Chapter 27 Patient Safety and Quality Copyright 2017

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Chapter 27 Patient Safety and Quality Copyright © 2017, Elsevier Inc. All Rights Reserved.

Chapter 27 Patient Safety and Quality Copyright © 2017, Elsevier Inc. All Rights Reserved.

Scientific Knowledge Base Environmental safety A patient’s environment includes physical and psychosocial factors that

Scientific Knowledge Base Environmental safety A patient’s environment includes physical and psychosocial factors that influence or affect the life and survival of that patient Ø A safe environment protects the staff to function optimally Ø Basic needs Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 2

Physical Hazards Physical hazards in the environment threaten a person’s safety and often result

Physical Hazards Physical hazards in the environment threaten a person’s safety and often result in physical or psychological injury or death. Motor vehicle accidents Poison Falls Fire Disasters Copyright © 2017, Elsevier Inc. All Rights Reserved. 3

Environmental Safety Transmission of pathogens Pathogens and parasites pose a threat to patient safety

Environmental Safety Transmission of pathogens Pathogens and parasites pose a threat to patient safety Ø Educate patients about hand hygiene Ø Immunization Ø Pollution Air, land, water Ø Noise Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 4

Case Study Mr. Gonzales is a 68 -year-old man who has lived alone in

Case Study Mr. Gonzales is a 68 -year-old man who has lived alone in a senior apartment building since his wife died 6 months ago. He and his wife were born in Mexico but came to live in the United States shortly after they were married. He is retired from a produce warehouse, where he worked for 37 years. They have raised 3 sons; the closest son, Carlos, is 30 minutes away by car. Carlos visits Mr. Gonzales every week to socialize and take him shopping. Copyright © 2017, Elsevier Inc. All Rights Reserved. 5

Quick Quiz! 1. While caring for a child, you identify that additional safety teaching

Quick Quiz! 1. While caring for a child, you identify that additional safety teaching is needed when a young and inexperienced mother states that: A. teenagers need to practice safe sex. B. a 3 -year-old can safely sit in the front seat of the car. C. children need to wear safety equipment when bike riding. D. children need to learn to swim even if they do not have a pool. Copyright © 2017, Elsevier Inc. All Rights Reserved. 6

Nursing Knowledge Base Factors influencing patient safety Patient’s developmental level Ø Mobility, sensory, and

Nursing Knowledge Base Factors influencing patient safety Patient’s developmental level Ø Mobility, sensory, and cognitive status Ø Lifestyle choices Ø Knowledge of common safety precautions Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 7

Risks at Developmental Stages Infant, toddler, and preschooler School-age child Adolescent Adult Older adult

Risks at Developmental Stages Infant, toddler, and preschooler School-age child Adolescent Adult Older adult Copyright © 2017, Elsevier Inc. All Rights Reserved. 8

Individual Risk Factors Lifestyle Impaired mobility Sensory or communication impairment Lack of safety awareness

Individual Risk Factors Lifestyle Impaired mobility Sensory or communication impairment Lack of safety awareness Copyright © 2017, Elsevier Inc. All Rights Reserved. 9

Case Study (Cont. ) Joani Green, a 25 -year-old married mother of two, is

Case Study (Cont. ) Joani Green, a 25 -year-old married mother of two, is currently a nursing student at the local college. As part of the clinical environment, she and her study partner are conducting health screenings and providing health promotion education for the residents of apartments where Mr. Gonzales lives. Part of Joani’s screening will include Mr. Gonzales’ home environment. Copyright © 2017, Elsevier Inc. All Rights Reserved. 10

Risks in the Health Care Agency Medical errors TJC and CMS “Speak Up” campaign

Risks in the Health Care Agency Medical errors TJC and CMS “Speak Up” campaign National Quality Forum mission Environmental risks Copyright © 2017, Elsevier Inc. All Rights Reserved. 11

Risks in the Health Care Agency (Cont. ) Specific risks to a patient’s safety

Risks in the Health Care Agency (Cont. ) Specific risks to a patient’s safety within the health care environment Falls Ø Patient-inherent accidents Ø Procedure-related accidents Ø Equipment-related accidents Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 12

Critical Thinking Successful critical thinking requires a synthesis of knowledge, experience, critical thinking attitudes,

Critical Thinking Successful critical thinking requires a synthesis of knowledge, experience, critical thinking attitudes, and intellectual and professional standards. Ongoing process. Copyright © 2017, Elsevier Inc. All Rights Reserved. 13

Critical Thinking Copyright © 2017, Elsevier Inc. All Rights Reserved. 14

Critical Thinking Copyright © 2017, Elsevier Inc. All Rights Reserved. 14

Nursing Process Assessment Through the patient’s eyes Ø Nursing history Ø Health care environment

Nursing Process Assessment Through the patient’s eyes Ø Nursing history Ø Health care environment Ø • Risk for falls • Risk for medical errors • Disasters Ø Patient’s home environment Copyright © 2017, Elsevier Inc. All Rights Reserved. 15

Nursing Process (Cont. ) Assessment (cont’d) Ø Patient’s home environment • Perform hazard assessment

Nursing Process (Cont. ) Assessment (cont’d) Ø Patient’s home environment • Perform hazard assessment • Walk through the home with the patient and discuss how he or she normally conducts daily activities and whether the environment poses problems • Help individuals focus on avoiding losses and reducing their risk for injury associated with disasters Copyright © 2017, Elsevier Inc. All Rights Reserved. 16

Nursing Diagnosis Nursing diagnoses for patients with safety risk: Risk for falls Impaired home

Nursing Diagnosis Nursing diagnoses for patients with safety risk: Risk for falls Impaired home maintenance Risk for injury Deficient knowledge Risk for poisoning Risk for suffocation Risk for trauma Copyright © 2017, Elsevier Inc. All Rights Reserved. 17

Case Study (Cont. ) Joani has also discovered through the screening that Mr. Gonzales

Case Study (Cont. ) Joani has also discovered through the screening that Mr. Gonzales has decreased visual acuity and has not had a new pair of glasses for 3 years. He fell in his apartment about a month ago but did not have any injuries. Gait assessment reveals that Mr. Gonzales does not pick his feet very high up off the floor, and his movements are stiff. Copyright © 2017, Elsevier Inc. All Rights Reserved. 18

Planning Goals and outcomes Prevent and minimize safety threats Ø Are measurable and realistic

Planning Goals and outcomes Prevent and minimize safety threats Ø Are measurable and realistic Ø May include active patient participation Ø Setting priorities Teamwork and collaboration Copyright © 2017, Elsevier Inc. All Rights Reserved. 19

Planning (Cont. ) Copyright © 2017, Elsevier Inc. All Rights Reserved. 20

Planning (Cont. ) Copyright © 2017, Elsevier Inc. All Rights Reserved. 20

Implementation Skills Health promotion Developmental interventions Ø Lifestyle Ø Copyright © 2017, Elsevier Inc.

Implementation Skills Health promotion Developmental interventions Ø Lifestyle Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 21

Implementation (Cont. ) Copyright © 2017, Elsevier Inc. All Rights Reserved. 22

Implementation (Cont. ) Copyright © 2017, Elsevier Inc. All Rights Reserved. 22

Implementation (Cont. ) Environmental interventions Ø Basic needs General preventive measures Lighting Ø Changing

Implementation (Cont. ) Environmental interventions Ø Basic needs General preventive measures Lighting Ø Changing the environment Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 23

Case Study (Cont. ) The son, Carlos, has purchased a medication organizer that Mr.

Case Study (Cont. ) The son, Carlos, has purchased a medication organizer that Mr. Gonzales has not used because he is concerned he will make a mistake. Mr. Gonzales is unable to read the labels on his medication bottles. Copyright © 2017, Elsevier Inc. All Rights Reserved. 24

Acute and Restorative Care Fall prevention Follow fall protocols Ø Patient-centered care Ø Assistive

Acute and Restorative Care Fall prevention Follow fall protocols Ø Patient-centered care Ø Assistive aids Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 25

Acute and Restorative Care Restraints Physical Ø Chemical Ø Ongoing assessment Ø Objectives Ø

Acute and Restorative Care Restraints Physical Ø Chemical Ø Ongoing assessment Ø Objectives Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 26

Acute and Restorative Care Side rails Increase patient mobility and/or stability Ø Most commonly

Acute and Restorative Care Side rails Increase patient mobility and/or stability Ø Most commonly used as restraint Ø Can cause falls or death Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 27

Implementation Acute care safety Fires Ø Electrical hazards Ø Seizures Ø Radiation Ø Seizures

Implementation Acute care safety Fires Ø Electrical hazards Ø Seizures Ø Radiation Ø Seizures Ø Disasters Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 28

Quick Quiz! 2. A newly admitted patient was found wandering the hallways for the

Quick Quiz! 2. A newly admitted patient was found wandering the hallways for the past two nights. The most appropriate nursing interventions to prevent a fall for this patient would include: A. raise all four side rails when darkness falls. B. use an electronic bed monitoring device. C. place the patient in a room close to the nursing station. D. use a loose-fitting vest-type jacket restraint. Copyright © 2017, Elsevier Inc. All Rights Reserved. 29

Case Study (Cont. ) What additional health behavior can be encouraged for Mr. Gonzales?

Case Study (Cont. ) What additional health behavior can be encouraged for Mr. Gonzales? What effects could this health behavior produce? Copyright © 2017, Elsevier Inc. All Rights Reserved. 30

Evaluation Through the patient’s eyes Are the patient’s expectations met? Ø Are the family’s

Evaluation Through the patient’s eyes Are the patient’s expectations met? Ø Are the family’s expectations met? Ø Patient outcomes Monitor care by the health care team. Ø Measure outcomes for each diagnosis. Ø Continually assess needs for additional support. Ø Copyright © 2017, Elsevier Inc. All Rights Reserved. 31

Case Study (Cont. ) It has been 2 weeks since Joani implemented the plan

Case Study (Cont. ) It has been 2 weeks since Joani implemented the plan of care for Mr. Gonzales. Joani will observe Mr. Gonzales’ environment for elimination of threats to patient safety. She will reassess motor, sensory, and cognitive status for appropriate environmental modifications. Copyright © 2017, Elsevier Inc. All Rights Reserved. 32

Quick Quiz! 3. A nurse floats to a busy surgical unit and administers a

Quick Quiz! 3. A nurse floats to a busy surgical unit and administers a wrong medication to a patient. This error can be classified as: A. a poisoning accident. B. an equipment-related accident. C. a procedure-related accident. D. an accident related to time management. Copyright © 2017, Elsevier Inc. All Rights Reserved. 33

Case Study (Cont. ) With regular exercise, Mr. Gonzales has found that his walking

Case Study (Cont. ) With regular exercise, Mr. Gonzales has found that his walking has improved, and now he feels safer about leaving the apartment. The new medication labels and organizer have made it easier for him to tell his several medications apart. He reports that his vision is much better with his new glasses. He understands that he is able to make changes in his environment that will keep him safe. Mr. Gonzales has been injury-free and plans to live to a “ripe old age. ” Copyright © 2017, Elsevier Inc. All Rights Reserved. 34

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