Clinical Judgement & Safety in Nursing

Clinical Judgement in Nursing

• Clinical judgment is essential for nurses to provide safe, patient-centered care.
• It requires informed decisions based on evidence and assessing individual patient needs, and vulnerabilities.
• Integrate critical thinking and clinical judgment effectively to address safety needs in care planning.
• Effective clinical judgment reduces adverse events in healthcare, shown through case studies.
• The Joint Commission emphasizes clinical judgment to maintain a patient-centered safety culture.

Vulnerable Populations and Environmental Hazards

• Children, the elderly, and people with disabilities are at higher risk for safety threats.
• Poor housing and lack of healthcare access worsen these risks.
• The CDC reports unintentional injuries are a leading cause of death in vulnerable groups.
• Nurses are essential in identifying and acting on risk factors.
• Education and community involvement helps lower risk in vulnerable populations.

Common Environmental Hazards and Prevention

• Environmental hazards include motor vehicle accidents, falls, poisoning, and fires.
• Motor vehicle accidents are the primary cause of injury-related deaths; car seat use is critical.
• Falls are the second leading cause of unintentional injury deaths; risk increases with age, mobility issues, and certain environmental factors.
• Poisoning from household substances is a significant risk, especially for children, and safe storage education is essential.
• Fires, often from cooking, require community education on fire safety and preparedness.
• Fall risk assessments and environmental modifications reduce hazards.
• Evidence-based alternatives to restraints are important for alert and oriented patients.
• Regular training for healthcare staff is vital for maintaining safety
• Community drills increase safety awareness.
• Monitoring systems can prevent accidents in healthcare.

Safety Risks Through Development Stages

• Infants and toddlers are highly susceptible to injuries due to exploratory behavior
• School-age children are at risk due to more independence and sports with education on safety rules being essential.
• Adolescents face risks because of peer pressure, leading to more injuries.
• Substance use and stress management represent safety risks for adults.
• Cognitive decline and multiple medications make older adults vulnerable.

Risk Factors and Nursing

• Individual risk considerations include lifestyle, job, and health conditions.
• Delirium, dementia, and depression affect the ability to maintain safety.
• Economic factors and healthcare access are important for safety.
• Nurses should assess patient knowledge to provide specific education.
• PPE and workplace safety cultures can prevent injuries in healthcare.
• Nurses advocate for patient safety, identifying risks and acting preventatively.
• Continuous training in safety protocols is important for nurses patient care
• Working with multiple healthcare providers increases ability to solve compound safety issues
• Engage in root cause analysis to understand and prevent adverse events.
• Effective communication promotes a culture of safety.

Safety Risk Management

• Assess mobility and psychosocial status to identify patients at risk of falls and injuries.
• Fall risk assessments must be standard practice.
• Home safety education must include medication storage and preparedness.
• Consider environmental factors that affect patient safety.
• Regularly update safety protocols based on current evidence and practices.

Groups Driving Patient Safety

• Joint Commission: Accredits healthcare organizations in the U.S. to improve safety and quality of care.
• National Patient Safety Goals: Created by The Joint Commission to improve patient safety, such as reducing infections and ensuring correct identification.
• Speak Up Campaign: Patients are encouraged to be active in healthcare by speaking up and asking questions.
• National Quality Forum: Aims to improve healthcare quality via performance standards.
• Serious Reportable Events: Adverse, preventable events of concern to the public and providers are outlined in Box 27.2.
• "Never Events": Events that should not occur, like wrong-site surgery, are detailed in Box 27.3.
• Centers for Medicare and Medicaid Services (CMS): A federal agency that administers healthcare programs, focusing on quality and safety.
• Healthy People 2030: Aims for data-driven national objectives to improve health, safety, and quality of care.
• Incident Reports and Root Cause Analysis: Identifies causes of adverse events using the '5 whys' technique to foster a culture of reporting without punishment.

Health Agency Safety Risks

• Procedure-related Accidents: Errors during procedures where adherence to protocol helps.
• Medication Errors: Mistakes in prescribing, dispensing, or administering medications.
• Equipment-related Accidents: Incidents involving malfunctioning equipment needing proper training and maintenance.
• Chemical Exposure: Exposure to hazardous substances like in chemotherapy requires Material Safety Data Sheets (MSDS).
• First Aid Guidelines: Essential protocols for medical emergencies ensuring swift and effective action.
• One million falls happen each year, effective action is critical, with ~11,000 resulting in fatalities.
• Falls lead to injuries, and extended stays, increasing healthcare costs.
• Falls affect patients' mental status and confidence.
• Fall Risks include age, mobility issues, and medication side effects as identified in Table 27.1.
• Morse Fall Scale: Assesses patient's fall risk to guide precautions.

Violence in Healthcare

• Violence in healthcare settings, from verbal abuse to physical assault is a significant issue.
• Incivility from patients, visitors, and coworkers highlights the need for a zero-tolerance policy.
• Physical assaults include hitting, biting, or shoving, posing risks to workers.
• Workplace violence is not part of the job, implement training and reporting for staff.
• Reporting incidents and support for workers are musts for a safe environment.
• Critical thinking is essential for nursing to ensure high-quality patient care.
• Involves analyzing data to create a comprehensive understanding of patients' needs.
• Nurses assess situations and make informed decisions for patient care.

Critical Thinking

• Critical thinking helps discover the underlying issue
• Since the 1980s, greater emphasis on critical thinking in response to patient complexity.
• Collaboration fosters better patient outcome.
• Use nursing process assessment, diagnosis, and implementation to employ critical thinking.
• Assess the patient and the surrounding enviornment.
• Recognize psychosocial factors.

The Nursing Process and Patient Safety

• Patient-centered communication emphasizes what safety means to them.
• Continuous adaptation utilizing patient feedback yields positive results.
• Nursing process includes patient history, exam, and environmental factors.
• Example: Assessing home access may prevent falls.
• Use interpreting services and cultural competence to improve engagement.
• Key components include identifying potential risks and evaluating mobility.
• Diagnosis will lead to appropriate nursing diagnoses.
• Common nursing diagnoses related to include 'Risk for Falls', 'Risk for Injury', and 'Deficient Knowledge'.
• Example: A patient that may be diagnosed with 'Risk for Falls' from impaired mobility.
• Set SMART goals in the planning phase to enhance patient safety and health outcomes.
• Communication through SBAR strengthens planning.
• Developmental interventions are age specific.
• Implement general preventive measures for home safety.

Evaluations and Measuring Effectiveness

• Evaluate the effectiveness of implementation through feedback assessment.
• Continuous improvement is integral to improving patient safety.
• Continuous learning is essential to best incorporate practices and safety protocols
• Collaboration amongst healthcare teams ensures growth of safety and knowledge

Chemical Medications

• Chemical medications such as benzodiazepines are used for sedative/ anxiolytic properties in health care
• Overperscribing medications can lead to death and complication
• Frequent assessments, 15 mins for violent and 2 hrs for non-violent patients
• Closely monitor vitals and skin integrity
• Only use restraints when necessary to prevent further harm
• Remove as soon as possible

Safety Protocols

• Review restraints every 4 hours for adults, 2 for 9-17 year olds and 1 hour for under 9
• Fire Safety measures
• PASS, Pull, Aim, Squeeze, Sweep is essential for using extinguishers
• RACE stands for, Rescue, Alarm, Confine, Extinguish to outline what to do in case of fire
• Electrical safety measures, look for inspections
• Maintain patients if they're at risk for a seizure.

Emergency Preparedness and Violence Prevention

• Have disaster preparedness drills to support influxes in patients
• Use standard precautions to prevent spread of diseases
• Prevent workplace violence by being mindful and respectful of space

Evaluating Patients

• Base the evaluation on their comfort
• Use continuous assessment and assessment to determine and provide better intervention
• Safety risks during patient transfers.