Accident Prevention and Event Reporting (Nursing)

00:01 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 and injuries.

00:44 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 temporary harm.

01:27 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.

01:51 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.

02:29 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.

02:43 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.

03:15 A major injury after a fall would require a surgery, casts, or even further evaluation.

03:25 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.

03:38 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.

04:28 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.

05:39 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.

06:06 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.

06:43 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.

07:08 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.

08:57 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.

09:14 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.

09:24 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.

10:14 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.

11:41 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.

12:32 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.