Practical nursing clinical (online help)
Jack Fowler
PNC121-ClientSafetySafeWorkingEnvironments2221.pptxClient Safety & Safe Working Environments
Potter & Perry, 2019)
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Client Safety
The aim of the Canadian health care system is to provide quality care and access for all. This includes the following:
Cultural Competence, Safety and Humility
Evidence-Informed Practice (EIP)
Quality and Patient Safety
Quality Workplaces
Improved Patient Outcome Metrics
Potter & Perry, 2019)
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Quality Care
How is quality care delivered?
How do nurses achieve quality in nursing practice?
Potter & Perry, 2019)
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Quality Improvement and Risk Management
Risk management is a system of ensuring appropriate care by identifying potential hazards and preventing harm from occurring.
One tool used in risk management is the “incident report” or “adverse occurrence report”
By tracking incidents areas for improvement can be identified
Potter & Perry, 2019)
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Patient Safety Incidents (or Adverse Events)
An event or circumstance that could have resulted, or did result in unnecessary harm to a patient
Harmful incident – resulted in patient harm
Near miss- did not reach the patient
No-harm incident – reached the patient but did no harm
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Factors Affecting Patient Safety
Patient and Provider Factors
Task Factors
Technology Factors
Environmental Factors
Organizational Factors
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Risk Factors at Developmental Stages
Infant/toddlers – poisoning
Toddlers/preschoolers – not restrained properly in vehicles, drowning
Adolescents – risk taking behavior, substance use
Adults – accidents due to alcohol or drugs
Older people – age related changes
Potter & Perry, 2019)
Risk Factors in the Home Environment
Physiological
Environmental
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Fire Safety in the Home Environment
Smoke detectors on every floor of the house
Have a fire extinguisher at home
What other fire risks are there in the home environment?
Potter & Perry, 2019)
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Risk Factors in the Health Care Environment
What can the nurse do to improve safety for patients in hospital?
Potter & Perry, 2019)
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Prevention of Falls
Screen individuals – history of previous falls, balance, gait or mobility issues, use of clinical judgement
Use a validated fall assessment tool for those at risk – e.g., Hendrick II Fall Risk Model
Use falls prevention interventions
Assess after a fall
Potter & Perry, 2019)
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Medication Errors
A medication error is any event that could lead to a patient either receiving inappropriate medication therapy or failing to receive appropriate medication therapy.
Causes of medication errors include nurse fatigue, burn out, distractions and interruptions.
Potter & Perry, 2019)
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Fire Safety in the Clinical Setting – Code Red
If a fire is suspected call a code RED
R - Remove those in immediate danger
E – Ensure fire is contained, close doors
A – Activate the nearest fire alarm
C – Call fire department
T – Try to extinguish the fire if able to do so safely
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Fire Extinguishers
Fire extinguishers are designated according to the cause of the fire.
Class A fires – ordinary combustibles such as paper, wood, cloth
Class B – fires involving flammable or combustible liquids
Class C – fires involving live electricity or power
Class D – combustible metals such as magnesium, uranium spills (not very common)
Class K - fires involving cooking materials such as cooking oils and grease
P – Pull the pin
A – Aim
S – Squeeze
S – Sweep
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Code Green - Evacuation
Evacuation will be ordered if:
The fire cannot be controlled, or patients, visitors and employees are in immediate danger
There will be a DESIGNATED CODE CAPTAIN whose role is to communicate the fire fighters
Two types of evacuation:
Horizontal- Evacuation through smoke/fire barrier doors to a safe area on the same floor
Vertical - Evacuation of all occupants on a floor to another safe floor
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Staff Safety
Environmental Risk
Infection Prevention and Control
Violence
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Global Harmonized System
The global harmonized system includes criteria for the classification of health, physical and environmental hazards, as well as specifying what information should be included on labels of hazardous chemicals as well as safety data sheets.
The goal is that the same set of rules classifying hazards, and the same format and content for labels and safety data sheets will be adopted and used around the world (ccohs.ca, retrieved 2020)
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WHMIS
This sets a standard for the control of hazardous substances in workplaces across Canada (Health Canada, 2015)
WHMIS consists of 3 main elements – worker education programs, cautionary labelling of products and the provision of Material Safety Data Sheets (MSDS)
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WHIMS Symbols
Potter & Perry, 2019)
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Infection Prevention and Control
Employers have a responsibility to protect employees from risk from infectious diseases
They must have policies and procedures in place for staff to follow
Must provide ongoing education
Must ensure sufficient, appropriate PPE is available
Potter & Perry, 2019)
Code White- Violent patient
Safety of patients and staff is critical when dealing with violent patients. Steps to reduce risk of injury include:
Prevention – know history, potential for violence, look for signs and symptoms
De-escalate – use strategies to prevent further escalation and ensure safety of self and others
Potter & Perry, 2019)
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Restraints
“Restraints are physical, chemical or environmental measures used to control the physical or behavioural activity of a person or a portion of his/her body”. (CNO. 2017b).
Restraints have been linked to significant patient harm such as pressure injuries, decreased mobility, increased agitation, increased falls and even death
Potter & Perry, 2019)
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Alternatives to Restraints
In June 2001, the province of Ontario in Canada enacted the Patient Restraints Minimization Act, 2001 (Bill 85).
Most facilities now have a least restraint policy.
Potter & Perry, 2019)
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Other Important Codes
Code Blue- Cardiac Arrest
Code Pink- Cardiac Arrest (18 yrs & under)
Code Yellow – Missing person
Code Amber- Missing child
Code Black-Bomb threat
Code Brown-Hazardous spill
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Code Orange - External Disaster
An emergency may be described as a present or imminent event that requires a rapid and skilled response to protect the health, safety and wellness of individuals and limit damage to property or the environment (Public Safety Canada, 2015a)
A disaster is the outcome of a natural hazard or event (e.g. hurricane, flood, earthquake) or as a result of human action or error whether malicious (e.g., terrorist attacks, use of biological warfare) or unintentional (e.g., accidental chemical spill), that seriously disrupts the functioning of a community or society (Public Safety Canada, 1015a)
Potter & Perry, 2019)
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Approaches to Disaster Planning
Two common approaches:
1. Agent-specific approach – planning efforts are directed those likely to be affected in a specific geographical region
2. All-hazards approach – comprehensive strategy for potential possibilities, used across all jurisdictions.
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Steps in Emergency/Disaster Management
Mitigation
Preparedness
Response
Recovery
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CNO Practice Guideline – RN and RPN Practice: The Client, the Nurse and the Environment
Designed to ensure patient safety by looking at 3 areas that impact patient care.
The Client
The Nurse
The Environment
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Regulated Vs Unregulated Staff
An Unregulated Care Provider (“UCP”) refers to someone who is not regulated under the Regulated Health Professions Act but who may provide health or other care to patients.
Regulated Health Professions - In Ontario, regulated health professions are governed under the Regulated Health Professions Act, 1991 (RHPA) and health profession Acts (i.e., Medicine Act, 1991).
Potter & Perry, 2019)
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CNO Practice Guideline - Working with UCPs
A nurse cannot assume that a UCP is competent to perform any procedure regardless of how straight forward the procedure appears
Nurses must ensure there is ongoing assessment of the patient’s health care needs, develop a plan of care, evaluate the patient’s condition and judge the ongoing effectiveness of the interventions
Potter & Perry, 2019)
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