Safety and Infection Control / 08

Make sure to:

  • Prevent errors.
  • Report any incidents or errors.
  • Report any variances.

Unfortunately, an incident which is an unexpected, abnormal occurrence, can happen in a healthcare facility, potentially causing harm to a client. As a result, nurses in all healthcare facilities must follow employee policies and procedures focused on client safety.

In this learning experience, learners will be instructed on maintaining client safety by preventing errors and reporting incidences, errors, and variances.

4.1 Prevention of Errors

According to Burke (2023a), nurses can prevent errors by assessing clients for allergies, identifying clients before providing care, and verifying healthcare providers’ orders.

Assessing Clients for Allergies

Nurses must determine whether their clients and/or family have any allergies at admission and continually assess their clients for allergies throughout their stay in the healthcare facility. Once identified, these allergies must be communicated to other members of the healthcare team. This is done by documenting the allergies in the client’s medication administration record (MAR) and in their medical records or electronic health records. Each hospital facility has its own policies and procedures.  Typically, the client wears an armband that lists their allergies, and these may also be incorporated into bar code technology.

Understanding the types of allergic responses and interventions, such as cardiopulmonary resuscitation (CPR) and corticosteroid medication as ordered by the healthcare provider, is important.

Allergic responses can range from mild to severe. Clients with severe reactions may exhibit signs and symptoms of anaphylaxis, such as, hypotension, laryngeal edema, respiratory distress, tachycardia, rash, and potentially death if they do not receive immediate treatment.

Clients can be allergic to medications, contrast medium, latex, food, and environmental factors.

  • Medication and Contrast Media: Medication allergy is more commonly associated with penicillin, sulfonamides, and cephalosporins. The reaction can range from moderate to severe. On the other hand, clients on beta blockers for hypertension, the elderly, females, and those with a history or heart or renal disease have an increased risk of allergy to contrast media. Contrast media are usually administered during certain diagnostic procedures.

  • Latex Allergy: This allergy can occur after the first exposure or after prolonged exposure to latex. Clients may experience rapid onset contact dermatitis or, in severe cases, present with symptoms such as itching, burning skin, flu-like symptoms, chest pain, tachycardia, hypotension, dyspnea, and anaphylaxis. Clients who are immunosuppressed, such as those with AIDS/HIV, and those with eczema and asthma, are at increased risk of latex allergy. Those allergic to some foods such as avocados are at increased risk. It is important to remember to avoid latex gloves in clients with latex allergies.

  • Food Allergy: Including questions about food allergies during client admission is essential. Notably, clients allergic to avocados are at increased risk for latex allergy. Therefore, it is crucial to observe clients carefully for signs and symptoms of an allergic reaction.

  • Environmental Factors:Clients may have allergies to environmental elements like air pollution and pet dander. Therefore, it is important to assess them for these types of allergies by specifically inquiring if they have such allergies.

Identifying Clients Before Providing Care

It is important to ensure proper identification of clients in every healthcare setting. The use of at least two identifiers is recommended; this should not include their room numbers. Identifiers can include a special code number, the client’s full name, complete birth date, or a bracelet with an encoded barcode containing two identifiers and a photograph. Room numbers should never be used as identifiers, as clients can wander into each other’s rooms for various reasons. Errors are more likely in clients whose primary language is not English, those in a coma, if a client is confused, or in cases with identical or similar names, such as “Mr. Smith and Mr. Smythe.” Proper identification reduces the risk of surgery on the wrong client, medication errors, incorrect treatment, and incorrect procedures being administered to clients.

Verifying Healthcare Providers’ Orders

Nurses must verify all orders written by healthcare providers. These orders include medication, treatment orders for diagnostic tests, and invasive procedures. This is particularly important for high-risk procedures such as surgeries, cardiac catheterization, and the insertion of peripheral venous, central venous catheter, and chest tubes.

Nurses must ensure that all orders are appropriate, transcribed correctly, and executed in a timely manner.  They should obtain clarification from the person who wrote the order if they have any questions or concerns about it.

4.2 Reporting Incidents/Errors

Nurses aim to prevent incidents/errors, but when they do occur, it is important to assess the client immediately, intervene appropriately, and then report it (Burke, 2023b).

Each healthcare facility has policies and procedures for reporting incidents and errors that nurses must adhere to. These should be reported to the supervising nurse at the time of the incident or error. A written report is usually required, and the completed report is usually shared with the risk management and/or performance improvement department (Burke, 2023b).

According to Burke (2023b), the incident report form usually contains pertinent information about the incident, including:

  • Date, time, and location.
  • Objective information.
  • Affected person(s).
  • Witnesses.
  • Subsequent injuries.
  • Intervention(s).
  • Persons informed about the incident/error, such as the healthcare provider.

4.3 Reporting Variances

Photo representing a nurse using proper body mechanics while assisting a clientAccording to Burke (2023b), variances are deviations from standard practice that lead to a quality defect or problems. They include practitioner, system/institutional, and client variances.

  • Practitioner Variance: This applies to irregularities made due to the service and/or care provided by a healthcare provider. An example of this type of variance occurs when a healthcare provider fails to complete a medical assessment promptly.

  • System/Institutional Variance:Refers to irregularities resulting from the service and/or care provided by the healthcare facility. Examples of this type of variance include inadequate equipment and supplies needed for client care, and the lack of staff training and validation of competency.

  • Client Variance: This type of variance relates to irregularities occurring solely because of the client. For example, a client developing pressure ulcers due to immobility and poor nutrition.

Adhering to the healthcare facility’s policies and procedures regarding the prevention, identification and reporting of variances is crucial.

Upon concluding this learning experience, learners will acquire a deeper understanding of practice-related incidents and variances.

The resources provided will enable learners to gain proficiency in preventing errors and reporting errors, incidents, and variances. The main goals are to achieve success in both the NCLEX examination and in the workplace.

After reviewing the resources, identify areas for improvements and concentrate on addressing them.

  • Burke, A. (2023a, August 11). Accident/error and Incident Prevention: NCLEX-RN. https://www.registerednursing.org/nclex/accident-error-incident-prevention/
  • Burke, A. (2023b, October 13). Reporting Incident, Event, Irregular Occurrence, Variances: NCLEX-RN. https://www.registerednursing.org/nclex/reporting-incident-event-irregular-occurrence-variances/

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