Patient Safety Protocols in Nursing

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Questions and Answers

A nurse is caring for a patient who has a history of falls. Which of the following interventions is most crucial to implement?

  • Ensuring the patient's call light is always within easy reach. (correct)
  • Applying physical restraints to prevent the patient from ambulating independently.
  • Administering sedative medications at night to promote sleep.
  • Instructing the patient to remain in bed at all times.

A nurse is assessing a patient's risk for falls. Which of the following findings would indicate the highest risk?

  • Patient demonstrates confusion and disorientation. (correct)
  • Patient reports needing assistance to ambulate.
  • Patient is currently prescribed an antihypertensive medication.
  • Patient has a history of one fall in the past year.

In which scenario is the use of restraints considered ethically justifiable?

  • As a routine measure to prevent falls in elderly patients.
  • When a patient is at risk of harming themselves or others. (correct)
  • When a patient's family requests them for ease of care.
  • To prevent a patient from removing necessary medical devices.

A nurse is preparing to administer medication. What is the MOST important step to ensure patient safety?

<p>Confirming the patient's identity using two acceptable identifiers. (A)</p> Signup and view all the answers

Which action demonstrates a nurse's understanding of QSEN's safety competency?

<p>Actively participating in identifying and addressing potential safety hazards within the healthcare system. (B)</p> Signup and view all the answers

After implementing a new protocol, the data reveals an increase in adverse drug events (ADEs). What is the nurse's MOST appropriate next step?

<p>Thoroughly analyze the data to identify the root causes of the increased ADEs and adjust the protocol accordingly. (A)</p> Signup and view all the answers

A patient with impaired mobility is being transferred from the bed to a chair. Which intervention demonstrates the nurse's understanding of safety principles?

<p>Using proper body mechanics and seeking assistance when necessary. (C)</p> Signup and view all the answers

Which action exemplifies a healthcare organization's commitment to fostering a culture of safety?

<p>Encouraging open communication and learning from errors without fear of reprisal. (A)</p> Signup and view all the answers

How should the nurse prioritize interventions to maintain environmental safety for a patient with a history of seizures?

<p>Placing padded side rails on the patient's bed. (B)</p> Signup and view all the answers

A nurse is teaching a community group about strategies to prevent falls in older adults. Which suggestion is MOST appropriate?

<p>Installing grab bars in bathrooms and using assistive devices as needed. (D)</p> Signup and view all the answers

A nurse finds a patient unresponsive and not breathing. What action should the nurse take FIRST?

<p>Call a code. (A)</p> Signup and view all the answers

A patient is receiving oxygen therapy. What safety precaution is MOST important for the nurse to implement?

<p>Placing a &quot;No Smoking&quot; sign in the patient's room. (C)</p> Signup and view all the answers

A nurse is caring for a confused patient who is repeatedly attempting to remove their IV line. What is the initially MOST appropriate action?

<p>Reorient the patient to their surroundings and explain the purpose of the IV. (D)</p> Signup and view all the answers

A visitor spills water on the floor in a patient's room. What action should the nurse take FIRST?

<p>Clean up the spill immediately. (C)</p> Signup and view all the answers

A nurse is implementing a "time-out" procedure before a surgical procedure. What action is MOST important for the nurse to perform during this process?

<p>Ensuring all members of the surgical team agree on the patient's identity, the correct procedure, and the correct site. (D)</p> Signup and view all the answers

To prevent medication errors, what is the MOST effective strategy a nurse can employ when receiving verbal orders from a physician?

<p>Repeating the order back to the physician to confirm accuracy. (B)</p> Signup and view all the answers

A nurse discovers a small fire in a patient's room. Following the RACE acronym, what action should the nurse take FIRST?

<p>Rescue the patient from the room. (C)</p> Signup and view all the answers

A nurse is using a fire extinguisher. Following the PASS acronym, what should the nurse do FIRST?

<p>Pull the pin. (A)</p> Signup and view all the answers

When administering medications, what is the MOST critical step to avoid medication errors related to patient identification?

<p>Scanning the patient's wristband and verifying with the MAR. (B)</p> Signup and view all the answers

What is the nurse's PRIMARY responsibility in preventing healthcare-associated infections (HAIs)?

<p>Following strict hand hygiene practices. (D)</p> Signup and view all the answers

A hospital implements a new electronic health record (EHR) system to improve patient safety. What action is MOST crucial during the initial rollout?

<p>Providing comprehensive training and ongoing support to all staff members. (D)</p> Signup and view all the answers

A patient with a known allergy to peanuts is served a meal containing peanut oil. Despite not consuming the meal, the patient experiences a severe allergic reaction due to cross-contamination in the kitchen. What type of medical error is this?

<p>Preventative error. (A)</p> Signup and view all the answers

What is the most effective strategy to reduce the risk of wrong-site surgery?

<p>Completing a pre-operative checklist with the patient and surgical team. (D)</p> Signup and view all the answers

How frequently should a nurse assess a patient in restraints for skin integrity, circulation, and psychological well-being?

<p>Every 15 minutes. (D)</p> Signup and view all the answers

A patient is deemed at "high risk" for falls using the Hendrick II Fall Risk Assessment. What indicates this determination?

<p>Score of ≥ 5 (D)</p> Signup and view all the answers

According to the Morse Fall Scale, what score qualifies a patient as "high risk"?

<p>≥ 51 (C)</p> Signup and view all the answers

A patient is restrained. According to the guidelines, which task may be performed by a UAP?

<p>Remove and reapply restraints as needed for safety and hygiene. (A)</p> Signup and view all the answers

When providing care for a patient in restraints, what complication is most likely to be associated with long periods of immobilization?

<p>Constipation (D)</p> Signup and view all the answers

An older adult patient, who has weakness on their left side has a high risk of falling. Which nursing intervention would be appropriate?

<p>Placing the nurse on their right side closest to the handrails. (B)</p> Signup and view all the answers

When is it appropriate to use restraints?

<p>Only when other methods have been tried and failed. (D)</p> Signup and view all the answers

When assessing a client in restraints, what is the minimum frequency skin integrity should be assessed?

<p>Every 2 hours (D)</p> Signup and view all the answers

What must be included in the documentation regarding a client in restraints?

<p>The nurse's rationale for using restraints. (D)</p> Signup and view all the answers

Which of the following BEST defines a "restraint alternative"?

<p>Devices or techniques employed to avoid the use of restraints. (C)</p> Signup and view all the answers

What is the appropriate way to determine if a patient understands how to request assistance?

<p>Testing the the patient's ability to use the call light and ability to express need. (B)</p> Signup and view all the answers

According to the safety guidelines, what factor increases the risk of fire when using supplemental oxygen?

<p>Supplemental oxygen poses a fire risk. (A)</p> Signup and view all the answers

What activity is the leading cause of fire-related deaths?

<p>Careless smoking (D)</p> Signup and view all the answers

What patient accidents are ranked the second leading cause of accidental death worldwide?

<p>Falls (A)</p> Signup and view all the answers

Which factor does NOT require consideration when implementing safety strategies?

<p>Patient's preferred brand of personal care products (C)</p> Signup and view all the answers

When evaluating the effectiveness of a new fall-prevention program, which metric offers the MOST comprehensive insight into its success?

<p>Decrease in the severity of injuries sustained from falls. (B)</p> Signup and view all the answers

A patient with a history of unpredictable agitation requires a safety plan. What is the MOST critical INITIAL nursing intervention to ensure both the patient's and staff's safety?

<p>Establishing consistent communication and de-escalation techniques. (C)</p> Signup and view all the answers

Which statement best reflects the relationship between system effectiveness and individual performance in maintaining patient safety, according to the QSEN safety competency?

<p>Patient safety is optimized when system effectiveness and individual performance are both prioritized and integrated. (B)</p> Signup and view all the answers

A nurse is caring for a patient who reports feeling increasingly anxious and unsafe despite the implementation of standard safety protocols. What action should the nurse prioritize?

<p>Conduct a comprehensive re-evaluation of the patient's physical and psychological needs. (B)</p> Signup and view all the answers

An elderly patient with cognitive impairment is at risk for falls. The care team explores the use of technology to enhance safety. Which approach balances patient autonomy with safety MOST effectively?

<p>Using a wearable sensor that alerts staff to changes in the patient's gait and activity levels. (D)</p> Signup and view all the answers

In designing a safe patient care environment, which strategy is MOST effective in mitigating risks associated with shared medical equipment?

<p>Designate specific equipment for patients with known infections to implement contact precautions. (B)</p> Signup and view all the answers

A healthcare organization is implementing a new "speak-up" campaign to encourage staff to report safety concerns. Which organizational action is MOST likely to undermine the campaign's success?

<p>Implementing a system for anonymous reporting of safety concerns without feedback. (A)</p> Signup and view all the answers

When prioritizing interventions to minimize environmental risks for a patient with a seizure history, what is the MOST proactive and preventative approach?

<p>Collaborating with occupational therapy to assess the patient's environment and remove potential hazards. (B)</p> Signup and view all the answers

A nurse is teaching a family how to create a safer home environment for their visually impaired relative. Which recommendation reflects the BEST understanding of the interaction between mobility and environmental safety?

<p>Maintain consistent arrangement of furniture and ensure clear, well-lit pathways free from obstacles. (A)</p> Signup and view all the answers

In the event of a facility-wide power outage, what action BEST reflects a proactive approach to ensuring patient safety?

<p>Locating patients dependent on electrical equipment and manually operating life-sustaining devices. (B)</p> Signup and view all the answers

A patient receiving oxygen therapy in their home suddenly becomes dyspneic and agitated. Despite checking the device settings, the nurse suspects a malfunction. What is the BEST immediate action?

<p>Immediately switch the patient to a backup oxygen delivery system using a nasal cannula. (A)</p> Signup and view all the answers

A patient with dementia is repeatedly attempting to climb out of bed despite the use of non-pharmacological interventions. What is the MOST ethical and clinically sound next step?

<p>Evaluate the underlying cause of the patient's behavior, such as unmet needs. (B)</p> Signup and view all the answers

While walking through the hallway, a nurse notices a significant spill of an unidentified liquid. What action demonstrates the HIGHEST level of accountability and proactive safety management?

<p>Immediately cleaning the spill to prevent accidents and reporting the incident to risk management. (B)</p> Signup and view all the answers

During a pre-operative 'time-out,' a discrepancy is identified: the patient states they are having surgery on their left knee, but the consent form indicates the right knee. What action is MOST critical to ensuring patient safety?

<p>Holding the procedure until the discrepancy is resolved and a new consent is obtained. (B)</p> Signup and view all the answers

A provider gives a telephone order for a medication that the nurse believes is contraindicated based on the patient's known allergies. What is the nurse's BEST course of action?

<p>Clarify the order with the provider, expressing concerns about the potential contraindication. (D)</p> Signup and view all the answers

Upon discovering a fire, after rescuing a patient, what is the NEXT action the nurse should take, according to the RACE acronym?

<p>Contain the fire by closing doors and windows. (B)</p> Signup and view all the answers

When operating a fire extinguisher, after pulling the pin, what does aiming the extinguisher involve, according to the PASS acronym?

<p>Aiming at the base of the fire. (A)</p> Signup and view all the answers

To ensure correct patient identification during medication administration, what is the MOST reliable method for verifying patient identity, especially in complex clinical situations?

<p>Scanning the patient's wristband and matching it with the medication administration record (MAR). (C)</p> Signup and view all the answers

What is the MOST crucial strategic intervention for nurses to minimize the occurrence of healthcare-associated infections (HAIs) across a healthcare system?

<p>Strictly enforce hand hygiene protocols for all healthcare personnel. (D)</p> Signup and view all the answers

Following the go-live of a new electronic health record (EHR) system, which action is MOST critical for ensuring a smooth transition and minimizing patient safety risks?

<p>Providing comprehensive, ongoing training and support to all users. (A)</p> Signup and view all the answers

Flashcards

Define Safety

Freedom from psychological and physical injury; prevention of patient injury from health care errors.

Medical errors

Medical errors are the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.

Patient Identification

The first and best way to check you have the RIGHT patient is to have them STATE their name and birthday.

Environmental Safety

A safe environment protects the staff to function optimally.

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Basic human needs

Sufficient oxygen, nutrition, and optimum temperature influence a person's safety.

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Falls

Falls rank as the second leading cause of accidental or unintentional injury deaths worldwide

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Influences on Patient Safety

Factors influencing patient safety: developmental level, mobility, sensory, cognitive status, lifestyle choices, and knowledge of safety precautions

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Safety Risk Diagnoses

Nursing diagnoses related to safety risks include: Risk for falls, impaired home maintenance, risk for injury, impaired cognition, lack of knowledge, risk for poisoning, risk for trauma

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Patient Fall

A patient fall is a sudden, unintentional change in position, coming to rest on the ground or other lower level, is among the most commonly reported adverse hospital events, with more than 1 million occurring annually

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Fall Risk Assessment

Assessment of a patient's risk factors for falling is essential in determining specific needs and developing targeted interventions to prevent falls.

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Morse Fall Scale

The Morse Fall Scale is a tool for assessing a patients likelyhood of falling.

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Hendrick II Fall Risk Model factors

Confusion/disorientation, Depression, Altered elimination, Dizziness/vertigo (subjective), Gender (male), Any prescribed antiepileptics, Any prescribed benzodiazepines, Get-up-and-go 'Rising from Chair'

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Restraints

Restraints are devices used to immobilize a client or an extremity.

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Appropriate Restraint Use

Appropriate use of restraints is when a client is a danger to themselves or others, are trying to pull out their IVs or airway, or are delirious.

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Restraint Alternatives

Restraint Alternatives include: devices or techniques employed to avoid the use of restraints. Depending on the intent and how it is used, it can be an alternative or a restraint.

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Restraint Definition

Manual method, physical or mechanical device, material, or equipment immobilizing or reducing movement.

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Ongoing Monitoring

Vital Signs, Circulation Checks, Skin Integrity, Correct Application, Mental Status, Cognitive Functioning, and Level of Distress/Agitation

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Activities of Daily Living

ADLs include bathing, dressing, eating, elimination, and mobility.

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Instrumental Activities of Daily Living

instrumental Activities of Daily Living include Writing, Reading, Cooking, Cleaning, Shopping, Doing laundry, Going up stairs, Using the telephone.

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Study Notes

  • Safety means protecting from psychological and physical harm.
  • Safety also prevents patient injuries caused by healthcare errors.
  • Nurses should minimize harm to patients and providers through system effectiveness and individual performance.
  • Preventable medical errors in hospitals exceed deaths from motor vehicle wrecks, breast cancer, and AIDS.
  • Healthcare provided in a safe manner is essential for a patient's survival and well-being.
  • Nurses use critical thinking to promote patient safety.

Patient Identification

  • The best way to identify a patient is to have them state their name and birthday. It is secondary to check a name bracelet. This should be done before contact.
  • Bar scans are used when giving medications.

Scientific Knowledge Base

  • Environmental safety protects staff, while sufficient oxygen, nutrition, and temperature influence a person's safety.
  • Supplemental oxygen poses a fire risk.
  • Knowledge of healthy food and food safety is needed for nutrition.
  • Extreme temperatures pose safety risks for vulnerable populations.
  • Physical hazards often result in physical or psychological injury or death.
  • Motor vehicle accidents are a physical hazard for the elderly.
  • Falls are the second leading cause of accidental or unintentional injury deaths worldwide.
  • The leading cause of fire-related death is careless smoking.

Nursing Knowledge Base

  • Factors influencing patient safety include:
    • Patient’s developmental level
    • Mobility, sensory, and cognitive status
    • Lifestyle choices
    • Knowledge of common safety precautions

Nursing Process

  • Assessment includes:
    • Nursing history and examination
    • Healthcare environment (risk for falls, medical errors, disasters)
    • Patient's home environment

Nursing Diagnosis (Safety Risks)

  • Risk for fall
  • Impaired home maintenance
  • Risk for injury
  • Impaired cognition: confusion
  • Lack of knowledge
  • Risk for poisoning
  • Risk for trauma

Implementation

  • Environmental interventions include:
    • Basic needs
    • Fall safety in the home
  • General preventive measures include:
    • Lighting
    • Changing the environment

Falls

  • A patient fall is a sudden, unintentional change in position to a lower level.
  • Falls are among the most commonly reported adverse hospital events with more than 1 million annually.
  • Approximately 30% of falls result in injury, and 10% result in serious injury, like head trauma or fracture.
  • Falls are especially dangerous for older adults due to causation of morbidity and mortality.

Fall Assessment Tools

  • Fall assessment is essential in determining specific needs and developing interventions to prevent falls.
  • The Morse Fall Scale and Hendricks II Fall Risk Scale are used.

Fall Precautions

  • Set bed alarms while a patient is in bed.
  • Apply yellow non-skid socks on patients when ambulating
  • Place patients with a strong side by the handrails when walking with the patient.
  • Use an electronic device to ensure the patient is safe in bed.
  • DO NOT USE 4 SIDE RAILS

Bathroom Safety

  • To facilitate the safety make sure there is a hand rail, the door is open, it is well lit, and there is a call light.

Restraints

  • Restraints immobilize a client or extremity and are physical or chemical.
  • Restraints are used temporarily to control behavior.
  • Restraints protect from self-injury or prevent violence toward others.
  • Restraints can be manual, physical, or mechanical and reduce the ability to move freely.
  • Least restrictive and safest environment is needed for restraint free guidelines.
  • Clinically appropriate restraints are not routine and are limited to 24 hours.

Restraint-Free Guidelines

  • Establish a restraint-free standard.
  • Use the least restrictive but safest environment.
  • Apply restraints only in clinically appropriate situations, avoiding routine use - evaluate each patient individually.
  • Document the rationale because orders are limited in duration to 24 hours.

Harm caused by restraints

  • Injuries from improperly positioned restraints can cause patients to get tangled in straps and choke.
  • The struggle to free can cause broken bones, cuts, and concussions. Long-term restraint use can cause:
    • Poor circulation
    • Incontinence
    • Constipation
    • Weak muscles
    • Pressure Sores
  • Mental and emotional issues with restraints:
    • Humiliation
    • Imprisonment
    • Depression
    • Agitation

Restraint Usage

  • Use restraints as a last resort, only after exhausting all alternative interventions.
  • Protect the patient’s rights and dignity if restraints are used.
  • It is essential to:
    • Choose the least restrictive method
    • Document each occurrence of restraint use
    • Only properly trained and authorized staff may apply and remove restraints
    • Choose the correct restraint size because it may cause increased agitation or sliding, leading to asphyxiation

Initiation of Restraints

  • Only a Registered Nurse(RN) can initiate the first-time application of restraints.
  • A UAP or LPN may remove and reapply restraints as needed for safety and hygiene.

Restraints Monitoring

  • Behavioral Restraints;
  • Observe every 15 minutes for behaviors and physical conditions and document on Behavioral Restraint/Seclusion Flowsheet
  • Offer liquid, nutrition, comfort, and bathroom every 2 hours
  • Remove restraints every 2 hours for no less than 5 minutes for range of motion and skin care
  • Medical/Surgical Restraints: ​​
    • Observe every 2 hours for behaviors and physical conditions and document
    • Offer liquid, nutrition, comfort, and bathroom every 2 hours
    • Remove restraints every 2 hours for no less than 10 minutes for range of motion and skin care

Criteria to Discontinue Restraints:

  • Able to follow directions
  • Able to participate in care
  • Behavior improves/changes
  • Lines tubes discontinued
  • Positive response to medication intervention

Examples of Restraint Alternatives:

  • Freedom Splints and Soft Hand Mitts

Activities of Daily Living (ADLs):

  • Activities include bathing and grooming, ambulation, transfers, toileting, eating, and dressing.

Instrumental Activities of Daily Living:

  • Activities include writing, reading, cooking, cleaning, shopping, doing laundry, going up stairs, using the telephone, outside activities, managing medications and money, and transportation.

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