Patient Safety Chapter 27

Front 1

What is QSEN? What does each letter stand for?

Back 1

Quality Safety Education for Nurses

QSEN is a project to help prepare student nurses with the necessary tools (Knowledge, skills, and attitudes) to continuously improve the quality and safety of the healthcare system in which they work.

QSEN also stresses system effectiveness and individual performance

Front 2

QSEN teaches students that as a nurse... (4 things)

Back 2

1. you are responsible for using critical thinking skills

2. use the nursing process

3. assess each patient and their evironment for hazards

4. plan and intervene appropriately

Front 3

True or false. Being mentally challenged or having dementia are factors that can influence patient safety.

Back 3

True.

Other factors influencing patient safety include:

-child abuse/elder abuse

-Risky behaviors (typically in adolescence)

-Lifestyle habits like alcohol, smoking, stress (typically adults)

-Multiple medications, acute/chronic disease, increased fall risk, poor eyesight, slow response time, decreased sensory perception, and/or decreased muscle mass. (seen in older adults)

-mentally challenged or dementia

Front 4

True or false. Alcohol is a common risk factor that influences patient safety in OLDER adults.

Back 4

False. Alcohol is a lifestyle habit typical for adults.

Factors influencing patient safety for OLDER adults include: multiple medications, acute/chronic disease, increased fall risk, poor eyesight, slow response time, decreased sensory perception, and/or decreased muscle mass.

Front 5

What are never events?

Back 5

Serious adverse events that should NEVER occur in the health care setting.

Front 6

What does MSDS stand for? What does it provide?

Back 6

Material Safety Data Sheets

They are on every unit and can provide information on how to deal with chemical health hazards (i.e. spills)

Front 7

When an event (or near miss) occurs an __________ is filled out.

Back 7

Incident report (unusual occurrence report) is filled out.

Front 8

True or false. We fill out incident reports so we can watch for trending or repeated issues.

Back 8

True.

Reports help the organization by:

-watching for trending of repeated issues

-initiating "root cause analysis" (RCA) to discover why the event occurred

-promote teaching and process improvement

Front 9

What is the leading cause of unintentional injury in adults 64 years of age and older?

Back 9

FALLS!!!

Front 10

True or false. You have an increased risk for falling if you have urinary incontinence.

Back 10

True.

Other factors that increase risk for falling include:

-history of falling

-being age 65 or over

-reduced vision

-urinary incontinence

-use of walking aids

-effects of various medications

-orthostatic hypotension

-gait and balance problems

Front 11

What patients are at MOST risk for injury from falls?

Back 11

Patients with BLEEDING TENDENCIES resulting from:

-disease (like clotting disorders)

-anticoagulants

-osteoporosis

Front 12

Patients on ____________ have increased risk for intracranial bleeding.

Back 12

Anticoagulants

Front 13

True or False. Placement of tubes and catheters can put hospitalized patients at a higher risk for falling.

Back 13

True.

Hospitalized patients have inherent risk for falling for many reasons...

-unfamiliar environment

-acute illness

-surgery

-mobility status

-medications (diuretics, anxiolytics, antihypertensives)

-treatments

-placement of tubes and catheters

Front 14

What three clothing items indicate fall risk? What color are they?

Back 14

Yellow gown, Yellow armband, Yellow footies

Front 15

True or false. Medicare will still cover medical costs associated with "never events"?

Back 15

FALSE.

In 2007 medicare ruled it would no longer pay for medical costs associated with these errors.

(pg 15. Chapter 2 potter)

Front 16

Who publicly reports patient safety information and listed the 28 serious reportable events that are nurse-sensitive indicators (events that were caused by poor nursing)?

Back 16

National quality forum

Front 17

What is a hyperexcitation and disorderly discharge of neurons in the brain?

Hint: sometimes leads to sudden, violent, jerking, involuntary serious of muscle contractions for around 2 minutes

Back 17

Seizure

Front 18

True or false. The patient will never know when they are about to have a seizure.

Back 18

False.

Patients generally feel an "aura" before the advent of a seizure. Auras can be a bright light, smell or taste.

So as a nurse you should prepare for seizures by:

-padding side rails

-have bite blocks at bedside

(pg. 387, Chapter 27 Potter)

Front 19

What is a "postictal" period?

Back 19

Period after a seizure characterized by confusion and perhaps amnesia to the event

Front 20

True or false. You should never restrain a patient as they are having a seizure.

Back 20

True.

Restraining a patient during seizure could cause additional harm to the patient.

Front 21

Name the four equipment-related accidents.

Back 21

-Malfunction (make sure IVs have free-flow)

-Disrepair (tag and remove equipment from service)

-Misuse of equipment (inadequate instruction)

-Electrical hazard (frayed cords)

Front 22

What kind of restraint involves medicating a person to the point of incapacitation?

Back 22

Chemical restraint

Front 23

True or false. We only use physical restraints are for violent patients.

Back 23

False.

Physical restraints can be used to non-violent patients as well when they are

-confused, disoriented

-at risk for removing lines/tubes

-patients that repeatedly fall

Front 24

Breathing, circulation, pressure ulcers, and even death are all concerns of improper use of _______

Back 24

Restraints

Front 25

True or False. Evidence shows patient outcomes are worse when restraints are used

Back 25

True.

Can cause :

-pressure ulcers

-contractures

-decreased activities of daily living

-increased morbidity and mortality

Front 26

True or False. A physicians order is necessary for restraints.

Back 26

True.

Physicians must see the patient face to face.

Front 27

True or false. A physicians order for restraint must be renewed every 48 hours.

Back 27

False.

Orders may be renewed to the time limits for amaximum of 24 consecutive hours

restraint order and renewal is limited to:

-4 hours for adults,

-2 hoursfor ages 9 through 17, and

-1 hour for children under age 9

Front 28

True or false. Time limitations are different for non-violent patient vs. violent patient restraints.

Back 28

True.

Front 29

True or False. Restraint orders can be PRN (as needed).

Back 29

FALSE.

Restraint orders are NEVER prn.

Front 30

When is it okay to apply restraints without an MD order?

Back 30

An RNmay apply restraints using hospital policy and procedure without a MD order inthe evidence of harm to self and/or others however, it must be followed up witha MD order a.s.a.p.

Front 31

When documenting use of restraints you must include what four things?

Back 31

-behavior that necessitated the use of restraint

-procedure used in restraining

-Condition of the body part restrained (circulation, movement, sensation)

-Evaluation of patient response

Front 32

When is 4 side rails up appropriate?

Back 32

When you need to prevent the patient from falling in the case of transportation, pre-op before surgery, and post-operative situations

Front 33

During a fire, all patient doors must be _______ (open or closed?)

Back 33

Closed.

During a fire/disaster drill close all patient doors; fire doors will close automatically as they are help open with magnets

Front 34

What three things limit exposure to radiation?

Back 34

Time, distance, and shielding

-Time = limit your time spent near the source of radiation

-Distance = stay reallllly far away or as far as you can from the source

-Shielding = use protective lead aprons and thyroid protection if exposure is unavoidable

Front 35

A parent calls the pediatrician’s office frantic about the bottle of cleaner that her 2-year-old son drank. What is the most important instruction you could give to this parent?

Should the parent call the poison control center or take the child to the emergency department?

Back 35

A poison control center is the best resource for patients and parents needing information about the treatment of an accidental poisoning.

(pg 367, chapter 27 potter)

Front 36

At 3 am the emergency department nurse hears that a tornado hit the east side of town. What action does the nurse take first?

A. Prepare for an influx of patients

B. Contact the American Red Cross

C. Determine how to restore essential services

D. Evacuate patients per the disaster plan Inco

Back 36

A. Prepare for an influx of patients

Rationale:

The emergency department nurse needs to prepare for the potential influx of patients first. Staff need to be aware of the disaster plan. Patients may need to be evaluated but not initially. The American Red Cross is not contacted initially. Determination of how to restore essential services is part of the disaster plan and is determined before an actual event.

Front 37

A couple is with their adolescent daughter for a school physical and state they are worried about all the safety risks affecting this age. What is the greatest risk for injury for an adolescent?

A. Home accidents

B. Physiological changes of aging

C. Poisoning and child abduction

D. Automobile accidents, suicide, and substance abuse

Back 37

D. Automobile accidents, suicide, and substance abuse

Rationale:

Risks to the safety of adolescents involve many factors outside the home because much of their time is spent away from home and with their peer group. According to the Centers for Disease Control and Prevention, the risk of motor vehicle accidents is higher among 16- to 19-year-old drivers than any other age-group. In an attempt to relieve the tensions associated with physical and psychosocial changes and peer pressures, some adolescents engage in risk-taking behaviors such as smoking, drinking alcohol, and using drugs.

Front 38

What is the leading cause of burns, reported first, deaths, and injuries involving home medical oxygen?

Back 38

Smoking

(pg 366, chapter 27 Potter)

Front 39

According to Maslow’s hierarchy of needs, thesebasic needs must be met before physical and psychological safetyand security can be addressed. (3 basic needs)

Back 39

-Sufficient oxygen

-nutrition

-optimum temperature

(pg 366, chapter 27 Potter)

Front 40

What are patient-inherent accidents?

Back 40

Patient-inherent accidents are accidents(other than falls) in which the patient is the primary reasonfor the accident.

Examples include:

-self-inflicted cuts, injuries, andburns;

-ingestion or injection of foreign substances;

-self-mutilationor fire setting;

-pinching fingers in drawers or doors.

(pg 371, Chapter 27Potter)

Front 41

What are procedure-related accidents?

Back 41

Procedure-related accidents arecaused by health care providers and include:

-medication and fluidadministration errors

-improper application of external devices

-accidents related to improper performance of procedures suchas dressing changes or urinary catheter insertion.

(pg. 371, Chapter 27 Potter)

Front 42

There is a fire and you need to move the patients away! If the patient ison life support, you need to maintain his or her respiratory status by using a __________

Back 42

bag-valve-mask device (e.g. Ambu-bag)