Hi! I’m Jessica Spellman. I’m going to be
reviewing accident injury prevention, as
well as event reporting. So after taking this
course, you’ll be able to better understand
the types of accidents and injuries that occur in
the healthcare setting. Identify developmental
and age specific risks for clients throughout
the lifespan. Implement nursing interventions
or nursing education that can help decrease
accidents and injuries in clients. Understand
the purpose of event reporting, and be able
to implement the guidelines related to event
reporting and documentation of accidents
So The Joint Commission has set forth some definitions
that we need to review. First is the patient
safety event. That’s any event, incident, or
condition that could have resulted in injury
and did result in harm to the patient. An
adverse event, a patient safety event that
resulted in harm to a patient. And a sentinel
event which is the subcategory of the adverse
event, and it’s not related to the natural
course of the patient’s illness or underlying
condition, but it’s an incident that reaches the
patient and results in any of the following:
death, permanent harm, or severe
Some additional definitions we need to review.
A no-harm event, that’s the patient safety
event that occurred, however, the patient
was not harmed in any way. A close call or
a good catch or a near miss, all are labelled the
same thing. A patient safety event that did
not reach the patient. So it was caught ahead
of time. Or hazardous conditions.
Hazardous conditions are circumstances that are not
ideal that maybe put patients at a greater
risk for sustaining an adverse event. So the
incidents of falls. They’re associated
with the quality of nursing care and the healthcare
organization, and it is something that healthcare
organizations track. But what we’re starting
to do instead of just track the incident’s
rate of falls is to differentiate between
the fall rate and the fall rate that result
in injury. So overall, the fall rate estimation
risk rate is about 1.7% to 3% for patients.
The rate of injury from inpatient falls is
estimated to be between 6% and 44% of those
falls. Serious injury from those falls occurs
2% to 8% of the time on average.
We break our falls into certain categories.
The American Nurses Association and NDNQI
have five categories to rate their falls.
One, is no injury was sustained during the
fall. Two, minor injury was sustained that
required a simple intervention, maybe an ice
pack or evaluation by a physician. Three,
moderate. The injury required sutures or splint.
A major injury after a fall would require a
surgery, casts, or even further evaluation.
And then the highest risk category is death.
Okay. So there are a few other ways we could
categorize our falls. One is accidental. Those
are related strictly to extrinsic factors.
Environmental factors that could cause a fall,
example, wet floor, tripping over carpet or
an item on the floor are what categorize our
accidental falls. Our second type of falls
is anticipated physiological falls. These are
intrinsic factors related to the patient’s
physiological condition may put them at a
higher risk for a fall. A good example of
that is a confused patient that is unable
to stay in bed and is constantly trying to
get up. They are at an anticipated physiological
fall risk. Anticipated physiological falls
are the third type. They’re also due to
intrinsic factors, but generally, not able
to be identified prior to occurring such as
syncope or stroke.
There are a few other types of patient safety
related events. Medication and IV fluid bolus
administration errors, improper application
of therapeutic devices such SCD’s, heating
blankets, improper performance of procedures,
not following protocols; example, breaking
sterile technique during the insertion of
a Foley. Four, equipment related injuries
from malfunctioning of the device. So in
order to better understand the risk
for each age group, we need to review the
developmental and age-related risks throughout
the lifespan. Let’s start with the infants.
Infants are the high risk for falls, asphyxia,
and burns. So in order to combat that, we
need to educate parents on having the infants
sleep on their backs, water safety, never
leaving an infant alone in water, checking
the temperature of water to prevent burns. Also,
car safety with this population is extremely
important in car seats. Car seat education
and use of the car seats.
In the toddlers, they’re gaining more mobility,
they’re very curious about everything. So
they’re at a higher risk for poisoning, choking
and drowning. As a nurse, we need to recognize
those risks and educate parents on home safety,
using gates, outlet covers, keeping medications
out of reach. And again, car safety in this
group is extremely important.
In school-age children, many safety risks in
this group; traffic, water, fire, strangers,
accidents during play. So for school-age children,
it’s important to educate parents on developing
fire safety plans, teaching water skills,
traffic safety, stranger danger, and again,
for awhile in this age group, car seats until
a child is either 4’9” and 80 lbs has
to meet both of those requirements in order
to not have a car seat.
In adolescents, they have an increased amount
of independence, and they also have an invincible
attitude, meaning, they don’t think anything
bad is going to happen to them. So in this
age group, maybe including the parents in
this but especially educating the adolescents
and driver education, sexual health information,
and alcohol and substance abuse disorders.
For adults, in this time of their lives; accidents
and sports-related injuries are one of the
highest risks for accidents. In this age group,
we would emphasize motor vehicle and fire
safety, wellness promotion, and injury prevention.
And for the older adult, this is the highest
risk for falls. So, medication side effects could
also be a risk for this group, and increase
in physical and cognitive impairments. So
between the medication side effects and
the physiological and cognitive impairments,
either from their medical history or through
the medications unsolved, they’re at a higher
risk for falls. So in this group, we need
to review medications for side effects, assess
for elder abuse, neglect and fall risk, as
well as evaluate confusion and self-care,
ability to care for themselves and provide
education on that. Nursing interventions
to consider. So there’s
a standard tool that we can use to identify
clients at risk for falls. We can communicate
risk to other healthcare providers. We can
apply ID bands and allergy bands to prevent
errors. We can instruct clients to call for
assistance when needed. We can keep the bed
in a low locked position and call light within
reach. We can follow the five rights of medication
administration. And we can become familiar with
the policies and procedures in our facilities
to prevent errors. So, what happens
if an accident or an injury
does occur? Well, first, we need to evaluate
the patient for injury and treat that injury.
That’s the immediate first thing that we need
to do. Next, we need to eventually fill
out an incident report. And what is an incident
report? It’s a description of the accident
or injury that occurred while the patient is
being cared for in a healthcare environment.
Examples of why you might fill out an incident
report are: if a medication occurred, a patient
fell, or if they sustained an injury
from medical equipment.
There are several purposes for an incident
report. Number one, it provides a factual
and detailed account of the accident or injury.
So basically, it’s the: who, what, when,
where, why, and how the event occurred. The
documented injuries sustained, healthcare
provider is notified, and treatment provided, provides
documentation for that. Provide information
about additional circumstances. It gives nurses
and nursing assistance the opportunity to
address other issues that were occurring on
the unit that may have set that patient up
for a higher risk of injury, specifically,
maybe there was a higher than normal patient
to nurse ratio, there was a code going on
on the unit, something like that.
So, why do we need them? Well, we need them
to protect everyone involved, the patient,
the nurse, the physician, and the facility.
We fill them out right away so that we can
document the incident, who was involved and what
happened. It also provides a way to identify
and reduce risks if we’re seeing a pattern
and the type of incident reports that are
being filled out. We can maybe put a policy
in place that can help prevent injury from
that. It can improve the quality of patient
care. It can track adverse events and injury
statistics. And we can revise policies and
procedures to improve the quality of the nursing
care. So, few things to keep in
mind when you’re
filling out an incident report. Number one,
you want to provide detail and specific facts
about the incident. Avoid opinions, blame, and
speculation. You would want to use comments
like, “At 1700, the patient was ambulating
to the bathroom and fell.” You would want
to avoid using terms like, “Patient seem
like he was confused” or speculating about
why the patient was getting up. You want to
avoid all of that and just stick to the facts.
Do not put a copy of the incident report on
the chart. Don’t document in the medical
record that an incident report was completed.
And you want to complete it as soon as possible
after the event occurs so that the details
are fresh in your mind. So then, what happens
after that? Risk management will follow up
on any cases until they are totally resolved,
and safe nursing practice may be enhanced
because of reviewing these reports and being
able to change policies and procedures and
how we care for patients could prevent injuries
in the future. The risk managers, nurse managers,
and supervisors review these reports, and
in event of an adverse or sentinel event,
they may perform a root cause analysis.
And the root cause analysis is the portion that
helps us revise our policies and procedures
in order to provide safe quality care to patients.
In summary, falls make up a large percentage
of the accidents that occur in facilities.
Others include medication errors, equipment
failures, and performing procedures incorrectly.
The largest at-risk population for falls are
the older adults. Reason for falls varies.
They can be extrinsic factors or intrinsic
factors, as well as accidents. Understanding
the developmental and the age-related risks
throughout the lifespan can assist the nurse
with assessing for safety risks and implementing
interventions to decrease injury. When accidents
or injuries do occur, it is
important to assess the patient for any injuries
and treat that, and then complete an incident
report as soon as possible. The goal of the
report is to improve the quality of nursing
care not to place blame on anyone, professional.