Transcript Basic Human Needs

Safety
Clicker Question
• What percentage of medical errors
are considered preventable?
A. 50%
B. 35%
C. 70%
D. 40%
Safety
• A basic human need
• Freedom from psychological or
physical injury
• Concept central to nursing and
health care today
• Environmental, Personal, Patient
Safety Needs
Where do you feel safe?
Why focus on patient safety?
Medical mistakes kill as many as
98,00 patients per year
NAME SOME SAFETY ISSUES
IN HEALTH CARE SETTINGS
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
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)
Environmental Safety
• Basic Needs
• Physical Hazards
• Transmission of Pathogens
• Pollution
• Terrorism/Bioterrorism
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
Recommended Immunizations
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DPT
MMR
Hepatitis A & B
Varicella
Haemophilus influenzae
Pneumonia
Polio
Rotavirus
HPV (females 13-18)
Yearly flu vaccine
TB (health care workers)
Terrorism/Bioterrorism
Personal Safety
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
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American Nurse Today July 2010
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
(www.ahrq.gov)
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
National Patient Safety
Initiatives
• The Joint Commission National Patient
Safety Goals
• Institute for Healthcare Improvement
“5 Million Lives” Campaign
• The Leapfrog Group
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
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www.cdc.gov
http://www.jointcommission.org/assets/1/6
/HAP_NPSG_6-10-11.pdf
Joint Commission National Patient
Safety Goals
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Identify patients correctly
Improve staff communication
Use medicines safely
Prevent infection
Identify patient safety risks
Prevent mistakes in surgery
• www.jointcommision.org
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
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 bestknown leveraged processes for hospital Boards of Directors,
so that they can become far more effective in accelerating
organizational progress toward safe care
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Source: www.ihi.org/campaign
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
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
Keeping Patients Safe
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Making Hospitals Safer
http://www.youtube.com/watch?v=D35EmKbjTmI
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Josie’s Story
http://today.msnbc.msn.com/id/32917267
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Discussion
Safety and the Nursing Process
• Assessment
• Nursing Diagnosis
• Planning
• Implementation
• Evaluation
Assessment
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Nursing History (Assessing Risk)
Home Hazard Appraisal
Risk for falls
Medication Reconciliation
Implementation
• Health Promotion (wearing seat
belts, use of car seats, bike
helmets, participation in wellness
programs)
• Developmental Interventions:
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Infant, Toddler, Preschooler
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School-Age
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Adolescent
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Adult
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)
Environmental Interventions
• General Preventive Measures: Meet
client needs (Oxygen,
nutrition/fluids, temperature)
• Medical Asepsis
• Isolation Precautions
• Environmental lighting
• Security measures and concerns
Healthcare Worker Safety
• Proper Body Mechanics and Use of
Lifting /Transfer Devices
• Blood & Body Fluid Exposure
• Radiation Exposure
• Exposure to pathogens
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
Figure 49-7 A mitt restraint.
Clicker Question
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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
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.
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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
Patient Safety Internet
Resources
• Institute of Safe Medication
Practice http://www.ismp.org
• The Joint Commission
http://www.jointcommission.org
• National Patient Safety Foundation
http://npsf.org
• Agency for Healthcare Research
and Quality http://www.ahrq.gov
• Institute for Healthcare
Improvement http://www.ihi.org
primum non nocere
“First do no harm”