Safety - Giddens Concept 45 PDF

**Safety -- Giddens Concept 45** ANA Code of Ethics - Nurse promotes, advocates for and strives to protect the health, safety and rights of patient - Utilize red wordbook to study - IOM's definition of safety - Freedom from accidental injury - Giddens - Freedom from ac...

**Safety -- Giddens Concept 45** ANA Code of Ethics - Nurse promotes, advocates for and strives to protect the health, safety and rights of patient - Utilize red wordbook to study - IOM's definition of safety - Freedom from accidental injury - Giddens - Freedom from accidental injury; ensuring patient safety involves the establishment of operational systems and processes that minimize the likely hood of errors and maximizes the likelihood of intercepting them when they occur Safe Care - Avoiding injuries to patients from care that was intended to help them - Using evidence in clinical decisions to maximize health outcomes while reducing potential harm - Types of Errors - Diagnostic errors - Result from diagnosis or failure to test or failure to act on results of test - Treatment errors - Occur in performance of procedure, operation, test, or avoidable delay of treatment - Failure to use soap after surgery and they develop an infection - Preventative errors - Error from treatment or lack of monitoring - Failure to read vital signs after surgery, watch for hemrogaging, administer meds to prevent blood clots or SCDs, give them asenmin speromitor - Communication failure - Communicate in timely manner - Can result in treatment errors - Latent error - Flaw in system that does not immediately lead to an accident - Doesn't immediately affect patient, could become an active error - Wrong medication in wrong spot - Active Error - Typically spawns from latent error - Directly affect patient - Nurse pulls wrong medication, doesn't check it, administers to patient - Levels of Errors - Adverse Event - Unintended harm caused by act of commission or omission - Largely preventable - Near Miss - Error of commission -- did not provide care correctly - Errors of omission -- did not provide care - Serious harm did not occur but could have - Sentinel Event - Unexpected occurrence involving death or serious injury, or risk thereof - **Signal need for immediate investigation and response** - QSEN Project (quality, safety, evaluation of nurses) - Competencies needed to keep patient safe - Knowledge - Skills - Attitudes - Focus area competencies - Patient Centered Care - Evidence based care - Teamwork and collaboration - Safety - Quality improvement - Informatics - Culture of Safety - Historically, blame has been on person that had the error - Now, the focus is on what went wrong, rather than who to blame - Culture of safety needed to prevent errors - High Reliability Organizations (HROS) - Manage work that involve hazardous environments in which consequence of errors is high, but occurrence of errors is low - Work to predict and prevent errors, rather than reacting to errors - Reluctant to simplify, know that taking shortcuts can lead to errors - Just Culture - Health care systems value is in reporting errors without punishment - Seeks to find a balance between the need to learn from mistakes and the need for disciplinary action against employees - Human error vs at risk vs reckless - Focuses on effective communication - Best way to have safety - Transparency in health care - Ethical responsibility - Improves outcomes, fewer errors, more satisfied patients, lower costs - Open communication w/ patients and families - Disclosure of errors is key - Interrelated concepts - Health care quality - Care being delivered matches ideal care - Communication - Standardized communication promotes safety - Collaboration - Conflict resolution to promote best care outcomes - Care coordination - Cross departmental coordination to address patient needs - Exemplars - Fall prevention - Concern for all ages - Bed in lowest position - Call light - Table w/in reach - Assistive devices - Rounding - Environmental Adaptation - Free of clutter - They know their way around - Minimization of psychoactive medications - Postural hypotension - Drop in blood pressure with position changes (sitting to standing) - Footwear and foot problems - Balance, strength and training exercises - MOST IMPORTANT, WE WANT THEM TO CALL FOR HELP - Medication administration - Most common errors in acute setting - 3 medication checks - 2 identifiers - Care coordination - Poorly coordinated care systems lead to safety compromise - Team systems - Effective team functioning - Error reporting - Adverse outcomes can only be addressed when they are reported - Morse Fall Risk - History of falling? - 25 points - Secondary Diagnosis - 15 points - Ambulatory Aid? - 0-30 points - No -- 0 - Crutches, canes - 15 points - Furniture -- 30 points - IV or IV Access - 20 points - Gait - 0-20 points - Normal, bedrest, wheelchair -- 0 points - Weak -- 10 - Impaired -- 20 - Mental Status? - 15 points - **Risks -- must have memorized** - High Risk -- 45 and higher - Moderate Risk -- 25-44 - Low Risk -- 0-24 - 60 second assessment - Helps develop situation awareness in patient area - Promotes safer patient care environment and helps nurse set priorities for care - General survey/observation of patient, family, and environment - Includes observing - ABCs -- not touching - Airway - Breathing - Circulation - Tube lines - Respitatory equipment - Patient safety - Environmental survey - Sensory -- what do senses tell you **HAC's -- Hospital acquired conditions** - High cost and/or high volume - Could have reasonably been prevented - Examples - Foreign body retained after surgery - Air embolism -- air through IV line - Pressure ulcers/DTI - Falls/trauma - Complications of diabetes - CAUTI -- UTI from catheter, comes from not inserted sterile or not maintained appropriately - Surgical Site infections - DVT/PE - CLABSI -- Central line associated blood site infection - Blood compatibility Standard precautions - Gloves for blood or body fluid - Alcohol based hand sanitizer when not visibly dirty - Anything that might splash = face protection - Clothing potential = gown Never Events - Adverse Events that are unambiguous, serious, and usually preventable -- result in death or serious disability -- different from sentinel events but similar - Performing surgery on wrong patient/body part - Retention of a foreign body - Error embolism - Discharging a patient that is unable to make decisions - Medication errors - Suicide in hospital - Person impersonating doctor or nurse - Abductions or sexual assault on hospital grounds - Sending baby home w/ wrong parents Sentinel Events - **Unexpected** events involving death or serious physical injury, or risk thereof - Require immediate investigation/response National Quality Forum (NQF) -- lab manual - Set standards for quality improvement and reporting. Membership based -- enhancing healthcare value, patient, safety and improved outcomes - 34 safe practices National Patient Safety Goals -- goal is to improve pt safety -- **problems in health care and how to solve them** - Id patient correctly - Improve staff communication - Use meds safely - Use alarms safely - Prevent infections - Identify patient safety risks - Prevent mistakes in safety **Nurse Practice Act** - **Series of state laws** - **Defines scope of practice** - **Sets standards for education programs** - **Sets licensure requirements** - **Disciplinary actions** **Self Management -- Giddens concept 7 and NCLEX ch 13** Self management - Day to day tasks an individual must undertake to control or reduce the impact of disease on physical health status - Or - Individual's ability to manage the symptoms treatment physical and psychosocial consequences and lifestyle changes inherent in living w/ chronic conditions - Must be able to relay information to their provider - Ex -- reporting blood glucose levels over past two weeks to pcp Scope of self-management - Absence of self-management - Optimal self-management Ability to self-manage is going to vary from person to person and stage of life to stage of life Attitudes and criteria that affect self-management - Self efficiency-confidence in ones ability to reach outcome - How to improve -- education experiences that improve knowledge of their condition. Ongoing successful performance of daily tasks - Engaging in shared decision making and problem solving w/ caregivers - Individual and community-based support services - Patient engagement-having willingness to self-manage - Health education -- have to expand knowledge - Patient-provider relationship -- provider gives them tools to self-manage - Disease manage -- work management into life style Context of nursing and healthcare - Health enhancement and wellness - Eat right - Exercise - Sleep well - Pre-disease/disease prevention - Prehypertension - Prediabetes - Disease/new diagnosis education and management - Must make lifestyle changes - Education related to disease and management - Acute event management - Heart attack, stroke, etc. Interrealted concepts - Adherence to treatment - Patient doing treatment - Optimal management means few or no symptoms or limited interference in day to day life - Patient education - Education to help patient understand causes and consequences of disease - Health promotion - Helping individuals and communities take control of health - Care coordination - Multiple health care providers, maybe a pcp and endocrinologist - Collaboration - Between patients and providers - Health disparities - Populations shown to have higher disease and poorer self management skills - Elderly, those in poverty, etc Exemplars - Prenatal care - Depression - Pediatric asthma - Type 2 diabetes Immobility -- potter and perry ch 39 - mobility -- person's ability to move freely - immobility -- person's inability to move freely - bedrest can impact muscle deconditioning - lose muscle mass \@3% per day - Nervous system regulates movement and posture - Factors affecting mobility - Balance - Can be affected by diseases - Gravity - Alignment - Reduces strain - Aids in maintaining adequate muscle tone - Contributes to balance and conservation of energy - Friction - Factors affecting mobility - Pathological influences on mobility - Postural abnormalities (scoliosis) - Muscle abnormalities (parkinsons) - Damage to the central nervous system (trauma from head injury, menogitis) - Direct trauma to the musculoskeletal system (bruise, fracture) - Joint disease (arthritis) - Nursing Process -- Assessment - Through the patient's eyes - Do they feel like they're moving well today - Mobility and activity tolerance - Range of motion - Questions about stiffness, swelling, and pain - Compare both sides of body, look for equal/unequal movement - Assess gait - Body alignment when sitting/standing/laying down **Functional Ability -- Giddens concept 2 -- highly covered in exam Tuesday** - Person's ability to perform normal daily activities required to meet basic needs, fulfill role in family, workplace, and community, and maintain health and well-being - Cognitive, social, physical, and emotional ability to carry on normal activities of life - Continuum from full function to disability - Function - Disability -- negative aspects of a person's physical or social limitation - Impairment -- physical abnormality that contributes to limitation and is part of disease process - Basic activities of daily living (BADLs) - Instrumental activities of daily living (IADLs) - Lifespan considerations - Influenced by - Development stage - Physical health - Psychosocial health - Cognitive ability - Social and cultural factors - 12 ADLs central to human life according to roper-logan Tierney model of nursing - Maintain safe environment - Elimination - Breathing - Person cleansing/dressing - Communication - Maintaining body temperature - Mobilizing - Working and playing - Eating and drinking - Sleeping - Expressing sexuality - Dying - Risk recognition - Essential to the early identification of factors that affect function - Risk reduction should be focus for patients with identified risks - Mental health issues - Aging - Teach patients and families about factors associated with the maintenance of high level functional ability - Exercise - Diet - Following medication regimen - Well visit checks - Stress management - Avoiding tobacco and other substances - Functional assessment conclusion - Levels of assistance or dependency - No assistance - Partial assistance - Total assistance - Levels of difficulty - Some difficulty - A lot of difficulty - Unable to perform - Care Delivery - Maintain optimal independent function and prevent functional decline for health-related quality of life - Risk assessment - Early detection and screening - May involve different aspects of health care system - Clinical Exemplars - Primary vs secondary - Primary conditions affecting functional ability -- affect functional ability from day 1 - Autism - Cerebral palsy - Down syndrome - Secondary conditions affecting functional ability -- affect functional ability later in the disease process - Alzheimer's Disease - Parkinson's disease - Rheumatoid arthritis - Cerebral Palsy - Group of neurologic disorders that affect body movement, posture, and muscle coordination - Caused by abnormal development or injury to developing brain, usually occurs before birth, during birth, or in first few years of childhood - They have impaired movement and muscle coordination - Autism spectrum disorder - Broad category of conditions with a wide range of impairments and disabilities affecting children in early childhood that lasts throughout life - Two areas of dysfunction-social impairment and repetitive behaviors - More common in males, cause is not understood -- could be genetic or environmental factors - Alzheimer's disease - Irreversible progressive brain disease - Common cause of dementia in older adults - Loss of cognitive functioning, behavioral changes resulting in a decline of functional ability - Pain is not a side affect - Rheumatoid arthritis - Systemic autoimmune condition with genetic predisposition, creates an inflammatory process in the synovial membrane of the joints and other body tissues - Joint inflammation leads to erosion of cartilage, causing pain, swelling and joint deformity resulting in significant functional ability and mobility - Parkinson's Disease - Neurologic disorder caused by a loss of dopamine-producing cells in brain resulting in motor disability - Four primary symptoms - Tremors - Rigidity - Bradykinesia - Impaired balance and coordination - Usually occurs in adults over age 50, more common in men - Guillain Barre Syndrome - Neuromuscular disorder characterized by muscle weakness and tingling that starts in lower extremities and progresses to the upper body and arms - Can turn into paralysis - Most can completely recover but severe cases can lead to death - Rare disorder in which the body's immune system attacks the nervous system. Exact cause is unknown - Multiple Sclerosis - Complex neurodegenerative disease affecting the central nervous system - Patients may experience a wide array of neurological symptoms that can vary by individual -- progression varies by individuals - Functional ability may become impaired as a result of visual disturbances, muscular/limb weakness, difficulty walking, generalized fatigue, and bowel difficulty - May be a result of an autoimmune disorder typically seen in ages of 20-40 - Health History -- formal method of obtaining health information on patient - Biographical information - Age - Gender - Address - Insurance info - Occupation - Working status - Marital status - Chief concern - Why are they here? - Tell me more about what brought you in today? - Patient expectations - Present illness or health concerns - Past health history - Hospitalized, injured, prior surgeries? - Have they ever had an illness that altered functional ability? - Medication history - Allergies - Patient habits - Emotional status - Lifestyle patterns - Family history - Immediate and blood relatives - Reveals information about the family structure, interaction, and support - Provides risk for illness - Psychosocial history - Support system - Grief and coping - Stress - Spiritual health - Life experiences - Beliefs - Rituals - Review of systems - Comprehensive review of systems - What is their normal functioning? - Do a physical assessment - Observation of patient behavior - Verbal and nonverbal - Function status - Does the information we gather match what patient is communicating to us - Subjective vs Objective - Subjective -- what patient is communicating to us - Objective -- what we see, hear, touch, smell -