Healthcare Safety Principles

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Questions and Answers

What is a primary factor contributing to increased falls in the elderly?

Reduced vision (correct)

Increased muscle strength

Stable gait

Improved balance

Which of the following best defines patient safety in healthcare?

Efficiency in healthcare delivery

Keeping patients comfortable during procedures

Providing all necessary treatments to patients

Freedom from psychological and physical injury (correct)

What role does a blame-free environment play in a culture of safety in healthcare?

Assigns punishment for mistakes

Facilitates open reporting of errors without fear (correct)

Limits communication about safety issues

Encourages competitive practices among staff

What is one way nurses can help manage safety risks in patient's homes?

Implementing safety devices to prevent falls Signup and view all the answers

Which of the following factors should be assessed before placing a patient in physical restraints?

Patient's psychosocial status Signup and view all the answers

What is a common consequence of poor vision in individuals with IDD?

Increased risk of falling Signup and view all the answers

Which medication-related issue could contribute to falls in individuals with IDD?

Sedation and blood pressure drops Signup and view all the answers

Which of the following environmental changes could help prevent falls in individuals with IDD?

Installing grab bars and railings Signup and view all the answers

What health condition may lead to an increased risk of falls due to dizziness?

Meniere's disease Signup and view all the answers

Which age group is at the greatest risk for home accidents leading to severe injury or death?

Younger than 5 years Signup and view all the answers

What is a serious reportable event (SRE)?

An event that leads to negative patient outcomes and should never occur. Signup and view all the answers

Which of the following is classified as a 'never event'?

Retention of a foreign object in a patient after surgery. Signup and view all the answers

Why does CMS deny hospitals higher payments related to 'never events'?

To encourage hospitals to improve patient safety and care quality. Signup and view all the answers

What is one example of a patient protection event?

Patient death associated with elopement for more than four hours. Signup and view all the answers

Which event is NOT considered a 'never event' according to the current NQF list?

Patient allergic reaction to a medication. Signup and view all the answers

Study Notes

Safety Defined

Freedom from psychological and physical injury
Basic human need
Patient Safety - prevention of errors and adverse effects associated with health care

Culture of Safety in Healthcare

High-risk nature of activities and the determination to achieve consistently safe operations
Blame-free environment for error reporting
Encouragement of Collaboration
Commitment of resources to address safety concerns

Why is Safety Important in HealthCare Settings

Reduces the incidence of illness and injury
Prevents extended length of stay
Improves or maintains functional status
Increases patient's sense of well-being
Contains the cost of healthcare

Falls

Leading cause of unintentional death in adults 65+
Factors that contribute to falls in older adults:
- Reduced vision
- Orthostatic hypotension
- Lower extremity weakness
- Gait and balance problems
- Urinary incontinence
- Improper use of walking aids
- Effects of various medications
Other fall hazards:
- Improper lighting
- Obstacles in walking paths (rugs, cords)
- Spills on floors
- Lack of safety devices in the home

Causes of Falling in People with IDD

Individuals with IDD are at high risk for falls
Factors that contribute to falls in people with IDD:
- Arthritis - Pain may not be expressed verbally, but may be causing difficulty in ambulation.
- Seizures - Can present in several ways including increased falls.
- Medications - Can be sedating; cause blood pressure to drop, or affect balance and increase risk of falling.
- Vision - Poor vision may not be verbally expressed but can cause falling if people are less able to see obstructions.
- Dehydration - may cause orthostatic hypotension, causing a falls
- Hypoglycemia - when blood sugar drops they are at increased risk for fall, may not be able to express what they are feeling.
- Infection - severe infections (sepsis) can increase risk of falls.
- Brain conditions: brain tumor, Multiple sclerosis, parkinsons, strokes...
- Ear related conditions: meniere's disease, vertigo can cause dizziness
- Unfamiliar Environments: May cause confusion, and increase incidence of falls

Preventing Falls in People with IDD

Review medications that could be contributing.
Assessing for reversible health conditions.
Assessment for proper, well fitting shoes.
Removing hazards like cords, small tables, loose rugs, clutter and spills.
Providing adequate lighting.
Installing grab bars and railings.
Using assistive devices when necessary.

Safety Risk by Developmental Age

Younger than 5 years: At greatest risk for home accidents that result in severe injury & death.
School-aged child: At risk at school and transporting back and forth to school. Start participating in team and contact sports. Use of protective equipment: helmets. Instruct use of seatbelts.
Adolescent: Greater independence. Begin to develop a sense of identity. Peer pressure. Engage in risk taking activity: alcohol, drugs, smoking. Teen driving. Sexually active. Suicide.
Adult: Lifestyle habits: smoking, drinking, driving under influence. Hazards at work. Stress from work and family, juggling many roles. Headaches, GI upset.
Older Patient: Psychological and physiological effects. Dementia. Falling eyesight and hearing. Fear of falling.

Serious Reportable Events (SRES)

Incident report is a confidential document that describes patient accidents that occur on the premises of a health care agency.
Allow an organization to identify trends & patterns throughout the facility & areas for improvement.

"Never Events"

CMS Centers for Medicare & Medicaid Services named select serious reportable events (SRES) as "Never Events".
These are adverse events that should never occur in a healthcare setting.
CMS denies hospitals higher payments resulting from or complicated by a "never event".
Many hospital-acquired conditions are NURSE Sensitive indicators.

Current NQF List of "Never Events"

Surgical Events
- Surgery performed on the wrong body part
- Surgery performed on the wrong patient
- Wrong surgical procedure on a patient
- Retention of a foreign object in a patient after surgery or other procedure
- Intraoperative or immediately post-operative death in a normal health patient (defined as a Class 1 patient for purposes of the American Society of Anesthesiologists patient safety initiative.
Product or Device Event
- Patient death or serious disability associated with the use of contaminated devices, or biologics provided by the healthcare facility.
- Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended (injecting air).
- Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility.
Patient Protection Event
- Discharge or release of patient of any age who is unable to make decisions to anyone other than an authorized person.
- Patient death or serious disability associated with patient elopement (disappearance) for more than four hours.
- Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a healthcare facility.
Care Management Event
- Patient death or serious disability associated:
  - medication error
  - hemolytic reaction due to the administration of ABO-incompatible blood or blood products
  - Maternal and/or neonate death or serious injury associated with labor and delivery in low-risk pregnancy.
  - Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility.
Environmental Event
- Patient death or serious disability associated with an electric shock while being cared for in a healthcare facility.
- Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances.
- Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility.
- Patient death associated with a fall while being cared for in a healthcare facility.
- Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility.
Criminal Event
- Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider.
- Abduction of a patient of any age.
- Sexual assault on a patient within or on the grounds of a healthcare facility.
- Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare facility.

Restraints

Physical restraints: Physical or mechanical devices that immobilize a patient.
Chemical restraints: Medications such as anxiolytics and sedatives used to manage a patient's behavior.
Orders:
- RN may apply restraint based on patient behavior.
- Provider needs to assess patient and order restraint within 1 hour of restraint application.
- Restraint orders expire after 24 hours and cannot be PRN.
Implementation:
- Assess patient every 30 minutes (check circulation).
- Release restraints every 2 hours (check for skin breakdown, perform ROM, assess behavior)
- Use quick-release method (slip knot, clasp) to secure the restraint.
- Never tie restraint to bed rail.
- Discontinue restraints when no longer indicated.

Hazards Associated with Restraints

Immobilization:
- Suffocation from entrapment or strangulation
- Changes in mental status
Impaired circulation:
- Fractures
- Diminished muscle and bone mass
- Altered nutrition and hydration
- Aspiration and breathing difficulties

Alternatives to restraints

Orient patients and families.
Sitters or companions.
Diversionary activities.
Locate near nurses station.
Calm, simple statements and physical cues.
Use de-escalation techniques to manage aggressive behavior.
Provide visual and auditory stimuli.
Promote relaxation techniques and normal sleep patterns.
Institute exercise and ambulation schedules.
Attend frequently to toileting, food, and liquid.
Hide intravenous lines with clothing, stockinette or kling dressing.
Evaluate all medications patient in receiving and give proper pain management.
Reassess physical status and review lab findings.

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Description

Explore the essential concepts of safety in healthcare settings, focusing on patient safety and fall prevention for older adults. This quiz covers the importance of creating a culture of safety, error reporting, and the impact of safety on health outcomes.