NURS 1510
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According to the Institute of Medicine,
44,000 – 98,000 people die each year
because of “preventable” medical errors
Most often these deaths result from a
combination of errors and oversights by
several people, and not simply o person’s
error=Procedural errors
The most common error involve medications
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1. Patient identification: Improve the accuracy
of patient identification:
◦ 2 identifiers: name band + DOB
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2. Communication: improve the effectiveness
of communication among caregivers: VO or
PO note “read Back” Standardize
abbreviations to be used
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Improve the safety of using high-alert
medications:
Remove concentrated meds from client
care units
Standardize and limit the number of drug
concentrations available per organization
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4. Eliminate Wrong: eliminate wrong-site,
wrong-patient, wrong procedure or surgery
Create and use pre-op verification process,
checklists, to confirm that appropriate
documents are available
Implement a process to mark the surgical site
and involve client in the marking process
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Improve the safety of using infusion pumps:
◦ Ensure free-flow protection on all general-use and
PCA IV pumps by the organization
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Improve the effectiveness of clinical alarm
systems:
◦ Implement reg preventive maintenance and testing
of alarm systems
◦ Assure alarms to be activated and audible
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Infection control:
◦ Handwashing and reporting nosocomial infections
◦ Reporting deaths from nosocomial infections
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Primary responsibility as a nurse is to protect
client from harm
Safe environment includes:
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Comfortable
Private
Low risk of infection
Low risk of injury
Low risk of undesirable effects of RX, TX
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Falls account for 90% of all reported incidents
in hospitals
Hip Fx results in more hospital admissions
than any other injury
Client- inherent accidents: accidents other
than falls. Cuts, burns, seizure with injury
Procedure-Related accident: caused by HCO,
med errors, contamination of equipment or
wound
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Improper performance of nursing procedure
Equipment-related incidents: result from the
malfunction or improper use of medical
equip-electrocution and fire.
◦ Mark faulty equipment
◦ Place in designated place
◦ Call bio-med
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Oxygen-furnace malfunction leading to
carbon monoxide. Gas binds with
hemoglobin reducing available O2 to tissues
Nutrition-poor food handling and storage
may lead to food poisoning, Hep A.
Temperature-exposure to extremes
temperature=accidental hypothermia or heat
exhaustion
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MVA leading cause of death f/u by falls,
poisonings, drowning, fires and burns.
Common Hazards in the home include:
◦ Inadequate lighting
◦ Clutter
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Others:
◦ Lack of security
◦ Pathogens, carcinogens, sanitation and pollution
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Developmental age: infant, toddler,
preschooler need supervision hi risk for
accidents
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School age sports injuries
Adolescents have risk taking behaviors
Adults life style concerns: alcohol, stress
Older adults physiological changes of age,
medications, other illnesses. The older, the greater
the incidents of falls
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Impaired mobility
Sensory impairments
Cognitive impairments
Safety awareness-placing meds out of reach
of young children, maintaining smoke, CO2
detectors, furnace checks, wearing seat belts,
etc
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Consider your action and how they affect patient safety
Don’t leave products behind
Evaluate products before purchasing (avoid look a likes)
Know how to use products, equipment, etc
Don’t misuse containers
Stay alert for things that do not seem right
Take appropriate steps to address the problem
Trust your instincts and don’t make assumptions
Listen to patients as they express a problem and
communicate it effectively
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Healthcare is a complex system
Everyone makes errors or has near misses
Promote learning
Identify why key systems, processes, or
procedures are in place, learn them and
follow through correctly consistently
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Falls
Physical / chemical restraint (see handout)
Bed/chair alarms
Side rails
Fire RACE: Rescue, Alarm, Confine,
Extinguish or Evacuate
Code-BLS
(see Alegent handout)
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Body Image
Economics
Level of Knowledge
Socio-economic variables
Personal preferences
Physical condition
Age
Gender
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Practice Standard precautions
Utilize safety practices
Provide privacy
Maintain body warmth –use bath blanket
Promote independence
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Oral hygiene: cleanse teeth of food particles,
plaque & bacteria
Massage gums to prevent periodontal ds
Moisturize oral mucosa
Improve sense of taste
Enhances client’s sense of well being
Palm dentures to clean
Note drainage
 Soak gently with H20 if crusted
 Wipe from inner to outer canthus
EARS
Note drainage
Ear wax (cerumen)
DO NOT use cotton tipped applicators
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Maintain integrity
Control body odors
Improves self image
Promotes relaxation
Daily cleanse folds and peri area
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Observe for dryness, inflammation
Corns, calluses
Clean toenails carefully
Dry thoroughly
DO NOT cut corns or calluses
Use lotion
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File nails
Greenish-black indicates fungus growth
Note ingrown nails or thickened nails
DO NOT cut nails of diabetics
If ordered to cut nails in general population
soak for 20 min to soften prior to cutting
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Clean to soiled (outer to inner)
Front to back
Retract foreskin in uncircumcised male
Replace foreskin over glans after rinsing and
drying
Rinse and dry area well
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Promotes relaxation
Stimulates circulation
Opportunity to inspect skin
Relieves muscle tension
Promotes comfort
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Complete bedbath
Partial
Self with help –sponge bath
Shower
Chair-shower
Tub-often avoided post-op
Tipid
Sitz
Aveeno / oatmeal therapeutic