Chapter 27

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Patient Safety
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Chapter 27 Cont-'d Patient Safety

Basic Human Needs (three needs?)

  • Oxygen-can be low concentration & high concentration : supplemental O2 for low concentration to help patient breath. prevent low concentration due to open fire and smoking.
  • Carbon monoxide- especially during winter and warming cars in closed garage can cause low concentration
  • Nutrition- food needs and must have proper storage
  • Temperature (heat and humidity)- a normal comfort zone of 65-75 degrees
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Basic Human needs continued-

Explain concepts of Nutrition and Temperature?

Nutrition: needs proper storage and house without vermin. Proper refrigeration- do patients have refrigeration. Proper preparation area- is it clean and do moms know how to prepare formula..

Temperature : too much or too little temperature : Hypertherma- fever, lack of electricity, air conditioning. At higher risk- elderly, babies and chronically ill.

Hypothermia- core body temperature 95 f or below. At risk people: homeless, elderly. babies and can be caused by alcohol or drug ingestion

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Basic Needs

Who can help meet basic needs?

social service assistance may be needed to meet basic human needs and help those unable to pay bills for electric/gas and vermin control (rats, bugs, roaches)

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Environmental Hazards- at home and at health care centers

What are the environmental hazards include?

1. Falls: increased incidence dependent on previous falls, age, vision, balance problems. walkers, Make a patient assessment daily.

2. Transmission of pathogens: need infection control measure: isolation. gloving, washing hands before and after each patient procedure including:

  • dressing changes, emptying urinary catheter bags, use gloves, wash hands after removing gloves and follow isolation procedure.

3. Pollution: environmental, smoking esp. in cars w/ children

5. Disasters: * natural- tornado snow storms flooding or *manmade: bioterrorism ect.

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Safety Risks by Developmental stage

1. Risk to: children younger than 5 years?

2. Risks to school-aged children?

1. ex. choking

2. Bike safety and head gear to prevent injuries

6

Safety Risks by Developmental stage

1. Risk to: adolescents?

2. Risks to adults?

3. Risks to older adult patients?

1. risk taking behaviors: car accidents, drug overdose and most are due to peer influences

2. lifestyle habits, smoking drinking, drug use that can cause cardio and pulmonary diseases

3. physiological changes: sight, hearing, reflexes, falls chronic disease, become a "polyfarm"-multiple medications

7

National Quality Forum

What is on the list of serious reportable events or "Never Events" and steps?

*major focus of healthcare providers for patient safety (book 27-3 box)

  • has issued a list of "never events" or "serious reportable events"
  • Surgical events: wrong part, side or procedure, foreign object left, mark a site with ink
  • Product or device event: contaminated drugs, pumps, devise not function- Report and remove any questionable devise . ( Equipment related accidents).
  • Patient protection events: elopement, suicide, infant to the wrong person
  • Care management events: medication, blood error, maternal death, pressure ulcer, wrong sperm donor- ID checked, personnel double check blood
  • Environmental events: O2 and gas mix up, electrical shock, burn death or serious injury- restraint checks and surgical suite errors
  • Criminal events: abduction, sexual assault, by a person impersonating a Health care professional (HCP). Should introduce self to staff and ask for credentials
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CMS list of "Never Events"

Define "Never events"?

  • "never events" -should NEVER OCCUR
  • CMS: denies hospital payments resulting from or complicated by a never event.
  • Many hospital-acquired conditions are nurse sensitive indicators
  • The National Quality Forum has issued a list of "never events" or "serious reportable events" pertaining specifically to maternal and child health.
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Risks in Health Care Agencies

What are the specific risks to patients within the hare care environment?

  • 8th leading cause of death and includes:
  • Nurses assesses for potential problems
  • 1.medical errors in: medication errors, infection, bed sores, failure to diagnose and treat in time
  • 2.Falls
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specific Risks in Health Care Agencies (cont'd)

What are the classifications of health care agency accidents?

Nurses assesses for potential problems:

1. Patient-inherent accidents: self induced injury: cut burn, setting fire

2. Procedure-related accidents:occurs during therapy, improper use of external devices

3. Equipment-related accidents: results from the malfunction, misuse or disrepair og equipment

4. Falls- that can result in broken hip and head trauma

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Safety and the Nursing Process

How do nurses use critical thinking approach in care of patients?

Development of a individualized care plan includes;

1. Assessments- though the patient's eyes and patients home environment because patient view of safe may not be the same as the standards. use of wheel chairs, walkers?

2. Assessments Questions- ask about: activity and exercise, medication history, history of falls and home maintenance and safety. medications? have you fallen, who shovels?

3. Nursing history-

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Implementation in Acute Care Safety

Use of Fall Risk prevention and protocols used to prevent falls?

  • Restraints as a last resort: when patients behavior puts them at risk for injury or falls
  • Restraints as an alternative: to keep them safe for those who repeatedly fall. restraints are any manual method, physical or mechanical that reduces a patients ability to arms & legs or head freely. used when moving patients, can include safety bars on bed to prevent falls
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Safety and the Nursing Process Implementation

Acute Care Safety:

  • evaluate for seizures
  • poisoning (accidential)
  • prevention and elimination of electrical hazards
  • disasters
  • Hospitals must have an emergency management plan
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What are the expected Expected Outcomes:

keypoints?

  • a safe physical environment
  • a patient whose knowledge about safety factors and precautions
  • a patient free of injury