ATI: SAFETY
National Patient Safety Goals (NPSGs)
The Joint Commission (TJC) establishes annual goals to improve client safety and clinical outcomes.
Identify Clients Correctly
Use at least two client identifiers (e.g., name, date of birth, hospital number, telephone number).
Verify identity before medications, treatments, and procedures.
Safety Implementation: Use barcode scanning; never use the client’s room number.
Improve Staff Communication
Promptly report Critical Results: Laboratory or diagnostic findings outside expected ranges that are life-threatening (e.g., Sodium level of 120mEq/L; reference range is 135135 to 145mEq/L145mEq/L).
Requirements: Defined reporting timeframes, direct communication to providers (no voicemail), and written documentation.
Use Medications Safely
Labeling: All medications/solutions in syringes and containers must be labeled, especially in procedural areas.
Anticoagulants: (e.g., warfarin, heparin) Require strict monitoring of weight, renal/hepatic labs, and food-drug interactions.
Medication Reconciliation: Compare home meds with new prescriptions during admission, transfer, and discharge.
Alarm Safety
Manage clinical alarms (e.g., bed alarms, IV pumps) to prevent Alarm Fatigue, where staff become desensitized to noise, increasing the risk of missed emergent events.
Hospital-Acquired Infections (HAIs) and Injuries
Infection Types:
CLABSI: Central line-associated bloodstream infection.
CAUTI: Catheter-associated urinary tract infection.
SSI: Surgical-site infection.
VAP: Ventilator-associated pneumonia.
Risk Factors: Multidrug-resistant organisms (MDROs) like MRSA, VRE, and C. diff.
Prevention: Hand hygiene is the single most important intervention.
Medical and Behavioral Risks to Safety
Safety-Limiting Disorders
Medical Conditions: Stroke, Multiple Sclerosis, Parkinson’s disease, and frailty increase fall and injury risks.
Behavioral/Mental Health: Schizophrenia, personality disorders, and substance use disorders complication care.
Disabilities:
Vision: Cataracts or decreased acuity hinder navigation.
Communication: Hearing impairments or aphasia triple the likelihood of adverse events.
Cognitive: Dementia, Alzheimer’s, or intellectual impairments lead to impulsive behaviors.
Suicide Prevention
Screen all clients aged ≥12≥12 years admitted for behavioral conditions.
Implement round-the-clock surveillance and remove environmental hazards (checklists) for those at risk.
Surgical Safety: Universal Protocol
Time-Out: A pause before surgery to confirm correct client, site, and procedure.
Site Marking: The surgeon must mark the site if there are multiple options (e.g., right vs. left breast), unless the area is delicate (e.g., premature infant).
Environmental Safety and Fire Response
Home Hazard Interventions:
Set water heaters to 49∘C49∘C (120∘F120∘F).
Install grab bars, non-slip mats, and GCFIs in bathrooms/kitchens.
Secure electrical cords; remove loose rugs.
Fire Safety (Facility):
R.A.C.E.: Rescue, Alarm, Contain, Extinguish.
P.A.S.S.: Pull pin, Aim at base, Squeeze handle, Sweep side-to-side.
Fire Extinguisher Classes:
Class A: Wood, paper, plastic.
Class B: Liquids, grease, oils.
Class C: Electrical fires.
Class K: Kitchen oils/fats.
Mass Casualty and Exposure
Radiation:
Alpha: Low risk, low penetration.
Beta: Moderate risk, small distance.
Gamma: Most serious; requires lead shielding for protection.
Intervention: Decontamination (showering, scrubbing skin, discarding clothing), and administration of Potassium Iodide to protect the thyroid.
Biological/Chemical: Immediate skin scrubbing, eye irrigation, and double-bagging of contaminated clothing.
Physical Restraints
Guidelines: Used only as a last resort; requires a provider prescription (re-evaluated every 2424 hours).
Monitoring:
Remove restraints every 2 hours for skin/circulatory checks and Range of Motion (ROM).
Ensure a quick-release knot is used and tied to the bed frame (not the side rail)