Safety: Clinical decision making

Patient safety involves the protection from psychological and physical injury by minimizing risk of harm to individuals seeking healthcare.

Prioritizing patient safety allows nurses to successfully navigate patient needs within various clinical scenarios. It is essential for providing safe, quality care and improving patient outcomes.

Now, preventing patient harm is a top priority for healthcare organizations, and requires a culture of safety, where every healthcare team member shares responsibility for keeping patients safe.

Healthcare organizations adopt evidence-based practices that are recommended by organizations like the Joint Commission in the Agency for Healthcare Research and Quality to enhance patient safety.

These practices involve implementing systems and processes that help nurses plan and prioritize safe care during activities such as patient identification, communication, medication administration, and the prevention of adverse events like falls and infections.

Starting with patient identification, nurses use at least 2 methods to identify patients, such as their name and birth date, to prevent misidentification.

Similarly, communication tools like SBAR, which stands for situation, background, assessment, and recommendation, allow the healthcare team members to organize and share the most essential information about a patient's condition across teams and settings.

As far as medication administration goes, safety can be enhanced by several methods. For instance, using medication reconciliation to compare the medications they're currently taking to the medications a patient has been prescribed can reduce errors by providing an up to-date medication list.

Additionally, medication errors can be reduced when systems are in place to properly label, store, prescribe, dispense, and administer sound-alike, look-alike drugs.

Or salad for short, for example, diazepam and diltiazem, or metformin and metronidazole, which use tall man lettering to help distinguish differences.

Another way to promote patient safety is to implement universal fall precautions. These can include orienting patients to their environment, ensuring patients know how to use the call system, keeping personal items within reach, and keeping beds in a low position with wheels locked in two side rails up.

Also, each patient's fall risk should be evaluated using a standardized fall risk assessment tool, so specific strategies can be applied based on their individual risk factors.

Lastly, preventing infections is another way to keep patients safe. Infection control practices can include routinely performing hand hygiene, using clean or sterile techniques as indicated, and implementing transmission-based precautions as needed to protect other patients, their families, and members of the healthcare team.

On top of that, healthcare workers should follow the latest evidence-based guidelines to prevent hospital-acquired infections related to invasive equipment, such as indwelling urinary catheters and central lines.

Now let's look at a scenario where a nurse uses principles of patient safety to make decisions and prioritize care. Nurse Hannah arrives at the home of Diego, a patient who requires complex wound care for lower leg cellulitis.

As she prepares for the wound care, nurse Hannah notices his dressing is saturated with blood. No other areas of visible bleeding are present.

After cleansing Diego's wound and securing a new dressing, nurse Hannah reviews the electronic health record, or EHR. Nurse Hannah is reminded that Diego has a mechanical heart valve, and takes warfarin to prevent blood clots.

Using the point of care device, she checks Diego's international normalized ratio, or INR, which shows a reading of 5.2, higher than his prescribed range of 2.5 to 3.5.

Nurse Hannah knows that an elevated INR means it takes longer for blood to clot, so Diego's risk of bleeding is increased.

Upon further review of the EHR she notices that Diego's healthcare provider prescribed a new antibiotic two days ago to treat his cellulitis.

After consulting her pharmacology resource, she discovers that this antibiotic can interact with warfarin and increase INR levels.

Nurse Hannah prioritizes Diego's safety risk to make clinical decisions. First, she notifies the healthcare provider using the SBA communication tool.

The healthcare provider discontinues Diego's original antibiotic and orders a new antibiotic. She also receives orders to hold Diego's warfarin for 1 day, and recheck his INR in 2 days.

Nurse Hannah informs Diego and removes tonight's warfarin dose from his medication organizer. Next, nurse Hannah explains to Diego that his elevated INR is due to his new antibiotic interacting with warfarin, so his body requires less medication to keep his blood within the prescribed range.

She also discusses ways to reduce his bleeding risk while his INR remains elevated, such as using a soft bristled toothbrush and an electric razor, as well as removing tripping hazards at home, like throw rugs.

Nurse Hannah encourages Diego to immediately notify his healthcare provider if he gets injured, falls, or if he has other signs of bleeding like easy bruising, a nosebleed, dizziness, or severe abdominal pain.

Two days later, nurse Hannah returns to check Diego's INR again, which is now 3.4. Diego mentions he hasn't noticed any new signs of bleeding.

Nurse Hannah notes his wound dressing has only a scant amount of bloody drainage. Given these findings, nurse Hannah determines she was successful in keeping Diego safe from his risk of bleeding, and will continue to monitor him closely to promote safety.

All right, as a quick recap. Patient safety involves the protection of patients from psychological and physical injury by minimizing risk of harm.

Prioritizing patient safety allows nurses to successfully navigate patient needs within various clinical scenarios, and is essential for providing safe, quality care and improving outcomes.