The Need for Safety in Healthcare

Need for Safety

• Objectives include discussing the need for safety, examining the relationships between patient safety and quality of care, describing patient safety incidents, differentiating between harmful incidents, near misses, and no-harm incidents.
• Objectives also include discussing safety risks across healthcare settings and developmental stages, describing aging-related changes that increase accident risk, discussing the importance of home assessments for safety threats, identifying safety measures to limit risks to clients, and reviewing potentially useful fall assessment tools.

Significance of Safety

• The need for safety is a basic need for human survival.
• It is mandated by legislation.
• It is regarded as the right thing to do from a moral and ethical standpoint.
• It is fundamental to healthcare nursing across all settings.
• Awareness of safety prevents injury.
• Safety contributes to the overall quality of care.

Quality of Care

• Quality of care incorporates effective, safe, people-centred, timely, equitable, integrated, and efficient domains.

World Patient Safety Day 2023

• World Patient Safety Day's theme for 2023 is engaging patients for patient safety.

Types of Patient Safety Incidents

• Patient Safety Incident: An event that could have or did result in unnecessary harm.
• Harmful Incident: An incident that resulted in client harm.
• Near Miss: An incident that did not reach the client.
• No-harm Incident: An incident that reached the client but caused no significant harm.

Factors Affecting Safety

• Scientific Knowledge is a factor affecting safety.
• Factors that influence safety include patient and healthcare provider factors, task factors, technology factors, environmental factors, and organizational factors.
• Systems thinking, analysis and safety improvement techniques, human factors, and interdisciplinary teamwork impact safety.
• Nursing Knowledge is a factor affecting safety.
• Risks in healthcare settings include staff and patient safety.
• Risks at developmental stages involve lifespan considerations.
• Individual Risk Factors: Impaired mobility, sensory or communication impairment, and lack of safety awareness.

Nurses Role in Safety

• Best practice involves reducing or preventing unsafe acts, leading to optimal patient outcomes.
• Assess for safe environments by identifying risks, such as scatter mats or water on the floor.
• Nurses should aim to improve situations by recognizing needs.
• Nurses play a role in dealing with biological environments. WHMIS (Work Hazardous Material Info Systems) and HAZ MAT (hazardous material training) are part of safety.
• Infection prevention with asepsis and infection control procedures, including PPE's, are important.

Chain of Infection

• There are six links in the chain of infection.
• Breaking any link in the chain is the key to infection prevention and control.
• Etiological Agent: The microorganism or infectious agent.
• Reservoir: The source of infection/carrier, such as people, animals, birds, or food.
• Portal of Exit: How the microorganism leaves the reservoir.
• Mode of Transmission: How the microorganism travels (direct or indirect).
• Direct Transmission: The spread through person to person contact, which includes touching, biting, kissing, or sexual intercourse.
• Droplet Transmission: Transmission from a host within 1-2m via coughing, spitting, talking or suctioning.
• Vehicle-borne: When a substance transports infectious agents into a susceptible host, such as toys, doorknobs, soiled clothes, surgical instruments, IV poles, bed pans, water, food, milk, or blood.
• Vector-borne: When an animal/insect transports infectious agents into a susceptible host through biting or depositing of fecal matter through traumatized skin.
• Airborne: Transmission via droplet nuclei i.e., tuberculosis or dust particles with infectious agents e.g., varicella, C-diff.
• Portal of Entry: How the infectious agent enters the susceptible host body ie. skin, mucous membranes of the eyes, respiratory tract, GI tract, bloodstream.
• Susceptible Host: Any person at risk for infection, where impairment of the body's natural defenses can affect susceptibility.

Clients at Risk For Infections

• Discuss clients at risk of infection.
• Discuss normal defense mechanisms against infection in patients.

Health Care-Associated Infections

• Health care-associated infections, otherwise known as nosocomial infections, are acquired after admission to a healthcare facility.
• They were not present or incubating at the time of admission.
• In-patients are at risk due to acute illness, aggressive treatments, and compromised immunity.

Signs of Infection

• Evidence or Signs of Infection can be identified through physical assessments, including indications and symptoms.
• Signs of Local Inflammation: Localized swelling, redness, pain, warmth, and drainage.
• Signs of Systemic infection: Fever, increased pulse & respirations, loss of energy, anorexia, lymph node enlargement & tenderness.

Nursing Interventions for Infection Control

• Nursing interventions are implemented to break the chain of infection.
• Sterile, Aseptic, and Clean techniques should be used.

Asepsis

• Asepsis: The process of keeping away disease-producing microorganisms.
• Aseptic technique involves practices that render an area and objects free from microorganisms.
• Medical Asepsis (clean technique): procedures used reduce and prevent the spread of microorganisms i.e., hand hygiene, disposable gloves, cleaning the environment.
• Surgical Asepsis involves the destruction of all microorganisms.

Infection Control

• Infection control involves hand washing using proper procedures.
• Utilize personal protective equipment.
• Take precautions.
• Dispose of soiled equipment and supplies properly.
• Infection Control to Reduce Reservoir Sites:
• Bathing: Use soap & water to remove drainage/secretions.
• Dressing changes: Change if wet or soiled.
• Contaminated articles: Place soiled tissue, dressings, or linens in moisture resistant bags.
• Contaminated needles: Use puncture-proof containers.
• Bedside units: Keep surfaces clean and dry.
• Bottled solutions: Do not leave open for prolonged periods.
• Surgical wounds: Keep dry and keep drainage bags patent.

Safe Use of Restraints

• Physical, chemical, or environmental measures can be used as restraints.
• Used to control physical or behavioral activities.
• Skin deterioration, constipation, urinary incontinence, repiratory infection, falls, and suffocation can result from restraints.
• Restraints use is a last resort, alternatives should be considered first.
• Follow the least restraint policy (CNO Practice Standard).
• Use the minimum restraint needed to ensure safety.
• Legal implications (freedom, consent, emergency) must be considered when using restraints.
• Procedures for applying restraint should be known (policies and training in agencies).

Incident Reports

• Incident reports document injury for statistics & education.
• Falls and medication errors require an incident report.
• Contains - assessment of patient (possible cause, actions taken by staff, ways to prevent in the future)
• Check and complete incident reports as per agency policy.

Specific Safety Measures

• Safety measures should be considered for seizures, poisoning, carbon monoxide poisoning, choking or suffocation, excessive noise, and electrical hazards.

Preventing Hazards

• Risks are present in healthcare settings due to malfunctioning equipment or combustion/gas.
• Risks are present in home settings due to cigarettes/matches, grease, or faulty wiring.
• Hazards are dangerous for patients who are incapacitated & unable to leave.
• Nurses need to know safety regulations.
• Use fire prevention practices.

Fire Safety Guide (RACE)

• Rescue
• Activate the Alarm or Announce Fire
• Confine/Contain the Fire
• Extinguish

Nursing Assessment and Planning

• It is important to use an assessment guide for safety, collect data, and complete the assessment.
• The nursing process that should be used: A.D.P.I.E.
• The Nursing Diagnosis that should be used: Risk for Injury etc. You must identify the type of injury.
• Goals must be specific to the patient's needs.
• Nursing interventions should include "how", "what" and "when".
• It is important to review safety measures throughout the life span for young, middle, and older adults.
• Identify age-specific potential injuries.
• Educate clients on prevention.
• Consider safety in health care settings.