1
Q
Safety
A
- Communication
- Nursing Process
- Comfort
- Mobility
2
Q
Definition of Safety
A
- Basic human need
- Freedom from danger, harm or risk
- Paramount concern that underlies all nursing care
3
Q
Safety Exemplars
A
- Drug Dosage Calculation
- Asepsis
- Medication Safety
- Risk for Injury
- National Patient Safety Goals
- Risk for Infection
4
Q
2017 National Patient Safety Goals
A
As related to medication administration:
- Identify patients correctly
- Improve staff communication
- Use medicines safely
- Prevent infection
5
Q
Minimizing the risk of medication errors
A
- Systems approach & good communication between systems
- Strictly apply the Six Rights of medication administration
- Clarify unclear orders
- Have knowledge of each medication prior to administration
- Culture of Safety instead of blame
6
Q
Six rights of medication administration
A
- Right drug
- Right dose
- Right client
- Right route
- Right time
- Right documentation
7
Q
Generic name
A
nonproprietary or official name - Furosemide
8
Q
Brand name
A
proprietary or trade name
- Lasix
9
Q
Classification
A
- groups of drugs that share similar characteristics
* Effect on body systems, chemical composition, clinical indication, or therapeutic action
10
Q
Action
A
how medications act & type of action
11
Q
Indication
A
reason why medication is prescribed
12
Q
Contraindications
A
why medication should NOT be given to certain client populations & disease processes
13
Q
Dosage
A
- amount of medication given at one time to achieve a therapeutic effect
- Measured in mg, mEq, gram, mcg, etc.
- Varies according to age, gender, weight, type of disease, or administration route
- Too large a dose could be toxic
- Too little a dose could be ineffective
14
Q
Frequency of administration
A
time interval between doses
15
Q
Side effects
A
predictable & often unavoidable secondary effects produced at a usual therapeutic dose
16
Q
Adverse reactions
A
unintended, undesirable, & often unpredictable severe responses to medications
17
Q
Route
A
method of administering the medication
18
Q
Drug interactions
A
effect of one medication on another, which may alter desired effect
19
Q
Nursing implications
A
- Administration recommendations
- Lab values’ relation to medication
- Teaching points
20
Q
Absorption
A
The process by which a medication is transferred from its site of entry into the body to the bloodstream
21
Q
Distribution
A
Occurs after a medication has been absorbed into the bloodstream & distributed throughout the body
22
Q
Metabolism
A
Change of a medication from its original form to a new form
23
Q
Excretion
A
The process of removing a medication, or its metabolites, from the body
24
Q
Factors affecting body’s response to medication
A
- Weight
- Age
- Gender
- Physiological factors
- Pathological factors
- Genetic factors
- Immunological factors
- Psychological factors
- Environmental factors
- Drug tolerance
- Interactions
- Cumulation
25
Half life
* The time it takes for excretion processes to lower the amount of unchanged medication by half
* Based on "healthy person"
* Increased in persons with liver or kidney impairment, also in very young & very old
26
Development consideration
* contraindicated during pregnancy due to effects on fetus
* cross breast milk to nursing infants
* Small size, reduced body weight & body water, ↓ cardiac output & ↓ organ perfusion alter distribution
* Infants & children require lower dosages than adults
27
Medication effects on older adults
* Slower to metabolize with ↓ excretion rate
* Due to ↑ gastric motility, ↑ adipose tissue, ↓ circulation
* Exacerbated response to cardiovascular medications
* More pronounced hypotensive effects
28
Peak concentration
The highest level of medication in a clients bloodstream
29
Trough
The lowest level of medication in a clients bloodstream
30
Allergies
* Immune system responds to medication as foreign substance & forms antibodies against the medication
* ALWAYS ask the client about any allergies when administering medications
* Client needs to be wearing red arm band if allergic to medications or any substance
* Do not administer medication if client states they are allergic to it
* Allergic reactions range from rash to anaphylactic shock
* If reaction occurs, notify physician
31
When anaphylactic shock occurs
* ↑ head of bed
* Administer oxygen
* Call Rapid Response Team
* Notify physician STAT
32
OTC Medications
* Prescription not required
* Allow people to treat common ailments without seeking medical attention
* It is wise to ask clients about OTC medications or herbs they take due to potential interactions with prescribed medications
33
Herbal remedies
* Rapidly growing area in self-care
* used since ancient times
* Placebo effect?
* The key: Balance herbal remedies & alternative therapies with the medical regimen the client is currently following
* Not controlled or tested by the FDA
* The Dietary Supplement Health & Education Act of 1994 classifies herbal products, vitamins, & minerals, & amino acids as dietary supplements
* Not required to go through premarketing testing
34
Issues with herbal remedies
* Not tested by FDA
* May interact with other medications
* Client doesn't always tell HCP of use of herbal medications or alternative therapies
35
Substance abuse
* Refers to use of illicit & street drugs for recreational use
* Alcohol
* Addiction to prescription narcotics, such as opioids
36
Drug seeking behaviors
* Stealing
* Lying
* Making excuses which don't make sense
37
Requirements of medication orders
* Client's name
* Date & time order is written
* Name of medication to be administered
* Dosage of medication
* Route medication is to be administered
* Frequency of administration
* Signature of person writing the order
38
Telephone orders
* A medication order from the HCP which is received over the phone by a nurse
* Time, date, & other required order elements
* Be sure to repeat order back to HCP to assure accuracy
39
Verbal orders
* A medication order from the HCP which is received verbally by a nurse
* Time, date, & other required order elements
* Be sure to repeat order back to HCP to assure accuracy
* Mostly used in emergency situations
40
Standing order/routine medication order
* A standing order is carried out until a prescriber cancels it by writing a different order or until the prescribed number of doses elapse
* Used by EDs, LDRs, & for post-surgical orders
41
PRN Orders
* Orders for medication that are written to be administered on an "as needed" basis
* Ex: Morphine 2-4 mg IV every 3 hrs PRN for incisional pain
42
Single Orders (One time)
* A medication order for which the client is to receive the medication one time only
* Ex: Ativan 1 mg IV on call to MRI; Valium 10 mg p.o. at 0900 x1
43
Stat orders
*An order in which a single dose of a medication is to be given immediately & only once
Ex: Give Apresoline 10 mg IV STAT; Morphine 5 mg IV STAT
44
Documenting safety tips
* Document medications ASAP after administration, including injection sites
* Inaccurate documentation or failure to document has contributed to medication errors
* Verify any inaccurate documentation before administering medications
45
Documenting meds on MAR
* Client's full name & date of birth on EMAR
* Name of medication is written out in full
* Time, dosage, route & frequency of administration
* Allergies, if any, are listed
* Injection sites
46
Medication Reconciliation
* Current, accurate list of medications the client is receiving
* Initiated on admission & updated after surgery or unit transfer
* Completed at discharge, HCP indicates which meds are to be continued so client has complete, accurate, updated list
47
System errors
The majority of these incidents were a result of errors within the system & conditions within the work environment
48
Responsibilities of Healthcare Providers
* Promoting safety
* Preventing injury
* Real changes cannot occur without conscious effort of every healthcare professional
49
Patient-centered care
Clients are partners int heir care, and thus their prospectives, beliefs, and culture need to be taken into account during their care
50
Quality improvement
Adverse events must be monitored and reported so they can be tools for learning in similar situations in the future and catalyst for improvements in quality and safety
51
Evidence-based practice
Medicine is evolving and changing every day, and thus current medical findings must be monitored for the possibility of improved care.
52
Teamwork/collaboration
Because treatment sometimes involves multiple departments and 24-hour care, teamwork across departments and shifts is necessary for optimal care.
53
Informatics
As information technology becomes further integrated into medicine, nurses' input is an essential part of the design.
54
Factors effecting safety in a persons environment
* Development level
* Lifestyle
* Mobility
* Sensory perception
* Knowledge level
* Communication ability
* Physical health state
* Psychosocial state
* Defective equipment
55
Fetus developmental safety risk
Abnormal growth and development
56
Neonatal developmental safety risk
Infection, falls, SIDS
57
Infant developmental safety risk
Falls, injuries from toys, burns, suffocation or drowning, inhalation or ingestion of foreign bodies
58
Toddler developmental safety risk
Falls, cuts from sharp objects, burns, suffocation or drowning, inhalation or ingestion of foreign bodies, poisons
59
Preschooler developmental safety risk
Falls, cuts, burns, drowning, inhalation or ingestion, guns & weapons
60
School-aged child developmental safety risk
Burns, drowning, broken bones, concussions, inhalation or ingestion, guns & weapons, substance abuse
61
Adolescent developmental safety risk
MVC, drowning, guns & weapons, inhalation & ingestion
62
Adult developmental safety risk
Stress, domestic violence, MVC, industrial accidents, drug & alcohol abuse
63
Older adult developmental safety risk
Falls, MVC, elder abuse, sensorimotor changes, fires
64
Physical abuse
*unexplained or repeated injuries resulting from physical force
Ex: Bruises, fractures (arms, legs, facial, ribs), burns, bite marks, head injuries, etc.
65
Sexual abuse
*engaging a child in sexual acts including fondling, rape, & exposing a child to other sexual activities
Ex: Vaginal discharge, UTI, difficulty walking or sitting, STI, & genital pain, bruised labia majora
66
Emotional abuse
*behaviors that harm a child's self-worth or emotional well-being
Ex: Behavior extremes, sleep problems, headaches or stomachaches, avoiding activities
67
Neglect
*failure to meet a child's basic needs including housing, food, clothing, education, & access to medical care
68
Leading causes of nonfatal injuries in ED
* Birth to 9 years: Unintentional falls
* 10-24 years: Unintentional struck by/against
* 25-65+ years: Unintentional falls
69
Leading causes of death in US by age groups
* Birth to 1 year: Congenital anomalies
* 1-44 years: Unintentional injury
* 45-64 years: Malignant neoplasms
* 65+ years: Heart disease
70
Assess client for risk of injuries by
Person, environment, and specific risk factors
71
Specific risk factors
* falls
* fires
* poisoning
* suffocation & choking
* firearm injuries
72
Clients at high risk for falls
* 65+ years
* Documented history of falls
* Impaired vision or sense of balance
* Altered gait or posture
* Taking diuretics, tranquilizers, sedatives, hypnotics, or analgesics
* Postural hypotension
* Slowed reaction time
* Confusion or disorientation
* Impaired mobility
* Weakness and physical frailty
* Unfamiliar environment
73
Nursing interventions to prevent injury in healthcare setting
* Orient the client to the room, including bed controls, call light, & location of bathroom
* Always verify client's identity before administering medications or performing procedures
* Answer call lights promptly
* Hourly rounds
* Risk assessment on admission
* Fall risk signs on chart & in room
* Bed in low & locked position
* Call light within reach
* Use night lights
* Avoid clutter, clean up spills
* Yellow arm band
* Nonskid footwear
* Leave water, tissues, urinal within reach
* Bed rails up (top 2)
74
Fall prevention safety bundle
* Safety huddle
* Hourly rounding
* Morse Fall Risk Scale
* Individualized care interventions
* Nurses have the option to ask for a gerontology review
* Post-fall debriefing
75
Morse fall scale
* Assessment used at health care facilities to assess client's risk for falls
* 7 risk factor variables
* Rated as high, moderate, or low risk
* Should be performed every shift
* Refer to Morse Fall Score handout
* Used in DocuCare
76
Restraint
Defined as physical devices used to limit a client's movement
77
Physical restraints
all 4 bedrails up, geriatric chairs with attached trays, & appliances tied at the wrist, ankle or waist
78
Chemical restraints
drugs used to control behavior & not included in client's normal medical regimen
ex: haldol
79
Alternatives to using restraints
* Bed and chair alarms
* Rule out causes for agitation
* Involve family in client's care
* Ask family members or significant other to sit with client
* Reduce stimulation, noise & light
* Distract & redirect, using calm voice
* Simple, clear explanations & directions
* Night light
* Allow restless client to walk
* Low-height beds
* Floor mats on each side of bed
* Move to room close to nurse's station
80
What if restraints have to be used?
* Only as a last resort
* Least restrictive restraint should be 1st option
* Physician's order REQUIRED and NEVER written for PRN use
* Monitor & assess client every 1 hour
* Monitor & assess inpatient psychiatric client every 15 minutes
81
Documentation of restraints
* Date & time restraint applied
* Type of attempted restraint alternatives & their results
* Notification of client's family & physician
* Frequency of assessment - every 1 hour
* Skin integrity: skin tears, abrasions, bruises
* Neurovascular: paleness, coolness, ↓ sensation, tingling, numbness, or pain in extremity
* Findings
* Regular intervals when restraint is removed - usually every 2 hrs
* Nursing interventions
* Continuing need for restraints
82
Items for positioning clients
* Pillows
* Mattresses
* Adjustable beds
* Bed side rails
* Trapeze bar
* Gait belt
* Hoyer lift
* Overbed (ceiling) lifts
83
Variables leading to back injuries among workers
* Uncoordinated lifts
* Not using assistive devices
* Lifting when tired
* Repetitive movements
* Standing for long periods of time
* Transferring clients alone
* Transferring confused or uncooperative clients
84
Safety event reports
* Was previously known as an incident report
* Required to be filled out when an accident or incident occurs that compromises safety in a healthcare facility
* Needs to be completed immediately following the incident
* Describe incident objectively & client s/s
* Do not mention the safety event report in the client's nursing notes
* Notify the HCP & the nursing supervisor
85
Workplace violence in healthcare
* A recognized hazard in healthcare.
* Any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site
* OSHA recommends zero-tolerance policy toward workplace violence
86
Factors to reduce healthcare acquired infections
* Hand hygiene
* Follow infection control policies
* Sterile technique during urinary catheter insertion & other sterile procedures
* Catheter care every shift for clients with indwelling urinary catheters
* Surgical asepsis when working with central, PICC, & peripheral IV lines, inserting IVs, and giving injections
* Follow standard- & transmission-based precautions
87
R
A
C
E
* Rescue anyone in immediate danger
* Activate the fire alarm/notify personnel
* Contain the fire - close doors & windows
* Evacuate clients & others to safety
88
Disaster
* a tragic event of great magnitude that requires the response of people outside the involved community
* Natural: massive flooding, tornado, earthquake, tsunami
* Man-made: toxic spill, war, terrorist event
89
Bioterrorism
The deliberate spread of pathogenic organisms into a community to cause widespread illness, fear, and panic.
90
Types of terrorism
* Chemical
* Nuclear
* Cyber
91
Chemical terrorism
The deliberate release of a chemical compound that has the potential for harming people's health
* Choking/lung/pulmonary agents
* Blood agents
* Vesicants/blister agents
* Nerve agents
* Incapacitating agents
92
Nuclear terrorism
Intentional introduction of radioactive materials into the environment for the purpose of causing injury & death
* Dirty bomb
* Planned assault at a nuclear power station or weapons facility
* Dispersal of radioactive material into food or water supply
93
Cyber terrorism
* The use of high technology to disable or delete critical infrastructure data or information.
* An attack on a hospital could potentially compromise physicians' and nurses' ability to care for clients & respond to health care emergencies
* Result: Chaos & could be devastating to client safety
94
Biological agents of concern
* Anthrax
* Plague or "black death"
* Smallpox
* Botulism
* Tularemia
* Viral hemorrhagic fevers
95
Disaster resources
* National Disaster Medical System
* Federal Emergency Management Agency
* Centers for Disease Control & Prevention
* The Joint Commission
* American Red Cross
* Department of Homeland Security
