Class 19: MH Nursing and Patient Safety

Patient Safety

the absence of preventable harm to a patient during the process of healthcare and reduction of risk of unnecessary harm associated associated with health care to an acceptable minimum.

Patient safety events can be categorized as

adverse events or medical errors

Adverse events

• an incident that causes harm to the person (pt.) & negatively affects the person’s health & quality of life. It causes illness, injury, disability, suffering or death. It affects social, physical &/or psychological well being.

• always involves harm

Severe adverse events

Patient safety events that lead to the death or permanent disability.

Medical errors

• consists of any mistake that was made during the diagnostic & treatment process.

• does not always cause harm

Non drug-related adverse events

• Falls

• Assault

• $exu@l contact

• Self harm

Factors that can lead to falls

• Medication effects

  • Sedation, Orthostatic hypotension, 

• Cognitive impairment: 

  • Dementia, Delirium, 

• Behavioural Factors:

  • Agitation, Impulsivity, Poor judgment/insight

• Additional risk factors: 

  • Older age, Unfamiliar environment, Independent ambulation without assistance

Assault

• Forcible physical contact that may include: slapping, kicking, biting, punching, hair pulling

• Assault can occur:

• patient → staff

• patient → patient

• Risk Factors: 

• Agitation, Substance use or withdrawal, History of violence, Poor impulse control, Environmental triggers (noise, crowding)

$exu@l contact

• Always an adverse event if not voluntary. And sometimes when voluntary particularly if person is cognitively impaired or cannot consent. Risks of STIs & unwanted pregnancy are high.

Self harm

• Among inpatients the most common method of self harm is ripping the skin

• Psychological distress has been cited as most common reason for self-harm. Environmental restrictions also increase risk.

Drug adverse effects

• refers to the response of a drug that results in unintended and harmful consequences when given in doses that are typically used. This reaction can result in increased mortality & morbidity, high treatment costs & non-adherence to treatment.

• Especially difficult for those living w mental illness as they may have limited insight into their illness & the ADR further complicates  situation.

• Antipsychotic drugs are responsible for the majority of ADRs on MH Units (e.g. NMS)

Treatment errors and outcomes

• Medication

• Restraint and seclusion

• Elopement

• Contraband

Medication error

Refers to a deviation from the instructions given by prescriber or institutional policy

Restraint and seclusion error

Perceived by some as infringement of human rights & others as an unavoidable last resort. Error results from misuse of restraints or holding technique. Errors also result from inadequate monitoring while the individual is restrained, Comorbid conditions increase risk of sudden death.

Elopement error

Unauthorized absence of an individual from the MH unit. Individuals who are detained under MH Care & Treatment Act more likely to abscond.

Contraband error

Potentially hazardous items that prohibited on the Unit. Although the contraband is not the error, inadequate searching of belongings.

Are MH nurses important for patient safety?

Yes, they play a critical role in ensuring patient safety by assessing and managing risks, promoting a safe environment, and implementing evidence-based interventions, while also addressing the unique challenges of mental health settings. 

Risk assessment and management

• Identifying and Assessing Risks

• Developing and Implementing Safety Plan

• Monitoring and Evaluating

Creating a safe environment

• Physical environment

• Psychosocial environment

• Staff safety

Evidence-based interventions

• Medication management

• Therapeutic intervention

• De-escalation techniques

• Restraint and seclusion

The measurement and monitoring of safety framework

• Reinforces the power of inquiry with lots of questions

• Example of safety framework a health organization could use when doing safety assessments. This particular one focuses on past, present, and future of patient to make safety assessment

Interprofessional collaboration and safety

• prioritizing safety involves fostering a psychologically safe environment where team members feel comfortable sharing concerns and learning from mistakes, ultimately improving patient care and team performance. 

Collaborative teamwork

• Cultivating a psychologically safe environment

• Shift from punishment to learning

• Promote open communication

• Recognize and address power dynamics

• Emphasize interprofessional collaboration

Teamwork: Specific strategies for mental health teams

• Recovery-oriented approach

• Patient-centered care

• Trauma-Informed practices

• Early intervention and prevention

Recovery-oriented approach

Focus on empowering patients and their families to participate in their care, building on their strengths and promoting self-advocacy.

Patient-centered care

Prioritize the needs and preferences of patients, ensuring that their voices are heard and their concerns addressed. 

Trauma-Informed practices

Be aware of the potential impact of trauma on patients and team members, and implement practices that promote safety and healing.

Early intervention and prevention

Identify and address potential risks and challenges early on, preventing situations from escalating into and learn from them.