Patient Safety Chapter 38 5/26/2019 NRS 105 2011_Collings

JCAHO 2011 National Patient Safety Goals: Long term care Identify residents correctly Use at least two ways to identify residents. For example, use the resident’s name and date of birth. This is done to make sure that each resident gets the medicine and treatment meant for them Use medicines safely Take extra care with residents who take medicines to thin their blood. Record and pass along correct information about a resident’s medicines. Find out what medicines the resident is taking. Compare those medicines to new medicines given to the resident. Make sure the resident knows which medicines to take when they are at home. Tell the resident it is important to bring their up-to-date list of medicines every time they visit a doctor. Prevent infection Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Use proven guidelines to prevent infection of the blood from central lines. 5/26/2019 NRS 105 2011_Collings

JCAHO – LT Care 2010 Prevent residents from falling Prevent bed sores Find out which residents are most likely to fall. For example, is the resident taking any medicines that might make them weak, dizzy or sleepy? Take action to prevent falls for these residents. Prevent bed sores Find out which residents are most likely to have bed sores. Take action to prevent bed sores in these patients. From time to time, re-check residents for bed sores. Check resident medicines Find out what medicines each resident is taking. Make sure that it is OK for the resident to take any new medicines with their current medicines. Give a list of the resident’s medicines to their next caregiver. Give the list to the resident’s regular doctor before the resident goes home. Give a list of the resident’s medicines to the resident and their family before they go home. Explain the list. (2011, http://www.jointcommission.org/assets/1/6/LTC_NPSG_6-10-11.pdf) 5/26/2019 NRS 105 2011_Collings

Environmental Safety A safe environment includes meeting basic needs, reducing physical hazards, reducing the transmission of pathogens, maintaining sanitation, and controlling pollution. A safe environment also includes one where the threat of attack from biological, chemical, or nuclear weapons is prevented or minimized. 5/26/2019 NRS 105 2011_Collings

Basic Needs Oxygen Nutrition Temperature and Humidity 5/26/2019 NRS 105 2011_Collings

Physical Hazards Lighting Obstacles Bathroom Hazards Security 5/26/2019 NRS 105 2011_Collings

Environment Safety Transmission of Pathogens Pollution Terrorism Air pollution Water pollution Noise pollution Terrorism Bioterrorism 5/26/2019 NRS 105 2011_Collings

Risks at Developmental Stages Infant, Toddler, Preschool School aged child Adolescent Adult Older Adult 5/26/2019 NRS 105 2011_Collings

Individual Risk Factors Lifestyle Impaired Mobility Sensory or communication Impairment Lack of Safety Awareness 5/26/2019 NRS 105 2011_Collings

Risks in the Health Care Agency Falls Patient-Inherent Accidents Procedure-related Accidents Equipment-related Accidents Medication errors 5/26/2019 NRS 105 2011_Collings

Nursing Diagnosis Risk for injury Related to: As evidenced by: General weakness Right or Left sided weakness Side effects of medication Poor eyesight As evidenced by: Recent falls New CVA Confusion Macular degeneration 5/26/2019 NRS 105 2011_Collings

Implementation Risk for injury related to (r/t) generalized weakness as evidenced by recent falls Pt. will ask for help to the bathroom each time this shift Call light will be in reach at all times Pt will not fall this shift Work with other care providers to make sure patient is seen q hour Document on rounding sheet 5/26/2019 NRS 105 2011_Collings

Use of Restraints in the Health Care Setting Physical or chemical means of stopping a patient from being free to move. Used only in emergency situations to ensure the patient’s safety. Restraint orders must be specific and time-limited. 5/26/2019 NRS 105 2011_Collings

Restraints & Alternatives Bed rails may be considered restraints Usually OK to have 2 up 4 up considered a restraint Contributes to more frequent, severe injury Alternatives to restraints – Check on pt. at least hourly Place close to nurse’s station Control environment, re-orient pt frequently Provide call light, personal needs, access to BR 5/26/2019 NRS 105 2011_Collings

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Other Mechanisms to Prevent Falls Tab Alarms Arm Bands ID outside of Patient room Notice Inside the Patient room Colors of gowns, slippers, blankets Bed Alarms Chair Alarms 5/26/2019 NRS 105 2011_Collings

Restraint Use Must have a physician order May apply in emergency, then get order Order must be rewritten every 24h. No automatic renewal, verbal order Restraint policies are specific to health care setting Nursing documentation must occur at least every two hours Including need for continued restraint use, skin assessment Generally – ICU and ED have more flexible restraint policies R/T confused, intubated patients Infants and children may have iv secured with armboard, etc that would be a restraint in an adult 5/26/2019 NRS 105 2011_Collings

Complications from Restraints Skin breakdown Constipation Pneumonia Incontinence Urinary retention Nerve damage Circulatory damage Another complication – patients are not checked as often; not moved, changed, etc 5/26/2019 NRS 105 2011_Collings

Questions? Discussion? 5/26/2019 NRS 105 2011_Collings