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Course: Fundamentals of Nursing

Topic: Client Safety

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Student Learning Outcomes

Learners will be able to:

Define client safety.
State the prevalence of client harm due to adverse events and unsafe care.
Detail the most concerning client safety situations.
Describe the International Patient Safety Goals (IPSG) to ensure the safe delivery of care to clients.

Contact info: info@nursesinternational.org

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Definition of Client Safety

WHO, 2019

Client safety is “the prevention of errors and adverse effects to clients associated with health care”

The goal is to prevent and reduce risks, errors and harm that may occur to clients during provision of health care.

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Basic Concepts

Ernstmeyer, & Christman, 2021

Never Events:

Are adverse events that are clearly identifiable, measurable, serious (resulting in death or significant disability), and preventable.

The current list of never events includes seven categories of events:

Surgical or procedural event:

Surgery performed on the wrong body part.

Product or device:

Injury or death from a contaminated drug or device.

Client protection:

Such as client suicide in a health care setting.

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Basic Concepts

Ernstmeyer, & Christman, 2021

Never Events (continued…..):

Care management:

Death or injury from a medication error.

Environmental:

Death or injury as the result of using restraints

Radiologic:

A metallic object in an MRI area.

Criminal:

Death or injury of a client or staff member resulting from physical assault on the grounds of a health care setting.

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Basic Concepts

Sentinel Events:

Defined as an “unexpected occurrence involving death or serious physiological or psychological injury, or the risk thereof.”
Example: injury or death from a properly prescribed and administered medication is a sentinel event.

Near Misses:

According to WHO, defined as “An error that has the potential to cause an adverse event (client harm) but fails to do so because of chance or because it is intercepted.”

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

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Why does Clients Harm Occur?

WHO, 2019

The factors that lead to the occurrence of errors:

The increasing complexity in health care settings

Example, a client in hospital might receive a wrong medication because of a mix-up that occurs due to similar packaging

A lack of standard procedures for storage of medications that look alike
Poor communication between the different providers
Lack of verification before medication administration and
Lack of involvement of patients in their own care

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Prevalence of Client Safety issues

Adverse events due to unsafe care is likely one of the 10 leading causes of death and disability in the world.

In high-income countries, estimated that one in every 10 clients is harmed while receiving hospital care.

Each year, 134 million adverse events occur in hospitals in low- and middle-income countries (LMICs), due to unsafe care, resulting in 2.6 million deaths.

WHO, 2019

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Critical Thinking Question

You are a nurse working in a medical surgical ward.

What might be your concerns about client safety?

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Client Safety Situations

WHO, 2019

Situations of most concern are:

Medication errors
Health care-associated infections:

Occur in 7 and 10 out of every 100 hospitalized clients.

Unsafe surgical care procedures:

Cause complications in up to 25% of clients.

Unsafe injections practices:

Can transmit infections, including HIV and hepatitis B and C.

Diagnostic errors:

Occur in about 5% of adults in outpatient care settings.

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Client Safety Situations

WHO, 2019

Unsafe transfusion practices:

Expose clients to the risk of adverse transfusion reactions and the transmission of infections.

Radiation errors:

Involve overexposure to radiation and cases of wrong-patient and wrong-site identification.

Venous thromboembolism (blood clots):

Contributing to one third of the complications attributed to hospitalization.

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International Patient Safety Goals (IPSGs)

Purposes:

To promote specific improvements in client safety
To highlight problematic areas in health care and describe evidence- and expert-based consensus solutions to these problems

IPSGs are:

Goal -1: Identify Patient Correctly
Goal -2: Improve effective communication
Goal -3: Improve the safety of High Alert Medications
Goal -4: Ensure Safe Surgery
Goal- 5: Reduce the Risk of Healthcare- Associated Infection
Goal -6: Reduce the Risk of client harm resulting from fall

Joint Commission International, 2017

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Goal 1: Identify Patient Correctly

The Joint Commission, 2021

Use 2 identifiers:

Name
IP/OP numbers

Each time for:

Medication administration
Blood administration
Blood draws
Obtaining specimens (label in presence of client)
Treatment/procedures

Do not use client room number as an identifier

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Goal 2: Improve Effective Communication

The Joint Commission, 2021

Critical Test Result and Values:

The complete verbal and telephone order or test result is written down by the receiver.
The complete verbal and telephone order or test result is read back by the receiver of the order or test result.
The order or test result is confirmed by the individual who gave the order or test result.

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Goal 2: Improve Effective Communication

ISBARR:

Introduction: Who you are, your role, where you are and why you are communicating.
Situation: What is happening at the moment?
Background: What are the issues that led up to this situat.
Assessment: Share abnormal assessment findings and your concerns.
Recommendation: What should be done to correct.
Repeat back: If you are receiving new orders from a provider, repeat them to confirm accuracy. Be sure to document communication with the provider in the client’s chart.

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

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Goal 2: Improve Effective Communication

Ernstmeyer, & Christman, 2021

Contact info: info@nursesinternational.org

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Users: ISBAR

The Joint Commision, 2021

The ISBAR framework may be used in any information handover situation:

Shift changes
Discharge to community services
Inter-hospital transfers
Intra-hospital transfers
Time-critical situations
Procedure documents
Reports, memorandums and briefings

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Goal 3: Improve the Safety of High Alert Medication

The Joint Commision, 2021

High-Alert Medications are:

Medications involved in a high percentage of errors and/or sentinel events.
Medications that carry a higher risk for adverse outcomes.
Look-alike/sound-alike medications.

Labeling medications,solutions, and containers
Anticoagulation therapy

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Goal 3: Improve the Safety of High Alert Medication

Labeling includes:

Drug/solution name
Strength/amount
Initials of person preparing solution
Date/time prepared and the diluents for IV and mixtures
Expiration date/time if not used within 24 hours

Should be verified by 2 qualified individuals whenever, person preparing medication/solution is not the person administering it.
Any unlabeled medications are immediately discarded.

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Critical Thinking

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Why focus on Anticoagulants

Anticoagulants account for 4% of preventable Adverse Drugs Effects (ADEs) and 10% of potential ADEs.
Associated with serious and frequent ADEs in both inpatients and outpatients.
Example: Warfarin
To Reduce harm:

Closely monitor side effects.
Utilize protocols for administration of anticoagulants.
Obtain baseline INR before initiating Warfarin.
Dietary notified when Warfarin is ordered.
Educate client about risks and side effects.

The Joint Commission, 2021

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Goal 4: Ensure Safe Surgery

The Joint Commission, 2021

Uses an instantly recognized mark for surgical-site identification and involves the client in the marking process.
Uses a checklist or other process to verify preoperatively:

The correct site
Correct procedure, and
Correct client
All documents and equipment needed are on hand, correct, and functional

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Time out

The Joint Commision, 2021

Full verification that is performed immediately prior to the induction of Anesthesia or the start of an invasive procedure.
The entire care team actively and verbally presence and confirms:

Client’s identity (two identifiers) ,
Procedure to be performed ,
Correct procedure side/site ,
Necessary imaging, equipment, implants or special requirements are present.

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Goal 5: Reduce the Risk of Healthcare-Associated Infections

The Joint Commission, 2021

Address Healthcare-Associated Infections (HAI’s):

Multiple-Drug Resistant Organisms
Central Line-Associated Bloodstream Infections
Surgical Site Infection

Five Moments of Hand Hygiene:

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Goal 5: Reduce the Risk of Healthcare-Associated Infections

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Goal 6: Reduce the Risk of Patient Harm Resulting from Falls

Ernstmeyer, & Christman, 2021

Implements a process for the initial assessment of clients for fall risk and reassessment of clients when indicated by a change in condition or medications
For detailed about the Morse Fall Scale for the assessment can be viewed in: https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/morse-fall-scale.html

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What would the nurse do?

You are a nurse working in an orthopedic ward and received a 70 yrs client with a history of fall. On your assessment you found that the client is at risk for fall.

What will be the precautions will you implement to prevent falls?

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Intervention to Prevent Falls

Ernstmeyer, & Christman, 2021

Universal fall precautions include:

Familiarize the client with the environment.
Have the client demonstrate call light use.
Maintain the call light within reach.
Keep the client’s personal possessions within safe reach.
Have sturdy handrails in client bathrooms, rooms, and hallways.
Place the hospital bed in the low and locked position when a client is resting.
Raise the bed to a comfortable height when the client is transferring out of bed.

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Intervention to Prevent Falls

Ernstmeyer, & Christman, 2021

Universal fall precautions include:

Keep the hospital bed brakes locked
Keep wheelchair wheels in a “locked” position when stationary
Keep no-slip, comfortable, and well-fitting footwear on the client
Use night lights or supplemental lighting
Keep floor surfaces clean and dry. Clean up all spills promptly.
Keep client care areas uncluttered
Follow safe client handling practices

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References:

Ernstmeyer, K., & Christman, E. (Eds.). (2021). Open RN Nursing Fundamentals by Chippewa Valley Technical College is licensed under CC BY 4.0.

Joint Commission International (JCI), (2017). International Patient Safety Goals (IPSGs). https://www.jointcommissioninternational.org/-/media/jci/jci-documents/offerings/other-resources/jci_2017_ipsg_infographic_062017.pdf

Contact info: info@nursesinternational.org

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References:

The Joint Commission, (2021). National Patient Safety Goals® Effective January 2021 for the Hospital Program. https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2021/npsg_chapter_hap_jan2021.pdf

World Health Organization (WHO), (2019). Patient Safety. https://www.who.int/news-room/fact-sheets/detail/patient-safety

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