Chapter 18

Patient Safety

Admission Safety

Ongoing Safety

Special Patient Situations

The Confused Patient

Common Psychiatric Disorders

Common Psychiatric Tests

Treatment Methods

Emergencies

For an in-depth study of patient safety, consult the following publications:

Lewis SM, et al: Medical-surgical nursing, ed 8, St. Louis, 2011, Mosby.

Lueckenotte AB: Pocket guide to gerontologic assessment, ed 3, St. Louis, 1998, Mosby.

Nugent P, Green J, Hellmer Saul MA, Pelikan P: Mosby’s comprehensive review of nursing for the NCLEX-RN examination, ed 20, St. Louis, 2012, Mosby.

Potter PA, Perry AG, Stockert PA, Hall A: Fundamentals of nursing, ed 8, St. Louis, 2013, Mosby.

Weilitz P, Potter PA: Pocket guide for health assessment, ed 6, St. Louis, 2007, Mosby.

Admission Safety

When a patient is admitted to the hospital or nursing home, it is important that the patient is aware of all equipment located in his or her room. This can prevent accidents and make the stay in the hospital or nursing home safer. Point out the following items on admission: call light or bell, room lights, bathroom, bathroom lights, nurses’ station, side rails, and room number.

Make sure that all equipment is working properly.

Ongoing Safety

To ensure ongoing safety, take the following precautions:

Clear the patient’s room of excess debris.

No furniture should block the doorway to the patient’s room.

Immediately clean up any water or other liquid spills on the floor.

Do not leave needles or other sharp items near the patient.

Remove unmarked bottles and syringes from patient’s room.

Label all intravenous and central lines, and nasogastric, gastrostomy, and jejunostomy tubes.

Check all electrical equipment for proper functioning and condition.

Double check all medications before giving them to the patient, referring to the 10 patient rights.

Double check the patient’s identification ID bracelet before giving medications, performing any procedures, and transferring the patient to another department for tests, another unit, surgery, or therapy appointments.

Special Patient Situations

Hospitalized patients with the following problems may require additional safety measures:

Alcohol Withdrawal

Signs and Symptoms. Confusion, sweating, pallor, palpitations, hypotension, seizures, coma. Protocols may vary by facility.

Withdrawal protocols may include seizure precautions, keeping the side rails up and padded, taking vital signs frequently (every 30–60 minutes or per hospital protocol), and close observation. Provide a safe environment. Perform neurologic, memory, and orientation checks. Document any withdrawal activity and actions taken.

Bleeding or Hemorrhage

Locate the source of the bleeding. Apply direct pressure with a clean drape. Call for assistance but stay with the patient. Assess for early signs of shock such as a change in sensorium and later signs of shock such as hypotension; pale skin; and a rapid, weak pulse.

Prevention. Closely supervise confused or heavily medicated patients and patients just returning from surgery. Make sure surgical dressings are secure. Encourage patients to call for assistance if bleeding begins. Document any bleeding and actions taken.

Choking

Follow standard Heimlich maneuver guidelines.

Prevention. Closely supervise confused and heavily medicated patients. Make sure patients are sitting up or are placed in high Fowler’s position when eating. Encourage the use of the call lights. Assess the patient’s ability to chew and swallow. Order a diet appropriate to the patient’s eating ability. Document any choking situations and actions taken.

Drug Reactions

Assess for difficulty breathing, wheezing, tearing, palpitations, skin rash, pruritus, nausea or vomiting, rhinitis, diarrhea, and a change in mood or mental status. These are general drug reactions, not the side effects of specific drugs. Immediately report all drug reactions.

Prevention. Closely supervise confused and heavily medicated patients and patients who are taking medications for the first time. Encourage the use of the call lights if any of the signs of a drug reaction occur. Know your patient’s drug allergies. Document all drug reactions and actions taken.

Syncope and Common Causes

Neurologic Vertebrobasilar transient ischemic attacks, subclavian steal syndrome, hydrocephalus

Metabolic Hypoxia, hyperventilation, hypoglycemia

Cardiac Orthostatic hypotension, vasovagal reaction or syncope

Vasomotor Obstructive lesions, arrhythmias

Assess for dizziness, lightheadedness, visual blurring or any visual or hearing changes, weakness, apprehension, nausea, sweating, blood pressure, and pulse

Prevention or intervention Stay with the patient. Help patient sit or lower to the chair, bed or floor. Protect patient’s head at all times. Call for help. Elevate the legs, assess vital signs, use ammonia (if needed), help the patient sit up slowly when he or she is ready, and document per organizational policy.

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