Safety
Organizational environment where "core values & behaviors emphasize safety over competing goals"
Culture of Safety
Examples of biological Agents (list 4)
Anthrax, Botulism, Plague, Smallpox
Most common cause of TBI in older adults
Falls
Type of error that includes Wrong dose, wrong patient, wrong time
Medication error
Federal agency ensuring safe working conditions
OSHA
Used in the care of all hospitalized patients regardless of their diagnosis or possible infection status
Standard Precautions
Number of mL in 1 Liter
1000
The amount of time it takes for 50% of the serum concentration of a drug to be eliminated from the body
Half-life
Unexpected occurrence involving death or serious physical/psychological injury, or risk thereof, defined by The Joint Commission.
Sentinel Event
Number of mcg in 0.05mg
50 mcg
Communication method used to improve hand-off communication
SBAR
Acronym that refers to the type of hazardous materials or devices that may be used in a terrorist attack or other emergency situation.
CBRNE
The developmental stage that includes safety risks associated with drug alcohol abuse, vehicle accidents, drowning, guns and weapons.
Adolescent stage
Type of error that includes unclear orders, missed handoffs
Communication error
Leading causes of healthcare worker injuries:
Musculoskeletal injuries (lifting), needlestick injuries, slips/falls, workplace violence
List at least 3 most common Healthcare-Associated Infections (HAIs)
•Central Line-Associated Bloodstream Infections (CLABSI)
•Catheter-Associated Urinary Tract Infections (CAUTI)
•Ventilator-Associated Pneumonia (VAP)
•Surgical Site Infections (SSI)
•C. difficile Infections
6 Rights of medication administration
Right patient
Right medication
Right dose
Right route
Right Time
Right Reason
The concentration of drug in the blood serum that produces the desired effect without causing toxicity.
Therapeutic range
Serious, largely preventable patient safety events that should never occur, defined by National Quality Forum.
Never Event
Number of mL in 1 oz
30 mL
True or False: Patient safety is a responsibility of ALL healthcare providers
True
Factors related to radiation exposure
Time, distance, shielding
Fall prevention interventions (List at least 3)
Hourly rounding
Bed/chair alarms
Non-slip footwear
Clear pathways
Adequate lighting
Type of error related to inappropriate interventions or delays
Treatment Errors
Acronym related to fire safety
RACE (rescue, alarm, contain, evacuate)
Common Portals of Exit for microorganisms (list at least 3)
Respiratory
Gastrointestinal
Genitourinary tracts
Breaks in skin
Blood and tissue
Type of needle used when drawing medication from an ampule
Filter needle
The highest plasma concentration of a drug.
Peak level
True or False: Prevention is always more costly than treatment.
False (prevention is more cost-effective and safer)
Order: potassium chloride 10 mEq po bid
Supply: liquid labeled 20 mEq/30mL
How many mL will be given?
15 mL
Goals that establish standards for ensuring patient safety in health care facilities, set by the Joint Commission and updated annually.
National Patient Safety Goals
Agency that supports citizens and emergency personnel to build, sustain, and improve the nation's capability to prepare for, protect against, respond to, recover from, and mitigate all hazards.
FEMA
Common Routes of Poisoning
•Ingestion (most common) - medications, household products, plants
•Inhalation - carbon monoxide, cleaning chemicals, gases
•Dermal - pesticides, industrial chemicals
•Injection - drug overdoses, venomous bites/stings
A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm comes
Risk Management System
Acronym related to fire extinguisher use
PASS
Used in addition to standard precautions for patients in hospitals with suspected infection with pathogens that can be transmitted by airborne, droplet, or contact routes.
Transmission-Based Precautions
Route of medication administration that involves using the inside of the cheek
Buccal
The point when the drug is at its lowest concentration, indicating the rate of elimination.
Trough Level
Type of isolation precaution used for a patient with Tuberculosis (TB), also include what is required for this type of precaution.
Airborne precautions
N95 mask or respirator along with standard precautions (gloves)
Negative Pressure room, if available
Order: heparin 6000 units SQ every 12hrs
Supply: vial labeled 10,000 units /mL
How many mL will be administered? Name the sites for SQ injections
0.6 mL
back of arms, abdomen (2in away for umbilicus), thighs
Evidence-based standards that focus on improving patient outcomes and safety across healthcare facilities.
Core Measures
The most immediate and extreme threat to global security
Nuclear Terrorism
Type of safety that encompasses all physical and psychosocial factors in the healthcare setting that can impact patient and staff wellbeing.
Environmental
type of prevention that requires systematic approaches to identify, analyze, and prevent mistakes before they reach the patient.
Error Prevention
Principle that ALL human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens
Universal Precaution Principle
Five Moments for Hand Hygiene (WHO)
Moment 1—Before touching a patient
Moment 2—Before a clean or aseptic procedure
Moment 3—After a body fluid exposure risk
Moment 4—After touching a patient
Moment 5—After touching patient surroundings
Pharmacokinetics involves the movement of drug molecules in the body and includes these processes.
Absorption, distribution, metabolism, and excretion
The process in which drugs act on target cells, resulting in alterations in cellular reactions and functions.
Pharmacodynamics
Negative outcomes related to safety restraints (list at least 3)
• Skin breakdown • Incontinence• Depression, delirium, anxiety• Aspiration• Sometimes death
Order: chlorpromazine 50 mg IM now
Supply: vial labeled 25mg/mL
How many mL will be injected? Based on the amount what sites would be appropriate for administration? what length and gauge would you use?
2mL
Vastus lateralis (max 2mL, 1-1.5 in needle 20-22 gauge) or ventrogluteal (max 3mL, 1-2 in needle 20-22 gauge)