Safety & Security Study Notes

Safety & Security Chapter 9

Health Insurance Portability and Accountability Act (HIPAA)

• HIPAA is a federal law enacted in 1996 to protect the privacy and security of patients’ health information.

  • It serves as a framework ensuring that individuals have rights regarding their medical information, and that healthcare providers protect that information.

Safety Definition and Types

• Individual safety can be defined as the state of being free from physical or psychological harm.

  • Types of safety include:

  • Occupational Safety: Protecting workers from injury.

  • Environmental Safety: Protecting and preserving the natural environment, ecosystems and human health from hazards, such as air pollution, water pollution, and hazardous waste.

  • Personal Safety: Keeping oneself free from injury (examples include wearing seatbelts, using eye protection, and avoiding risky behaviors such as smoking and drug use).

Individual Safety Risk Factors

• Modifiable Risk Factors:

  • Factors that can be altered or controlled by an individual or society.

  • Examples: diet, exercise, smoking, alcohol consumption, exposure to environmental pollutants.

• Non-modifiable Risk Factors:

  • Factors that cannot be controlled or altered by an individual or society.

  • Examples include genetic predispositions, age, gender, geographical or climate conditions.

Age & Development Considerations

• Infants & Preschoolers (0-4 years):

  • Prone to burn injuries related to hot liquids or steam, accidental poisonings, choking, drowning, and car safety.

• School-Age Children (5-12 years):

  • Share similar risks as younger children but also include vehicle safety (cars/buses/bikes), contact sports, internet safety, and firearm safety.

• Adolescents (13-19 years):

  • Risks involve water, fire, sports, firearms, and vehicles.

  • Peer bullying, intimate-partner violence, and an increased risk of suicide.

  • High risk of death due to motor vehicle accidents (MVA), texting while driving, not using seatbelts, and substance use.

• Adults (19 and older):

  • Leading causes of death include heart disease, cancer, and then COVID-19.

  • Problematic life choices and coping strategies, along with workplace accidents.

• Older Adults:

  • Leading cause of injury includes falls and motor vehicle accidents (MVA).

  • Risks include fires, accidental overdose, abuse (including financial abuse), age-related changes, and mobility changes.

Lifestyle & Behavior Considerations

• Adopting healthy lifestyle practices:

  • Healthy diet

  • Exercise regularly

  • Adequate sleep and rest

  • Avoiding or limiting drugs and alcohol

  • Maintaining infection prevention, considering travel precautions, etc.

Health Knowledge Deficit

• A health knowledge deficit refers to a lack of information or understanding regarding health-related topics that can impact an individual’s ability to make informed health decisions.

  • It is essential to assess a patient’s education level and use the teach-back method, where the patient repeats back steps to ensure understanding.

Alterations Related to Safety

• Physical issues (broken foot, injured tooth, change in balance) may impact safety.

• Medications can have side effects that increase risks for harm.

• Impaired mobility can affect the ability to move safely, increasing risks for accidents, injuries, and falls.

• Altered sensory perceptions include impairments in vision, hearing, touch, taste, and smell.

  • Sensory Impairment Impact & Addressing Methods:

  • Visual Impairments: May require assistance devices (e.g., cane, guide dogs) for navigation.

  • Hearing Impairments: Use assistive devices like hearing aids, have an emergency plan in place.

  • Touch Impairments: Use temperature monitors to prevent burns.

  • Taste and Smell Impairments: Use caregivers to check for spoiled food and trained dogs for harmful odor detection.

Alterations in Psychosocial Health

• Psychosocial health refers to the psychological and social aspects of an individual’s overall health and well-being.

  • Key components include coping with stress, forming relationships, and making decisions.

  • Assess the risk of suicide, as many workplaces require a suicide risk assessment for all patients using evidence-based practice tools.

Types of Stress

• Physical Stress:

  • Example: Overexertion

  • Impacts: Increases risk of high blood pressure, stroke, heart disease, and weakens the immune system.

• Mental Health Stress:

  • Example: Job loss

  • Impacts: Increases risk of depression, anxiety; may impact decision-making.

• Social or Behavioral Stress:

  • Impacts: More likelihood of engaging in impulsive behaviors like reckless driving or substance abuse.

Risk for Falls

• Falls present a common and serious problem, especially among older adults.

• Factors increasing the risk include poor balance, weak muscles, limited mobility.

• Experiencing a fall can lead to fear of falling again, resulting in decreased activity.

Risk for Fires, Poisoning, and Suffocation

• Fires:

  • Risks include improperly used equipment, leaving cooking food unattended, flammable materials near stoves, smoking in bed, and unattended heat sources.

• Poisoning:

  • Commonly observed in young children, risks include cleaning products, medications, and contaminated food.

• Suffocation:

  • Infants and young children are the most susceptible, risks include small toys and food lodging in airways.

Risk for Substances & Impaired Thermoregulation

• Exposure to various substances, both legal and illegal, and alcohol.

• Impaired thermoregulation can lead to conditions like hypothermia or hyperthermia.

  • Hypothermia: Occurs when body loses heat faster than produced; suggestions include dressing appropriately, staying active, and avoiding drugs, alcohol.

  • Hyperthermia: Occurs when body retains too much heat; recommendations include staying hydrated and avoiding strenuous activities in hot weather.

Workplace Safety

• Safety concerns in a workplace include slips, trips, falls, chemical exposures, inadequate lighting, and heavy lifting.

Unexpected Events

• Definitions:

  • Near Miss: A potential error or event that could have caused harm but was avoided.

  • Client Safety Event: An unexpected event with or without client injury but with potential harm.

  • Adverse Event: An event causing unexpected harm to a client.

  • Sentinel Event (Never Event): A critical adverse event resulting in severe harm or death to a client.

Never Events

• Never events are identifiable, measurable, serious, and preventable.

  • Categories include:

  1. Surgical or procedural events (e.g., surgery on the wrong body part)

  2. Product or device errors (e.g., contaminated drug or device)

  3. Patient protection failures (e.g., patient suicide in a healthcare setting)

  4. Care management errors (e.g., death or injury from medication error)

  5. Environmental issues (e.g., death or harm from restraints)

  6. Radiological errors (e.g., metallic object in the MRI area)

  7. Criminal acts (e.g., assault resulting in patient/staff harm)

Consequences of Never Events

• Physical Outcomes: Potential for pain, infection, long-term complications, and impacts on quality of life.

• Psychological Outcomes: Conditions such as anxiety, depression, and post-traumatic stress disorder that may persist.

• Financial Outcomes: Increased healthcare costs due to longer hospital stays, additional treatments, and rehabilitation services.

• Trust Outcomes: Loss of trust between patients and healthcare providers, as well as the broader healthcare system.

Reporting of Events

• A tool to report adverse events, client safety events, or near misses, which tracks these events without punishing individuals.

• Types of events reported include:

  • Accidents or injuries

  • Unexpected vaccine or drug reactions

  • Incorrect administration of drugs or vaccines

  • Property damage or lost items

  • Exposure to infectious materials

  • Atypical behaviors against facility policy leading to potential client injury.

National Patient Safety Goals (NPSGs)

• Created by The Joint Commission (TJC), focusing on client safety and recommending practices to avoid adverse outcomes.

  • Goals include:

  • Identifying clients correctly

  • Improving staff communication

  • Using medications safely

  • Using alarms safely

  • Preventing hospital-acquired infections

  • Identifying client safety risks including suicide risk

  • Universal protocol preventing adverse events in surgery.

Specific Goals and Protocols

• Identifying Clients Correctly:

  • Use specific identifiers (e.g., name, DOB, hospital ID number) to ensure care is specific to the client.

• Improving Staff Communication:

  • Prompt reporting of critical results (example: Sodium levels).

• Using Medications Safely:

  • Label all medications, reconcile client medications on admission, transfer, or discharge.

• Using Alarms Safely:

  • Audible alarms in medical equipment can prevent serious events.

• Preventing Hospital-Acquired Infections (HAIs):

  • Implement CDC protocols to prevent HAIs including CLABSIs, CAUTIs, SSIs, VAP.

Reducing Suicide Risks

• Identify patients at risk, screen for suicidal thoughts, remove harmful items from rooms, and monitor closely.

  • Suicide is the 10th leading cause of death in the US and 2nd for individuals ages 10-34.

Universal Protocol in Surgery

• TJC mandates a "time out" before surgery to prevent wrong site surgery. Components include:

  1. Use of two client identifiers for establishing identity.

  2. Marking the surgical site when appropriate.

  3. Performing a time-out in the operating room.

Culture of Safety at the Bedside

• Hourly Rounding: Proactively address patient needs including toileting, positioning, pain, and safety checks (e.g., side rail position, call bell proximity).

• Rapid Response Team: A dedicated group responsible for providing critical care bedside.

• ISBARR: A communication framework involving identity, situation, background, assessment, recommendation, and read back.

Hospital Acquired Injury Definition

• An injury occurring while a patient is in the hospital and not present upon admission, includes events like SSIs, CAUTIs, CLABSIs, and injuries from falls.

Home Hazard Assessment

• Educating patients and families about home hazards is crucial to prevent injury or death.

  • Bathroom: Install grab bars, non-slip mats, waterproof chairs.

  • Bedroom: Adjust bed height, possibly install a hospital bed, use video monitoring.

  • Kitchen: Move frequently used items to lower cabinets.

  • General: Enhance lighting, eliminate loose rugs, clear pathways to reduce clutter.

Fire Safety Measures

• Install fire alarms, replace batteries regularly, keep combustible materials away from heat sources, ensure safe practices (e.g., teach stop/drop/roll).

• R.A.C.E: Acronym used in fire safety.

  • Rescue, Alarm, Contain, Extinguish.

• P.A.S.S: Acronym for fire extinguisher use.

  • Pull, Aim, Squeeze, Sweep.

Types of Abuse

• Abuse involves physical, emotional, verbal, or sexual acts that can cause harm.

  • Physical Abuse: Use of force resulting in physical harm (e.g., hitting).

  • Psychological Abuse: Manipulation or controlling behavior through words.

  • Financial Abuse: Exploitation of a person’s finances, often by a trusted individual.

  • Sexual Abuse: Violating bodily autonomy through unwanted behavior.

  • Child Abuse: Inflicted harm towards a child.

  • Elder Abuse: Mistreatment of older adults.

Types of Violence

• Family Violence: Occurs within family or intimate relationships (also known as domestic violence).

• Intimate Partner Violence: Involves physical or sexual violence by current or former partners.

• Social Violence: Community-based violence causing harm to individuals or groups.

• Workplace Violence: Aggression in the workplace, including physical and verbal abuse.