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The nursing process provides a framework for the assessment, diagnosis, planning interventions, and evaluation of..

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patient safety goals.

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Nurses play a critical role in .... patients and their families how to maintain safety in their homes and communities.

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teaching

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... is the condition of being free from physical or psychological harm and injury.

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Safety

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...result from incidents such as falls, motor vehicle crashes, poisonings, drownings, fire-associated injuries, suffocation by ingested objects, and firearms.

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Unintentional injuries

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...typically result from deliberate acts of violence or abuse and often have fatal consequences such as suicide and homicide.

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Intentional injuries

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Individuals in every ...around the world care about safety.

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setting and location

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The ...fosters safe and healthful environments nationally and worldwide.

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Centers for Disease Control and Prevention (CDC)

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A branch of the CDC, the ....is instrumental in detecting and investigating health problems of the U.S. population.

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National Center for Health Statistics (NCHS),

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In 2007, the NCHS found that unintentional injuries were the... cause of death in the U.S. population, following heart disease, cancer, stroke, and chronic lower respiratory diseases

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fifth leading

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...., an independent, not-for-profit group in the United States that accredits hospitals and other health care-related agencies.

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The Joint Commission (TJC)

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These are examples of ? Identify patients correctly. Improve staff communication. Use medicines safely. Use alarms safely. Prevent infection. Identify patient safety risks. Prevent mistakes in surgery.

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Recent National Patient Safety Goals include:

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These standards, known as the National Patient Safety Goals (NPSGs), are reevaluated every ...

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year.

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The ...of health care workers consists of nurses, and schools of nursing have increasingly emphasized a focus on patient safety in classroom and clinical courses.

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largest proportion

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The risk for injury is based on many ....factors. Individual Body system integrity Lifespan Environmental Pollution Lighting Communicable diseases Workplace hazards Patient safety concerns

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internal and external

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In all settings, including the health care setting, ...of accidents is the overall goal.

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reduction of risk and prevention

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... that affect personal safety include those related to the functioning of body systems and those associated with an individual's lifestyle.

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Individual factors

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Injury to the ....can make a person more susceptible to infections, because the body's protective barrier has been altered.

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integumentary system (skin, hair, nails, and exocrine glands)

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....of medications occurs in the hepatic and renal systems.

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Detoxification and excretion

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A compromised ...can impair perfusion, resulting in symptoms such as shortness of breath and chest pain, which can lead to activity intolerance.

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cardiopulmonary system

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The ...includes cognitive, or mental, ability and sensory perception, both of which are critical for safe functioning of individuals and their interactions with the environment.

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neurologic system

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Impairment of any component of the ... can restrict range of motion and diminish strength, producing a loss of balance and an unsteady gait.

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musculoskeletal system

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Life Span Factors: ... can influence the safety of individuals across the life span.

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Age and developmental issues

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... is the contamination of air, land, water, and the environment by unnatural or harmful substances.

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Pollution

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.... presents safety concerns in home, work, community, and health care environments.

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Inadequate lighting

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...are transmittable from one individual directly to another, usually through blood or body fluid exposure or through vectors such as insects and spores.

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Communicable diseases

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Adults and older adults encounter hazards in the ...and are at risk for injuries that need care in a variety of settings.

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workplace

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....Concerns related to patient safety in a health care agency are detailed throughout this chapter.

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Patient Safety Concerns:

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... Intentional or unintentional ingestion, inhalation, injection, or absorption through the skin of any substance harmful to the body

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Poisoning:

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....substances that can poison or harm individuals or other living organisms through ingestion, inhalation, and dermatologic exposure

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Toxins:

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... Occurs when lead levels build up in blood over months or years

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Lead poisoning:

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.... A colorless, odorless gas that can cause sudden illness and death

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Carbon monoxide:

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...of injuries is the overarching goal, and providing patients with safety information gives them the tools needed to ensure their own safety.

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Prevention

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...Anything offensive, harmful, or injurious to an individual that can pose a direct safety threat

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Abuse:

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....: Occurs when a person comes in contact with an energy source and the energy flows through the body or portion of the body to the ground

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Electrical shock

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.....: When air no longer

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Suffocation

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.... The deliberate release of biologic agents such as bacteria, viruses, and other microbes to cause illness or kill people, animals, or plants

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Bioterrorism:

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.... The federal organization that certifies all Medicare- and Medicaid-participating hospitals (facilities for acute care, psychiatric and rehabilitation services, and long-term care, as well as children's hospitals and treatment centers for alcohol and chemical dependence)

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Centers for Medicare and Medicaid Services:

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Safety risks in health care agencies include falls and the ...

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use of restraints.

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.... Mechanical or physical device, such as material or equipment attached or adjacent to the patient's body, used to restrict movement

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Physical restraint:

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....Medication that is administered to a patient to control behavior

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Chemical restraint:

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Health history and physical assessment should dictate specific safety questions about: ...

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Safety in the home Poisoning Fire and electrical hazards Biohazards Home temperature safety Tripping and falling hazards Outside environment Work

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...for safety hazards and potential sources of injuries is an important first step in the nursing process.

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Assessment

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...includes the collection of subjective information related to the patient's symptoms and chief complaint, history of environmental hazards and exposures, and objective assessment with a focus on affected body systems.

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Evaluation

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While obtaining the patient's ... the nurse should inquire about causes of prior injuries and probe further into the topic when safety issues are raised.

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history,

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Johns Hopkins Hospital Fall Assessment Tool ...., used nationally and internationally in hospitals, can be completed quickly and easily, includes fall prevention intervention guidelines

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Seven-item tool

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Morse Fall Scale ... fall risk assessment tool, widely used nationally and internationally since the late 1980s in acute care and long-term care settings

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Six-item

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Hendrich II Fall Risk Model .... assessment model, well established and used widely in acute care settings to assess the fall risk of patients

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Eight-factor

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The .....may reveal factors that place the patient at risk for safety concerns, and the physical assessment may reveal issues that should be further investigated.

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health history

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The health history may reveal factors that place the patient at risk for safety concerns, and the physical assessment may reveal issues that should be ....

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further investigated.

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The .....should be completed on admission to establish a baseline and repeated on a daily basis or with any change in the patient's condition.

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assessment of fall risk

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In any health care setting, assessment of fall risk includes ....and ....

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personal factors environmental factors

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The three most frequently used tools for the assessment of fall risk in hospital settings are the ...

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Johns Hopkins Hospital Fall Assessment Tool, the Morse Fall Scale, and the Hendrich II Fall Risk Model.

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After this assessment is completed, an overall summary score is calculated; the ...., the greater the patient's risk of falling.

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higher the score

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The Morse Fall Scale This tool has been rated by nurses as .... to use, taking approximately 3 minutes to complete.

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quick and easy

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The six items on the scale are weighted and focus on (1) history of falling, (2) existence of a secondary diagnosis, (3) use of an ambulatory aid, (4) use of an intravenous (IV) line or a saline lock, (5) gait, and (6) mental status

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The Morse Fall Scale

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The tool focuses on eight independent risk factors: (1) confusion/disorientation/impulsivity, (2) symptomatic depression, (3) altered elimination, (4) dizziness/vertigo, (5) male gender, (6) use of antiepileptics, (7) use of benzodiazepines, and (8) performance on the Get Up and Go Test.

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The Hendrich II Fall Risk Model

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The Hendrich II Fall Risk Model If a patient's total score is ..., the patient is considered at high risk for a fall.

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5 or higher

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The most common nursing diagnoses directly associated with safety concerns include: .... injury ...falls ....poisoning ....infection ....aspiration

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risk for

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While caring for a child, you identify that additional safety teaching is needed when a young and inexperienced mother states that: Teenagers need to practice safe sex. A 3-year-old can safely sit in the front seat of the car. Children need to wear safety equipment when bike riding. Children need to learn to swim even if they do not have a pool.

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A 3-year-old can safely sit in the front seat of the car.

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Before ..... for the promotion of safety of individuals across settings, the nurse considers critical assessment findings such as the patient's developmental level, cultural background, and baseline understanding of the issue.

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implementing interventions

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After taking these considerations into account along with the desires and goals articulated by the patient and family, the nurse can develop individualized, ....

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patient-centered interventions and goals.

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Examples of ?!?!?!? Patient will experience no injuries while hospitalized. Patient's risk for falls will be minimized when discharged home. Patient will not be exposed to household chemicals when discharged home.

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goals for the three nursing diagnoses:

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The....... of interventions to maintain the safety of patients across settings is often best promoted through the use of a multidisciplinary care team.

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planning, implementation, and evaluation

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For a patient with safety concerns, members of the multidisciplinary team together ... the issues associated with safety-related nursing diagnoses.

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address

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Patients should be aware of ....such as changes in ground slope and unevenness in walking surfaces and curbs.

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environmental challenges,

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The role of the nurse in mitigating safety risks is largely one of ... and safety promotion.

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patient education

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Nurses helping patients identify safety hazards at ...lay the groundwork for appropriate action.

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home and in the community

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Nurses... with other members of the health care team and with resources in the community can assist patients with arranging to have:

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collaborating

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In home and community settings, nurses must be aware of specific areas of ....

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fall prevention, fire prevention, poisoning prevention.

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Consistent with the focus of the ..., nurses must possess the knowledge, skills, and attitudes to maintain safety and prevent patient injury across health care settings.

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QSEN project

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In addition to being guided by the legal issues related to safety, the professional practice of nursing is guided by the American Nurses Association Code of Ethics, the individual's ...., and the state's nurse practice act.

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internal ethical code of conduct

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... is an acronym for the fire emergency response used by many health care facilities. The letters stand for:

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RACE

question

What does the R in RACE STANDS FOR?

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Rescue all patients in immediate danger, and move them to safe areas.

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What does the A in RACE STANDS FOR?

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Activate the manual-pull station or fire alarm, and have someone call 911.

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What does the C in RACE STANDS FOR?

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Contain the fire by closing doors, confining the fire, and preventing the spread of smoke.

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What does the E in RACE STANDS FOR?

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Extinguish the fire if possible after all patients are removed from the area.

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Health care facilities ...several actions to prevent fires and to ensure adequate preparation if one occurs.

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implement

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To enable successful evacuation, patients should be .. on the basis of their mobility levels.

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triaged

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When using a fire extinguisher, remember the ... acronym (i.e., pull, aim, squeeze, and sweep).

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PASS

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What does THE P IN PASS stand for? Pull pass pick pat

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pull

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What does THE two s IN PASS stand for and the order? sweep then squeeze squeeze and swipe squeeze and sweep sweep and swipe

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squeeze and sweep

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What does THE A IN PASS stand for? ass anal accurate aim

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aim

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To ensure fire safety, nurses should regularly check for ... or anything unusual.

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faulty or loose wiring

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Patients may be at increased risk for an electric shock because of the multiple electrical devices to which they may be connected for ....such as bed, IV pump, oxygen, cardiac monitor, and gastrointestinal suction.

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therapeutic purposes,

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The routine use of ....outlets and plugs on equipment in health care settings helps to minimize the risk of electrical exposure.

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three-pronged (grounded)

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....: Events in which an individual unintentionally and through the force of gravity drops to the ground, floor, or some other lower level.

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Falls

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What are these examples of? Keeping a call light within patient's reach Keeping frequently used items close to the patient Making hourly rounds to check on patients Keeping patients who are at a high risk for falling in rooms close to the nurse's station

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interventions

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... precautions are taken for any patient with a history of seizures.

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Special

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...equipment is kept at the bedside.

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Oxygen and suction

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During a ..., a patient should be protected from injury by placing the head on a soft surface and turning it to the side to prevent aspiration and by moving sharp or hard objects out of the way.

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seizure

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In light of all of the negative consequences that can result from the use of ....it is easy to conclude that they may do more harm than good for the patient.

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physical restraints,

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Nurses should use as many...alternatives as possible before requesting orders for and applying a physical restraint.

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restraint-free

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All deaths occurring while a patient is restrained or within 24 hours of physical restraint removal must be reported by phone to the ....by the close of the next business day after the death.

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CMS

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The Joint Commission ...focus on using physical restraints very infrequently and only after the many alternatives to their use have been exhausted.

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patient safety standards

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In the event of an immediate threat of harm to self or others, the nurse can apply a physical restraint ....order from the primary health care provider, but the order must be sought within an hour of application of the restraint.

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without an

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The interventions and their .... provide guidance for safe restraint application and measures that can be taken to prevent untoward consequences.

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corresponding rationales

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Physical restraints can be applied for either or both of two reasons: .....

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Medical necessity Behavioral or mental health issues

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Physical restraints can be applied only with a physician or health care provider order and only ... reasonable alternatives to restraint use have failed.

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after all

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These are examples of? To immobilize an extremity To prevent harmful patient behavior

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common reasons for the use of physical restraints

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Ethical considerations do not ... the use of restraints, but alternatives should be implemented before restraint initiation to avoid further physical, mental, ethical, and social harm.

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preclude

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Most facilities require restraints to be applied by a ....

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registered nurse or licensed practical nurse.

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Assistance with applying and monitoring a physical restraint may be delegated to unlicensed assistive personnel (UAP) after the .......of the patient.

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initial assessment

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Changes in basic assessments that can be ....to UAP, such as changes in vital signs

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delegated

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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: Raise all four side rails when darkness falls. Use an electronic bed monitoring device. Place the patient in a room close to the nursing station. Use a loose-fitting vest-type jacket restraint.

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Use an electronic bed monitoring device.

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Use of one of the bottom side rails is necessary in ..

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certain patient circumstances.

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The top two side rails are used for ...

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patient positioning.

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Note that when all... are raised, it is considered a form of physical restraint, which requires an order from a primary care provider.

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four side rails

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When all four side rails are raised what is that considered?

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form of physical restraint,

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Are you aloud to just put up all four side rails? With out a PCP permission

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NO

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As with any physical restraint, it is critical to ... the benefits and risks of the use of side rails.

answer

weigh

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The ... requires reporting of incidents involving beds with rails. From 1985 through 2013, the FDA received reports of 901 incidents of patients being trapped, caught, entangled, or strangled in rails, with patient outcomes ranging from death to non-fatal injury.

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FDA

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A nurse floats to a busy surgical unit and administers a wrong medication to a patient. This error can be classified as: A poisoning accident. An equipment-related accident. A procedure-related accident. An accident related to time management.

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A procedure-related accident.

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.... for other areas of concern in the health care environment include: Safe medication administration practices Reduction of pathogen transmission Reduction of procedure- and equipment-related events Successful management of bioterrorist attack

answer

Safety interventions

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One of the 2014 National Patient Safety Goals is to improve the safe use of ....

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medications.

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The QSEN project focuses on developing nurses' ... each of which is crucial for the safe administration of medication to patients.

answer

knowledge, skills, and attitudes,

question

...., formerly called nosocomial infections, are acquired by patients during the course of treatment for other conditions; pneumonia, gastroenteritis, and urinary tract infections are common examples.

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Health care-associated infections (HAIs)

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...is an ongoing process that involves collaboration with the patient, family, and multiple health care professionals to keep patients safe in health care agencies, community environments, and at home.

answer

Evaluation

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