Nursing: A Concept-Based Approach to Learning, 2nd Edition

 The Concept of Safety Definitions Safety is protection from harm or injury Nurses in key position to improve the quality of health care through client safety interventions and strategies Preventable mistakes Institute of Medicine (IOM) To Err Is Human Building a Safer Health System Children in healthcare setting are at particular risk National patient safety initiatives See Table 511 OVERVIEW OF SAMPLE PATIENT SAFETY INITIATIVES, p. 2697 American Health Quality Association (AHQA) Agency for Healthcare Research and Quality (AHRQ) American Medical Association (AMA) Physician Consortium American Society for Healthcare Risk Management (ASHRM) Centers for Medicare and Medicaid Services (CMS) IOM Joint Commission National ePrescribing National Patient Safety Foundation (NPSF) World Health Organization (WHO) Information is crucial to safety Adverse events ( lack of knowledge about deficiencies and remedies 2005 Patient Safety and Quality Improvement Act Case Study A ( See CONCEPTS RELATED TO SAFETY, p. 2698 Quality and Safety Education for Nurses (QSEN) Six competencies Patient-Centered Care Teamwork and Collaboration Evidence-Based Practice Quality Improvement Safety Informatics Case Study B ( National Patient Safety Goals One of most important initiatives See Table 512 SAMPLE NATIONAL PATIENT SAFETY GOALS (NPSGs) FOR HOSPITALS, p. 2701 Case Study C ( Geoffrey Hacket, rN, works with primary care physician (PCP) Dr. Victor Larsson at a local clinic, p. 2701 Community and local initiatives See Table 513 LOCAL COMMUNITY HEALTH INITIATIVES, p. 2703 Minnesota Fall Prevention Initiative Mass in Motion ( wellness promotion/obesity prevention Injury prevention in the clinical setting Falls Very common in healthcare facilities and homes One third of adults over age 65 fall each year 2 million emergency department visits each year Falls can cause numerous injuries Nurses should implement strategies in clinical settings to prevent falls Restraints ( devices or medications that are intended to protect the client from injuring self or others Physical restraints ( any manual method, material, device,or equipment that is attached to the clients body with the intention of limiting or restricting free movement of the clients head, arms, legs, or body Limb restraints Belt restraints Mitt or hand restraints Chemical restraints ( pharmacologic agents that are administered for the purpose of controlling hyperactive behavior in agitated patients See Figure 512 RESTRAINT MONITORING AND INTERVENTION FLOW SHEET, p. 2705 Healthcare-associated infections (HAIs) ( infections that occur while a client is being treated for another condition Catheter-related bloodstream infections (CRBIs) Healthcare-associated pneumonia (HAP) Surgical site infections (SSIs) Central line-associated bloodstream infections (CLABSIs) Clostridium difficile-associated infections (CDIs) 10 common pathogens cause 87 of HAIs Wrong-site surgery (WSS) ( surgery performed on the wrong client, the correct client but the wrong body part, or the correct client but the wrong surgery Universal Protocol developed by Joint Commission to prevent WSS Medication errors Six rights of medication administration Right drug Right dose Right client Right route Right time Right documentation Review The Concept of Safety Relate Link the Concepts Refer Go to Nursing Student Resources Reflect Case Study Exemplar 51.1 Safety Considerations Across the Life Span Overview Safety risks follow us throughout the life span Common injuries vary with age Prenatal and infant risk for injury Prenatal risk Risks to fetus begin even before conception Miscarriage Teratogens Perinatal risk 87 of fetuses survive in utero Birth process inherently traumatic 1 in 13 American babies is born underweight Stillbirth and illnesses See Table 514 DEVELOPMENTAL HAZARDS DURING THE PRENATAL AND PERINATAL PERIOD, p. 2709, which describes the insults and their effects Neonatal risk 4 million neonatal deaths occur worldwide every year Causes of neonatal death include infection, premature birth, asphyxia Causes in U.S. include Congenital malformations, deformations, and chromosomal abnormalities Disorders related to short gestation, preterm delivery, or low birth weight Infant risk Congenital anomalies and short gestation continue to be common causes of mortality and neonates grow into infancy Sudden infant death syndrome (SIDS) ( 8 of deaths Suffocation, often as a result of co-sleeping Child abuse and neglect ( see Box 51-1, p. 2710 Children and unintentional injuries Toddlers Particularly vulnerable in MVCs Like to feel and taste everything Drowning Preschoolers Active and often clumsy ( susceptible to injury MVCs Education of preschooler Cross streets, traffic signals, pools Surveillance Keep in mind childs cognitive and motor skills See Box 51-2 PREVENTION OF WATER-RELATED INJURIES TO CHILDREN, p. 2711 School-age children 2800 school-age fatalities in 2010 Learning to think before act Want to play with children ( bicycling, hiking, swimming, boating Will respond to rules Injuries leading cause of death Unintentional fall Motor vehicle crash Drowning Fire Firearms Adolescents 10,000 died in 2010 Most due to unintentional injury MVCs, poisoning, drowning Drivers license important event in life of adolescent Risk for sports injuries Suicide accounts for 14 of adolescent deaths Nursing implications Nurses should have awareness of risk factors Identify risks unique to each client For very young children, aim teaching and education at parents/caregivers For older children, involve the client in teaching and preventive measures Adult safety and mortality Young adults 150,000 young adults died in 2010 Motor vehicle crash leading cause of mortality ( see Box 51-3 DISTRACTED DRIVING, p. 2713 Other causes Poisoning (drugs) Drowning Fire Burns Firearms Suicide Anticipatory guidance regarding hyperthermia, hypothermia Middle adults Leading causes of death are Malignant cancer Heart disease Motor vehicle crash Decreased reaction times and visual acuity Other causes Falls Fire Burns Poisoning Drowning Older adults Causes of death include Heart disease Malignant cancer Stroke Chronic respiratory disease Help older adults adapt to changes in lifestyle as result of normal changes of aging See Box 51-4 PREVENTING FUNCTIONAL DECLINE AND INJURY IN OLDER ADULTS IN THE CLINICAL SETTING, p. 2714 Nursing process Assessment Varies greatly depending on clients injuries Relationship between safety and development Take clients culture into consideration Diagnosis Risk for Injury Risk for Trauma Risk for Delayed Development Deficient Knowledge Planning Client will verbalize awareness of common safety hazards Client will describe methods of eliminating or minimizing exposure to specific safety hazards Client will seek medical assistance when injured Client will report any drastic changes in health to a medical professional Implementation Focus on wellness promotion Client education Screening May include Preventative measures Anticipatory guidance Educational activities May take place in Facility Home Community Evaluation Determine whether or not client implemented recommended safety measures Interview, home appraisal Review Safety Considerations Across the Life Span Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study Exemplar 51.2 Workplace Safety Overview Workplace safety is a concern in most professions Of particular concern to healthcare workers Protocols for safety promotion and injury prevention have become more prevalent Regulation of workplace safety Occupational Safety and Health Administration (OSHA) Enforces the guidelines presented in the OSHA Act of 1970 Consults with employers and employees regarding prevention methods for injuries and illnesses National Institute for Occupational Safety and Health (NIOSH) Generates new knowledge in the field of occupational safety and health and transfers that knowledge into practice for the betterment of workers National Occupational Research Agenda (NORA) ( works to conduct safety and health research across the country Injuries and etiology Injuries two categories ( fatal and nonfatal Causes depend on profession Majority of fatalities caused by transportation accidents, violence in the workplace, trauma from objects of equipment, falling or tripping, exposure to dangerous environments or substances, explosions or fires Prevalence In 2011, 3 million nonfatal illnesses/injuires reported In 2011, 4693 fatal work-related injuries All occupations Carry specific risks Lifting heavy objects Exposure to hazardous substances Nursing Back and shoulder injuries often from moving or supporting clients Falls and trauma Needlesticks and sharps injuries Work-related illnesses Contact with contagious clients or from bloodborne pathogens Injury prevention in nursing practice Standard precautions Standard precautions ( incorporate universal precautions and body substance insolation measures Includes measures such as Proper hand hygiene Use of protective equipment Safe injection practices Effective management of potentially contaminated surfaces/equipment Needlestick injuries Large and growing problem 385,000 sharps-related injuries each year STOP STICKS campaign Latex precautions Particularly important in nursing Continuous use of latex gloves and/or exposure to other products can put nurses at risk for developing sensitivity Safe client handling Nurses and Health Care Worker Act of 2009 Effective and safe handling of clients helps promote client safety as well as staff safety Workplace violence protection Any physical assault, threatening behavior, or verbal abuse occurring in the workplace Nurses at particular risk In 2009, 2050 RNs reported being assaulted in the workplace Psychiatric units and emergency departments are most noted areas See COMMUNITY-BASED CARE Home Healthcare Nurses and Injuries, p. 2718 Review Workplace Safety Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study 2015 by Education, Inc. 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