Safety in the Home, Community, and Healthcare Settings—The Nurse’s Role

Overview of Healthcare Safety

Hospital Errors, Injuries, Accidents, and Infections
- 1000 deaths per year are attributed to hospital-related errors, accidents, and infections.
- 1 in 25 patients develops an avoidable infection during hospital stays.
- 1 in 4 Medicare patients may experience harm, injury, or death when admitted.
- More than 500 deaths daily are due to preventable hospital errors.

Nurses' Role in Safety

Nurses play a crucial role in preventing harm to patients. Key responsibilities include:

Bed Safety
- Ensure beds are locked and in the lowest position.
- Raise side rails when needed.
IV Safety
- Monitor IVs for correct placement and functionality.
Medication Safety
- Prevent medication errors by using the 5 Rights of Medication Administration:
  - Right patient
  - Right medication
  - Right dose
  - Right route
  - Right time
Thorough Handwashing to prevent infection transmission.
Damaged Equipment
- Report and remove broken or malfunctioning equipment immediately.

Types of Injuries

Unintentional Injuries
- Caused by accidents like:
  - Falls (e.g., slipping in bathrooms)
  - Motor vehicle crashes
  - Poisonings (e.g., accidental ingestion of medications)
  - Drownings
  - Fire-related injuries
  - Suffocation by ingested objects (especially in children)
  - Firearms accidents
Intentional Injuries
- Result from acts of violence or abuse, leading to:
  - Suicide
  - Homicide

Nursing Safety Initiatives

Quality and Safety Education for Nurses (QSEN) Project (2005)
- Goal: Prepare nurses with the knowledge, skills, and attitudes (KSAs) necessary to promote quality and safety.
- Focus Areas:
  - Patient-centered care
  - Teamwork and collaboration
  - Evidence-based practice
  - Quality improvement
  - Safety
  - Informatics
National Patient Safety Goals (NPSG)
- Set by The Joint Commission (TJC) to improve patient safety:
  - Identify patients correctly (use at least two identifiers)
  - Improve staff communication
  - Use medications safely
  - Use alarms safely
  - Prevent infections (e.g., catheter-associated infections)
  - Identify patient safety risks (e.g., suicide risk)
  - Prevent surgical mistakes

Factors Affecting Safety

Individual Factors
- Physical and mental condition impact injury risk:
  - Musculoskeletal (MS) System: Decreased strength, range of motion (ROM), or balance issues can increase fall risk.
  - Neurological System: Memory loss can lead to confusion or unsafe behaviors.
  - Sensory Impairment: Diminished vision or hearing increases risk for accidents.
  - Cardiopulmonary System: Shortness of breath or orthostatic hypotension limits activity.
  - Hepatic/Renal System: Ineffective medication detoxification can lead to side effects or toxicity.
  - Integumentary System: Skin injuries increase infection risk.
Lifespan Considerations
- Infants: Should sleep supine (on their backs) to prevent sudden infant death syndrome (SIDS).
- Children: Use rear-facing car seats until at least age 12; all children under 13 should sit in the back seat.
- Adults: Manage stress and maintain regular health check-ups.
Environmental Factors
- Pollution, lighting, communicable diseases, and workplace hazards also pose risks to safety.

Home and Community Safety Hazards

Restraints in Healthcare

Physical Restraints
- Can only be used with a provider's order and as a last resort after less restrictive measures have failed.
- Types:
  - Physical (mechanical) restraints: Devices that limit movement.
  - Chemical restraints: Medications used to control behavior.
- Nursing Responsibilities:
  - Initial assessment by a nurse is required.
  - Application and monitoring may be delegated to unlicensed assistive personnel (UAP) after the initial assessment.

Healthcare-Specific Safety Risks

Medication Errors
- Avoid distractions when administering medication.
- Always follow the 5 Rights of Medication Administration.
Falls
- Use the Morse Fall Scale to assess fall risk.
- Predicting future falls: A history of falls is the strongest indicator.
Preventing Falls:
- Keep call light and frequently used items within reach.
- Make hourly rounds (4 Ps: Pain, Position, Potty, Possessions).
- Place high-risk patients near the nurse’s station.
- Use sensor alarms to detect movement.
- Encourage family visits for support.
- Ensure beds/chairs are low and locked.
- Install grab bars in bathrooms.
Drug-Resistant Microorganisms (e.g., MRSA)
- Implement strict infection control measures to limit the spread.
Procedural Errors
- Common mistakes include:
  - Not lowering the bed.
  - Forgetting to identify the patient.

Healthcare Fire Safety: RACE and PASS

If you discover a fire, remember RACE:

Using a Fire Extinguisher: PASS