Patient Safety and Quality by Erin Bates-Meehan

Environment = Physical/Psychosocial Factors Across Various Settings ( ex. community, home, hospital, school, etc.)
1. SAFE ENVIRONMENT=Reduced hazards & transmission of pathogens, controlled pollution, maintained sanitation & basic needs met
  1. BASIC NEEDS (Maslow)
    1. OXYGEN (Assess Risk: Smoking, Functioning Heat/Co2 Monitor)
      1. 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
  2. PHYSICAL HAZARDS (Nurse Role=Education&Prevention)
    1. MVA (seatbelt, airbag, helmet law)
      1. 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.)
  3. TRANSMISSION OF PATHOGENS
    1. #1 means of transmission = Hands
      1. 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
      2. Fecal-Oral Route
        Medical/Surgical Asepsis
        Ensure proper disposal of human waste
  4. Identify Relevant Nursing Diagnoses Assoc. W/ Safety Risks (p.382)
    1. Risk for falls
      1. Risk for Injury
        Deficient Knowledge
        Risk for Trauma
Risks/Interventions per Developmental Stages
1. Infant,Toddler,Preschooler
  1. #1 RISK = Injury (<5 =greatest risk of serious home injury
    1. Oral Activity=choking/Poisoning
      1. Limited Coordination=Falls(bike, playground equip)
    2. Exploring=drowning
    3. INTERVENTION
      1. Educate Parents: Immunizations, Home Safety, Incorp Safety into Care Plan
2. School Age Child
  1. Risks
    1. Head Injury
      1. Contact Sports
  2. Intervention
    1. Helmet/Seat belt
      1. Safe Play/Proper Equipment
3. Adolescent
  1. Risky Behavior
    1. Peer Infuence
      1. Substance Abuse
        Suicide
        Highest rate of MVA
  2. INTERVENTION
    1. Assess for psychosocial clues
      1. Provide examples/Set expectations
        Environmental clues
        Awareness of risks
        Educate no Cell/Text/Seatbelt
4. Adults
  1. Risks
    1. Lifestyle Habits
      1. Stress/Smoking
  2. Interventions
    1. refer to resources
      1. Encourage lifestyle changes
5. Older Adult
  1. Risks
    1. decreased independence
      1. falls/accidents
      2. wandering
      3. physiological changes d/t aging process
      4. multiple meds
  2. Interventions
    1. Provide resources on maintaining independence
      1. Educate on safe driving
        prevent burns/scalding
        reduce pedestrian accidents
Pt. Safety = Serious National Health Care Challenge
1. Individual Risk Factors
  1. Lifestyle
    1. Impaired Mobility
      1. Sensory/Communication Deficit
        Lack of Saftey Awareness
  2. 4 Categories of Risks in Health Care Agency
    1. Falls (Assess Risks/Know Interventions)
      1. 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
    2. SAFE HEALTH CARE ENVIRONMENT
      1. Reduced injury risk (including falls)
        Reduced Patient Inherent and Procedure/Equipment Related Accidents
QSEN:Quality & Safety Education For Nurses
1. Minimize risk of harm to patients/providers thru system effectiveness & individual performance
  1. Critical Thinking/Nursing Process
    1. Assess Patient and Environmental hazards
      1. Plan and Intervene as Necessary to Maintain Safety
Factors to Assess re: USE OF RESTRAINTS
1. Last Resort when patient behavior = risk of injury (self/others)
  1. What to try first/Possible Alternatives
    1. 1. Sensory Stimulation
        Frequent Reorientation
        More Frequent Observations
        electronic devices
        Posey Bed
  2. Or prevent interruption of therapy/life support equipment
2. Temporary and for safety only
  1. Physical
    1. Device to immobilize or reduce ability of movement
    2. Chemical
      1. 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
Assessment Activities Pertaining to Safety
1. Physical
  1. (Fall Risk) Observe gait, balance
  2. Psychosocial
    1. (Fall Risk) Assess adequate lighting, clutter in hallways
    2. Cognitive
      1. (Fall Risk) Assess Visual Acuity/Ability To Read

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Patient Safety and Quality by Erin Bates-Meehan

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	Created by Erin Bates-Meehan over 6 years ago