Question

Project 7-1: Classify Patient Incidents According to Policy

This primary source of information on patient safety will be used to analyze the incidents according to level of severity. The following policies define the three categories of severity

Policy on Level I Event: An incident that resulted in patient death or serious short or long-term (6 weeks or more) disability or harm

Policy on Level II Event: An incident that resulted in minimal short-term patient disability or harm
Policy on Level III Event: An incident that could have resulted in patient death, disability or harm but did not, either by chance or through timely intervention
Read the ten patient incident descriptions from your workbook. For each incident, indicate by policy definition how it should be categorized. If the description contains insufficient information to allow it to be categorized, indicate that "more information is needed." If you are not familiar with the terminology used in the incident descriptions consult a medical dictionary.

Report your findings by creating a tabular report that provides the following information to the risk management department. Remember to apply all guidelines/formatting rules when creating the tabular report. You may need to refer back to Chapter 4 of your textbook.

Incidents reported (incident 1, incident 2...)
Level of events including "more information is needed"
A total for each level of event that occurred

Incident # 1
The nursing staff was providing a patient with routine a.m. care. This consisted of showering the patient in the shower room on the ward. The patient was being washed while seated in a chair when he slid off the chair hitting his face, hip and shoulder. The patient was examined by the doctor at 0755 and transferred to the emergency department (ED) for further evaluation. The ED physician ordered x-rays No fractures were found however he did have some minor contusions. The patient was returned to the ward where neurological checks were initiated per policy and reported as normal.
Incident # 2
A 61-year old female was admitted for GI bleeding and underwent hemicolectomy. She was put on a ventilator postoperatively and transferred to the surgical intensive care unit. On the 8th post-operative day，while still on the ventilator, the patient developed copious respiratory secretions and became restless and agitated. She was sedated with Diprivan which seemed to improve her condition. On the 9th postoperative day two nurses turned the patient on her side for a bath. The patient started coughing and was noted to have copious secretions. A respiratory therapist was summoned to assist the nurses who had already started to suction the patient's secretions. The respiratory therapist checked the patient's endotracheal tube and found it to be in the oropharynx rather than the trachea. The tube was removed and respiratory therapist attempted re-intubation but was not successful. A "code red" (cardiac arrest) was called to alert professional staff that help was needed. A certified nurse anesthetist arrived within minutes and attempted to reintubate the patient but he could not visualize the patient's vocal cords (patient had very large tongue). Another attempt was made with a smaller tube and this was also unsuccessful. The third reintubation attempt was successful, however the patient could not be resuscitated and she expired.

Incident # 3
A 2-yr-old boy with retroperitoneal rhabdomyosarcoma was scheduled to undergo abdominal MRI. Anesthesia was provided by an anesthesiologist/nurse team with experience in anesthesia for MRI. After a check for removal of all ferromagnetic materials and of the MRI compatible ventilator, anesthesia was induced and maintained via a closely fitting facemask in the spontaneously breathing child using sevoflurane-nitrous oxide in 50 % oxygen , and vital signs were monitored using MRI - safe equipment (graphite electrocardiogram fiberoptic pulse oximetry, end-expiratory carbon dioxide, noninvasive blood pressure). When a low level of sevoflurane was noted in the vaporizer, the nurse was asked to refill it. However, because a refill bottle of sevoflurane was not immediately found, the nurse instead carried a portable sevoflurane vaporizer from the induction room into the MRI suite. Neither she nor the anesthesiologist considered that the almost empty sevoflurane vaporizer in the MRI suite was fixed to the ventilator and hence could not be replaced at all. When the nurse put the vaporizer on the examination table, it was rapidly attracted toward the MRI's 1.5-T magnet. It was only by the force of four hands that the vaporizer could be directed to strike against the gantry instead of flying directly into the magnet, where might have hit the child. The table with the sleeping child was rapidly moved out of the gantry avoiding further danger. Fortunately, neither the child nor the MRI machine was harmed, and the examination went on without further complications after excluding MRI damage and refilling the fixed vaporizer.

Incident # 4
A 59-year old patient with chronic obstructive pulmonary disease was ordered by his physician to have 100 % oxygen via facemask to correct his low PaO2 . The patient 's condition did not improve despite being on the 100 % oxygen for one hour . When the physician entered the patient 's room and moved the bed to begin intubation, it was discovered the patient was not on oxygen. Rather the oxygen tubing was attached to the medical air flow meter. Once the oxygen tube was connected to the oxygen flow meter the patient's condition improved. No further action was required.

Incident # 5
A 35-year old patient with left shoulder pain was seen in the physical therapy department for treatment of left shoulder and neck pain. His physician had prescribed several therapy modalities: hot packs, phonophoresis with ultrasound 1.5 watts per square centimeter and hydrocortisone 1 % for 8 minutes, massage, and interferential electrical stimulation. When the patient arrived for his first treatment, there were four other patients in the department at the time. He received electrical stimulation and hot packs to his left shoulder, followed by ultrasound. Following the patient's therapy the staff noted a reddened area on his left shoulder. The patient had been advised to report excessive heat from the treatment but he said he hadn't felt anything too hot. No treatment for the redness was deemed necessary and it was gone five days later when the patient came in for a second appointment.
Incident # 6
Two weeks after being admitted to the hospital's Alzheimer Unit, a 67-year-old patient wandered away from the facility. He was last seen at approximately 4:30 PM and was not in his room when dinner was delivered. The patient's nurse first looked for him in the outside hallways and other patient rooms. When he could not be located, the nurse contacted security. A full search of the building and grounds was initiated and this lasted about an hour. When the patient was not found, the local police department was notified of his missing status along with a physical description and information about his condition. The next morning the city police discovered the man wandering downtown (about 4 miles from the hospital) He was taken to the emergency department for evaluation where he was found to be dehydrated and suffering from pneumonia. He was admitted to the hospital for treatment and later transferred back to the Alzheimer Unit after six days of hospitalization.

Incident # 7
A laparotomy sponge was left in a patient who had undergone an esophagogastrectomy and thoracotomy At the end of the esophagogastrectomy, sponge counts done by the surgical nurse were reported as correct and the surgeon proceeded with the thoracotomy. At the end of the thoracotomy, the surgical nurse discovered the sponge count was incorrect by one sponge. A portable chest x-ray was done and erroneously read as negative by the surgeon (no radiologist was available in-house to interpret the x-ray). The next day the x-ray was read by a radiologist who found that a foreign object had been left in the patient's chest. The patient was returned to the operating room for removal of the sponge. According to the surgeon, this second procedure prolonged the patient's hospital stay by three days.
Incident # 8
A 9-year old girl was admitted to the pediatric unit with acute lymphocytic leukemia. This was a new diagnosis for this patient. Following six weeks of chemotherapy in the hospital, her immune system became extremely compromised. She was maintained in an isolation room for the last three weeks of therapy as her white count had dropped to very low levels. During week six in the hospital, the child spiked a fever to 104°F and became tachycardic. She complained of a new onset of pain in her head. This was reported to the oncologist immediately and cultures were obtained from blood, nasopharynx and spinal fluid. The spinal fluid and NP cultures grew Aspergillus fumigatus. Despite aggressive treatment, the child was taken to the operating room for removal of her left eye and cheekbone to prevent further damage from the Aspergillus. She was ultimately discharged home.

Incident # 9
A nurse on the medical ward tried to start an IV on a 72-year old patient, but was unsuccessful because the patient became agitated and moved around constantly. This occurred toward the end of the nurse's shift and she notified the incoming nurse that she had been unable to start the IV. The incoming nurse said she would try to do it as soon as she finished passing out medications to her other assigned patients When the incoming nurse finally got around to entering the room of the patient who needed to have the IV started, she discovered that the first nurse had not removed the tourniquet from the patient's arm. This was four hours after the original nurse had tried but failed to begin the IV. The patient's arm was swollen and there was some residual neurological and vascular damage that was still present at the time the patient was discharged.
Incident # 10
A female patient was scheduled for a phacoemulsification, cataract extraction, and an intraocular lens implantation on her right eye. Just prior to her operation, the anesthesiologist administered a lid block and partial retrobulbar injection to the patient's left eye even though her right eye was the operative site. The mistake was discovered by the surgeon before making an incision. The patient's right eye was anesthetized and surgically prepared and the surgery proceeded without incident.

Answer 1

Patient safety is the is safe activities delivered from the hospitals and other health care organizations to protect their patients from any errors,injuries,accidents and infections (safe guard from all the harm).Most of the hospitals are following the policy of the safe guard their patient.

A patient safety incident is an event or circumstances where that could have rsulted in unnecessary harm to a patient.We can see 3 types of patient safety incidents:

*Harmful incident: where a patient safety incident that resulted in harm to the patient

*Near miss: where a patient safety incident that did not reach the patient and therefore no harm resulted

*No-harm incident: where a patient safety incident taht reached the patient but no desirable harm resulted

Incident #	Patient Incidents according to the Policy
Incident #1	Here the incident was happened while giving a.m care by a nurse.While during the showeringof patient in the ward while sitting in a chair,the patient slid off the chair and resulted in hitting of the face,hip and shoulder.On the further evaluation in the emergency department and on the X-ray no fractures were found but he did have some minor contusions and the neurological check-ups reported as normal. Here we can apply the Policy on Level II event, why because the incident can resulted in a minimal harm to the patient suchas a minor contusion on the face hip and shoulder
Incident #2	A 61 year old female a hemicolectomy has done for GI bleeding.On the *th post-operative day in SICU she is on ventilator developed copious respiratory secretions and became restlessa nd agitated.On the 9th post-operative day while the patient was turned on her side by two nurses for bathpatient started coughing and noted copious secretions.A respiratory therapist was summoned to assist the nurses to assist with suction of the patient secretions and found that the ET tube was in oropharynx instead of trachea.The tube was removed by respiratory therapist and attempted for are-intubation but was unsuccessful.A code red alert was called to get a help.A nurse anesthetist arrived within minutes and attempted to re-intubate,but beacause of large tongue she cannot visualize the patient vocal cords and another attempt was made with a smaller tube and also unsuccessful.The third reintubation was successful but the patient could not be resuscitated and she expired. He we can apply the Policy on Level I Event because already theET tube is not inserted to the trachea during the surgery itself.And an attempt of re-intubation was done by a respiratory therapist when he found that it is in oropharynx,but it was not successful.A code red alert was called and a nurse anesthetist was tried for a attempt but it also was failed due to the large tongue of the patient,and an another was made with a small tube,but that also was failed,and the third attempt was successful,any way the patient could not be resuscitated and she expired. Here an incident can result in patient death
Incident # 3	Here we can apply Policy on Level III Event, why because through the tmely intervention by a nurse,other technician and the anesthtologist in the MRI suite they prevented or avoided a death,disability or harm of a 2 year old baby with rhabdomysarcoma and scheduled to undergo an MRI
Incident # 4	Here we can apply Policy on Level III Event, why because the timely interventin of the physician entered to a 59 year old patient with COPD and need 100%of oxygen via the face mask,but administration of the oxygen also not improves the patient condition and he discovered that the tubing is not connected to the oxygen flow meter.Once the tube was connected the patient condition was improved.
Incident # 5	Here we can apply Policy on Level II Event, why because 35 year old patient attended a physical therapy unit for his therapy after the prescription of a physician for the complaints of left shoulder and neck pain.On his first appointment in the physical therapy unit followed by a ultrasound therapy he received electrical stimulation, and hot packs to his left shoulder.Followed by the therapy the therapist found that a reddened area on his left shoulder and patient ha not felt any discomfort during the therapy.On the next appointment after 5 days it was gone off. Any way an incident that resulted a minimal short-term harm due to the the lack of alertness (ie,changes in skin color) from the staff during the electrical stimulation and hot pack application.
Incident # 6	Here we can apply Policy on Level I Event, why because,a 67 year old patient who admitted in the Alzheimers unit was wandered out from the hospital.After a thorough check made from the nurse and other security staff they have been notified it to the local police.On the next day morning city police was discovered the patient and was taken to the emergency department for evaluation and found to be dehydrated and suffering with pneumonia.He was admitted in the hospital for treatment and after 6 days of treatment he transferred back to the Alzheimer's Unit. Here due to the lack of alertness of the staff over the patients who were admitted in the Alzheimers Unit results in missing of patient and was discovered the patient with serious short term disability or harm.
Incident # 7	Here we can apply Policy on Level I Event,why because the surgeeon who were done a thoracotomy for a patient,and during the end of the thoracotomy the surgical nurse discovered and notified it to the surgeon's that sponge count was incorrect by one sponge.After an portable chest X-ray the surgeon were negatively interpreted the X-ray film in the absence of an radiologist.The next day the radiologist found that some foreign object was found in chest.The patient was returned to the operating roomfor the removal of sponge and surgeon reported that the second procedure prolonged the patient's hospital stay by 3 days. Here the patient has got a serious short-term harm to the patient and results in prolongation of hospital stay.
Incident # 8	Here we can apply Policy on Level III Event, why because due to timely intervention done by the oncologist to a 9 year old girl who was recently admitted to the hospital with the diagnosis of acute lymphocytic leukemia.Due to the immuno-compromisation and very low WBC count the girl was admitted to the isolation unit,and presents 104oF,tachycardia and new onset of pain in the head and reveals there is a presence of Aspergilus Fumigatus in the spinal and NP fluid.The timely intervention of the oncologist that he had removed her left eye and cheek bone to prevent further complication to other partsof the body.
Incident # 9	Here we can apply Policy on Level I Event, why because the first nurse had not removed the tourniquet from the patient arm after trying for starting an IV but unsuccessful because of agitation and the patient moved around constantly.It was 4 hours after and was swollen and there was some residual neurological and vascular damage that was still present at the time the patient was discharged. Thus results in a serious long term disability or harm
Incident # 10	Herewe can apply Policy on Level III Event, why because the timely intervention of the surgeon just prior to an incision for an phacoemulsification,cataract extraction and intraocular lens implantation of the right eye he identified that the anesthetologist administered a lid block and partial retrobulbar injection to the left eye instead of right one. After discovering the wrong incident the surgeon was anasthetized the patient's right eye and surgically prepared and the surgery proceeded without incident. The timely intervention of the surgeon save the patient from any disability or harm.