Transcript Diapositiva 1

Safety & Hygiene
B260: Fundamentals of Nursing
Cindy Bemis MSN, RN, NE-BC
Concept: Safety
• Safety is often defined as freedom
from psychological and physical
injury. Safety refers to the prevention
of patient injury caused by health care
errors.
• The QSEN safety competency for a
nurse is defined as “Minimizes risk of
harm to patients and providers
through both system effectiveness
and individual performance.”
TO ERR IS HUMAN:
BUILDING A SAFER HEALTH SYSTEM
• Health care in the United States is not as
safe as it should be--and can be. At least
44,000 people, and perhaps as many as
98,000 people, die in hospitals each year as
a result of medical errors that could have
been prevented, according to estimates from
two major studies. Even using the lower
estimate, preventable medical errors in
hospitals exceed attributable deaths to such
feared threats as motor-vehicle wrecks,
breast cancer, and AIDS.
BUILDING A SAFER HEALTH
SYSTEM
• Medical errors can be defined as the failure
of a planned action to be completed as
intended or the use of a wrong plan to
achieve an aim. Among the problems that
commonly occur during the course of
providing health care are: adverse drug
events and improper transfusions, surgical
injuries and wrong-site surgery, suicides,
restraint-related injuries or death, falls, burns,
pressure ulcers, and mistaken patient
identities.
• Published Nov. 1999
Patient Identification
• FIRST and best way to identify for the
RIGHT patient is to have them STATE
their name and birthday.
• SECOND is to check the name bracelet.
• BOTH of these should be done prior to
any patient contact
• Bar Scan when giving
medications/drawing
blood, where available
FALLS
• A patient fall, defined
as a sudden,
unintentional change in
position, coming to rest
on the ground or other
lower level, is among
the most commonly
reported adverse
hospital events, with
more than 1 million
occurring annually.
MORE THAN
1 MILLION FALLS
OCCUR EVERY
YEAR
FALLS
• Approximately 30% of
falls result in some
type of injury, and 10%
result in serious injury,
such as head trauma
and fracture. Among
older adults, falls are
especially dangerous
because of their
increased causation of
morbidity and mortality.
Fall Assessment Tools
• Assessment of a patient’s risk
factors for falling is essential in
determining specific needs and
developing targeted interventions
to prevent falls.
– Morse Fall Scale: used at Community
Hospital
– Hendricks II Fall Risk Scale
– John Hopkins Fall Risk Scale: used at
the IU Health Hospitals
Morse Fall Scale
Item
1. History of falling; immediate or within 3
months
2. Secondary diagnosis
Scale
Scoring
No 0
Yes 25
No 0
Yes 15
______
3. Ambulatory aid
Bed rest/nurse assist
Crutches/cane/walker
Furniture
0
15
30
4. IV/Heparin Lock
No 0
Yes 20
5. Gait/Transferring
Normal/bedrest/immobile
Weak
Impaired
6. Mental status
Oriented to own ability
Forgets limitations
Risk Level
No Risk
MFS Score
0 - 24
Low Risk
25 - 50
High Risk
≥ 51
______
______
______
______
0 10 20
______
0 15
Action
Good Basic Nursing Care
Implement Standard Fall
Prevention Interventions
Implement High Risk Fall
Prevention Interventions
Hendrick II Fall Risk Model
Risk Factor (≥ 5 = High Risk)
Risk Factor
Risk
Points
Confusion/disorientation
4
Depression
2
Altered elimination
1
Dizziness/vertigo (subjective)
1
Gender (male)
1
Any prescribed anti-epileptics
2
Any prescribed benzodiazepines
1
Get-up-and-go
“Rising from Chair”
Able to rise in single movement
Pushes up, successful in one attempt
Multiple attempts but successful
Unable to rise without assistance
0
1
3
4
Johns Hopkins Fall Risk
Assessment Tool
Complete the Following and Calculate Fall Risk Score
Age (Single-Select)
60-69 years (1 point)
70-79 years (2 points)
≥ 80 years (3 points)
Fall History (Single-Select)
One fall within 6 months before admission (5 points)
Elimination, Bowel and Urine (Single-Select)
Incontinence (2 points)
Urgency or frequency (2 points)
Urgency/frequency and incontinence (4 points)
Medications: Includes PCA/opiates, Anticonvulsants, Antihypertensives,
Diuretics, Hypnotics, Laxatives, Sedatives, and Antipsychotics(Single-Select)
On one high risk drug (3 points)
On two or more high-risk drugs (5 points)
Sedated procedure within last 24 hours (7 points)
Johns Hopkins Fall Risk
Assessment Tool
Complete the Following and Calculate Fall Risk Score
Patient Care Equipment: Any equipment that tethers patient (e.g. IV infusion,
chest tube, indwelling catheters, SCDs, etc.) (Single-Select)
One present (1 point)
Two present (2 points)
Three present (3 points)
Mobility (multi-select, choose all that apply and add points together)
Requires assistance or supervision for mobility, transfer, or ambulation (2
points)
Unsteady gait (2 points)
Visual or auditory or impairment affecting mobility (2 points)
Cognition (Multi-select, choose all that apply and add points together)
Altered awareness of immediate physical environment (1 point)
Impulsive (2 points)
Lack of understanding of one’s physical and cognitive limitations (4 points)
Mod Risk: 6-13 points
High Risk >13 points
Total Points _____
Automatic Fall Risk
FALL RISK FACTOR CATEGORY
Scoring not completed for the following reason(s) ( check any that apply):
Complete paralysis, or completely immobilized. Implement basic safety
(low fall risk) interventions.
Patient has a history of more than one fall within six months before
admission. Implement high fall risk interventions throughout hospitalization.
Patient has experienced a fall during this hospitalization. Implement high fall
risk interventions throughout hospitalization.
Patient is deemed high fall risk per protocol (e.g. seizure precautions).
Implement high fall risk interventions per protocol.
Assisted Fall
• Always use a gait belt when
assisting a patient to
ambulate
• If the patient begins to fall,
gently assist in lowering
them to the ground using the
gait belt
Falls
• Meeting the needs to prevent a fall.
– Rounding
– Call light
– Urinal
– Bedside commode
– Bedside table
– Night light
– Trip hazards
Place care light with in reach
Fall Precautions
Set bed alarm while patient is in bed
Fall Precautions:
Apply yellow non-skid socks on patient when
ambulating
Place patient with strong side by the hand rails
when walking with patient
Fall Precautions:
Ensure electronic device is attached to patient
when in bed or chair (be patient specific) and is
working correctly
Fall Precautions:
Place patient and Posey
bed/Soma bed
Use wedge seats and arm rests
Do Not Use 4 Side Rails