Patient Safety

Learning Objectives

• Key Goals:
    - Identify patients at risk for safety.
    - Describe specific safety risk factors for each developmental stage.
    - Identify learning needs of patients related to safety.
    - Describe methods to assess patients at risk for injury.
    - Identify common potential hazards throughout the lifespan.
    - Discuss use and legal implications of restraints.
    - Discuss alternatives to restraints.
    - List desired outcomes to use in evaluating the selected strategies for injury prevention.

Nursing Priority

• Patient Safety:
    - Patient safety should be a top priority for nurses.
    - Assess not only hospital safety concerns but also safety issues in the home and community.
    - Prevention is key!

Factors Affective Safety

• Key Factors:
    - Age and Development
    - Lifestyle
    - Mobility and Health Status
    - Sensory-Perceptual Alterations
    - Cognitive Awareness
    - Emotional State
    - Ability to Communicate
    - Safety Awareness
    - Environmental Factors:
      - Home
      - Work
      - Community

Safety in Healthcare Settings

• Types of Errors:
    - Medical errors
    - “Near miss” errors
    - Medication errors
    - Issues in the perioperative environment
    - Hospital acquired wounds or infections

• Causes of Errors in Hospital Settings:
    - Inadequate staff communication
    - Insufficient coordination of care
    - Poor patient assessment
    - Environmental hazards

The Joint Commission’s 2025 National Patient Safety Goals

• Key Goals:
    1. Identify patients correctly - NPSG.01.01.01
       - Use at least two identifiers for patients (e.g., name and date of birth).
    2. Improve staff communication - NPSG.02.03.01
       - Send important test results to the right staff person on time.
    3. Use medicines safely - multiple NPSGs
       - Label unlabeled medicines in procedures.
       - Careful management of blood-thinning medications.
       - Provide patients with written medication information.
    4. Use alarms safely - NPSG.06.01.01
       - Ensure alarms on medical equipment are heard and responded to promptly.
    5. Prevent infections - NPSG.07.01.01
       - Follow hand hygiene guidelines from reputable organizations.
    6. Identify patient safety risks - NPSG.15.01.01
       - Recognize and address potential risk factors in patients.
    7. Improve health care equity - NPSG.16.01.01
       - Address disparities in healthcare access and outcomes.
    8. Prevent surgery mistakes:
       - Mark the surgical site and pause before starting surgery to prevent errors.

Promoting Safety Across the Lifespan

• Developmental Stages:
    - Newborns/Infants
    - Preschoolers
    - School-Age Children
    - Adolescents
    - Adults
    - Older Adults

• Common Safety Problems:
    - Vary across different age groups and need tailored prevention strategies.

Newborns/Infants

• Safety Concerns:
    - Accidents are the leading cause of death in this group.
    - Parent Education:
      - Proper car seat usage (back seat and rear-facing).
      - Always check bath and formula temperatures.
      - Identify and mitigate choking hazards.
      - Promote the ABCs of infant sleep:
        - Alone, on Back, in a Crib

Toddlers/Preschoolers

• Developmental Behavior:
    - Very curious; need constant supervision, particularly near water.

• Safety Education for Parents:
    - Avoid putting objects in mouths.
    - Teach about hot surfaces and wearing helmets while riding.
    - Discuss stranger danger.

School-Aged Children

• Major Risks:
    - Injuries during accidents like MVAs, drowning, fires, and firearms.
    - Prone to minor accidents while engaging in playful activities.

• Safety Education Areas:
    - Sports, playground safety, traffic rules, and avoiding dangerous behaviors.
    - Promote awareness of smoking, drugs, alcohol, and sex education.

Adolescents

• Key Issues:
    - Suicide and homicide are leading causes of death.
    - Risk factors: economic deprivation, family issues, and firearm availability.

• Driving Safety:
    - Education on safe driving practices and stress management.

• Educational Topics:
    - Discuss drugs, alcohol, safe sex practices, and internet safety.

Adults

• Health Risks:
    - Risky behaviors, stress, domestic violence, and suicide.

• Nursing Assessment:
    - Observe for signs of depression, social withdrawal, and other behaviors indicating distress.

Older Adults

• Injury Prevention Focus:
    - Falls are crucial hazards; awareness and prevention strategies are essential.
    - Importance of fire safety and medication safety.
    - Mental Health Monitoring:
      - Recognize signs of depression that may lead to suicide.

Safety Problems Across the Lifespan

• Major Concerns:
    - Domestic violence, child abuse, intimate partner abuse, and elder abuse.
    - Nurses should work on prevention, screening for signs of abuse, and making necessary referrals.
    - Aim to restore dignity and promote health and safety for vulnerable individuals.

Assessing for Domestic Violence

• Screening Instrument:
    - E-HITS - Intimate Partner Violence Screening Instrument:
      - Questions regarding physical, emotional, and sexual abuse over the past year, answered on a 5-point Likert scale:
         - 1 = never
         - 2 = rarely
         - 3 = sometimes
         - 4 = fairly often
         - 5 = frequently
      - Score Range:
        - Cutoff for IPV: ≥7

• Manifestations of Child Maltreatment:
    - Physical Abuse:
      - Manifestations include unexplained injuries like bruises, fractures, burns.
    - Sexual Abuse:
      - Symptoms like urinary tract infections, genital pain, difficulty walking.
    - Emotional Abuse:
      - Behaviors harming self-worth; can lead to sleep problems or behavioral extremes.
    - Neglect:
      - Failure to meet basic needs (housing, education, medical care).

Preventing Specific Hazards

• Common Hazards:
    - Falls
    - Scalds and burns
    - Fires
    - Poisoning (Carbon monoxide, suffocation or choking)
    - Excessive noise
    - Electrical hazards
    - Radiation
    - Seizures

Falls: The Facts

• Vulnerable Population:
    - Elderly are most susceptible to falls.
    - Consequences:
      - Increase in likelihood of falls after one occurrence.
      - Falls are the leading cause of injury and hospital admission among adults over 65.
      - About 95% of hip fractures result from falls.

Falls: Risk Factors

• Important Factors:
    - History of falls
    - Polypharmacy
    - Poor balance, gait, and muscle strength
    - Vision impairment
    - Unsafe home environment (e.g., clutter, poor lighting)
    - Unsafe outdoor environment (e.g., uneven surfaces)

Falls: The Nurse’s Role

• Assessment Tools:
    - Use tools to determine fall risk (e.g., Morse Fall Risk Assessment Tool).

• Education Strategies:
    - Encourage regular eye exams.
    - Promote physical activity and modification of home environments.

Fall Risk Assessment Tool Example: Morse Fall Risk Assessment

• Assessment Criteria:
    - Recent history of falls: Yes/No
    - Secondary medical diagnoses: Yes/No
    - Ambulatory aids used: Type
    - Scoring:
      - Low Risk: <25     - Moderate Risk: 25-45     - High Risk: >45

Falls: Acute Care Settings

• Root Causes:
    - Inadequate staff communication
    - Incomplete orientation and training
    - Incomplete patient assessment and reassessment
    - Environmental issues and unsafe culture

Falls: Nursing Homes

• Incidence Rates:
    - High rates of falls, particularly during transfers.
    - Risk factors include cognitive issues and orthostatic hypotension.

Falls: Prevention in Healthcare Settings

• Priority Actions:
    - Conduct a comprehensive falls risk assessment.
    - Patient orientation to the environment.
    - Provide easy access to call bells and bedside necessities.

Restraints

• Definition:
    - Device used to immobilize patient or extremity for safety and behavior control.
    - Should always prioritize the least restrictive options.

Restraint Types

• Types Used:
    - Adults: bed rails, mitts, limb restraints.
    - Children: elbow restraints, crib nets.

Physiologic Hazards Associated with Restraints

• Associated Risks:
    - Increased injury risk from falls
    - Skin breakdown
    - Contractures
    - Increase in depression and anxiety
    - Potential for aspiration and respiratory difficulties

Legal Implications of Restraint Use

• Criteria:
    - Requires provider's order specifying type and rationale, renewed every 24 hours.
    - Documentation and patient education are required.

Restraint Use Guidelines

• Best Practices:
    - Monitor frequently (at least hourly) for health maintenance.
    - Allow for regular movement and elimination.

Alternatives to Restraints

• Intervention Strategies:
    - Involve family in care.
    - Identify causes of agitation.
    - Distract or redirect.
    - Address pain management and environmental stimuli.

Falls: Electronic Devices

• Technological Aids:
    - Bed alarms and monitoring devices.

Scalds and Burns

• Common Hazards:
    - Safety regarding cooking appliances and bathing temperatures.

Agency Fires

• Fire Response Protocol:
    - RACE: Rescue, Activate (alarm), Confine, Extinguish.
    - PASS: Pull, Aim, Squeeze, Sweep.

Home Fire Safety

• Preventative Measures:
    - Emergency numbers accessible, functioning smoke detectors, practice family fire drills.

Poisoning

• Definition:
    - Ingestion or exposure to harmful substances.
    - Types: solid, liquid, gas, aerosol.

Poison Prevention Strategies

• Prevention Tactics:
    - Store toxic substances securely and educate family about dangers.
    - Have poison control center information readily available.

Poisoning Response Procedure

• Immediate Actions:
    - Stay calm, identify poison, contact poison control with detailed information.

Suffocation or Choking

• Response Education:
    - Teach universal sign for choking and Heimlich maneuver.

Excessive Noise

• Impact of Noise:
    - Mitigate noise in healthcare settings, protect hearing abilities.

Electrical Hazards in Healthcare Settings

• Safety Practices:
    - Regular checks on equipment, maintain grounded electricity.

Firearms

• Safety Protocols:
    - Secure storage of firearms and educating children on their dangers.

Radiation

• Protection Measures:
    - Limit exposure time and maintain safe distance; utilize protective gear.

Seizure Precautions

• Types:
    - Partial: originate in one area.
    - Generalized: affect entire brain.

• Nursing Actions During Seizures:
    - Provide safety and support, document duration and interventions.

Disaster Planning

• Preparedness Strategy:
    - Understand the chain of command and have predefined roles and communication strategies for emergencies.

Bioterrorism

• Definition:
    - Deliberate release of pathogens to instigate widespread illness and panic in a community.

• Preparedness and Awareness:
    - Nurses should be informed on procedures and responses to potential bioterrorism threats.