Unit 3 Meeting Pt safety Needs.pdf

UNIT 3. MEETING PATIENT SAFETY NEEDS Learning Outcomes After completing this chapter students will be able to:- 1. Identify intervention in:  Providing safety  Providing comfort inclusive of comfort devices (ripple mattress)  Prevention of infection  Prevention of falls  Performing use of rest...

UNIT 3. MEETING PATIENT SAFETY NEEDS Learning Outcomes After completing this chapter students will be able to:- 1. Identify intervention in:  Providing safety  Providing comfort inclusive of comfort devices (ripple mattress)  Prevention of infection  Prevention of falls  Performing use of restraints INTRODUCTION Meeting Basic Needs; 1. Providing for safety 2. Prevention of falls 3. Prevention of infection 4. Providing comfort inclusive of comfort devices (ripple mattress) 5. Use of restraints 1. PROMOTING SAFETY IN THE HEALTH CARE SETTING  Patient safety in the health care setting is of primary importance.  Communication is of utmost importance to protect pt. from errors & maintain continuity of care.  Nurses are the frontline managers of patients care and must be actively involved in the priority of pt. safety and the prevention of medical errors. THE JOINT COMMISSION’S 2014 NATIONAL PATIENT SAFETY GOALS FOR HOSPITALS Goal 1: Improve the accuracy of patient identification Goal 2: Improve the effective of communication among caregivers Goal 3: Improve the safety of using medications Goal 4: Reduce the harm associated with clinical alarm system Goal 5: Reduce the risk of health care – associated Infections Goal 6: Prevent residents from falling Goal 7: Prevent health care – associated pressure ulcers (Decubitus Ulcers) Goal 8: The organization Identifies safety risks inherent in its patient population UNIVERSAL PROTOCOL FOR PREVENTING WRONG SITE, WRONG PROCEDURE (HOSPITALS) The Universal Protocol applies to all surgical and nonsurgical invasive procedures. Hospitals can enhance safety by correctly identifying the patient, the appropriate procedure, and the correct site of the procedure.  Conduct a pre-procedure verification process  Mark the procedure site.  A time-out is performed before the procedure. Universal fall precautions (From preventing falls in hospitals: A Toolkit for Improving Quality of Care, by AHRQ, 2013) 1. Familiarize the pt. with the environment. 2. Have the pt. “teach back” how to use the call light. 3. Keep the call light within reach at all times. 4. Keep the pt’s personal possessions within safe reach. 5. Provide sturdy handrails in pt. bathrooms, rooms, and hallway. 6. Keep the hospital bed in low position with brakes locked when pt. is resting in bed. 7. Provide nonslip, well-fitting footwear. 8. Use night-lights or supplemental light. 9. Keep floor surfaces clean & dry. Clean up all spills promptly. 10. Keep client area uncluttered. Practice Guidelines Preventing Falls among pt. in Health Care 1. On admission, orientate pt to the surroundings and explain the call system. 2. Assess the pt. ability to ambulate & transfer. 3. Provide walking aids & assistance as required. 4. Closely supervise the pt. at risk for falls, especially at night. 5. Encourage the pt. to use the call bell to request assistance. Ensure that the call bell is within easy reach. 6. Place bedside tables and overbed tablets near the bed or chair so the pt.s do not overreach and consequently lose their balance. 7. Always keep hospital beds in the low position & wheels locked when not providing care so that pt. can move in or out of bed easily. 8. Encourage pt. to use grab bars mounted in toilet & bathing areas & railings along corridors. 9. Mare sure non-skid bath mats are available in tubs and showers. 10. Encourage the pt. to wear non-skid footwear. 11. Keep the environment tidy, keep light cords from underfoot and furniture out of the way. 12. Use individualized interventions (eg; alarm sensitive to pt. position) rather than side rails for confused pt. 13. Use mechanical or electronic ceiling lifts to transfer dependent pt. RISK FACTORS AND PREVENTIVE MEASURES FOR FALLS Risk Factor Preventive Measures Poor vision Ensure eyeglasses are functional Ensure appropriate lighting Mark doorways and edges of steps as needed Keep the environment tidy Cognitive dysfunction Set safe limits to activities (confusion, disorientation, Remove unsafe objects impaired memory, or judgement impaired gait or Wear shoes or well-fitted slippers with non-skid soles. balance and difficulty walking Use ambulatory devices as necessary (cane, crutches, walker, braces, because of lower extremity wheelchair) dysfunction (eg; arthritis) Provide assistance with ambulation as needed Monitor gait and balance Adapt living arrangement Difficulty getting in & out of encourage pt. to request assistance chair or in bed Keep the bed in the low position install grab bars in bathroom Orthostatic hypotension Instruct pt. to rise slowly from a lying to sitting to standing position for few several seconds before walking Urinary frequency or receiving Provide a bedside commode diuretics Weakness from disease Encourage pt. to summon help process / therapy Monitor activity tolerance Current medication : sedatives, Attach side rails to – bed tranquilizers monitor orientation & alertness status Infection Prevention Microorganisms occur normally in various locations of the human body such as the surface of the skin and the GI tract. Recommended practices to prevent infection for all patients; 1. Perform proper hand hygiene after contact with blood, body fluids, secretions, excretions, and contaminated objects whether or not gloves are worn. 2. Perform proper hand hygiene immediately 10 Steps to Preventing Spread of Infection in Hospitals Centers for Disease Control and Prevention (CDC), World Health Organization (WHO). 1. Wash Your Hands.  Hand washing should be the cornerstone of reducing HAIs. Wash hands with warm soap and water vigorously for at least 20 seconds. Also, all staff members and people in the facility should be encouraged to wash their hands before drinking, eating, providing care and between caring for patients. 2. Create an Infection-Control Policy.  The infection control policy details what patients have the highest risks for contracting or passing along HAIs. The policy should include information on when patients should be placed on isolation precautions or otherwise preventing contact with other patients and staff.  Hand washing should be the cornerstone of reducing HAIs. 3. Identify Contagions ASAP.  Highly contagious infections, such as clostridium difficile (c. diff), should be identified as early as possible. For example, any patient admitted with diarrhea should be immediately tested for c. diff. Similarly, people with respiratory issues should be tested for the flu. 4. Provide Infection Control Education.  Staff members need to know how to identify common infections and help prevent their spread. Consequently, your organization should provide continued, recurring education on infection control. This includes training on bloodborne pathogen and droplet-borne infections. 5. Use Gloves.  Health care professionals may not always wear gloves when interacting with patients. But, if any contact with blood or bodily fluids is possible, such as when changing sheets or emptying trash, gloves should be worn. 6. Provide Isolation-Appropriate Personal Protective Equipment.  Isolation-appropriate protective equipment includes waterproof gowns, gloves, shoe covers, face shields and masks. If patients have a contagious illness, appropriate isolation equipment should be readily available for use. 7. Disinfect and Keep Surfaces Clean.  Between patients, every room in a facility should be cleaned thoroughly with a bleach-containing cleanser. This helps to prevent accidental transmission of infections as new patients are admitted. Furthermore, non-patient areas, such as the breakroom and nurses’ station should be cleaned daily. 8. Prevent Patients From Walking Barefoot.  No one really wants to wear shoes when ill, but all patients should be encouraged to wear slippers or non-slip socks when walking in the hospital, including in their patient rooms. Although this seems extreme, nurses and other persons entering individual rooms can carry pathogens into the room from other areas and patient rooms. 9. Change Linens When Daily and When Dirty.  Linens should be properly sanitized and cleaned in laundry, but they should not be left on patient’s beds for extended periods. Linens should be changed daily and whenever visibly dirty. Furthermore, linens that fall on the floor should immediately be sent back to laundry for cleaning. 10. Make Sure Foods Are Kept at Proper Temperatures.  Most hospitals and health care facilities have refrigerators for patient snacks on individual units. The temperature such equipment should be checked every shift for food safety reasons. Furthermore, patients should be encouraged to eat their meals when they arrive. If food stays out in a patient’s room for several hours, it should be trashed to prevent spoilage and the possibility of acquiring an infection. STANDARD PRECAUTIONS PRACTICES (MINISTRY OF HEALTH MALAYSIA) Standard Precautions involve work practices which avoid direct contact with blood and all body fluids and guard against needle-stick injuries and exposures to mucous membranes. The infection control practices should include: 2.2.1 Hand washing. 2.2.2 Appropriate use of personal protective equipment (PPE) including gloves, mask, eye goggles, face shield and gown. 2.2.3 Use of disposables and proper cleaning, disinfection and sterilisation of patient-care equipment. 2.2.4 Proper housekeeping and management of spillage. 2.2.5 Management of soiled/contaminated laundry 2.2.6 Disposal of sharps and infectious wastes 2.2.1 Hand washing  Hand washing is a process of removing of transient, potentially pathogenic micro-organisms from the hands and it is a critical factor in the management of patients with HIV/AIDS.  Hands should be washed routinely (5 moment of hand hygiene) 2.2.2 Appropriate use of personal protective equipment (PPE) i) Gloves a) Sterile surgical gloves should be worn for all surgical and invasive procedures. b) Disposable latex/rubber gloves should be worn when touching blood, body fluids, secretions, mucous membranes, non-intact skin, excretions, and contaminated items. c) Gloves should be promptly removed after touching these materials. d) Change gloves in between procedures and between patient contacts. e) Gloves should be discarded after a procedure. f) Hands should be washed immediately after removing gloves. ii) Masks, eye goggles or face shields  Mask, eye goggles or a face shield should be worn to protect mucous membranes of the eyes; nose; and mouth only when performing patient-care procedures that are likely to generate splashes of blood, body fluids, secretions and excretions.  Examples of such procedures are irrigation and suction procedures, delivery and dental procedures etc. iii) Plastic aprons/gowns  A separate disposable apron/gown should be worn for each patient. It is worn to prevent soiling of clothing when performing patient-care procedures that are likely to generate splashes of blood, body fluids, secretions or excretions. iv) Rubber boots/overshoes  Rubber boots and plastic disposable overshoes may be worn if a large area of floor is grossly contaminated with spillage. 2.2.3 Proper housekeeping and management of spillage i) Proper housekeeping  There should be a regular cleaning schedule which is diligently adhered to keep the environment clean and safe. ii) Management of spillage a) The spillage should be dealt with as soon as possible. b) Disposable latex/rubber gloves should be worn throughout the procedure. c) Rubber boots and plastic disposable overshoes may be worn if a large area is grossly contaminated with the spillage. d) Freshly prepared Sodium hypochlorite (Chlorox)* 1 : 10 or sprinkle Chloride granules to cover the spillage and left for 5-10 minutes. If it is a large spillage, it may be covered with suitable absorbent material. e) The spillage should be wiped up using paper towels or suitable absorbent material. Avoid direct contact between gloved hands and the spillage. f) The area should be mopped with Sodium hypochlorite (Chlorox)* 1 : 100. g) For a large spill, a mop can be used to wipe instead, but the mop needs to be disinfected with sodium hypochlorite and rinsed thoroughly. h) Broken glass pieces should be carefully swept with a broom and discarded into a sharps container. i) Equipments used for management of spillage should be decontaminated. 2.2.4 Disinfection and sterilisation of patient-care equipment a) Disposable, single-use instruments and items should be used whenever possible. b) When reusable items are used, they must be thoroughly cleaned, disinfected and sterilised after each use. However, no special procedures are required in the existing disinfection and sterilisation procedures to deal with the HIV virus. (Refer to Disinfection and Sterilization Policy, KKM 1998). c) Safety precautions should be practised in handling sharp instruments at all times. d) HIV is readily destroyed by heat at 70-80° C. If autoclaves are not available, reusable items may be disinfected by boiling for 10-30 minutes. 2.2.5 Management of soiled/contaminated linen a) Staff handling ward linen should wear disposable latex/rubber gloves and masks at all times. Handling should be done only when necessary and no sorting is allowed. b) Used linen should be placed into laundry bags at site. c) Soiled linen soaked with blood or body fluid should be placed into appropriate laundry bags with biohazard label. 2.2.6 Disposal of sharps and infectious wastes i) Disposal of sharps a) Sharps containers must be placed at the work sites. b) Needles should not be removed from disposable syringes, recapped, bent or broken by hands. c) Sharps (loose needles, scalpels, blades, razors, IV administration sets, glass pieces and ampoules) should be picked up with forceps and discarded into sharps containers. d) Sharps containers should not be more than two-thirds full before disposal. ii) Disposal of infectious Wastes a) Wastes contaminated with blood and blood products (including blood packs) and soiled dressings should be discarded into yellow-coloured bags, ensuring that no leaking of fluid from the bag. b) Excreta and other body fluids should be discarded directly into the toilet or into the sluice that is directly connected to the sewage system. COMFORT DEVICES / SUPPORTIVE DEVICES  For circulation to remain uncompromised, pressure on the bony prominences should remain below capillary pressure for as much time as possible through a combination of turning, positioning, and use of pressure-relieving surfaces. Types of support surfaces can be used to relieve pressure  Ripple Mattress  Mattress made of foam & gel combination  high-air-loss beds  low-air-loss beds  beds that provide kinetic therapy – provide continuous passive motion  pillows made of foam, gel, air Purpose of comfort devices  To provide pressure relief, eliminate shearing, and friction, and decrease moisture RESTRAINING PATIENTS  Restraints are devices used to limit the physical activity of a pt. or a part of the body.  The decision to use a restraint must be based on a comprehensive, individualized client assessment. Type of restraints i) Physical restraints : any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body , or head freely (Center for Medicaid Services, (CMS, 2008). ii) Chemical restraints: involve using a medication to control behaviour or to restrict the client’s freedom of movement and is not a standard treatment for the client’s medical or psychological condition. Purposes of Restraints i. To promote safety and prevent injury. ii. To allow a medical or surgical treatment to proceed without pt. interference (eg; to prevent movements that would disrupt therapy to a limb connected to tubes or appliance). Standards for use of Restraints and Seclusion  To ensure – pt. immediate physical safety, even if the pt. is not violent / self-destructive.  Seclusion may only be used for – management of violent or self-destructive behaviour that is an immediate threat to – pt’s physical safety.  To use when less restrictive interventions have been determined to be ineffective to protect – pt., staffs or others from harm.  The type / technique of restraints & seclusion used must be the least restrictive intervention that will be effective to protect- pt., staff, other from harm.  To be implemented in accordance with safe & appropriate techniques per hospital policy.  To discontinued at the earliest possible time. Selecting a Restraint i) It restricts – pt. movement as little as possible. ii) It is safe for the particular pt. which cannot self-inflict injury. iii) It does not interfere with the pt’s treatment / health problems. Eg; pt. has poor blood circulation to the hands, apply a restraint that will not aggravate that circulatory problem iv) It is readily changeable, when soiled, v) Choose a restraint with minimal disturbance to – pt. vi) Use less obvious, to feel comfortable Types of Restraints i) Adults : Jacket / vest restraints, belt restraints, mitt / hand restraints, & limb restraints, Geri chairs, wheelchairs with lap trays, bed rails. PRACTICE GUIDELINES – APPLYING RESTRAINTS i. Obtain consent from – pt. ii. Ensure – a primary care provider’s order / agency policy – provided. iii. Assure pt. & family that the restraint is temporary & protective. iv. Apply in such a way that the pt. can move as freely as possible while remaining safe. v. Ensure that limb restraints are applied securely but not so tightly that they impede blood circulation to anybody area or extremity. vi. Pad bony prominences (eg: wrists & ankles) before applying a restraint over them to prevent abrade then skin. vii. Always tie a limb restraint with a knot (eg: a clove hitch) that will not tighten when pulled viii. Tie the ends of a body restraint to the part of the bed that moves to elevate the head. ix. Never tie the ends to a side rail or to the fixed frame of the bed if the bed position is to be changed x. Assess the restraint per agency protocol time frame. xi. Assess skin integrity per agency protocol (eg; every 2 hours), and provide range-of-motion (ROM) exercises and skin care when restraint. xii. Assess & assist with basic needs xiii. Reassess the continued need for the restraint xiv. When a restraint is temporarily removed, do not leave the pt. unattended. xv. Loosen the restraint and exercise the limb, if indicated cyanosis, or pt. complaint of pain.. ASSESSMENT BEFORE APPLYING RESTRAINTS i. The behaviour the possible need for a restraint ii. Underlying cause for assessed behaviour iii. What other protective measures may be implemented before applying a restraint. iv. Status of kin to which restraint is to be applied v. Circulatory status distal to restraints & of extremities vi. Effectiveness of other available safety precautions MORSE FALL SCALE REFERENCES: From Hospital: 2014 National Patient Safety Goals, The Joint Commission, 2013a. Retrieved http://www.jointcommission.org/hap_2014_npsgs; and Long Term Care (Medicare/ Medicaid): 2014 National Patient Safety Goals, The Joint Commission, 2013b.