Deactivated
Amanda McRae
1 posts
Re:Topic 2 DQ 1
I’ve chosen to write about two clinical problems because they both stand out strongly and I believe that many organizations can relate to these issues. The first problem, which I have seen to be a problem in many hospitals, is patient falls. Research shows that falls, along with injuries from falls, are the most commonly reported adverse events among adults in the hospital inpatient setting (The Online Journal of Issues in Nursing, 2013). I have personally seen this more frequently on units that are understaffed. Nursing implications include filling out the fall scale in their documentation and recognizing patients that are “high risk.” Nurses may also use their personal judgement if they feel the patient is at high risk. A fall precaution sign should then be posted outside of the patient’s room, and the patient should have a yellow fall band around their wrist. The bed alarm must be on at all times while the patient is in bed. Side rails should be up x2, wheels locked, and the bed in the lowest position. The call must be within reach, and the patient educated on its use; nurses must ensure that the patient understands how to use the call light and to call for assistance before getting out of bed. If the patient isn’t oriented or confused, then they should be placed closest to the nurse’s station with the room door open, along with mats around the bed. Family should also be educated on finding staff assistance before getting the patient out of bed. Non-skid socks and proper mobility equipment should be in place before ambulating the patient.
The second issue is more specific to the unit that I’m on, which specializes in cardiovascular care: improper documentation of intake & output. There are many patients in heart failure on this unit, so this is a huge issue. Nurses and CNA must be educated on proper I&O documentation on the flow sheet in Cerner. Nurses can collaborate with their CNA’s to ensure that when a patient is having a heart failure exacerbation, or on diuretics, require *STRICT I&O documentation. If the patient is incontinent of urine, then they should be evaluated for an external or indwelling urinary catheter. Daily weights should be done on all patients by the night shift, between the hours of 0500-0600, the same time each day. Accurate weights should be obtained via a standing scale, or if the patient is unable to stand ensure that the bed is zeroed and there are no further items on it. Charts should be audited by leadership on a frequent basis to ensure proper documentation of I&O on the flow sheet, along with daily weights, is being performed. Involving patients and their families is also an important aspect to accurate I&O documentation (HealthTimes, 2016). Both should be educated on fluid restriction, and notifying staff of when they urinate or drink fluids.
HealthTimes (2016). A Balancing Act: Maintaining accurate fluid balance charting. Retrieved from https://healthtimes.com.au/hub/nutrition-and-hydration/42/practice/nc1/a-balancing-act-maintaining-accurate-fluid-balance-charting/2167/
The Online Journal of Issues in Nursing (2013). Hospital-Based Fall Program Measurement and Improvement in High Reliability Organizations. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Fall-Program-Measurement.html