Client Safety and Risk Management
The following themes were analyzed from the surveys and focus groups:
The nurses report using documentation as their primary method to ensure patient safety by completing nursing-specific indicators (NSI) that are promoted by the charting system after they completed their assessments. These indicators include patient falls risk and related intervention implemented, confusion assessment measures (CAM) scores related to fall risks, pressure ulcer charting, and risk for nutritional defects. The nurses start these documentation threads which follow the patient as they are admitted to each unit as a tool to measure improvement and decline and to indicate which interventions are implemented to mitigate patient risk. Implemented interventions include using bed alarms, patient fall risk bracelets for high-risk patients, and a thorough post falls monitoring documentation in the incident that a patient experiences a fall. The charge nurse indicates that they use these monitoring tools to audit the use of hospital protocols, quality assurance, and as educational tools for future improvement.
Another safety measure is checks for all high-risk medications that require co-signs and witnessed waste discarding. Additionally, incident reports are also filed for any medication errors to monitor for trends in errors that may require further staff education.
The safety of patients and staff is the most reported priority on the inpatient mental health units. The nurses report the use of personal safety buttons attached to their badges to ensure the safety of the staff working on the unit. Patient safety is maintained by ensuring the unit is locked and all the exits require a badge to open and close doors. The nurses also report completing a patient violence risk assessment to ensure the safety of the patient and to implement appropriate measures depending on the scores. High alert patients are always provided care in pairs or teams for medication administration and personal care.