Patient Safety 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....

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 prvening them. 4. Describe how a nurse assists patients in managing safety risks in the home. 5. Dsicuss how an individual’s developmental stage creats safety risks. 6. Conduct an assessement of mobility alternations 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 heatlh 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 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 ○ Spills on floors ○ Lack of safety devices in home What can nurses do to help prevent falls?Highfallrisksiderails bed alarms Causes of Falling in People with IDD Individuals with IDD are at high risk for Falls Arthritis – Pain may not be expressed Dehydration – may cause orthostatic verbally, but may be causing difficulty hypotension, causing a falls in ambulation Hypoglycemia – when blood sugar drops Seizures – Can present in several they are at increased risk for fall, may not ways including increased falls be able to express what they are feeling Medications – Can be sedating, Infection – severe infections (sepsis) can cause blood pressure to drop, or affect increase risk of falls balance and increase risk of falling Brain conditions: brain tumor, Multiple Vision – Poor vision may not be sclerosis, parkinsons, strokes… verbally expressed byt can cause Ear related conditions: meniere’s disease, falling if people are less able to see vertigo can cause dizziness obstructions Unfamiliar Environments: May cause confusion, and increase incidence of falls  Review medications that could be Preventing Falls in contributing People with IDD 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 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 drugs, 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 –Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility will kill the patient 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) Restraints are not a solution!! Only a Use quick-release method (slip knot, clasp) to secure the temporary way to maintain patient safety. restraint Never tie restraint to bed rail Used as a last resort when patient’s behavior Discontinue restraints when no longer indicated poses risk of injury to themselves or others. Hazards Associated with Restraints 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 is receiving and give proper pain management Reassess physical status and review lab findings