Competency 6: Safe Use of Equipment and Restraints

What is the purpose of the National Patient Safety Goals (NPSGs)?

To improve patient safety, prevent medical errors, and reduce injuries and adverse outcomes in health care settings.

What organization establishes national patient safety standards and accredits health care facilities?

The Joint Commission (JC).

What are the National Performance Goals (NPGs)?

Fourteen goals established by the Joint Commission to improve safety and quality of care in hospitals and critical-access hospitals.

What is a culture of safety?

An organizational environment where leadership and staff prioritize patient safety, communicate openly, report errors, and work together to prevent harm.

What are two acceptable patient identifiers?

The patient's full name and date of birth. A medical record number is another acceptable identifier.

Why should a patient's room number never be used as an identifier?

Room assignments can change and do not reliably identify the patient.

When should nurses verify a patient's identity?

Before administering medications, collecting specimens, performing procedures, providing treatments, or giving blood products.

What is a critical laboratory result?

A laboratory or diagnostic finding that is dangerously outside the expected range and may require immediate intervention.

How should a nurse communicate critical laboratory results?

Directly to the appropriate provider within the facility's required time frame, with documentation of the notification. Never leave critical results on voicemail.

What is alarm fatigue?

Desensitization to frequent clinical alarms, which may delay recognition of a true emergency.

What is the purpose of a surgical time-out?

To verify the correct patient, procedure, surgical site, and consent before beginning surgery.

What is a near miss?

An error or unsafe situation that is identified and corrected before causing harm.

What is an adverse event?

An unexpected event that causes harm to a patient.

What is a sentinel event?

An unexpected serious safety event involving death, severe injury, or serious harm.

What is a patient safety event?

An unexpected occurrence that causes harm or has the potential to harm a patient.

What is the purpose of a safety event or incident report?

To document unexpected events, identify contributing factors, and prevent similar incidents from happening again.

What should the nurse do first when a patient experiences a safety incident?

Assess the patient, provide necessary care, ensure immediate safety, and notify the appropriate personnel before completing the incident report.

Should the nurse document in the patient's medical record that an incident report was completed?

No. Document the objective clinical facts, assessment findings, interventions, and notifications in the medical record.

What is workplace bullying?

Repeated negative behavior such as harassment, intimidation, belittling, or social isolation that harms another employee.

What is workplace violence?

Physical violence, threats, harassment, intimidation, or other disruptive behavior occurring in the workplace.

What is the purpose of OSHA?

To protect employees by establishing and enforcing workplace health and safety standards.

What should a nurse do when witnessing workplace violence?

Prioritize immediate safety, seek assistance, and report the incident according to facility policy.

What is the purpose of an emergency preparedness plan?

To establish organized procedures for responding to disasters, emergencies, and threats to patient and staff safety.

What are the three priority actions during an active shooter emergency?

Run, Hide, Fight—in that order when possible.

What is the purpose of medication reconciliation?

To compare medication information during transitions of care and identify omissions, duplications, interactions, or other discrepancies.

Why are anticoagulant medications considered high-risk medications?

They increase the risk of serious bleeding and require careful administration and monitoring.

What is a hospital-associated infection (HAI)?

An infection acquired during health care that was not present or incubating when care began.

What are examples of hospital-associated infections?

Catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP).

What is the nurse's responsibility when a patient expresses suicidal thoughts?

Assess immediate safety, take the statements seriously, initiate appropriate precautions, and notify the care team.

What is the purpose of informed consent in patient safety?

To ensure patients understand the proposed procedure, its risks, benefits, and alternatives before voluntarily agreeing.

What is the purpose of hourly rounding?

To proactively assess pain, positioning, toileting, personal needs, and safety to reduce falls and other complications.

What does SBAR stand for?

Situation, Background, Assessment, Recommendation.

What does ISBARR stand for?

Identity, Situation, Background, Assessment, Recommendation, Read-back.

What is the purpose of read-back communication?

To repeat information or orders to verify accuracy and prevent communication errors.

What is a rapid response team (RRT)?

An interdisciplinary team that responds to sudden patient deterioration before cardiac or respiratory arrest occurs.

What findings may require activation of the rapid response team?

Sudden vital sign changes, persistent low oxygen saturation, unrelieved chest pain, seizures, or sudden changes in mental status.

A patient suddenly becomes confused and has an oxygen saturation of 82%. What should the nurse do?

Assess and support airway and breathing, provide appropriate immediate interventions, and activate the rapid response team.

What is the purpose of the Transforming Care at the Bedside initiative?

To improve patient outcomes by increasing direct nursing care, strengthening leadership, improving communication, and using rapid response teams.

What is the purpose of standardized handoff communication?

To ensure essential patient information is communicated accurately during transfers of responsibility.

How does nurse fatigue affect patient safety?

It increases the risk of medication errors, impaired judgment, accidents, and injuries.

What is a hospital-acquired injury?

An injury or harm that occurs during hospitalization and was not present on admission.

What patient conditions increase the risk of hospital-acquired injuries?

Stroke, Parkinson's disease, dementia, impaired mobility, visual impairment, cognitive deficits, and communication disabilities.

What is the purpose of a patient safety screening tool?

To identify risk factors early so individualized preventive interventions can be implemented.

What is the Morse Fall Scale used for?

To assess a patient's risk of falling.

What is the Braden Scale used for?

To assess a patient's risk of developing pressure injuries.

What is the Hendrich II Fall Risk Model used for?

To identify patients at increased risk of falling based on factors such as confusion, dizziness, medications, and mobility.

What is the difference between a screening and a comprehensive assessment?

Screening identifies possible risks; a comprehensive assessment evaluates those risks in detail to guide care.

What is the purpose of a home hazard assessment?

To identify environmental dangers and recommend changes that prevent injuries in the home.

What bathroom modifications help prevent falls?

Grab bars, nonslip mats, shower chairs, raised toilet seats, and step-free shower entryways.

What temperature should a home water heater be set to reduce scalding?

Approximately 120°F (49°C).

How can nurses reduce electrical hazards in a patient's home?

Recommend GFCI-protected outlets, replacement of damaged cords, and keeping electrical devices away from water.

What kitchen safety measures help prevent injuries?

Turn pot handles toward the back of the stove, keep toxic chemicals locked away, and use automatic stove shut-off devices when appropriate.

What household items commonly increase fall risk?

Loose rugs, clutter, electrical cords, poor lighting, slippery floors, and uneven surfaces.

How can a home be made safer for a patient with impaired vision?

Improve lighting, mark stair edges, eliminate clutter, and provide secure handrails.

How should medications and cleaning chemicals be stored to prevent poisoning?

In secure, preferably locked storage areas away from children and vulnerable individuals.

Why should window-blind cords be kept away from young children?

They can cause strangulation and asphyxiation.

What is asphyxiation?

Suffocation caused by inadequate oxygen reaching the lungs.

What is a poison control center?

A specialized service that provides immediate guidance about poison exposures and prevention.

What should a nurse teach a family to do if a child swallows a potentially poisonous substance?

Contact Poison Control promptly; call 911 for severe symptoms such as breathing difficulty or unconsciousness. Do not induce vomiting unless directed.

Why are smoke detectors and carbon monoxide detectors important?

They provide early warning of fires and dangerous carbon monoxide exposure.

What does RACE stand for in fire safety?

Rescue, Alarm/Activate, Contain/Confine, Extinguish or Evacuate.

What is the first nursing action when discovering a fire near a patient?

Rescue anyone in immediate danger.

Why should doors and windows be closed during a fire?

To help contain smoke and flames and limit airflow that supports the fire.

What does PASS stand for when using a fire extinguisher?

Pull, Aim, Squeeze, Sweep.

Where should a fire extinguisher be aimed?

At the base of the fire.

When should a nurse attempt to extinguish a fire?

Only when the fire is small, the appropriate extinguisher is available, the nurse is trained, and escape is safe.

What is a Class A fire extinguisher used for?

Ordinary combustible materials such as wood, paper, cloth, rubber, and plastic.

What is a Class B fire extinguisher used for?

Flammable liquids such as gasoline, oil, and paint.

What is a Class C fire extinguisher used for?

Fires involving energized electrical equipment.

What is a Class D fire extinguisher used for?

Fires involving combustible metals such as magnesium, titanium, and sodium.

What is a Class K fire extinguisher used for?

Kitchen fires involving cooking oils and fats.

What is an ABC fire extinguisher?

A multipurpose extinguisher suitable for ordinary combustibles, flammable liquids, and energized electrical equipment.

Why should water not be used on an electrical fire?

Water may conduct electricity and increase the risk of electric shock.

What is lateral evacuation?

Moving patients and staff to a safe location on the same floor.

What is vertical evacuation?

Moving patients and staff to another floor when necessary.

Which evacuation method is generally preferred in a hospital?

Lateral evacuation, when a safe area is available.

Which patients should be evacuated first during a fire?

Those in immediate danger or closest to the fire, following the facility's emergency plan.

How often should a household practice a fire escape plan according to the study material?

At least twice a year, including a nighttime practice.

What should a person do if their clothing catches fire?

Stop, Drop, and Roll while protecting the face.

What safety precautions are essential for patients using oxygen at home?

Prohibit smoking and open flames, maintain safe distances from heat sources, avoid oil-based products, and keep fire safety equipment available.

Why does supplemental oxygen increase fire risk?

Oxygen supports combustion, causing materials to ignite more easily and burn more rapidly.

What should a nurse inspect before using electrical equipment?

Cords, plugs, outlets, grounding, and signs of damage or malfunction.

What should a nurse do when discovering damaged electrical equipment?

Remove it from service, label it as unsafe, and notify the appropriate department.

Why should electrical devices never be handled with wet hands?

Moisture increases the risk of electric shock.

How should an electrical device be unplugged safely?

Grasp the plug rather than pulling on the cord.

What is a GFCI?

A ground-fault circuit interrupter that quickly interrupts electrical power when a ground fault is detected.

What are the four routes of chemical exposure?

Inhalation, skin or eye contact, ingestion, and injection.

What is a Safety Data Sheet (SDS)?

A document explaining a chemical's hazards, safe handling, protective equipment, first aid, and spill procedures.

What should a nurse do after accidental chemical exposure?

Follow the chemical-specific SDS and facility emergency procedures, initiate appropriate decontamination, and report the exposure.

What personal protective equipment may be used during chemical handling?

Gloves, gowns, masks or respirators, goggles, and face shields as indicated.

What are the three basic principles of radiation protection?

Minimize exposure time, maximize distance, and use appropriate shielding.

Which type of radiation has the greatest penetrating ability among alpha, beta, and gamma radiation?

Gamma radiation.

What is alpha radiation?

Radiation with low penetrating ability that generally cannot pass through intact skin or clothing.

What is beta radiation?

Radiation with moderate penetrating ability that can affect skin and requires appropriate shielding.

Why are children especially vulnerable to radiation exposure?

Their rapidly dividing cells are more sensitive to radiation damage.

What are early manifestations of significant radiation exposure?

Nausea, vomiting, diarrhea, skin changes, and sometimes hair loss.

What is the purpose of potassium iodide during certain radiation emergencies?

To block the thyroid gland from absorbing radioactive iodine when directed by public health authorities.

What is nuclear terrorism?

Intentional release or dispersal of radioactive material to cause injury, death, or fear.

What is a chemical emergency?

An event involving the release of hazardous chemicals that may harm human health.

What is bioterrorism?

The intentional release or spread of harmful biological agents to cause illness, fear, or panic.