2.  Promote health, prevent illness/injury  Broad knowledge base needed to meet patient needs in different health care settings

3.  Interventions to save patient lives:  Deploy Rapid Response Team (RRT)  Provide evidence-based care for acute myocardial infarction  Prevent central line infections

4.  Interventions to save patient lives (cont’d):  Prevent adverse drug events  Prevent surgical infections  Prevent ventilator-associated pneumonia (VAP)

5.  Institute of Medicine (IOM) “To Err is Human” report (2000)  Require health care organizations to focus on patient safety and quality care

6.  Address high risk issues:  Drug administration  Fall reduction  Pressure ulcer prevention  Communication

7.  Requires health care organizations to create culture of safety  National organization  Peer evaluation every 3 years

8.  Errors caused by health care team/system  Anything leading to patient injury or harm

9.  Intervenes for people at beginning of clinical decline  Can be used by family  Decreases medical complications and number of arrests

10.  Provide patient-centered care  Collaborate with interdisciplinary health care team  Implement evidence-based practice  Use quality improvement in patient care, informatics

11.  IOM added safety as separate competency  Knowledge, skills, attitudes (KSAs) added to develop each core competency  www.qsen.org

12.  Collaborative nursing functions  Independent nursing functions  Patient education  Patient advocacy-caring  Respect for ethical principles:  Patient autonomy  Beneficence  Justice

13.  Case manager  SBAR  PACE

14.  Often used for hand-off communication  4 steps:  S - Situation  B - Background  A - Assessment  R - Recommendation

15.  Used for patient reporting  Stands for:  P – Patient problem  A – Assessment/action  C – Continuing/changes  E – Evaluation

16.  Transferring a task/activity to a competent person  Certain tasks delegated to UAP (unlicensed assistive personnel)  Nurse always accountable for the task/activity delegated!

17.  Guidance or direction, evaluation, and follow-up to ensure a task/activity is performed appropriately

18.  Turning and positioning  Vital signs  Intake & output measurements

19.  Right task  Right circumstances  Right person  Right communication  Right supervision

20.  Integration of the best current evidence to make decisions about patient care

21.  Identify monitoring indicators  Collect data  Recommend ways for improvement  Implement activities for improvement

22.  Information & technology used to:  Communicate  Manage knowledge  Mitigate errors  Support decision-making

24.  Nurses play a key role in safety promotion and error prevention

25.  Nine key areas where nursing practice needs improvement: 1. Medication administration 2. Clear communication of patient data/clinical assessment 3. Attentiveness/patient surveillance

26. 4. Clinical reasoning or judgment 5. Prevention of errors/complications 6. Intervention (carrying out nursing actions)

27. 7. Interpreting authorized provider orders 8. Professional responsibility and patient advocacy 9. Mandatory reporting

29. What is an expected outcome for the patient who is scheduled to undergo a surgical procedure if the nurse successfully implements patient-centered care? A. Home health care for 8 weeks once he or she is discharged B. Physical therapy while hospitalized after the procedure to accelerate his or her rehabilitation C. Implementation of a low-fat, high-protein diet D. Questions about the procedure answered and a signed informed consent

30. A patient who had been admitted for evaluation of heart failure begins to act confused. At 4 AM, the nurse notes that his blood pressure has dropped from 132/78 to 108/60 and his pulse is 115 beats/min. The nurse should take what action next? A. Call the patient’s physician. B. Call the code team. C. Call the Rapid Response Team. D. Call the in-house resident physician.

31. . The nurse observes an increased incidence of contaminated blood cultures as indicated by laboratory report, thus requiring that the blood be redrawn. What quality improvement step could the nurse implement to reduce the blood culture contamination rates? A. Contact the hospital quality improvement nurse to inform him or her about the observation. B. Obtain data on the unit blood culture contamination rates to evaluate trends and develop a plan for improvement. C. Inform the unit nurse manager of this concern. D. Post a journal article on the unit that addresses proper blood culture technique.