Patient Safety: Make room for success in your plan of care

article will help you make sure you have the tools you need at your fingertips, so you can work efficiently to meet the patient's goals and ensure patient safety.

After receiving hand-off communication and completing a medical record review, head to your patient's room, perform hand hygiene, touch the patient's forearm or hold his or her hand, and introduce yourself as the nurse for the day. This lets you do several things at one time: When you touch the patient, you're establishing a rapport and making him or her feel safe. You can also note whether the patient's skin is warm and dry.

At the same time, do the first of many checks of the patient's ID band to see if it's correct. Then perform the second ID check, asking the patient to state his or her name and date of birth while looking at the ID band. When performing this check, you can make sure the patient is alert and oriented and isn't dyspneic. You can also palpate the radial pulse while checking the ID band, and assess the patient's quality of speech, noting the presence or absence of facial droop or cognitive impairment.

Next, ask the patient about allergies and check for the correct allergy band. Then check for any special alerts, such as high fall risk or do-not-resuscitate order.1 Confirm that these alerts match what's in the medical record.

With these simple steps, you can gather enough information about the patient to feel confident as you continue to collect patient data. Assess the patient's vital signs and oxygen saturation (if a pulse oximeter is in use). Then assess for pain, including a pain intensity rating.

Assess all tubes from their source to their connection to the patient. With every I.V. infusion, check for the proper prescribed solution and rate; check the tubing and the pump, and assess the I.V. infusion site.

If the patient is on a cardiac monitor, what's the rate and rhythm? Are the cardiac monitor alarms on and set correctly? Is an automatic noninvasive BP monitor in use and set to cycle appropriately? Is a respiratory module in use? Always confirm the respiratory rate by counting the rise and fall of the chest. I sometimes take a moment to trend the vital signs and other information from the last shift if it's available.

Next, check the suction equipment. Are an oral airway and suction catheters, including tonsil suction, nearby? If the patient is endotracheally intubated, note the endotracheal tube size, making sure it's secured properly. If the patient has a tracheostomy, look for an obturator and a new trach kit. When the patient is on mechanical ventilation, a bag-valve mask should also be immediately available.

After completing the physical assessment, you can proceed to the patient's immediate environment.

After assessing the patient and checking the equipment, perform a room assessment. This takes only 5 minutes, and it's time well spent. Start by making sure the bed is in a low position, that the patient call bell is within easy reach, and that the patient's over-bed table, with water and tissues, is within easy reach. Also, make sure side rails are positioned as indicated, floors aren't wet, and no obstacles are present that would prevent the patient from moving freely and safely.

Always determine where a crash cart would go and whether responders could readily access what they need. Also check the sharps container: Does it need to be replaced?

If the patient is going to be out of bed, move a comfortable chair to the side of the room closest to the oxygen, even if this is the side opposite the monitor or I.V. poles.2 This way, the patient will be close to the oxygen source in case of an emergency. If one of the patient's nursing diagnoses is impaired airway clearance, make sure the incentive spirometer is within the patient's reach.

Finally, remember to assess safety at regular intervals when you return to your patient's room.

The benefits of making the patient's room work for you will far outweigh the time you put into it at the beginning of your shift. A sense of direction will come over the plan of care and you too will make room for success-and safety.

REFERENCES

1. The Joint Commission. National Patient Safety Goals. http://www.jointcommission.org/patientsafety/nationalpatientsafetygoals/. [Context Link]

2. 2. Scalise D, Thrall TH, Haught R, Runy LA. The patient room. http://www.hhnmag.com/hhnmag/hospitalconnect/search/article.jsp?dcrpath=AHA/PubsNewsArticle/data/0405HHN_CoverStory_Patient_Rooms&domain=HHNMAG. [Context Link]