Safety Flashcards

1
Q

Fall: trigger

A

Morse scale

History of falling: 25

  1. Secondary diagnosis: 15
  2. Ambulatory aid

None/bed rest/nurse assist: 0

Crutches/cane/walker: 15

Furniture: 30

  1. Intravenous therapy/saline lock: 20
  2. Gait

Normal/bed rest/wheelchair: 0

Weak: 10

Impaired: 20

  1. Mental status

Oriented to own ability: 0

Overestimates/forgets limitations: 15

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2
Q

Morse scale

A
  1. history of falling,
  2. presence of 2 or more medical conditions,
  3. intravenous medications,
  4. gait assessment,
  5. ambulatory aid, and
  6. mental status. Patients are then classified into low-, moderate-, and high-risk categories.
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3
Q

Delirium: risk factors

A

Age older than 70 years, cognitive impairment, sensory impairment such as vision or hearing loss, and functional dependence

physical comorbidity, psychiatric comorbidity, dehydration and malnutrition, and drug dependence

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4
Q

CAM: specificity, sensitivity

A

sensitivity of 94 to 100 percent and a specificity of 90 to 95 percent

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5
Q

Suspected Delirium: trigger

A

Compute CAM score

  1. Acute and fluctuating course
  2. Inattention
  3. Disorganized thinking:

“rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?”

  1. Decreased LOC: “Overall, how would you rate this patient’s level ofconsciousness?”
    1. Normal = alert
    2. Hyperalert = vigilant
    3. Drowsy, easily aroused = lethargic
    4. Difficult to arouse = stupor
    5. Unarousable = coma
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6
Q

CAM: Level of consciousness component

A

Normal = alert

Hyperalert = vigilant

Drowsy, easily aroused = lethargic

Difficult to arouse = stupor

Unarousable = coma

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7
Q

CAM: positive when

A
  1. Acute onset, fluctuating course
  2. Inattention
  3. Disorganized thinking
  4. Decreased LOC

The diagnosis of delirium requires the presence of features 1 AND 2 plus either 3 OR 4.

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8
Q

Stress ulcer prophylaxis: indications

A

critically ill patients at high risk of bleeding:

  1. coagulopathy (platelet count <50 × 103/µL, INR >1.5),
  2. prolonged mechanical ventilation (more than 48 hours),
  3. gastrointestinal ulcer or bleeding within the past year, or
  4. severe burn injury and 2 or more minor criteria including sepsis,
  5. stay longer than 1 week in the intensive care unit,
  6. occult gastrointestinal bleeding for 6 or more days,
  7. steroid therapy with more than 250 mg of hydrocortisone daily
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9
Q

Braden scale

A

The Braden scale rates patients in six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction and shear using scores ranging from 1 to 3 or 4.

The maximum score is 23; a score ≤18 is indicative of high risk.

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10
Q

Non-blanching erythema on buttocks: Trigger

A

Pressure ulcer precautions

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11
Q

Pressure ulcer risk mitigation

A

advanced static or dynamic support surface

if “high-risk,” regardless of whether the assessment was made clinically or with a structured scoring scale.

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12
Q

Development of Stage 3 ulcer after admission: Trigger

A

considered a “never event” that must be reported to the Joint Commission.

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13
Q

Pressure ulcer prevention: minimum strategies

A
  1. formal institutional multicomponent strategy
  2. protocols for scheduled turning and mobilization of at-risk patients,
  3. education of physicians and nurses on recognition of early-stage ulcers,
  4. designated “skin champion” who regularly evaluates patients and makes specific recommendations
  5. regular audit and feedback of pressure ulcer rates.

Less evidence:

  1. use of special mattresses and overlays to reduce skin pressure
  2. championing by hospital leadership, although these strategies have less supporting evidence.
  3. close attention to nutrition and hydration is important to prevent ulcers, no clear data show that targeting a specific serum albumin level is beneficial.
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14
Q

Hypotension, tachycardia, mild abdominal/groin tenderness the day after cardiac cath

A

RP bleed

CT abdomen is the best test

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15
Q

High Risk Meds

A
  1. IV Adrenergic agonists
  2. IV Adrenergic antagonists
  3. Anesthetics, general + IV
  4. IV antiarrhythmics
  5. Anti-coagulants
  6. thrombolytics (e.g., alteplase, reteplase, tenecteplase)
  7. glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide)
  8. Cardioplegics
  9. Chemotherapy agents
  10. Dextrose 20% or higher
  11. Dialysis solutions, peritoneal and hemodialysis
  12. epidural or intrathecal medications
  13. hypoglycemics, oral
  14. inotropic medications, IV (e.g., digoxin, milrinone)
  15. insulin, subcutaneous and IV
  16. liposomal forms of drugs (e.g., liposomal amphotericin B) and conventional counterparts (e.g., amphotericin B desoxycholate)
  17. moderate sedation agents, IV (e.g., dexmedetomidine, midazolam)
  18. moderate sedation agents, oral, for children (e.g., chloral hydrate)
  19. narcotics/opioids
  20. neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium)
  21. parenteral nutrition preparations
  22. radiocontrast agents, IV
  23. sterile water for injection, inhalation, and irrigation (excluding pour bottles) in containers of 100 mL or more
  24. sodium chloride for injection, hypertonic, greater than 0.9% concentration
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16
Q

Heparin induced thrombocytopenia: timescale

A

Drop in platelet count is seen after 5 to 10 days of exposure in patients not exposed to heparin in the last 3 months

17
Q

Drug induced lupus: drugs

A
  1. procainamide,
  2. hydralazine,
  3. minocycline,
  4. diltiazem,
  5. penicillamine,
  6. isoniazid (INH),
  7. quinidine,
  8. anti-tumor necrosis factor (TNF) alpha therapy (most commonly with infliximab and etanercept),
  9. interferon-alfa,
  10. methyldopa,
  11. chlorpromazine, and
  12. practolol [35-37].
18
Q

Drug induced lupus: Dx test

A

anti-histone

90% sensitive

19
Q

Anti-Smith for SLE: sensitivity

A

30%

Specificity: 55 to 100%

20
Q

anti-dsDNA in lupus: why useful?

A
  1. Relatively High specificity
  2. correlates with disease activity
  3. association with active glomerulonephritis
21
Q

RCA

A
  1. Interview
  2. Identify proximate causes
  3. Structured analysis:
    1. Communication structures
    2. Leadership
    3. Human resource issues
    4. Environmental issues
    5. Information management issues
  4. Action plan