1. Safety

2. Concept: Safety
Safety is often defined as freedom from psychological and physical injury. Safety refers to the prevention of patient injury caused by health care errors.
The QSEN safety competency for a nurse is defined as “Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.”

3. TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM
Health care in the United States is not as safe as it should be--and can be. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented, according to estimates from two major studies. Even using the lower estimate, preventable medical errors in hospitals exceed attributable deaths to such feared threats as motor-vehicle wrecks, breast cancer, and AIDS.

4. BUILDING A SAFER HEALTH SYSTEM
Medical errors can be defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Among the problems that commonly occur during the course of providing health care are adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities.
Published Nov. 1999

5. Patient Identification
FIRST and best way to identify for the RIGHT patient is to have them STATE their name and birthday.
SECOND is to check the name bracelet.
BOTH of these should be done prior to any patient contact
Bar Scan when giving
medications
Page: 369

6. FALLS
A patient fall, defined as a sudden, unintentional change in position, coming to rest on the ground or other lower level, is among the most commonly reported adverse hospital events, with more than 1 million occurring annually.

7. FALLS
Approximately 30% of falls result in some type of injury, and 10% result in serious injury, such as head trauma and fracture. Among older adults, falls are especially dangerous because of their increased causation of morbidity and mortality.

8. Fall Assessment Tools
Assessment of a patient’s risk factors for falling is essential in determining specific needs and developing targeted interventions to prevent falls.
Morse Fall Scale: used at Community Hospital
Hendricks II Fall Risk Scale
John Hopkins Fall Risk Scale: used at the IU Health Hospitals

9. Morse Fall Scale Item Scale Scoring
1. History of falling; immediate or within 3 months
No 0
Yes 25
______
2. Secondary diagnosis
Yes 15
3. Ambulatory aid
Bed rest/nurse assist
Crutches/cane/walker
Furniture 15 30
4. IV/Heparin Lock
Yes 20
5. Gait/Transferring
Normal/bedrest/immobile
Weak
Impaired
6. Mental status
Oriented to own ability
Forgets limitations
0 15
Risk Level
MFS Score
Action
No Risk
0 - 24
Good Basic Nursing Care
Low Risk
Implement Standard Fall Prevention Interventions
High Risk
≥ 51
Implement High Risk Fall Prevention Interventions

10. Hendrick II Fall Risk Model Risk Factor (≥ 5 = High Risk)
Risk Points
Confusion/disorientation 4
Depression 2
Altered elimination 1
Dizziness/vertigo (subjective)
Gender (male)
Any prescribed antiepileptics
Any prescribed benzodiazepines
Get-up-and-go
“Rising from Chair”
Able to rise in single movement
Pushes up, successful in one attempt
Multiple attempts but successful
Unable to rise without assistance 3

11. Johns Hopkins Fall Risk Assessment Tool
Complete the Following and Calculate Fall Risk Score
Age (Single-Select)
60-69 years (1 point)
70-79 years (2 points)
≥ 80 years (3 points)
Fall History (Single-Select)
One fall within 6 months before admission (5 points)
Elimination, Bowel and Urine (Single-Select)
Incontinence (2 points)
Urgency or frequency (2 points)
Urgency/frequency and incontinence (4 points)
Medications: Includes PCA/opiates, Anticonvulsants, Antihypertensives, Diuretics, Hypnotics, Laxatives, Sedatives, and Antipsychotics(Single-Select)
On one high risk drug (3 points)
On two or more high-risk drugs (5 points)
Sedated procedure within last 24 hours (7 points)

12. Johns Hopkins Fall Risk Assessment Tool
Complete the Following and Calculate Fall Risk Score
Patient Care Equipment: Any equipment that tethers patient (e.g. IV infusion, chest tube, indwelling catheters, SCDs, etc.) (Single-Select)
One present (1 point)
Two present (2 points)
Three present (3 points)
Mobility (multi-select, choose all that apply and add points together)
Requires assistance or supervision for mobility, transfer, or ambulation (2
points)
Unsteady gait (2 points)
Visual or auditory or impairment affecting mobility (2 points)
Cognition (Multi-select, choose all that apply and add points together)
Altered awareness of immediate physical environment (1 point)
Impulsive (2 points)
Lack of understanding of one’s physical and cognitive limitations (4 points)
Mod Risk: 6-13 points High Risk >13 points Total Points _____

13. Automatic Fall Risk FALL RISK FACTOR CATEGORY
Scoring not completed for the following reason(s) ( check any that apply):
Complete paralysis, or completely immobilized. Implement basic safety (low fall risk) interventions.
Patient has a history of more than one fall within six months before
admission. Implement high fall risk interventions throughout hospitalization.
Patient has experienced a fall during this hospitalization. Implement high fall
risk interventions throughout hospitalization.
Patient is deemed high fall risk per protocol (e.g. seizure precautions).
Implement high fall risk interventions per protocol.

14. Restraints and Restraint Alternatives
Any manual method, physical or mechanical device, or material or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs or head freely.
Restraint Alternative Devices or techniques employed to avoid the use of restraints. Depending on the intent and how it is used, it can be an alternative or a restraint.

15. Escalating Progression
Prevention- Distraction
Alternative- Covering the line
Less Restrictive- Self-release lap belt
More Restrictive- Lap belt patient cannot release

16. Prevention- Environment
Repositioning
Alarms
Sitter at bedside
Low Bed
Decrease stimulation
Swaddling (infants)

17. Prevention- Diversion Activities
Conversations
Videos
Lego's
Fold Towels
TV Channels
Ambulate

18. On-going Monitoring Continuation/Discontinuation Patient Comfort
Mental Status
Cognitive Functioning
Level of Distress/Agitation
Patient Safety
Vital Signs
Circulation Checks
Skin Integrity
Correct Application
Patient Comfort
Food
Hydration
Toileting
ROM

19. Criteria to Discontinue Restraints
Able to follow directions
Able to participate in care
Able to participate in program
Behavior improves/changes
Lines tubes discontinued
Positive response to medication intervention