RCP 100 Ch 3: Safety and Communication

Patient Safety Continuum

• Includes respiratory therapists and the health care team, safety considerations, communication, and recordkeeping.

Safety Considerations: Patient Movement & Ambulation

• Good posture minimizes risk of injury when moving patients or heavy equipment.
• Respiratory therapists should use their legs with a straight spine to lift patients and heavy objects.

Ambulation Benefits

• Extended bed rest can lead to new medical problems, such as atelectasis.
• Ambulation (walking) helps restore and maintain normal body function.
• Ambulation should begin as soon as the patient is stable and free from severe pain.
• Ambulation can reduce the length of hospital stay.

Electrical Safety: Fundamentals

• Electricity moves from point A to point B due to differences in voltage.
• Voltage is the power behind electrical energy.
• Most homes and hospitals are powered with 120-V power sources.
• Objects with high resistance (e.g., rubber tubing) allow minimal or no current to flow.
• Current represents the greatest danger when electrical shorts occur.
• Current is reported in amperes, and resistance is reported in ohms.
• Harmful effects of current depend on the amount flowing through the body, its path, and duration.
• High currents passing through the chest can cause ventricular fibrillation, diaphragm dysfunction, and death.
• Most shock hazards are caused by inadequate grounding.
• All electrical equipment should be connected to grounded outlets with three-wire cords.
• All electrical equipment used for patient care must be checked by a qualified expert on a regular basis.

Fire Hazards

• Fires in oxygen-enriched atmospheres (OEAs) are larger, more intense, faster burning, and more difficult to extinguish.
• Hospital fires are more serious because the evacuation of critically ill patients is difficult.
• Most hospital fires start in the kitchen.
• About 15% of hospital fires occur in patient care areas and are often related to smoking.
• Hospital fires approximately cause $9 million in damage.
• Fires in patient care areas where oxygen is being used are especially dangerous.
• Three conditions must exist for a fire to start: flammable material, oxygen, and heat above ignition temperature.
• Oxygen is not flammable, but it can greatly accelerate the rate of combustion.
• Flammable material should be removed from the vicinity of oxygen use.
• Ignition sources, such as cigarette lighters, should not be allowed in rooms where oxygen is in use.
• Children should not play with toys that may create a spark when oxygen is in use.
• PASS is an acronym used during fire extinguisher training:
  • P - pull pin
  • A - aim nozzle at base
  • S - squeeze handle
  • S - sweep nozzle across base of fire
• RACE is the core fire plan acronym:
  • R - Rescue patients in immediate area of fire
  • A - Alert other personnel to fire
  • C - Contain the fire; shut doors to prevent spreading of fire
  • E - Evacuate other patients & personnel

General Safety Guidelines

• The direct patient environment should be free of impediments to care and potential fall risks.
• Respiratory Therapists have the responsibility to position equipment, tubing, and treatments out of the way of potential risk.
• Disaster preparedness includes transport and transfer of critically ill patients and preparation for loss of electricity.
• In Magnetic Resonance Imaging (MRI) suites, no metal components or objects are allowed.
• MRI compatible ventilators, oxygen supplies, and ancillary equipment must be used.
• Medical gas cylinders must be properly stored and handled to prevent fire risk and explosive release of high pressure cylinders.
• The National Fire Protection Association (NFPA) regulates the storage of medical gases.
• The Joint Commission (TJC) monitors hospitals and is a hospital accrediting organization.

Effective Communication Skills

• Communication is a complex and dynamic process at the heart of all human interaction.
• Effective communication is of utmost importance.
• Five Cs of Communication: Complete, Clear, Concise, Courteous, and Cohesive

Effective Communication: The Case

• Approximately, 44,000 patients experience a medical mistake or misadventure every year in the U.S.
• Medical mistakes are the 8th leading cause of death in the United States.
• Incomplete messages and incomplete facts can have potentially serious consequences.
• Observe the entire message and monitor your emotions before jumping to conclusions.
• Familiarity with medical language and commonly used medical expressions is essential.
• Care, diligence, and attention to detail are required when communicating with students from different cultures.
• Efforts must be made to enhance understanding of language and cultural norms.
• There is little margin for error when communicating the use and misuse of medication.

Communication in Health Care

• Success as an RT depends on the ability to communicate well with patients and other members of the team.
• Effective communication is the most important aspect of safe patient care.
• TJC's goals for 2018, improve:
  • Accuracy of patient identification
  • Communication of critical test values among caregivers
  • Should include "Read-back" scenario verifying accurate for reporting & recording of test values
• All healthcare personnel must use at least "two patient identifiers" before initiating care, including:
  • Patient name
  • Birth date
  • Medical record number
• Share information as opposed to simply telling it.
• Relate to people rather than attempting to control them.
• Value disagreement as much as you value agreement.
• Use effective nonverbal communication techniques.

The Practitioner as Listener

• Work at being a good listener.
• Stop talking; avoid interrupting the speaker.
• Resist distractions; tune them out.
• Keep your mind open; be objective.
• Hear the speaker out before making evaluations.
• Maintain composure; control emotions.

Improving Communication: Feedback

• Includes use of gestures and confirming remarks by attending.
• Paraphrasing: repeating others' responses using your own words.
• Request clarification if needed to ensure you understand; should be nonjudgmental in nature.
• Perception checking: done by confirming or disproving more subtle components of communication interaction.
• Reflecting feelings: provide opportunity for patients to express & reflect on their emotions.

Factors Affecting Communication

• Major Categories: Environmental, Emotional and sensory, Verbal expressions, Nonverbal cues, Internal or intrapersonal, Physical appearance and status.
• Environmental Factors include lighting, noise, climate, formality, familiarity and architecture.
• Sensory and Emotional Factors affecting communication are fear, stress, anxiety and pain.

Factors Affecting Communication: Verbal Expressions

• Include proper language/jargon.
• Use correct Choice of words or questions.
• Use correct Voice tone and quality.

Other Factors Affecting Communication

• Nonverbal cues are a form of communication without words which include body motion (kinesics).
• The use and interpretation of space (proxemics), the use of sounds (paralinguistics), and touch are also factors.
• Intrapersonal factors within the individual that affect communication and that make up the person's constitution affect communication.
• Physical Appearance and Status factors include gender, race, body and dress.

Basic Goals and Purpose of Communication from Sender's perspective

• Understanding
• Action
• Information
• Comfort

Recording Keeping Information

• The Medical record or chart provides written statements of occurrences pertaining to the patient.
• Medical records are strictly confidential & are protected under Health Insurance & Portability Act (HIPPA).
• Patient records include confidential health insurance or billing information.
• Records represent a legal document & could be used in court.

Recording Keeping details

• The federal government would like all medical recordkeeping done electronically by 2014 through the use of the electronic medical record
• Electronic medical record (EMR) is new way practitioners can document care
• Record keeping is major significant duty you perform

General Rules for Record Keeping

• Entries should be printed or handwritten.
• Do not use "ditto” marks
• Do not erase Draw a line through it and initial.
• Record each patient interaction & sign entry.
• Document patient complaints.
• Do not leave blank lines.
• Use standard abbreviations only.
• Use present tense.
• Use proper spelling
• Document all-important conversations.
• Be accurate.

Problem-Oriented Medical Record

• POMR is a documentation format used by some health care institutions.
• POMR contains 4 basic parts:
  • Database
  • Problem list
  • Plan
  • Progress notes
• POMR progress notes use the SOAP format:
  • S = Subjective (patient's complaints)
  • O = Objective (results of physical exam, lab tests, ABGs, chest radiograph, etc.)
  • A = Assessment (What is problem?)
  • P = Plan (How is problem to be treated?)

General Sections Found in a Patient Medical Record

• Admission data: Records pertinent patient information.
• History and physical examination: Records the patient's admitting history and physical examination.
• Health maintenance and immunizations: Dates of administration.
• Physician's orders: Records the physician's orders and prescriptions.
• Progress notes: Keeps a continuing account of the patient's progress.
• Nurses' notes: Describes the nursing care given to the patient.
• Medication record: Notes drugs and IV fluids given to the patient.
• Allergies: Notes reaction, severity, type, and date noted.
• Vital signs flowsheet: Records the patient's temperature, BP, pulse, and respirations.
• I/O sheet: Records patient's fluid intake (I) and output (0) over time.
• Laboratory results: Summarizes the results of laboratory tests.
• Consultation note: Records notes by consulting physicians to diagnose patients.
• Surgical or treatment consent: Authorization for surgery or treatment.
• Anesthesia and surgical record: Notes key events before, during, and immediately after surgery.
• Specialized therapy records and progress notes: Specialized treatments or treatment plans.
• Specialized flow data: Made over time during specialized procedures.
• Advanced directives: Regarding living wills, power of attorney, and do not resuscitate orders.
• Each health care facility has its own specifications for keeping medical records.
• Documentation flow sheets briefly report data and reduce documentation time.
• Use standardized terms and abbreviations and follow the "Do Not Use” abbreviation list established by TJC to reduce potential errors