SENTINEL EVENT - an unexpected occurrence involving death,

serious physical or psychological injury or the risk thereof; and any event that may cause embarrassment or risk to the hospital with potential legal ramifications and or media inquiries or coverage. Such events are called Sentinel because they signal the need for immedicate investigation and response. Death related to delay in treatment Medication error related event Hemolytic transfusion reaction involving administration of blood or blood products having major blood group incompatibilities. Suicide of a patient in a setting where the patient receives around the clock care. Surgery on the incorrect patient or incorrect body part Serious injury with loss of limb or function Infant abduction or discharge to the wrong family Assault, rape and homicide by another patient, visitor or staff.

NEAR MISS - an event or situation that could have resulted in an adverse

event but did either by chance or through timely intervention. Example: epinephrine was almost administered instead of lidocaine but uncovered during the final check of the nurse.

FIRE EXTINGUISHER
PULL holding the extinguisher upright, twist the pin to break the plastic safety seal. Pull the pin completely out. AIM aim low. Point the extinguisher nozzle at the base of the fire not on the flames. SQUEEZE Squeeze the handle. This releases the extinguishing agent. SWEEP Move the fire extinguisher sideways (back and forth) until the fire is completely out.

RACE
Rescue Alarm Confine Evacuate

CODES Blue cardiac arrest Red fire Pink child abduction White chemical spill Orange stat CS Green full disaster Yellow Limited disaster Black Bomb threat Mr. Strong Aggressive person 10 RIGHTS/RULES IN MEDICATION
1. PATIENT 2. DRUGS 3. ROUTE 4. DOSE 5. FREQUENCY 6. TIME 7. DOCUMENTATION 8. EDUCATION 9. REFUSE 10. PRIVACY

NURSING PROCESS
It is a systematic approach to meet the clients need in the health care setting, enabling the nurse to identify and understand, explain and analyze the problems and needs presented.

5 steps of the Nursing Process

1. Assessment- a comprehensive gathering of information using our senses such as touch, hearing, sight and smell. a. Subjective- verbalization b. Objective- observation based on clinical manifestation 2. Diagnosis (nursing) analyses of the data collected that leads to the areas of concerns or needs 3. Plan objectives or direct outcomes we want to achieve for our clients 4. Intervention/Implementation appropriate action taken to achieve the desired outcomes based on the concern or needs identified by the clients, nurses and physician. 5. Evaluation the desired outcome on the nursing care delivered whether it has a positive or negative response to the client.

Consent
Expressed / informed consent the patient has the procedure explained to him, understands and agrees to it. Implied Consent the patient is unable to communicate but life saving interventions are required. For instance, someone who has suffered a heart attack and is unconscious is legally offering implied consent for CPR to be performed on them Third Party consent the patient is mentally incapable of understanding the procedure and or the ramifications of consent or refusal, so consent is given or withheld on their behalf by a legal designate e.g a parent or a guardian in the case of children or a power of attorney delegated by a person suffering a degenerative neural disease.

High Risk Medications

KCl KPo4 NaHCo3 NaCl 3% Calcium Gluc Digoxin Inderal Adrenaline Atropine Sulfate Aminophylline Insulin Heparin Warfarin Oxytocin Lidocaine Amiodarone Streptokinase Propanolol Narcotics Glucose 25% Glucose 50% Adenosine

HANDWASHING
Wash hands only when visibly soiled. Otherwise use handrub: 20 30 seconds. Duration of the entire procedure: 40 60 seconds 1. remove all jewelries 2. roll the sleeves 3. wet hands with water 4. apply enough soap to cover all hands surfaces 5. rub hands from palm to palm 6. right palm over the left dorsum with interlaced fingers and vice versa 7. palm to palm with fingers interlaced 8. backs of fingers to opposing palms with fingers interlocked 9. rotational rubbing of left thumb clasped in right palm and vice versa 10.rotational rubbing, backwards and forwards with clasped fingers of right hand in left palm and vice versa 11. rinse hand with water 12. Dry hands thoroughly with a single use towel. Use towel to turn off the faucet.

PERFORMANCE IMPROVEMENT APPROACH

FOCUS PDCA F O C U S P D C A find a process to improve organize the team that knows the process clarify current knowledge of the process understand causes of process variation select the process improvement plan the improvement and continue the data collection do the improvement, data collection and analysis check the results and lesson learned from the team effort act to hold the gain and to continue to improve the process.

TIME OUT
Process: to conduct a final verification of the correct patient, procedure, site and as applicable, implants. Purpose: active communication among all members of the surgical/procedure team, consistency initiated by a designated member of the member of the team, conducted in a failsafe mode, the procedure is not started until any questions or concerns are resolved.

ROOT CAUSE ANALYSIS

It is an in-depth investigation, a process for identifying the basic causal factors of an adverse event and analyze them Collecting, analyzing, integrating evidences and establish causes, make recommendations and drawing conclusions.

BASIC LIFE SUPPORT

CRITICAL CONCEPT IN QUALITY CPR: 1. Push hard, push fast, compress at the rate of 100 compressions per minute. 2. Allow full chest recoil after each compression. -----to allow more oxygen to refill the heart between compression.. 3. Minimize interruptions in every chest compression. Less than 10 seconds 4. Avoid hyperventilation. CHEST COMPRESSION DEPTH Adult 1.5 to 2 inches Pediatrics 1 to 1.5 inches Infant 0.5 to 1 inches RESCUER EXHALED AIR 17% oxygen and 4% carbon dioxide To prevent gastric inflation: take one second to deliver each breath deliver enough air to make the victims chest rise 30 compressions : 2 breaths for 5 cycles With pulse give one breathes every 3 to 5 seconds ADULT CHAIN OF SURVIVAL Early access Early CPR Early Defibrillation Early advance care