Zusammenfassung der Ressource
Patient Safety and Quality by Erin
Bates-Meehan
- Environment = Physical/Psychosocial Factors Across Various Settings ( ex. community, home, hospital, school, etc.)
- SAFE ENVIRONMENT=Reduced hazards & transmission of pathogens, controlled pollution, maintained sanitation & basic needs met
- BASIC NEEDS (Maslow)
- OXYGEN (Assess Risk: Smoking, Functioning Heat/Co2 Monitor)
- NUTRITION (FDA Regulates@Risk FoodBorne Illness=Peds, Pregnancy, Elderly, Immunocompromised/Poor sanitation, storage)
- TEMP (WNL= 18.3-23.9C @Risk Hypothermia=peds, elderly, homeless, excess ETOH/drug, Cardiovascular Cond./@Risk Hyperthermia=infant, elderly, chronic ill
- Safety = adequate food sanitization
- PHYSICAL HAZARDS (Nurse Role=Education&Prevention)
- MVA (seatbelt, airbag, helmet law)
- POISON (lock cleaning solutions, know poison control number)
- FALLS(adequate light, clear clutter, remove loose
rugs, secure home)*
- DISASTERS (flood, hurricane, bioterrorism)
- FIRE (smoke and CO2 detectors, fire extinguishers, new/safe space heaters)
- POLLUTION (Contaminated water, air, soil, noise-if H2O polluted, drink bottled, etc.)
- TRANSMISSION OF PATHOGENS
- #1 means of transmission = Hands
- Good Hand Hygiene Essential!!
- Always - Educate Family
- Blood/Body Fluid
- High Risk Behavior (HIV Hep C)
- Needle Exchange Programs
- IMMUNIZATION (Reduce and prevent transmission of
disease)
- Nurse Role-Educate
Parents
- Fecal-Oral Route
- Medical/Surgical Asepsis
- Ensure proper disposal of human waste
- Identify Relevant Nursing Diagnoses Assoc. W/ Safety Risks (p.382)
- Risk for falls
- Risk for Injury
- Deficient Knowledge
- Risk for Trauma
- Risks/Interventions per Developmental Stages
- Infant,Toddler,Preschooler
- #1 RISK = Injury (<5 =greatest risk of serious home injury
- Oral Activity=choking/Poisoning
- Limited Coordination=Falls(bike, playground equip)
- Exploring=drowning
- INTERVENTION
- Educate Parents: Immunizations, Home Safety, Incorp Safety into Care Plan
- School Age Child
- Risks
- Head Injury
- Contact
Sports
- Intervention
- Helmet/Seat belt
- Safe Play/Proper
Equipment
- Adolescent
- Risky
Behavior
- Peer
Infuence
- Substance Abuse
- Suicide
- Highest rate of
MVA
- INTERVENTION
- Assess for psychosocial
clues
- Provide examples/Set
expectations
- Environmental
clues
- Awareness of
risks
- Educate no
Cell/Text/Seatbelt
- Adults
- Risks
- Lifestyle
Habits
- Stress/Smoking
- Interventions
- refer to resources
- Encourage lifestyle changes
- Older Adult
- Risks
- decreased independence
- falls/accidents
- wandering
- physiological
changes d/t aging process
- multiple meds
- Interventions
- Provide resources on maintaining independence
- Educate on safe
driving
- prevent
burns/scalding
- reduce pedestrian
accidents
- Pt. Safety = Serious National Health Care Challenge
- Individual Risk Factors
- Lifestyle
- Impaired Mobility
- Sensory/Communication Deficit
- Lack of Saftey Awareness
- 4 Categories of Risks in Health Care
Agency
- Falls (Assess Risks/Know
Interventions)
- Pt. Inherent
Accidents
- 1 Common
Cause=Seizure
- Seizure
Precautions
- protect from
injury
- position on side for ventilation and drainage of
secretions
- provide privacy/support
after
- POSSIBLE
PREVENTION
- Some Patients have an AURA
- bright light, smell,
taste
- warning of oncoming
seizure
- Procedure-Related
Accidents
- 1 example=Medication
Error
- PREVENTABLE!
- Equipment-Related
Accidents
- Malfunction, misuse, disrepair, electrical
hazard
- Tag Faulty Equipment-Always Get Proper Instruction On
Use
- Sticker w/Expiration date is SAFE (Biomedical has
inspected)
- Safety Includes
Staff
- Know protocol re: working with radiation,
etc
- wear appropriate
devices
- SAFE HEALTH CARE ENVIRONMENT
- Reduced injury risk (including falls)
- Reduced Patient Inherent and Procedure/Equipment Related Accidents
- QSEN:Quality & Safety Education For Nurses
- Minimize risk of harm to patients/providers thru system effectiveness & individual performance
- Critical Thinking/Nursing Process
- Assess Patient and Environmental hazards
- Plan and Intervene as Necessary to Maintain Safety
- Factors to Assess re: USE OF RESTRAINTS
- Last Resort when patient behavior = risk of injury
(self/others)
- What to try first/Possible Alternatives
- Sensory Stimulation
- Frequent Reorientation
- More Frequent Observations
- electronic devices
- Posey Bed
- Or prevent interruption of therapy/life support equipment
- Temporary and for safety only
- Physical
- Device to immobilize or reduce ability of movement
- Chemical
- Medication to manage behavior (not standard for
condition)
- Optimal Goal=Restraint Free
Environment
- COMPLICATIONS
- Pressure Ulcers, Pneumonia, constipation, incontinence, humiliation, agitation, EVEN DEATH d/t restricted breathing/circulation
- If/When Restraints Used
- Get informed consent
- Educate patient/family
- MD order required
- Know agency specific legal policy
- Current (No PRN)
- Type, location, duration, circumstances
- Hospital = 8 hour renewal/adults
- 2 hours/age 9-17
- 1 hour/under 9 y/o
- Face-to-face assessment
- Use Care w/ side rails- (can be considered restraint
- Assessment Activities Pertaining to Safety
- Physical
- (Fall Risk) Observe gait, balance
- Psychosocial
- (Fall Risk) Assess adequate lighting, clutter in hallways
- Cognitive
- (Fall Risk) Assess Visual Acuity/Ability To Read