Which is the main reason that the nurse Assistant must report broken equipment
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These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. They help us to know which pages are the most and least popular and see how visitors move around the site. All information these cookies collect is aggregated and therefore anonymous. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Show According to The Institute of Medicine, a medical error is “The failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” The Quality Interagency Coordination Task Force, a Federal Agency for Healthcare Research and Quality, describes a medical error as a “failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Errors can include problems in practice, products, procedures, and systems” (AHRQ, 2001). A medical error is usually a preventable adverse effect of medical care. Some of the most common problems that occur when providing health care are:
Higher error rates usually occur in stressful, fast-paced environments such as emergency departments, intensive care units, and operating rooms. Medical errors are associated with extreme age, high acuity, and new procedures. Errors often occur when necessary personnel are not available when needed. When multiple practitioners are involved, an incomplete preoperative assessment may occur. Students, interns, residents, and fellows may be inadequately supervised due to time constraints or lack of understanding their abilities. Inconsistent postoperative monitoring procedures may lead to errors. TYPES OF MEDICAL ERRORS While wrong site/wrong procedure surgery continues to be the most common basis for quality of care violations, the following areas have been determined as the five most misdiagnosed conditions: cancer-related issues; neurological related issues; cardiac-related issues; timely responding to complications during surgery and post-operatively; urological related issues. Surgical Errors Over 200 million surgical procedures are performed each year globally, and despite awareness of adverse effects, surgical errors continue to occur at a high rate. Surgical errors account for a significant number of adverse events (Christensen, 2015).
What is interesting about surgical errors is that these errors appear to be more common before and after the surgical procedure rather than mistakes made in the operating room. Some of the causes of surgical errors include the following:
Prevention of Surgical Errors Errors in surgery do not arise spontaneously. They develop from the interaction of multiple people and equipment. In order to decrease surgical errors, providers need to know when and where errors may occur (AHRQ, 2017). The key risk factors to be aware of include:
To prevent surgical errors and enhance patient safety, hospitals have introduced the following guidelines:
Wrong-site surgery can be minimized if patients and family members are given an opportunity to correct a significant mistake before it occurs. Engaging patients, nurses, scrub techs, anesthesiologists, anesthetists, and surgeons in knowing and minimizing the risks helps avoid wrong-part surgery, wrong-patient surgery, or a wrong-surgical procedure. Increasing communication with healthcare providers, family, and patients about the possibility of such mistakes alerts all involved to double and triple check to avoid grave mistakes. Probably the most essential surgical safety measure is a timeout: a preoperative pause involving all members of the surgical team. Timeouts need to occur when the patient is on the operating table before surgery begins. A timeout is done to ensure the correct site, correct procedure, and correct patient will minimize costly mistakes. Following a defined protocol is mandatory. General Diagnostic Errors Diagnostic errors result in death or injury to 40,000 to 80,000 patients per year according to the Joint Commission. Diagnostic errors are most common in primary care solo practice due to workload and the inability to cross-reference easily with colleagues. In healthcare institutions, patients are usually seen by many health care providers, e.g. attendings, residents, fellows, and medical students) decreasing the chance of diagnostic error. [13] Many of these deaths are preventable. The following data emphasizes the need for improved safety measures:
Commonly missed diagnosis includes the following:
Diagnostic error is a potential challenge for virtually all medical specialties. The overall misdiagnosis rate is approximately 10% to 15%. Cardiac Diagnoses Diagnostic error is the most common, with coronary atherosclerosis frequently missed. Aortic disease, such as an aneurysm and dissection, can also be misdiagnosed. Procedures involving angioplasty and cardiac catheterization are significant sources of medical cardiovascular liability. Pulmonary Embolism Diagnosis Pulmonary embolism (PE) is often challenging to diagnose. It is known as the "great masquerader" for a reason. The symptoms can be nonspecific and range from mild to severe. Patients present with a broad range of signs and symptoms similar to other diseases, including shortness of breath, chest pain, confusion, hypotension, and cardiovascular collapse. PE potentially has very mild symptoms, and it is an incidental finding in approximately 3% of chest CTs. Cancer Diagnosis Failure to diagnose and treat cancer early can result in more difficult therapy and lower the success rate of cure. Error rates in the tissue diagnosis of cancer are as high as 15%. The clinical diagnosis of malignancy is often challenging. High-risk patients need annual screening for skin and other cancers. Neurologic Diagnosis There is a challenge to making the initial diagnosis, particularly in young patients, psychiatric patients, and those with other diseases that may cause stroke-like symptoms. Misdiagnosis of a neurologic emergency may be mitigated with a detailed history and physical exam, early access to imaging, and rapid consultation with neurologists. Prevention of Diagnostic Errors Clinicians should be aware of the most commonly misdiagnosed conditions and take extra precautions to seek and confirm the diagnosis. Clinicians must be aware of and carefully consider the following common "high risk" diagnoses. Medication Errors Medication errors are considered a preventable event. [14] Common medication errors include:
Prevention of Medication Errors Systems can help decrease hospital medication errors. Some examples include electronic medical records, barcoding systems, standardized units of measure, avoiding confusing units of measure, weight-based dosing, and having a pharmacist available to assist with calculating the correct dose. To avoid preventable medication errors, it is critical to review medication and dosing prior to administration. Barcode administration and handheld personal digital assistants increase medication administration safety. Providing real-time patient information, medication profiles, laboratory values, drug information, and documentation reduces errors. Electronic medication administration helps identify incorrect and omitted medications and canceled or changed medication orders. Circumventing barcode procedures decreases safety at the point of care. Automatic dispensing systems that make drugs available to patients quickly at the point of carefree up pharmacists and nurses time to engage in other safety activities, such as medication reconciliation. Some techniques to reduce medication errors include:
All healthcare providers should work together for medication prescribing, administration, and monitoring. interprofessional collaboration is necessary to establish safe medication use and distribution. Physicians and nurse practitioners should double-sign high-alert medications, especially those with narrow safety ranges for a therapeutic effect. Pharmacists and nurses should stock look-alike medications away from more dangerous medications. Hospitals should reduce look-alike medications by grouping drugs by category instead of alphabetical order. Computer-based forms should be available for parenteral nutrition orders. Pharmacists should remove dangerous medications from floor stock and discard out-of-date drugs. Oral liquids should be in unit-dose packages only. Concentrated electrolytes should not be on patient care units. Tubing Misconnection Errors involving tube and catheter connections are common. If a misconnection is not caught early and corrected, these adverse events can have life-threatening effects. [15] To further complicate the situation, medications and food supplements are often delivered via these routes, and the wrong placement of a tube can result in a potentially toxic substance ending up in the wrong locations. Factors resulting in misconnections and misplacement include:
Prevention of Tubing Misconnections Clinicians and support staff must be educated that tubing misconnections and incorrect placement of feeding tubes, dialysis catheters, IV catheters, blood pressure cuff inflation lines, epidural lines, pulmonary artery catheters, and tracheostomy tubes may result in serious injury or death. The use of Luer connectors is a common factor in tubing misconnections. Luer-lock (a connection made by rotating connector) and Luer-slip (a connection made by the insertion of the tapered male end into the female receptor) connections vary which results in high-risk error-prone situations. Providers and support staff must always trace lines back to the origin before connecting or disconnecting devices or starting infusions. It is important to label high-risk catheters. In order to reduce the changes of tubing misconnections, non-Luer lock connections have been introduced. These include a unique NR-Fit connector for neuraxial and regional anesthesia catheters and EnFit connectors for feeding tubes. Device and Equipment Errors Health professionals generally believe technology will improve healthcare efficiency, lower cost, increase quality, and promote safety; however, these same technologies may also introduce errors and adverse events. Given that there are approximately 5000 types of medical devices used by millions of healthcare providers throughout the world, device-related errors are inevitable. The benefits of technology may not be realized due to four common pitfalls:
Medical and equipment flaws in the design, mishandling, user-error, and malfunction are common causes of medical errors. User errors are often attributable to:
There is also a tremendous increase in the number and type of medical devices implanted in patients such as pacemakers, defibrillators, nerve and brain stimulators to control pain and seizures, and shunts. Malfunction of these devices may result in life-threatening events. Prevention Workplaces, instruments, and equipment should be developed to consider human factors in design. A health professional user can maximize safety through the selection process, confirming that equipment is maintained, and proactive risk-assessment methods. Health professionals should:
Institutions should:
Iatrogenic Infection Healthcare-related infections are considered a failure of the system. As much as one in 20 hospitalized patients may acquire a healthcare-related infection which may increase complications, length, and cost of the hospital stay. Healthcare-related infections add close to $35 billion to the annual cost of healthcare in the United States. Nosocomial infections are a common problem in hospitalized patients. Preventing them requires adherence to infection control protocols. [16] Causes of hospital-acquired infections include:
Common Associated Organisms Acinetobacter baumannii has mainly been found in the intensive care unit and in other areas of the hospital where critically ill patients are managed. The bacteria do not pose a threat to healthy individuals but can lead to a severe infection in patients with a suppressed immune system. These organisms have been found to cause meningitis and pneumonia, wound infections, and urinary tract infections. Another major concern is that Acinetobacter is rapidly developing resistance to many of the commonly used antibiotics. Bacteroides fragilis is a normal occurring organism in the colon. The organism is generally not harmful but is an opportunist. When patients take antibiotics, this can suppress other normal flora and allow Bacteroides to enter the systemic circulation. The slow growth of bacteria and its occurrence with other colon pathogens often makes treatment difficult. Clostridium difficile is the most well known because of its ability to induce life-threatening colitis. The bacteria thrive in the presence of antibiotics and can easily spread via the oral-fecal route in a hospital setting. C. difficile is resistant to most routine cleaning solutions, including alcohol-based sanitizers. C. difficile can be treated, but in some cases, a fecal transplant may be required. Carbapenem-resistant Enterobacteriaceae have become very common in hospitalized patients. These organisms are easily transferred from human to human by contact with skin or an infected device such as a Foley catheter. High mortality rates occur in patients who develop sepsis with these resistant organisms. Enterococcus faecalis is a highly resistant colonic organism. Most isolated cases in hospitals revealed that this strain is resistant to vancomycin, leaving very few treatment options for patients. While enterococcus is normally found in the colon, it can enter the systemic circulation and cause sepsis, wound infections, urinary tract infections, and even pneumonia. Escherichia coli is another gram-negative organism found in the intestinal tract, but it can become pathogenic when the opportunity arises. It is the most common cause of urinary tract infections in hospitalized patients. The 0157.H7 strain can cause hemolytic uremic syndrome. Klebsiella pneumoniae is a common cause of pneumonia, urinary tract infections, wound infections, and meningitis. The risk of infection with Klebsiella is greater in patients with catheters and those on ventilators. Many species of Klebsiella are resistant to traditional antibiotics. These organisms are often a cause of infections in the neonatal intensive care unit and carry high morbidity and mortality. Other organisms that are associated with hospitalized patients include methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Staphylococcus aureus, Stenotrophomonas maltophilia, and vancomycin-resistant Staphylococcus aureus. Prevention of Infection Appropriate hand-washing is one of the single most effective methods to decrease infection transfer. High-risk procedures such as indwelling Foley catheter and vascular catheter infection rates can be decreased by adhering to the use of sepsis bundles. Effective hand washing is linked to decreased morbidity and mortality rates. Sink availability or alcohol-based hand rubs prevent nosocomial infections. The Centers for Disease Control and Prevention guidelines include:
Hospital-acquired pneumonia causes significant morbidity and mortality. Risk factors include anemia, malnutrition, chronic renal failure, depressed mental status, thoracic surgery, and recent hospitalization. While decreasing hospital-acquired infections is a difficulty, attention to risk factors and interventions may help decrease the incidence. C. difficile-associated infection has become a significant problem. C. difficile is most associated with the use of clindamycin, cephalosporin, and penicillin and warrants frequent surveillance. Falls Falls are a common problem. Each year, over one-third of people over the age of 65 suffer a fall, and one-third of these falls cause injuries [17]. In a healthcare setting, a number of factors may further increase the risk of falls, including:
Factors that induce falls may be divided into two types: intrinsic and extrinsic.
Prevention of Falls Patient falls decrease when patients who are assessed as at risk of falling are attended to hourly. To decrease the incidence of falls:
Information Technology Electronic Health Records Information technology may result in errors. Perhaps the most common is accidentally charting information or placing orders on the wrong patient. While electronic health records (EHR) provide more clearly written information, they also may facilitate charting information on the wrong patient. Currently, there are no regulatory agreed-upon design standards that successfully limit potential errors [18]. Some challenges with EHR include:
With the deployment of electronic records, three phases of medical malpractice risk have been recognized. They include the following:
Computerized Prescriber Order Entry Computerized order entry helps prescribers, pharmacists, and nurses distributing medications to reduce adverse drug events. Unfortunately, only about one-third of hospitals have these systems in place and even fewer use barcode medicine administration to decrease medication errors. [19] Prevention of Order Entry Error Actions to decrease errors in information technology include:
Studies have suggested that computerized provider order entry systems could reduce medical errors by approximately 50%. Clinicians completing orders should have distraction-free locations to optimize this potential. Communication Verbal Errors Errors in verbal communication are a common source of medical error [20]. Risk factors for verbal errors include:
Prevention of Verbal Communication Errors A courteous and respectful workplace in which the interprofessional team collaborates promotes a safe work environment for all members of the healthcare team, families, and patients. Risk management committees and interprofessional task forces should work collaboratively on risk assessment and risk reduction. Joint education programs help providers and support staff learn roles and develop relationships with the goal of improving safety. Healthcare organizations should maintain policies that require printed prescriptions. If verbal orders are given, they should be read back orders and receive confirmation. The Joint Commission’s Safety Goals require that for critical test results and verbal or telephone orders, a “read-back” is required by the person receiving and recording the result or order, who must read back the order verbatim to the practitioner. The practitioner should verbally acknowledge the orders accuracy. Clinicians should follow well-communicated protocols that guide care and communication. Providers should listen to patient questions concerning how care is delivered. Concerns need to be respected and accepted as correct and documented if contrary to established evidence-based medicine. Providers need to help patients with the information they need to know about their care. Well-informed patients avoid serious medical errors. The Joint Commission has supported “Speak Up” initiatives, which encourage hospitals to inform patients about the importance of their contributions to the care they receive. To make patients active participants in avoiding medical errors, encourage patients to ask about unfamiliar tests, unplanned diagnostic tests, medications, and to verify the correct surgical site. Written Errors Using non-standard abbreviations and illegible handwriting, failure to question inappropriately written orders, and failure to complete correct specimen labeling are common sources of written communication errors. Prevention of Written Errors Staff should never be reprimanded for questioning orders. When writing orders or prescriptions, clinicians should:
The Joint Commission requires healthcare professionals to use two or more patient identifiers when labeling, delivering and maintaining specimens. Practitioners should always double-check that the patient’s name is spelled correctly and their correct date of birth is present. Since this is a National Patient Safety Goal, The Joint Commission closely monitors healthcare institution adherence to this requirement as they prepare medications, transfusions, and transfer patients unit to unit. Patient Hand-offs Patient handoffs are a common source of errors. [21] This can occur if incorrect information is passed to the receiving clinician and/or there is a failure to remember to follow-up on all of the pending issues. Prevention of Hand-off Errors One common approach to reducing hand-off errors is the use of handoff tools developed in the EHR. In addition, there are several techniques to help minimize error development when handing off patients. These techniques (1) provide the receiving clinician with an action plan to assist in assuming the care of the patient and (2) use mnemonics to assist in remembering the checklists. Two mnemonics to assist in remembering the checklists are the following:
Finally, the clinician discharging the patient should remember to perform a final bedside evaluation and review discharge instructions before sending any patient home. Important components include:
Errors during Acute Intervention A code or arrest, intubation, or other acute, life-threatening event is a high-risk situation for medical error. Due to the rapidity of decision making and the instant need for life-saving drugs and procedures, there is a significant risk of error. Prevention of Errors in Acute Intervention Rapid response teams trained and organized to prevent or respond to cardiac or respiratory arrest mitigate errors in this acute setting. Critical response teams bring expertise to the bedside when it is needed. Team effectiveness is improved if end-of-life plans of care for deteriorating patients are addressed with the patient and family at the time of admission. Family meetings can result in identifying goals that improve end-of-life care and avoid unnecessary end-of-life procedures. Which of the following should be reported to your charge nurse immediately?prometric practice exam 2. Is a full waste basket a fire hazard?A traditional wastebasket in the home or office can be a potentially dangerous fire hazard as a volatile mix of combustible or improperly discarded materials can start a fire.
When lubricating a resident nose what type of lubricant is not allowed?Never use non-water-soluble lubricant (e.g., Vaseline), as it will not dissolve and may cause respiratory complications if it enters the lungs. 16.
When may a resident on oxygen therapy smoke?The person can smoke if you turn off the oxygen. Take the person to a nonsmoking area. A person is receiving oxygen therapy.
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