Ch 27 patient safety and quality

fundamentals exam 3

The joint commission national patient safety goals 

include standards such as identifying patients correctly, using medicines correctly, reducing falls and pressure injuries (PIs), and preventing infection

culture of safety

• Acknowledgment of the high-risk nature of an organization’s activities.

• blame-free environment where individuals can report errors or near misses without fear (reprimanded/ punishment) 

• Encouragement of collaboration across levels of employees and disciplines to seek solutions to patient safety problems.

  • Organizational commitment of resources to address safety concerns.

(importance:  for minimizing adverse events even as nurses perform complex and hazardous work.)

environment safety populations concerns

racial and ethnic minorities

the disabled

elderly

impoverished

substance use or mental illness

those with unstable housing

those within the criminal justice system

common environmental hazards 

Poisonings, falls, motor vehicle accidents, fire and disasters, 

Work: repetitive motion injuries, vehicle accidents, falling objects

Nurse’s role:  educate patients about common safety hazards in the home and at work, teaching them how to prevent injury and emphasizing the hazards to which patients are the most vulnerable.

individual risk factors violence Box 27.1

• History of violent victimization

• Attention deficits, hyperactivity, learning disorders

• History of early aggressive behavior

• Involvement with drugs, alcohol, or tobacco

• Poor behavioral control

• Deficits in social, cognitive, or information-processing abilities

• High emotional distress

• History of treatment for emotional problems

• Antisocial beliefs and attitudes

• Exposure to violence and conflict in the family

relationship risk factors box 27.1

• Authoritarian childrearing attitudes

• Harsh, lax, or inconsistent disciplinary practices

• Low parental education and income

• Parental substance abuse or criminality

• Poor family functioning

• Poor monitoring and supervision of children

• Association with delinquent peers

• Involvement in gangs

• Social rejection by peers

• Poor academic performance

• Low commitment to school and school failure

Community risk factors box 27.1 

• Communities with high rates of violence and crime

• Communities with diminished economic opportunities

• Communities with high unemployment rates

• Communities with high concentrations of poor residents

• Communities with unstable housing and where residents move frequently

• Communities with few community activities for young people

• Low levels of community participation

• Socially disorganized neighborhoods

Serious Reportable Events in Health Care box 27.2 pg: 417

• Surgical or invasive procedure events (Surgery or other invasive procedure performed on the wrong site)

• Patient protection events (Patient death or serious injury associated with patient elopement)

• Product or device events (Patient death or serious injury associated with the use or function of a device in patient care, in which the device is used or functions other than as intended)

• Care management events (Patient death or serious injury associated with a medication error)

• Environmental events (Patient death or serious injury associated with the use of physical restraints or bedrails while being cared for in a health care setting)

• Radiological events (Death or serious injury of a patient or staff associated with the introduction of a metallic object into the MRI area)

• Potential criminal events

what is speak up campaign pg: 417 

Speak Up campaign encourages patients and family caregivers to take an active role in preventing health care errors by becoming involved and informed participants on the health care team

National Quality Forum (NQF) pg: 417

leads the national collaboration among health care agencies and the public to improve health and health care quality through measurement

-NQF measurement standards for patient safety

-patient falls with injury, incidence of PIs, and central line–associated bloodstream infection [CLABSI]

Failure mode and effect analysis (FEMA) 

to identify problems with health care processes and products before they occur

• focuses on what could go wrong 

• goal: To anticipate and eliminate potential failures and risks

Intrinsic factors for falls/ injuries to hospitalized patients

History of previous fall

Advanced age

Behavioral (underestimates their risk to fall and does not seek assistance when needed)

Altered cognition (abnormal gait, shuffling/ stumbling, lower weakness/ paralysis)

Sensory deficit (Unable to see walking path clearly, Reduced visual field)

Medications

Toileting problems (Takes diuretics, Has urgency, frequency/incontinence)

Disease conditions causing (Dizziness, Vestibular disorders, Peripheral neuropathy, Foot or ankle disorders, Pain (especially in lower extremities) , Postural hypotension)

extrinsic factors for falls/ injuries to hospitalized patients

Communication issues

Education issues (fall prevention education for patient and family is not provided or is inconsistently given by all health care providers)

Physical hazards (liquids on floor, pathway clutter, unsafe footwear)

Competency (Increased use of restraints, especially bedrails, Inadequate supervision of patient)

at risk for falls

Patients most at risk for injury are those with osteoporosis or with bleeding tendencies resulting from disease or medical treatments

workplace violence

an act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults

most common violence in healthcare settings 

patient/ visitor to worker 

most common characteristic of perpetrators: is altered mental status

what is OSHA (Occupational Safety and Health Administration)

a federal agency that ensures safe and healthy working conditions for employees by setting and enforcing standards

anticipated falls are caused by

underlying symptoms or medical conditions

• anticipated falls are prevented by implementing tailored interventions to address specific areas of risk

fall assessment anticipate base on the presentation of the patient, med history, medication, assessment. bed alarm, sitter w/ patient at bedside before CONSIDERING RESTRAINTS 

nursing assessment questions 

Perceptions of safety (what it means to feel safe, any changes you think should be made to improve your safety at work and at home)

Lifestyle (wearing seatbelt, assistive devices, any difficulties w/ bathing, dressing, toileting)

Medication history (Which medications, any side effects, doctor or pharmacist reviewed your medicines with you in the last year)

History of falls (sustained an injury from a fall, any symptoms right before you fell, what you think caused you to fall, ever fallen or tripped over anything in your home) 

Home maintenance and safety (feel safe in your home, modifying your home to make it safer, an emergency at home, whom can you call for help) 

Bioterrorism 

• bioterrorist attack is likely to resemble a natural outbreak

• Acutely ill patients representing the earliest cases after a covert attack seek care in emergency departments

• early signs of a bioterrorism-related illness often include nonspecific symptoms

• Rapid detection of a bioterrorism attack occurs through syndrome surveillance and reporting of suspected cases

common distractions & how to reduce medical errors

• phone calls, alarms, or staff needing assistance

• use two identifiers (Name, and DOB)

Home assessment for safety

nursing assessment must identify the potential for disruption of family relations when a patient requires home health care services and assisting family members to reconcile the demands of home care with the needs of other family members.

home assessment for safety cont. 

assess for food borne illness

hazard assessment 

know where medication and cleaning supplies are located 

room assessment: adequacy of lighting, condition of flooring and walking surfaces, presence of safety devices (alarms, side rails on steps, safety bars in bathtubs) 

placement of furniture and items that could create a barrier 

what does R.A.C.E stand for

RACE (Rescue, Alarm, Contain, Extinguish/Evacuate) describes the steps for a general fire response

what does P.A.S.S stand for

PASS (Pull, Aim, Squeeze, Sweep) outlines the technique for using a fire extinguisher

oxygen

-flammable, do not exposed to open flames

-make sure oxygen is delivered at amount it needs to be bad

root cause analysis 

is assessing what had went wrong after it has happened 

safety during seizures

stay w/ the patient

pad area around them and measure how long it has started

document any lost of bowel or urine

medication Intrinsic Factors of Fall risk

• Benzodiazepines

• Antipsychotics

• Antidepressants

• Opiates

• Barbiturates

• Antihistamines

• Anticonvulsants

• Sedatives

• Antihypertensives

• Diuretics