Basic Human Needs Safety
Dec 27, 2015
Basic Human Needs
Safety
Clicker Question• What percentage of medical
errors are considered preventable?
A.50%B.35%C.70%D.40%
Safety• A basic human need
• Freedom from psychological or physical injury
• Concept central to nursing and health care today
• Environmental, Personal, Patient Safety Needs
Where do you feel safe?
Why focus on patient safety?
Medical mistakes kill as many as 98,00 patients per year
NAME SOME SAFETY ISSUES IN HEALTH CARE SETTINGS
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
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)
Environmental Safety
• Basic Needs
• Physical Hazards
• Transmission of Pathogens
• Pollution
• Terrorism/Bioterrorism
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
Recommended Immunizations• DPT• MMR• Hepatitis A & B• Varicella• Haemophilus influenzae• Pneumonia• Polio• Rotavirus• HPV (females 13-18)• Yearly flu vaccine• TB (health care workers)
Terrorism/Bioterrorism
Personal Safety
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
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
(www.ahrq.gov)
Patient Safety Risks• Preventing Falls/Pressure Ulcers• Client-Inherent Accidents
(Seizures)• Procedure-related accidents
(surgery, chest tube & catheter insertions, med/IV errors)
• Equipment-related Accidents (electrical hazards, fires from faulty equipment)
• Preventing Health Care-Associated Infections (HAI)
• Preventing Medication Errors• Failure to Rescue
National Patient Safety Initiatives
• The Joint Commission National Patient Safety Goals
• Institute for Healthcare Improvement “5 Million Lives” Campaign
• The Leapfrog Group
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• www.cdc.gov
Joint Commission National Patient Safety Goals
• Improve the accuracy of patient identification• Improve the effectiveness of communication
among caregivers• Improve the safety of using medications• Reduce the risk of health care associated
infections (HAI)• Accurately and completely reconcile
medications• Reduce the risk of patient harm from falls• Encourage patients’ active involvement in their
own care as a patient safety strategy• The organization identifies safety risks
inherent in its population• Improve recognition and responses to changes
in a patient’s condition• www.jointcommission.org/patientsafety/nationalpatientsafetygoals
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
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: www.ihi.org/campaign
37 Million Admissions(Source: The AHA National Hospital Survey for 2005)
(Source: IHI “Global Trigger Tool” Guiding Record Reviews)
X
40 Injuries per 100 Admissions=
15 Million Injuries per Year
How Many Injuries in the United States?
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
Keeping Patients Safe• Making Hospitals Safer• http://www.youtube.com/watch?v=D35EmKbjTmI
• Josie’s Story• http://today.msnbc.msn.com/id/32917267
• Discussion
Safety and the Nursing Process• Assessment
• Nursing Diagnosis
• Planning
• Implementation
• Evaluation
Assessment• Nursing History• Home Environment Assessment• Risk for falls• Medication Reconciliation
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
ImplementationOlder 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)
Environmental Interventions• General Preventive Measures:
Meet client needs (Oxygen, nutrition/fluids, temperature)
• Medical Asepsis• Isolation Precautions• Environmental lighting• Security measures and
concerns
Healthcare Worker Safety• Proper Body Mechanics and
Use of Lifting /Transfer Devices• Blood & Body Fluid Exposure• Radiation Exposure• Exposure to pathogens
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
Clicker Question Which of the following
restraints would be preferred for a patient pulling at IV lines:
• A. Wrist restraints• B. Belt restraints• C. Mitten restraint• D. Ambualarm
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. 38 - 36
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
Break into Groups:• You are assigned to a hospital
task force on one of the following safety initiatives. Develop a teaching plan for the staff to improve compliance with the issue:
• Preventing Falls• Preventing Medication Errors• Preventing Infection• Improving Staff Communication• Keeping Patients Involved in
their Care
Patient Safety Internet Resources
• Institute of Safe Medication Practice http://www.ismp.org
• The Joint Commission http://www.jointcommission.org
• National Patient Safety Foundation http://npsf.org
• Agency for Healthcare Research and Quality http://www.ahrq.gov
• Institute for Healthcare Improvement http://www.ihi.org
primum non nocere“First do no harm”