1. SafetyandAccident Prevention (Sept 9th),Infection Control (Sept 30th) Marilee Elias, MSN, RN, CNE June Thompson, DrPH, RN NF I Fall 2014

2. True or False There is no such thing as an accident? True Accident Definition: Chance, fortune, luck Act of God An unfortunate event

3. Injury Epidemiological Model Host • Environment • Social • Physical • Agent (energy) • Mechanical • Chemical The key to prevention

4. Unit Outcomes 1. Identify factors that influence accident/injury prevention. 2. Discuss implementation of the National Patient Safety Goals 3. Identify methods to protect clients from injury. 4. Describe safe use of equipment 5. Use clinical decision making/critical thinking when using restraint /safety devices. 6. Identify methods to maintain a safe environment

5. Safety is a Basic Human Need

6. NCLEX Test Plan 2013 Safe and Effective Care Environment • „ Safety and Infection Control 9-15% • „ Reduction of Risk Potential 9-15%

7. Safety/Accident PreventionInjury Prevention • Host factors Affecting Safety • Age • Individual Risk Factors • Lifestyle • Cognitive Awareness • Sensory/Perceptual Alterations • Impaired Mobility • Physical & Emotional Status • Safety Awareness

8. What’s age got to do with it? • Safety concerns across the lifespan • Children • Adolescents • Adulthood • Older Adult

9. Children: Why are they susceptible to Injury? • Infants/Toddlers • Preschooler • School-age

10. Young Children (<1-4) Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control

11. School age Children (5-9) Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control

12. Adolescents • Look! Up in the air! It’s a “Super Teen”! • Judgment lags behind Strength & Confidence • Drugs & ETOH = More risk with any activity

13. Adolescent/Young Adult (10-24) Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control

14. Adult & Older Adult • Adult • Workplace injuries • Drugs & ETOH • Physical Activity = Risk of Injury • The “Weekend Athlete” • Older Adult • Physiological Changes • Balance • Sensory changes

15. Adults (25-54) Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control

16. Older Adults (65 +) Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control

17. In Summary Total Leading Causes of Unintentional Injury Deaths United States - 2011 Centers for Disease Control And Prevention National Center for Injury Prevention and Control

18. Let’s talk About Lifestyle Is this • Host • Agent • Environment • None of the above

19. Safety & Injury Prevention Risk Modifiable vs. Non-modifiable Modifiable: Those things that may be changed or modified Non-modifiable: Those things that may not be changed or modified Why is it important to know the difference?

20. Adults: Let’s talk about Lifestyles • Smoking • ETOH • Drugs • Rx and/or Illegal • Risk-taking Behaviors • Automobiles • Employment • Recreation/ Sports Modifiable or Non-modifiable?

21. Sensory/Perceptual Alterations • Changes or Loss of First Line Defenses • Vision • Hearing • Smell • Taste • Sensation (think Diabetic Neuropathy) • Can also relate to Cognitive Impairment Modifiable or Non-modifiable?

22. Mobility • Changes in: • Strength • Mobility • Balance • Endurance • Use of Assistive Devices Modifiable or Non-modifiable?

23. Injury Epidemiological Model Host • Environment • Social • Physical • Agent (energy) • Mechanical • Chemical The key to prevention

24. There’s been an Incident!What Happens in Healthcare? Types of Event • Host / Client Behavior: Behavior precipitates incident • Falls • Agitation/ Aggression • Agent / Therapeutic Procedures: Occurs during delivery of medical or nursing interventions • Radiation • Chemotherapy • Environment / Equipment: • Failure • Improper Use • Not engaging safety features

25. Leading causes of medical errors in hospitals (Becker’s Infection Control & Clinical Quality, Hospital Review, Jan 2014) • Adverse drug events (medication errors) • Catheter- associated urinary tract infection • Central line- associated bloodstream infection • Injury from falls and immobility • Obstetrical adverse events • Pressure ulcers (bed sores) • Surgical site infections • Venous thrombosis (blood clots) • Ventilator- associated pneumonia

26. Let’s talk Prevention! Assess & Reduce Risks in All Environments • Home • Poisonings • CO Poisoning • Scalds & Burns • Fires • Firearm Injury • Suffocation/Asphyxiation • Take-Home Toxins • Home Safety Assessment Scale (SAS) (vol.2 p.376) • Falls • Choking (let’s rescue) Host • Environment • Social • Physical • Agent (energy) • Mechanical • Chemical

27. Community • MVCs • Pathogens • Food-Borne • Vector-Borne • Water-Borne • Pollution • Air • Water • Noise • Soil • Mother Nature Host • Environment • Social • Physical • Agent (energy) • Mechanical • Chemical

28. Healthcare Facilities Medication Errors Never Events Falls • Risk Assessments (Morse Fall Scale) & Fall Prevention Equipment-Related Injuries Fires • R.A.C.E. Electrical Hazards Restraints • Mechanical and/or Chemical • Proper Use & Patient Care • Siderails • Patient Alarm Devices Host • Environment • Social • Physical • Agent (energy) • Mechanical • Chemical

29. More Healthcare Facilities… Mercury Exposure Biological Hazards Hazards to Healthcare Workers Needlestick Injury Back Injury Radiation Injury Violence (Who’s at risk for violent behavior?) Host • Environment • Social • Physical • Agent (energy) • Mechanical • Chemical

30. Safe Use of Equipment • Proper Training • When in doubt, ASK! • Lock those Wheels • Inspect and Observe Equipment • Report Problems & Remove Equipment • Facility Policies about Patients bringing Electrical Devices from Home Host • Environment • Social • Physical • Agent (energy) • Mechanical • Chemical

31. Now there’s been an Incident! • Incident Reports • What are they? • What do we report? • Won’t they just get someone in trouble? • Won’t my peers think I’m a snitch? • Won’t it make a big deal out of nothing? • Isn’t it just more paperwork? • What’s the Result of Incident Reports?

32. Why learn about safety ? • Estimated 440,000 Americans die annually from preventable hospital errors. • This makes hospital errors the 3rd leading cause of death in the U.S.* • Annual cost to society is over $17.1 billion annually ** • Hospital Safety Score, Washington, Oct. 2013 • National Institutes of Health, Millwood, Oct 2011

33. Two initiatives focused on Safety 1. Quality and Safety Education for Nurses [QSEN] 2. National Patient Safety Goals [NPSG]

34. Quality and Safety Education for Nurses Project(QSEN) • Prepare future nurses with the knowledge, skills and attitudes (KSAs) to improve the quality and safety of healthcare systems • Defines competencies and proposed targets for the knowledge, skills and attitudes (KSAs) to be developed in nursing pre-licensure programs

35. QSEN 6 Competencies • Patient Centered Care • Teamwork and Collaboration • Evidence Based Practice • Quality Improvement • SAFETY • Informatics www.qsen.org

36. Promoting Patient Safety • National Patient Safety Goals (NPSG) brought to us by: • The Joint Commission (TJC) • Formerly known as the Joint Commission for Accreditation of Healthcare Organizations (JCAHO)

37. NPSG Purpose • The purpose of the Joint Commission’s National Patient Safety Goals is to promote specific improvements in patient safety • The requirements highlight problematic areas in health care and describe evidence and expert-based solutions to these problems • The requirements focus on system-wide solutions, wherever possible

38. The NPSG Safety Goals ProjectWe will focus on: • Goal1: Patient Identification (NPSG.01.01.01) • Goal 2: Improve Staff Communication (NPSG.02.03.01) • Goal 3: Use Medications Safely- Labeling (NPSG.03.04.01) • Goal 3: Use Medications Safely- Passing on Info (NPSG.03.06.01) • Goal 7: Prevent Infections- Hand Washing (NPSG.07.01.01) • Goal 7: Prevent Infections- Catheters (NPSG.07.06.01)

39. 2014 National Patient Safety Goals • NPSG.01.01.01 Use at least 2 patient identifiers when providing care, treatment, and services. • NPSG.02.03.01 Report critical results of tests and diagnostic procedures on a timely basis. • NPSG.03.04.01 Label all medications, medication containers, and other solutions on and off the sterile field in perioperative and other procedural settings (includes syringes, medicine cups and basins). • NPSG.03.06.01 Maintain and communicate accurate patient medication information. • NPSG.07.01.01 Comply with either the CDC or WHO hand hygiene guidelines. • NPSG.07.06.01 Implement evidence-based practices to prevent indwelling catheter-associated urinary tract infections (CAUTI).

40. QSEN vs. NPSG

41. High Alert Medications • What’s a high alert medication? • Do medication worksheets for: • Digoxin (Lanoxin) • Warfarin (Coumadin) • NPSG 03.05.02 Take extra care with patients who take medicines to thin their blood

42. Tall Man Lettering FDA and ISMP 2014

43. Thinking and Teaching about Safety • You are making a home health nurse visit to Teresa, her 2 year old child and her elderly grandmother who is recovering from a hip fracture. They live in a rural area and Teresa is the primary caregiver for both of them. Teresa’s husband is a long-distance truck driver and is often away for a week at a time.

44. How is Safety Assessed in Acute Care Settings? • Morse fall risk scale • Braden scale • Sleep apnea scale • Medications • Basic Nursing Care

45. What do you know? • Teresa tells you that the toddler is very active and getting “into everything” • Teresa tells you that since her grandmother was discharged from the rehabilitation center she has been very afraid of falling and does not want to do anything for herself

46. What’s a nurse to do? • Why are Teresa’s child and grandmother at risk for injuries? • What will you look for as you assess the family’s home environment? • What interventions will you suggest to Teresa to improve home safety for her and her family?

47. Safety ProjectInstructions and Group Assignments

48. Infection Control Tuesday, Sept 30th

49. Unit Outcomes • Describe methods to control the spread of infectious agents. • Identify methods to control or eliminate infectious agents. • Use clinical decision making/critical thinking to ensure standard/transmission based/other precautions.

50. Infection Control Chain of Infection • Handwashing Defense Mechanisms Types of Infectious Responses Stages of Infection Nosocomial Infections • Handwashing Medical & Surgical Asepsis • Handwashing Standard & Isolation Precautions • Handwashing