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nurse 177
Safety
| Question | Answer |
|---|---|
| Who is The Joint Commission? | organization responsible for evaluating and accrediting health-care organizations and programs in the US |
| National Patient Safety Goals address what? | identifying patients, improving communication, med safety, alarm safety, preventing infection, identifying safety risk preventing surgery mistakes |
| Why are older patients at risk for falling? | cognitive impairments, meds, unfamiliar surroundings, don't realize they are attached tubes and cords |
| ambulate | walk |
| factors attributing to unsafe environment | age and ability to understand, impaired mobility, communication, pain and discomfort, delayed assistance, equipment |
| What should be done if patient does not speak english? | arrange for interpreter |
| T/F Call lights should be answered promptly and that assistance be quickly available to maintain a safe environment for patients | TRUE |
| fall assessment rating scales | forms that give a numerical rating for each patients risk |
| Who/ what determines the patients that are considered at risk? | facility policy |
| Patient is admitted and is rated a 65 on the fall assessment rating scale. Facility states patients rated 50 or higher are at strict risk. How is the patient identified? | flags or stickers on the chart, Kardex and patients door to serve as reminders to staff |
| restraints | vests, jackets, bands connected straps that are tied to bed, chair or wheelchair to keep patient in one place |
| restraint alternatives | less restrictive ways to help patients remember not to get up and try to walk or alert nursing staff |
| chair/bed monitor or position alarm | pressure-sensitive device that generates an alarm at the nurse's station when the patients weight is no longer sensed |
| leg monitor | attaches patients leg like a large bandage and generates an alarm at the nurse's station when leg is in dependent position |
| Morse Fall Scale Risk level I | 0-24; preventive fall precautions interventions |
| Morse fall risk levelII | 25-50; modified fall risk interventions |
| Morse fall risk level III | >51; strict fall risk interventions |
| Morse fall risk item 1 | history of falling; immediate or within 3 months |
| Morse fall risk item 2 | secondary diagnosis |
| Morse fall risk item 3 | ambulatory aid *bedrest/nurse assist*crutches/cane/walker*furniture |
| Morse fall risk item 4 | IV/saline lock |
| Morse fall risk item 5 | gait/transferring*normal/bedrest/immobile*weak*imapired |
| Morse fall risk item 6 | mental status* oriented to own ability* forgets limitations |
| soft devices | bolsters that can be placed in the bed on either side of the patient to prevent them from slipping between or through the side rails |
| actions to take if a patient has fallen | check for obvious injuries, call for help, take vital signs, code blue if necessary, assist to bed, notify provider, document to facility policy |
| names for restraints | protective devices/safety reminder devices/ Poseys |
| What restraints can go across the patients lap in a wheelchair? | soft devices |
| What must be provided to use restraints? | health-care providers order |
| How often should you check on patient in restraints? | every 30 min |
| How often should you remove the prescribed restraints? | every 2hrs |
| What do you check for when a patient is in restraints? | skin for redness or chafing; extremities for warmth and color |
| chemical restraints | meds prescribed to prevent restlessness and anxiety in the patient who may be in an unsafe situation without meds |
| Can chemical or physical restraints be used on patient that is irate and yelling? | NO, only with order |
| How many fingers should you be able to inert between body and restraint? | two fingers |
| How are restraints tied? | quick-release knot |
| Vest restraint | crossover in front and the straps ties to the lower portion of the back of wheelchair; attached to moveable portion of bed frame not bed rails |
| waist | around waist then tied to moveable portion of bed frame or to lower portion of back of wheelchair |
| extremity | around patients wrist then tied to moveable portion of bed frame and not bed rails |
| mitt | hand placed inside, mitt secured around wrist; straps can also be tied to moveable portion of bed frame but not bed rails |
Created by:
nursebailey
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