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What are the steps in the nursing plan for safety?
- Assess environment for safety.
- Analyze and make appropriate nursing diagnoses.
- Plan for maintaining patient safety.
- Implement safe practices.
- Evaluate safety behaviors, nursing diagnosis, and nursing care.
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What are the 6 areas to assess in a patient's environment?
- 1. Physical safety
- 2. Microbial safety
- 3. Chemical safety
- 4. Thermal safety
- 5. Environmental safety
- 6. Psychological safety
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How do you implement safe practices for physical safety of a patient?
- Use side rails in accordance with patients condition.
- Keep call light within reach.
- Keep bed in lowest position.
- Keep floors dry and free of clutter.
- Provide adequate lighting.
- Use restraints as appropriate.
- Transfer patient accordingly.
- Ambulate patient accordingly.
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How do you implement safe practices for microbial safety of a patient?
- Medical asepsis (hand washing, handling of food and linens, cleaning of equipment)
- Standard precautions
- Surgical asepsis
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How do you implement safe practices for chemical safety of a patient?
- Keep all hazardous ingestible substances out of reach of patient.
- Administer medication according to the 9 rights.
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What are the 9 rights of medication administration?
- Right patient
- Right drug
- Right route
- Right time
- Right dose
- Right documentation
- Right action
- Right form
- Right response
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How do you implement safe practices for thermal safety of a patient?
- Heat and/or cold treatments accordingly.
- Properly ground electrical equipment.
- Know fire procedures as well as locations of alarms and extinguishers.
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How do you implement safe practices for environmental safety of a patient?
- Properly handles and disposes of hazardous waste.
- Minimize noise in patient's environment.
- Control odors.
- Smoke free environment.
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How do you implement safe practices for psychological safety of a patient?
- Identify emotional responses to illness.
- Assess for coping resources and defense mechanisms.
- Use facilitative communication when appropriate.
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What do you think of first when tackling a patient problem?
Safety!
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ANA
American Nursing Association
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IOM
Institute of Medicine
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What are the 6 aims to improve health care?
- Patient safety
- Patient centered care
- Effectiveness
- Timeliness
- Efficiency
- Equity
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What is the leading cause of both fatal and nonfatal injuries?
Falls
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QSEN
Quality and Safety Education for Nurses
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What are a patient's most basic needs?
- Oxygen
- Nutrition
- Temperature
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What is Mazlow's Criteria?
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What are the intrinsic patient safety risk factors?
- Chronic conditions (postural hypotension)
- Alcohol use
- Previous falls
- Drug treatment/polypharmacy
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What are the extrinsic patient safety risk factors?
- Lighting
- Obstacles
- Bathroom hazards
- Security
- Pathogens
- Pollution
- Terrorism
- Medications/chemicals
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What are the developmental risks for adults?
- Lifestyle habits (medications, alcohol)
- Stress (work)
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What are the developmental risks for older adults?
- Physiological changes
- Falls, accidents
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How does the musculoskeletal system change for an older adult?
- Decreased bone mass, muscle fiber size, strength, range of motion
- Gait and postural changes
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What is the leading cause of functional impairment in older adults?
Osteoarthritis
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What are a large proportion of fall deaths caused from?
Hip fracture complications
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How often are nursing rounds?
Every hour
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How often do you reposition a patient?
Every 2 hours
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What is the Morse scale?
Fall risk scale, score of over 50 is high risk
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How often do you renew a restraint order?
Every 24 hours
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How often do you check restraints on a patient?
Within 15 minutes of placing them and every 2 hours after that
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What is the 15 minute restraint check?
- Level of consciousness
- Respiratory status
- Circulation
- Patient comfort
- Body alignment
- Position of restraints
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What is the 2 hour restraint check?
- Continued need for restraints?
- Skin integrity/circulation
- Release extremities
- Change position/ROM
- Nutrition/hygiene/elimination
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What is the RACE acronym?
- Fire safety:
- R: Rescue/remove
- A: Alarm/activate
- C: Confine/contain
- E: Extinguish/evacuate
- Close all doors.
- Don't use elevators.
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SRE
Serious reportable events
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What are the nursing-sensitive quality indicators?
- HAI's
- Falls/with injury
- Pressure ulcer
- Restraint use
- Pediatric peripheral intravenous infiltration
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Just Culture
Errors have just as serious of consequences
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RCA
Root cause analysis for errors
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Sentinel events
Never events, should never happen and are preventable
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CMS
- Centers for Medicare & Medicaid Services
- Oversees many programs
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JCAHO
Joint Commission on Accreditation of Healthcare Organizations
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Near Miss
A potential safety issue that was stopped by intevention
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System Error
Equipment error
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