Safety and Infection Control: Reporting of Incident / Event / Irregular Occurrence / Variance & Safe Use of Equipment Lorelei Sepulveda 1

Reporting of Incident / Event / Irregular Occurrence / Variance  Incident: “ a report of any event that is not consistent with the routine operation of the health care agency that results in or has the potential to result in harm to a patient, employee, or visitor”, (Taylor, 2016). Reports are used to identify trends, patterns, and the precipitating cause.  Event: Sentine l- an unexpected occurrence which resulted in death or serious physical or psychological injury Never event – “serious reportable events” and extremely rare errors that should never happen to a client The National Patient Safety Goals are guidelines used to promote a culture of safety The National Quality Forum establishes priorities and protocols to prevent  Irregular Occurrence: situation when a client do not meet expected outcome or a planned intervention was not implemented. It is the responsibility of the staff to identify and speak up against unsafe practices  Variance: “documentation method in case management that records unexpected events, the cause for the event, actions taken in response to the event, and discharge planning when appropriate”, (Taylor, 2016). Document accurately, objectively, and timely, but never place the report in the medical record. * As nursing students, we should never attempt to do a clinical procedure is we are unsure of the steps to follow. 2

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NCLEX Question 4 A nurse is reading a medication order that contains unfamiliar abbreviations. Which of the following is the appropriate action for the nurse to take? a)Report the incident to the risk manager. b)Clarify the order with a more experienced coworker. c)Call the provider to clarify the order. d)Ask the supervisor is the abbreviations are approved by the institution.

5 a)Report the incident to the risk manager. Rationale: no incident took place b) Clarify the order with a more experienced coworker. Rationale: there is no way to determine whether or not the coworker’s opinion of the meaning of the abbreviation is correct. c) Call the provider to clarify the order. Rationale: It’s the only way to ensure that the nurse will administer what the provider has prescribed for the client. Reduce the possibility of medical error. d) Ask the supervisor is the abbreviations are approved by the institution. Rationale: the “do not use” and error-prone” abbreviations are from the Institute for Safe Medication Practices and The Joint Commission only. NCLEX Answer

Safe Use of Equipment 6  Inspect equipment for safety hazards Prevent falls: keep the path to hallways and doors clear of unnecessary clutter Tape electrical cables to baseboards or use tie Install and check smoking detectors regularly  Teach client about the safe use of equipment needed for health care Medical equipment are not “Toys” Only medical personnel should use equipment after inspection Avoid smoking within 50 feet of oxygen tanks, or the use of petroleum based products, or synthetics fabrics  Facilitate appropriate and safe use of equipment Use PPE when necessary When in doubt –Wash your hands-  Remove malfunctioning equipment from client care area and report the problem to appropriate personnel Important to learn signs of malfunctioning Fail safe mechanisms Check expiration date on equipment / materials when available

7 NCLEX Question A nurse enters a client’s room and finds smoke coming from under the bed. In which order should the nurse take the following steps in this situation? (All steps must be used).  Shut all surrounding windows and doors  Move the client out of the room  Attempt to put out the fire with a fire extinguisher  Pull the unit fire alarm

8 NCLEX Answer 1.Move the client out of the room 2.Pull the unit fire alarm 3.Shut all surrounding windows and doors 4.Attempt to put out the fire with a fire extinguisher Rationale: when responding to a fire in a client’s room the nurse should follow the R-A-C-E acronym.

9 NCLEX Question A charge nurse is observing a newly licensed nurse provide care for a client receiving internal radiation therapy for the treatment of cervical cancer. Which of the following actions by the newly licensed nurse should most concern the charge nurse? a)Leaving soiled linens in a container in the room. b)Instructing the visitors to remain 8 feet away from the client. c)Borrows a film badge from another nurse before entering the room. d)Removes and extra IV pole from the room to be used for another client.

10 NCLEX Answer a)Leaving soiled linens in a container in the room. Rationale: the nurse should place a sign on the client’s door that states “Caution: Radioactive Material” when they are receiving internal radiation (brachytherapy). Saving all dressings and bed linens in a container inside the room is necessary until the source (implant) is removed. b) Instructing the visitors to remain 8 feet away from the client. Rationale: Temporary therapy -the clients are radioactive only during the time the source (implant) is in place. Permanent therapy – the radioactive exposure to the outside and others is low. For safety, visitors (only 16 yrs. and older) should limit their time to 30 minutes per day and to stay 6 feet away. c) Borrows a film badge from another nurse before entering the room. Rationale: one should NEVER borrow a dosimeter film badge. They must be worm at all times when entering the client’s room to measure the radiation levels. It should not be worn outside work, shared or returned. d) Removes and extra IV pole from the room to be used for another client. Rationale: the only items that should be given special consideration are dressings and or linens.