Comprehensive Notes on Patient Safety, Hazards, and Risk Assessment (Video Transcript)

Definition and purpose of patient safety

• World Health Organization (WHO) defines patient safety as the prevention of errors and adverse effects to patients associated with health care. ext{Patient safety} = ext{prevention of errors and adverse effects in health care}
• The overall goal in health care is to increase the quality of care and ensure safe care delivery.

Culture of safety in health care

• Safety is a core, ongoing focus at all levels of health care, reinforced by annual education and evidence-based practice.
• Workplace culture should promote:
  • Acknowledgement that work is high risk and requires consistent safety.
  • A blame-free environment to encourage reporting and problem-solving after errors (with fair review to distinguish negligent practice vs. good-faith mistakes).
  • Collaboration across all care team members (nurses, physicians, assistants, PT/OT, etc.) to gather diverse perspectives on safety.
  • Organizational backing of safety efforts, including necessary resources.
• Regulatory pressure from bodies such as CMS and the Joint Commission shapes safety goals, with the National Patient Safety Goals issued by the Joint Commission.
• Some safety goals stay for years (highlighting their importance) but may be updated periodically.

Key safety concepts and responsibilities

• Safety is the collective responsibility of every member of the health care team.
• Ongoing evaluation is required to determine what can be improved and how to prevent harm.
• Safety encompasses both physical and psychosocial patient environments and spans the continuum of care (hospital to home).

Basic human needs and safety environment

• Physical and psychosocial factors in the patient environment affect safety.
• Basic physiologic needs include:
  • Oxygen
  • Nutrition
  • Temperature (thermoregulation)
• Maslow’s hierarchy note: basic needs must be met before more advanced care can be effectively delivered.
• In safety planning, assess hazards that could compromise these needs and address them.

Oxygen: safety risks and prevention

• Supplemental oxygen is common in patients; risk factors include home hazards (smoking, heat sources) and improper storage.
• Oxygen tanks are tall and top-heavy; they must be secured in holders to prevent tipping and explosion in case of forceful impact.
• Environmental risks: presence of carbon monoxide (CO) or poor venting can reduce oxygen availability; CO is a “silent killer.”
• CO monitoring is recommended in homes; educate patients to use CO detectors where appropriate.

Examples and considerations

• Home safety education about not smoking while on oxygen or near heat sources.
• Ensure oxygen delivery devices and reservoirs are properly stored and secured during transport.

Nutrition: safety considerations

• Education on basic nutrition and healthy food choices.
• Food safety protocols: proper storage and preparation, especially in care facilities following state guidelines.
• In home care, leftovers and food spoilage increase infection risk; minimize this in patients with compromised health.

Temperature: safety considerations

• Extreme temperatures (cold in winter, heat in summer) increase risk for frostbite, heat illness, dehydration, and electrolyte disturbances.
• Assess living conditions to ensure adequate heating/cooling and hydration; address environmental factors that could compromise safety.

Common hazards and safety domains

Car seat and child safety

• Car seat safety guidance (example domain discussed):
  • Infants/toddlers should remain rear-facing as long as possible; switch to forward-facing with a 5-point harness when appropriate.
  • Children should ride in seats appropriate to their size; when transitioning to seat belts, ensure lap belt and shoulder belt fit properly.
  • Children 12 years and younger should ride in the back seat.
  • Teens (ages 16–19) have the greatest crash risk due to inexperience and risk-taking; older adults also face NBAs (note: context-dependent acronym in notes).

Poison and poisoning prevention

• Poison includes any substance that impairs health or causes death if ingested, inhaled, injected, or absorbed (not limited to “poison” in the traditional sense).
• Common sources: medications, cleaning products, pesticides, gases, and vapors.
• Young children are most at risk due to curiosity.
• Poison control number should be readily available; educate families on when to call.

Falls and fall risk

• Falls are the second leading cause of accidental death worldwide; they are multifactorial (intrinsic and extrinsic factors).
• Intrinsic risk examples: dizziness from polypharmacy, age-related factors, poor vision, cognitive impairment, muscle weakness, balance problems.
• Extrinsic risk examples: environmental hazards (cords, wet floors, clutter), inadequate supervision.
• One in four older adults falls; many do not report falls promptly. ext{Fall incidence in older adults}
  ightarrow rac{1}{4}
• Fall prevention: routine risk assessments, environmental modifications, timely reporting of any change in condition after a fall, and implementation of preventive strategies.

Fire safety

• Cooking and heating sources are leading causes of fires in homes and health care facilities.
• Plan for prevention and emergency response in the event of a fire.

Disasters and bioterrorism

• Natural disasters (tornadoes, floods, hurricanes) require disaster preparedness and drills to protect patients.
• Bioterrorism (e.g., anthrax) is a real threat; facilities train annually on disaster response and patient triage, isolation, and care.

Transmission of pathogens and infection prevention

• The leading transmission route in health care settings is hands; emphasis on proper hand hygiene.
• Health care–associated infections (HAIs), also known as nosocomial infections, occur when infections are acquired in the care setting.
• Prevention strategies include:
  • Standard precautions (gloves, hand hygiene, respiratory etiquette)
  • Contact and droplet precautions as indicated
  • Immunizations to reduce infection risk (childhood vaccines and adult vaccines as risk-based)
• Immunizations are a public health strategy to prevent disease spread; exemptions exist (religious, medical) in some contexts; policies vary by jurisdiction.

Immunizations and preventive care

• Childhood vaccinations are promoted to prevent disease spread; adults should receive vaccines based on risk and guidelines.
• Vaccination debates and policy variations exist regionally; understanding local exemptions and policies is important.
• Other preventive health measures include tuberculin skin testing and other routine screenings where applicable.

Developmental stages and safety risk profiles

Note: Developmental stage informs safety risk assessment and preventive strategies.

Infant, toddler, preschooler

• Key risks: SIDS (sudden infant death syndrome); safe sleep practices (baby on back, firm mattress) to reduce suffocation risk.
• Injury risks include suffocation from small objects; supervise closely around hazards.
• Falls become an increasing risk as mobility develops; supervision and safe environments important.
• Fire safety and drowning are notable risks; close supervision near water and around hot surfaces.
• Education for caregivers: safety behaviors, anticipatory guidance, nutrition and food safety considerations.

School-age children

• Generally more coordinated, yet still at risk from sharp objects, hot surfaces, and supervision gaps.
• School environment introduces new hazards (transportation, playground equipment, etc.).
• Bullying (including cyberbullying) and school violence can impact safety and mental health; monitor for signs of abuse and self-harm.

Adolescents

• Identity formation and autonomy increase; peer influence strong.
• Higher risk-taking behaviors: experimentation with alcohol and drugs; potential for injury or overdose.
• Mood and behavioral changes can signal risk for self-harm; screen for suicidal thoughts or intent.
• Early driving (teen licensed drivers) increases crash risk; safety education is critical.

Adults

• Injury risks more related to lifestyle and behavior (substance use, high-stress living, and chronic diseases).
• Chronic stress can manifest as illness; health maintenance and preventive actions remain essential.

Older adults

• Physiologic aging increases fall risk; mobility limitations and polypharmacy are common.
• Cognitive changes and possible dementia affect decision making and safety; living environment adaptations may be required.
• Falls are particularly problematic; many older adults fear loss of independence and may underreport incidents.

Workplace and individual risk factors for safety

• Workplace culture and management commitment shape safety outcomes.
• Resource availability (PPE, staffing, equipment) directly influences safety.
• Accountability structures are needed to discourage unsafe practices.
• Lifestyle factors: substance use, high-risk professions (construction, law enforcement), and risk-taking tendencies influence safety.
• Mobility and accessibility: impaired mobility or inaccessible environments increase risk of injury and hinder safe care delivery.
• Sensory, cognitive, and communication impairments raise the likelihood of accidents (burns, burns, miscommunication).
• Economic resources: lower-income status and homelessness correlate with higher risk and reduced access to care/ prevention.
• Safety awareness: assess patient and caregiver knowledge to identify gaps; education is essential for injury prevention.
• Workplace violence: health care workers experience higher rates of workplace violence; patients are frequent aggressors; ensure safety protections and reporting.

Safety assessment in practice (home health and hospital transitions)

• Conduct comprehensive safety assessments for each patient, including:
  • Home environment: space for safe care, presence of hazards (electrical outlets, clutter, accessibility aids like grab bars), and potential safety barriers.
  • Medical needs: medications that affect alertness or balance, diuretics that increase bathroom trips, and devices the patient uses.
  • Environmental controls: heating, cooling, smoke detectors, carbon monoxide detectors, and safe storage of poisons/medications.
  • Social supports: caregiver capacity, access to resources, and socioeconomic barriers to safety adaptations.
• Reassess after any change in condition (e.g., falls) and at transitions of care (admission, transfer, discharge).
• Use a patient-centered approach: ask patients about prior falls, home hazards, and safety concerns; tailor interventions accordingly.

Preventive measures and protocols

• Universal protocol (Joint Commission): ensure the right patient, the right surgery, and the right site through a timeout process with all team members.
  • If there is any doubt about the correct site or procedure, the operation is stopped for verification.
• Never events and sentinel events: some adverse events are considered never events (unpreventable in proper care) and must be prevented; sentinel events trigger immediate investigation and corrective action.
• Critical results reporting: timely communication of critical lab/imaging results; delays can compromise patient safety.
• Medication safety and reconciliation: at admission, transfer, and discharge, verify current meds, dosages, and indications to prevent med errors; “good faith effort” is used to identify and resolve gaps.
• Hand hygiene: ongoing monitoring of hand-washing practices, sometimes via auditing or “secret shopper” style programs to improve compliance.
• Isolation precautions and immunizations: apply standard precautions and additional precautions based on pathogens; ensure vaccinations to reduce preventable infections.

Restraints and de-escalation

• Restraints: last-resort intervention for safety; associated with psychological harm and risk of pressure injuries.
• Alternatives preferred: de-escalation techniques, environmental adjustments, and close supervision.
• RACE mnemonic (as described in the material) to recognize escalating patient behavior:
  • R: Raised voice or rapid, loud, and aggressive communication
  • A: Aggression and irritability; threatening body language
  • C: Cursing or abusive language
  • E: Attitude or demeanor that escalates risk
• If a patient is repeatedly aggressive or dangerous, restraints require strict policy, supervision, and documentation; reassess necessity regularly.

Ethical and practical considerations

• Safety ethics: protecting patients from harm is a primary professional obligation; balance risk reduction with patient autonomy and dignity.
• Communication and trust: transparent discussions with patients and families about safety plans and necessary precautions.
• Equity and access: ensure safety protocols do not disproportionately burden or exclude lower-resource populations; address disparities in care.

Quick reference: key numeric and procedural notes

• Falls in older adults: rac{1}{4} of older adults fall at least once.
• Teen driving risk: ages 16-19 have the greatest crash risk due to inexperience and risk-taking.
• Hand hygiene: standard practice aims for a thorough 20-second handwash routine (educational emphasis).
• Oxygen safety: secure storage and proper handling of oxygen tanks; prevent ignition sources near oxygen.
• SIDS prevention: back-sleeping and firm mattresses for infants; safe sleep guidelines.
• Universal protocol timeout: right patient, right procedure, right site; verification by the team prior to surgery.
• Never events and sentinel events: events that should never occur (e.g., certain preventable injuries or wrong-site procedures) and trigger investigations.
• Critical results: timely reporting and action on critical lab/imaging results to avoid harm.

Summary takeaways

• Patient safety is a core, ongoing commitment requiring a blame-free culture, multi-disciplinary collaboration, and organizational support.
• Safety spans physical and psychosocial environments from hospital to home and must consider basic human needs (oxygen, nutrition, temperature).
• Regular risk assessment, adherence to universal protocols, and proactive education are essential to prevent falls, infections, medication errors, and other hazards.
• Developmental stage-informed care helps tailor prevention strategies to the patient’s age and capabilities, from infants to older adults.
• Restraints are a last resort; de-escalation and safety planning are preferred, with clear policies and supervision.
• Continuous training, monitoring, and accountability are necessary to maintain a culture of safety and reduce sentinel and never events.