Quality and Patient Safety Notes

Safety Hazards in Health Care Setting

Quality and Patient Safety, based on Potter and Perry (2024), Canadian Fundamentals of Nursing, Elsevier.

Staff Safety:
- Environmental risk chemicals
- Infection prevention and control
- Violence
- Nurse safety
Patient Safety:
- Falls
- Procedure-related accidents (e.g., not using sterile technique)
- Equipment-related accidents (e.g., malfunctioning or disrepair of equipment)

Impaired Mobility:
- Muscle weakness
- Paralysis
- Poor coordination or balance
Sensory or Communication Impairment:
- Visual impairment
- Hearing impairment
- Communication impairment (Aphasia; language barrier)
Lack of Safety Awareness:
- Lack of knowledge regarding safety, especially concerning medications

Examples:
- A 24-year-old client with a traumatic brain injury in a wheelchair, who is impulsive and doesn't wait for staff assistance.
- A 60-year-old with degenerative joint disease using a walker.
- A 73-year-old fully ambulatory diabetic patient taking diuretics for hypertension.

Sensory changes:
- Visual alterations
- Hearing impairment
Genitourinary changes:
- Nocturia
- Incontinence
Musculoskeletal changes:
- Examples : decreased muscle strength, reduced flexibility
Nervous system changes
- Examples: delayed reaction time, impaired balance

(NA if comatose, complete paralysis, or completely immobilized)
Age
- 70-79 years: 2 points
- \geq 80 years: 3 points
Fall history
- Fall within 3 months before admission: 5 points
- Fall during this hospitalization: 11 points
Mobility
- Ambulates or transfers with unsteady gait and NO assistance or assistive devices: 2 points
- Ambulates or transfers with assistance or assistive device: 2 points
Visual or auditory impairment affecting mobility: 4 points
Elimination
- Urgency/nocturia: 2 points
- Incontinence: 5 points
Mental status changes
- Affecting awareness of the environment: 2 points
- Affecting awareness of one's physical limitations: 4 points
Medications:
- One present: 3 points
- 2 or more present; or sedated procedure within the past 24 h: 5 points
  - Psychotropics (antidepressants, hypnotics, antipsychotics, sedatives, benzodiazepines, some antiemetics)
  - Anticonvulsants
  - Diuretics/cathartics
  - PCS/narcotics/opiates
  - Antihypertensives
Patient care equipment:
- One present: 1 point
- \geq 2 present: 2 points (IV, chest tube, indwelling catheter, SCDs, etc.)
Risk levels
- Moderate risk = 6-10 Total points
- High risk > 10 Total points

Orientation
- Keep close to desk if confused
- Supervise if confused
- Orient to call bell – always within reach
- Tables close to client
- Remove clutter
- Side rails – one up, one down
- Bed alarm
Transport
- Lock beds/wheelchairs during transfers
- Side rails
- Safety straps

Health promotion (exercise balance, nutrition, stress management)
Remove excess equipment
Orient patient & significant others to new environment – use of phone; call bell; pt bed; lighting
Provide low bed if required – floor mat for protection
Non-skid footwear
Bed alarms

Search Locations:
- Everywhere (under beds, in closets, locked rooms & staff areas)
- May need to involve the police if client has left the facility

Do not clear the building unless ordered by the person in charge because it can be upsetting for clients.
REACT sequence:
- R - Remove those in immediate danger
- E - Ensure all doors are closed
- A - Activate fire alarm
- C - Call designated fire emergency number & report location of fire
- T – Try to extinguish or control the fire

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2024). Canadian Fundamentals of Nursing (7th ed). Elsevier.