Patient Safety PDF

Patient Safety Dr. Nagwa Mohamed Helmy Lecturer Of Medical Surgical and Critical Nursing  Outlines  Introduction  Basic human needs  Definition of safety  Purpose of safe environment  Environmental hazards  Factors influencing safety  Safety and nursing pro...

Patient Safety Dr. Nagwa Mohamed Helmy Lecturer Of Medical Surgical and Critical Nursing  Outlines  Introduction  Basic human needs  Definition of safety  Purpose of safe environment  Environmental hazards  Factors influencing safety  Safety and nursing process Introduction Safe care is a basic need of all clients regardless of the setting. Nurses are responsible for providing the client with a safe environment through the delivery of professional, quality nursing care that incorporates safety precautions, infection control practices, and hygiene assistance. This chapter describes the nurse’s role in each of these areas.  Definitions patient safety Is defined as freedom from psychological and physical injury ,is a basic human need Another definition Patient safety is the absence of preventable harm to a patent during the process of health care. ▪ Safe environment : is one where the threat of attack from biological, chemical, or nuclear weapons is prevented or minimized.  What is safety ? S- Sense of error A- Act to prevent it F- Follow safety guidelines E- Enquire into accident /death T- Take appropriate remedial measure Y- your responsibility The goal estimated burden to unsafe care is :  1 in 10 patients globally harmed while receiving health care.  7% :10% of patients in developing and developed countries respectively acquire health care associated infections (HAIs).  Basic Human Needs Basic needs: Maslow's hierarchy Oxygen Temperature  Low concentration  Normal  High concentration  Hyperthermia  Carbon monoxide  Hypothermia Nutrition  Proper storage  Proper refrigeration  Preparation area  Critical Thinking  Critical thinking is the intellectually disciplined process of applying, analyzing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action  Critical thinking is the objective analysis of facts to form a judgment  In patient safety, critical thinking is an ongoing process.  Standards have been developed by American Nurses Association and The Joint Commission.  Use of the nursing process when planning care promotes safety. Purpose of Safety in Health Care Settings Reduces the incidence of illness and injury Prevents extended length of treatment/stay Improves or maintains functional status Increases patient’s sense of well-being  Purpose of Safe Environment  Meeting patients’ physical and psychosocial needs  Applies to all places where patients receive care  Increase sense of well-being  Reduces risk of injury and transmission of pathogens  Maintains sanitation and reduces pollution  Environmental Hazards  Physical hazards: Lighting Obstacles Bathroom hazards  Motor vehicle accidents  Poison  Fires  Environmental Hazards  Falls Risk factors for falling : History of falling Age Reduced vision Orthostatic hypotension Effect of various drugs Gait and balance problem  Transmission of pathogens=any microorganism capable of producing an illness Medical aseptic practice of hand washing is the most effective method of limiting transmission Immunization  Pollution A pollutant: is a harmful chemical or waste material discharge into the water, soil, or air. Types of pollution: Air pollution (Cigarette smoking) Water Noise  Disasters Natural Man-made Terrorism: Bioterrorism: is the use of biological agents To create fear, threat  Quick Quiz! 1. While caring for a child, you identify that additional safety teaching is needed when a young and inexperienced mother states that A. Teenagers need to practice safe sex. B. A 3-year-old can safely sit in the front seat of the car. C. Children need to wear safety equipment when bike riding. D. Children need to learn to swim even if they do not have a pool. Risks to safety  Risk Factors influencing safety: A-Risks according to developmental stages B-Individual risk factors C-Risks in the health care agency  A- Risks to safety according to developmental stage Infant, toddler, and preschooler: Injuries and poisoning School age: Food, sports, bicycle-related injuries. Adolescent: Nicotine and other drugs, alcohol, drowning, motor vehicle accidents Adults: alcohol excess, smoking, stress Older adults: Falls, burns, car accidents  B- Individual risk factors for safety Life style: stress, anxiety, fatigue, alcohol or drug withdrawal Impaired mobility: physiological and emotional hazards Sensory ,cognitive and communication impairment: aphasia or language barrier, visual ,hearing and tactile barrier. Lack of safety awareness: safety precautions as keeping medicines or poisons away from children, expired date of medication or food products and storage.  C-Risks in Health Care Agencies  Medical errors Medication errors Infection Bed sores Failure to diagnose and treat in time  Falls  Risks in Health Care Agency (cont’d)  Classification of health care agency accidents: Patient-inherent accidents( self- inflicted cuts, injuries , and burns, drug ingestion or injection of foreign substances ) Procedure-related accidents: occur during therapy As medication administration error Iv therapy error improper use of external device improper performance of procedure as NG tube insertion and Foley catheter insertion  Equipment-related accidents Result from the malfunction or misuse of equipment or from an electrical hazard. *make sure the equipment has been well maintain and has undergo a safety inspection /check.  Medication safety  Is preventing errors or mistakes in the medication use process.  Rights of medication administration 1.Right patient 2.Right drug 3.Right dose 4.Right route 5.Right time 6.Right reason 7.Right assessment 8.Right to refuse 9.Right education 10.Right documentation 11.Right evaluation 12.Right response  National Quality Forum  List of serious reportable events (SREs) Surgical events Product or device events Patient protection events Care management events Environmental events Criminal events  Procedure to report an event  Safety and the Nursing Process  Assessment Through the patient’s eyes , adequate lighting Patient’s home environment Assessment questions Activity and exercise Medication history History of falls Home maintenance and safety Nursing history  Safety and the Nursing Process (cont’d)  Assessment (cont’d) Health care environment Risks in immediate environment Risk for falls Risk for medication errors Disaster preparedness  Diagnosis Nursing diagnoses for patients with safety risk:  Risk for falls  Impaired home maintenance  Risk for injury  Deficient knowledge  Risk for poisoning  Risk for suffocation  Risk for trauma  Safety and the Nursing Process: Planning  Goals and outcomes Prevent and minimize safety threats Are measurable and realistic May include active patient participation  Setting priorities  Teamwork and collaboration Safety and the Nursing Process : Implementation Nursing care to promote safety A- Health promotion: ▪Passive strategies include public health and government legislative interventions ( Sanitation and clean water laws) ▪Active strategies ( the individual is actively involved through changes in lifestyle)  B- Developmental intervention: ▪ Infant, toddler, and preschooler: Immunizations Car seat has restraint strap and is used consistently.. Fire, police, and poison control numbers are posted by telephones.  Adolescent: Teenagers take drivers’ education; cautioned about drinking and driving. Older Adult: Food is properly refrigerated. Medications are kept in properly labeled containers with readable print. adequate lighting ,Food is properly refrigerated.  Bathrooms Install grab bars on walls around the tub and beside the toilet, strong enough to hold your weight.. Mount liquid soap dispenser on the bathtub- wall. Install a portable, hand-held shower head. Add a padded bath or shower seat. Install a raised toilet seat if needed. Implementation in Acute Care Safety  Fall risk prevention  Restraints as a last resort  Restraint alternatives  Apply Restraints Restraints: are protective devices used to limit the physical activity of a client or to immobilize a client or extremity. Restraints are used to protect the client, allow for treatment in a safe environment, and reduce the risk of injury to others.  Types of restraints  Chemical : Medications that affect the patient's mood and behaviors.  Physical: Any technique or device that is attached to the patient body that the patient can't easily move and restricts freedom of movement and normal access to the body  Preventing falls Eat or drink sufficient calcium. Get sufficient vitamin D in order to enhance the absorption of calcium into the bloodstream. Engage regularly (e.g., every other day for about 15 minutes daily) in exercise designed to increase muscle and bone strength, and to improve balance and flexibility. Undertake daily activities in a safe manner Wear proper fitting, supportive shoes with low heels or rubber soles. Have regular checkups by an ophthalmologist. Clean eye glasses often to improve visibility. Safety Measures to Prevent Accidental Poisonings Store medications in child-resistant containers Do not take medications in front of children. Never call medicine candy. Limit the number of tablets in a medicine container. Place toxic substances in a locked cabinet out of reach of children. Never remove labels from containers. Do not place poisonous substances in food or beverage containers. Place poison stickers on toxic substances. Display poison control center phone numbers near telephones.  Acute care safety to prevent fires Fires: “RACE” and “PASS” The acronym “RACE” explains priorities during a fire Correct use of a fire extinguisher is demonstrated: Pull the pin (upper left). Aim at the base of the fire. Squeeze the handles (upper right). Sweep from side to side to coat the area evenly (lower right). PASS is the acronym for pull, aim, squeeze and sweep. Rescue patients. Activate alarm. Confine fire. Extinguish. Implementation (cont’d)  Quick Quiz! 2. A newly admitted patient was found wandering the hallways for the past two nights. The most appropriate nursing interventions to prevent a fall for this patient would include A. Raise all four side rails when darkness falls. B. Use an electronic bed monitoring device. C. Place the patient in a room close to the nursing station. D. Use a loose-fitting vest-type jacket restraint.  Safety and the Nursing Process: Evaluation  Through the patient’s eyes Are the patient’s expectations met? Are the family’s expectations met?  Patient outcomes Monitor care by the health care team. Measure outcomes for each diagnosis. Continually assess needs for additional support.  Quick Quiz! 3. A nurse floats to a busy surgical unit and administers a wrong medication to a patient. This error can be classified as A. A poisoning accident. B. An equipment-related accident. C. A procedure-related accident. D. An accident related to time management.  Expected Outcomes  A safe physical environment  A patient whose expectations have been met  A patient who is knowledgeable about safety factors and precautions  A patient free of injury Thank you