Patient Safety

Environmental Events

• Patient or Staff Death/Serious Injury:

  • Associated with electric shock during patient care.

  • Misuse of oxygen or gas systems (wrong or no gas).

  • Burns from any source during patient care.

  • Serious incidents related to restraints or bedrails.

Radiological Events

• Patient Death/Serious Injury:

  • Due to introduction of metallic objects in MRI areas.

Potential Criminal Events

• Impersonation:

  • Care ordered or provided by impersonators of licensed health care providers.

• Abduction:

  • Of patients or residents.

• Sexual Assault:

  • Against patients or staff within healthcare settings.

• Physical Assault:

  • Resulting in serious injury or death to patients or staff.

Hospital-Acquired Conditions (HACs)

• Non-payments for Conditions Post-Admission (after Oct. 1, 2008):

  • Retained foreign objects.

  • Air embolism.

  • Blood incompatibilities.

  • Pressure injuries (Stage 3 or 4).

  • Falls and trauma.

  • Catheter-associated urinary tract infections.

  • Vascular catheter infections.

  • Poor glycemic control manifestations.

  • Surgical site infections:

    • After specific orthopedic procedures, coronary artery bypass grafts, or bariatric surgeries.

  • Deep Vein Thrombosis/Pulmonary Embolism:

    • Post orthopedic procedures.

  • Iatrogenic Pneumothorax:

    • With venous catheterization.

Risk Factors for Falls/Injuries in Hospitalized Patients

Intrinsic Factors

• History of Previous Fall:

  • Lack of seeking assistance for toileting.

• Altered Cognition:

  • Dementia, sedation, delirium affecting risk awareness.

• Altered Mobility:

  • Weak lower extremities, abnormal gait, assistive device dependency.

• Sensory Deficits:

  • Poor visual acuity affecting path perception.

• Medications:

  • Use of benzodiazepines, antidepressants, opiates influencing fall risk.

Extrinsic Factors

• Communication Issues:

  • Inadequate communication about patient fall risks.

• Education Issues:

  • Insufficient fall prevention education for patients and families.

• Physical Hazards:

  • Wet floors, electrical cords, and inappropriate medical devices cause hazards.

• Competency Issues:

  • Increased restraint use and lack of patient mobilization.

Fall Risk Assessment

• Assessment Tools:

  • Utilize validated assessment tools like Morse Fall Scale, STRATIFY scale, Hendrich II.

• Universal Fall Precautions:

  • Familiarization with environment, maintaining call light reach, ensuring proper footwear, and keeping surroundings clean.

  • Balance fall prevention with mobilization needs and infection control measures.

• Interprofessional Involvement:

  • Collaborate across teams to manage patient safety effectively.

Nursing Assessment Questions

Perceptions of Safety

• Inquire about feelings of safety, use of assistive devices, and lifestyle habits.

• Discuss any changes needed for improved safety and assess home maintenance.

History of Falls

• Gather information on previous falls, circumstances, and injury histories.

Illustration of Nursing Process in Home Assessment

• Example Scenario:

  • Assessing home safety for Mrs. Cohen to identify risks and establish a fall prevention plan.

  • Involvement of family caregivers in promoting patient safety and ensuring understanding of care.

Psychosocial and Economic Factors

• Caregiver Knowledge:

  • Assess the capability and understanding of caregivers in relation to patient care needs.

• Economic Resources:

  • Determining if patients can afford the necessary medications and assistive devices important for safety.

Planning and Outcomes Identification

• Setting Outcomes:

  • Establishing goals for fall prevention, mobility improvement, and promoting health-seeking behaviors.

• Evaluating Progress:

  • Regularly reassess patient conditions and effectiveness of implemented safety measures.

Interventions for Fall Prevention

• Educational Content:

  • Discuss hazards, recommend home modifications, and encourage collaboration for mobility exercises.

• Continuous Evaluation:

  • Use teach-back methods to confirm understanding of fall risks and prevention strategies with patients and families.

Restraints in Patient Care

• Indications for Use:

  • Documented instances requiring restraints for patients showing confusion or agitation.

• Alternatives:

  • Introduce methods to reduce restraint reliance, emphasizing individual safety.

Factors Influencing Patient Safety

• Developmental/Individual Factors:

  • Recognizing the significance of age-related changes, risk behaviors associated with lifestyle, and environmental influences on patient safety.

• Addressing Vulnerabilities:

  • Implement tailored interventions focusing on preventing emotional abuse, violence, and accidents among vulnerable populations including children and older adults.