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

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

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)

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.

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

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

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

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.

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

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

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-

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

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

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