Download Chapter 38 Patient Safety

Chapter 27
Patient Safety
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Safety in Health Care Organizations






Performance improvement
Risk management and safety reports
Current reliable technology
Evidence-based practice
Safe work environment
Adequate staff education
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
2
Quality and Safety Education
for Nurses (QSEN)



Future nurses need knowledge, skills, and
attitudes to promote safety.
Continuous improvement is essential.
QSEN minimizes risk of harm to patients and
providers by


System effectiveness
Individual performance
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
3
Critical Thinking



In patient safety, critical thinking is an
ongoing process.
Standards have been developed by American
Nurses Association and The Joint
Commission.
Use of the nursing process when planning
care promotes safety.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
4
Safety in Health Care Settings
Reduces the incidence of illness and injury
Prevents extended length of treatment/stay
Improves or maintains functional status
Increases patient’s sense of well-being
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
5
A Safe Environment





Includes meeting patients’ physical and
psychosocial needs
Applies to all places where patients receive
care
Includes patients’ and health care providers’
well-being
Reduces risk of injury and transmission of
pathogens
Maintains sanitation and reduces pollution
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
6
Basic Human Needs
Oxygen
Temperature
Low concentration
 High concentration
 Carbon monoxide


Normal
 Hyperthermia
 Hypothermia
Nutrition
Proper storage
 Proper refrigeration
 Preparation area

Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
7
Case Study


Mr. Gonzales is a 68-year-old man who has lived
alone in a senior apartment building since his wife
died 6 months ago. He and his wife were born in
Mexico but came to live in the United States shortly
after they were married.
He is retired from a produce warehouse, where he
worked for 37 years. They have raised 3 sons; the
closest son, Carlos, is 30 minutes away by car.
Carlos visits Mr. Gonzales every week to socialize
and take him shopping.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
8
Environmental Hazards

Physical hazards:






Lighting
Obstacles
Bathroom hazards
Motor vehicle
accidents
Poison
Fires
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
9
Quick Quiz!
1. While caring for a child, you identify that
additional safety teaching is needed when a
young and inexperienced mother states that
A. Teenagers need to practice safe sex.
B. A 3-year-old can safely sit in the front seat of
the car.
C. Children need to wear safety equipment
when bike riding.
D. Children need to learn to swim even if they
do not have a pool.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
10
Environmental Hazards




Falls
Transmission of pathogens
Pollution
Disasters


Natural
Man-made
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
11
Case Study (cont’d)


Mr. Gonzales is generally healthy but has
decreased visual acuity, hearing loss from the
noisy warehouse job, and some “arthritis.”
He expects to live at least as long as his
father, who lived to be 92 years old. Since his
wife’s death, Mr. Gonzales has attended
Catholic mass every day at his parish church,
where his wife had attended daily.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
12
Safety Risks by
Developmental Stage





Children younger
than 5 years of
age
School-aged
child
Adolescent
Adult
Older patient
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
13
Nursing Knowledge Base

Factors influencing safety:



Developmental stages
Individual risk factors
• Mobility, sensory, and cognitive status
• Impaired mobility
• Lifestyle choices
• Lack of safety awareness
Risks in the health care agency
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
14
Case Study (cont’d)

Joani Green, a 25-year-old married mother of two, is currently a
nursing student at the local college. As part of the clinical
environment, she and her study partner are conducting health
screenings and providing health promotion education for the
residents of apartments where Mr. Gonzales lives.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
15
National Quality Forum

List of serious reportable events (SREs)







Surgical events
Product or device events
Patient protection events
Care management events
Environmental events
Criminal events
Procedure to report an event
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
16
CMS list of “Never Events”



“Never events” should never occur.
The Centers for Medicare and Medicaid
Services (CMS) now denies hospitals higher
payments resulting from or complicated by a
“never event.”
Many hospital-acquired conditions are nurse
sensitive indicators.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
17
Risks in Health Care Agencies


Chemical use (Material Safety Data Sheets
[MSDSs])
Medical errors





Medication errors
Infection
Bed sores
Failure to diagnose and treat in time
Falls
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
18
Risks in Health Care Agency
(cont’d)

Classification of health care agency
accidents:



Patient-inherent accidents
Procedure-related accidents
Equipment-related accidents
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
19
Safety and the Nursing Process

Assessment




Through the patient’s eyes
Patient’s home environment
Assessment questions
• Activity and exercise
• Medication history
• History of falls
• Home maintenance and safety
Nursing history
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
20
Safety and the Nursing Process
(cont’d)

Assessment (cont’d)

Health care environment
• Risks in immediate environment
• Risk for falls
• Risk for medication errors
• Disaster preparedness
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
21
Diagnosis
Nursing diagnoses for patients with safety risk:







Risk for falls
Impaired home maintenance
Risk for injury
Deficient knowledge
Risk for poisoning
Risk for suffocation
Risk for trauma
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
22
Case Study (cont’d)



Joani has also discovered through the
screening that Mr. Gonzales has decreased
visual acuity and has not had a new pair of
glasses for 3 years.
He fell in his apartment about a month ago
but did not have any injuries.
Gait assessment reveals that Mr. Gonzales
does not pick his feet very high up off the
floor, and his movements are stiff.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
23
Safety and the Nursing Process:
Planning

Goals and outcomes






Prevent and minimize safety threats
Are measurable and realistic
May include active patient participation
Setting priorities
Teamwork and collaboration
Goals for Mr. Gonzales
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
24
Safety and the Nursing Process:
Implementation


Health promotion
Individualization of
implementation



Developmental stage
Lifestyle
Environment
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
25
Safety and the Nursing Process:
Implementation (cont’d)


Basic needs
General preventive
measures


Lighting
Changing the
environment
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
26
Case Study (cont’d)



The son, Carlos, has purchased a medication
organizer that Mr. Gonzales has not used
because he is concerned he will make a
mistake.
Mr. Gonzales is unable to read the labels on
his medication bottles.
What additional interventions are justified as
a result of Mr. Gonzales’ safety assessment?
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
27
Implementation in Acute Care Safety



Fall risk prevention
Restraints as a last
resort
Restraint alternatives
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
28
Safety and the Nursing Process:
Implementation

Acute care safety






Seizures
Poisoning
Electrical hazards
Radiation
Disasters
Hospitals must have an emergency
management plan.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
29
Implementation

Acute care safety

Fires: “RACE” and “PASS”
• Rescue patients.
• Activate alarm.
• Confine fire.
• Extinguish.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
30
Implementation (cont’d)
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
31
Quick Quiz!
2. A newly admitted patient was found
wandering the hallways for the past two
nights. The most appropriate nursing
interventions to prevent a fall for this patient
would include
A. Raise all four side rails when darkness falls.
B. Use an electronic bed monitoring device.
C. Place the patient in a room close to the
nursing station.
D. Use a loose-fitting vest-type jacket restraint.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
32
Case Study (cont’d)
What additional health behavior
can be encouraged for Mr.
Gonzales?
What effects could this health
behavior produce?
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
33
Safety and the Nursing Process:
Evaluation

Through the patient’s eyes



Are the patient’s expectations met?
Are the family’s expectations met?
Patient outcomes



Monitor care by the health care team.
Measure outcomes for each diagnosis.
Continually assess needs for additional support.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
34
Case Study (cont’d)



It has been 2 weeks since Joani implemented
the plan of care for Mr. Gonzales.
Joani will observe Mr. Gonzales’ environment
for elimination of threats to patient safety.
She will reassess motor, sensory, and
cognitive status for appropriate environmental
modifications.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
35
Quick Quiz!
3. A nurse floats to a busy surgical unit and
administers a wrong medication to a patient.
This error can be classified as
A. A poisoning accident.
B. An equipment-related accident.
C. A procedure-related accident.
D. An accident related to time management.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
36
Case Study (cont’d)





With regular exercise, Mr. Gonzales has found that
his walking has improved, and now he feels safer
about leaving the apartment.
The new medication labels and organizer have made
it easier for him to tell his several medications apart.
He reports that his vision is much better with his new
glasses.
He understands that he is able to make changes in
his environment that will keep him safe.
Mr. Gonzales has been injury free and plans to live to
a “ripe old age.”
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
37
Expected Outcomes




A safe physical environment
A patient whose expectations have been met
A patient who is knowledgeable about safety
factors and precautions
A patient free of injury
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
38