Fall Prevention
Name that Bundle
CAUTI Prevention
VTE
Decubitus Prevention
100
Consider this for prompt response to clinical alarms
What is "No Pass Zone"?
100
A nasal swab is collected on patients that are high risk or with a known history
What is MRSA (Methicillin Resistant Staph Aureus/Multidrug Resistant Organisms?
100
List three ways to prevent urine from building up in or re-entering the bladder when a patient has a Foley catheter.
What is keeping the tubing free from kinks, dependent loops, or obstructions. Keeping the drainage bag below the level of the bladder at all times (not touching the floor) *Empty the urine collection bag at the end of every shift, prior to transporting, or when 2/3 full.
100
This is done on admission to initiate treatment to prevent blood clots.
What is VTE risk assessment?
100
Incorporating a turning schedule of every 2 hours and keeping heels up off the bed.
What is relieving pressure?
200
These items are needed if the patient is a level 2 or high injury risk.
What is placing a yellow armband on patient, yellow star on doorway, & proceed with interventions including: Scheduled toileting, Constant bathroom observation Request family to stay Gait belt with ambulation Bed and chair alarms Consider low bed/mats, sitter, helmet Room close to nurses' station
200
Soap and water is the preferred method of hand hygiene to kill these spores
What is Clostridium-Difficile?
200
Perform this when a patient has a Foley with bath each day and prn soiling.
What is catheter and pericare?
200
The physician has a time frame for ordering VTE prophylaxis treatment.
What is 24 hours?
200
A head to toe and skin assessment is performed routinely on patient and should be done how often.
What is every 12 hours?
300
You should assess and document this on all patients every shift.
What is Fall risk assessment?
300
A braden scale is performed and documented upon patient arrival to floor and every 24 hours.
What is Decubitus Prevention?
300
Perform this every shift while the patient has a Foley. If no longer needed then consult with physician to see if the Foley can be removed.
What is daily review of necessity
300
This is a form that is used to document the education of anticoagulation therapy.
What is the anticoagulation education form?
300
These two forces are used in prevention of pressure ulcers.
What is friction and shearing?
400
This is documented and updated every 12 hours.
What is Fall prevention plan of care?
400
A foley should be removed if no longer a necessity for the patient to prevent.
What is Catheter Associated Urinary Tract Infection?
400
A prevention method to preventing catheter associated urinary tract infection is maintaining the foley bag below the level of:
What is the bladder?
400
This takes place prior to initiation of ordered VTE prophylaxis for a patient.
What is education of patient and family?
400
This tool is used to assess the patients risk of developing pressure sores.
What is Braden Scale?
500
Placing patients on this type of schedule for bathroom use during hourly rounding helps to decrease falls.
What is scheduled toileting?
500
Consider the "No Pass Zone" for prompt response to clinical alarms.
What is Fall Prevention?
500
This is a for sure way to prevent CAUTI.
What is removal of the foley?
500
These are types of devices that are applied to the patient's lower legs as VTE prophylaxis.
What is SCD's (Sequential Compression System) or TED's anti-embolism stockings?
500
Waffle boots, pillow wedges, heel protectors, sacral mepilex boarders, and special beds are examples that help nurses relieve pressure over patients' bony prominence.
What is support surfaces or devices?
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