reaction time can affect driving safety

Child Car Seats

• Infants → rear-facing

• Toddlers/preschoolers → appropriate forward-facing/convertible seat according to size and manufacturer's guidelines

• Older children → booster seat until seat belt fits properly

• Always follow manufacturer and current safety guidelines

Food Safety

Clean

• Wash hands

• Clean surfaces

• Wash produce

Cook

• Cook foods to appropriate safe internal temperatures

• Use a food thermometer

Chill

• Refrigerate food promptly

• Keep refrigerator ≤40°F (4°C)

Combat Cross-Contamination

• Keep raw meat separate

• Wash hands, utensils, and cutting boards after contact with raw foods

• Don't put cooked food on a plate that held raw meat

⭐ 4 Cs = Clean, Cook, Chill, Combat cross-contamination.

VECTOR-BORNE PATHOGENS-Mosquitoes

• Remove standing water

• Keep rain gutters unclogged

• Maintain swimming pools

• Use appropriate mosquito repellents

VECTOR-BORNE PATHOGENS-Ticks

• Use EPA-registered insect repellent

• Wear light-colored clothing

• Wear long sleeves/pants

• Tuck pants into socks

• Check for ticks after outdoor exposure

• Remove ticks promptly

Rodents and Other Animals

• Cover food

• Clean up food immediately

• Do not leave food/water accessible

• Keep garbage in closed containers

• Repair holes/cracks around the home

Reducing Pollution

• Properly dispose of hazardous waste

• Reduce air pollution

• Avoid unnecessary pesticide use

Air Pollution

• Avoid high-traffic areas when possible

• Check air-quality warnings

• Avoid exposure when pollution levels are high

Noise Pollution

• Avoid exposure to high noise levels

• Wear hearing protection in loud environments

WEATHER HAZARD SAFETY

• Have a disaster plan

• Know evacuation routes

• Keep emergency supplies available

• Stay informed about weather conditions

• Have a plan for extreme weather

RACE

R — Rescue anyone in immediate danger
A — Activate the alarm
C — Confine the fire
E — Extinguish/Evacuate

PASS

• P — Pull the pin

• A — Aim at the base

• S — Squeeze the handle

• S — Sweep side to side

Fire Extinguisher Classes-Class A 

→ ordinary combustibles

Fire Extinguisher Classes-Class B 

→ flammable liquids

Fire Extinguisher Classes-Class C

 → electrical equipment

Fire Extinguisher Classes-Class D

 → combustible metals

Fire Extinguisher Classes- Class K 

→ cooking oils/fats

RESTRAINTS

• Restraints are a last resort

• Use the least restrictive intervention

• Try alternatives before restraints

• Follow facility policy

• Obtain the required order

• Monitor the patient carefully

Provide Consistency

• Keep the environment consistent and familiar

• Remain with the patient when possible

• Help with the patient's care

• Bring familiar objects from home

⭐ Helpful for patients experiencing anxiety/confusion.

Using a Bed-Monitoring Device

• Explain the device to the patient

• Ensure the device is functioning properly

• Follow facility policy

• Use alternatives when possible

• Restraints are a last resort

• Reassess the patient regularly

Mercury Spill

• Do NOT touch mercury droplets

• Do NOT use a vacuum cleaner

• Do NOT sweep mercury

• Keep people/animals away from the area

• Contact the appropriate healthcare/environmental agency

• Follow the facility's mercury-spill procedure

• Ventilate the area as appropriate

NEVER vacuum mercury.

REDUCING ALARMS

• Check that monitoring equipment is properly maintained

• Reduce unnecessary alarms

• Set alarms according to patient-specific needs

• Respond appropriately to alarms

Coping With Violence

• Anxiety often precedes violence

• Treat underlying medical conditions

• Use a calm, reassuring approach

• Avoid using threatening or aggressive body language

• Maintain a safe distance

• Do not enter a room alone with an angry/violent patient

• Remove objects that could be used as weapons

Which Safety Interventions Can I Delegate?

• The RN remains responsible for assessment

• The RN determines what can safely be delegated

• Delegation depends on:

  • Patient condition

  • Complexity of task

  • UAP's education/competency

  • Facility policy

Restraints:

• UAP may assist with monitoring/basic care according to policy

• The nurse remains responsible for assessment and clinical judgment

in a meeting the safety needs of adolescents client, it would be most important for the nurse to focus his or her teaching on
a. smoking cessation

b. sports injuries

c.alcohol abuse

d. drivers education

d

what initial instructions should a nurse give to a mother whose childs clothing has come in contact with mercury

remove clothing immediately

could cause renal and neurological disorders

a child has had hiccups for 2 hours. is this a sign of suspected ingestion of poison

a. yes

b.no

b