Egan CH 3: Patient Safety & Communication PDF

Egan Chapter 3 Patient Safety, Communication, and Recordkeeping Patient Safety Continuum 2  Safety Considerations Patient Movement & ambulation – Good posture minimizes risk of injury when moving patients or heavy equipment – RTs should use their legs w...

Egan Chapter 3 Patient Safety, Communication, and Recordkeeping Patient Safety Continuum 2  Safety Considerations Patient Movement & ambulation – Good posture minimizes risk of injury when moving patients or heavy equipment – RTs should use their legs with straight spine to lift patients & heavy objects 3 Basic Body Mechanics 4 Moving the Patient in Bed 5  Ambulation Extended bed rest can lead to new medical problems, such as atelectasis Ambulation (walking) helps restore & maintain normal body function Ambulation should begin as soon as patient is stable & free from severe pain Ambulation can reduce length of hospital stay http://www.youtube.com/watch?v=woofpnw-u74 6 Extended bed rest can result in which of the following? A. atelectasis B. Diabetes C. COPD D. asthma Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 7  Electrical Safety Fundamentals of Electricity – Electricity moves from point A to point B due to differences in voltage – Voltage is power behind electrical energy – Most homes & hospitals are powered w/ 120-V power sources 8  Electrical Safety (cont.) Objects with high resistance (e.g. rubber tubing) allow minimal or no current to flow Current represents greatest danger when electrical shorts occur Current is reported in amperes; resistance is reported in ohms 9 Electrical Safety 10  Electrical Safety (cont.) Harmful effects of current depend on: – Amount of current flowing through body – Path it takes – Duration current is applied High currents passing through chest can cause ventricular fibrillation, diaphragm dysfunction, & death 11 High currents that pass through the chest can cause all of the following , except: B.Death C.ventricular fibrillation D.diaphragm dysfunction E.atelectasis Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an imprint of Elsevier Inc. 12  Electrical Safety (cont.) Preventing Shock Hazards – 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 qualified expert on regular basis 13  Fire Hazards (cont.) Fires in oxygen-enriched atmospheres (OEAs) are larger, more intense, faster burning, & more difficult to extinguish Hospital fires are more serious because evacuation of critically ill patients is difficult 14  Fire Hazards (cont.) 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 cause approximately $9 million in damage. Fires in patient care areas where oxygen is being used are especially dangerous. 15  Fire Hazards (cont.)  Three conditions must exist for fire to start:  Flammable material must be present.  Oxygen must be present.  The flammable material must be heated above its ignition temperature.  Oxygen is not flammable, but it can greatly accelerate the rate of combustion. 16  Fire Hazards (cont.) 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. 17  Fire Hazards (cont.) PASS – fire extinguisher training P – pull pin A – aim nozzle at base S – squeeze handle S – sweep nozzle across base of fire 18  RACE – core fire plan 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. 19  General Safety Guidelines  Direct patient environment should be: – Free of impediments to care Beware of anything creating direct fall risk – RTs responsibility to position equipment: tubing & treatments out of way of potential risk  Disaster preparedness includes: transport & transfer of critically ill, & preparation for loss of electricity  Magnetic resonance imaging (MRI) safety – No metal components or objects allowed in MRI suite! – MRI compatible ventilators, oxygen supplies, & ancillary equipment. 20 Fire extinguisher training includes learning which acronym ? A. RACE B. NBRC C. CBC D. PASS 21 http://www.youtube.com/watch?v=byRIwDk21sw 22  General Safety Guidelines (cont.) Medical gas cylinders: – Proper storage & handling to prevent fire risk Explosive release of high pressure cylinders – Toxic effects of some gases National Fire Protection Association (NFPA) – Regulates storage of medical gases – Monitoring by The Joint Commission ( TJC) Hospital accrediting organization 23 Communication Skills  Miscommunication: The Case for Effective Communication Communication is a complex and dynamic Skills process at the heart of all human interaction. The importance of its effectiveness cannot be overstated. Five Cs of Communication o Complete o Clear o Concise o Courteous o Cohesive  Miscommunication: The Case for Effective Communication 44,000 patients experience a medical Skills every year in the mistake or misadventure U.S. Medical mistakes are the 8th leading cause of death in the United States. Communication has been cited as a significant factor associated with this problem. Misinterpretation and a lack of rapport can lead to communication issues. Incomplete messages and incomplete facts can have potentially serious consequences.  Miscommunication In 2007 Dennis & Kimberly Quaid’s two week old newborns were given 1,000 times the normal dose of heparin (a blood thinner) The miscommunication was partially to do with the Nurse not double checking her meds but also the vial labeling was ineffective Pharmaceutical companies have since then made changes to improve labeling  Miscommunication: The Case for Effective Communication Skills Be certain that you hear or observe the entire message and monitor your emotions before jumping to conclusions. Be familiar with medical language and commonly used medical expressions. All communications occurring with students from different cultures requires care, diligence, and attention to detail. Efforts must be made to enhance understanding of language and cultural norms. In communicating use and misuse of medication, there is little margin for error.  Communication in Health Care Success as an RT depends on your ability to communicate well with patients & other members of team. 29  Communication in Health Care (cont.) Effective communication: 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 reporting & recording of test values. 30  Communication in Health Care (cont.) All healthcare personnel must use “two patient identifier” before initiating care, which includes: – Patient name – Birth date – Medical record number 31  Improving Communication Share information rather than tell it Seek to relate to people rather than to control them Value disagreement as much as agreement Use effective nonverbal communication techniques 32  Improving Communication (cont.) The Practitioner as Listener – Work at being good listener – Stop talking; avoid interrupting speaker – Resist distractions; tune them out – Keep your mind open; be objective – Hear the speaker out before making evaluation – Maintain composure; control emotions 33  Improving Communication (cont.) Providing feedback – Attending; involves use of gestures & confirming remarks – Paraphrasing; repeating others’ response in one’s own words – Requesting clarification; 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 34  Factors Affecting Communication -Major Categories- Environmental Emotional and sensory Verbal expressions Nonverbal cues Internal or intrapersonal Physical appearance and status  Factors Affecting Communication -Environmental Factors- Lighting/Noise Temperature/Climate Formality/Warmth Privacy/Familiarity Feelings of constraint Physical distance between people Mood Architecture/Furniture arrangement  Public, social, personal, and intimate spaces of the patient requiring healthcare. Adapted from Wilkins RL, et al. Clinical Assessment in Respiratory Care. 4th ed. Mosby; 2000.  Factors Affecting Communication -Sensory and Emotional Factors- Fear/Stress Anxiety/Pain Compromised mental acuity, sight, hearing, or speech  Factors Affecting Communication -Verbal Expressions- Language/Jargon Choice of words or questions Voice tone and quality Feedback  Factors Affecting Communication Nonverbal cues are a form of communication without words and include messages created through body motion (kinesics), the use and interpretation of space (proxemics), the use of sounds (paralinguistics), and touch. Intrapersonal factors are factors within the individual that affect communication and that make up the person’s constitution. See Table 60–3: Guidelines to Facilitate Communication with Individuals from Other Cultures.  Factors Affecting Communication -Physical Appearance and Status Factors- Age, gender, and race Body size and shape Body movements and posture Dress/Hair Body adornments/Body smell Role/position Organizational status and influence Professionalism Basic Goals and Purpose of Communication -Sender’s Expectations from Receiver- Understanding Action Information Comfort  Recording Keeping Medical record or chart provides written statements of occurrences pertaining to patient Medical records are strictly confidential & are protected under Health Insurance & Portability Act (HIPPA) Includes confidential health insurance or billing information Records represent legal document & could be used in court 44  Recording Keeping (cont.) Federal government would like all medical recordkeeping done electronically by 2014 Electronic medical record (EMR) is new way practitioners can document care Record keeping is major significant duty you perform 45 General Rules for Record Keeping 46  General Rules for Record Keeping (cont.) Do not leave blank lines Use standard abbreviations only Use present tense Use proper spelling Document all important conversations Be accurate 47 Problem-Oriented Medical Record POMR: documentation format used by some health care institutions POMR has 4 basic parts 1. Database 2. Problem list 3. Plan 4. Progress notes 48  Problem-Oriented Medical Record POMR progress notes use 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?) 49 General Sections Found in a Patient Medical Record Admission data – Records pertinent patient information (e.g., name, address, religion, nearest of kin), admitting physician, and admission diagnosis History and physical examination – Records the patient’s admitting history and physical examination, as performed by the attending physician or resident Health maintenance and immunizations – Records the dates of administration Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an 50 imprint of Elsevier Inc.  General Sections Found in a Patient Medical Record (Cont.) Physician’s orders – Records the physician’s orders and prescriptions Progress notes – Keeps a continuing account of the patient’s progress for the physician Nurses’ notes – Describes the nursing care given to the patient, including the patient’s complaints (subjective symptoms), the nurses’ observations (objective signs), and the patient’s response to therapy Medication record – Notes drugs and IV fluids that are given to the patient Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an 51 imprint of Elsevier Inc.  General Sections Found in a Patient Medical Record Allergies (Cont.) – Notes reaction, severity, type, and date noted Vital signs flowsheet – Records the patient’s temperature, pulse, respirations, and blood pressure over time I/O sheet – Records patient’s fluid intake (I) and output (O) over time Laboratory results – Summarizes the results of laboratory tests Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an 52 imprint of Elsevier Inc.  General Sections Found in a Patient Medical Record Consultation note (Cont.) – Records notes by physicians who are called in to examine a patient to make a diagnosis Surgical or treatment consent – Records the patient’s authorization for surgery or treatment Anesthesia and surgical record – Notes key events before, during, and immediately after surgery Specialized therapy records and progress notes – Records specialized treatments or treatment plans and patient progress for various specialized therapeutic services (e.g., respiratory care, physical therapy) Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an 53 imprint of Elsevier Inc.  General Sections Found in a Patient Medical Record (Cont.) Specialized flow data – Records measurements made over time during specialized procedures (e.g., mechanical ventilation, kidney dialysis) Advanced directives – Records wishes and documents regarding living wills, power of attorney, and do not resuscitate orders Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an 54 imprint of Elsevier Inc.  General Rules for Recordkeeping (Cont.) Each health care facility has its own specifications for keeping medical records Documentation flow sheets are designed to: – Briefly report data – Decrease time spent in documentation Use standardized terms and abbreviations TJC has published a “Do Not Use” abbreviation list developed to reduce potential errors Copyright © 2013, 2009, 2003, 1999, 1995, 1990, 1982, 1977, 1973, 1969 by Mosby, an 55 imprint of Elsevier Inc. When documenting notes in POMR, what format should be followed? A.RACE B.PASS C.SOAP D.NBRC 56