1. Safety

2. Clicker Question
What percentage of medical errors are considered preventable?
50%
35%
70%
40%

3. Safety A basic human need
Freedom from psychological or physical injury
Concept central to nursing and health care today
Environmental, Personal, Patient Safety Needs

4. Where do you feel safe?

5. Why focus on patient safety
Why focus on patient safety? Medical mistakes kill as many as 98,00 patients per year

6. Name some safety issues in health care settings

7. Calls for Improvements in Patient Safety
To Error is Human: Building A Safer System (IOM 1999)
Crossing the Quality Chasm: A New Health System for the 21st Century
The Agency for Healthcare Research and Quality
Institute for Healthcare Improvement
National Patient Safety Foundation

8. Nightingale’s Message
“It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm”. (Florence Nightingale, 1859, Notes on Nursing)

9. Environmental Safety Basic Needs Physical Hazards
Transmission of Pathogens
Pollution
Terrorism/Bioterrorism

11. Transmission of Pathogens
Pathogen: Any microorganism capable of producing an illness
Medical asepsis
Immunizations
Standard precautions (transmission of HIV, Hepatitis)
Health Care Acquired Infections
Isolation Procedures
STD’s
Adequate disposal of human waste, insect, rodent control

12. Recommended Immunizations
DPT
MMR
Hepatitis A & B
Varicella
Haemophilus influenzae
Pneumonia
Polio
Rotavirus
HPV (females 13-18)
Yearly flu vaccine
TB (health care workers)

14. Terrorism/Bioterrorism

15. Personal Safety

16. Safe Patient Handling Back pain and injuries in nurses are widespread
Nurses should not lift more than 35 lbs.
How much can nurses push or pull safely?
Very heavy patients threaten nurses’ backs, necks, and knees
Seven states have laws to protect nurses from patient-handling injuries
Lifting and transfer equipment
American Nurse Today July 2010

18. Patient Safety: Scope of the Problem
Medical errors are the 8th leading cause of death in this country
2.4 million prescriptions per year are filled incorrectly in Massachusetts
61% of Americans fear being given the wrong medicine
70% of medical errors are preventable (

19. Patient Safety Risks Preventing Falls/Pressure Ulcers
Client-Inherent Accidents (Seizures)
Procedure-related accidents (surgery, chest tube & catheter insertions, med/IV errors)
Use of Restraints
Equipment-related Accidents (electrical hazards, fires from faulty equipment)
Preventing Health Care-Associated Infections (HAI)
Preventing Medication Errors
Failure to Rescue

20. National Patient Safety Initiatives
The Joint Commission National Patient Safety Goals
Institute for Healthcare Improvement “5 Million Lives” Campaign
The Leapfrog Group

21. HAI’s: Scope of the Problem
Health care-Associated Infections are one of the top 10 leading causes of death in the U.S.
1.7 million infections and 99,000 associated deaths per year
Billions of dollars in health-care costs
32% of HAI’s are UTI’s
22% of HAI’s are surgical site
15% of HAI’s are pneumonias
14% of HAI’s are bloodstream

23. Joint Commission National Patient Safety Goals
Identify patients correctly
Improve staff communication
Use medicines safely
Prevent infection
Identify patient safety risks
Prevent mistakes in surgery

24. IHI Safety Initiatives
The six interventions from the 100,000 Lives Campaign:
Deploy Rapid Response Teams…at the first sign of patient decline
Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack
Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation
Prevent Central Line Infections…by implementing a series of interdependent, scientifically grounded steps
Prevent Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time
Prevent Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps

25. IHI Patient Safety Platform
New interventions targeted at harm:
Prevent Pressure Ulcers... by reliably using science-based guidelines for their prevention
Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) Infection…by reliably implementing scientifically proven infection control practices
Prevent Harm from High-Alert Medications... starting with a focus on anticoagulants, sedatives, narcotics, and insulin
Reduce Surgical Complications... by reliably implementing all of the changes in care recommended by the Surgical Care Improvement Project (SCIP)
Deliver Reliable, Evidence-Based Care for Congestive Heart Failure…to reduce readmissions
Get Boards on Board….Defining and spreading the best-known leveraged processes for hospital Boards of Directors, so that they can become far more effective in accelerating organizational progress toward safe care
Source:
Detailed How-to Guides on each intervention are available at under the Materials tab.

26. How Many Injuries in the United States?
37 Million Admissions
(Source: The AHA National Hospital Survey for 2005) X
40 Injuries per 100 Admissions
(Source: IHI “Global Trigger Tool” Guiding Record Reviews) =
15 Million Injuries per Year

27. The Leapfrog Group
Reduce preventable medical mistakes and improve the quality and affordability of health care
Encourage health providers to publicly report their quality outcomes so consumers can make informed choices

28. Keeping Patients Safe Making Hospitals Safer
Josie’s Story
Discussion

29. Safety and the Nursing Process
Assessment
Nursing Diagnosis
Planning
Implementation
Evaluation

30. Assessment Nursing History (Assessing Risk) Home Hazard Appraisal
Risk for falls
Medication Reconciliation

31. Implementation
Health Promotion (wearing seat belts, use of car seats, bike helmets, participation in wellness programs)
Developmental Interventions:
Infant, Toddler, Preschooler
School-Age
Adolescent
Adult

32. Implementation Older Adult
Reduce the risk for falls and other injuries
Compensate for physiological changes related to aging
MVA prevention (Safe driver tips, eyesight/hearing issues)
Burn and scald prevention
Pedestrian accidents (wear reflectors, walk on sidewalks, cross at light)

33. Environmental Interventions
General Preventive Measures: Meet client needs (Oxygen, nutrition/fluids, temperature)
Medical Asepsis
Isolation Precautions
Environmental lighting
Security measures and concerns

34. Healthcare Worker Safety
Proper Body Mechanics and Use of Lifting /Transfer Devices
Blood & Body Fluid Exposure
Radiation Exposure
Exposure to pathogens

35. Specific Safety Concerns
Falls (Fall Assessment Tool)
Restraints and bed alarms
Side rails, bed height, bed and wheelchair locks
Fires
Poisonings
Electrical Hazards
Seizures
Radiation exposure
Preventing medication errors
Preventing health care associated infections

36. Figure 49-7 A mitt restraint.

38. Clicker Question
Which of the following restraints would be preferred for a patient pulling at IV lines:
A. Wrist restraints
B. Belt restraints
C. Mitt restraints
D. Bed Alarm

39. Clicker Question
1. A newly admitted client was found wandering the hallways for the past two nights. The most appropriate nursing interventions to prevent a fall for this client would include:
A. Raise all four side rails when darkness falls.
B. Use an electronic bed monitoring device.
C. Place the client in a room close to the nursing station.
D. Use a loose-fitting vest-type jacket restraint.
Answer: B

40. What we can do to prevent errors
Better communication between health care team members
Monitor patients closely for changes in condition
Prevent medication errors
Prevent infection
Prevent falls
Identify patients correctly

43. Patient Safety Internet Resources
Institute of Safe Medication Practice
The Joint Commission
National Patient Safety Foundation
Agency for Healthcare Research and Quality
Institute for Healthcare Improvement

44. primum non nocere
“First do no harm”