Patient Safety and Quality by Erin Bates-Meehan

Patient Safety and Quality by Erin Bates-Meehan

1. Environment = Physical/Psychosocial Factors Across Various Settings ( ex. community, home, hospital, school, etc.)

   • SAFE ENVIRONMENT=Reduced hazards & transmission of pathogens, controlled pollution, maintained sanitation & basic needs met
     • BASIC NEEDS (Maslow)
       • OXYGEN (Assess Risk: Smoking, Functioning Heat/Co2 Monitor)
         • NUTRITION (FDA Regulates@Risk FoodBorne Illness=Peds, Pregnancy, Elderly, Immunocompromised/Poor sanitation, storage)
           • TEMP (WNL= 18.3-23.9C @Risk Hypothermia=peds, elderly, homeless, excess ETOH/drug, Cardiovascular Cond./@Risk Hyperthermia=infant, elderly, chronic ill
           • Safety = adequate food sanitization
     • PHYSICAL HAZARDS (Nurse Role=Education&Prevention)
       • MVA (seatbelt, airbag, helmet law)
         • POISON (lock cleaning solutions, know poison control number)
           • FALLS(adequate light, clear clutter, remove loose rugs, secure home)*
             • DISASTERS (flood, hurricane, bioterrorism)
               • FIRE (smoke and CO2 detectors, fire extinguishers, new/safe space heaters)
                 • POLLUTION (Contaminated water, air, soil, noise-if H2O polluted, drink bottled, etc.)
     • TRANSMISSION OF PATHOGENS
       • #1 means of transmission = Hands
         • Good Hand Hygiene Essential!!
           • Always - Educate Family
             • Blood/Body Fluid
               • High Risk Behavior (HIV Hep C)
                 • Needle Exchange Programs
                   • IMMUNIZATION (Reduce and prevent transmission of disease)
                     • Nurse Role-Educate Parents
         • Fecal-Oral Route
           • Medical/Surgical Asepsis
           • Ensure proper disposal of human waste
     • Identify Relevant Nursing Diagnoses Assoc. W/ Safety Risks (p.382)
       • Risk for falls
         • Risk for Injury
           • Deficient Knowledge
             • Risk for Trauma

2. Risks/Interventions per Developmental Stages

   • Infant,Toddler,Preschooler
     • #1 RISK = Injury (<5 =greatest risk of serious home injury
       • Oral Activity=choking/Poisoning
         • Limited Coordination=Falls(bike, playground equip)
       • Exploring=drowning
       • INTERVENTION
         • Educate Parents: Immunizations, Home Safety, Incorp Safety into Care Plan
   • School Age Child
     • Risks
       • Head Injury
         • Contact Sports
     • Intervention
       • Helmet/Seat belt
         • Safe Play/Proper Equipment
   • Adolescent
     • Risky Behavior
       • Peer Infuence
         • Substance Abuse
           • Suicide
             • Highest rate of MVA
     • INTERVENTION
       • Assess for psychosocial clues
         • Provide examples/Set expectations
           • Environmental clues
             • Awareness of risks
               • Educate no Cell/Text/Seatbelt
   • Adults
     • Risks
       • Lifestyle Habits
         • Stress/Smoking
     • Interventions
       • refer to resources
         • Encourage lifestyle changes
   • Older Adult
     • Risks
       • decreased independence
         • falls/accidents
         • wandering
         • physiological changes d/t aging process
         • multiple meds
     • Interventions
       • Provide resources on maintaining independence
         • Educate on safe driving
           • prevent burns/scalding
             • reduce pedestrian accidents

3. Pt. Safety = Serious National Health Care Challenge

   • Individual Risk Factors
     • Lifestyle
       • Impaired Mobility
         • Sensory/Communication Deficit
           • Lack of Saftey Awareness
     • 4 Categories of Risks in Health Care Agency
       • Falls (Assess Risks/Know Interventions)
         • Pt. Inherent Accidents
           • 1 Common Cause=Seizure
             • Seizure Precautions
               • protect from injury
                 • position on side for ventilation and drainage of secretions
                   • provide privacy/support after
             • POSSIBLE PREVENTION
               • Some Patients have an AURA
                 • bright light, smell, taste
                   • warning of oncoming seizure
           • Procedure-Related Accidents
             • 1 example=Medication Error
               • PREVENTABLE!
             • Equipment-Related Accidents
               • Malfunction, misuse, disrepair, electrical hazard
                 • Tag Faulty Equipment-Always Get Proper Instruction On Use
                   • Sticker w/Expiration date is SAFE (Biomedical has inspected)
             • Safety Includes Staff
               • Know protocol re: working with radiation, etc
                 • wear appropriate devices
       • SAFE HEALTH CARE ENVIRONMENT
         • Reduced injury risk (including falls)
           • Reduced Patient Inherent and Procedure/Equipment Related Accidents

4. QSEN:Quality & Safety Education For Nurses

   • Minimize risk of harm to patients/providers thru system effectiveness & individual performance
     • Critical Thinking/Nursing Process
       • Assess Patient and Environmental hazards
         • Plan and Intervene as Necessary to Maintain Safety

5. Factors to Assess re: USE OF RESTRAINTS

   • Last Resort when patient behavior = risk of injury (self/others)
     • What to try first/Possible Alternatives
       • • Sensory Stimulation
           • Frequent Reorientation
             • More Frequent Observations
               • electronic devices
                 • Posey Bed
     • Or prevent interruption of therapy/life support equipment
   • Temporary and for safety only
     • Physical
       • Device to immobilize or reduce ability of movement
       • Chemical
         • Medication to manage behavior (not standard for condition)
           • Optimal Goal=Restraint Free Environment
             • COMPLICATIONS
               • Pressure Ulcers, Pneumonia, constipation, incontinence, humiliation, agitation, EVEN DEATH d/t restricted breathing/circulation
                 • If/When Restraints Used
                   • Get informed consent
                     • Educate patient/family
                       • MD order required
                         • Know agency specific legal policy
                         • Current (No PRN)
                           • Type, location, duration, circumstances
                         • Hospital = 8 hour renewal/adults
                           • 2 hours/age 9-17
                             • 1 hour/under 9 y/o
                   • Face-to-face assessment
                 • Use Care w/ side rails- (can be considered restraint

6. Assessment Activities Pertaining to Safety

   • Physical
     • (Fall Risk) Observe gait, balance
     • Psychosocial
       • (Fall Risk) Assess adequate lighting, clutter in hallways
       • Cognitive
         • (Fall Risk) Assess Visual Acuity/Ability To Read