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Presentation on theme: "Safety."— Presentation transcript:

1 Safety

2 Clicker Question What percentage of medical errors are considered preventable? 50% 35% 70% 40%

3 Safety A basic human need
Freedom from psychological or physical injury Concept central to nursing and health care today Environmental, Personal, Patient Safety Needs

4 Where do you feel safe?

5 Why focus on patient safety
Why focus on patient safety? Medical mistakes kill as many as 98,00 patients per year

6 Name some safety issues in health care settings

7 Calls for Improvements in Patient Safety
To Error is Human: Building A Safer System (IOM 1999) Crossing the Quality Chasm: A New Health System for the 21st Century The Agency for Healthcare Research and Quality Institute for Healthcare Improvement National Patient Safety Foundation

8 Nightingale’s Message
“It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm”. (Florence Nightingale, 1859, Notes on Nursing)

9 Environmental Safety Basic Needs Physical Hazards
Transmission of Pathogens Pollution Terrorism/Bioterrorism


11 Transmission of Pathogens
Pathogen: Any microorganism capable of producing an illness Medical asepsis Immunizations Standard precautions (transmission of HIV, Hepatitis) Health Care Acquired Infections Isolation Procedures STD’s Adequate disposal of human waste, insect, rodent control

12 Recommended Immunizations
DPT MMR Hepatitis A & B Varicella Haemophilus influenzae Pneumonia Polio Rotavirus HPV (females 13-18) Yearly flu vaccine TB (health care workers)


14 Terrorism/Bioterrorism

15 Personal Safety

16 Safe Patient Handling Back pain and injuries in nurses are widespread
Nurses should not lift more than 35 lbs. How much can nurses push or pull safely? Very heavy patients threaten nurses’ backs, necks, and knees Seven states have laws to protect nurses from patient-handling injuries Lifting and transfer equipment American Nurse Today July 2010


18 Patient Safety: Scope of the Problem
Medical errors are the 8th leading cause of death in this country 2.4 million prescriptions per year are filled incorrectly in Massachusetts 61% of Americans fear being given the wrong medicine 70% of medical errors are preventable (

19 Patient Safety Risks Preventing Falls/Pressure Ulcers
Client-Inherent Accidents (Seizures) Procedure-related accidents (surgery, chest tube & catheter insertions, med/IV errors) Use of Restraints Equipment-related Accidents (electrical hazards, fires from faulty equipment) Preventing Health Care-Associated Infections (HAI) Preventing Medication Errors Failure to Rescue

20 National Patient Safety Initiatives
The Joint Commission National Patient Safety Goals Institute for Healthcare Improvement “5 Million Lives” Campaign The Leapfrog Group

21 HAI’s: Scope of the Problem
Health care-Associated Infections are one of the top 10 leading causes of death in the U.S. 1.7 million infections and 99,000 associated deaths per year Billions of dollars in health-care costs 32% of HAI’s are UTI’s 22% of HAI’s are surgical site 15% of HAI’s are pneumonias 14% of HAI’s are bloodstream


23 Joint Commission National Patient Safety Goals
Identify patients correctly Improve staff communication Use medicines safely Prevent infection Identify patient safety risks Prevent mistakes in surgery

24 IHI Safety Initiatives
The six interventions from the 100,000 Lives Campaign: Deploy Rapid Response Teams…at the first sign of patient decline Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation Prevent Central Line Infections…by implementing a series of interdependent, scientifically grounded steps Prevent Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time Prevent Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps

25 IHI Patient Safety Platform
New interventions targeted at harm: Prevent Pressure Ulcers... by reliably using science-based guidelines for their prevention Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) Infection…by reliably implementing scientifically proven infection control practices Prevent Harm from High-Alert Medications... starting with a focus on anticoagulants, sedatives, narcotics, and insulin Reduce Surgical Complications... by reliably implementing all of the changes in care recommended by the Surgical Care Improvement Project (SCIP) Deliver Reliable, Evidence-Based Care for Congestive Heart Failure…to reduce readmissions Get Boards on Board….Defining and spreading the best-known leveraged processes for hospital Boards of Directors, so that they can become far more effective in accelerating organizational progress toward safe care Source: Detailed How-to Guides on each intervention are available at under the Materials tab.

26 How Many Injuries in the United States?
37 Million Admissions (Source: The AHA National Hospital Survey for 2005) X 40 Injuries per 100 Admissions (Source: IHI “Global Trigger Tool” Guiding Record Reviews) = 15 Million Injuries per Year

27 The Leapfrog Group Reduce preventable medical mistakes and improve the quality and affordability of health care Encourage health providers to publicly report their quality outcomes so consumers can make informed choices

28 Keeping Patients Safe Making Hospitals Safer
Josie’s Story Discussion

29 Safety and the Nursing Process
Assessment Nursing Diagnosis Planning Implementation Evaluation

30 Assessment Nursing History (Assessing Risk) Home Hazard Appraisal
Risk for falls Medication Reconciliation

31 Implementation Health Promotion (wearing seat belts, use of car seats, bike helmets, participation in wellness programs) Developmental Interventions: Infant, Toddler, Preschooler School-Age Adolescent Adult

32 Implementation Older Adult
Reduce the risk for falls and other injuries Compensate for physiological changes related to aging MVA prevention (Safe driver tips, eyesight/hearing issues) Burn and scald prevention Pedestrian accidents (wear reflectors, walk on sidewalks, cross at light)

33 Environmental Interventions
General Preventive Measures: Meet client needs (Oxygen, nutrition/fluids, temperature) Medical Asepsis Isolation Precautions Environmental lighting Security measures and concerns

34 Healthcare Worker Safety
Proper Body Mechanics and Use of Lifting /Transfer Devices Blood & Body Fluid Exposure Radiation Exposure Exposure to pathogens

35 Specific Safety Concerns
Falls (Fall Assessment Tool) Restraints and bed alarms Side rails, bed height, bed and wheelchair locks Fires Poisonings Electrical Hazards Seizures Radiation exposure Preventing medication errors Preventing health care associated infections

36 Figure 49-7 A mitt restraint.


38 Clicker Question Which of the following restraints would be preferred for a patient pulling at IV lines: A. Wrist restraints B. Belt restraints C. Mitt restraints D. Bed Alarm

39 Clicker Question 1. A newly admitted client was found wandering the hallways for the past two nights. The most appropriate nursing interventions to prevent a fall for this client would include: A. Raise all four side rails when darkness falls. B. Use an electronic bed monitoring device. C. Place the client in a room close to the nursing station. D. Use a loose-fitting vest-type jacket restraint. Answer: B

40 What we can do to prevent errors
Better communication between health care team members Monitor patients closely for changes in condition Prevent medication errors Prevent infection Prevent falls Identify patients correctly



43 Patient Safety Internet Resources
Institute of Safe Medication Practice The Joint Commission National Patient Safety Foundation Agency for Healthcare Research and Quality Institute for Healthcare Improvement

44 primum non nocere “First do no harm”

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