CH 14 NOTES

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University of South Alabama *

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NU 325

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Chemistry

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Dec 6, 2023

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CH 14 NOTES 1) NEVER EVENTS: Are adverse events that are ▪ clearly identifiable and measurable, ▪ serious (resulting in death or significant disability), and ▪ usually, preventable ▪ Never events are ▪ not reimbursable by insurers ▪ Prevention requires a culture of safety ▪Examples: Wrong site surgery, Fall-related death or serious injury, MRI-related death or serious injury, Death or serious injury related to medication error or blood transfusion error, Patient suicide. Electrical shock of patient or staf 2) PATIENT SAFTEY : defined as the prevention errors and adverse effects to patients associated with health care - requires effective communication, teamwork, critical thinking, and timely clinical decisions QSEN skills for safety competency include: 1) Demonstrate efective use of technology and standardized practices that support quality and safety. 2)Demonstrate efective use of strategies to reduce risk of harm to self or others. 3)Use appropriate strategies to reduce reliance on memory. 4)Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. ▪5) Participate appropriately in analyzing errors and designing improvements. 6)Use national patient safety resources. PRINCIPLES for practice:

1) The integration of evidence-based practice (EBP) into nursing skills and procedures promotes a safer health care environment and improves patient outcomes. 2)A nurse must be responsible for incorporating critical thinking skills to maintain a safe environment. 3)The Joint Commission’s Speak Up campaign has the goal of helping patients and their advocates become active in their care. 4)It is essential that health care providers share information about any patient injury, learn from errors, and participate in the trending and evaluation of those errors THE JOINT COMMISSION (TJC): is an accrediting agency that evaluates healthcare facilities with the goal of continuously improving healthcare. -TJC—National Patient Safety Goals (NPSG)2022 ▪ Identify patients correctly ▪ Improve staf communication ▪ Use medicines safety ▪ Use alarms safely ▪ Prevent infection ▪ Identify patient safety risks ▪ Prevent mistakes in surgery FALLS ▪ Falls are one of the most reportable events in health care facilities especially in older adults ▪ Why might clients in health care facilities be more at risk for adverse events? ▪ Unfamiliar environment ▪ Older, sicker, weaker, unsteady ▪ Culturally diverse ▪ Multiple lines and equipment ▪ Immunocompromised interdisciplinary. ▪ Fall prevention needs to be individualized UNIVERSAL FALL PRECAUTIONS: Familiarize the patient with the environment ▪ Have the patient demonstrate call- light use ▪ Maintain call light within reach ▪ Keep personal belongings within safe reach ▪ Keep hospital bed brakes locked ▪ Keep WC locked when patient is stationary ▪ Keep bed in low position when patient resting ▪ Use non-slip footwear ▪ Keep patient care areas uncluttered 13

▪ Sleep deprived ▪ Polypharmacy* FALL prevention Promote early mobility in hospitalized patients and collaborate with physical therapist to ensure that appropriate gait training (if needed) and assistive device are used. ▪ Implement Universal Fall Precautions. ▪ Implement the use of checklists that incorporate hospital-approved fall prevention interventions. ▪ In the community setting, evidence- based exercise programs have been shown to be efective. ▪ CDC evidence-based toolkit: Stopping Elderly Accidents, Deaths, and Injuries (STEADI) - MORSE FALL SCALE WHEELCHAIR SAFTEY: -Patients in wheelchairs can sufer falls and pressure injuries. ▪ Maintain brake on when chair is stationary ▪ Keep personal items in reach so patient won’t overreach and tip the chair ▪ Teach to call for help to transfer ▪ To prevent pressure injury, have patient shift in wheelchair periodically DELEGATION OF FALL RISK: The skill of assessing a patient’s risks for falling cannot be delegated to assistive personnel (AP). Skills used UNEXPECTED OUTCOME AND RELATED INTERVENTIONS: Unexpected outcome: Patient found on floor after falling. ▪ Related Interventions: ▪ Call for assistance. ▪ Assess patient for injury and stay until help arrives. ▪ Notify primary health care provider and family caregiver. ▪ Complete an agency occurrence or sentinel event report ▪ Conduct a postfall huddle/debrief quickly after the fall. ▪ Involve staf at all levels and the patient if possible. Discuss whether appropriate interventions were in place, considerations as to why fall occurred, staffing at time of fall, which environment of care factors

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to prevent falls can be delegated. The nurse directs the AP by: ▪ Explaining a patient’s specific fall risks and associated prevention measures needed to minimize risks ▪ Explaining environmental safety precautions to use ▪ Explaining specific patient behaviors that are precursors to falls and that should be reported to registered nurse (RN) immediately DESIGNATING A RESTRAINT FREE ENVIROMENT: I s the first goal of care for all patients Restraint ▪ Any method (chemical or physical) of restricting an individual’s freedom of movement, including physical activity or normal access to his or her body that ▪ Is not a usual part of a medical diagnostic or treatment procedure ▪ Is not indicated to treat the individual’s medical condition ▪ Does not promote the individual’s independent functioning 24 BEHAVIORAL VS MEDICAL RESTRAINT BEHAVIORAL VIOLENT Associated with phychiatric patients Much more strict use and observation MEDICAL Used in hospitals for RESTRAINTS ARE DANGEROUS limb restraints, posey/vest restraints, all side rails raised CHEMICAL RESTRAINTS : pharmacological agents REASONS FOR RESTRAINTS: to keep patients from wandering, falling, prevent patients from removing medical devices RISK OF RESTRAINTS: PHYSICALLY: Bruises ▪ Pressure injury ▪ Respiratory complications ▪ Urinary incontinence or constipation ▪ Undernutrition ▪ and many more ▪ including, increased risk for mortality caused by strangulation or as a consequence of serious injuries--i.e. fractures or head trauma

patients who might harm themselves or others or to protect the integrity of a medical device ▪ Always try other methods first ▪ Remove as soon as safely possible BEFORE USING RESTRAINTS: Thoroughly assess ▪ Try alternatives ▪ Move close to nurses’ station ▪ Anticipate needs ▪ Mobilize regularly ▪ Use diversion techniques—games, TV, pets ▪ Encourage family and friends to stay with patient ▪ Use bed alarms or GPS technology Use strategies to reduce accidental removal of medical devices ▪ Anchor tubes ▪ Remove or hide from visual field ▪ Consider alternatives Use : use restraints with caution APPLYING PHYSICAL RESTRAINTS: Physical restraints are used to • Prevent patients from injuring themselves or others • Protect the integrity of medically necessary devices Restraints or seclusion • May only be used to ensure immediate physical safety • Must be discontinued at the earliest possible time -Use the least restrictive restraint Possible -NO KNOTS - do NOT tie restraints to side rails, attach to part of bed frame that moves when the HOB is raised or lowered -restraints should be secure but NOT so tight as to restraict circulation 30

Monitor: monitor patient closely per hospital policy and state law to ensure freedom of law Teach: teach patients and family members Obtain: obtain a current healthcare providers order for restrains PERCRIPTIONS FOR RESTRAINTS MUST INCLUDE: Prescription for restraints must include: ▪ Purpose ▪ Type ▪ Location ▪ Time or duration of restraint (p. 397) ▪ Prescription cannot be a prn (or as needed) order ▪ Prescription (for non-violent restraints) must be renewed per hospital policy (p. 401) DELEGATION: APPLYING PHYSICAL RESTRAINTS: The skill of assessing a patient’s behavior, orientation to the environment, need for restraints, and appropriate use of restraints cannot be delegated to AP. The application and routine checking of a restraint can be delegated to AP. The nurse instructs the AP about: ▪ Appropriate restraint to use and correct placement of restraint ▪ When and how to change patient’s position and provide range- of-motion exercises, hydration, toileting, skin care, and time for socialization ▪ When to report signs and symptoms of patient not tolerating restraint and what to do 36 FIRE ELECTRICAL AND CHEMICAL SAFTEY APPLY PHYSICAL RESTRAINT EVALUATION: Non-Violent ▪ Based on agency policy, evaluate for ▪ signs of injury ▪ circulation, ROM, behavior, readiness to D/C ▪ needs for toileting, nutrition, fluids, hygiene, and elimination ▪ Release restraints at least every 2 hours ▪ Renewal of restraints per agency policy Violent/self-destructive ▪ Perform the same evaluation every 15 minutes ▪ Violent restraints must be reordered ▪ Every 4 hours for age 18 or older ▪ Every 2 hours for age 9 to 17 ▪ Every 1 hour for less than 9 years ▪ Provide continuous monitoring USE THE ACRONYM RACE R:rescue patient A: activate alarm C:contain the fire E:evacuate patients USE THE ACRONYM PASS TO

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FIRE: Leading causes of fires in health care facilities ▪ Cooking equipment in cafeterias ▪ Electrical distribution and lighting equipment ▪ Intentional causes ▪ Smoking materials ▪ Review your hospital’s policy for all emergencies ▪ Know the location of fire alarms and extinguishers 39 ELECTRICAL Health care agencies routinely check and maintain all electrical devices ▪ Every biomedical device must have a safety inspection sticker with an expiration date applied to it. ▪ Monitor for frayed electrical cords or broken plugs ▪ Electrical equipment brought in by patients and families must be checked out by the biomedical department ▪ If a patient receives an electrical shock, immediately turn of the source of the power. ▪ Do not touch a person who is being shocked. CHEMICALS: Chemicals in medications, anesthetic gases, cleaning solutions, and disinfectants are potentially toxic. ▪ Safety data sheet (SDS) (previously called material safety data sheet) ▪ Provided for each hazardous chemical in the workplace ▪ Contains information about the properties of the particular chemical and how to handle the substance safely 42 SEIZURE PRECAUTIONS:

Seizure: A sudden, abnormal, electrical discharge in the brain causing alterations in behavior, sensation, or consciousness ▪ Epileptic seizures ▪ Generalized-both sides of brain ▪ Partial-one side of brain ▪ Status epilepticus ▪ 5 minutes of continuous seizure activity or repetitive seizures ▪ Convulsive or nonconvulsive ▪ Seizure precautions ▪ Guidelines to minimize injury during a seizure SEIZURE PRECAUTION PHASES: Aura ▪ warning or start of a partial seizure ▪ visual illusions, noises, metallic taste, etc. Ictus ▪ attack Postictal ▪ post-seizure afterefects such as arm numbness, altered LOC, partial paralysis, loss of memory ADMISSION TRANSFER, DISCHARGE Transitions can be some of the most dangerous times for patients in health care facilities ▪ It is the role of the nurse to implement actions to ensure coordination and continuity of care ▪ Careful communication among providers about necessary interventions to promote patient safety is required. ▪ Hand-of communication ▪ Medication reconciliation