Patient Safety and Fall Prevention (PDF)

# Patient Safety ## Chapter 27 NURS 300 ### Objectives 1. Describe the complex nature of clinical judgement for nurses delivering patient-centered care for patients improved safety. 2. Explain the rationale for vulnerable populations being at risk for threats to safety. 3. Discuss common environm...

# Patient Safety ## Chapter 27 NURS 300 ### Objectives 1. Describe the complex nature of clinical judgement for nurses delivering patient-centered care for patients improved safety. 2. Explain the rationale for vulnerable populations being at risk for threats to safety. 3. Discuss common environmental hazards and methods for preventing them. 4. Describe how a nurse assists patients in managing safety risks in the home. 5. Discuss how an individual's developmental stage creates safety risks. 6. Conduct an assessment of mobility alterations that pose risks for falling. 7. Conduct a fall risk assessment in a health care agency setting. 8. Describe ways to prevent procedure-related accidents. 9. Describe assessment activities that identify the psychosocial status of patients as it pertains to their safety. 10. Explain the role critical thinking and clinical judgement play in planning care for a patient's safety needs. 11. Discuss how to select environmental interventions for fall prevention for the hospital and home environment. 12. Identify evidence-based alternatives to restraints for patients who are alert, oriented and low-risk. 13. Identify factors to assess before and during placement of patients in physical restraints. ### Safety Defined - Freedom from psychological and physical injury - Safety is a basic human need - IOM report To Err Is Human: Building a Safer Health System (IOM, 2000) - Patient Safety- prevention of errors and adverse effects associated with health care (WHO, 2021) ### Culture of Safety in Healthcare- Agency for Healthcare Research & Quality (2019) - Acknowledgement of high-risk nature of activities and the determination to achieve consistently safe operations - Blame-free environment where individuals are able to report errors or near misses without fear of punishment - Encouragement of Collaboration - Organization commitment of resources to address safety concerns ### Why is Safety Important in HealthCare Settings - Reduces the incidence of illness and injury - Prevents extended length of stay - Improves or maintains functional status - Increases patient's sense for well-being - Contains the cost of healthcare ### Falls - Age 65 and older, falls are the leading cause of unintentional death - **Factors that lead to increase falls in elderly** - Reduced vision - Orthostatic hypotension - Lower extremity weakness - Gait and balance problems - Urinary incontinence - Improper use of walking aids - Effects of various medications - **Other hazards are** - Improper lighting - Barriers in normal walking paths (rugs, cords) - Spills on floors - Lack of safety devices in home ### What can nurses do to help prevent falls? ### Causes of Falling in People with IDD - Individuals with IDD are at high risk for Falls - **Arthritis** - Pain may not be expressed verbally, but may be causing difficulty in ambulation. - **Seizures** - Can present in several ways including increased falls. - **Medications** - Can be sedating; cause blood pressure to drop, or affect balance and increase risk of falling. - **Vision** - Poor vision may not be verbally expressed but can cause falling if people are less able to see obstructions. - **Dehydration** - may cause orthostatic hypotension, causing a falls - **Hypoglycemia** - when blood sugar drops they are at increased risk for fall, may not be able to express what they are feeling. - **Infection** - severe infections (sepsis) can increase risk of falls. - **Brain conditions:** brain tumor, Multiple sclerosis, parkinsons, strokes... - **Ear related conditions:** meniere's disease, vertigo can cause dizziness - **Unfamiliar Environments:** May cause confusion, and increase incidence of falls ### Preventing Falls in People with IDD - Review medications that could be contributing. - Assessing for reversible health conditions. - Assessment for proper, well fitting shoes. - Removing hazards like cords, small tables, loose rugs, clutter and spills. - Providing adequate lighting. - Installing grab bars and railings. - Using assistive devices when necessary. ### Safety Risk by Developmental Age | Age Group | Safety Risk | |-----------------------|---------------------------------------------------------------------------------------------------------| | Younger than 5 years | At greatest risk for home accidents that result in severe injury & death. | | School-aged child | At risk at school and transporting back and forth to school. Start participating in team and contact sports. Use of protective equipment: helmets. Instruct use seatbelts. | | Adolescent | Greater independence. Begin to develop a sense of identity. Peer pressure. Engage in risk taking activity: alcohol, drugs, smoking. Teen driving. Sexually active. Suicide. | | Adult | Lifestyle habits: smoking, drinking, driving under influence. Hazards at work. Stress from work and family, juggling many roles. Headaches, GI upset. | | Older Patient | Psychological and physiological effects. Dementia. Falling eyesight and hearing. Fear of falling. | ### Serious Reportable Events SRES - If these events occur the healthcare provider involved completes and incident report. - **Incident report is confidential document that describes patient accidents that occur on the premises of a health care agency.** - Allow an organization to identify trends & patterns throughout the facility & areas for improvement. ### "Never Events" - CMS Centers for Medicare & Medicaid Services named select serious reportable events (SRES) as "Never Events". These are adverse events that should never occur in a healthcare setting. - CMS denies hospitals higher payments resulting from or complicated by a "never event". - Many hospitals-acquired conditions are NURSE Sensitive indicators - Indicate that a nurse can directly impact their development, such as a fall or a Stage III pressure ulcer. ### Current NQF List of "Never Events" #### Surgical Event - Surgery performed on the wrong body part - Surgery performed on the wrong patient - Wrong surgical procedure on a patient - Retention of a foreign object in a patient after surgery or other procedure - Intraoperative or immediately post-operative death in a normal health patient (defined as a Class 1 patient for purposes of the American Society of Anesthesiologists patient safety initiative. ### Never events continued #### Product or Device Event - Patient death or serious disability associated with the use of contaminated devices, or biologics provided by the healthcare facility. - Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended (injecting air). - Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility. #### Patient Protection Event - Discharge or release of patient of any age who is unable to make decisions to anyone other than an authorized person. - Patient death or serious disability associated with patient elopement (disappearance) for more than four hours. - Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a healthcare facility. ### Never Events cont #### Care Management Event - Patient death or serious disability associated: - medication error - hemolytic reaction due to the administration of ABO-incompatible blood or blood products - Maternal and/or neonate death or serious injury associated with labor and delivery in low-risk pregnancy. - Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility. ### Never Event #### Environmental Event - Patient death or serious disability associated with an electric shock while being cared for in a healthcare facility. - Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances. - Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility. - Patient death associated with a fall while being cared for in a healthcare facility. - Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility. ### Never Events continued #### Criminal Event - Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider. - Abduction of a patient of any age. - Sexual assault on a patient within or on the grounds of a healthcare facility. - Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare facility. ### Restraints #### Types - **Physical restraints** are physical or mechanical devices that immobilize a patient. - **Chemical restraints** are medications such as anxiolytics and sedatives used to manage a patient's behavior. #### Orders - RN may apply restraint based on patient behavior. - Provider needs to assess patient and order restraint within 1 hour of restraint application. - Restraint orders expire after 24 hours and cannot be PRN. #### Implementation - Assess patient every 30 minutes (check circulation). - Release restraints every 2 hours (check for skin breakdown, perform ROM, assess behavior) - Use quick-release method (slip knot, clasp) to secure the restraint. - Never tie restraint to bed rail. - Discontinue restraints when no longer indicated. - Restraints are not a solution! Only a temporary way to maintain patient safety. - Used as a last resort when patient's behavior poses risk of injury to themselves or others. ### Hazards Associated with Restraints - Immobilization: - Suffocation from entrapment or strangulation - Changes in mental status - Impaired circulation: - Fractures - Diminished muscle and bone mass - Altered nutrition and hydration - Aspiration and breathing difficulties ### Alternatives to restraints - Orient patients and families. - Sitters or companions. - Diversionary activities. - Locate near nurses station. - Calm, simple statements and physical cues. - Use de-escalation techniques to manage aggressive behavior. - Provide visual and auditory stimuli. - Promote relaxation techniques and normal sleep patterns. - Institute exercise and ambulation schedules. - Attend frequently to toileting, food, and liquid. - Hide intravenous lines with clothing, stockinette or kling dressing. - Evaluate all medications patient in receiving and give proper pain management. - Reassess physical status and review lab findings. The attached document contains information regarding patient safety. It outlines objectives, defines safety, explores the importance of safety in healthcare settings, discusses falls, and the causes of falling in people with IDD. It also explores the importance of preventing falls, and outlines safety risks by developmental age. It summarizes serious reportable events (SRES) and "Never Events" while defining the different components of each category. The attachment also contains information on restraints including types, orders, implementation, hazards of restraints and alternative solutions.