Nurse's Role: Patient Safety and Error Prevention

Nurse Responsibilities for Patient Safety

• Nurses play a crucial role in fostering a culture of safety in healthcare settings.
• Nurse staffing levels, resource availability, and management responsiveness are critical factors in ensuring patient safety.
• Spending more time at the bedside allows nurses to reduce adverse outcomes like falls, HAIs, and medication errors.
• Transforming Care at the Bedside plan aims to have nurses spend 70% of their time in direct client care.

Quality and Safety Education for Nurses (QSEN)

• QSEN prepares nurses with the necessary knowledge, skills, and attitudes to improve healthcare quality and safety.
• Key components of QSEN include patient-centered care, teamwork, evidence-based practice, quality improvement, safety, and informatics.

Root-Cause-Analysis (RCA) and Event Reporting

• RCA is a review process used to investigate potential or actual errors to prevent future occurrences.
• RCA determines whether human error or system failure caused the error and establishes a corrective action plan.
• Errors are reviewed to determine the cause, and a corrective action plan is implemented to address the problem or system error.
• Event/occurrence reporting is used to track near misses or actual events and intended as an investigational tool to prevent future occurrences; it is not punitive.
• Occurrence reports are for internal use only and should never be referenced in the client's Electronic Health Record (EHR).
• Occurrence report information includes persons involved, witnesses, problems/systems involved, and outcomes.
• Barriers to event reporting include fear of repercussions, lack of time, unclear policies and standards, bullying, and insufficient education.

Creating a Culture of Safety

• Focus is on what went wrong, not who to blame.
• A culture of safety is needed to address errors and prevent their recurrence.
• Continuous monitoring detects clinical deterioration, errors, or near misses.

Key Areas for Patient Safety

• Six rights of medication administration: right patient, drug, dose, route, time, and documentation.
• Implement rigorous infection control measures.
• Assess patients for fall risks and take preventive measures.
• Foster open dialogue with patients, families, and healthcare teams.
• Advocate for patient safety by promoting positive practice environments.
• Report adverse events promptly to improve safety systems.
• Work within multidisciplinary teams to coordinate care and reduce risks.
• Recognize signs of burnout and advocate for adequate staffing ratios.
• Stay updated on research findings and incorporate evidence-based practices.
• Follow standardized protocols for patient identification, sharps disposal, and safe handling techniques.

Delegation

• Delegation involves transferring task performance to another team member while retaining accountability.
• RNs supervise the performance of delegated tasks.
• Factors to consider include education/training, facility policies, required critical thinking, competence demonstration, and scope of practice.
• Five rights of delegation: right task, right situation, right worker, right direction and communication, right teaching, supervision, and evaluation.
• Delegation steps: assess and plan, communicate, ensure surveillance and supervision, evaluate and give feedback.
• Delegate when patient is stable, task is within worker’s job description, and planning, teaching and supervision can be provided.
• Don't delegate when thinking, complex assessment, judgment, unpredictable outcomes, increased risk of harm, creativity, or problem-solving are required.

Error Types

• Near miss: A potential error that was caught and avoided.
• Client safety event: An unexpected event that occurred with or without injury.
• Adverse event: A situation that caused unexpected harm to the client.
• Sentinel event (never event): A critical, unexpected event that causes severe harm or death.

Fall Risk Screening

• Fall risk assessment tools include the Fall Risk Assessment Tool (FRAT), Berg Balance Scale (BBS), Fall Risk for Older People in the Community (FROP-Com), sit-to-stand tests, and 4-stage balance test.
• FRAT is a 4-item tool used in sub-acute and residential settings.
• Berg Balance Scale evaluates balance via 14 tasks.
• FROP-Com assesses 13 risk factors in community-dwelling older adults.
• Sit-to-stand tests measure lower limb strength and balance.
• Balance tests evaluate static balance.
• Risk factors for falls include mobility issues, cluttered environments, bad weather, surgeries, cognitive impairment, medications, diseases, age, stroke, assistive device use, and unsafe environments.

Restraints

• Restraints limit a client’s movement and are used as a last resort.
• Types of restraints: belt, elbow, limb, and mitt.

Age-Related Safety Concerns

• In the home setting: address tripping hazards, lighting, medication safety, and emergency preparedness.
• Store medications safely and clearly labeled to encourage adherence.
• In the clinical setting: conduct fall risk assessments, manage polypharmacy, and consider frailty.
• Engage patients and families in care planning and establish routines.

Joint Commission Patient Safety Goals

• The Joint Commission (TJC) accredits healthcare facilities based on safety performance.
• TJC creates National Patient Safety Goals (NPSGs) and standards each year.
• NPSGs focus on client safety, effective healthcare delivery, and adverse outcome prevention.
• Use two client identifiers and ensure correct medication, treatment, or procedure for the client.
• Acceptable client identifiers include the client’s name, date of birth, designated hospital number, telephone number, or alternative client-specific documentation.
• Never use the client’s assigned room for identification purposes.
• Report critical results promptly, with documented notification of results to the provider.
• Label all medications, including solutions, syringes, and containers.
• Discard unlabeled medications, ensure that the nurse never assumes what the medication is..
• Exercise caution with anticoagulant medications, reviewing weight, renal and hepatic lab values, dosage frequency, amount prescribed, and drug interaction potential.
• Reconcile the client’s medications upon admission, comparing home medications with newly prescribed medications.
• Ensure clinical alarm systems are used safely in healthcare, avoiding alarm fatigue.
• Prevent hospital-acquired infections (HAIs) such as CLABSI, CAUTI, SSI, and VAP.
• Implement suicide prevention methods and screen clients 12 years and older for suicidal ideation.
• Implement Universal Protocol to prevent adverse events in surgery, including time-outs, use of two client identifiers, and marking surgical sites.

Fire Safety (RACE and PASS)

• RACE: Rescue, Alarm, Contain, Extinguish/Evacuate.
• PASS: Pull the pin, Aim the nozzle, Squeeze the lever, Sweep from side to side.
• Maintain fire drills, smoke alarms, fire extinguisher, and electrical safety to prevent fires.
• Evacuate, stay out, and call for help.

Seizure Safety

• Risk factors include brain injuries, tumors, infections, high fevers, family history, Alzheimer’s, and strokes.
• Nursing interventions during a seizure: stay with the patient, time the seizure, protect the airway (turn to the side), do not restrain or put anything in the mouth, protect from injury.
• After a seizure, monitor vital signs and level of consciousness and reorient the patient.
• Catalogue potential triggers, duration, and symptoms to try and prevent future episodes.
• Medications for seizures can be contraindicated if the patient has hepatic failure or renal impairments.
• Valproic acid and felbamate are associated with hepatotoxicity, so they are contraindicated in patients with hepatic failure.