1. Patient Safety Craven Chapter 22
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2. Safety High priority need Maslow basic need [safety/security]
High Nursing Priority [ABC/Safety/Pain
State of being free from harm or danger
Unintentional Injury is 5th leading cause of death in U.S.
Results in disability, pain, emotional distress, financial hardship
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3. Safety in Nursing Critical Thinking + Nursing Process
Assess Patient and Environment
Formulate Nursing Diagnosis/ Plan to provide safe care
Injury control/prevention
3 levels:
Individual: education about hazards and prevention
Design phase: use of safety features in equipment, products
Regulatory Level: to ensure safe products and environments
Provide/ maintain a Safe environment
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4. Environmental Safety
A safe environment includes meeting basic needs, reducing physical hazards, reducing the transmission of pathogens, maintaining sanitation, and controlling pollution.
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6. Safety regulations and guidelines in healthcare
Patient safety goals
Joint Commission Hospital National Patient Safety Goals [2010]
Accurate Patient identification
Effective Communication among caregivers
Medication Safety
Reduce HAI’s
Medication Reconciliation
ID suicide risk in patients
(The Joint Commission (2011). National patient safety goals)

7. Sentinel Event: safety errors that result in death or serious injury
QSEN [Quality and Safety Education for Nurses]:
Provides framework for knowledge, skills, attitudes
Defines 6 competencies for entry into practice
Pt. centered care Teamwork & Collaboration
EBP Quality Improvement
Safety Informatics
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8. Characteristics of safety
Pervasiveness
Affects all aspects of life
People assume or neglect responsibility for own safety
Perception and judgment
Perception of danger influences safety practices
Safety measures only effective if hazard is accurately perceived and understood [e.g. smoking]
Management
Nursing responsibility to protect patients
Safety practices to avoid /prevent danger
Prevention is key
Lifestyle & behavior affect risk for injury

9. Physical Hazards Lighting Obstacles Bathroom Hazards Security 1/1/2019
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10. Lifespan Considerations
Infant
Falls, burns, choking, trauma
Depend on caregivers to prevent injury
Temperature, ID, airway, monitoring
Toddler, Preschool
Increasing mobility , curiosity
Need modeling, caregiver awareness
School aged child & Adolescent
Better physical skills and communication of needs
Wider world experiences, less supervision
Risk-taking behavior – need education, example
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11. Lifespan Considerations
Adult
Home, work, recreation
Safety habits self-enforced
Alcohol use
Older Adults
Loss of physical function, sensory acuity, judgment, slower reflexes increase risks
Balance, temperature sensitivity, eyesight
orthostatics
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12. Cultural Considerations
Safety practices learned through family/culture [risk tolerance]
Socioeconomic status influences ability to maintain safe environment, water, heat
Higher rates/tolerance of high-risk lifestyle behaviors [smoking, drinking, obesity, food choices] in some areas increase risk
Subculture [mountain biking/rock climbing] brings specific risks
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13. Risks in the Health Care Agency
Falls
Confusion, dizziness, altered mobility, unfamiliar environment
Procedure-related Accidents
ID check, IV lines
Equipment-related Accidents
Unlocked w/c, O2, electrical
Medication errors
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14. Healthcare Worker Risks
Exposure
needle sticks
Back injuries
Lifting
Infertility
Exposure to antineoplastic
Violence
Patients, visitors
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15. Incident Report Required for any accident/injury in healthcare setting
NOT part of medical record
Includes:
What happened
Patient assessment
Interventions provided
For internal use only
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16. Assessment [cont.] Changes in: Environment Support system
Developmental status
Health status
Perception, cognition, mobility, activity, sensation
Functional status/ ability to do ADL’s
Medications
Medical conditions
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17. Assessment [cont.] Physical Assessment Neurological Sensory
Alertness, orientation, judgment, cognition
Sensory
Visual, auditory, balance, sensation, taste, smell
Cardiac/Respiratory: Activity tolerance, orthostatics
Skin integrity – assess past/present injuries
Musculoskeletal – mobility, activity tolerance
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18. Nursing Diagnosis Risk for injury Related to: As evidenced by:
General weakness
Right or Left sided weakness
Side effects of medication
Poor eyesight
As evidenced by:
Recent falls
New CVA
Confusion
Macular degeneration
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19. Outcome Identification/Planning
Focus on:
Identification /avoidance of hazards
Demonstration of safety habits
Decrease/ absence in frequency/severity of injury
E.g. Pt. will not fall this shift
Pt. will use call light each time he needs to use BR this shift
Pt will demonstrate proper use of car seat prior to d/c
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20. Implementation
Risk for injury related to (r/t) generalized weakness as evidenced by recent falls
Pt. will ask for help to the bathroom each time this shift
Call light will be in reach at all times
Call light will be answered within 5 minutes this shift
Pt will not fall this shift
RN/CNA will collaborate to ensure patient is seen q hour
RN/CNA will Document on rounding sheet q 1 hr
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21. Evaluation Was goal met? AEB? Plan?
Example: [Goal] Pt. will use call light each time he needs to use BR this shift
Evaluation:
Goal partially met; pt. used call light 5/6 times to use BR, but attempted to get up alone 1 time. Stated “ I couldn’t wait any longer”. Revision: provide urinal for urgent need and reinforce need to use call light. Reinforce need for staff to respond within 5 minutes at shift report.
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22. Use of Restraints in the Health Care Setting
ANY Physical or chemical means of stopping a patient from being free to move.
Used only in emergency situations to ensure the patient’s safety.
Restraint orders must be specific and time-limited.
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23. Restraint Basics Try other options first
Limit use – temporary solution
Prescriber must evaluate [in person] within 1 hour for violent/self-destructive behavior
Obtain consent before use; but if necessary, explain reason to pt. and family
Document behavior, interventions, response, teaching
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24. Restraints & Alternatives
Bed rails may be considered restraints
Usually OK to have 2 up
4 up considered a restraint
Contributes to more frequent, severe injury
Alternatives to restraints –
Check on pt. at least hourly
Place close to nurse’s station
Control environment, re-orient pt frequently
Provide call light, personal needs, access to BR
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31. Other Mechanisms to Prevent Falls
Tab Alarms
Arm Bands
ID outside of Patient room
Notice Inside the Patient room
Colors of gowns, slippers, blankets
Bed Alarms
Chair Alarms
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32. Restraint Use Must have a physician order
May apply in emergency, then get order
Order must be rewritten every 24h.
No automatic renewal, verbal order
Restraint policies are specific to health care setting
Nursing documentation must occur at least every two hours
Including presence/type, need for continued use; skin assessment; circulation, movement, sensation [CMS]; offer food/fluids if appropriate, offer toileting, ADL’s
Generally – ICU and ED have more flexible restraint policies R/T confused, intubated patients
Infants and children may have iv secured with armboard, etc that would be a restraint in an adult
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33. Complications from Restraints
Skin breakdown
Constipation
Pneumonia
Incontinence
Urinary retention
Nerve damage
Circulatory damage
Increased agitation
Another complication – patients are not checked as often; not moved, changed, etc
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34. Questions?
Discussion?
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