Healthcare Safety for Nursing Personnel 1st Edition by James Tweedy 9781040181867 1040181864

Chapter 1 Nursing Safety

I. Introduction

A. Ana Nurse Health & Safety Survey Results

B. Safe Patient Handling and Mobility: Interprofessional National Standards

C. New Patient Safety Survey: Few Nurses Call Their Hospitals Safe

D. International Board for Certification of Safety Managers

II. Function of Safety

A. Safety Responsibilities

B. Nursing Supervisor Involvement

C. Addressing Behaviors

D. Employee Engagement

III. Understanding Hazards

A. Hazard Identification

B. Preparing for Inspections

C. Job Hazard Analysis

D. Job Design

E. Hazard Control and Risk Management

F. Hazard Control and Correction

1. Active and Passive Controls

2. Engineering Controls

3. Administrative Controls

4. Work Practice Controls

G. Personal Protective Equipment

H. Areas to Evaluate

IV. System Safety

V. Understanding Accidents

A. Accident Reporting

B. Accident Investigations

1. Classifying Accident Causal Factors

2. Interviewing Witnesses

3. Accident Analysis

4. Root Cause Analysis

C. Preparing Accident Reports

Vi. Human Factors

A. Error

B. Motivating People

Review Exercises

Chapter 2 Leadership and Management Overview

I. Introduction

II. Leadership

A. Practical Leadership

B. Leadership Ethics

III. Management

A. Knowledge Management

B. Decision-Making

C. Psychological Safety

D. Crisis Management

E. Traditional Organizational Structure

IV. Organizational Culture

A. Covert and Overt Cultures

V. Interfacing Support Functions

A. Operational and Support Functions

B. Human Resources

C. Facility Management

D. Employee Health

VI. Workers’ Compensation

A. Return to Work/Modified Duty Positions

B. Substance Abuse

VII. Orientation, Education, and Training

A. Providing Adequate Sessions

B. Safety Training

VIII. Effective Speaking and Writing

A. Communication

B. Communication Barriers

C. Effective Writing

Review Exercises

Chapter 3 Nursing Hazards

I. Introduction

A. Administrative Area Safety

II. Shift Work and Job Stress

A. Shift Work

B. Stress

III. Slip, Trip, and Fall Prevention

IV. Safety Signs, Colors, and Marking Requirements

V. Electrical Safety (29 Cfr Subpart S)

VI. Three Common Hazards

A. Bloodborne Pathogens

B. Hazardous Material Safety

C. Nursing Personnel and Workplace Violence

VII. Helicopter Safety

VIII. Noncompensated Or Voluntary Worker Safety

IX. Home Health Safety

X. Surgical Department

XI. Perinatal Nursing

XII. Intensive Care Units

XIII. Emergency Department

XIV. Dialysis Unit Safety

A. Equipment

B. Personal Protective Equipment

XV. Medical Equipment Management

A. Medical Equipment Management Plan

B. Joint Commission Requirements

C. Maintenance, Testing, and Inspecting

D. Medical Equipment Reporting

E. Safe Medical Device Act of 1990

F. Smda Reportable Events

G. Other Reporting Requirements

XVI. Security

A. Nfpa 99-2012, Security Management (Chapter 13)

B. Resources

C. Incident Reporting

D. Property Protection

E. Sensitive Area Access

F. Identification of Patients, Visitors, and Staff

G. Traffic Control and Vehicle Access

H. Weapons On Campus

I. Handling Civil Disturbances

J. Handling Situations Involving “Vips” Or The Media

K. Access and Crowd Control

L. Communications

M. Orientation and Education

N. Evaluation of Security

O. Using Proven Practices to Improve Security

P. Forensic Patients

Q. Workplace Violence

1. Workplace Violence Protection for Nurses By Accrediting Bodies

2. Workplace Violence Prevention (Niosh Publication No. 2002-101)

3. Management Commitment and Employee Involvement

XVII. Ergonomics

A. Evaluation of Ergonomics Efforts

B. Workstation Evaluations

C. Workstation Interventions

D. Human Factors

E. Musculoskeletal Disorders

F. Administrative Issues

G. Equipment Maintenance

H. Facility Designn Issues

I. Mechanical Lift and Assist Devices

J. Understanding The Body

K. Injuries and Disorders

L. Back-Related Problems

M. Back Injury Prevention

1. Lateral Transfers

2. Ambulating, Repositioning, and Manipulating

3. Performing Activities of Daily Living

4. Useful Tips

5. Lift Teams

6. Guiding and Slowing Falls

7. Transfer Task Safety

8. Personal Factors

9. Work Evaluation Tools

N. Training and Education

XVIII. Patient Transport Functions

A. Transporting Patients

B. Patient Care

C. Transport Team Development

1. Wheelchair Safety

Review Exercises

Chapter 4 Patient Safety

I. Introduction

A. Worker Fatigue and Patient Safety

II. Leading Efforts

III. Iom Reports

IV. Errors and Adverse Events

A. Active and Latent Errors

B. Factors Impairing Human Performance

C. Error Reporting

1. Reporting Using Technology

D. Analyzing Events and Errors

E. Common Error Causal Factors

F. Medical Education and Error Acknowledgment

V. Safety Cultures

A. Safety Culture Perceptions

B. Healthcare Bureaucratic Structure

C. Proactive Organizations

D. Understanding Change

E. Organizational Change

F. Teamwork

VI. Understanding Systems

A. Systems Approach

B. Key System Safety Elements

C. System Reliability

D. Failure Mode and Effect Analysis

E. Technology and Safety

VII. Patient-Centered Healthcare

A. Error Disclosure

B. Medical Error Disclosure Guidance

C. Evidence-Based Medicine

D. General Patient Safety Practices

E. Using Patient Safety Checklists

VIII. Human Factors

IX. Patient Safety Officers and Committees

X. Quality Improvement

A. Benchmarking

B. Other Measurements

C. Stakeholders

D. Plan-Do-Study-Act

E. Root Cause Analysis

F. Patient Roles In Patient Safety

XI. Improving Patient Safety

A. Wrong Surgeries

B. Diagnostic Errors

C. Display Confusion

D. Air Embolism From Contrast Media Injectors

E. Serious Reportable Events

F. Handoffs

1. Implementing Structured Handoff and Sign-Out Procedures

G. Foreign Bodies

H. Surgical Fires

I. Anesthesia Hazards Due to Inadequate Inspection

J. Medical Device Alarm Safety

K. Discharged Patient Events

XII. Healthcare-Associated Infections

A. Central Venous Catheter–Related Bloodstream Infections

B. Surgical Site Infection

C. Ventilator-Associated Pneumonia

D. Catheter-Associated Urinary Tract Infection

XIII. Medication Safety

A. Medication Errors

B. Risk Factors for Adverse Drug Events

C. Prevention of Adverse Drug Events

D. Accomplishing Medication Reconciliation

E. Medication Administration

F. Reducing Medication Errors

G. Reporting Medication Errors

H. Investigating Medication Errors

I. Computerized Provider Order Entry

XIV. Emergency Department Patient Safety

XV. Other Key Patient Safety Issues

A. Infusion Pumps

B. Ambulatory Care

C. Work Hours and Patient Safety

1. Acgme 2010 Standards

D. Rapid Response Systems

E. Call System Operation

F. Health Insurance Portability and Accountability Act

G. Patient Restraints

1. Most Medical/Surgical Restraints Exempt

H. Patient Fall Prevention

I. Environmental Hazards

J. Bed Safety

XVI. Electronic Records

A. Key Components of Electronic Health Records

B. Electronic Charting

XVII. Infant Abduction Prevention

A. Preventive Measures

XVIII. Quality and Safety Education for Nurses

Review Exercises

Chapter 5 Emergency Management and Fire Safety

I. Introduction

II. Joint Commission Requirements

III. Other Emergency Planning Issues

A. Hospital Evacuation Planning

IV. Community Involvement

A. Partnership for Community Safety

B. Hospital Roles In Community Emergencies

V. Incident Command System

A. Incident Commander Responsibilities

VI. Strategic National Stockpile

VII. Planning for Terrorism

VIII. Pandemic Planning

IX. Fire Safety

A. Life Safety Code Comparisons

B. Design Considerations

C. Fire Prevention

D. Inspections

E. Fire Warning and Safety

1. Manual Alarm Stations

2. Electrically Supervised Systems

3. Special Requirements for Cooking Areas

4. Fire System Inspections

F. Fire Confinement

G. Emergency Egress

1. Osha Egress Standards

H. Fire Extinguishers

1. How Fire Extinguishers Work

2. Proper Maintenance

I. Surgical Fires

1. Astm Surgical Fire Standard

2. Fire Blankets

X. Life Safety

A. Interim Life Safety

Review Exercises

Chapter 6 Hazardous Materials

I. Introduction

II. Hazardous Substance Safety

A. Hazardous Substance Exposures

B. Hazardous Chemical Determination

C. Reproductive Hazards

D. Threshold Limit Values (Tlvs)

E. Chemical Properties

F. Flash Points

G. Airborne Exposure

H. Emergency Showers and Eyewashes

I. Compressed Gas Safety

III. Osha Hazard Communication Standard (29 Cfr 1910.1200)

A. Globally Harmonized System

B. Major Hazard Communication Standard Changes

C. Safety Data Sheet Changes

D. Managing and Communicating Changes to The Hazard Communication Standard

E. Employee Training

IV. Healthcare Hazardous Materials

A. Acetone

B. Acryl Amide

C. Ammonia

D. Cadmium (29 Cfr 1910.1027)

E. Chlorine Compounds

F. Iodine

G. Isopropyl Alcohol

H. Methyl Methacrylate

I. Peracetic Acid

J. Pesticides

K. Phenol Substances

L. Quaternary Ammonium Compounds

M. Solvents

N. Ethyl Alcohol

O. Glutaraldehyde

P. Orthopthalaldehyde

Q. Ethylene Oxide (29 Cfr 1910.1047)

R. Formaldehyde (29 Cfr 1910.1048)

V. Hazardous Drugs

A. Hazardous Pharmaceutical Wastes

VI. Medical Gas Systems

A. Anesthetic Gas Hazards

B. Scavenging

C. Nitric Oxide

D. Nitrous Oxide

VII. Managing Waste

A. Medical Waste

VIII. Respiratory Protection (29 Cfr 1910.134)

A. Types of Respirators

Review Exercises

Chapter 7 Infection Control and Prevention

I. Introduction

II. Healthcare Immunizations

A. Guidelines of The Advisory Committee for Immunization Practice

B. Other Vaccination Considerations

III. Centers for Disease Control and Prevention

A. Cdc Guidelines for Hand Hygiene In Healthcare Settings

B. Guidelines for Environmental Infection Control In Healthcare Facilities

C. Cdc Standard Precautions

D. Cdc Isolation Precautions

1. Airborne Precautions

2. Droplet Precautions

3. Contact Precautions

E. New Infection Risk

IV. Centers for Medicare & Medicaid Services, Hospital-Acquired Conditions, and Present On Admission Indicators

V. Disinfectants, Sterilants, and Antiseptics

A. Germicidal Effectiveness

B. Regulatory Approval of Disinfectants

C. Epa’S Registered Sterilizers and Tuberculocidal and Antimicrobial Products

D. Cdc Recommendations

E. Selecting A Disinfectant

VI. Osha Bloodborne Pathogens Standard (29 Cfr 1910.1030)

A. Exposure Control Plan

B. Osha Hand Hygiene Requirements

C. Employee Involvement

D. Recordkeeping

E. Engineering Controls

F. Needleless Systems

G. Exposure Determination

H. Control Measures

I. Personal Protective Equipment

J. Housekeeping, Laundry, and Waste Practices

K. Hepatitis B Virus

1. Hepatitis B Vaccination

L. Hepatitis C

M. Human Immunodeficiency Virus

N. Other Key Topics

O. Latex Allergies

P. Information and Training

1. Training Methods and Interactive Question Opportunities

2. Trainer Qualifications

Q. Medical Recordkeeping

1. Training Recordkeeping

R. Hazardous Waste Operations and Emergency Response (29 Cfr 1910.120)

S. Post-Exposure Evaluation and Follow-Up

VII. Tuberculosis

A. Tb Screening Procedures for Settings Classified As Low Risk

B. Tb Screening Procedures for Settings Classified As Medium Risk

C. Tb Screening Procedures for Settings Classified As Potential On Going Transmission

D. Osha Tuberculosis Exposure Enforcement Guidelines

1. Osha Citations for Tb Exposures

2. Osha Abatement Methods

3. Osha Tuberculosis Respirator Requirements

E. Tb Exposure Control Plan

1. Administrative Controls

2. Environmental Controls

3. Respiratory-Protection Controls

4. Engineering Controls

VIII. Healthcare Opportunistic Infections

A. Bacteria

B. Methicillin-Resistant Staphylococcus Aureus

C. Viruses

D. Aspergillus

E. Anthrax

F. Severe Acute Respiratory Syndrome

G. Pseudomonas

H. Legionella

I. Infection Control Risk Assessment

IX. Medical Waste

A. Sharps Containers

B. Separating Medical and Hazardous Wastes

C. Infectious Wastes

D. Medical Waste Best Practices

E. Waste Handling for Offsite Transfer

F. Containers

G. Medical Waste Disposal

H. Dot Infectious Shipping Requirements

Review Exercises

Chapter 8 Radiation, Lab, and Drug Hazards

I. Radiation Safety

A. Osha Ionizing Radiation Standard (29 Cfr 1910.1096)

B. Restricted Areas

C. Surveys and Monitoring

D. Radiation Areas

E. Caution Signs

F. Airborne Radioactivity

G. Storage Areas

H. Tuberculosis Exposures

I. Ergonomics

J. Slips, Trips, and Falls

K. Bloodborne Pathogens

L. Storage and Handling Procedures

M. Medical Radioactive Materials

N. Shielding

O. Alarp

II. Nuclear Medicine

A. Brachytherapy (Implant) Patients

B. Medical, Reproductive, and Fertility Considerations

III. Nuclear Regulatory Commission

A. Nrc Performance-Based Standards

B. Radiation Control Planning

C. Radiation Safety Committee

D. Radiation Safety Officer

E. Regulatory and Occupational Dose Considerations

F. National Council On Radiation Protection

IV. Food and Drug Administration and Radiation Safety

A. Radiological Society of North America

B. American College of Radiology

V. Radioactive Waste Management

VI. Nonionizing Radiation (29 Cfr 1910.97)

A. Ultraviolet Radiation

B. Radio Frequency and Microwave Radiation

C. Wireless Medical Telemetry

D. Fda/Cdrh Recommendations for Emc/Emi In Healthcare Facilities

E. Consensus Standards

F. Other Recognized Standards

VII. Lasers and Electrosurgery

A. Laser Safety

B. Laser Safety Officer

C. Laser Standards

D. Laser Classifications

1. Class 1 Laser

2. Class 1M Laser

3. Class 2 Laser

4. Class 2M Laser

5. Class 3R Laser

6. Class 3B Laser

7. Class 4 Laser

E. Laser Plumes

F. Laser Skin Protection

G. Fire Prevention Tips During Laser Surgery

VIII. Magnetic Resonance Imaging

A. Fda Mri Safety Guidelines

B. Other Mri Safety Recommendations

C. Mri Burns

IX. Other Clinical Risks

A. Ct Radiation Doses

B. Fiber-Optic Light Burns

C. Sonography

X. Laboratory Safety

A. Clinical Laboratory Improvement Amendments

B. Joint Commission Laboratory Accreditation

C. College of American Pathologists Accreditation Program

D. Cola Accreditation

E. Osha Laboratory Standard (29 Cfr 1910.1450)

F. Summary of Lab Safe Work Practices

G. Centrifuges

H. Laboratories and The Osha Bloodborne Pathogens Standard

I. Tuberculosis

J. Morgue

K. Chemical and Fire Hazards

L. Chemical Exposure Response

M. Standard Operating Procedures

N. Laboratory Equipment

O. Microtome Safety

P. Pressure and Vacuum Systems

Q. Fume Hoods and Laboratory Ventilation

R. Employee Training

S. Medical Examinations and Consultations

T. Supervisor Responsibilities

U. Safety Personnel Responsibilities

V. Laboratory Personnel Safety Responsibilities

W. Animal Research Facilities

X. Laboratory Hazardous Waste Disposal

Y. Autoclaves

Z. Good Clinical Laboratory Practices

AA. Laboratory Physical Environments

XI. Drug Hazards

A. Clinical Pharmacy

B. General Safety Considerations

C. Pharmacy Safety

D. Osha Hazard Communication Standard

E. Pharmacy Ergonomics

F. Workplace Violence

G. General Medication Labeling

H. Closed Pharmacy Procedures

I. Drug Recalls Or Safety Alerts

J. High-Risk Medications

K. Investigational Medication Safety

L. Evaluation of Medication Management

M. Drug Quality and Storage

N. Hazardous Drug Safety

O. Current Standards

P. Niosh Revision of Ashp Definition

Q. Developing A Hazardous Drug List

R. Where to Find Information Related to Drug Toxicity

S. 2010 Niosh Update of Hazardous Drug Alert for Healthcare Settings

T. Hazardous Drug Safety Plan

U. Transfer Procedures

V. Caregiver Exposure Precautions

W. Administering Aerosolized Drugs

X. Hazardous Drug Waste

Y. Spill Control

Z. Medical Surveillance

AA. Ventilated Cabinets

AB. Recordkeeping

XII. Proposed Universal Waste Rule for Pharmaceuticals

A. Current Rcra Requirements

B. Usp 797: Pharmaceutical Compounding—Sterile Preparations

C. Usp 797 2008 Revision

Review Exercises

Chapter 9 Agencies, Associations, and Organizations

I. Administrative Law

II. Occupational Safety and Health Administration

A. Summary of General Duties

B. Priorities

C. Citations

D. State-Approved Plans

E. Recordkeeping (29 Cfr 1904)

F. Recording Work-Related Injuries and Illnesses

1. Medical Treatment

2. Restricted Work

3. Classifying Injuries

4. Classifying Illnesses

5. Posting The Summary

6. Form 301 Injury and Illness Incident Report

G. Access to Employee Exposure and Medical Records (29 Cfr 1910.1020)

III. Environmental Protection Agency

A. Resource Conservation and Recovery Act

B. Comprehensive Environmental Response, Compensation and Liability Act

C. Superfund Amendments and Reauthorization Act of 1986

D. Clean Air Act

E. Clean Water Act

F. Federal Insecticide, Fungicide, and Rodenticide Act

G. Toxic Substances Control Act

IV. Other Federal Agencies