Safety
Evaluation Format for Nursing
Assessments follow a structure of use and competencies based on Quality and Safety Education for Nurses (QSEN).
Key components include:
Patient-Centered Care
Teamwork and Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics
Home Safety Considerations
Focus on identifying environmental risks in the home setting.
Assessment Process:
Begin with the individual's history (e.g., previous falls, use of assistive devices).
Observe surroundings (e.g., presence of ashtrays, recycling of alcohol containers).
Inquire about family support and cognitive abilities.
Important safety questions:
Are there working smoke alarms?
Is there a carbon monoxide monitor?
Is there a history of substance abuse or cognitive decline?
Assessing Patient Safety
Identify communication abilities and sensory perception (e.g., hearing and vision impairments).
Recognize potential hazards in the environment (e.g., objects left on the floor).
Prioritize developmental considerations such as literacy and mobility.
Provide education and strategies to protect the patient after hazard identification.
Medication Absorption and Metabolism
Overview of how orally taken medication (e.g., ibuprofen) travels through the body:
Absorption: Drug dissolves in the stomach, travels to the small intestine, enters bloodstream via intestinal wall.
Distribution: Blood carries medication to various organs and tissues.
Metabolism: Liver metabolizes drug into forms more easily excreted; some medications may be affected by liver function changes over time.
Excretion: Primarily through urine after filtration by kidneys.
Variability in drug processing related to age, genetics, and health status.
Pharmacodynamics
Study of the effects of drugs on the body, including therapeutic effects and side effects.
Key terminology:
Peak: Highest concentration of the drug.
Trough: Lowest concentration before next dose.
Therapeutic range/index: Range of effective dosing without adverse effects.
Types of Drug Reactions
Adverse Effects: Unwanted side effects, range from mild (nausea) to severe (respiratory depression).
Drug Tolerance: Reduced response to a drug over time, requiring higher doses.
Idiosyncratic Effects: Unusual reactions to drugs not related to the drug's pharmacologic action.
Allergic Reactions: Immune responses that can range from mild (rash) to life-threatening (anaphylaxis).
Safe Medication Administration
Key principles for ensuring medication safety:
Right patient
Right medication
Right dose
Right route
Right time
Right documentation
Medication reconciliation process: Ensures continuity of care during transitions (e.g., hospital to home).
Managing Medication Refusals
Understand patient rights to refuse medication; assess and document refusal clearly.
Discuss potential risks with patients (e.g., refusing anticoagulants).
Follow protocols if medication errors occur, including notifying the provider and documenting incidents.
Types of Medication Orders
Routine Orders: Scheduled doses
PRN: As needed
Stat: Immediate administration
Med passes must adhere to scheduled time frames, impacting nursing workload.
Special Considerations
Some populations may have distinct reactions:
Children may require dosage adjustments due to fluctuating liver enzyme levels.
Elderly patients may experience decreased metabolism requiring dose adjustments for safety.
The therapeutic effect is the intended effect of medication, while adverse effects must be monitored and managed accordingly.