Chapter 27

Patient Safety and Quality

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 Scientific Knowledge Base

 Environmental safety
 A patient’s environment includes physical and
psychosocial factors that influence or affect the life
and survival of that patient
 A safe environment protects the staff to function
optimally
 Basic needs

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 Physical Hazards

 Physical hazards in the environment threaten a

person’s safety and often result in physical or
psychological injury or death.
 Motor vehicle accidents
 Poison
 Falls
 Fire
 Disasters

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 Environmental Safety

 Transmission of pathogens
 Pathogens and parasites pose a threat to patient
safety
 Educate patients about hand hygiene
 Immunization
 Pollution
 Air, land, water
 Noise

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 Case Study

 Mr. Gonzales is a 68-year-old man who has lived

alone in a senior apartment building since his
wife died 6 months ago. He and his wife were
born in Mexico but came to live in the United
States shortly after they were married.
 He is retired from a produce warehouse, where
he worked for 37 years. They have raised 3
sons; the closest son, Carlos, is 30 minutes
away by car. Carlos visits Mr. Gonzales every
week to socialize and take him shopping.

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 Quick Quiz!
1. While caring for a child, you identify that
additional safety teaching is needed when a
young and inexperienced mother states that:
A. teenagers need to practice safe sex.
B. a 3-year-old can safely sit in the front seat of
the car.
C. children need to wear safety equipment
when bike riding.
D. children need to learn to swim even if they
do not have a pool.

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 Nursing Knowledge Base

 Factors influencing patient safety

 Patient’s developmental level
 Mobility, sensory, and cognitive status
 Lifestyle choices
 Knowledge of common safety precautions

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 Risks at Developmental Stages

 Infant, toddler, and

preschooler
 School-age child
 Adolescent
 Adult
 Older adult

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 Individual Risk Factors

 Lifestyle
 Impaired mobility
 Sensory or communication impairment
 Lack of safety awareness

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 Case Study (Cont. )

 Joani Green, a 25-year-old married mother of

two, is currently a nursing student at the local
college. As part of the clinical environment, she
and her study partner are conducting health
screenings and providing health promotion
education for the residents of apartments where
Mr. Gonzales lives.
 Part of Joani’s screening will include Mr.
Gonzales’ home environment.

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 Risks in the Health Care Agency

 Medical errors
 TJC and CMS “Speak Up” campaign
 National Quality Forum mission
 Environmental risks

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 Risks in the Health Care Agency
(Cont.)
 Specific risks to a patient’s safety within the
health care environment
 Falls
 Patient-inherent accidents
 Procedure-related accidents
 Equipment-related accidents

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 Critical Thinking

 Successful critical thinking requires a synthesis

of knowledge, experience, critical thinking
attitudes, and intellectual and professional
standards.
 Ongoing process.

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Critical Thinking

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 Nursing Process

 Assessment
 Through the patient’s eyes
 Nursing history
 Health care environment
• Risk for falls
• Risk for medical errors
• Disasters
 Patient’s home environment

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 Nursing Process (Cont.)

 Assessment (cont’d)
 Patient’s home environment
• Perform hazard assessment
• Walk through the home with the patient and discuss how he
or she normally conducts daily activities and whether the
environment poses problems
• Help individuals focus on avoiding losses and reducing their
risk for injury associated with disasters

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 Nursing Diagnosis

Nursing diagnoses for patients with safety risk:

 Risk for falls

 Impaired home maintenance

 Risk for injury

 Deficient knowledge

 Risk for poisoning

 Risk for suffocation

 Risk for trauma

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 Case Study (Cont.)

 Joani has also discovered through the screening

that Mr. Gonzales has decreased visual acuity
and has not had a new pair of glasses for 3
years.
 He fell in his apartment about a month ago but
did not have any injuries.
 Gait assessment reveals that Mr. Gonzales does
not pick his feet very high up off the floor, and
his movements are stiff.

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 Planning

 Goals and outcomes

 Prevent and minimize safety threats
 Are measurable and realistic
 May include active patient participation
 Setting priorities
 Teamwork and collaboration

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Planning (Cont.)

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 Implementation

 Skills
 Health promotion
 Developmental
interventions
 Lifestyle

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Implementation (Cont.)

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 Implementation (Cont.)

 Environmental
interventions
 Basic needs
 General preventive
measures
 Lighting
 Changing the
environment

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 Case Study (Cont.)

 The son, Carlos, has purchased a medication

organizer that Mr. Gonzales has not used
because he is concerned he will make a
mistake.
 Mr. Gonzales is unable to read the labels on his
medication bottles.

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 Acute and Restorative Care

 Fall prevention
 Follow fall protocols
 Patient-centered care
 Assistive aids

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 Acute and Restorative Care

 Restraints
 Physical
 Chemical
 Ongoing assessment
 Objectives

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 Acute and Restorative Care

 Side rails
 Increase patient mobility and/or stability
 Most commonly used as restraint
 Can cause falls or death

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 Implementation

 Acute care safety

 Fires
 Electrical hazards
 Seizures
 Radiation
 Seizures
 Disasters

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 Quick Quiz!

2. A newly admitted patient was found

wandering the hallways for the past two
nights. The most appropriate nursing
interventions to prevent a fall for this patient
would include:
A. raise all four side rails when darkness falls.
B. use an electronic bed monitoring device.
C. place the patient in a room close to the
nursing station.
D. use a loose-fitting vest-type jacket restraint.

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 Case Study (Cont.)

What additional health behavior can be

encouraged for Mr. Gonzales?

What effects could this health behavior

produce?

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 Evaluation

 Through the patient’s eyes

 Are the patient’s expectations met?
 Are the family’s expectations met?
 Patient outcomes
 Monitor care by the health care team.
 Measure outcomes for each diagnosis.
 Continually assess needs for additional support.

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 Case Study (Cont.)

 It has been 2 weeks since Joani implemented

the plan of care for Mr. Gonzales.
 Joani will observe Mr. Gonzales’ environment for
elimination of threats to patient safety.
 She will reassess motor, sensory, and cognitive
status for appropriate environmental
modifications.

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 Quick Quiz!

3. A nurse floats to a busy surgical unit and

administers a wrong medication to a patient.
This error can be classified as:
A. a poisoning accident.
B. an equipment-related accident.
C. a procedure-related accident.
D. an accident related to time management.

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 Case Study (Cont.)
 With regular exercise, Mr. Gonzales has found that his
walking has improved, and now he feels safer about
leaving the apartment.
 The new medication labels and organizer have made it
easier for him to tell his several medications apart.
 He reports that his vision is much better with his new
glasses.
 He understands that he is able to make changes in his
environment that will keep him safe.
 Mr. Gonzales has been injury-free and plans to live to a
“ripe old age.”

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