Patient Safety Goals
Name of patient
Medical history number
Patient birthday
What are patient identifiers?
This lab value is drawn 6 hours after a medication drip change and every morning
PTT
Risk assessment to be completed twice a day
Morse Falls
Name 2 expectations for a nurse to complete when identifying a stage 2 wound?
Notify MD
Implement Skin IPOC
Consult wound/ostomy RN
Implement pressure reduction strategies
A patient has no pulse and is not breathing when you assess your patient.
Medical Emergency
No dependent loops
Use a securing device
Assess daily for need
Keep bag below bladder
Bag should not touch the floor
What is prevention of a CAUTI (Catheter associated urinary track infection)?
Common side effect of Haldol
Prolonged QT interval
Patient is going to surgery or a procedure requiring sedatives
Pre-procedure checklist
Lab notifies the RN with a critical lab result and asks you to repeat the lab result and for your name
What is Critical lab result protocol?
Patient has a new facial droop, slurred speech, and is unable to lift his right arm
Code stroke
Change dressings at least every 7 days
Replace needleless connectors every 96 hours
Scrub site for at least 30 seconds using CHG
Daily bath with CHG wipes
What are CLABSI reduction strategies?
Insulin drip
Pain assessments and reassessments should occur how often?
1 hour after PO med
15 minutes after IV med
Every 4 hours if actively having pain
Patient has increased respiratory rate, fever, elevated or low WBC, and/or increased lactic acid lab prompting a pop up alert in Cerner
What is Severe Sepsis or SIRS alert?
A patient's family member suddenly becomes confused and is leaning to the left side in the chair.
Call 1st responders
Personnel who may place an isolation order
Nursing, mid-level provider, physician, or infection control
Lorazepam or diazepam is part of this protocol
CIWA (Clinical Institute Withdrawal Assessment)
Partial and/or focal assessments are done how frequently
Every 4 hours and prn or per specialty protocol
Nursing assessment tool used to determine if patient is able to get out of bed safely.
What is the BMAT (Bedside Mobility Assessment Tool)?
Despite paging the physician several times, your patient continues to decline: respiratory rate is decreasing, BP is low, patient is lethargic, who/what may be called as a resource?
Rapid response team
Lap belt
Toileting schedule
Bed or chair alarm
Video monitor
Mitts not tied to the bed
What are fall prevention strategies?
IV tubing should be changed every 24 hours when hanging this at 1800.
TPN and lipids
This is reviewed, documented, and cleared every 4 hours: drug, dose frequency, dose, amount given, amount attempted, reservoir volume, respiratory rate, and ETCO2
PCA pumps and Epidural pumps
Class II and Class III patients may have this removed after 24 or 48 hours.
What is telemetry discontinuation protocol?
Documentation that needs to be completed when a patient has an unwitnessed fall.
RRT paperwork
Significant event for falls in Cerner
Incident report