Assessment of Patient Safety and Quality Care

Patient identifiers

-Name
-Date of birth
-Medical record number

Goal 1

Identify patients correctly

Goal 2

Improve staff communication

Goal 3

Use medicines safely

Goal 4

Use alarms safely

Goal 5

Prevent infection

Goal 6

Identify patient safety risk

Goal 7

Prevent mistakes in surgery

Timely communication of critical results is ___ minutes

30

ISBAR

Identification
Situation
Background
Assessment
Recommendation

Identification

Who you are and who the patient is

Situation

Why you are calling

Background

What the relevant background is

Assessment

What you think the problem is
-Relevant vital signs

Recommendation

What you want them to do
-Readback

Six Rights of Medication Administration

1. Right Patient
2. Right Medication
3. Right Dose
4. Right Time
5. Right Route
6. Right documentation

Alarm Fatigue

Sensory overload that occurs when clinicians are exposed to an excessive number of alarms

Should you silence an alarm if you are not certified and/or have not verified status of patient?

NEVER

What is the single most important action to reduce the transmission of infection

Hand Hygiene

Standard Universal Precautions include...

-Hand hygiene
-PPE
-Respiratory/cough etiquette
-Appropriate patient placement
-Managing contaminated equipment
-Environmental infection control

PPE includes:

Gloves
Masks
Goggles/face shields
Gowns
Caps
Shoe covers

Droplet Precautions

MASK and GOGGLES
-Prevent transmission of diseases spread over short distances through the air by droplets
-Coughing, sneezing, talking
-Ex: flu, rhinovirus

Contact Precautions

GOWN and GLOVES
-Prevent transmission of diseases spread by direct or indirect contact
-Ex: VRE, ESBL
-Dedicated equipment

Enteric Contact Precautions

GOWN and GLOVES
-Prevents spread of highly transmissible diarrhea illnesses
-> 3 loose stool in 24hrs
-Dedicated equipment
-NO HAND SANITIZER, must WASH hands with soap and water
-Use bleach wipes to clean equipment
-Ex: C. diff

Enhanced Droplet and Contact Precautions

GOWN, GLOVES, N95 mask, and GOGGLES
-Spread by both contact and droplet precautions
-Ex: COVID-19

Airborne Precautions

N95 or PAPR
-Prevent inhalation of aerosolized particles expelled from the respiratory system
-Negative air flow room
-Ex: Tuberculosis

Donning PPE

1. Gown
2. Mask
3. Goggles
4. Gloves

Doffing PPE

1. Gloves
2. Goggles
3. Gown
4. Mask

CLABSI

Central Line-Associated Bloodstream Infections
-STERILE insertion and dressing changes
-Clean caps appropriately (15 second scrub curls caps on (clean for you))
-Daily CHG baths

CAUTI

Catheter-Associated Urinary Tract Infection
-Sterile insertion
-Daily catheter care with CHG wipes

How can you reduce the rick for suicide?

Be direct

When should you assess risk for falls?

-On admission
-Every 8 hours
-On arrival to a new unit
-With a change in patient condition
-Post procedure
-Post fall
-As needed per nursing judgement

Seizure precautions

-Seizure pads
-Suction
-Oxygen
-Airway equipment
-IV access

Preventing DVTs

-SCD pumps - always apply as ordered
-Educate patients and family members on the importance of DVT prophylaxis

Disruptive Behavior

Crude jokes, ride behavior, cultural bias, gossip/rumors

Threatening Behavior

Belittling, directed profanity, discriminatory remarks, yelling

Aggressive/Violent Behavior

Assault, harassment, intimidation/threats, throwing objects, violent outbursts

De-escalation Strategies for Threatening Behavior

-Stay calm
-Actively listen
-Respect personal space
-Validate understanding
-Be respectful
-Be consistent
-Enforce limits
-Provide options
-Keep yourself safe

Non-violent restraints

Pulling at tubes, agitation, climbing out of bed

Violent restraints

Hitting, kicking, biting, or threatening physical harm

Restraints MUST:

-Exhaust alternatives first
-Get a physicians order for use
-Educate patient and family
-Complete safety checks
-Complete circulation and skin checks every 8 hours

Safety Checks and Documentation for NV and V Restraints

NV: 2 hours
V: 15 minutes

Physician's order for NV and V Restraints

NV: Prior
V: Prior or immediately after

NEVERs for Soft-limb Restraints

-Attach restraint to side rails
-Apply over IV site or wound site
-Use in a dislocated or fractured limb

ALWAYs for Soft-Limb Restraints

-Use bucket or slip knots
-Attach to part of bed frame that moves when the HOB is raised or lowered

Nociceptive Pain

-Pain arising from tissue damage
-Visceral
-Parietal
-Responds to non-opioid and opioid medication

Neuropathic Pain

-Pain arising from nervous system
-Ex: diabetic neuropathy, herniated disc, spinal cord lesion
-Burning, tingling, or numbness
-Responds poorly to traditional analgesic medication

Acute Pain

-

Chronic Pain

-> 3 months
-Mild to severe
-Often do not mention it unless asked
-Pain behaviors often absent
-Vital signs usually normal
-Often limits normal functioning