27 Patient safety and quality Preliminary reading Chapter 27 Comprehensive understanding 1. Identify the Joint Commission 2019 National Patient Safety Goals. a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ d. ____________________________________________________________________________________________ e. ____________________________________________________________________________________________ f. _____________________________________________________________________________________________ Scientific knowledge base 2. Identify Maslow’s hierarchy of basic needs that influence a person’s safety. a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ 3. List the physical hazards in the environment that threaten a person’s safety. a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ d. ____________________________________________________________________________________________ e. ____________________________________________________________________________________________ Define the following terms. 4. Pathogen: _____________________________________________________________________________________ 5. Immunization: _________________________________________________________________________________ 6. Pollutant: _____________________________________________________________________________________ Nursing knowledge base 7. In addition to being knowledgeable about the environment, nurses must be familiar with: a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ d. ____________________________________________________________________________________________ 8. Identify the individual risk factors that can pose a threat to safety. a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ d. ____________________________________________________________________________________________ 9. List the four major risks to patient safety in the health care environment. a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ d. ____________________________________________________________________________________________ Nursing process Assessment 10. Identify the specific patient assessments to perform when considering possible threats to the patient’s safety. a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ d. ____________________________________________________________________________________________ Nursing diagnosis 11. Identify actual or potential nursing diagnoses that apply to patients whose safety is threatened. a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ d. ____________________________________________________________________________________________ e. ____________________________________________________________________________________________ Implementation 12. Identify the strategies needed to provide safe nursing care. a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ Give an example(s) of an intervention for the following developmental stages. 13. Infant and toddler: ____________________________________________________________________________ 14. Preschooler: __________________________________________________________________________________ 15. School-age child: ______________________________________________________________________________ 16. Adolescent: ___________________________________________________________________________________ 17. Adult: ________________________________________________________________________________________ 18. Older adult: ___________________________________________________________________________________ 19. Nursing interventions directed at eliminating environmental threats include: a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ 20. The Joint Commission recommends that hospitals have formal fall-reduction programs, which include a fall risk assessment of every patient conducted: a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ 21. A physical restraint is: ________________________________________________________________________ 22. A chemical restraint is: ________________________________________________________________________ 23. Use of restraints must meet one of the following objectives. a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ d. ____________________________________________________________________________________________ 24. Explain the mnemonic RACE to set priorities in case of fire. a. R: ________________________________________________________________________________________ b. A: ________________________________________________________________________________________ c. C: ________________________________________________________________________________________ d. E: ________________________________________________________________________________________ 25. Explain seizure precautions. _______________________________________________________________________________________________ _______________________________________________________________________________________________ 26. The Joint Commission (2015) requires that hospitals have an emergency management plan that addresses: a. ____________________________________________________________________________________________ b. ____________________________________________________________________________________________ c. ____________________________________________________________________________________________ Case study 27. The nurse finds a 68-year-old woman wandering in the hallway and exhibiting confused behavior. The patient says that she is looking for the bathroom. State some interventions that would be appropriate to ensure the safety of this patient. Review questions Select the appropriate answer and cite the rationale for choosing that particular answer. 28. Which of the following would most immediately threaten an individual’s safety? 1. 70% humidity 2. A sprained ankle 3. Lack of water 4. Unrefrigerated fresh vegetables Answer: _______________________________________________________________________________________ Rationale: ______________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 29. The developmental stage that carries the highest risk of an injury from a fall is: 1. Preschool 2. Adulthood 3. School age 4. Older adulthood Answer: _______________________________________________________________________________________ Rationale: ______________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 30. Mrs. Field falls asleep while smoking in bed and drops the burning cigarette on her blanket. When she awakens, her bed is on fire, and she quickly calls the nurse. On observing the fire, the nurse should immediately: 1. Report the fire 2. Attempt to extinguish the fire 3. Assist Mrs. Field to a safe place 4. Close all windows and doors to contain the fire Answer: _______________________________________________________________________________________ Rationale: ______________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ 31. Place the following steps for applying a wrist restraint in the correct order. 1. Pad the skin overlying the wrist 2. Insert two fingers under secured restraint to be sure it is not too tight 3. Be sure the patient is comfortable and in correct anatomical alignment 4. Secure restraint straps to bed frame with quick-release buckle 5. Wrap limb restraint around wrist or ankle with soft part toward skin and secure snugly Answer: _______________________________________________________________________________________ Rationale: ______________________________________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ Critical thinking model for nursing care plan for risk for falls 32. Imagine that you are Mr. Key, the nurse in the care plan in Chapter 27 of your text. Complete the Assessment phase of the critical thinking model by writing your answers in the appropriate boxes of the model shown. Think about the following. a. As you review your assessment, what key areas did you cover? b. In developing Ms. Cohen’s plan of care, what knowledge did Mr. Key apply? c. In what way might Mr. Key’s previous experience assist in this case? d. What intellectual or professional standards were applied to Ms. Cohen? e. What critical thinking attitudes might have been applied in this case?
